Comparison of indirect and direct approaches to measuring patient satisfaction

One indirect (PSQ) and two direct (CSQ-18B and ERS) measures of patient satisfaction were compared across a series of psychometric, acceptability, and concurrent validity criteria. None of the three measures was significantly related to health status or demographic characteristics. Each measure performed as expected from prior research on their psychometric properties. The scales contrasted, however, in regard to acceptability, with the PSQ being much less acceptable to patients than the other two. The PSQ also produced more missing data. The results on the PSQ reflected patient inconsistency on cross-check items and patients tended to be uncertain in their responses to many items. In multivariate analyses the three measures were used as predictors of patient-rated indices of global service satisfaction. The CSQ-18B and the ERS were significant predictors of patient-rated indices of global service satisfaction, whereas the PSQ was unrelated to these indices. It was concluded that the direct and indirect approaches measure different satisfaction domains. The PSQ likely assesses more generalized attitudes about health services while the CSQ-18B and the ERS efficiently reflect opinions about the specific setting in which they are administered.     

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.     

An extension of ebloc to valued graphs

In this paper we show how the algorithm EBLOC can be extended to deal with valued data directly. The technique is then applied to Sampson's (1969) monastery data and comparisons are made with the original EBLOC algorithm.     

The use of statistics to examine the association between fluoride in drinking water and cancer death rates

"The basis of statistical tests of significance of association between fluoride level in drinking water and cancer death rates is discussed. Reference is made to two reported studies in each of which cancer death rates of a number of [U.S.] cities were used. It is argued that between city variation should be taken into account when performing tests of significance. In one of the two studies this was done informally; in the other between city variation was ignored."     

Statistical estimation of socio-economic factors affecting migration in W. Europe

A statistical estimation of the relationship between socioeconomic factors and net international migration in Western Europe from 1977 to 1980 is presented using data from the Monthly Bulletin of Statistics and the Statistical Yearbooks of the United Nations and each country. It is found that the rate of change in the gross national income, the percentage of the gross national income in the tertiary sector, and the number of automobiles per 1,000 inhabitants are the major factors affecting net migration in the most industrialized countries of Western Europe.     

The dynamics and differentials of fertility in the USSR (survey results)

The results of a fertility survey carried out in the USSR in 1978 are presented. The survey included 33,076 women aged 18 to 59. Data are included on fertility rates by region and Union Republic and by urban or rural area, and on expected fertility of women aged 18 to 44. Changes in actual and desired fertility over time are compared for five-year periods from 1945 to 1978. Differences in fertility are analyzed by type of settlement, educational status, and nationality.     

Involving constituents in agency priority setting: a case study

Many government agencies have "constituents" who believe the agencies should hear and consider their needs and desires in establishing program priorities. This article describes how one involves interested constituents (consumers, industry, medical professionals, and state organizations) in the agency's annual priority-setting process. This participation has produced a number of beneficial results-some expected and some unexpected.     

International and internal migration decision making: a value-expectancy based analytical framework of intentions to move from a rural Philippine province

"The study compares determinants of internal and international migration intentions, drawing upon interview data from a sample of adults in Ilocos Norte, a largely rural province in the Philippines. A regression model is applied to test the relative determinants of intentions to migrate to Manila and to Hawaii. The study is based on a value-expectancy model of migration decision making. The results document the importance of subjective expectations related to the attainment of different values and goals in Manila and Hawaii."     

Voting cycles and the structure of individual preferences

Empirical studies have shown that cyclical preferences are infrequent, but they have been less clear about why. Using thermometer ratings from nationally-representative samples of the U.S., we examine preferences for presidential candidates in order to determine what it is about them that leads to few cycles. Single-peaked preferences as usually construed (meaning that all of a set of preferences satisfy single-peakedness criteria) are, of course, rare. Yet we find a high degree of unidimensionality in the sense that for any given set of preferences, a relatively high proportion of the preference orders are consistent with single-peakedness. We also find that the highest amounts of unidimensionality often do not occur along partisan or left/right lines. Strong feelings for or against candidates, often not derived from an issue base, form the basis for the dimensionality discovered.We would like to thank Daniel Severance for programming the random model calculations and three anonymous referees, whose comments were very helpful in clarifying the presentation in this paper.