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.     

Cohort size effects and migration

"This article explores whether changes in the size of [U.S.] cohorts entering the labor force affect the propensity to migrate and the socioeconomic circumstances of migrants at destination. The flow of young in-migrants to large SMSAs declined during the 1965-76 period, but the relative socioeconomic standing of migrants at destination was unaffected by either cohort size or regional differentials in economic growth. It is suggested that a significant reduction in the volume of migration among members of the baby boom cohort was the primary adjustment mechanism, hence reducing the need for degrading the opportunities available to migrants."     

Recent trends in Hispanic immigration to the United States

Recent patterns of Hispanic immigration to the United States are examined using data from the U.S. Immigration and Naturalization Service. "From 1960 to 1978 Hispanic immigration increased significantly, reflecting the general acceleration in total immigration to the United States. Demographic trends reveal that Hispanic immigrants are increasingly working-age women. Their occupation composition is primarily blue collar, with operatives emerging as the predominant job category during the 1970s." The authors note that these immigrants settle primarily in a small number of urban centers of Hispanic population and culture in the United States, and thus the effects of immigration will be concentrated on the low-skill segment of particular urban labor markets that already contain large numbers of Hispanic workers.     

Assessment of patient satisfaction: development and refinement of a service evaluation questionnaire

A series of seven studies was conducted by the authors and their colleagues to produce an efficient measure of service satisfaction that can easily be related to symptom level, demographic characteristics, and type and extent of service utilization. The resulting measure, the Service Evaluation Questionnaire (SEQ) is a brief, global index that has excellent internal consistency and solid psychometric properties. Data from an extensive SEQ field study can be used as a comparison base for future applications of the two SEQ component scales, the CSQ-8 and the SCL-10. A new hypothesis has emerged from this series of studies that will guide future research: Service recipients may find if difficult to formally express dissatisfaction in the face of significant caring--however ineffectual--when the technical capacity to offer definitive treatment is not yet fully developed and when criteria for evaluating the efficacy of treatment are not yet crystal clear.