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.     

Behavioral evaluation of a state program of deinstitutionalization of the developmentally disabled

The purpose of this study was to evaluate one phase of a statewide program of deinstitutionalizing developmentally disabled individuals. Forty adults who had spent a minimum of six months in community placements were evaluated with respect to changes in behavior associated with movement out of state institutions and into community settings such as group homes and day activity centers. Pre- and post-deinstitutionalization measures were taken with the Behavior Development Survey. Post-deinstitutionalization measures on Cataldo and Risley's Resident Activity Manifest were compared to the same measures obtained on 159 developmentally disabled individuals scheduled for deinstitutionalization. A consistent pattern of positive changes on both instruments favored deinstitutionalization, but changes could not be unequivocally attributed to movement out of the institutions per se.     

Waste paper and the market mechanism

Increasing attention is being given to the possible consequences which might follow from the exhaustion of the world's natural resources. Countering the pessimistic conclusions of such institutions as the Club of Rome, economists such as Wilfred Beckerman have emphasized the importance of substitution, pointing to many examples where a shortage of one raw material has led to the discovery or development of alternative materials, e.g. artificial for natural rubber, aluminium for copper.Substitution usually occurs through normal market mechanisms, i.e. changes in relative prices. However in some circumstances the market mechanism may be inhibited by a variety of factors, so that its operation requires to be supplemented by an outside agency. This article explores this possibility in relation to the paper making industry, which provides a particularly interesting example owing to the existence of a well established market in waste paper, the main substitute for the major natural resource, woodpulp.A brief indication is given of the relative importance of waste paper and an outline of the structure of the U.K. market; the conditions under which greater utilization of waste paper might occur are then considered taking a sideways look at the influence of the individual. In the final section the various implications for the role of the state are summarized.     

THE CALCULUS OF VOTING RECONSIDERED

A rational economic hypothesis of the citizen's decision tovote or not vote in U. S. presidential elections has been citedas an example of the replacement of social-psychologically oriented"empirical generalizations" by axiomatically based deductivepropositions in political science. However, close scrutiny showsthat the rational (or political) economic paradigm is no moreaccurate a theory than previously popular systems analysis orfunctional paradigms. The claimed verification of the originalhypothesis was based on an apparently imprecise, adhoc, ordinalprocedure that could not distinguish between the intimatelyrelated rational economic and social-psychological hypotheses.A more powerful technique resolves the issue in favor of thelatter model for the data used by the original authors.