The health care Titanic: women and children first?

The plight of people who lack access to health care has captured national attention and led to a number of proposals to remedy the problem. The authors look at three types of proposals being advanced--"pro-competition" plans, "pay-or-play" plans, and a national health care system--and find that they fail to address adequately the pressing needs of two groups of the poor: women of childbearing age and elderly women.     

Reformulating the development theory of welfare

Industrialization, technological change and overall economic development are often cited as important factors in the development of welfare states. This article examines the importance of cycles in economic activity and cycles in technological innovation to enhancing our understanding of welfare. The history of technological change in health-care services is used to illustrate the argument.     

Estimates of fertility in Bangladesh

The attempt is made to estimate fertility levels in Bangladesh on the basis of data collected during the 1974 Census. In the 1st section attention is directed to providing an overall picture of the demographic situation in the country. Comparisons between the 1961 and 1974 data demonstrates that the 1974 Census data provide consistent results. Factors such as the degree of urbanization, literacy and economic participation rates--considered as indicators of development--all seem to show little progress during the intercensal period. The use of child/women ratios (CWRs) provides plausible evidence of the likelihood of a fertility decline. A decline in CWR values is small for "all areas" but a marked decline can be noted for "urban areas." The recorded mean number of children is less in 1974 than in 1961 for women under age 35 whereas for the older groups the 1974 Census shows higher mean numbers. The Bangladesh Fertility Survey (BFS) data result for the total fertility rate of 6.58 is very close to that estimated for the 1974 Census--6.59. The reverse survival method also indicates that birthrates have been lower during the 1969-1974 period.     

The impact of P.L. 93-641, the National Health Planning and Resources Development Act, upon health and mental health programming

Federal legislation regarding health care in the U.S. has increased rapidly in the past few years. A major law with potential far-reaching effects was enacted as a result of increasing legislation and rising health care costs. This law,The National Health Planning and Resources Development Act,has created a network of over 200 local, mostly nongovernment units, called health systems agencies. These agencies are responsible for areawide health planning, plan implementation, review and approval of federal health care expenditures for local programs, and facilities review. They will affect health and mental health programs at the local level. The article is directed to local health and mental health care providers who will, of necessity, deal directly with the local HSA's.     

Setting health priorities: a review of concepts and approaches

The setting of health priorities is primarily concerned with the equitable distribution of resources and is now more than ever an important part of strategic planning within the National Health Service (NHS). The basic information which can be used to assist in such decision-making and the process by which different agencies become involved are important aspects of priority-setting; this article is based on a major review of the research literature on these aspects and provides a discussion and an analysis of experience within health and other fields. From this material a number of possible approaches to priority-setting are identified and discussed. The article concludes that, before it can be decided how priorities should be set in the future, outstanding questions about how far rational approaches are feasible, about who is to be involved and what role they should play, and about how far such decisions are to be taken nationally or locally will need further consideration.     

Institutional factors,government policies and appropriate technologies

Traditionally the use of inappropriate technologies in the developing countries has been explained by the existence of factor price distortions, e.g. the price of labor being artificially raised by labor legislation, and the price of capital being reduced by subsidies and unrealistic exchange rates. In reality the technological choice is often determined by economic conditions and the local sociocultural/political conditions. The institutional framework of the country may discourage the appropriate technology. The obstacles can be overcome when the following conditions are met: 1) a national consensus about the need for development efforts and importance of policy goals; 2) promising market prospects and/or an effective marketing system; and, 3) sufficient industrial competition in both home and international markets. Institutional problems come from the generation and diffusion of technologies from the supply side which are introduced to people who do not see the need for them. More emphasis on the marketing side ususally results in application of correct technology, especially where governments fund research and development projects and formulate their plans on the basis of a concrete investment or production plan and a clear idea about the target market. Land reforms and agricultural price policies are needed as well as the establishment of an efficient national administrative network.     

Network analysis in evaluation: some words of caution

Network analysis, a methodology derived from general systems' theory, can be utilized as a community mental health administrative-evaluation procedure. Evaluation parameters derived from analysis of patient data as they “flow” through a network of agency services, provide measures of systemic functioning. These parameters include “longest paths” and various ratio relationships as evaluation measures of service delivery. The limitations of network analysis are examined by means of conceptual analyses, and phenomena that emerged from research experience. The necessity for both quantitative and qualitative data to ensure a meaningful evaluation of mental health services is explained. Conclusions about the value of the network analysis approach are considered.     

The hospitals and population growth: The voluntary general hospitals, mortality and local populations in the English provinces in the eighteenth and nineteenth centuries part 2

Summary In the second part of this article the number and nature of hospital cases treated in the light of physical, medical and surgical limitations are examined. Each hospital's records of treatment are summarised and discussed. Whether or not the hospitals were able to tackle successfully some of the major diseases and causes of death and thereby exert a positive influence in reducing mortality rates is then considered. Two main conclusions are drawn. First, that the hospitals had a positive role to play within their patient catchment areas, but that this was insufficient to affect national mortality trends decisively. Secondly, the hospitals' influence was of greater importance before the mid-nineteenth century. Despite advances in medical knowledge and techniques, population pressure, overcrowding and the growing incidence of serious cases in hospitals coupled with outbreaks of 'hospital diseases' meant that the results of hospital treatment may have become less impressive. But even then, mortality levels in the hospitals were low and the hospitals did not merit their reputation of being 'gateways to death' or as institutions 'which positively did harm'.     

Seasonal patterns of fertility measures: theory and data

The distribution of births by month exhibits a seasonal pattern in most populations. The monthly marital fertility rate for an area of Bangladesh provides a good example of the seasonal periodicity. Seasonal patterns of measures of reproduction in a population of married women are considered. Equations are developed that predict the seasonal patterns of these alternative measures under the assumption that the fertility rate (R) follows a trigonometric curve. This is followed by an empirical analysis of the measures in a Bangladesh population that has a pronounced seasonal fertility. The investigation is intended both to validate the theoretical framework developed in the 1st part of the paper as well as to determine whether seasonal variation in actual populations is sufficiently large to affect the alternative measures significantly. 4 measures are considered: pregnancy prevalence (PP)--the proportion of married women who are pregnant at the survey date; mean open birth interval (MOI)--the time from the last live birth to the date of the survey for parous women and from the time of marriage to the date of the survey for nulliparous women; mean closed interval-birth (MCIB)--the mean interval between the last 2 live births for married women who have a birth in the period immediately preceding the survey date; and mean closed interval-woman (MCIW)--the mean interval between the last 2 live births for women who have had at least 2 children by the time of the survey. It is assumed that the seasonal pattern of the fertility rate of a population follows a cosine curve and that there is no trend in annual fertility from year to year. The lag and relative variability of the other measures are considered in comparison with the fertility rate curve. The predictions from this theoretical effort, when compared with observed patterns and trigonometric regression results for each measure in data from Bangladesh, are shown to be quite accurate. The figure and regression results show that R, PP, and MOI have definite seasonal periodicity, but MCIB and MCIW do not display any seasonal patterns. If there is a secular trend in fertility in addition to seasonality, these relationships between the seasonal patterns of the measures may no longer hold. There is a disadvantage to using closed interval measures, for they are unable to detect effects of limiting of childbearing in a population since they are based only on information from women who have births.