Program analysis using the client oriented cost outcome system.

The client oriented cost outcome system has been under development in Pennsylvania community and hospital programs since 1972. The system builds upon the behavioral and decision data generated with or on behalf of consumers. Flexibility for local program system design is permitted if the procedures of consumer intake, review, and termination document each consumer's (a) problems, resources, and goals, (b) overall functioning level in their ordinary community, and (c) services intended and rendered as related to (a), above. While the system's primary application is in providing feedback for local program quality assurance and evaluation procedures, aggregation of data permits program planning and evaluation at county, state, and federal levels in terms of (a) client demographic or diagnostic characteristics, and (b) program service characteristics and objectives.     

Occupation and housing adjustment of migrants to Surabaya,Indonesia: the case of a second city

The adjustment of migrants to Surabaya, Indonesia was examined with respect to occupation and housing characteristics. The data are based on information obtained in interviews from a multistage random sample of 600 residents of Surabaya between the ages of 20-44. Both females and males were interviewed and information on occupation was also collected for the spouses of respondents. In the analysis, 3 comparison groups were used: migrants to the city within the 5 years previous to the survey; migrants who moved in 1969 or before; and lifetime residents of Surabaya who were either born there or moved before the age of 15. The analysis used 2 methods to determine the extent and nature of adjustment. In the first, migrants of short and long durations of residence were compared to determine if change on the aggregate level has taken place and to indicate the direction of change. A control group of lifetime residents was used to determine whether the migrants are coming to resemble the characteristics of the native urban population. The 2nd, and equally serious problem, involves outmigration, in which migrants selective of certain characteristics leave the city either to return to the rural area or to move to another city. Initial comparisons between recent migrants, longterm migrants, and lifetime residents revealed no significant differences for either employment status or occupational skill. By occupational skill, approximately 35% had unskilled occupations, 27% semiskilled occupations, and 37% skilled occupations, with no significant difference by migrant status group. Overall, the distributions showed this sample to have significant concentrations in traditional, labor intensive employment, with a large percentage self employed. Controlling occupational skill for education showed somewhat different results. Those with primary school or less did not show a significant difference by migrant status, while among those with more education there was a significant difference. The longterm migrants wree overwhelmingly employed in skilled occupations. Initial analysis showed no significant difference in housing quality for each of the 3 migrant status groups. Recent migrants to the city were having no more difficulty in finding housing than changing migrants and lifetime natives. Housing conditions appeared to improve with duration of residence in the city, either through residential mobility or through improvements to the dwelling. That housing showed improvement with time, while occupation did not, may be because of the nature of each of the markets.     

Optimal Times to Contact Sample Households

Finding a suitable respondent at home is an essential and expensivecomponent of a household survey. This article reports on theresults of a study of the probabilities of finding someone aged14 or older at home and discusses the application of such datato survey design and budgeting.     

Evaluating a private foundation's health program

Public policy decisions in health are increasingly difficult and expensive. Although there will never be enough information available, private foundations can help to bridge the most important gaps in knowledge. Larger foundations may also wish to respond to those who doubt the value of foundation activities. This article reviews the experiences over the past eight years of The Robert Wood Johnson Foundation in employing evaluation and related social research procedures in the planning and implementation of a major philanthropic effort to improve the health and medical care of Americans. Discussed are the still evolving Foundation evaluation framework, the unanticipated problems in undertaking specific evaluations, and the substantive findings of some of the studies.     

Lactation and fertility in Rural Bangladesh

Summary Analysis of data from various phases of a study of post-partum amenorrhoea in Bangladesh illustrated good aggregate consistency of response on menstrual status, but less individual consistency on duration of post-partum amenorrhoea. Using life table techniques, the median duration of amenorrhoea was calculated as 19.9 months for women with births between February and September 1974. There were substantial seasonal variations in duration, with the median decreasing from 21.5 months for women with February births to 16.9 months for those with September births. By contrast, the median duration of post-partum amenorrhoea varies by only two months for women in the lowest and highest quartiles of weight and weight for height. The seasonal pattern was similar for all weight groups.     

There is no low-level fertility and development trap

Summary The theory of the low-level equilibrium trap asserts that an increase in income stimulates population growth sufficiently so that the additional people 'eat up' the 'surplus' over subsistence, and hence drive the level of income back to subsistence. Originally the theory referred primarily to mortality, but nowadays its application is to fertility. In the long-run equilibrium context in which the theory is ordinarily presented, the fact that the long-run elasticity of fertility with respect to income is negative in less developed countries fatally contradicts the accepted version of the trap. But to give every chance for trap theory to be meaningful, the paper presents a period-by-period analysis, embodying larger-than-observed positive elasticities during the early years and the logically necessary counterbalancing negative elasticities during the later years. These elasticities are combined with consumption and production figures for various age groups to estimate the effect in each year after the windfall, and altogether. The results show that even under assumptions not charitable to the conclusion of this paper, additional children do not even come close to 'eating up' the increase in income which induced their births, so that the trap theory is falsified.