Fertility,development, and family planning, 1970–1980: An analysis of cases weighted by population

A series of related studies (Freedman and Berelson, 1976; Mauldin and Berelson, 1978; and Tsui and Bogue, 1978) have presented empirical findings based on multiple regression analysis which indicated that family planning program effort (FP), as measured by an index developed by Lapham and Mauldin (1972), was the single most important predictor of (or influence on) fertility reduction in less-developed countries (LDCs). The basic results have been confirmed repeatedly. A more extensive data set was used to extend the analysis to a comparison of results of corss-sectional models circa 1970 and 1980. The study builds upon the results of past studies yet differs from them in several ways. All the variables in the present study were measured at 2 points in time: circa 1970 and circa 1980, allowing a comparison between cross-sectional models for 1970 and 1980. Among the cases included in this multivariate analysis was China, a country usually excluded for lack of data. The analysis was extend to 85 countries. Cases were weighted by population, having the effect of increasing the impact of larger countries such as India and China on the outcome of the analysis. Total fertility rate (TFR) was used as an indicator of fertility. For 1970, family planning program effort had the strongest direct influence on fertility (a result consistent with previous studies). Life expectancy at birth was the other direct influence. The direct influence of life expectancy at birth was less than that of family planning, but the total influence was greater. After life expectancy and family planning, school enrollment and relative educational status of women had the strongest indirect and total influences. The other variables all had a positive influence on fertility. When the total variance attributable was considered, directly and indirectly to each of the independent variables, urbanization, carlorie supply, and per capita gross national product all accounted for less than 5% of the variance in fertility, all of it indirect. Life expectancy, family planning, and school enrollment each explained (directly plus indirectly) more than 10% of the variance in fertility. The pattern differed somewhat for 1980. Calorie supply, per capita gross national product, and relative educational status of women had no influence, direct or indirect on fertility. Also for 1980, life expectancy had a stronger direct influence on fertility than family planning. Overall, life expectancy at birth, family planning program effort, and total school enrollment emerged as the principal influences on fertility.     

Reviews

Terry Cox and Gary Littlejohn, eds., Kritsman and the Agrarian Marxists. (Library of Peasant Studies, No. 7), London: Frank Cass & Co. Ltd., 1984, 149 pp., £18.50.

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The impact of health maintenance organizations and competition on hospitals in Minneapolis/St. Paul

The Healthcare Educational and Research Foundation (HERF) in Minneapolis undertook a two-year research project to study the effects of health maintenance organizations (HMOs) and competition on the hospital industry in Minneapolis/St. Paul. This article summarizes HERF's major findings surrounding three key questions: (1) do the HMOs in Minneapolis/St. Paul use fewer hospital resources relative to conventional payers?; (2) do recent overall community trends in inpatient use suggest evidence of hospital utilization-reducing effects attributable to HMOs?; and (3) given the highly visible competitive process among Minneapolis/St. Paul providers, do hospital cost and revenue data suggest any evidence of cost-containment? The findings (based on data through 1982) indicate that for comparable patients, Twin Cities HMOs appear to use fewer medical care resources per hospitalized patient. There was, however, no clear evidence of community-wide, utilization-reducing effects directly attributable to the "competitive effect" of HMO introduction and development in the market. In addition, there was no empirical evidence that HMOs (which had enrolled 25 percent of the consumer market by 1982), or other large buyers of inpatient services, have selected hospitals on the basis of price as hypothesized by competition advocates.     

Legalization of consensual unions in Mexico

Data examined in this study are from the 1976 Mexican Fertility Survey. The authors review previous findings and compare information from this survey with data from the 1969 PECFAL Survey. They then examine the types of consensual union and factors such as women's age, educational status, occupation, premarital fertility, and rural or urban residence. The focus of the study is on the extent to which consensual unions eventually become legal marriages. The authors also investigate the increasing probability of termination of marriage through divorce or separation, especially in urban areas.     

Practitioner fraud and abuse in medical benefit programs: government regulation and professional white-collar crime

Physicians who defraud and abuse medical benefit programs provide a unique group of lawbreakers for scientific study. They could be considered to epitomize white collar criminals given their exceedingly high socioeconomic status and power as a professional group. Using official reports and documents, as well as interviews with enforcement and program personnel at both state and federal levels, this study examines the problem of physician fraud and abuse in Medicare and Medicaid. Major areas relevant to understanding this phenomenon and its control are presented and policy implications of present knowledge in the area are discussed.