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.     

Policy sources of worker dissatisfactions: the case of human services in aging

This article explores job dissatisfaction experienced by service providers in the field of aging and the policy sources of such dissatisfactions. Workers interviewed identified four major areas of complaint about their jobs: lack of resources, agency problems, mandates and regulations, and client characteristics. Such problems, it is argued, are associated with specific characteristics of policies under which the respondents work. These characteristics include the symbolic nature of legislation, policy ambiguity, universal entitlement, and calculated fragmentation. Whether or not policy changes should be made to alleviate worker dissatisfactions is discussed in the concluding section of the article.     

Behaviorally caused loss of health and the use of medical care

This paper extends the analysis of the demand for medical care to an aspect which has previously been ignored: variations in expected, as opposed to experienced, cause of losses of health and the current use of medical care. Losses of health which cannot be prevented by the prior use of medical care are hypothesized to decrease the use of medical care by reducing the rate of return to investments in health, ceteris paribus. The reduction in the rate of return occurs both because these losses curtail the length of the stream of benefits to the use of medical care and because prior use of medical care is not effective in reducing the occurrence of these types of loss. Empirical findings support this hypothesis. Results suggest that differences in expected losses may account for some of the differences in utilization of medical care by sex.     

Are sex differences in nonverbal and verbal behavior generalizable to mentally retarded persons?

Sex differences in three communication behaviors consistently found to be more common among females than males — smiling, gazing at one's partner, and sentence complexity — were examined through analysis of interviews with 78 institutionalized mentally retarded adults. While females were significantly more likely than males to smile or laugh, and tended to use longer, more complex sentences, the commonly observed sex difference in gazing failed to generalize to a retarded sample. These findings clarify limits on the generalizability of sex differences beyond college students and other normal populations.This research was partially supported by a grant to the Texas Tech University Research and Training Center in Mental Retardation from the Rehabilitation Services Administration, Department of Health Education, and Welfare.     

Specification of nonverbal behaviors for clinical assessment

Nine categories of nonverbal behavior (extremity movements, self-manipulations, facial expression, posture, orienting, gestures, voice quality/tone, speech rate/pressure, and sense of timing) were tested in a standardized role play situation of social skills. Each category was judged using a new midi-level system of assessment which permitted specification of component behaviors but allowed observers to make single ratings at the ends of videotaped episodes. The midi-level measurements were as reliable and practical as more traditional global measures of social skill and social anxiety. Midis were superior to globals (i.e., single overall ratings of skill and anxiety) in terms of predicting physiological indices of social anxiety. Voice quality/tone and sense of timing appeared to be the best predictors of criterion social skill measures and self-manipulations, extremity movements, and gestures had the highest weights in predicting criterion measures of social anxiety.     

Gentleman bountiful: Repairing the patriarch

Illustrating a patient's use of the transference as a play-ground... an intermediate region between illness and real life through which the transition from one to the other is made (Freud, 1914), the author presents the case of a man in his late fifties attempting to transcend former male role stereotypes. Using the therapist as a transitional object, this patient experimented, both in therapy and in his social activities, with various patterns in relationships with women, becoming increasingly aware of his dominating benevolence and his concommitant denial of dependency needs. Several new ways for viewing both masochistic and acting-out behaviors are proposed, ways that lead to therapeutic responses tending to convert both to reparative regressions.