This paper presents the findings of an epidemiological analysis of disability among adults in the noninstitutionalized continental United States population. Data were collected through interviews with a probability sample of persons 18 and over, yielding 6,493 completed schedules comprising 80.3 percent of the sample. Distinctions were made among concepts and indicators of pathology, impairment, individual performance, and social performance. Central to the analysis were two dimensions of individual performance (physical and emotional) and two dimensions of disability in social performance (work and independent living). A number of socio-demographic characteristics were included in the analysis. The results show the relative contributions of pathology and impairment to performance on the individual level, and the relative contributions of all of these factors on social performance, that is, the two dimensions of disability. Through pathology, impairment, performance at the individual level, and the socio-demographic characteristics, it was possible to account for 38 percent of the variance in work disability and 74 percent of dependence-independence in community living. Further explanations are given for variance in work disability. Estimates of the size of populations reporting varying types and severities of disability are also presented.
Reactions to teamwork, whether in health care, science and research, or in other areas, are seldom neutral. While some see in it a panacea that will help solve many stubborn organizational problems, others condemn it on a variety of grounds. Impetus to the development of team approaches to the delivery of health care and concern over their performance have been tied to a number of trends: a marked increase in specialization and division of labor as a result of expansion in health-related knowledge and technology, a corresponding emphasis upon coordination, a broadening concept of health and an increase in the types of activities included under its rubric, and a manpower shortage especially in the highly trained professions. This paper reviews current studies, important findings, and points out neglected dimensions. Themes prominent in the literature include: (a) status, power, authority, and influence; (b) roles and professional domains; and (c) decision making and communication. A number of important dimensions seem to be neglected, such as the effectiveness of teams as an approach to the delivery of services, the modes of organization and the dilemma of gate-keeping decisions, and the relations of team approaches to the manpower problems.
Change in the patterns of utilization of services is an important indicator of the influence of policies and programs concerning health care. This paper focuses on these patterns as revealed in a survey of a probability sample of the U.S. adult population conducted in 1972. The analysis sought to assess the influence of a number of health dimensions, as well as economic and sociodemographic characteristics, on utilization. Coverage through insurance or other payment plants constituted one of the independent factors in the analysis. The dimensions of health included indicators of disabilities in work and independent living, limitations in physical and emotional performance, and the existence and severity of pathology and impairment. A discriminant analysis was employed to assess the relative importance of these variables in their influence upon the utilization of services. Finally, the paper presents information about unmet needs for care.
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