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.     

Using macro variables in program evaluation

This paper discusses the importance of using macro-level variables for program analysis. It is argued that three types of macro variables--cultural, economic, and demographic--provide a context for evaluation, and offer alternative explanations for the success or failure of a program. The problems of causality and availability of data are discussed. Macro variables are seen to be especially useful in "meta evaluation," and in integrating the results of specific program evaluations into general conclusions.     

The utilization of prevailing evaluation policy in the selection of performance measures

This study considers the problem of inferring a functional evaluation criterion from existing performance measure policies. The objective is to develop a rational basis by which to adaptively evaluate a current best set of performance measures from alternative sets. The analysis is based on a matrix approach for relating system characteristics to performance measures across a set of activities. A procedure for ranking measure combinations which are candidate implementation alternatives is devised using this matrix representation and cost information. An example illustrating the procedure is presented.     

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.     

Pragmatic decisions in the evaluation of consumer satisfaction with mental health treatment

This article examines pragmatic choices which must be made in conducting consumer satisfaction assessment of mental health treatment. It is argued that choices involving sample, format, and procedure for examining satisfaction may influence the results of such research, and must be considered when creating or evaluating these efforts. These choices are examined in detail.     

Evaluating employee assistance programs. A review of methods, outcomes, and future directions

Renewed interest in assisting troubled employees has led to an upsurge in the development of employee assistance programs, coupled with demands for demonstrable effectiveness. This review examines the nature and scope of these programs, their administrative and methodological context, and the types and outcomes of evaluation studies conducted thus far. Proposals for improving future investigations through a number of different approaches and strategies are then made.     

On the limiting properties of social indicators

Characteristics of the population and economic measures that constitute traditional social indicators are compared with more recent “quality of life” measures to demonstrate that social indicators are always value statements at the policy level. The possibility of alternative perspectives is illustrated. It is suggested that an awareness of the assumptions implicit in any given indicator is as important as the data they provide.     

融资代建制─公共工程项目建设管理新模式

本文明确了融资代建制的概念,将公共工程项目–项目融资–代建制联系起来,构建了公共工程项目融资代建制模式框架为:二个层次、三种管理和三项保证。进一步指出融资代建制是有中国特色的PFI,是公共工程项目建设管理的创新模式。