The meaning of patient satisfaction with prepaid primary health care in Israel

This paper reports the development of a self-administered Hebrew-language questionnaire for assessing patient satisfaction with primary care in Israel. Four scale measures of patient satisfaction were empirically constructed. These scales pertained to doctor conduct, doctor-patient communication, teamwork, and ease of access. In addition, a single direct question was used to measure overall satisfaction with the care. Ratings of all aspects of care were negatively skewed, with doctor-conduct and doctor-patient communication usually being the most satisfactory aspects and access the least satisfactory. It was shown that different practices, or the same practice at different points in time, can easily and meaningfully be compared, using mean satisfaction scores, measures of standard deviation, or percentages in each practice with ratings above (or below) the overall mean of all practices. The use of specific measures of patient satisfaction for comparison and intervention is discussed.     

Maternal care receptivity--an innovative approach for the evaluation of MCH services

Despite rapid expansion in the maternal and child health and family planning services, there have been few attempts made to study the extent of utilisation of these services and their impact. The present study reports a simple method evolved in the quantification of utilisation of maternal care services (called maternal care receptivity - MCR), the relationship of factors such as age, parity, caste of the women and the distance of the health centre on the MCR and the impact of MCR on perinatal and neonatal mortalities. An inverse relationship was observed between MCR and perinatal and neonatal mortality rates and the two rates were three times less among babies born to mothers with high MCR scores compared to those with poor MCR scores.     

The utilization of prevailing evaluation policy in the selection of performance measures

This study considers the problem of inferring a functional evaluation criterion from existing performance measure policies. The objective is to develop a rational basis by which to adaptively evaluate a current best set of performance measures from alternative sets. The analysis is based on a matrix approach for relating system characteristics to performance measures across a set of activities. A procedure for ranking measure combinations which are candidate implementation alternatives is devised using this matrix representation and cost information. An example illustrating the procedure is presented.     

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.     

Explanation and social policy: 'the' problem of social inequalities in health

Inequalities in rates of sickness and mortality between social groups has long been a matter of concern and of inquiry in Britain. Disciplinary differentiation has resulted in the problem now being treated within what have become three distinct intellectual traditions. These are social administration, epidemiology, and sociology, and the accounts they provide differ significantly from each other. This is partly because 'the' problem is somewhat differently defined in each; and partly because of their different orientations to theory and to practical amelioration. This article explores the strengths and weaknesses of each approach, and raises the possibility of a more adequate explanation than any one discipline provides. The implications for study of social administration are considered.     

The management of offshore resources—Some implications of the 200-mile limit

This article examines in depth the strategic implications for those States who have recently declared 200 mile off-shore resource management zones. The authors, in a comprehensive and stimulating paper, examine the implications of so-calling a nation's offshore limit. It is an appropriate name for a nation's offshore limit since the primary reason for many nations declaring a 200 mile limit has been the abundance of resources which have often been found within those limits either in the sea or the sea bed itself. This paper reviews the current background of off-shore resource management and outlines suitable roles for adoption by the coastal States in the management of their off-shore renewable and non-renewable resources. Furthermore, it examines the contentious but nonetheless central issue of the benefits and costs which accrue through coastal state jurisdiction. The authors also examine an appropriate resource management process and the implications of resource use conflicts within the off shore limit as well as defining these conflicts on the basis of ‘stakeholder’ interests and introduces a new concept of the maximization of economic equity amongst competing stakeholders. The problem remains that the measurement of economic equity perhaps leaves the States concerned within a situation of only having defined the problem; the political process has then to deal with any reallocation measures that may be deemed appropriate.     

An innovative approach to selecting an executive director

As a guide for how to select a new executive director, a family agency adopted the search committee process from higher education. The approach included clarifying agency goals and the director's qualifications, a board-staff screening, and interviews held jointly with public representatives before final board selection.