DOCONEIT RESUME TO 189 271 CE 023 824 - Ed
DOCONEIT RESUMETO 189 271TITLECE 023 824PUB DATEGRANTHealth Manpower Literature, Volume 2, Number 2,December 1978.Northeastern Univ., Boston, Mass. Center for MedicalManpower Studies&Employment and Training Administration (DOL),Washington, D.C. Office of Research andDevelopment.Dec 78DOL-42-25-72-10NOTE101p.!DRS PRICEDESCRIPTORSMF01 Plus Postage. PC Not Available from EDRS.Abstracts: Collective Bargaining: EmploymentPatterns: Employment Potential: *EmploymentProlections: Federal Legislation: Federal Regulation:Foreign Countries: Health Insurance: *HealthPersonrel: Health Services: Labor Legislation: *LaborSupply: Literature Reviews: Policy Formation: *PublicPolicy: *Staff UtilizationBelgium: Canada: Italy: United StatesINSTITUTIONSPONS AGENCYIDENTIFIERSABSTRACTThis booklet covering health manpower literature isdivided into four sections. First, health manpower indicators arepresented, such as estimated employment in selected potentiallyertry-level health occupatiors. Next follows a paper entitled"Regionalization of Health Insurance in Italy." The third sectionconsists of five book abstracts, including "The Health Care Dilemma:Problems of Technology in Health Care Delivery," "A Manpower Policyfor Primary Health Care," and "Promoting Health: Consumer Educationand National Policy." Finally, the last section contains theabstracts of sixteen articles: some representative titles are HealthInsurance: The Canadian Experience: A Pilot Study of the InitialBargaining Demands by Newly-Organized Employees of Health CareInstitutions: The National Labor Relations Act: The Health CareAmendments: Manpower Planning for Nurse Personnel: Work LoadManagement System Ensures Stable Nurse-Patient Patio; An Effect ofOrganization of Medical Care Upon Health Manpower Distribution:Physicians and Non-physician Health Practitioners: TheCharacteristics of Their Practices and Their Relationships: andContinuino Education: An Approach Toward Structure and a Call forHelp. A comprehensive list of current health articles andthe titlesof lournals searched for health manpower literature are **********************************Reproductions supplied by EDRS are the best that can be madefrom the original ******************************
Cr%CqCP'COr-1LL:HEALTH MANPOWER LITERATUREVolume 2, Number 2December 1978Published Semiannually byThe Center for Medical Manpower 5"udiesEditorsHarold M. GoldsteinMorris A. HorowitzGustav SchachterParticipants in the CenterIrwin L. HerrnstadtEnzo LanciaAlec CheloffUS OEPARTMENT OF HEALTH,EDUCATION I WELFARENATIONAL INSTITUTE OF.EDUCATION1H15 DOCUMENT HAS BEEN REPRODUCED EXACTLY AS RECEIVED PROMTHE PERSONOR ORGANIZATION ORIGIN-ATING IT POINTS(); vIEW OR OPINIONSSTATED r0 NOT NECESSARILY REPRESENT Or r it 1AL NATIONAL INSTITUTE OFEDUCATION ,OSI TION OR POLICYSPONSORED BYOffice of Research and DevelopmentEmployment and Training AdministrationU.S. Department of LaborGrant No. 42-25-72-10Since grantees p2rforming research under government sponsorship areencouritged to express their own judgment freely, this work does notnecessarily represent the official opinion or policy of the U.S. Department o: Labor or Northeastern University. The faculty of the Center ofMedical Manpower Studies is solely responsible for the contents.a
EDITORS NOTEThe Heal.th Manpower indicators presented in thisissue remain unchanged from the last issue since nonew data are available.The recent health articleslisted in the current issue come ZargeZy from recentissues of the Journal of Economic Literature, published by the Amerycan Economic Association, and health related sources.The article included in this issue, "Regionalization of National Health Insurance in /taZy," i8 an up-dated version of a paper presented at the North American Regional Science Meeting in Philadelphia, November1977.It assesses the possible effects of the decen-tralization of the Italian heaZth care system.Theabstracts are true representations of the views ofthe author(s); a strong effort was made not to introduce the editors' v1ewa or opinions.we are indebted to Dr. Howard Rosen, Director,Office of Research and Development, Employment andTraining Administrction, U.S. Department of Labor, andto Mr. wiZliam Throckmorton of the same office, fortheir ideas, encouragement, and support.
CONTENTSEditor's NcteHEALTH MANPO"SR INDICATORS1. Estimated Employment in Selected HealthOccupations that are Potentially EntryLevel32. Hosrltal Indicators43. Percent Distribution of Personal HealthCare Expenditures by Type of Care andSource of Payment5BASIC SOURCES FOR HEALTH MANPOWER STATISTICS63TAFF ARTICLERegionalization of National Health Insurancein Italy9BOOKS ABSTRACTEDBrown, J.H.U., The HeaZth Care Dilemma:Problems of Technology in Health CareDelivery33Hyman, Herbert Harvey, Health Regulation:Certificate of Need and 112235Institute of Medicine, National Academy ofSciences, A Manpowe- Policy for PrimaryHealth Care38Most., Frank E. and Val J. Halamandaris.Too Old Too Sick Too Bad42
.-4i1;77,1%Somers, Anne R., ed., 'nlomoting Health;Consumer Eduaation and National Policy45JOURNAL ARTICLES ABSTRACTEDCharron, K.C., "Health Insurance: TheCanadian Experience:"49Da Arcangelis, Antonio, "Worma sanitaria0 cornice vuota?"51DeMarko, Ken, James W. Robinson, andErnest C. Houck. "A Pilot Study of theInitial Bargaining Demands by NewlyOrganized Employees of Health CareInstitutions."53Dolan, Andrew K., "The Now York StateNurses Association 1985 Proposal:Who Needs It?"55Durant, Guy, "Gerer L'Hopital"57. ,Parkas, Emil C., "The National LaborRelations Act: The Health Care Amendments."59Feldstein, Paul J. and Irene Butler,"The Foreign Medical Graduate andPublic Policy: A Discussion of theIssues and Options."62Keaveny, Timothy J. and Roger L. Hayden."Manpower Planning for Nurse Personnel."64Lysaught, Jerome P., Mary Ann Christ, andGloria Hagopian, "Progress in Professional Service: Nurse Leaders Queried."67Meyer, Diane. "Work Load Management SystemEnsures Stable Nurse-Patient Ratio."69iv,tj
Perkoff, Gerald Top "An Effect of Organizationof Medical Care Upon Health ManpowerDistribution"70Richards, Thomas B. "Knowledge About theWorkplace: A Helpful Factor in Analysisof Health Facility Labor-ManagementProblems."72Rosario, Lucio, "Riforma sanitaria emeridionalismo"74Simborg, Donald W., Barbara H. Starfield,and Susan D. Horn, "Physicians andNon-physician Health Practitioners:The Characteristics of Their Practicesand Their Relationships"76Stamps, Paula L., et.al. "Measurement ofWork Satisfaction Among Health Professionals"78Westbury, Stuart A., Jr., John E. Mosher,and Michael A. Sachs. "ContinuingEducation: An Approach Taward Structureand a Call for Help"80LIST OF RECENT HEALTH ARTICLESJOURNALS SEARCHED FOR HEALTH MANPOWERLITERATURE85101
HealthManpowerIndicators
I.ESTIMATED EMPLOYMENT IN SELECTED HEALTH OCCUPATIONSTHAT ARE POTENTIALLY ENTRY-LEVELSelected Weasel 0670006700070000Dental Asstotant55200na9100095000114000116000116000Dental Lab. Assistant21000na2550047000311501200032000Diettic Techniciannanana600070002100024700Medical Library 36000SOO2100600014000250002800034000Occupational TheraPVAidenanana .500650065006500optometric Assistantnananana500050005000Optometrlc 1echniciannananana100010001000Physical TherapyAsnistantnanona8000900081000100Radioloqic tory Thermpistnanana8000120001200019000Health office Servicesnanana275000100000300000looftoSocial Mork AideRdnsno1500410043004300Ambul.nce AttendantnAnamaha5600207000260000Animal Techniciannanananana50005000EKG TechniciannananA7000950095009500EEC TeChniciannana12003000350040004000Total Selected Occupationsnanana1429000162266026876001991400Total Health l Lab. Tuch.A AssistantRecord TecnniclanNurse's AideHome Health AideSource.Health Resource Statistics, vslious years.3
a.HOSPITAL INDICATORSIf436tat 1950.41756 of Hospitalsof Leda (000s,of Toll-tIas 269of Pull-tlaa Personnalpet 100 Patianta84ut PhystcLans/DantLatsnarutnananena49236 00785376754712of RN'snananananana425728446187476577510118of LPN'shananananana215692222599211534239949ot Othersnanaviananana1980106204954121532582217818of Total 78129812371209118911671125Inpatient AdaissiOna(000'6)Outpatient Visite44(00PelAverago DAILYCennuy ()O's)1253Payroll (000'11) 2191 5588 8551311997 15706 17615 19530 21310 23821 27135Total Algot* (000'a) 7791511714 24502 11019 36159 16625 43157 47369 5170635)302 7 98516.46 25.29 37.78 53.95 63.62 71.89 83.67 97.23 118.69Hospital ExpensesLpei Patkent 04yHeepsta: Statistic's, 1972-1976.
).PERCENT DISTRIBUTION OF PERSONAL HEALTH CARE EXPENDITURES BY TYPE OF CARE AND SOURCE OF PAYMENTSelected Yeats; !:.5.: 5;9,25!025:2)5::U511.31',15:00;:9 1Hoepttel 103. .12.12.015.9.11. :',.1t11.1:j011:12%Type ut Cate - Fut4lperittets. 5erk04-mOther Prulemeturlel butytvesDrks9tlDrug Sundrtetl15tlSYedlaesee b 4ppl3alicev4.6Nuretn4 Horne t'ate1.7other Muelth 0:321.-ol1.4Souree of PaymvnrPtlYilto-IS tai4:t,1.4t1 %21TutalPttekt PayMent 5e:.6.3109%e4.311).112.14.2 49.137.610.816.113.632.5Insurance therLiZ.12.121.41.41.41.31.1Pulpit:.11'-D03a11 43e4e141itate 6 Lok.alTotal Personal u.Aith 'Aree.54-end,tutus (MIII4Qui 5): .234.,'1:tl3.2'.2.4 14.-kP.'rsohal Health :Aro% 912.012.112.4 314115Sb01115(37.2254 74828 82490 911158.51.34,.:: 10574528.012.2 1204313.314 WI5 IT6.116.616.756.116.71".3%7.52 67.75 124.5,1 170.12 289.76 120.84 153.66 3136.84 425.15 488.23 4.47379.7817. 14194.7731112 .8b127.76140.98158.56191.76221.72Sele,ted Por t'Apita Exvond.torePeriunal 11e41th C'areBrviate conrttbott.mPubltv ,ontttbuttorl800rk:o11.69271)2/73,, p.12; 4/77. Pp.15.18'
WSIC SCURCES FOR HEALTH MANPOWER STATISTICSAmerican Hospital Association, Hospital Statistics, Chicago: annual.American Medical Association, Profile of MedicalPractice, Chicago: annual.Distribution ofPhystmans 141 the U.S., Chicago: 1963, 1964, 1965,1967, 1970, 1971, 1972.Distribution ofPhysicians, HcapitaiiT7WITTET,Fital Beds in the U.S.,Chicago: 1966, 1968, 1969, 1970.Bureau of Census, U.S. Census of Population,Washington: GPO, 1950, 1960, 1970.Statistical Abstract of theUnited States, Washington: GPO, annual.,National Center for Health Statistics, A Countryand Metropolitan Area Data Book, Washington: GPO,1971.HealthResources Statt.stics: Health Manpower and HealthFacilities,Washington: GPO, annual.,,Unitei states,Health7975, Washington: GPO, 1976.National Institutes of Health, Health Manpower inflospitals, Washington: GPO, 1974., Health ManpowerSslurce Sook, Section 2: Nursing Personnel, WashingtonGPO, revised 1969.Section 21: Allied Health Manpower 1950-80, Washington: GPO, 1970.
StaffArticle
taREGIONALIZATION Or NATIONAL HEALTH INSURANCEIN ITALYShift Article1
01.INTRODUCTIONItaly's administrative divisiop into twenty re- gions in 1970 marked the beginning of what has become'a strong push toward decentralization, even though thecountry's economic conditions have been precarious forthe past five years.While regions have no power oftaxation, each region can use as it wishes the fundsallocated to it on a per capita basis.In line withthis decentralization trend, the Italian National In-stitute of Health (INAM), the agency that provided thefinancing and'administration qf national health insur-ance, was officially terminated on July 1,'1977, andits functions were transferred to the regions--therationale being that public policies aimed at improving the efficiency and quality of health care must bebased on the particular socioeconomic framework ofeach area.In a country where all government activities arecentralized--even township finances have to be govern-ment approved and local treasuries live only by thegrace of the central governmentregionalization ofhealth care insurance is a concept that cannot be di-gested easily, either by government bureaucrats or thegeneral public. Arguments for regionalization areconvincing from the point of view of income distribution.The richest region (Lombardia) has a per1411
capita income twice as high as the poorest one (BasiThe health problems of the rich, but frigid,licata).North are different from the problems of the poor, butbalmy South.Social customs in the North are closerto those of its central European neighbors, while theSouth is essentially Levantine.Socio-economic differences require differenttypes of health care to be administered by differentYet, the greatest numberstypes of health personnel.of health personnel (especially physicians) concentrate in a few large northern cities and in Naples,while the rest of the country, especially in theSouth, must make dp with proportionately fewer healthpersonnel.2.General Characteristics of HeaZth Care Systemin ItalyItaly has had comprehensive national health in-surance for over twenty years.The Italian Parliamenthas made health care practically a free commodity bypassing new and increasingly comprehensive legislationevery few years.The result has been a substantialincrease in demand without an efficient adjustment ofsupply.In the governmen's rush to provide universalhealth coverage, private industry and the intermediaryinsurance agencies have placed greater and greateremphasis on more costly capital-intensive forms ofhealth care.Because the components of the system12
have not been altered to accommodate the new demandschedule, bottlenecks have occurred and costs have.risen dramatically.A piece of legislation does not necessarilychange the institutionis intended to control.For many years before national health insurancecoverage was introduced, Italy had been plaguedwith poblems asnociated with health care delivery-among them, the lack of adequate training for medicaland allied health personnel, the lack of physicianhospital affiliations, the overutilization of hospital facilities, and the absence of extended carefacilities.These problems were severly aggravatedby the introduction of comprehensive insurancecoverage.Lack of comprehensive planning alloweda malfunctioning bureaucracy to mushroom and negatethe positive attributes of national health insurance.A comprehensive health insurance program is apowerful public instrument, but its success dependson supporting sectors and personnel.While "scarcityof health care" was overcome by law, the necessaryreorganization to accomplish the ultimate socioeconomic goal did not accompany it.This is not to say that the general health ofthe population has not improved.In fact, the majorhealth indicators have shown substantial improvementsince World War II.Infant mortality dropped from1316
110 per 1,000 to 27.4 per 1,000.Malaria cald poliohave virtually disappeared, while disease due to malnutrition has declined significantly.The crude deathrate dropped from 13.6 to 9.6 per 1,000, while lifeexpectancy jumped from 60 to 74.5 years.However,this dramatic progreSs in the health of the country isa direct result of improved sanitary and social conditions following World War II, coupled with the availability of improved medicines. (in the form of innoculations), previously developed in the West.Once theoriginal spurt of improved health levels off, otherproblems must be dealt with--the acute and chronicdLseases which have little effect on the health indicatnrs but have major consequences for worker produc-.tivity and the economic well-being of the state.One of the main shortcomings of the Italianhealth care system is the lopsided skill distributionof health personnel.There are too many inadequatelytrained physicians and there is lAtle use made ofauxiliary personnel.It has been estimated that thereare 114,000 active physicians in Italy, or one physician for every 518 people, compared to a 1 to 733ratio for the United States.In addition, there areapproximately 137,000 medical students in a systemthat includes only 25 medical schools.The open stan-dards for admission, coupled with overcrowded classrooms and laboratory facilities, have resulted in afactory-like production of physicians.V.14Hospital
privileges are reserved for a select few, and many newgraduates are reqpired to practice medicine in generalwards on a voluntary basis as stand-ins for absentee,hospital-tenured physicians.Because of their large numbers, physicians perform many tasks that can be done by nurses or techni.cians.Italy has about 18 active registered nursesper 10,000 people, far below the optimum figure of 30per 10,000 set by the World Health Organization.In1971, the total number of allied health workers emploied outside of hospitals was as low as 16,633 for55 million Italians, or a ratio of 1 to 3,562.In theUnited States, this ratio was 1 to 126.3.Regional and Socio-Fconomic Factors in ItalyWhat is true for the nation as a whole is exacerbated at the regional level. Table 1 presents fiveselective economic indicators and their relationshipsbetween the South and the North.This admittedlysmall sample indicates .that the South is far belowthe North in terms of economic well-heing.Whi.:.e both'income and consumption have remained relatively stableover a :2-year period, per capita savings in the Southhave plummeted dramatically in relation to those inthe North. Tht. only indicator which has shown relative improvement is investment, due in large part tomassive government outlays.15
SARIS 1Negionil Indicators for Selected Year.Y/P0p.lira)(000'e lira)1951 - 1973Sp/Pop,1000'4 lira)L/Pop.651461901883639I/Pop.(000' llralNorth 4.5465.5382Non.Italy/N. Italy.b2b0.6363.6736.6736Y/PopPer capita IncomeC/PopPer capita 3riV3tO COMIUMPtiOnSp/PopPer cupita Private SavingsL/Pvp - Vu11-timo Labor Force as a percent of populationl'PopPer capita InvestmentSOURCESitaliana delle camera di commercio industria artigianato a aorlooltura, I conti econcmiciruqionali 1974 Seri storiza 1963-74, Franco hn9eli Editore, Milano, Italy 1976.1STAT, Jccupati presenti in Italia hnni 1951-1972, Rome, Italy, 1973 (boater)hnnuario di contabilita narionale 1974, Rome, Italy:Valuing. distet/at/rho del lavero 1:6,Rome, Italy1.4928.6470n.7219.0934
Yet, it is obvious the. the primary motivation forthese invuotments, i.e., improving the economic wellbeing of the South, has failed to increase substantially either income or employment.Health indicators reflect the sane regional disparity as do the economic indicators. Table 2 records selected health indicators for 1972 and theirrelative value to the South and the North.Onceagain, the South lags behind in all the indicators,most notably in the number of hospital-employed allied health personnel per number of people. The onlyindicator comparable between North and South is thatreflecting total number of physicians per capita.4.A Statistical. Exercise to Test Regional HealthPersonnel UtilizationAn attempt is made here to explain the regionalvariation of de,mand for health personnel through theavailability of health care proxies and socioeconomic indices.The main hypothesis derives fromour cursory knowledge of the socio-economic fabric ofthe South and the North. To begin with, we testedthe hypothesis that the demand for health personnelof type "i" is influenced by the demand for healthcare and the availability of health care facilities.This follows from the traditional economic theorythat health personnel demand is derived from finalhealth care demand.We hypothesized that aparticular-skilled employment will depend on the17)()
Table 2Selected Health Indicators1972KM per1000 personsT per1000 persons.Beds per1000 personsPhysiciansper 1000rsonuConsumption ofHealth perCe itaPopulations((IOC's)North Italy3.13.811.91.18233335402South Italy1.82.28.41.95878018343SiN Ltaly.5806.5789.7059.9048Source:ISTAT, Annuario di Statistichs Sanitarie 1973Model1i Italiani e Stranieri di Assistenza Sanitarie, Vol. 1NotesNMTnurses nd midwivestechnicians.7139.5200
nature and quantity of fixed assets used.Finally,we assumed that the laxger areas (measured by population) and the wealthier areas (gross regional productper capita) wouldemploy more health personnel.We postulated that:P. f(BED, ADC, PHYS,POPSM, GNP, CHEALTH, WAGE, TECH, BHOSP, POP)where:P stands for NMZ nurses and midwivesiper population;TZ technicians and others per population;TPERZ total health care personnel perpopulation.BEDS total number of hospital bedsADC average daily census, or average in-patientpopulation per dayPHYS total number of physicians, both inhosnital and private practitionersPOPSM population'per square mileGNP gross national product per capitaCHEALTH consumption expenditures for health careWAGE average yearly wageTECH change in capital assetsBHSOP average size of hospital, measured as beds/hospitalPOP populationA more detailed discussion of the variables, alongwith sources, is presented in the Appendix.We normalized our variables either by populationor, in the case of wages, by personnel, to get more1922
homogeneous results.The outcome, though, was dis-torted by multicollinearity, implying a defect inspecification.In the second round, rather than eX-plain the demand for personnel based on our firstmodel, we eliminated the independent variables whichintroduced disturbances.We limited ourselves totesting a hypothesis for Italy as a wholes then theThree dependent varia-North and South separately.bles were used:nurses and midwives, NM; techniciansand others, T; and total health personnel, TPER.Allequations take the same form and are estimated by loglinear regression equations: f(ADCZ, WAGE, GNPZ,.46SZ, TECHX)Piwhere for each geographical area the independent variables for each equation are:ADCZ average daily census per capitaWAGE wages per personnelGNPZ GNP per capitaPHYSZ physicians per capitaTECHZ net change in capital assets of healthfacilities per capitaThe results of our regressions are reported in Table3.Even in these modified models, all nine equations show high coefficients of multiple determination (It2 .84 to .95).From a statistical point ofview, however, the independent variables are not al-ways significant in explaining regional variation ofri20t./
TABLEfl.zysits tan Resultunite11P!"-4.174t1""At( (.(1 11,.8468/1,.144 /3171.1: h.;1(.1.452 111((.21714.(2.2 46)1.(1 1))(2. 597081"-.11 8». S4446(1 .64882 )-. 349981-.28 3421-.0 51591-.59279)10vW.1vit.95. 4,1 79(t(', 40118).41975(1.499 18). 38211(1.499301.08177(0.1 3268).94.2246f.96.1 '143f -(tsin(.1 icanceint( :canc.0 3148.84(0.875631 1.4nLfL.dflcolevol n.11 :eve(-.1 7002.138(-. 31 34 1)tri.11114 8.15114(U. P 7511stcat.96-.4279 3(-. 51756I (2-4.901.1,21401it»es 't-.1 5485- .04171(-.11/1 .31.94.(" (8(.444t.,(/4.04462(0.797827(1.4 (721 I. : 4 s1. 17764-.46777(-. 741.1u1.1 51 11(3.364221'(2. 55182)1'11. N.,.4582 71.02477/.:;97u93-.1913121P'1,4414»1(.4 184( 1. 598 34)6Mar(4.484 »1/141,,4.1 743(1!11,Z. 115(1(.1(s.03.1)-.411 .111. 1211:91-.5915 47*m.1 3824(1.1 304).96
deMand for health personnel (t-statistics aresignificant at the 10 percent level or in over 38percent of the cells).By far the most significant variable is theaverage daily census per capita (at 1 percent levelof significance)*. As we expected, there is a closerelationship between daily census and personnel.Yet, we obtained elasticities of .80 for the Northand .45 in the South for demand for technicians.Itseems that the demand for technicians is influencedby the average patient population much less in theSouth than in the North.Less significant is the eKplanation of regionalvariation by the availability of physicians.In theNorth the presence-of physicians, as we expected, hasa high explanatory valuI), while in the South the co-efficient .00594.The inference is that in thesouthern regions allied health personnel play a moreindependent role from physicians than they do in theNorth.Indeed, the variable approximating materialwell-being,.GNPZ, is a more important explanatoryvariable** for the employment of nurses and midwives*In all cases, the level of significance for theSouth is below 10 percent because of the lower numberof observations made in the South than in the North.**This variable is highly significant for Italyas a whole, but not for the North and South separately.22
while for other health personnel,.it is similar forboth regions. Moreover, the negative sign for theNorth implies that the larger the GNP, the lower theregional variation in demand.The reverse happens inthe South, where the sign is negative in the techni-,cian equation, probably for the same reason.*These kinds of relationships also occur with regard to the wage variable, 'which is statistically insignificant in all equations.is constantly negative,In the North the signand in the South, constantlypositive.The implication is that in the North higher wages diminish regional personnel demand, while inthe South the opposite occurs.This is contrary toeconomic theor Y. suggesting a case of unlimited laborsupply with no downward sloping curve.What we call technology is really a proxy of required net assets of health providers. The resultsari uneven--in some cases the t-statistics indicatehign significance while in'other cases a low signifi-cance (t .9279 to 3.36422).Yet, the value of thecoefficient 6 ib flrInsistently low, and in one case(the technician equation for the North)it is negative.rn general this is a weak proxy variable and can beinterpreted as having little influence in regional*We recognize that this may be interpreted in avariety of ways. For example, the negative sign fornurses/midwives in the North may indicate that thehigher the GNP, the more people will demand the services of physicians instead.of nurses/midwives.2326
.variation of demand for health personnel.Perhaps a'better proxy, if available, could be more closely re-.lated to technological expansion and innovations.5.Conouaionaased on these preliminary tests, regional de-mand tr allied health personnel seems tO be mainlya funct'on of average daily census, and only marginally adac,ted by the number of physicians availableand the per capita income.In the South wages do notinfluence the demand for health personnel, a lack ofinfluence which might simply characterize a state ofunderdevelopment or which might be attributable to.the fact that the proxy usedtotal wages in thehospital divided by the total personnel employed inthe hospital--includesa very heterogeneous type ofpersonnel.To be sure, conclusions based on the behavior ofthe occupancy variable are misleading because overutilization of hospital capacity is a serious healthcare bottleneck in Italy as a whole.A survey ofRoman hospitals for 1975 revealed an average occupancy rate of 114 percent.One of the reasons for sucha high occupancy rate is that hospital-based ambulatory facilities are practically non-existent in Italy.Once the patient arrives at the typical Italian hospital, he becomes an inpatient with an average lengthof stay of 17 days, twice as long as in hospitals in224
the United States.One could have expected the health care institu-.tional structure to be a reflection of the level ofdevelopment in each area.A direct inference wouldbe that the level of technological sophisticatim-not to be confused with superior health care--isafactor of regional wealth.Higher technology meansthat a larger number of highly skilled allied healthpersonnel is required.These expectations have beenjustified by 4 study of regional variation of healthcare and personnel utiL.zation in the United States,*but apparently, they are unjustified for Italy.It seems that conditions of health care deliveryin Italy are generally in a poor state and that theusual relationships among hospital occupancy, technology, and number of physicians and requirements forallied health personnel do not hold. Yet, as indicated earlier (see Table 2), the South fares worse inthe delivery of adequate health care than the North.The regionalization of the nation's health care systrm, that seems equitatle on a per capita basis, maynot close the regional gap.Policies of regional de-velopment for depressed areas should necessarily bediscriminatory against more affluent areas as advanced regions can attract more and better providers,leaving poor regions even further behind. If a*See Health Manpower Literature, Vol. 2, No.2525I1.\
distribution of health resources is centrally accomplished on a per capita basis, the areas that aremost in need receive the same proportion as the lessneedy.By the same token, if each region manages itsown health system, financial resources can be wastedand Nnedical resources," i.e., physicians, technologyand allied health personnel, further deflectedtowards the wealthier areas, which c.a accomodate theregional
DOCONEIT RESUME TO 189 271 CE 023 824 TITLE Health Manpower Literature, Volume 2, Number 2, December 1978. INSTITUTION Northeastern Univ., Boston, Mass. Center for Medical. Manpower Studies& SPONS AGENCY Employment and Training Administration (DOL), Washington, D.C. Office of Research and. De
Quits set Monklands and WGH 500 494 600 Monklands Hospital 500 600 Wishaw Hospital 318 402 459 271.5 271.5 271.5 271.5 271.5 271.5 271.5 271.5 300 400
1,750 1,775 176 176 176 176 1,775 1,800 179 179 179 179 1,800 1,825 181 181 181 181 1,825 1,850 184 184 184 184 1,850 1,875 186 186 186 186 1,875 1,900 189 189 189 189 1,900 1,925 191 191 191 191 1,925 1,950 194 194 194 194 1,950 1,975 196 196 196 196 1,975 2,000 199 199 199 199 If line 43 (taxable income) is— And you are— At least But less .
Quaker Old Fashioned or Quick Oats 139 8-12 Ct. Quaker Instant Oatmeal 189 11.5-13 Oz. Quaker Cap’n Crunch Cereal 189 13 Oz. Quaker Life Cereal 189 14.5 Oz. Quaker Oatmeal Squares Cereal 24 Oz. 189 Aunt Jemima Syrup 199 32-35 Oz. Aunt Jemima Pancake & Waffl e Mix 169 46 Oz. Del Monte Tomato Juice 14.5 Oz. Hunt’s Tomatoes 1 Oz .
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work/products (Beading, Candles, Carving, Food Products, Soap, Weaving, etc.) ⃝I understand that if my work contains Indigenous visual representation that it is a reflection of the Indigenous culture of my native region. ⃝To the best of my knowledge, my work/products fall within Craft Council standards and expectations with respect to
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