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The article examines abstracts of papers submitted but not included in the program of the annual meeting of the American Public Health Association, Medical Care Section, 1962. Some of these are "Experiences and Activities at a Medical Computing Center," by L.D. Cady, M.A. Woodbury, and L.J. Tich and "An Internist's Experiences With Medical Care of Welfare Patients in Proprietary Nursing Homes," by Sidney M. Greenberg. The first abstract focuses on the center that is cooperating with investigators in the area of mathematical and theoretical analysis and statistical data handling and analysis, information coding, keypunching and storage of medical data for further study and retrieval. The second abstract contains observations of the medical, nursing, and administrative practices in four nursing homes as made by an internist responsible for the medical Scare of welfare patients in these homes. In evaluating these activities the recognition and meeting of the patient's total needs was utilized as the criterion of quality of performance.

This article focuses on the changing methods of government consultation in Great Britain. The method used in the first Green Paper of April 1967 was to invite public discussion on the memorandum which the Green Paper contained and which the Government had previously sent to the National Economic Development Council and the regional planning councils for their comments. In the nine Green Papers published by the Labour Government, five of them followed the pattern of the first Green Paper in inviting public discussion while policy was still in a formative stage. A comparison was made between the two Green Papers on reorganization of the national health service and the Consultative Document with a view to arriving at an understanding of the fundamental differences which exist between these two types of document. But there has been little, if any let-up in the production of Green Papers since the Conservative Government came to power.

Deals with the position paper presented to the President's Committee on Health Education in Boston, Massachusetts on January 6, 1972 concerning health promotion in the U.S. Basis of the health promotion recommendations of the paper; Importance of having a massive consumer health education effort; Establishment of state health education training centers.

The article presents a memorandum of the Royal Medico-Psychological Association on the Second Green Paper on the future of the National Health Service in Great Britain. The association aims to coordinate the National Health Service and the Local Government services and welcome the participation of legal professionals and consumers. Policies concerning the management are given more importance rather than the daily administration activities. Furthermore, a single authorities should be recognized in each areas of the Health Service, including the social work and medical services.

The article discusses the use of newspaper as a source material in health education. In evaluating the extent and the nature of material on public health and hygiene, and the methods of using the material in teaching public health and hygiene at college level, the selected article must include material on hygiene, must treat topics included in standard texts on public health and hygiene. Each article clipped from one of the issues of the newspapers should be marked with the name and date of the paper from which it had been taken, and inserted in an envelope. In some articles publicity was given to meetings and conferences, awards of prizes for distinction in health activities, openings of hospitals and health centers. In determining the extent to which the average person is interested in reading news on public health and hygiene, students were asked to check the articles they read in the papers during a period of one week. It was noted that health news was not widely read.

The article presents information related to upcoming events on rural sociology. The Program Committee for the Rural Sociological Society announces a call for papers for the annual meeting to be held in Baton Rouge, Louisiana, from August 25-27, 1972. Submission of papers is required by April 1, 1972. Abstract and text should be sent to Rabel J. Burdge, Program Chairman, Department of Sociology. University of Kentucky, Lexington, Kentucky 40506. A series of workshops is planned on topics of current interests to encourage more active participation in the program. This years program will reduce the number of formal presentations. Papers will be made available for distribution prior to the meeting. Graduate students are asked to submit papers to any session. Sessions organized by graduate students will review papers from all sources. The other information is that J.L. Charlton has directed a study now published by the University of Arkansas Agricultural Experiment Station. The co-author, Joseph F. Singer, also used the data for a Ph.D. disseration in economics, Charlton is currently directing a study of factors affecting the use of medical services in three subregions of Arkansas.

The article presents several abstracts dealing with administrative science, including a study of administrative decision-making in federal field offices, a summary of emergency medical care in disaster situations, and a paper on the factionalization and organizational change in a research laboratory.

This paper studies the use of a collection of semi-Markov processes (referred to as paths) to describe the movement of coronary patients within a hospital. Two earlier papers by the same author [Health Serv. Res. 7, 191-208 (1972) and IEEE Trans. on Systems, Man, and Cybernetics SMC-3, 327-336 (1973)] define the state of a patient by a specific set of care requirements dictated by his 'state of health;' this paper considers a state definition based solely on the care unit in which the patient resides. This new state definition is simpler to administer, especially when patients of different diagnoses are included in the model. The paper uses field data to estimate the parameters of the underlying processes and evaluate the adequacy of using such a model. Procedures involving simple matrix operations are introduced to obtain length-of-stay and patient-day statistics in each care unit as well as in the hospital. An approach for reconstructing the original arrival distribution based on admission data is also presented with application. [ABSTRACT FROM AUTHOR]

This is the second of two papers which involve a "triangulation" on medical performance in an effort to test the proposition that organizational stratification is related to hospital care. The triangulation consists of the measurement of performance from the subjective, reputational, and objective points of view. The present paper presents evidence based upon the objective medical records. The evidence is organized around a conception of the hospital as an institution performing seven key functions. Criterion measures related to these seven functions are examined, and it is shown that units which differ in their degree of stratification also differ in their performance with respect to a number of these criteria (e.g., the length of patient stay, and the use of the consultation process). Taken together, the two papers show that when performance is independently measured in three fundamental ways, there is a basic congruence which supports the proposition that the degree of stratification of organizational units is related to variations in task performance. [ABSTRACT FROM AUTHOR]

Health planning in this paper is considered as a developmental process in which different types of planning appear at different times. These types are discussed and the place in the complex health care system developing in the United States is assessed. [ABSTRACT FROM AUTHOR]

Predictions that measles would be eradicated through vaccination have not been fulfilled. The reasons for this failure are analyzed in this paper, and the possibilities for successful action against measles are outlined. [ABSTRACT FROM AUTHOR]

The following six papers examine a broad range of disease processes and relevant social conditions, such as urban living, social disorganization, poverty, socioeconomic status, and emotional conflict and instability, and show that much illness and death is caused, directly and indirectly, by social and personality factors. [ABSTRACT FROM AUTHOR]

During the 1960's and continuing into the 1970's, the charge that birth control and abortion are integral elements of a white genocidal conspiracy directed against Afro--Americans has been heard with increasing frequency and stridency in black communities. The genocide theory finds greatest acceptance among spokesmen for black nationalist and black revolutionary groups, but suspicion of family planning programs is not limited to them. An analysis of black leadership opinion on birth control is provided in this paper. The black debate over the desirability of population limitation is traced back approximately fifty years. It began with a dispute between those blacks who believed that in sheer numbers there was strength and those blacks, such as W. E. B. DuBois, who argued that among human races, as among vegetables, quality and not quantity counted. An appreciation of the sexual exploitation of the chattel slave in the ante-bellum period, which did not end with emancipation, is also essential to an understanding of the roots and rationale of the genocide notion which arc the foci of this paper. [ABSTRACT FROM AUTHOR]

This paper presents an activity analysis model of primary medical care which, through the use of integer constraints, captures both the technology of ambulatory care and the institutional restriction that labor inputs must be employed in discrete units. The result is that staffing patterns and optimal choice of techniques depend on the scale of practice. Empirical experiments demonstrate this relationship and, furthermore, reveal that introduction of physician extenders into the medical care system increases the scale at which economies of staffing are obtained and raises the diseconomies of suboptimal practice. [ABSTRACT FROM AUTHOR]

The physician assistant is a title applied to individuals who assume at least a portion of physicians' traditional duties. This paper develops a production function methodology to estimate the potential contribution of physician assistants in the delivery of medical care. This methodology is applied to a paradigm delivery mode, an urban health center. Following upon a discussion of the possibilities for delegation and the efficient assignment of medical tasks to physician assistants, a numerical production function is estimated for physicians and physician assistants working together. When taking on his most productive assignments, it is found, a physician assistant can replace half of a full-time physician. [ABSTRACT FROM AUTHOR]

In this paper we apply some multivariate statistical methods to the problem of personnel planning in a hospital. We first determine the average day of activities of a nurse team for a given health care unit and then we compare the activities of two different health care units. Personnel planning is simpler when some care units can be considered equivalent from the point of view of activities. The techniques presented in this paper can prove effective. [ABSTRACT FROM AUTHOR]

This paper presents an improved stochastic model for the behavior of the daily census and associated waiting variables in general-acute hospitals. The development and form of the distributions derived follow the general approach of a previous paper by Shonick [J. Amer. Statist. Assoc. 65, 1474–1500 (1970)], but greater flexibility is provided for the health-services planner by increasing the number of decision choices available for achieving given outcomes. This increased flexibility is attained via a generalization of the queuing discipline, permitting admissions of elective patients to be suspended when the number of occupied beds reaches a predetermined level (which may be less than the total bed complement). For any emergency-elective mix of the demand for hospitalization, this model permits the computation of many measures of operating efficiency, including expected overfill rate, percentage occupancy, waiting-list length, and loss of emergency patients. A variant of the model permits computation of the expected number of patient days that will be served in ‘nonapproved’ facilities when emergencies arriving during ‘full’ periods are accommodated therein, rather than turned away. [ABSTRACT FROM AUTHOR]

In planning for health services, the need arises to determine the location, capacity, and member of health centers for a geographically defined region. The present paper formulates this problem in a form convenient for solution and presents results from the model to clarify some important aspects of this allocation decision. The planning region is assumed to consist of geographically defined subareas or census blocks, of known location. The population is stratified in such a way that each stratum exhibits relatively homogeneous patterns of health-care utilization. The model characterizes the effects of center locations upon aggregate utilization and utilization of individual centers, and gives optimal locations of centers with respect to several alternative criteria. An example illustrating computational feasibility and the implications of various criteria for the location decision is presented. [ABSTRACT FROM AUTHOR]

This paper introduces patient state and physician state of information as two unifying concepts for the analysis of health-care systems. The concepts are presented in the context of four specific problem areas. As a demonstration of the utility of these concepts, a technique for evaluating alternative facility macroplans is described and some results from an actual application are presented and reviewed. [ABSTRACT FROM AUTHOR]

This paper examines the characteristics of our social and rehabilitation programs, and discusses some of the more pronounced factors affecting their susceptibility to quantification, measurement, and analysis. As an illustration of the potential role of OR, it describes the child-welfare-services program, a small but influential one having many of the attributes and characteristics prototypal of the social and rehabilitation field. The paper describes the program comprehensively: its legal authority, objectives, funding arrangements, state-plan requirements, Federal and state organizations, private service agencies, staffing of state agencies, juvenile facilities, the nature of child and family services, the characteristics of the clientele, unmet program needs, information requirements, evaluative research efforts and unresolved program questions for OR study. Finally, the paper discusses the analytical methods and problems in model building, program data collection, and costs-and-benefits analysis. The challenge to the operations-research profession is to contribute effectively to solving problems in this field, and, to this end, to succeed in convincing policy officials and administrators of the social- and rehabilitation-service programs that OR has the capability and desire to participate meaningfully in this sphere of American life. [ABSTRACT FROM AUTHOR]

En conclusion, we may revert to the questions raised earlier in this paper, and see whether we can attempt answers to them. The first question was whether the rapid rate of population growth in the last few decades has led the countries of the Caribbean to adopt or try to adopt family planning measures to control this rate of growth. The survey of the changes in attitudes and activity in most of the Caribbean, as outlined above, leaves no doubt that, taking the region as a whole, there have been considerable strides forward in recent years as regards family planning information and practice. The traditional sources of opposition have considerably reduced their antagonism. Excellent examples are the attitude and action of the Roman Catholic church which, while retaining its opposition in principle to certain forms of birth control, has accepted the idea of planned and responsible parenthood, and is represented in the body responsible for organizing the national family planning program in the Dominican Republic, Trinidad and Tobago, and Curacao. [ABSTRACT FROM AUTHOR]

To be meaningful social indicators must be components of some social systems model so that changes in the values of these social statistics over time tell us something about the functioning of the social system. A necessary next step in developing social indicators is constructing models involving interrelated sets of social indicators in each major institutional area of society. This paper reports an initial effort to derive a set of social indicators for the area of health care. A structural equation model has been constructed fox the health care system serving the state of New Mexico. The model includes a network that specifies the causal relationships hypothesized as existing among a set of social, demo graphic, and economic variables related to the availability and use of health services and to health status; a set of structural equations that indicate the direct effect of variables in the model on each endogenous variable; a set of reduced form equations that indicate the combined direct and indirect effect of each predetermined variable on each endogenous variable included in the model. The model can be used to provide monitoring information pertaining to the effect of a change in a particular variable on all other variables comprising the health care system. Also it provides explanatory information regarding the differences in the availability of health care services, their use, and the health-status of the population in various counties. Finally, predictions of the effects of alternative health care policies that would affect the supply, the organization of care, or patterns of use of health services can be made based on the model. [ABSTRACT FROM AUTHOR]

In modern pluralist societies, notably Great Britain and the United States, there has been a growth of full-time expert agencies officially empowered to implement legitimation in particular institutions or sectors of society. Thus control of the family is variously the responsibility of genetic, marriage and child guidance counsellors as well as "generic" social workers, doctors, teachers and so on. In this paper, authors attempt to show how several official agents doctors, social workers, voluntary associations for the disabled and also family and friends may act to redefine the situation of parents with disabled children so that they may continue to appear as "good" parents acting in accordance with the prescriptions of the official morality of child-rearing or making appropriate use of its rhetoric. Medical science was presented as based on a "disease model," the distinctive nature of its explanations deriving from their being conceptualized in terms of the structure and functioning of the body. Secondly, parents' ideology, though expressed in common-sense terms, was shown as grounded also in various scientific legitimations.

This paper has shown that the aggregate pricing and use of physicians' services can be understood best by assuming that permanent excess demand prevails. Sheltered by this excess demand, physicians have discretionary power to vary both their prices and the quantity of services which they supply. There appears to be a tendency to increase prices when patients' ability to pay improves through higher income or more complete insurance coverage. More than a third of the potential gain from improved insurance coverage has been dissipated by these induced price increases. The supply equation provides evidence that physicians reduce the quantity of services provided when fees rise. This dominance of the income effect over the substitution effect implies that government policies to restrain price inflation may increase excess demand but will not decrease and may even increase the quantity of physicians' services provided. Another surprising result, supported by both the price and supply equations, is that greater use of paramedical personnel and supplies has not decreased the cost and price of physicians' services. Although this may be due to higher quality, it is a warning against carelessly assuming that policies to encourage physicians to use more inputs will help limit the inflation of physicians' fees. Both the supply and price equations also indicate that increased government provision of medical services has decreased the quantity of private practice services and raised their price. Among the by-products of estimating these behavioral relations are revised estimates of the rates of increase of physicians' fees, output and productivity. In comparison to the CPI "customary price" index of physicians' fees which rose at 3.2 per cent annually from 1948 to 1966, the average price index described in section II rose at 4.1 per cent. The growth of output per physician was therefore revised to 1.9 per cent annually instead of the 2.8 per cent implied by the CPJ. The proportion of the population covered by physician care insurance rose from 12 per cent in 1948 to 46 per cent in 1966 (an annual rate of 7.9 per cent). The proportion of their bills that the insured paid themselves fell at 2.2 per cent per year. But the average net price of physicians' services did not fall but actually rose at 2.1 per cent annually. It should again be emphasized that the estimates discussed in this paper are based on a rather small sample of quite imperfect data. The conclusions should therefore be treated as preliminary and subject to revision. But they differ sufficiently from the implications of traditional economic analysis and the conventional wisdom of health care experts to indicate the importance of re-examining the basis for future policy toward physicians' services and prices. [ABSTRACT FROM AUTHOR]

SUMMARY In this paper an attempt is made to use the methodology of economics and operations research for determining the optimum allocation of resources among different methods of preventing or curing diseases. First, after comparing the different indices proposed to measure the output of health services, a very simple one is adopted: the number of deaths. The objective of health planning is assumed to be the minimization of the number of deaths. Next, the optimum distribution of resources between prevention and cure of one particular disease is studied in some detail, and a numerical example is presented. Finally, the generalization of this model to include several diseases, under both static and dynamic conditions, is considered. [ABSTRACT FROM AUTHOR]

With more than half a century of history behind them, social service departments in the medical setting have become an integral part of total medical care facilities. The value of theft professional contribution to patient care is receiving ever increasing recognition. Viewed in perspective and in totality, the growth process is remarkably satisfactory. Paradoxically, the key figures in the social service department, the directors, have usually graduated into positions of responsibility with little training in administration. This paper will examine the role of the social service director in the medical setting in a threefold way: defining the director's function and responsibility, describing some of the methods through which the director can fulfill his role, and commenting on some of the personality, educational, and experiential factors that have a bearing on the fulfillment of his role. This paper has been written to share the author's experience. It is admittedly subjective, although to the degree that it is possible an objective approach has been used.

ABSTRACT The purpose of this paper is to explore the implications of employing "physicians' assistants" in delivering primary medical care. It seeks to identify the optimal role of paramedical personnel and to assess the impact of efficient delegation of tasks on the productivity of the physician, his opportunities for leisure, and the cost of care. The technical opportunities for delegation and the specific demands for medical services imposed on the primary care practice are identified. These data are then analyzed in an activity analysis model of the practice to identify and assess the implications of efficient patterns of delegation. [ABSTRACT FROM AUTHOR]

This paper provides information on contraceptive practices of women in certain low-income areas useful for family planning agencies, and examines the utilization patterns of the medically indigent poor as compared with others in low income areas. [ABSTRACT FROM AUTHOR]

This paper presents a group process for conducting an exploration of the qualitative and quantitative elements, patterns and total structure of a health care problem under preliminary investigation. Reasons for employing the nominal group process as a pilot research instrument are given. The authors emphasize that it is appropriate for some problems but not for others. [ABSTRACT FROM AUTHOR]

Do organized employee protests for the improvement of health services have a positive aspect? This paper endeavors to show some of the potentially positive contributions of such movements and the need for understanding the social context of organized protest. [ABSTRACT FROM AUTHOR]

How do planners and politicians relate to each other? This is the question to which this paper addresses itself. The analysis deals with various aspects including choice of problem, its analysis, values related to the problem, allocation of resources, program design and a number of other facets. [ABSTRACT FROM AUTHOR]

Attitudes toward the liberalized abortion law in New York State were assessed among obstetrician-gynecologists in the state. This paper presents findings on various issues and relates them to a number of variables. In general, the New York State practitioners were found to favor the new law and to take a rather liberal view of some critical social issues involved in abortion. [ABSTRACT FROM AUTHOR]

This paper develops hypotheses regarding the impact of select organizational factors on the distribution of service among applicants to health or welfare agencies. It is hypothesized that agencies with more control over exchange with their environments, i.e. more "boundary control," will under conditions of surplus applicants choose to serve smaller and more homogeneous applicant populations. Also, applicants will tend through referral and rejection processes to flow from agencies with high boundary control to agencies with low boundary control. The extensiveness of agency domains is hypothesized to be directly related to both the size of the applicant populations and the number of applicants serviced. Finally, the size of "domain discrepancy" is seen as directly related to the proportion of applicants rejected and referred. The necessity to relate other organizational characteristics to referral and rejection patterns is stressed. [ABSTRACT FROM AUTHOR]

This paper evaluates and describes methods for making psychiatric distinctions. It is by means of psychiatric distinctions that individuals are labeled mentally ill or mentally well. Within the mentally ill category, patients are differentially placed according to the severity and type of their mental illness. The placement of individuals into psychiatric categories is an essential prerequisite not only to the clinical treatment of patients but also to any research where the objective is to determine empirical regularities associated with mental illness. Until the patient is categorized, the practitioner has no logical guide for how to perform treatment or even whether he should treat the patient—i.e, the patient may not be a patient. Similarly, unless the psychiatric researcher has categorized his subjects according to some notion of mental illness he has no way of making comparisons or of assessing change, the two essential processes in research. Thus, the logical first step for arty discovery of new knowledge in the field of mental illness is to appraise the reliability and validity of methods for making psychiatric distinctions. No research findings can be more reliable or valid than the psychiatric distinctions used in carrying oat the research. [ABSTRACT FROM AUTHOR]

Much research has been done in the past fifteen years on the effects of medical education, viewed as professional socialization. Although the significance of social origins, viewed as early sources of socialization, is recognized, there has been little empirical research on the effects of specific background characteristics on specific attitudes, behavior, and careers of professionals. This paper examines the effects of practicing physicians' socioeconomic and religious background on their concern with success values and on their political ideology, including their attitudes toward government participation in medical care. [ABSTRACT FROM AUTHOR]

Shares the author's experience in his participation in the 1970 White House Conference on Children in December 1970 in Washington D.C. Privilege of the author to serve on one of the 25 forums, which were charged with responsibility of planning the meeting for one segment of the conference and preparing a position paper and other materials; Participation of distinguished laymen in the Developmental Child Care Forum; Excellence of the delegates who attended Forum 17 on Developmental Child Care in their attendance and interest and demonstration of considerable competence and experience in the area of child care.

This paper offers an historical review, an assessment of the present status, and some indication of the immediate future of federal programs in the field of occupational health. [ABSTRACT FROM AUTHOR]

The community health center has been viewed by many Americans as an important mechanism for the improvement of health of the urban poor. The millions of dollars allocated for a relatively small percentage of the population, however, has led to some criticisms of the concept. This paper deals with factors influencing the cost of dental services in a community health center and an analysis of several existing programs. The major factors affecting the cost effectiveness of the clinics appear to be the (1) broken appointment rate, (2) age distribution of the population served, (3) mixture of services rendered, and (4) additional community services rendered. Programs which have low broken appointment rates and which treat both adults and children seem to maintain a higher revenue-cost ratio. This ratio was in the range of 0.78 to 1.10 for the three dental programs studied. [ABSTRACT FROM AUTHOR]

This paper reviews the quality assessment literature, presents a study which compares five different methods of assessing quality of care, and proposes policy recommendations. Results are: (1) Most quality assessment issues are a century old. (2) The results of assessment of quality of care are dependent on the method used; therefore, more methodologic research is needed. (3) The use of lists of criteria, concerning what a physician does, to assess quality of care could result in decreased efficiency in the health system by requiring the performance of' ineffective procedures. (4) it is not certain that examination of the level of care rendered will increase the health Level of the population; therefore, any national program which assesses quality of care must be prospectively evaluated. (5) A quality assessment system must be concerned with both the population who received services at the institution, and the population who did not but for whom the institution is responsible. [ABSTRACT FROM AUTHOR]

The pediatrician is in a unique and powerful position, both in his own office and in his community. By taking an active role in designing, executing, and evaluating screening programs, he can help insure that resources are used economically and usefully, and that a broadened view of screening and health results in positive programs. He should insist that vital components of any screening program include intervention and dissemination of information to those who need it. To do less is to abdicate a responsibility which cannot be delegated to others, even though many screening programs are initiated and conducted by nonphysicians. [ABSTRACT FROM AUTHOR]

This paper discusses a program developed to train and utilize community health workers to screen, treat, and follow up Harlem area residents with stroke, hypertension, and related illnesses. [ABSTRACT FROM AUTHOR]

Hospitalized mental patients are increasingly being discharged into the community. Yet, despite the construction of hundreds of community mental health centers, readmission rates continue to rise. This paper analyzes the reasons for this problem and provides suggestions for its solutions. [ABSTRACT FROM AUTHOR]

As in the preceding paper, the activities of a consortium in Newark, New Jersey, to develop appropriate programs to meet the needs for health personnel in an urban situation are discussed. [ABSTRACT FROM AUTHOR]

This paper discusses the training and performance of paramedical personnel in family planning services. [ABSTRACT FROM AUTHOR]

Increasing professionalization of the occupational structure and increasing pressures for organizational innovations of various types suggest the importance of understanding the factors influencing variability in the responses of professionals to organizational innovation efforts. This paper reports the results of a study designed to explore this issue in the context of the health care system. Variability in the responses of practicing physicians to an organizational innovation is examined in light of a number of hypotheses derived from the literature on adoption of innovation. The findings support five of the sit hypotheses tested, and suggest that receptivity to organizational innovation in professionally dominated systems is influenced by factors similar to those in other systems. [ABSTRACT FROM AUTHOR]

This paper takes note of the convergence of both research and opinion supporting the assertion that perceived symptoms and ability to pay are the major determinants of health services utilization. Four reservations pertaining to this body of evidence are offered and research supporting the role of cultural factors in determining the utilization of services is cited. Several cultural barriers to the full utilization of services are discussed. [ABSTRACT FROM AUTHOR]