University of Southern California Dissertations and Theses

Resource allocation among organizations within urban communities

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Resource allocation among organizations within urban communities

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Content RESOURCE ALLOCATION AMONG ORGANIZATIONS
WITHIN URBAN COMMUNITIES
by
Isabelle Margaret Walker
A Dissertation Presented to the
FACULTY OF THE GRADUATE SCHOOL
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF PHILOSOPHY
(Sociology)
June 1972
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University Microfilms
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I
73-785
WALKER, Isabelle Margaret, 1925-
RESOURCE ALLOCATION AMONG ORGANIZATIONS WITHIN
URBAN COMJNITIES.
University of Southern California, Ph.D., 1972
Sociology, general
University Microfilms, A X ER O X Com pany, Ann Arbor, Michigan
THIS DISSERTATION HAS BEEN MICROFILMED EXACTLY AS RECEIVED.
UNIVERSITY O F SO UTHERN CALIFORNIA
THE GRADUATE SCHOOL
UNIVERSITY PARK
LOS ANGELES. CALIFORNIA 8 0 0 0 7
This dissertation, written by
under the direction of h.ftx.... Dissertation Com
mittee, and approved by all its members, has
been presented to and accepted by The Graduate
School, in partial fulfillment of requirements of
the degree of
D O C T O R O F P H I L O S O P H Y
JSABELLE..MABGARE1..WALKER.
Dtan
D ate June..1972
DISSERTATION COMMITTEE
Chairman
PLEASE NOTE:
Some pages may have
indistinct print.
Filmed as received.
University Microfilms, A Xerox Education Company
ACKNOWLEDGMENTS
Any research project of sizeable proportions can
never be the work of one individual working alone; the
present writer is no exception to this generalization and
would like to thank persons whose support, guidance,
advice, and interest sustained her during the lengthy
process which the following study entailed. Professors
Joan Moore and Jon Miller, members of the dissertation
guidance committee, supplied far more professional support
and availability than could possibly have been expected of
them; as Chairman of the committee, Professor Herman Turk's
supervision and warm interest in the topic helped me
through those inevitable periods of desperation. For his
continued and unsparing attention I am deeply grateful.
Without the aid--and more importantly, indulgence--of my
family and friends, this dissertation could never have been
completed. A special acknowledgment goes to Ronald Thisted
who gave valuable statistical and philosophic aid as
familial affection.
ii
TABLE OF CONTENTS
ACKNOWLEDGMENTS
Page
ii
LIST OF TABLES iv
Chapter
I. STATEMENT OF THE PROBLEM 1
The Problem and Its Significance
Community Emphasis
Community Viability
Volunteer Participation
Structural Characteristics of Urban
Communities
Hospitals as Units of Study
Statement of the Problem
II. RESEARCH DESIGN.............................. 13
Hospital Manpower Shortage and Volunteer
Support: The Shortage Support Measure
Measures of the Community's Health
Emphasis
Multiple Regression Analysis
Sampling Hospitals within Cities
Data Source
III. RESULTS 19
IV. SUMMARY AND CONCLUSIONS 46
BIBLIOGRAPHY 55
iii
LIST OF TABLES
Table
1.
2 .
3.
4.
5.
6 .
Page
Cumulative Frequency Distribution of 125
Cities by Number of Hospitals per City . .. 15
Product-Moment Correlation Between Patient-
Employee Ratio and Number of In-Service
Volunteers per B e d ......................... 21
Association Between Health Emphasis Measures
and Shortage-Support Measures ............... 24
Association of the Shortage-Support Measure
(1967) with Health Emphasis Measures and with
Structural Characteristics of the Community
(1960, Except as Noted) in 81 Central Cities
Having Four or More Hospitals.............. 27
Extreme Residuals from Regression Analysis
(Table 4 ) ................................... 38
Association of the Shortage-Support Measure
(1967) with Health Emphasis Measures and with
Structural Characteristics of the Community
(1960, Except as Noted) and Northeast Region
in 81 Central Cities Having Four or More
Hospitals--Considering also Region, Value
Added by Manufacturing, Number of Profes
sional Workers, and Number in Group Quarters 40
iv
CHAPTER I
STATEMENT OF THE PROBLEM
The Problem and Its Significance. The degree of
emphasis placed within a community upon a given one of its
institutional sectors affects the patterns of social
participation within that sector. The foregoing served as
the guiding assumption of an exploratory empirical investi
gation in the virtually untapped problem area of resource
allocation among a community's organizations.^" Specifi
cally, we are saying that the way in which voluntary
manpower distributes itself among hospitals is a function
of the degree to which the community emphasizes the
provision of health care. The degree of such emphasis can
determine (a) the extent to which health care needs are met
by individuals--either because of sanction or conviction--;
but, by implication, it can also determine (b) the extent
to which the health sector serves as a source of power or
prestige for individuals, who may therefore act where power
and prestige are the greatest (thus where resources are
often plentiful and needed the least). Hence the paradox
that the greater the emphasis placed by the community upon
health care the more likely or the less likely are
1
individuals to donate voluntary labor to the community's
hospitals on the basis of labor shortages within them.
We have chosen to investigate these two systematic
bases for the allocation of voluntary labor among organi
zations, either of whose existence is assumed to be a
correlate of emphasis placed by the community upon the
provision of health care. Other bases of allocation will
undoubtedly occur to other investigators, but the main
point we are making in this dissertation is that any
systematic basis of allocation within an institutional
sector is likely to be associated with the degree of
emphasis placed upon that sector. This observation may be
deduced from a number of different sociological frameworks,
including those emphasizing ecological process, power
distribution, historical origins, or social integration.
Our own ideas stemmed from introduction of the, admittedly
remote, hypothetical construct of value orientation
(Williams, 1967; Parsons, 1968; Warren, 1963 and 1970,
among others). The greater the emphasis placed upon values
of health care, the greater was the emphasis expected to be
that was placed on the general United States values that
health care is a right, not a privilege. Under these
conditions, it was further assumed that this value would be
implemented by individuals wherever its realization was the
most precarious (where need was greatest). Paradoxically,
however, the more dominant a given value is the more it
serves as a basis of prestige for individuals, who may
therefore participate in greatest number where prestige is
greatest rather than where greatest need, often the inverse
of prestige, prevails.
Community Emphasis. As we have already implied,
communities vary in the extent of emphasis placed within
them upon any given institutional sector; this in turn
affects the manner in which resources are committed to
community organizations (Vogt and O'Dea, 1953). Numerous
case studies have demonstrated that shifting emphases
directly affect the degree to which community support is
supplied or denied to the relevant organizations (Warner
and Low, 1946; Presthus, 1964; Stotland and Kobler, 1965;
Hasenfeld, 1971). From these stemmed our expectation that
emphasis within an institutional sector guides and channels
the voluntary organizational affiliations of the commu
nity's members; and measures of emphasis upon the provision
of health care that implement implications of this expecta
tion shall be described in Chapter III.
Community Viability. Emphasis upon given institu
tional sectors will in large measure set the criteria for
support, priority, and effectiveness of action within that
sector (Warren, 1970). Whether these criteria can be met,
however, is not only determined by the degree of emphasis
placed by the community upon the institutional sector in
question, but also depends on the community1s viability.
its ability to organize or to mobilize for oganized action
or process within any or all institutional sectors. In
other words, communities not only vary in the emphasis they
place on the provision of health care, but they also vary
from one to the next in the degree to which they are
capable of implementing these emphases in terms of any kind
of allocational system in any institutional sector. Thus,
whether need, prestige, or some other criterion is the
basis for allocation, whether or not allocation indeed
exists depends both upon the emphasis placed by the commu
nity upon the relevant institutional sector and upon the
community's general structural viability as well.
In their comparison of the health and welfare
systems in two urban communities, Belknap and Steinle
(1963) noted that although the communities were demograph-
ically similar, their health and welfare systems were
dissimilar. They found that the community whose health and
welfare system was highly integrated (i.e., well-financed
and organized) also enjoyed a high level of government
agreement and support of the health and welfare system's
goals and policy. Here the system was primarily financed
by municipal taxes; voluntary health and welfare agencies,
on the other hand, received comparatively poor support.
The second community's health and welfare system operated
without any organized community effort to improve the
situation. The system was fragmented in both goals and
policy and received the major portion of its financial
support through various voluntary agencies and private
donations. Belknap and Steinle concluded that, although
little diversity was apparent in the income and medical
resources available in the two communities, striking
differences existed in the ability to mobilize income and
resources. This strongly suggests that the political
structure of a community may affect the efficient function
ing of its other institutional sectors. Yet Presthus1
comparative study failed to support the premise that the
political process shapes consensual decisions in a commu
nity having political rule as opposed to one governed by a
"business elite" (1964:411-412). On the basis of his
evidence Presthus hypothesized that there
is a positive relation between the degree to which
a community is socially integrated (i.e., political
and class structure, ethnic, and religious charac
teristics) and the manner in which it solves its
problems, i.e., through some citizen participation
or through more centralized control and action by
a few hyperactive leaders. (1964:412)
Presthus' study, however, did not refer to urban communi
ties of the scale considered in the present research and,
for that reason, may be of limited applicability to the
problem considered here. Nonetheless, these writings
suggested the need to devise measures of the community's
viability, also to be described in Chapter III.
Volunteer Participation. The basic decisions
concerning the degree of emphasis that the community places
upon any given institutional sector, or upon all of them as
well as the resources available for their implementation,
are often long established and have become settled proce
dure . The degree of emphasis placed by various communities
upon the acquisition and maintenance of parks and other
recreational areas, for example, has generally been deter
mined in the past. Social welfare policies and structures
that are now in force, by way of further example, origi
nated during the first three decades of this century. Yet
the degrees of such emphases, no matter how static or long
standing, are likely to determine the degree of emphasis
that the individual places upon the relevant institutional
sector in her or his social participation.
Whereas resource allocation for these and similar
areas may vary slightly from yearly budget to yearly
budget, it has been demonstrated that the allocations tend
to maintain proportional parity vis-d-vis their various
recipients (Wheaton, 1964:180). It is only when problems
of sufficient magnitude to precipitate a "crisis" arise
that communities may perceive any specific set of institu
tionalized practices as an issue requiring debate and
discussion and subsequent community action (Rose, 1964;
Warren, 1966; Hasenfeld, 1971). Such debates frequently
deal with modes of community response, especially when the
practice is a widely accepted one, as in Wheaton's example:
. . . even so great a national debate as that over
the establishment of urban renewal policies did not
lead to intense controversy in most major cities of
the country. It was adopted by common consent
because it was recognized there was a need for
public and private action. . . . (1964:181)
One such "crisis" has created increased concern for the
national health care delivery system and for its articula
tion within communities. "The basic fault in the American
health service," as Roemer puts it, "is the discrepancy
between our assertion of health care as a basic human right
and our practice of treating it as a market place commodity"
(1971:31).
While there has been an increase in the priorities
given to financing medical care and building health facili
ties (i.e., Medicare and Hill-Burton funding), a gap
remains between the number of health personnel to serve the
population and the number of persons being trained in the
health field (National Manpower Council, 1953; Ginsberg,
1965). Yet until recently there has been little contro
versy over the traditional way of training personnel. One
response to the continued man- and woman-power shortage has
been to reclassify the job requirements for health
personnel. Many duties long a part of the registered
nurses' responsibilities have been delegated to less
trained, nonprofessional personnel. Of primary signifi
cance to this research is the fact that lay community
8
persons have been recruited as volunteers to function as a
2
supplemental labor force. Both job reclassification and
the use of volunteers have met with little criticism. In
fact, when nursing personnel recently went on strike in a
3
large city, all parties involved agreed that the hospital
volunteers should be asked to assume certain of the non
medical functions for those patients who were forced to
remain hospitalized through the strike period. Of course,
as hospitals per se have a low controversy profile, one
would expect that communities could and would relieve a
pressing labor shortage in hospitals through citizen
participation as a result of organizational efforts to find
solutions perceived as acceptable (see March and Simons
[1958] for a discussion of "search behavior").
Given a general inclination to volunteer or pres
sures to do so in the solution of health care crises, the
individual can still choose where to volunteer. In
communities placing considerable emphasis upon health care,
volunteering can, according to the argument thus far,
either be ad hoc or it can be based on systematic criteria
such as the two alternatives chosen for study here: (a)
need-based volunteering or (b) prestige-based volunteering.
All of these considerations led to an interest in
determining the extent to which the degree that a community
emphasizes the provision of health care is associated with
the correlation between the degree of employee shortage
that each of the city's hospitals experiences and how many
in-service volunteers it has. If the association between
health emphasis and such need-based support were to prove
negative, the latter measure will be taken as a reverse
indicator of prestige-based support for reasons to be given
later.
Structural Characteristics of Urban Communities.
Various studies have concluded that certain structural
characteristics do influence the amount and manner in
which support is allocated to institutional sectors
(Belknap and Steinle, 1963; Presthus, 1964; H. Turk, 1970a;
T. Turk, 1970; Walker, 1971). They do so by affecting
particular institutions and also by affecting the viability
of the community as a whole. The form of municipal govern
ment, the nature and extent of a city's orientation to the
larger society in which it operates, and various social-
economic factors are among the characteristics considered
in predicting the association between the degree of emphasis
placed by a city upon the provision of health services and
the extent to which social participation in the health
sector is on the basis of resource shortages.
In addition to the emphasis that the city places on
its health affairs, its structural characteristics are
likely to play a role in determining the extent to which
the city is capable of organization for any purpose in any
10
institutional sector—-in short, its viability. Type of
government is to be seen in this light as well as the
presence of voluntary associations both within and outside
the health arena; heterogeneity, fragmentation, and
turbulence within the city are to be investigated as
potential negative indicators of its viability.
The structure of the city also determines the
nature of the pressures placed upon and the needs that
occur among its health care institutions. Andersen and
Anderson, for example, found a bimodal income distribution
in utilization of health services (1967:38). They deter
mined that high and low income families were more likely
than middle income families to use health services, but
that low income families were apt not to have a private
physician, seeking service instead in clinics and tax-
supported (public) hospitals (1967:151). Higher income
families, by contrast, sought service from specialists, a
segment of the medical community requiring an elaborate
network of ancillary services and facilities (Andersen and
Anderson, 1967:15). The presence of these economic group
ings in the community would imply pressure on the
community's health delivery system on one hand and a value
oriented vested interest on the other. Measures of
variables such as these will also be included in the
analysis to follow, if only for purposes of control.
11
Hospitals as Units of Study. Hospitals provide an
excellent field for study of the taxonomy of support as
well as the conditions under which it is received, since
these organizations, though often privately sponsored,
derive many forms of support from the community. They
receive monies from private, public, and client sources.
They enjoy many tax-exempt privileges not afforded other
organizations, while receiving their share of municipal
services. Most importantly, they recruit personnel from
the traditional labor market and also from various lay and
professional sources of voluntary manpower. These forms of
support comprise three of the four types of resources
discussed earlier (the other being organization). Assess
ment of the affects of variations in these resources from
one city to the next and of the interrelationships among
the different types of variation provide clues concerning
characteristics of the cities in which the hospitals
operate.
While hospitals operate with the traditional labor
force, many have also developed a voluntary labor force of
in-service volunteers under the direction of administrative
officers. These volunteers are recruited, screened,
trained, supervised, and dismissed according to the general
regulations governing paid employees. Utilization of this
fora of manpower is an advantage for the institution's
overall operation, being a labor resource used to relieve
peak periods of daily operation.
Statement of the Problem. The neglected area of
allocation of support among organizations will be studied
by determining which variables are associated with the
degree to which volunteer support is allocated on the basis
of need. These variables will be (a) the emphasis that is
placed by the community upon the given institutional sector
to which the organizations belong (here the health arena),
(b) structural characteristics that are related to the
community's capacity for organization, and (c) structural
characteristics of the community that bear directly upon
the institutional sector under consideration. The dependent
variable of this research will be the correlation between
the degree of employee shortage within a hospital in
relation to the community's other hospitals and the number
of in-service volunteers that it has. The various inde
pendent variables used as indicators of institutional
emphasis and community structure will be described as they
are encountered.
CHAPTER II
RESEARCH DESIGN
The research was designed to investigate allocation
of volunteers to general hospitals within the 130 incor
porated cities in the United States with 1960 populations
greater than 100,000. Each city constitutes a separate
unit of analysis. Only the ones having two or more general
hospitals could be considered, since the variable in ques
tion was one of intracity association between hospital
characteristics. One hundred twenty-five cities met this
criterion. The characteristics of these municipalities,
including those of hospitals within each of them, were
provided by the Urban Data File, maintained by the Labora
tory for Organizational Research at the University of
Southern California. This file, compiled from various
documentary sources, includes demographic information about
each city from the 1960 United States census as well as
other relevant material. The hospital data in the file
were obtained from the 1967 Guide Issue of Hospitals,
published by the American Hospital Association. Statistics
in this publication include such items as number of beds
per hospital, number of employees, total operating expenses
13
14
for the published year, and other classificatory informa
tion concerning the status of services and facilities
offered by each institution.
A second criterion for selecting the study cities
was initiated to enhance reliability of the dependent vari
able. Product-moment correlation coefficients were used as
the dependent variable (to be discussed below). Those
cities having only two or three hospitals were deleted,
since coefficients for such small numbers of cases were
considered unstable. The 81 cities with four or more
hospitals were accepted as providing adequate estimates of
association. The deleted cities comprised 35.2 percent of
the original 125 cities (see Table 1).
General hospitals are defined as health facilities
furnishing primarily short-term, or emergency, care for
4
acute medical and surgical conditions. Because data were
derived from American Hospital Association sources, only
hospitals accredited and registered by this association are
covered in the study. Excluded from consideration were
long-term institutions, hospitals treating specific medical
conditions of a chronic nature only (i.e., psychiatric,
tuberculosis, orthopedic, etc.), and federal institutions.
Proprietary hospitals (profit-corporate) were further
excluded as they lack property tax exemption, a variable
considered be discussed to measure health commitment.
While each of the excluded categories might have had
15
TABLE 1
CUMULATIVE FREQUENCY DISTRIBUTION OF 125 CITIES
BY NUMBER OF HOSPITALS PER CITY
Number of Cumulative
Hospitals Frequency Percent
per City of Cities
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
i
i
t
35
i
i
i
59
i
t
i
75
17
44
64
78
85
93
97
100
106
110
112
113
115
116
118
119
120
121
122
i
i
123
>L
i
I
125
13.6
35.2
52.0
64.0
69.6
74.4
77.6
80.0
84.8
88.0
89.6
90.4
92.0
92.8
94.4
95.2
96.0
96.8
97.6
t
i
98'.4
i
i
99'.2
i
i
100'.0
volunteers, methods of funding these institutions and vary
ing policies concerning the utilization of personnel--both
salaried and volunteer— in these hospitals could radically
affect the type of volunteer support present. For example,
federal hospitals are not funded locally and therefore do
not directly reflect the local priority given to health
care. Long-term hospitals tend to have a higher number of
allied health personnel than do the health facilities
chosen for this study, and they employ fewer registered
nurses, who are considered particularly essential in the
acute hospital setting. These two factors could greatly
distort the health commitment measures discussed below;
accordingly, long-term, proprietary, and federal hospitals
were excluded.
Sampling Hospitals within Cities. In addition to
sampling among cities. it proved necessary to sample among
hospitals within certain of the cities. The cumulative
distribution of numbers of general hospitals in the cities
displayed in Table 1 shows that 78 cities had hospitals
ranging from two to five in number. The remaining 47
cities (40 percent) varied in the total number of general
hospitals, which ranged from 6 to 75. Only five of the
hospitals within each such city were selected by random
means for use in this investigation (also see T. Turk,
1970:25-26). Selecting only five hospitals from these
17
cities was dictated (a) by serious data management problems
resulting from the physical limitations of computer stor
age, and (b) by the fact that limiting the research
population size in considering only cities with a maximum
number of five hospitals would have reduced the number of
cities by 40 percent."* The decision to select five
hospitals at random wherever necessary retained the
largest cities and also avoided the introduction of
systematic error which would have been created by using
all of the hospital data. City size being correlated with
number of hospitals (r = .84), the error in the dependent
variable, degree of association, would have been system
atically (negatively) associated with city size (i.e.,
correlations based on many hospitals are more reliable than
those based on few), thereby increasing the likelihood of
spurious interpretation of results.
Data Source. Data on the number of in-service
volunteers in each hospital studied was obtained from a
survey conducted by the American Hospital Association in
1967. Of 8,000 hospitals, over one-half responded to a
survey questionnaire covering activities involving volun
teers. This information was made available to the present
investigator on computer-readable magnetic tape. From
this, the pertinent volunteer information was extracted and
merged with the Urban Data File to form a composite tape
18
which held data for the cities of interest to this study.
This composite data were then subjected to statistical
analysis. The data from the file were first used to obtain
a product-moment correlation within each of the 81 cities
between manpower shortage in its hospitals and the amount
of volunteer support that each hospital received. A second
set of product-moment correlations--one in which each of
the 81 study cities (no longer the individual hospitals
within each one)--was then obtained between manpower short
age support correlations and various commitment, struc
tural, and demographic variables. After the variables
under investigation (to be described in the next chapter)
were considered singly, they were considered simultaneously
in a multiple regression analysis.
CHAPTER III
RESULTS
Hospital Manpower Shortage and Volunteer Support:
The Shortage Support Measure. First, a measure of manpower
shortage was computed for each hospital as a patient to
employee ratio. This patient-employee index is the ratio
of the mean occupancy rate (the average percentage of beds
occupied at a given time) of the hospital to the average
number of full-time equivalent employees for each bed:
P ' E = ii
where P/E is the index of health manpower shortage,
MOR is the percentage of time patients occupy a
bed, and EPB is the number of employees for that
bed.
This index was employed for the simple reason that
when a hospital offers a bed for use it obviously must be
serviced with personnel. However, since some beds can be
closed for periods of time and personnel shifted to other
areas of service, a hospital's number of beds considered
alone offers only a crude measure of manpower shortage.
By using a ratio between patients to be served and
employees to serve, a better measure of shortage is
19
20
obtained than if a bed-employee ratio was utilized. The
greater the magnitude of this patient-employee ratio, the
smaller is the number of employees who serve a given number
of patients. Correlatively, the smaller the magnitude of
this ratio, the larger is the number of employees who serve
a given number of patients. A small ratio would imply a
prestigious hospital since cost per patient day, used by
T. Turk (1970) and Walker (1971) as a measure of prestige,
is inversely associated with patients per employee (P/E),
used here as a measure of need. T. Turk states:
The average relationship (gamma) between cost per
patient day and the number of employees per
patient (E/P) was 1.00 in terms of the mode and
.66 according to the median for all 126 cities.
(1970:27)
In other words, cost per patient per day has a positive
association with the E/P index; hence, a negative associa
tion with the inverted index (P/E) used in this study.
Following the computation of the P/E index, the
number of in-service volunteers serving per hospital bed
in 1967 was also assessed. Only adult females were
counted. The product-moment correlation between employee
shortage and the volunteer measure was then computed for
each city, providing the main dependent variable of the
extent to which volunteering was based on employee short
age. Table 2 shows the distribution of this variable among
those 81 cities having four or more short-term hospitals.
21
TABLE 2
PRODUCT-MOMENT CORRELATION BETWEEN PATIENT-EMPLOYEE RATIO
AND NUMBER OF IN-SERVICE VOLUNTEERS PER BED
Cities with 4-5 Hospitals and
Product-Moment Cities from Which 5 Hospitals
Correlation Were Sampled
(r) ____________(N=81)____________
_________________________Percent______Number_____
.60 -- 1.0 5 4
.20 — .59 9 7
.19 — -.19 16 13
-.20 -- .59 44 36
-.60 — 1.0 26 21
Total 100 81
22
Table 2 reveals that the correlations range from
+1.0 to -1.0, with 16 percent of the cases showing no or
very low correlation in the shortage-support measure.
Also of note is the larger proportion of cases having
negative correlation coefficients. While 84 percent of
the cities having a correlation between the patient-
employee index and the number of volunteers per bed, over
four times as many cities have negative coefficients as
have positive ones. This result was not unexpected. It
had been asserted that cities having a positive association
between employee shortage and volunteer support would
reflect need-based allocation. Conversely, cities having
a negative coefficient would suggest allocation by a
prestige-based criterion. Assuming such to be the case,
one may note from this table that while in 11 cities
volunteers seem to have distributed themselves among
hospitals on the basis of need for such support, a prestige
criterion seems to have applied in 57 others.
The alternative theoretical arguments asserted that
either need-based or prestige-based volunteer support is
positively associated with the degree of a community's
emphasis on health. One would anticipate volunteer distri
bution on the basis of neither criterion when such an
emphasis is low. To explore these speculations, the study
cities were subjected to cross-tabulation between three
measures of a community's emphasis on health, on the one
23
hand, and the correlational measure of need-based alloca
tion, on the other.
Measures of the Community’s Health Emphasis. Three
measures (suggested by H. Turk, 1970b:6) were used to
determine the degree to which each city emphasized the
provision of health care. Whatever its reasons--economic,
ideological, or historically accidental--the degree of such
emphasis is likely to affect the degree of salience that
the health arena has for the city's inhabitants.
The first measure was per capita number of medical
and other health workers in the city. A city with a high
per capita number of health-related persons in the labor
force was assumed to possess an extensive health delivery
system. The second one was per capita amount of municipal
money expended on hospitals and other health facilities.
The third measure of the degree of a community's emphasis
upon health care was the per capita number of hospital
beds--considering all types of hospitals.
The three measures of health emphasis were split at
the median. Their cross tabulations with the shortage-
support measure are shown as Table 3. Of the three
measures, only the first, per capita number of medical and
other health workers, shows any appreciable association.
Of the total number of cities, 20 percent of those ranked
high on this emphasis measure also had a positive
TABLE 3
ASSOCIATION BETWEEN HEALTH EMPHASIS MEASURES* AND SHORTAGE-SUPPORT MEASURES**
*Per Capita *Per Capita
Number of Expenditures
Medical for Hospital *Per Capita
**Product-Moment Correlation (r) and Other and Health Number of
Between Patient-Employee Ratio Health Workers Facilities Beds
and Number of Volunteers -------------- -------------- --------------
per Bed High Low High Low High Low
w Of Of Of Of Of
/o /o /o /o 1 0 _ /q
.60 — 1.0 10.0 0 7.5 5.0 5.0 5.0
.20 — .59 10.0 7.5 7.5 8.0 5.0 12.5
.19--- .19 12.0 12.5 12.0 15.0 17.0 7.5
-.20 — .59 36.0 52.5 44.0 42.0 39.0 47.5
-.60 -- 1.0 32.0 27.5 29.0 30.0 34.0 27.5
Total 100.0 100.0 100.0 100.0 100.0 100.0
(Number of Cities: 81) (41) (40) (41) (40) (41) (40)
N>
25
coefficient on the shortage-support measure, while only 7.5
percent of those having low emphasis had a positive coeffi
cient . Of the other cities, 68 percent also yielded
negative coefficients, while 80 percent of those ranked low
had negative coefficients. The percentages of cities with
little or no correlation were the same for both classifica
tions .
One anticipated possibility was those cities with a
high per capita number of health-related workers would tend
more than others to display positive shortage-support
coefficients. This, in fact, did occur. The greater
number of cities with negative coefficients distributed
under the low emphasis classification had not been antici
pated, however, but such a distribution did occur. No
reasonable explanation suggests itself.
Shortage-support, when cross-tabulated with the
second measure of health emphasis, per capita municipal
expenditures for hospital and health facilities, shows
virtually the same distribution of coefficients under
conditions of relatively high expenditures at that under
conditions of low expenditures. This suggests that this
measure is not a factor in the way volunteers distribute
themselves among hospitals, at least not when the possible
intrusion of other variables has not been controlled.
The third measure, per capita number of hospital
beds, yielded yet a third distribution pattern, a slight
reversal of that expected. While the ratio of positive to
negative coefficients is about the same for the two
categories of this emphasis measure, there are fewer zero
coefficients in the low classification, and more of them
are in the negative range. This suggests that need and
prestige were more operative under conditions of low
community emphasis on health care than under high community
emphasis. However, caution must be exerted on any conclu
sion of this segment of Table 3, since the small number of
cases could make this relationship spurious without further
analysis to be exacted from subsequent statistical tech
niques discussed below.
Multiple Regression Analysis. It has been argued
above that certain structural characteristics of the urban
communities would affect the degree to which support is
based on either need or prestige. Multiple regression
analysis was used to assess the affects of those structural
characteristics discussed earlier, together with those of
the three measures of health emphasis. This technique
makes it possible to assess the effects of each variable
independently of the effects of all the other variables.
The results of this analysis appear in Table 4. Both zero-
order correlation coefficients (r) and standardized partial
regression coefficients (beta- ) are reported in order to
2
allow comparison. The variance accounted for (R ) is also
27
TABLE 4
ASSOCIATION OF THE SHORTAGE-SUPPORT MEASURE (1967) WITH
HEALTH EMPHASIS MEASURES AND WITH STRUCTURAL
CHARACTERISTICS OF THE COMMUNITY (1960,
EXCEPT AS NOTED) IN 81 CENTRAL CITIES
HAVING FOUR OR MORE HOSPITALS
a I d
Predictors Overall Independent
Measures of Health Emphasis:
Per Capita Number of Medical and
Other Health Workers .12 .22
Per Capita Expenditures for
Hospitals and Other Health
Facilities .04 -.01
Per Capita Number of Hospital Beds .09 .20c
Structural Characteristics of the
Community Affecting Viability:
Reform Government .17 .03
Export Diversity -.03 -.06
National Voluntary Headquarters -.29 -.10
Hospital Associations (1969) -.27 -.20°
Community-wide Associations .13 .12
Structural Characteristics of the
Community Affecting Fragmentation:
Foreign Stock .06 .28°
Non-Whites .10 .35c
aZero-order product-moment correlation coefficients (r)
^Standardized partial regression coefficients (beta).
cOne-tailed level of significance = .10 or above.
TABLE 4--Continued
28
p K
Predictors Overall Independent
Structural Characteristics of the
Community Affecting Utilization:
Families with Less Than
$3,000 Income .13 .24
Families with More Than
$10,000 Income .03 .19
Other Characteristics of the Commu-
nith Used for Purposes of Control:
Net Population Increase
(1950-1960) .00 .16
Percent Democratic Vote -.05 .07
City Size -.27 -.16
Children's Hospitals in the
Sample (1967) -.15 -.25°
Variance accounted for: 27%
29
included for the equation.
Of the three health emphasis measures incorporated
into the regression equation, only two--per capita number
of medical and other health workers and per capita number
of hospital beds--proved to be significantly and independ
ently associated with the dependent variable. The
directions of association between dependent variable and
per capita number of health workers is consistent with that
found in the cross-tabulation reported earlier (Table 3)
before controlling the effects of other variables. Little
association was visible, either in cross-tabulation or its
alternative, the zero-order correlation coefficient; thus
one can conclude from Table 4 that other variables were
obscuring the association between the two emphasis measures
and that of shortage- (need-) based support. That the
municipal hospital expenditure failed to yield significant
association gives rise to the post hoc observation that
such support of hospitals varies by region and does not
preclude county or private expenditure.
The first structural characteristic of the commu
nity considered is the type of city government. The reform
government index used by Clark (1968a), H. Turk (1970a),
T. Turk (1970), and Walker (1971) was constructed by
scoring the cities on a 0-3 scale, depending upon how many
of the features of this governmental form the individual
cities had adopted (i.e., [a] presence of city manager,
30
[b] "at-large," and [c] nonpartisan election of council-
men). It will be remembered that It was assumed that the
greater this measure of depoliticization, the larger the
number of features there were assumed to be that would
enhance the community's viability, its capacity for
organization, including systematic resource allocation,
regardless of whether such allocation were along a need or
along a prestige continuum. This predictor played no
independently significant part in the equation.
Another characteristic of cities is the manner in
which they are "tied" to the larger society (Warren, 1956;
H. Turk, 1970a). An index devised by H. Turk, "export
diversity," reflects the variety of a city's economic
establishments having "an export emphasis--i.e., serving
nonresident persons and nonlocal organizations" (H. Turk,
1970a:5). A vertical linkage with other cities could
diminish the city's ability to handle and control its
internal affairs. A negative association between this
measure of external control and the dependent variable
would suggest its adverse effect upon the ability of the
community to meet problems of need. Since social partici
pation within an institutional sector is of paramount
concern here, a second measure of "extra-local" orientation
was also selected for the regression equation: the number
of national voluntary association headquarters (H. Turk,
1970a), used by H. Turk as a measure of extra-local
31
integration. He states:
. . . such an association often reflected what is
nationally held in common along certain specialized
lines, and the presence of its headquarters within
a given city should also signify the institutional
integration of that city into the broader socio
cultural setting. (1970a:5)
One would then anticipate the greater the number of these
headquarters that located in a city, the more likely is it
that any institutional sectors within the city could have
been fragmented by such extra-local linkages--i.e., the
less likely might that city have been to possess the
necessary capacity for organized action for the allocation
of either need-based or prestige-based support.
The entry of these two indicators failed to influ
ence the equation although both measures were in the
direction predicted. Neither measure was independently
associated with the dependent variable, although the number
of national voluntary headquarters was negatively corre
lated (r = -.29), as anticipated, with the shortage-support
measure when other factors were held constant.
The occurrence of hospital associations was deemed
an appropriate measure of institutional linkage (cf. H.
Turk, 1970b) and of the presence of a vehicle for taking
care of hospital needs as well. This measure, reflecting
the degree of coordination among hospitals, is a dichoto-
mous one showing the presence or absence in 1969 of a local
association to which at least some of the hospitals
32
belonged (H. Turk, 1971). While the presence of a hospital
association in a city is independently associated with the
dependent variable, the association is negative, not
positive as anticipated (r = .20 at the .10 significance
level). This finding suggests that the absence of hospital
associations volunteers distribute themselves according to
specific hospital employee needs. An ad hoc interpretation
of this negative association would rest upon the assumption
that hospital associations assist their organizational
membership to meet their individual needs, one such need
being a more equitable distribution of employees among the
membership. Therefore, the absence of hospital associa
tions would indicate a lack of "leveling out" of needs--a
differential distribution, with some hospitals experiencing
a greater shortage than others. This interpretation is
suggested by the findings of Belknap and Steinle (1963)
that a community with a well-organized health delivery
system had minimal voluntary agency activity, while the
community lacking such coordination was the one in which
voluntary agency activity proved instrumental in attempting
to provide the delivery system with an adequate labor
force.
The presence of community-wide associations was
also considered a measure of community viability— or as the
absence of institutional cleavage (for example, see
H. Turk, 1970a). However, the measure was not independently
33
and significantly associated with the dependent variable.
Two further indicators of fragmentation were
entered into the equation. These indices were suggested
by Banfield and Wilson (1963:38): the proportion of the
population of foreign stock and the proportion of non
whites. Ethnic and racial differentiation was employed
because of the differential treatment such segments of a
community receive from the remainder of the community.
Such differentiation facilitates the development of a
parallel- institutions which in turn "perpetuate norms
posited upon a difference in kind between the ethnic (and
racial) enclave and the remainder of the city" (Greer,
1962b:129). The proportion of the population having
foreign-born parents was independently associated with the
dependent variable, and significantly so. However, the
direction of association is positive, rather than negative
as anticipated. This means that those cities whose popula
tion includes a sizeable proportion of foreign stock also
distribute their volunteers relative to employee shortage.
The second such indicator of fragmentation--proportion of
non-whites in the population--also was independently and
significantly associated with the shortage-support measure,
but also in a direction not anticipated.
These results run counter to the argument that
fragmentation would lower the ability of the community to
take concerted action in the form of volunteer support
relative to employee shortage. Yet both socioeconomic
status and central city residence might make minorities
prone to over-utilize public health facilities, and thereby
create disproportionate employee shortages within these
facilities relative to others in cities that have large
minority populations. The acute needs of public hospitals
in those minority cities is less likely to be ignored by
volunteers than less dramatic needs in other cities. Also,
minority populations may tend to make relatively great
demands in terms of high birth rates, and possibly many old
persons. The Europeans among them may utilize public
g
facilities by tradition. One might also speculate more
concentration of minorities in specific geographical
regions (i.e., non-whites concentrated in the south whose
cities may have been highly integrated through racism or
the concentration of foreign minorities in the established
cities of the northeast). The importance of region was
accordingly tested in the subsequent regression equation
to be discussed below.
Two indicators of economic stratification were
introduced to determine utilization of health facilities.
One was positively associated with the dependent variable,
and significantly so. The proportion of families with less
than $3,000 annual income, as one of these measures, was
correlated with the shortage-support measure independent of
the other factors in the equation. It had been suggested
35
that the presence of low income families would indicate a
disproportionate use of tax-supported hospitals and out
patient clinics (Anderson, 1966; Weinerman, 1966; Andersen
and Anderson, 1967; Duff and Hollingshead, 1968), with an
effect on the distribution of volunteers like the one just
discussed in the case of minorities.
On the other hand, the proportion of families with
annual incomes of $10,000 or more was not significantly
associated with the dependent variable. It had been
posited that high income families seek the services of
medical specialists more than others, and therefore antici
pated that their number in the community would connote the
extent of vested interest in preserving an effective health
care system, through meeting need by volunteerism or other
devices.
Net population increase was used in the regression
equation as a measure of community instability. However,
this variable was not significantly associated with the
dependent variable, suggesting that turbulence from
population migration, annexation, or a high dependency
ratio does not appreciably affect the distribution of
hospital volunteers.
The last two measures of the structural character
istics of the community, percentage of the two-party
Presidential vote that was Democratic (1960) and city size,
did not contribute independently to the variation found in
36
the shortage-support measure. Since these two variables
are of a global nature, their inclusion and failure to
affect the other results adds confidence to our findings.
The final predictor was employed as a means of
controlling for the presence of acute general hospitals for
children in the city's hospitals.^ This measure was
negatively associated with the dependent variable, and
significantly so. It had been thought that children
attract more volunteers than do adults, irrespective of
need. All volunteers in this study are women; it could
well be that they have been made to be especially drawn to
children, regardless of whatever need might exist in other
parts of the community health care system. However, this
interpretation can only be speculated upon. Another
interpretation is that children's hospitals reflect a type
of specialized medical services used by high income
families. However, these two measures lack zero-order
correlation (r = .06); this reduces the acceptability of
this interpretation. A third line of reasoning is that
children's hospitals are more likely than others to be
teaching hospitals and that this type of hospital is held
in high esteem by professionals and public alike (T. Turk,
1970:27)^ Support for this interpretation might be gained
from the fact that teaching hospitals (in this case,
pediatrics) requires a full range of medical diagnostic and
prognostic cases. While one segment of the community might
37
provide such medical diversity (e.g., higher income
families), it is more reasonable to assume that such
diversity would be found throughout the community but
acceptance of all could lead to overcrowding. Evidence to
support this statement is found in the positive zero-order
correlation between children's hospitals in the city
sample, and proportion of non-whites in the population, and
the percentage of families having an annual income of under
$3,000 (r = .30 and .24 respectively).
The significant two of the fragmentation measures
had raised the question of geographical regions. A second
regression analysis was constructed entering regions into
the original equation one at a time. Only one region
produced changes in the original findings--Northeast.
These will be discussed subsequently.
A further methodological step taken was to ascer
tain whether there might be characteristics of the deviant
cases that could provide further insight and direction.
Duncan et al. state that "what cities are like depends at
least in part on what cities do (their functions) and that
the functions of cities are in some measure a reflection of
inner-community relationships" (Duncan et al., 1960:46).
Twenty of the most deviant cases (ones that varied
greatly from the regression line) were extracted from the
original regression equation (Table 4) and appear on
Table 5. The ten highest positive cases reflect
TABLE 5 38
EXTREME RESIDUALS FROM REGRESSION ANALYSIS (TABLE 4)
Functional Classification
Residuals Cities (Duncan £t al., 1960)
2.26 Montgomery
1.52 Providence Manufacturing Center:
manufac turing
specialized
1.46 Knoxville Special Case (agriculture-
educational center)
1.16 Sacramento
1.10 Scranton
1.01 Pittsburgh Metropolitan Center:
manufac turing
diversified
.89 Dallas Metropolitan Center:
metropolis
regional
.89 Tampa Special Case (agriculture-tourist
center)
.82 Cincinnati Metropolitan Center:
manufacturing
diversified
.80 Cleveland Metropolitan Center:
manufacturing
diversified
-.59 Spokane
-.62 Worchester
-.74 Tacoma
-.80 Madison
-.80 Rochester Manufacturing Center:
manuf ac turing
specialized
00
00
•
1
Denver Metropolitan Center:
manufacturing
diversified
-.91 Los Angeles
1.08 Jackson
1.41 Syracuse Manufacturing Center:
manuf ac turing
diversified
-1.50 Little Rock
39
under-estimation of the dependent variables. In other
words, factors other than those considered also had a
positive effect upon the dependent variable. The ten
highest negative cases indicate that other factors had a
negative effect, that the dependent variable was over
estimated. These cities were compared for their functional
specialization as explicated by Duncan et al. (1960).
Manufacturing specialization was about as frequent
in the over-estimated as in the under-estimated cities, but
possibly more frequent than in the ones more accurately
estimated. Seven of the cities are state capitals,
suggesting service oriented cities. Of the nine cities not
treated for analysis by Duncan et al., more were found in
the over-estimated cases, and of these three are known as
educational or military centers (Tacoma, Madison, and Los
Angeles). Therefore, three measures were selected to test
whether functional specialization of cities would affect
the way volunteers distribute themselves relative to need,
or prestige. Per capita value added by manufacturing, per
capita number of professional and technical workers in the
labor force, and percentage of the population living in
group quarters were added to the foregoing regression model
together with the dichotomous attribute of northeastern
location. The results of this final analysis appear on
Table 6.
40
TABLE 6
ASSOCIATION OF THE SHORTAGE-SUPPORT MEASURE (1967) WITH
HEALTH EMPHASIS MEASURES AND WITH STRUCTURAL CHARACTER
ISTICS OF THE COMMUNITY (1960, EXCEPT AS NOTED) AND
NORTHEAST REGION IN 81 CENTRAL CITIES HAVING FOUR
OR MORE HOSPITALS--CONSIDERING ALSO REGION, VALUE
ADDED BY MANUFACTURING, NUMBER OF PROFESSIONAL
WORKERS, AND NUMBER IN GROUP QUARTERS
d I d
Predictors Overall Independent
Measures of Health Emphasis:
Per Capita Number of Medical
and Other Health Workers .12 .20
Per Capita Expenditures for
Hospitals and Other Health
Facilities .04 -.05
Per Capita of Hospital Beds .09 .22
Structural Characteristics of the
Community Affecting Viability:
Reform Government .17 .06
Export Diversity -.03 -.01
National Voluntary Headquarters -.29 -.14
Hospital Associations -.27 -.18°
Community-wide Associations .13 .12
Structural Characteristics of the
Community Affecting Fragmentation:
Foreign Stock .06 .21
Non-Whites .10 .42°
aZero-order product-moment correlation coefficients (r).
^Standardized partial regression coefficients (beta).
cOne-tailed level of significance = .10 or above.
TABLE 6--Continued
41
Predictors Overall Independent
Structural Characteristics of the
Community Affecting Utilization:
Families with Less Than
$3,000 Income .13 .25
Families with More Than
$10,000 Income -.03 .17
Other Characteristics of the Commu
nity Used for Purposes of Control:
Net Population Increase .00 .38c
Percent Democratic Vote .05 .09
City Size -.27 -.14
Children's Hospitals -.15 -.23c
Northeastern Location .15 .25c
Per Capita Value Added
Manufacturing (1958) .03 .25
Per Capita Number of Profes
sional and Technical Workers .07 .11
Percentage of Population Living
in Group Quarters .02 -.07
Variance accounted for: 34%
42
Of the seven measures found significant in the
original regression equation, four remained so in the
present equation--per capita number of health workers,
hospital associations, proportion of non-whites, and
children's hospitals in the sample. Three measures dropped
just below the .10 level of significance--per capita number
of beds, proportion of foreign stock, and families with
less than $3,000 annual income. The large number of vari
ables in this equation (20) makes it likely that the
reductions in correlation are more the result of statis
tical artifacts than they are of substantive concern. For
this reason all seven measures may be deemed to have
significantly independent effect upon the dependent
variable.
Three other measures are also significantly associ
ated with the shortage-support coefficient--net population
increase, northeastern location, and per capita value added
by manufacturing.
Net population increase, while not significantly
associated in the original equation, became so in this one,
but not in the direction predicted. It had initially been
suggested that this measure reflected community turbulence.
It was anticipated that this measure would be inversely
associated with the shortage-support coefficient, but this
did not occur. A positive association was found between
these two measures. Two interpretations may be offered
for this finding.
First, this positive association may be an arti-
factual increase that is a function of the statistical
technique used in this research. The fact that the
coefficient reported in this study is beta, the direction
of association found may be due to its characteristics
rather than due to a natural increase in population.
Linear analysis from net decrease to no change in popula
tion could be treated statistically as positive associa
tion, and thus this finding could constitute a sign of
stability--that of no change. However, whatever decreases
there were, were very small. The maximum increase among
the 130 cities was more than three and one-half times as
high in absolute value as the maximum decrease. Also,
there is some question whether population decrease denotes
instability in the same sense as jurisdictional ambiguities
likely to be caused by annexation and the organizational
overload likely to be caused by rapid population growth.
Indeed, the latter may have the effect of oversubscribed
facilities alluded to in our discussion of minorities.
A second interpretation would treat the correlation
as reflecting an actual increase of population, due to
migration into the central city and/or annexation of
unincorporated areas to it. One can assert that central
cities are ports of in-migration. Also, there is a birth
rate disparity between the inner city and its surrounding
suburbs. However, this measure was inversely related to
proportion of non-whites in the population (r = -.13), a
racial category more identified than others with these
social characteristics. Further, this measure is nega
tively associated with northeastern location (r = -.57), an
area that experiences high non-white migration, and with
per capita value added by manufacturing (r ■ -.67), a
measure of an industrial sector where non-whites might be
more prominently located. On the other hand, the measure
is positively associated with the western and southwestern
regions (r = .23 and .32 respectively), geographical areas
where annexation of unincorporated areas was most active
during the decade covered in this measure (1950). In
either case this umbrella measure does raise questions
concerning the feasibility of interpreting its effects.
What can be stated in regard to the positive association
between this measure and the dependent variable is that
this variable cannot be treated as a measure of non
viability in the same sense as were the fragmentation
measures (if natural increase is assumed), since this
measure is inversely related with the foreign stock measure
(r = -.42) and, it will be recalled, with the non-white
measure.
Northeastern location was positively associated
with the shortage-support variable. This index, however,
is another umbrella measure. One can view the positive
45
association in terms of the characteristics of cities
located in this region. The Northeast has a tradition of
charity hospitals, and the forces aroused by this tradition
may encourage need-based volunteering;
Per capita value added by manufacturing is also
positively associated with the dependent variable. This
measure logically implies the large number of blue collar
workers. While the number of blue collar workers is
negatively associated with the poverty rate (the product
moment correlation) with the less than $3,000 income
measure is -.22, blue collar workers might stem from a
tradition of low cost health care, and therefore over
subscribe to such facilities as clinics and public
hospitals with the same results as in cases of large
minorities and poverty rates. Thus, overutilization of
public hospitals would occur and, it has been argued
before, volunteers would be more likely than elsewhere to
be distributed relative to employee shortages.
CHAPTER IV
SUMMARY AND CONCLUSIONS
In summary, then, the data from this exploratory
investigation suggest that the degree to which volunteer
participation is correlated with relative personnel
shortage in a city's hospitals depends upon the emphasis
that an urban community places on its health care delivery
system. Further, certain structural measures presumed to
indicate a given urban community's ability to mobilize for
organized action in general or to indicate pressures placed
upon its health care delivery system in particular appear
to affect the degree of such need-based volunteer support;
but often not in the expected direction and not always it
seems for the reasons given initially.
Specifically, the findings indicate that a commu
nity's emphasis on health accounts for part of the variance
found in the association between a hospital's employee
shortage and its share of volunteers. It had been argued
that certain structural characteristics would determine the
extent to which the city is capable of organization for any
purpose in any institutional sector. This, in fact,
occurred selectively. Moreover, variance was accounted for
46
47
in part by degrees of ethnic and racial differentiation,
although their positive association with the measure of
need-based allocation ran counter to the argument that
such fragmentation would lower the ability of the community
to take concerted action in the form of volunteer support
relative to hospital employee shortage. The presence of
low income families in the city's population and net
increase of population also contributed to variance in the
dependent variable, as did the implied presence of a blue-
collar labor force--as measured by per capita value added
by manufacturing.
Various other structural measures used in other
urban studies as indicators of viability proved to have
little bearing on the relationship between labor resource
shortage and supplemental voluntary manpower in the health
sector of cities: reform government, export diversity,
national voluntary association headquarters, and community-
wide associations.
The three final measures accounted for the remain
der of the variance in the need-based volunteering. First,
the absence of hospital associations in cities was a direct
correlate of volunteer participation relative to need
suggested that voluntary action is oriented to need when a
coordinating agency is absent. Second, and more indirectly,
the presence of children's hospitals indicate the character
of teaching hospitals within the health sector: they
48
service the indigent and low income segment of the commu
nity and yet enjoy a high level of prestige and may draw
volunteers based on that prestige. Third, northeastern
geographical location--a feature of health sectors by
implication, where the concept of "charity" hospital has
been traditional (T. Turk, 1970:9)--yielded positive
association with the dependent variable.
Urban characteristics found to be meaningful were
such socioeconomic variables which suggest overutilization
of the tax-supported segments of a city's health care
delivery system (e.g., public hospitals and clinics), as
ethnic and racial differentiation, poverty rates, and the
size of the blue-collar labor force. Low cost health
services are more likely to be offered by inner-city health
facilities where such a population composition resides than
by health facilities serving more affluent suburbs. Public
hospitals in such "minority" cities may also be less likely
to be ignored by volunteers than do facilities with less
dramatic needs in other cities. Historically, volunteer
participation has been shown to be stronger where there
were visible needs not being met by traditional community
services (Bowen, 1926; Sieder, 1966; Coe, 1970:336-337).
The effect of absence of hospital associations lends
support to this interpretation. The aims of these sorts of
interorganizational associations may vary with respect to
specific short-run objectives but one frequent purpose they
49
have is to assess the health needs of a given community and
design procedures whereby various health facilities can
efficiently and effectively meet these needs (Guzzardi,
1966:535-539). Federal grants encourage such emphasis.
A reassessment of Belknap and Steinle's findings
(1963) support this evaluation. When the health care
delivery system they examined was well integrated, volun
tary agency participation was negligible; when the health
system lacked such integrative features, agency participa
tion predominated. One may suggest, therefore, that formal
coordination is a substitute for systematic "informal"
processes. Or, as Coe states conversely, voluntary
agencies are
an expression of the traditional value that private
citizens (and corporations) must seek out and
assume some public responsibility. This has been
particularly the case when official agencies, both
governmental and private, have failed to discharge
their duties to the public. (1970:337)
Implied by the findings is the idea that volunteers
distribute themselves according to a prestige criterion
rather than one of need in most of the cities studied. The
key to this assertion is the inverse relationship between
the prestige-based allocation (measured by cost per patient
day) used by T. Turk (1970) and Walker (1971) and need-
based allocation (measured by employee shortage relative to
patients) employed in this research. While in some of the
cities (11 of the 81) volunteers seemed to distribute
50
themselves in the light of employee shortages, in a larger
number (57) distribution seemed to run contrary to need,
especially where the city had a relatively low per capita
rate of health manpower. But the latter apparent reversal
disappeared under the control of other variables in the
regression analysis.
This alternative support pattern had been alluded
to by both T. Turk and Walker. They found that allocation
patterns did vary from city to city. T. Turk concluded
that "where no clear prestige hierarchy emerges need may
motivate hospital funding" (1970:97). Walker, in replicat
ing and expanding upon Turk's study--using a different form
of support (volunteers) but in the same way--found some
evidence, albeit elusive, of an alternative basis for
support allocation where community emphasis on health was
high (Walker, 1971:32). Moreover, Walker found that
characteristics of a stratified urban community--measured
negatively by orientation to extralocal factors and rates
of population increase, and positively by the presence of
private enterprise--accounted for an appreciable portion of
the variance found in the association between urban
hospital prestige and share of volunteers (a finding
similar to T. Turk's).
The suggestive role of the community's emphasis
upon an institutional sector upon the patterning of
resource support led to the present study of hospitals and
their community environment. It became apparent that these
as well as other earlier studies which used variables of
prestige, order, and support could suggest points of
departure for the present study. This had been indicated
in two comparative investigations of hospital prestige
(Elling and Halebsky, 1961, as well as the aforementioned
study by Walker, 1971). Further, the various studies
cited in Chapter I which agreed that communities having
certain structural characteristics exceeded others in the
development of an effective health care delivery system--
especially those of Belknap and Steinle (1963) and Presthus
(1964)--suggested heuristic constructs for the present
research.
The above argument, and its supportive evidence,
indicates that need and prestige are inversely related
using the indices employed here. On the other hand,
structural characteristics of urban communities used to
delineate a prestige hierarchy (T. Turk, 1970, and Walker,
1971) were not inversely associated with the need-based
measures used, save one--net population increase.
Finally, it had been argued that the crisis in the
health services field was of concern to urban communities
and that those cities which emphasized health care would
respond more than others allocating resources to relieve
such a crisis. In fact, this occurred in terms of two of
the three emphasis measures.
52
To conclude, then, this exploratory study of
support allocation among organizations has attempted to
examine what appeared to be need-based allocation of
volunteer service and, by implication, its obverse of
prestige-based allocation. It further sought to identify
various community variables associated with such allocative
patterns. The degree to which a community emphasizes its
health care sector was shown, by and large, to affect the
pattern of voluntary participation within that sector,
though the manner in which resources are allocated to
organizations within it varies with variations in community
structure. In urban communities where a particular segment
of the sector (e.g., hospitals and clinics) appears to be
oversubscribed and where organizational means of coordinat
ing the allocation of resources among organizations were
absent, voluntary participation seemed to be allocated by
need. But the fact that voluntary manpower support was
found to be associated with the converse of need in the
majority of the cities studied, regardless of the degree to
which they emphasized health care, one must entertain the
possibility that prestige-based allocation operates more
frequently than does need-based allocation.
Finally, the statistical tools available could not
fully distinguish between need-based allocation and the
absence of prestige-based allocation, nor could they fully
distinguish between the opposites of these respective
53
conditions. The provision of such distinctions constitutes
a basis for further research.
A major aspect of this exploratory study was not
fully resolved. It had been argued that two forms of
resource support--funds and voluntary manpower--were
subject to similar allocative patterns when resources were
scarce, one based upon prestige. The question now arises
where funding might also be allocated in accordance with
need when resources are plentiful, such as in the case of
volunteers. In other words, one form of resources seems
capable of allocation in two distinctly different ways,
depending upon certain conditions. The question then
becomes, would another resource form assume the same two
patterns under the same respective conditions? The
question suggests a direction for future research.
54
NOTES
^■Resources may be broadly defined as "more or less
generalized means of facilities that are potentially
usable--directly or indirectly--in relationship between the
organization and its environment" (Yuchman and Seashore,
1967:900).
^Voluntary activity has been a traditional aspect
of hospitals, but most of their activity has been outside
the hospital (e.g., fund raising and public relations).
It was not until World War II, when a shortage of nursing
personnel in civilian hospitals became acute, that hospital
and medical leadership used lay persons as a supplemental,
albeit unpaid, labor force.
In San Francisco during 1966 the present author
was involved in a state-wide policy decision as to whether
this use of volunteers was or was not appropriate.
^The American Hospital Association defines "short
term" hospitals as those where more than 50 percent of the
patients admitted for care remain less than 30 days.
Long-term hospitals" are those institutions where most
patients stay longer than 30 days.
^The hospitals used in this study had previously
been entered on the composite Data File by T. Turk (1970),
which she used for her research on hospital prestige and
allocation of Hill-Burton funds.
^Anderson compared the health care delivery systems
in the United States and in other countries. He notes that
at the end of the nineteenth century European hospitals
were totally tax supported, in Great Britain they were both
tax supported and privately supported, and in the United
States health services establishments were privately
supported with tax-supported hospitals for the indigent
(Anderson, 1966:213-215).
^The hospitals, as noted in footnote 5, in the
sample constitute a variable which did not bias T. Turk's
study but could have biased this research if not con
trolled. Of the 81 cities, 17 had hospitals for children
in their sample.
B I B L I O G R A P H Y
55
BIBLIOGRAPHY
Aiken, Michael, and Robert R. Alford
1970 "Community structure and innovation: the case
of urban renewal." American Sociological Review
35 (August):650-664.
Alford, Robert R., and Harry Scoble
1965 "Political and socio-economic characteristics of
American cities." Pp. 82-97 in Municipal Year
book 1965. Chicago: International City
Managers Association.
American Hospital Association
1963 Hospital Auxiliaries and Volunteers Report
No. 3.
Andersen, Ronald, and Odin W. Anderson
1967 A Decade of Health Services. Chicago: Univer
sity of Chicago Press.
Anderson, Odin W.
1966 "Health-services systems in the United States
and other countries." Pp. 213-233 in Leslie J.
De Groot (ed.), Medical Care; Social and
Organizational Aspects. Springfield, Illinois:
Charles C. Thomas.
Angell, Robert C.
1947 "The social integration of American cities of
more than 100,000 population." American
Sociological Review 12 (June):335-342.
Bach, George Leland
1966 Economics. Englewood Cliffs, New Jersey:
Prentice-Hall, Inc.
Banfield, Edward C., and James Q. Wilson
1963 City Politics. New York: Vintage Books.
Baum, Rainer C.
1968 "Values and democracy in Imperial Germany."
Sociological Inquiry 38 (Spring):179-195.
56
57
Belknap, Ivan, and John G. Steinle
1963 The Community and Its Hospitals. Syracuse:
Syracuse University Press.
Boulding, Kenneth G.
1968 Beyond Economics. Ann Arbor: University of
Michigan Press.
Bowen, Louise de Koven
1926 Growing Up with a City. New York: Macmillan
Company.
Brooks, Ralph M., Leslie D. Wilcox, George M. Beal, and
Gerald E. Klonglan
1971 "Toward the measurement of social indicators:
conceptual and methodological implications."
Pp. 231-240 in The Proceedings of the Social
Statistics Section, American Statistical
Association.
Clark, Terry N. (ed.)
1968 Community Structure and Decision Making:
Comparative Analysis. San Francisco: Chandler.
Cloward, Richard A., and Frances Fox Piven
1969 "The professional bureaucrat: benefit systems
as influence systems." Pp. 359-372 in Ralph M.
Kramer and Harry Specht (eds.), Readings in
Community Organization Practice. Englewood
Cliffs, New Jersey: Prentice-Hall, Inc.
Coe, Rodney M.
1970 Sociology of Medicine. New York: McGraw-Hill
Book Company.
Crain, Robert L., Elihu Katz, and Donald B. Rosenthal
1969 The Politics of Community Conflict: The
Fluoridation Decision. New York: Bobbs-
Merrill.
Dahl, Robert A.
1961 Who Governs? New Haven: Yale University Press.
de Grazia, Alfred, and Ted Gurr
1961 American Welfare. New York: New York Univer
sity Press.
Duff, Raymond S., and August B. Hollingshead
1968 Sickness and Society. New York: Harper & Row.
Duncan, Otis Dudley, W. Richard Scott, Stanley Lieberson,
Beverly Duncan, and Hal H. Winsborough
I960 Metropolis and Region. Baltimore: Johns
Hopkins Press.
Elling, Ray H., and Sandor Halesbsky
1966 "Organizational differentiation and support."
Administrative Science Quarterly 6 (September):
185-209.
Emery, F. E., and E. L. Trist
1965 "The causal texture of organizational analysis:
a critique and a suggestion." Administrative
Science Quarterly 5 (September):21-32.
Etzioni, Amitai
1960 "Two approaches to organizational analysis:
a critique and a suggestion." Administrative
Science Quarterly 5 (September):258-278.
Georgopoulos, Basil, and Arnold S. Tannenbaum
1957 "A study of organizational effectiveness."
American Sociological Review 23 (October):534-
540.
Gibbs, Jack P.
1961 Urban Research Methods. Princeton, New Jersey:
D. Van Nostrand Co., Inc.
Ginsberg, Eli
1965 Manpower Strategy for the Metropolis. New York
Columbia University Press.
Glaser, William A.
1970 Social Settings and Medical Organizations:
A Cross-National Study of the Hospital.
New York: Atherton Press.
Gordon, Daniel N.
1970 "Immigrants and municipal voting turnout:
implications for the changing ethnic impact on
urban politics." American Sociological Review
35 (August):665-681.
Gottmann, Jean
1961 Megalopolis: The Urbanized Northeastern Sea
board of the United States. Cambridge,
Massachusetts: M.I.T. Press.
Greer, Scott
1962a Governing the Metropolis. New York: Wiley.
59
Guzzardi, Walter, Jr.
1966 "What the doctor can't order--but you can."
Pp. 529-543 in W. Richard Scott and Edmund H.
Volkart (eds.), Medical Care: Readings in the
Sociology of Medical Institutions. New York:
Wiley.
Hasenfeld, Yebeskel
1971 "Organizational dilemmas in innovating social
services: the case of the community action
centers." Journal of Health and Social Behavior
12 (September):208-215.
Hunter, Floyd, Ruth Connor Schaffer, and Cecil G. Sheps
1956 Community Organization: Action and Inaction.
Chapel Hill: University of North Carolina
Press.
Journal of the American Hospital Association
1967 Guide Issue to Hospitals.
Kluckhohn, Clyde
1951 "Values and value-orientations in the theory of
action: an exploration in definition and
classification." Pp. 388-433 in T. Parsons and
E. A. Shils (eds.), Toward a General Theory of
Action. Cambridge, Massachusetts: Harvard
University Press.
Lazarsfeld, Paul F.
1962 "Interpretation of statistical relations as a
research operation." Pp. 115-124 in Paul F.
Lazarsfeld and Morris Rosenberg (eds.), The
Language of Social Research. Glencoe, Illinois:
The Free Press.
Lundberg, George
1950 "Human Values— a research program" [Research
Studies of the State College of Washington], as
quoted by Clyde Kluckhohn, "Values and value-
orientations in the theory of action: an
exploration in definition and classification."
Pp. 406-408 in T. Parsons and E. A. Shils
(eds.), Toward a General Theory of Action.
Cambridge, Massachusetts: Harvard University
Press.
March, James G., and Herbert A. Simon
1958 Organizations. New York: Wiley.
60
McConnell, Grant
1969 "The public values of the private association."
Pp. 147-160 in J. Roland Pennock and John W.
Chapman (eds.), Voluntary Associations.
New York: Atherton Press.
McNemar, Quinn
1969 Psychological Statistics. 4th ed. New York:
Wiley.
Minnis, Mhyra S.
1959 "The patterns of women's organizations:
significance types, social prestige, rank, and
activities." Chapter 14 in Marvin B. Sussman
(ed.), Community Structure and Analysis.
New York: Thomas Y. Crowell.
Moore, Joan W.
1961 "Patterns of women's participation in voluntary
associations." American Journal of Sociology 66
(May):592-598.
National Manpower Council
1953 A Policy for Scientific and Professional
Manpower. New York: Columbia University Press.
Nix, Harold
1969 "Concepts of community and community leader
ship." Sociology and Social Research 53 (July):
500-510.
Parsons, Talcott
1951 The Social System. Glencoe, Illinois: The Free
Press.
1956 "Suggestions for a sociological approach to the
theory of organizations." Administrative Science
Quarterly 1:63-86.
1968 "On the concept of value-commitments."
Sociological Inquiry 38 (Spring):135-160.
1971 "Higher education as a theoretical focus."
Pp. 233-252 in Herman Turk and Richard Simpson
(eds.), Institutions and Social Exchange.
New York: Bobbs-Merrill.
Pennock, J. Roland, and John W. Chapman
1969 Voluntary Associations. New York: Atherton
Press.
61
Perrow, Charles
1965 "Hospitals: technology, structure, and goals."
Pp. 910-971 in James G. March (ed.), Handbook of
Organizations. Chicago: Rand-McNally.
Perrucci, Robert, and Marc Pilisuk
1970 "Leaders and ruling elites: the interorganiza
tional bases of community power." American
Sociological Review 35 (December):1040-1057.
Polsby, Nelson W.
1963 Community Power and Political Theory.
New Haven: Yale University Press.
Presthus, Robert
1964 Man at the Top: A Study in Community Power.
New York: Oxford University Press.
Roemer, Milton I.
1971 "National medicine in America." Transaction 8
(September):31-36.
Rose, Arnold M.
1954 "A theory of the function of voluntary associa
tions in contemporary social structures."
Chapter 3 in Theory and Method in the Social
Sciences, Minneapolis: University of Minnesota
Press.
1967 The Power Structure. New York: Oxford
University Press.
Selznick, Phillip
1948 "Foundations of the theory of organizations."
American Sociological Review 13 (February):
25-35.
Sidorsky, David
1969 "Pluralism, empiricism, and secondary associa
tion." Pp. 161-169 in J. Roland Pennock and
John W. Chapman (eds.), Voluntary Associations.
New York: Atherton Press.
Sieder, Violet M.
1966 "The historical origins of the American
volunteer." Pp. 4-13 in William A. Glasser and
David L. Sills (eds.), The Government of
Associations. Totowa, New Jersey: The
Bedminster Press.
62
Smelser, Neil J.
1963 The Sociology of Economic Life. Englewood
Cliffs, New Jersey: Prentice-Hall, Inc.
Smith, David Horton
1966 "The importance of formal organizations for
society." Sociology and Social Research 50
(July):483-495.
Stein, Maurice R.
1960 The Eclipse of Community: An Interpretation of
American Studies. Princeton, New Jersey:
Princeton University Press.
Stinchcombe, Arthur L.
1965 "Social structure and organizations." Pp. 142-
193 in James G. March (ed.), Handbook of
Organizations. Chicago: Rand-McNally.
Stotland, Ezra, and Arthur L. Kohler
1965 Life and Death of a Mental Hospital. Seattle:
University of Washington Press.
Theodorson, George A., and Achilles G. Theodorson
1969 A Modern Dictionary of Sociology. New York:
Thomas Y. Crowell.
Thomas, William I., and Florian Znaniecki
1918-20 The Polish Peasant in Europe and America.
5 volumes. Chicago: University of Chicago
Press.
Turk, Herman
1970a "Interorganizational networks in urban society:
initial perspectives and comparative research."
American Sociological Review 35 (February):1-19.
1970b "Coordination among hospitals: an instance of
interorganizational structures in urban communi
ties." Paper presented at the 7th World Confer
ence of Sociology of the International Sociolog
ical Association, Varna, Bulgaria.
1971 "The occurrence of new interorganizational
events in urban communities: an application of
nominal theory and specification to social
systems analysis." Paper presented at the
American Sociological Association Annual Meet
ing, Denver, Colorado.
63
Turk, Theresa G.
1970 The Allocation of Support to Urban Organiza
tions: Hill-Burton Funding of General Hospitals
in Large Cities. Unpublished doctoral disserta
tion, University of California at Los Angeles.
Vogt, Evon Z., and Thomas I. O'Dea
1953 "A comparative study of the roles of values in
social action in two southwestern communities.1 1
American Sociological Review 18 (December):645-
647; 652-654.
Walker, Isabelle M.
1971 "Allocation of voluntary manpower in urban
communities." Unpublished research, University
of Southern California.
Walton, John
1968 "Differential patterns of community power
structure." Chapter 21 in Terry N. Clark (ed.),
Community Structure and Decision Making:
Comparative Analysis. San Francisco: Chandler
Press.
Warner. W. Lloyd, and J. 0. Low
1946 "The factory in the community." Pp. 31-45 in
William Foote Whyte (ed.), Industry and Society.
New York: McGraw-Hill.
Warren, Roland L.
1956 "Toward a reformulation of community theory."
Human Organization 15 (Summer):8-11.
1963 The Community in America. Chicago: Rand-
McNally .
1966 Perspectives on the American Community.
Chicago: Rand-McNally.
1967 "The interorganizational field as a focus for
investigation." Administrative Science
Quarterly 12 (December):396-419.
1970 "Toward a non-utopian normative model of the
community." American Sociological Review 35
(April):219-227.
64
Weinerman, G. Richard
1966 "Outpatient clinic services in the teaching
hospital." Pp. 161-181 in Leslie J. DeGroot
(ed.), Medical Care; Social and Organizational
Aspects. Springfield, Illinois: Charles C.
Thomas.
Wheatron, William L. C.
1964 "Public and private agents of change in urban
expansion." Pp. 154-196 in Melvin M. Webber
(ed.), Explorations into Urban Structure.
Philadelphia: University of Pennsylvania Press.
Williams, Robin M., Jr.
1967 "Individual and group values." The Annals 371
(May):20-37.
Willis, Charles V.
1970 "Institutional vitality and institutional
alliances." Sociology and Social Research 54
(January):249-259.
Yuchman, Ephraim, and Stanley E. Seashore
1967 "A system resource approach to organizational
effectiveness." American Sociological Review 32
(December):891-903.
Zald, Mayer N.
1967 "Urban differentiation, characteristics of
boards of directors, and organizational
effectiveness." American Journal of Sociology
73 (November):261-272.

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Asset Metadata

Creator Walker, Isabelle Margaret (author)

Core Title Resource allocation among organizations within urban communities

Degree Doctor of Philosophy

Degree Program Sociology

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag OAI-PMH Harvest,Sociology, general

Language English

Contributor Digitized by ProQuest (provenance)

Advisor Turk, Herman (committee chair), Miller, Jon P. (committee member), Moore, John W. (committee member)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c18-772985

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