Physician perceptions of medical malpractice and defensive medicine

Using judgments obtained in interviews with 33 Massachusetts physicians, the annual statewide volume of expenditures incurred for defensive medical reasons in 1982 was estimated to be $1.0 billion, 12% of all medical care expenditures. Estimates for the nation were $37 billion, 14% of expenditures. Nationally, 180,000 cesarean deliveries were thought to be performed for defensive motives. In their own institutions, respondents judged 43% of all skull x-rays following injury to be medically justified, 30% to be defensive medicine, 16% to be placebos, and 11% to be physician misjudgments. In considering the economic and noneconomic costs of medical malpractice procedures, the dollar costs of insurance were considered most serious, followed closely by defensive medicine, unfairness, and poorer relations with patients. Thirty-two percent of the responsibility for the negative aspects of malpractice processes was assigned to lawyers, 21% to physicians, 18% to legislatures and courts, 16% to patients, and 13% to insurance companies.     

Major obstacles to control of irregular migrations: prerequisites to policy

This paper examines 3 basic obstacles thwarting all attempts to reduce irregular migration. The 1st, rather well known and analyzed, underscores the dependency of all regulation of migratory flows on the system of economic and political relations between developed and developing countries. The 2nd obstacle resides in the persistance and growth of subsequent dependent irregular migration. This obstacle also reveals the relative autonomy of population movements compared with the employment situation in the labor market. The 3rd generally ignored obstacle is the role played by migration itself, particularly the discriminatory status of foreign workers in the labor market, in producing irregular migration.     

Premarital information efforts under way

Premarital couples are among priority targets of family planning information in the Philippines national population program as they can serve a pivotal role in slowing population growth. Applicants for marriage licenses are required to attend a family planning session as a prerequisite. Following recommendations of a training effort and seminar on Premarital Family Planning Counseling, on July 20, 1976, premarital information was institutionalized in the country by Presidential DEcree 965 which made family planning counseling obligatory to the marriage license applicants. Shortly after that, a multiagency effort gathered information on the status of the Premarital information program in the Philippines, which showed that there is no full-time specialist for the work. Medical officers; social workers; community welfare supervisors; and program and training officers do this work of information in addition to their usual duties. Distribution of the applicants varied greatly in age groups, educational levels, and professional category. The size of the group, length of session and topics of discussion varied greatly. Necessary efforts should be made to solve the major problems by selecting better sites for group sessions and training more personnel for the purpose. There is a great need fordeveloping more effective and research oriented information, education and communication materials, according to the needs and cultural traits of the target audience.     

The Consequences of Validated and Self-Reported Voting Measures

This paper reports on the results of validation of the self-reportedregistration status and voting behavior of respondents in the1976 and 1978 American National Election Studies. The resultsindicate about one in seven of the respondents misreported theirregistration status or voting behavior. Comparative analysesare conducted using simple regression models to see if differencesin their explanatory power arise using validated and self-reporteddependent variables. The results show that there are no majorchanges in the fundamental nature of basic relationships thathave been observed since the first surveys were conducted. Analysisof the effects of overreported participation on estimates ofthe partisan division of the vote in three sets of subnationalcontests reveals a likely "bandwagan" effect. . Portions of the data utilized in this article were made availableby the Inter-university Consortium for Political and SocialResearch. The data for the 1976 and 1978 American National ElectionStudies were originally collected by the Center for PoliticalStudies of the Institute for Social Research. The Universityof Michigan, under a grant from the National Science Foundation.Neither the original collectors of the data nor the Consortiumbear any responsibility for the analyses or interpretationspresented here. The comments of an anonymous reviewer, whichresulted in a fruitful extension of the analysis, are gratefullyacknowledged.     

The administrative costs of non-profit health insurers

Interest in the efficiency or inefficiency of non-profit firms has spawned research on the administrative costs of Blue Cross and Blue Shield plans. Relying on plausible implications of the property rights theory of the firm, both Blair, Ginsburg, and Vogel (1975) and Vogel (1977) noted some evidence of inefficiency in these firms. Our analysis, however, utilizing their models and more recent data, reveals little convincing evidence for the view that Blue Shield plans are inefficient.     

Federal statistics in a complex environment: the case of the 1980 census

A discussion of the 1980 U.S. census is presented. The authors suggest that the taking of a national census is not just a statistical exercise, but an exercise involving ethics, epistemology, law, and politics. They contend that conducting a national census can be defined as an ill-structured problem in which the various complexities imposed by multidisciplinarity cannot be separated. "The 1980 census is discussed as an ill-structured problem, and a method for treating such problems is presented, within which statistical information is only one component."     

The validity of indices for rural health manpower needs assessment

Population-to-practitioner ratios have long been the primary index in the designation of health manpower shortage areas. This paper documents that application of the widely used population-to-dentist index results in understatement of the need for dental health manpower in rural areas. Through the analysis of utilization data collected from a statewide health screening program in Colorado, the practice of sole reliance on the population-to-dentist indices as an indicator of need was tested. Another measure, the area-(square miles) to-dentist ratio was formulated, examined, and found to be a more useful referent of the need for additional health manpower in rural areas. Utilization of dental services in sparsely settled rural counties of Colorado was unrelated to population-to-dentist ratios. A strong, statistically significant association of utilization with land area-to-dentist ratios was found. The findings of this analysis suggest a need for reevaluation of needs assessment methodologies used in the designation of health manpower shortage areas. Indices more sensitive to consumer circumstance than to the number of health care providers available must be considered.