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.     

A time series analysis of Swedish illegitimacy rates, 1911-1974

Using a sociodemographic model of the determinants of illegitimacy rates, a multivariate regression analysis of annual change in age-specific Swedish illegitimacy rates is applied to the 1911-74 period. The proxy measure of change in sexual activity was significant for all age groups. Legitimation rates for out-of-wedlock conceived births were significant for all ages except teenagers, and the final predictor, women's status, was significant for all ages except women 35-44. Explained variance for annual change was highest among ages 20-24 (66%), 25-29 (66%), and 30-34 (63%) and lower among teens (34%) and women 35-44 (47%). These results support earlier research that used a sociodemographic model to explain post-World War II change in cross-national illegitimacy rates among 23 developed countries.     

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.