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Research Agenda for Psychosocial and Behavioral Factors in Womens Health: Health Services Research
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Although women are a majority
of health care consumers, women's issues in health services research have not
received adequate attention. Recent debates over health care reform and the
continued growth of managed care systems have highlighted a number of important
questions about how women access health care through the life span, the quality
of relationships between women and their physicians, the ways in which health
care delivery systems define the scope of women's health care services and coordinate
care, and the components of women-centered care.
For example, women may
have difficulties accessing health care for financial reasons (e.g., lack of
health insurance or inadequate insurance) and for non-financial reasons (e.g.,
barriers associated with inconvenient hours or locations, a lack of child care,
cultural barriers). Women may have difficulties communicating with male physicians
about sensitive issues such as sexual behavior or domestic violence. Women may
find that their health care plans limit the scope of needed services (e.g.,
preventive tests, mental health services) through restrictive benefit structures.
Because reproductive health care tends to be provided by different physicians
or in different settings than other components of basic care, care may not be
coordinated and mental health services may be omitted.
Research Priorities
for Health Services
Identify and understand
non-financial barriers to use of key preventive health services (e.g., prenatal
care, mammography screening) by women.
Informational deficits,
attitudinal factors, and cultural barriers may be as important as financial
factors in inhibiting use of preventive services that are key to women’s health
and quality of life. Research is needed to identify and elaborate the psychosocial
factors that promote women’s use of basic services at different stages of the
life span.
Develop a better understanding
of ways in which physician gender influences the quality of women's health care.
Current information about
women's communication with their physicians and about physicians' influences
on women's receipt of services suggests that physician gender may play a role
in several ways. Some studies, for example, suggest that specialty may be more
important than physician gender in determining services received. Research is
needed to clarify whether female physicians in different specialties communicate
more effectively than male physicians with female patients, whether they provide
more preventive services, and whether they are more sensitive to psychosocial
issues. Interventions to improve physician training depend on clarification
of these issues.
Analyze differences in
provision of services and outcomes of care in different types of service systems.
Managed care systems, particularly
certain types of HMOs, may provide opportunities for integrating reproductive
and other components of women’s basic health care. However, little is known
about how managed care systems define the scope of services for women, the types
of coordination mechanisms used, or the types of outcome monitoring most appropriate
for women. These issues must be resolved before the services and outcomes analyses
can be accomplished.
Analyze the relative advantages
and disadvantages of women-centered health care for the health of women.
The growth of women's health
centers of various types - ranging from comprehensive primary care centers to
highly specialized centers focusing on a specific service or condition - has
raised questions about the uniqueness of these centers and their ability to
respond to the specific health care needs of women.
Analyze the effectiveness
of increased utilization of mental health services for improving overall health,
and for reducing medical services utilization and costs.
Research has shown that
much of the higher cost associated with unnecessary medical treatment would
be avoided with early mental health treatment. Moreover, extensive research
has shown a direct link between behavior and many of the nation's leading health
problems. In addition, recent research strongly suggests that immunological
functioning and immune-related diseases are affected by psychological stress.
Increased attention to mental health issues may have a significant impact on
overall health.
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