Defining and measuring patient satisfaction with medical care

This paper describes the development of Form II of the Patient Satisfaction Questionnaire (PSQ), a self-administered survey instrument designed for use in general population studies. The PSQ contains 55 Likert-type items that measure attitudes toward the more salient characteristics of doctors and medical care services (technical and interpersonal skills of providers, waiting time for appointments, office waits, emergency care, costs of care, insurance coverage, availability of hospitals, and other resources) and satisfaction with care in general. Scales are balanced to control for acquiescent response set. Scoring rules for 18 multi-item subscales and eight global scales were standardized following replication of item analyses in four field tests. Internal-consistency and test-retest estimates indicate satisfactory reliability for studies involving group comparisons. The PSQ well represents the content of characteristics of providers and services described most often in the literature and in response to open-ended questions. Empirical tests of validity have also produced generally favorable results.     

Equity and efficiency in the allocation of the personal social services

This paper investigates two issues of equity in the receipt of the home help service, one about territorial justice, the other about sex discrimination. It uses GHS data for 1980. An argument is developed about the efficiency with which services are targeted on persons who by normative criteria would appear to have most need of them. Efficiency is of two types: horizontal efficiency, the proportion of persons judged in need who receive services; and vertical efficiency, the proportion of services allocated to persons judged in need. The findings are that there is evidence of inequity both between different areas and between the sexes. Metropolitan areas are advantaged compared with rural areas, and this cannot be explained by differences in social support nor by the availability of other domiciliary services. Among the elderly living alone, neither sex is advantaged, but in elderly married couple households the home help service is more frequently provided in the case of a husband caring for a disabled wife than in the case of a wife caring for a disabled husband.     

The marketing approach to purchasing

The determination of supply and demand is a complex problem to which both sides of the equation must contribute. Although marketing departments have organized themselves to provide such a contribution to data, purchasing has done little to promote its contribution to demand forecasting. Until it does the equation will remain not merely complex but insoluble.A continuous inter-change between marketing and purchasing, supplier and customer, is essential for improving the accuracy of longer range forecasting and for logistical co-ordination of investment planning. The corporate plans of manufacturing organizations, at least, should reflect these considerations.     

Forecasting the Penetration of a New Product—A Bayesian Approach

We adopt a Bayesian approach to forecast the penetration of a new product into a market. We incorporate prior information from an existing product and/or management judgments into the data analysis. The penetration curve is assumed to be a nondecreasing function of time and may be under shape constraints. Markov-chain Monte Carlo methods are proposed and used to compute the Bayesian forecasts. An example on forecasting the penetration of color television using the information from black-and-white television is provided. The models considered can also be used to address the general bioassay and reliability stress-testing problems.     

Ranked-Weighted Utilities and Qualitative Convolution

For gambles—non-numerical consequences attached to uncertain chance events—analogues are proposed for the sum of independent random variables and their convolution. Joint receipt of gambles is the analogue of the sum of random variables. Because it has no unique expansion as a first-order gamble analogous to convolution, a definition of qualitative convolution is proposed. Assuming ranked, weighted-utility representations (RWU) over gains (and, separately, over losses, but not mixtures of both), conditions are given for the equivalence of joint receipt, qualitative convolution, and a utility expression like expected value. As background, some properties of RWU are developed.     

Drug use and mental well being among a sample of undergraduate and graduate college students.

Stress related disorders in college students are widespread and largely preventable. Students do not have the preventative skills necessary to manage stress in their lives and, because of the inability to cope, students may turn to alcohol and drugs to alleviate the pressures they are experiencing. The purpose of this study was to describe the association between stress and alcohol and drug use. A total of 772 undergraduate and graduate students from a small, elite, private university were randomly selected from 4000 students to complete two anonymous questionnaires. The Core Alcohol and Drug Survey identified the frequency and consequences of alcohol and drug use, and the General-Well Being Schedule was used to assess subjective well being and mental health status. The results of this study revealed that, for this sample of students, health behaviors such as using drugs recreationally and drinking alcohol played an associative role with general well being. A significant relationship was also found between student participation in intramural or club sports and positive mental well being.     

“I Want to Feel Like a Full Man”: Conceptualizing Gay,Bisexual, and Heterosexual Men’s Sexual Difficulties

Current understandings of sexual difficulties originate from a model that is based on the study of heterosexual men and women. Most research has focused on sexual difficulties experienced by heterosexual men incapable of engaging in vaginal penetration. To better understand men’s perceptions and experiences of sexual difficulties, seven focus groups and 29 individual interviews were conducted with gay (n = 22), bisexual (n = 5), and heterosexual (n = 25) men. In addition, the extent to which difficulties reported by gay and bisexual men differ from heterosexual men was explored. Data were analyzed using thematic analysis applying an inductive approach. Two intercorrelated conceptualizations were identified: penis function (themes: medicalization, masculine identity, psychological consequences, coping mechanisms) and pain (themes: penile pain, pain during receptive anal sex). For the most part, gay, bisexual, and heterosexual men reported similar sexual difficulties; differences were evident regarding alternative masculinity, penis size competition, and pain during receptive anal sex. The results of this study demonstrate the complexity of men’s sexual difficulties and the important role of sociocultural, interpersonal, and psychological factors. Limitations and suggested directions for future research are outlined.     

DISSECTING THE MONTY HALL ANOMALY

We assess competing explanations of irrational behavior in the Monty Hall problem by creating new variants of the problem. Some variants employ a feature that automates the merging of probabilities, thus rendering transparent the probabilistic advantage of the rational choice. That feature also enables systematic variation in informational asymmetry, and in ordering of actions. Data from 77 subjects, each of whom makes 30 binary decisions, indicate that automated merging raises the fraction of rational choices from around 40% to over 80%. Other features examined have much less impact, indicating the importance of a Bayesian updating failure. (JEL C91, D02, D81, D83)     

Making Development Assistance More Effective Through Using Political‐economy Analysis: What Has Been Done and What Have We Learned?

Politics often explains where development assistance has been effective and where it has not. Yet, until the 2000s there has been little focus by development agencies on political issues. This has recently begun to change with political‐economy analysis (PEA) now being more systematically used by development agencies to understand the real world. Nigeria and Bangladesh are two positive examples. Much remains to be done in these countries and more widely, to ensure stronger uptake of PEA. On the supply side this includes getting the ‘product’ right, and better communicating the message. On the demand side, there is a need to take more account of the incentives facing development agencies and to gather more systematic evidence on the operational impact of PEA to date.