A social indicator model of a health services system.

Abstract

A social indicator model of the health services system serving the state of New Mexico is presented. The model specifies the causal relationships hypothesized as existing among a set of social, demographic, and economic variables known to be related to the supply and use of health manpower and facilities, and to the health status of a population. Inclusion of feedback into the model as well as lagged values of endogenous variables permits the examination of the dynamic behavior of the social system over time. Methods for deriving the reduced and final forms of the structural model are presented along with their equations. The structural and reduced form equations have been used to predict the consequences for one New Mexico county of state and federal policies that would affect the organization and delivery of health services. Early definitions limited social indicators to direct measures of welfare that are of normative interest (H.E.W., a, b; Tunstall). Campbell and Converse also emphasize the importance of defining social indicators that permit the assessment of changes in the quality of life that are relevant to policy formation. Recent discussions have proposed that social indicators be defined as components of a social systems model that describes a specific social process (Anderson, a; Land, a; Sheldon and Freeman; Wilcox and Brooks). Based on this definition Sheldon and Land, and Land (c) propose three distinct types of social indicators that measure social conditions. Output descriptive indicators are measures of the outcomes of a specific social process. These measures are directly relevant to the assessment of social problems and the evaluation of the efficacy of social programs. Other more general measures of social conditions are termed other descriptive indicators. Analytic indicators are viewed as components of the social process that result in the values of the output measures. McFarland (b) goes even farther in proposing that social indicator *I wish to thank the New Mexico Health and Social Services Department for providing morbidity and mortality data for this study. I also wish to acknowledge the assistance of Marsha Yaggie in the preparation and analysis of the data, and David Bartkus for many helpful suggestions.