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Abstract The research reported here is a case study of mandated consolidation in the organization of Alberta's health care system. Informed by the concept of organizational context, this study illustrates [...]

This essay addresses challenges in evaluating collaboration by examining two distinct approaches to its measurement. Evaluators frequently assess collaboration on the basis of relationships, climate, and expectations (RCE), and, less often, via extent of collaboration (EC). RCE measures are based on perceptions by coalition members regarding satisfaction with the collaboration, representativeness of the surrounding community, confidence in the leadership, and related areas. EC measures reflect more direct and concrete features of coalitions, such as regularity of communication and commitment of resources. An illustrative study of programs sponsored by a private foundation and a federal agency compares these approaches, finding that RCE and EC measures reflect different underlying features of collaboration and that higher levels of collaboration are likely to be found when evaluators use RCE indicators. Substantively, the study finds large differences in extent of collaboration across areas of operation within each program and a rarity of very high levels of collaboration in most areas. Both face validity and findings from the illustrative study suggest that EC is the more essential measure of collaboration. Comparison of these measures raises issues for both evaluation and grant making.

This article synthesizes interview data from evaluation directors and top executives of philanthropic foundations on how evaluation might better advance their missions. In key informant interviews, respondents commented on the purposes of evaluation from the foundation's perspective, challenges to effective evaluation, and the means by which evaluation could be made more valuable to foundations. Informants emphasized promoting accountability, improving programs, advancing organizational learning, and disseminating intervention models as desired uses of evaluation. Application of appropriate research techniques, relevance and timing of evaluation products, and internal thinking and social dynamics within foundations were cited as challenges to evaluation. Emerging concerns include the need to evaluate achievements of foundations as a whole and for evaluation to further develop as a science. In terms of increasing the value of evaluation, the current study indicates the importance of improved relationships and dialogue between evaluators and foundation personnel, stronger leadership consensus within foundations regarding evaluation, and safeguarding of the evaluation process.

This article assesses the relative importance of several factors believed to reduce the likelihood of health insurance coverage among working Latinos in California, including cost, immigration history, availability of insurance, beliefs about insurance, and beliefs about health and health care. According to a survey of 1,000 randomly selected adults, the most prominent factors contributing to working Latinos' lack of health insurance include low income, absence of or ineligibility for a plan at work, birth outside the United States, and recent immigration. Although the availability of affordable plans plays a predominant role, the importance of potentially inaccurate perceptions of the cost of health insurance and unidentified factors associated with recent immigration may also be important in some segments of the population. Maintenance and redesign of employer-provided or public insurance programs seem essential for increasing health insurance among working Latinos, as may be encouragement of low-cost clinics in some Latino communities.

'Why me?' This question of causal attribution is pervasive among cancer patients--so pervasive, in fact, that it is the basis for the name of the largest national breast cancer patient [...]

Objectives. Treatment and mortality risk were compared between prostate cancer patients receiving care in fee-for-service settings and those receiving care in a health maintenance organization (HMO). Methods. Two samples were obtained from a population-based tumor registry. Patients in the first sample (n = 201) were interviewed shortly after diagnosis to obtain data on income, education, overall health status, and expenditures for health care. These data were combined with information from the tumor registry on cancer stage, age, treatment, place of residence, and source of care. Only tumor registry data were obtained for most patients in the second sample (n =962). For both samples, survival time was monitored for up to 80 months. Results. Multivariate analysis of data from the interviewed sample indicated that HMO patients were less likely to receive surgery but more likely to receive radiation therapy than were those in fee-for-service settings. Mortality risk was lower for the HMO patients than for those in fee-for-service plans. Findings based on the second sample were nearly identical. Conclusions. This study suggests that HMOs may offer important advantages to lower-income patients at risk for specific life-threatening diseases. (Am J Public Health. 1992;82: 1099-1104)

To identify factors affecting the ability of persons with recent cancer diagnoses to remain in the labor force and retain premorbid levels of work performance, the investigators analyzed data on 247 individuals with lung, pancreatic, prostatic, or cervical cancer. Subjects were selected from a population-based tumor registry. According to Pearson correlations, ordinary least squares multiple regression, and logistic analysis, physical factors related to disease were the strongest predictors of work disability, defined as either leaving the labor force or functioning less fully at work than before becoming ill. The strongest predictors of work disability were physical dysfunction measured by the Sickness Impact Profile (SIP) and disease stage. Social background factors such as age, sex, income, and education were not statistically significant predictors. Two job characteristics, (1) physical demands of work and (2) discretion over hours worked and how much work would be done, predicted work disability, the latter appearing to help prevent this condition. Strictly disease-related factors appear more important here in predicting work disability than in studies of other diseases. Still, it appears that increasing flexibility of working hours and the pace of work could help some individuals with cancer histories remain in the labor force. Unwillingness of employers to facilitate such accommodation where technically feasible may constitute a form of discrimination against the cancer patient.