Social Science & Medicine (1967)最新文献

The costs of diseases and violence are calculated considering production losses, compensations and costs of health services in Finland in 1972. The costs total 18.700 million Fmk (=4.500 million US $). The production losses make 75%, compensations 6%, and health services 18% of the total costs. About 83% of the costs can be classified according to the main disease group. In the order of magnitude they are diseases of the circulatory system (24% of the costs), mental disorders (18%), diseases of the musculoskeletal system and connective tissue (17%), and accidents, poisonings and violence (14%).

A correspondence may be noted between the models used by clinicians for computer-aided diagnosis and the models required by social scientists to explain utilization of medical resources. Cost-benefit studies of a health facility require some assumption to be made in respect of utilization. The theory of individual decision-making under uncertainty may be used as a basis for the development of utilization models. Prior to this it is shown that decisions taken on one patient, and in particular the search for a diagnosis may all be explained. A marginal patient is defined and certain reasons for changes in the identity of the marginal patient are considered. Finally, some implications for the evaluation of policy changes in the N.H.S. are noted.

Correct specification of a number of definitions and problems is essential for realistic and useful research in health economics. Societal values with regard to women's status and roles are reflected in current concepts, which need review. For example, health status is a concept with many applications. Two areas of health status are discussed: (i) Definitions of severity for adult males, children and adult females all reflect the female role as caretaker. (ii) Reproductive efficiency should be incorporated into a life-cycle-oriented concept of health status for women.

The evaluation of patient time as an input into health care is conditioned by women's labor force participation and the extent of the earnings differential by sex. Additionally, a concept of a block of time as capital that is available for optimal reproduction or optimal career investment would be useful in tracing important effects of improved fertility-related health care and for other purposes.

Specifications for a health care service and financing system that is responsive to women's health needs must include an appropriate definition of comprehensiveness in relation to fertility control and pregnancy, relative financial burdens for women based on their utilization, need, income and other characteristics, and compatibility of payment methods with health care objectives.

Increasing recognition has been given to the fact that in developing countries improved health may make an important contribution to economic development. In analysing this relationship it is important to distinguish between the immediate, stable situation with organizational modes and technology held constant and longer term issues in which organizational and technical change induced by improved health standards must be taken into account.

Development policy can be more effectively planned if both levels of analysis are considered.

This paper reports some of the findings of an on-going research project on physician extenders (P.E.s). Data were collected between 1971 and 1973 utilizing an air mail survey, sent to Physician Assistants, Medex, and Nurse Practitioners. Included in this report is information on the distribution of physician extenders' tasks among patient care, laboratory work, clerical duties, and teaching responsibilities, as well as a discussion of their salary levels.

A regression model is employed to analyze the affect the time spent by the physician extender in patient care either directly or indirectly supervised by a physician. A separate analysis of the determinants of the earnings of P.E.s is also presented.

The results indicate that the physician extenders spend more of their time in patient care when working closely with three or fewer physicians in general medicine. Also, the amount of time in patient care under the indirect supervision of the physician is higher in general medicine and rural areas. The earnings function indicates that health experience prior to training as a physician extender, employment in a hospital, a public health clinic, or in a rural area has a positive impact on earnings.