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.     

The determinants of modern Maltese emigration

The author evaluates studies by Huw R. Jones and Russell King concerning the determinants of emigration from Malta and tests a new set of migration functions using cross-sectional and time-series data for the inter-censal years 1957 to 1967. Jones and King concluded that emigration was influenced more by socio-demographic factors than by economic forces. In the present article, the author concludes that economic factors did influence the decision to migrate from Malta. The policy implications of these findings are also considered. (summary in FRE, SPA)     

Medical care, living conditions, and children's well-being

We examine the effect of medical care and living conditions on children's physical and psychological well-being. We develop a causal model in which living conditions (including the socioeconomic status of the family and the social-psychological aspects of family functioning) may affect well-being both directly, and indirectly through medical care. We find that families in the higher social classes and families that function well tend to go to large prepaid groups where they receive good medical care. High quality technical care of illness, in turn, improves physical health. The quality of psychotherapeutic care, on the other hand, has no effect on psychological well-being. For this aspect of health, the effect of living conditions is largely direct, rather than indirect by way of medical care. Families characterized by high levels of functioning have children who are psychologically healthy. In addition, physical health affects psychological well-being, but not vice versa.     

Demographic determinants of perceived well-being in eight European countries

This paper reports results of a harmonised study of subjective social indicators carried out in eight member countries of the European Community, sponsored, on an experimental basis, by the Statistical Office of the European Communities (Luxembourg). Comparative data from nationwide representative samples from Germany, France, Italy, the Netherlands, Belgium, the United Kingdom, Ireland and Denmark are presented for three key dependent measures of perceived well-being: Self-Assessed Health, Satisfaction with Housing and Life Satisfaction. The cross-cultural generalisability of the influence of demographic variables on these three measures in examined, using 4-way analysis of variance. The analyses revealed a remarkable consistency across nations in terms of the effects of certain demographic variables on some of the dependent measures; however, some inconsistencies were also revealed. Substantial discrepancies in mean scores of the same sub-groups in different countries were also observed. While further research would be required to determine whether these differences were due to objective circumstances or to cultural differences in subjective perceptions or response patterns, some tentative interpretations of the differences were put forth.