Public opinion and the privatization of welfare: some theoretical implications

The social policy of the Thatcher government is characterized by an abrupt shift in the direction of the private sector. To what extent does this reflect what people want? The Institute of Economic Affairs conclude from the only suitable national opinion survey that such a move is strongly supported. Our reanalysis of their data shows that this strand in public opinion can coexist with, and need not contradict, an equal public enthusiasm for state welfare. Such results have important implications for our understanding of social policy. We conclude, therefore, with a discussion of contrasting marxist and liberal accounts which seeks to show that the evidence of ambivalence in popular attitudes about the welfare state supports particular developments in theory.     

Using macro variables in program evaluation

This paper discusses the importance of using macro-level variables for program analysis. It is argued that three types of macro variables--cultural, economic, and demographic--provide a context for evaluation, and offer alternative explanations for the success or failure of a program. The problems of causality and availability of data are discussed. Macro variables are seen to be especially useful in "meta evaluation," and in integrating the results of specific program evaluations into general conclusions.     

Pragmatic decisions in the evaluation of consumer satisfaction with mental health treatment

This article examines pragmatic choices which must be made in conducting consumer satisfaction assessment of mental health treatment. It is argued that choices involving sample, format, and procedure for examining satisfaction may influence the results of such research, and must be considered when creating or evaluating these efforts. These choices are examined in detail.     

Frustrated fertility: a population paradox

This Bulletin examines the causes of subfecundity -- the diminished ability to reproduce -- and its effect today and in the past on the fertility, or actual reproductive performance, of individuals and, hence, populations. By definition, all real populations are subfecund since all experience some degree of involuntary biological factors affecting coitus, conception, or the ability to carry a conceptus to live birth which reduces their fecundity below the estimated biological population maximum of 15 children per woman. Affecting both men and women, these factors fall into 5 categories: genetic factors such as blood group incompatibilities and inherited sickle cell anemia or diabetes; psychopathology, including psychic stress and behavioral disorders (e.g., drug and alcohol abuse); infectious diseases such as gonorrhea, malaria, tuberculosis, and postabortion infection; malnutrrition, including the chronic undernutrition of the 3rd World and the overnutrition of developed societies; and hazards posed by increasing amounts of radiation and toxic chemicals in the environment. Reducing subfecundity requires improved living conditions, avoidance of or protection from known hazards, and adoption of medical advances which now can help 40 to 60% of subfecund couples. But even in the U.S. fertility would certainly rise among the 15% of couples now estimated to be involuntarily childless and the 10% who have fewer children than they want, and among disadvantaged groups, and teenagers.     

Was there compression of disability for older Americans from 1992 to 2003?

Medical advances and the growth of the elderly population have focused interest on trends in the health of the elderly. Three theories have been advanced to describe these trends: compression of morbidity, expansion of morbidity, and dynamic equilibrium. We applied multistate life table methods to the Medicare Current Beneficiary Survey to estimate active and disabled life expectancy from 1992 to 2003, defining disability as having difficulty with instrumental activities of daily living or activities of daily living. We found increases in active life expectancy past age 65 and decreases in life expectancy with severe disability. These trends are consistent with elements of both the theory of compression of morbidity and the theory of dynamic equilibrium.     

Using age and spatial flow structures in the indirect estimation of migration streams

This article outlines a formal model-based approach for inferring interregional age-specific migration streams in settings where such data are incomplete, inadequate, or unavailable. The estimation approach relies heavily on log-linear models, using them to impose some of the regularities exhibited by past age and spatial structures or to combine and borrow information drawn from other sources. The approach is illustrated using data from the 1990 and 2000 U.S. and Mexico censuses.