Evaluating a private foundation's health program

Public policy decisions in health are increasingly difficult and expensive. Although there will never be enough information available, private foundations can help to bridge the most important gaps in knowledge. Larger foundations may also wish to respond to those who doubt the value of foundation activities. This article reviews the experiences over the past eight years of The Robert Wood Johnson Foundation in employing evaluation and related social research procedures in the planning and implementation of a major philanthropic effort to improve the health and medical care of Americans. Discussed are the still evolving Foundation evaluation framework, the unanticipated problems in undertaking specific evaluations, and the substantive findings of some of the studies.     

Social forecasting: An integral part of corporate planning?

The increasing need for business to monitor the social dimensions of its environment and, hopefully make some forecasts of future trends has met with some constructive response from academics and consultants although not as yet on a very liberal scale. The published literature does not indicate to what extent companies in general attemp social forecasting and, where they do, the degree of integration which exists within their corporate planning systems. The authors, therefore, decided to survey a sample of British organizations to see if they could shed some light on these issues and thereby add some information to the excellent accounts of individual cases of social forecasting in, they suspect, the more advanced and atypical companies. The survey suggests a general picture of: awareness of the value of social forecasting; fairly widespread ignorance of the techniques which do exist, primitive though these may largely be; successful integration of social forecasting into the corporate planning systems of a substantial number of organizations but not in the majority.     

Perceived morbidity, utilisation of health services and factors affecting it in a rural area

A survey of perceived morbidity was carried out in rural population in eight villages and four wards of Saoner town, covering a total population of 8,876. The nature of illness was assessed by weekly visits to the families. History regarding treatment taken for disease and its source was taken. The overall incidence of perceived morbidity was 176.35 spells of sickness per 1000 population per month. Health care agency was contacted for 36.7 per cent spells of sickness. Utilisation of health services was found to be affected significantly by factors like age (chi 2 = 138.36), literacy (chi 2 = 14.123), type of occupation (chi 2 = 433.74), nature of illness (chi 2 = 83.578) and accessibility of health services. A health behaviour model of the population has also been discussed in this paper.     

Regression of area mortality rates on explanatory variables: what weighting is appropriate?

"One can often gain insight into the aetiology of a disease by relating mortality rates in different areas to explanatory variables. Multiple regression techniques are usually employed, but unweighted least squares may be inappropriate if the areas vary in population size. Also, a fully weighted regression, with weights inversely proportional to binomial sampling variances, is usually too extreme. This paper proposes an intermediate solution via maximum likelihood which takes account of three sources of variation in death rates: sampling error, explanatory variables and unexplained differences between areas. The method is also adapted for logit (death rates), standardized mortality ratios (SMRs) and log (SMRs). Two [United Kingdom] examples are presented."     

The administrative costs of non-profit health insurers

Interest in the efficiency or inefficiency of non-profit firms has spawned research on the administrative costs of Blue Cross and Blue Shield plans. Relying on plausible implications of the property rights theory of the firm, both Blair, Ginsburg, and Vogel (1975) and Vogel (1977) noted some evidence of inefficiency in these firms. Our analysis, however, utilizing their models and more recent data, reveals little convincing evidence for the view that Blue Shield plans are inefficient.     

Artifact in client satisfaction assessment: experience in community mental health settings

Artifact in client satisfaction assessment is discussed and the results of a study of three factors thought to mediate client satisfaction ratings; (a) general life satisfaction, (b) mode of administration, and (c) psychological symptomatology, are reported. A standard client satisfaction questionnaire (CSQ) was modified to yield parallel forms and was administered orally and in writing to 92 clients in two mental health day treatment programs. Satisfaction ratings obtained from these clients were quite similar to out-patient ratings obtained in previous studies conducted in this setting and using the same measures. Oral administration of the CSQ produced 10% higher satisfaction ratings than written administration (p less than .05) and less missing data (p less than .01). Satisfaction ratings were also obtained using a simple graphic instrument. Graphic ratings were comparable to CSQ ratings. Satisfaction with life in general and level of psychiatric symptoms together accounted for 25% of CSQ variance. The implication of these findings for future client satisfaction research is discussed.     

Corporate planning at Rolls-Royce Motors Limited

In this article the authors describe the introduction to date of a formal planning process at a British manufacturing company which, according to its recent performance, had no pressing need to implement radical change. Is Rolls-Royce Motors' decision the symptom of a new trend in industry to overhaul planning techniques while the going is good? How was company morale used to justify a new planning style? Why did an evidently capable organization choose to engage consultancy assistance? While the company's intentions are not yet fully achieved, its experience may be of benefit to others contemplating a similar decision.