Children's Living Conditions in Sweden. Social Patterns and Trends in Parental Accessibility, Child Care and Economic Resources

In this study, using data from the Swedish level of living surveys in 1981 and 1991 of more than 3,500 children, social patterns and trends in children's living conditions are analysed. The conditions focused on are linked to parental employment, namely, parental accessibility, use of child care and economic resources. The primary statistical method used is logistic regression analysis. The results show differences in children's access to mothers and fathers as parental access is restricted by various aspects of employment. There were also differences in childrenrsquo;s resources by social class and family structure. Of further importance was the combination of these, especially in the way that social class was more decisive for the children of single parents.     

The extent and limits of solidarity in Dutch health care

Solidarity and equal access are twin principles in the Dutch health care system: solidarity between the rich and poor and among people with high and low risks formally guarantees equal access to health care services. However, in the past few years government policies, guided by the ideology of market reform and free choice, have resulted in patterns of inequality that favour privately insured over sickness fund insured. In the meantime, the level of public support for the principles of solidarity and equal access is dropping. A significantly larger portion of the Dutch people now believes that it would be too costly to grant everyone the right to all medical treatments possible. An important reason for the decline of solidarity and equal accessibility is the scarcity of resources. The scarcity of resources and the waiting lists resulting from it will reduce the extent of the benefits package and the access to the care services of the health system. The better-off will have the resources to receive care services that are not part of the basic package. Moreover, the scarcity of resources will affect the readiness in society to provide informal care. Opposed to the compulsory macro solidarity of the health insurance system, informal care is based on a voluntary kind of solidarity in which personal choice plays an important role. Waiting lists and diminishing professional support weaken this readiness, as such support is a necessary condition for informal carers to keep caring for their relatives and friends. Because the informal care system is a necessary supplement to the formal system of care, the lack of help offered by the latter will in the end endanger the solidarity not only in informal care, but in the institutional care system as well.     

How do policy levers shape the quality of a national health system?

Poor quality of care may have a detrimental effect on access and take-up and can become a serious barrier to the universality of health services. This consideration is of particular interest in view of the fact that health systems in many countries must address a growing public-sector deficit and respond to increasing pressures due to COVID-19 and aging population, among other factors. In line with a rapidly emerging literature, we focus on patient satisfaction as a proxy for quality of health care. Drawing on rich longitudinal and cross-sectional data for Spain and multilevel estimation techniques, we show that in addition to individual level differences, policy levers (such as public health spending and the patient-doctor ratio, in particular) exert a considerable influence on the quality of a health care system. Our results suggest that policymakers seeking to enhance the quality of care should be cautious when compromising the level of health resources, and in particular, health personnel, as a response to economic downturns in a sector that traditionally had insufficient human resources in many countries, which have become even more evident in the light of the current health crisis. Additionally, we provide evidence that the increasing reliance on the private health sector may be indicative of inefficiencies in the public system and/or the existence of features of private insurance which are deemed important by patients.     

Access, Choice and Travel: Implications for Health Policy

The UK National Health Service is introducing policies offering patients a choice of the hospital where they would like to be treated. ‘Patient choice’ policies form part of a wider debate about the access to health care and the interaction between providers (including information, provision, performance and reputation) and patients (including knowledge, resources and willingness to travel). As the hospital of ‘choice’ might not necessarily be the ‘local’ provider, such policy developments are predicated on an assumption that some patients will be willing to travel further. This will, in turn, affect patients’ access to services. In general, use of services decreases with distance but this is dependent on accessibility to services, the organization of those services, the socio‐economic characteristics of the patient, perceptions of the provider and the condition for which they are to be treated. This article reviews the evidence on patients’ willingness to travel in terms of access to health care and assesses the emerging implications of and for current UK policy on patient choice.     

"Just like I'm saving money in the bank": client perspectives on care coordination services

Older adults face many challenges to community living. The literature has not sufficiently explored the roles of care coordination in the maintenance of housing and access to health care among older adults, particularly from their own perspectives. This qualitative study analyzes the findings from 25 interviews and 6 focus group discussions (48 participants) with a multiethnic sample of older adults in the New York City area. Care coordination services appear to assist older adults access health care, and to a lesser extent, maintain affordable housing. Disparities in access to care coordination appear to remain for immigrant, minority and suburban populations.     

How do immigrant parents of children with complex health needs manage to cope in their daily lives?

Daily life with children who have complex health needs can be stressful for parents. Immigrant parents are vulnerable to stress because they may lack language skills and knowledge about the health care system and have limited social networks. In this study, we focus on how immigrant parents of children with complex health needs use emotion‐focused and problem‐focused coping strategies to manage their daily life, and how their self‐efficacy and the immigration process may affect their coping. This qualitative study had an exploratory design with individual and focus group interviews. The sample comprised 27 parents—18 mothers and 9 fathers—from Pakistan, Poland, and Vietnam. The findings indicated that the parents' love for their child helps them to cope in their daily life. Newly arrived migrants, single mothers with a severely ill child who lacked support and migrant parents with language difficulties struggle to cope. Some of the stress is related to personal, social and structural problems, and to the insufficient resources available to meet the child's needs. The parents used both emotion‐focused and problem‐focused coping strategies. The parents noted that access to both universal and selective welfare services is an important factor that contributed to their self‐efficacy and coping.     

An alternative response to "The best interests of the child thesis: some thoughts from Australia"

Many of the concerns about recent changes in child welfare services practice in Australia have also been raised in the USA. Although it certainly may be the case that mandatory reporting is causing a broadening of child welfare services in Australia, close data-informed scrutiny suggests that this is not the case in the USA. Further, there are positive alternatives to overly intrusive child welfare service interventions that are arising in the USA. There is reasonable evidence to suggest that too little protection rather than too much intrusion remains the more significant problem in the USA; this may also be true elsewhere. The quality and range of services certainly determines whether intrusion is helpful to children and families. In some cases, for example life-threatening health problems that parents will not or cannot treat, engaging the assistance of child welfare services should not be ruled out for ideological reasons.     

An alternative response to "The best interests of the child thesis: some thoughts from Australia"

Many of the concerns about recent changes in child welfare services practice in Australia have also been raised in the USA. Although it certainly may be the case that mandatory reporting is causing a broadening of child welfare services in Australia, close data-informed scrutiny suggests that this is not the case in the USA. Further, there are positive alternatives to overly intrusive child welfare service interventions that are arising in the USA. There is reasonable evidence to suggest that too little protection rather than too much intrusion remains the more significant problem in the USA; this may also be true elsewhere. The quality and range of services certainly determines whether intrusion is helpful to children and families. In some cases, for example life-threatening health problems that parents will not or cannot treat, engaging the assistance of child welfare services should not be ruled out for ideological reasons.     

Health Care in Asia and the Pacific: Increasing the focus on social health insurance

This paper focuses on health insurance reform within the broader frameworks of both social security and health services system development. In most countries in Asia and the Pacific, it is indeed the reform of the health services system, through policy changes in health care financing, that has led to an increased focus on health insurance. The underlying issue in this reform is the shift in responsibility that has taken place in most countries in the region over recent years. In the past, governments were responsible for financing health care for their populations. This shifted to defining, legislating and implementing an appropriate health care financing mechanism, presenting several challenges: to reach universal health insurance coverage through new initiatives for new populations, mainly the informal sector accounting for the majority of the population in almost all these countries; to apply provider payment systems that enable control over costs and the volume of utilization; and to strengthen primary health care as a foundation for rational utilization and more resources for prevention, including prevention of chronic diseases among the ageing population. This approach will require an active partnership between health insurance schemes and government that should reflect the new division of responsibilities to guarantee access to high-quality health care for all.     

Double jeopardy: the link between child abuse and maternal depression in child and family social work

The link between child care and mental health problems in social work clients has begun to attract some attention. Despite some review articles, research is, as yet, at a very early stage of development. Maternal depression and child care problems in particular appear likely to be closely associated. This paper focuses on the link between maternal depression and the most severe of child care problems: child abuse. The paper shows a significant relationship between maternal depression and child abuse. It explores this relationship by distinguishing three groups: families where no abuse had occurred (non abuse families), families where abuse had occurred but where the mother was not depressed (non depressed-abuse group) and families where both child abuse and maternal depression were present (depressed-abuse group). The depressed-abuse group are shown to be considerably worse off than both the other groups for a range of measures, including indices of deprivation and range and severity of social problems. The depressed-abuse group were also more chronic users of services and consumed far more resources than the other two groups. Remarkably, there were few differences between the non abuse group and the non depressed abuse group in nature and severity of problems and intervention. Depression in mothers, then, provides the major distinction between families where abuse was an issue compared with families where abuse was not present. Such families are characterized not simply by maternal depression and child abuse, but frequently by abuse of the mother herself, who is often socially isolated. These findings are of major importance for child care practice, indicating that working with the mother's depression and the social conditions that provide its backdrop, are a major aspect of social work practice.     

Overcoming barriers to effective practice in child care

This paper describes the work of three Action Learning Sets – two groups of child care social workers and one group of health visitors. Given the substantial investment in child care research and its dissemination, we wanted to examine barriers to effective practice from the vantage point of workers themselves. Our core question was: ‘What can we do about the things that get in the way of effective practice?’ The method, based on that of ‘co‐operative inquiry’, sought to engage front‐line practitioners as active collaborators in the research. While several of the barriers can be seen as part of the common predictable experience of professionals working in large public sector organizations, a key message is the importance of re‐invigorating models of supervision that can sustain high quality practice. What emerges is a contemporary picture of the pressures on child care workers and of the struggles to make sense of professional roles in different organizational landscapes. We are committed to evidence‐based practice, practice that is derived from the best knowledge available. We would simultaneously stress the importance of ‘holding environments’ to promote effective learning. Our experience suggests that Action Learning offers a constructive method for encouraging such environments and facilitating better practice.     

Quality Control in Child Care

Correspondence to June Thoburn, School of Ecnomics and Social Studies, University of East Anglia, Norwich NR4 7TS Summary This article takes as its starting point recent evidence aboutpoor practice in child care social work. It identifies a largenumber of mechanisms for ensuring quality control, and considerswhy they appear to be having so little effect. The writer suggeststhat because of the complexity of cases and the need for direction,and also because of disagreements about what is ‘quality’in child care, bureaucratic or procedural mechanisms have seriouslimitations as the major means for ensuring good practice. Shefocuses on the statutory review as the solution most frequentlysuggested but concludes that too much is being expected of it. Whilst accepting the need for procedural, inspectorial, judicial,and political checks and for more appropriate resources forfamily support, she suggests that the main remedy for poor practicemust lie in professional mechanisms. These include increasedspecialization, more time, improved training, and consultation.The weight of evidence and the intractable nature of the problemmay call for drastic measures, such as the introduction of theApproved social worker(child care).     

An Analysis of Selected Pension and Health Care Initiatives for Informal Sector Workers in India

India's demographic trends portend moderately rapid ageing of the population. This, combined with the limited coverage of pension and health care programmes in terms of population, types of risks covered, and benefit levels has led to greater urgency in extending the coverage and reform directions of the current pension and health care programmes. This article analyses three pension and health care initiatives in India directed at the workers and their families engaged in the informal sector. The first initiative, India's National Social Assistance Programme (NSAP), undertaken in 1995 provides budget‐financed transfers targeted at older persons. It is funded by the Union government but implemented by the state governments. The second initiative, called Swavalamban, was started in 2010, but has been subsumed under Atal Pension Yojana (APY), in the 2015–16 budget. Both are voluntary co‐contributory initiatives aimed at providing access to retirement income to low‐income individuals (government co‐contributing with the individual). Unlike Swavalamban, the APY initiative has provisions for minimum guaranteed pension benefits, with contributions required by the members adjusted accordingly. Effectiveness in increasing enrollment and in sustaining contributions over a longer period will impact on the extent of retirement income security obtained by the members. The third initiative, Rashtriya Swasthya Bima Yojana (RSBY), is insurance‐based and aims to provide hospital care to low‐income households. The article argues that for improving outcomes of these initiatives, more effective implementation, greater fiscal resources, and an integrated and systemic approach which is aided by technology‐enabled platforms such as Aadhaar, will be needed.     

The role of "Theatre for Development" in mobilising rural communities for primary health care: the case of Liwonde PHC Unit in southern Malawi

The improved health conditions that are essential for development may depend more upon the self-help motivation of local people than upon the provision of Western-style health facilities. Such motivation can be created by the culturally-appropriate dissemination of health education at the community level. This article describes an effective health improvement strategy implemented in three villages in southern Malawi during the late 1980s. After an introduction, the paper presents an overview of current strategies used in Malawi for the dissemination of primary health care information and notes that these strategies have failed to reach the rural population. Next, the paper describes the health status of two of the villages, Mbela and Mwima, before the introduction of the Liwonde Agricultural Development Division Primary Health Care Program. None of the three village involved had access to modern health care facilities. This program involved the joint efforts of the community, a primary health care team, and the Chancellor College Theatre for Development. The paper continues by presenting a conceptual model of the process. Community involvement was assured by the election of the members of village health committees and the delivery of health training to two members of each committee. The Theatre for Development used interactive dramatic techniques and participatory research activities in Mwima and Mbela to help the communities assess their health needs and possible solutions in conjunction with the introduction of primary health care activities. The article also contrasts the Theatre for Development technique with the focus group approach and notes that the latter may not be successful in motivating self-help efforts. Finally, the relative success of the Theatre for Development methodology used in the two villages is described by comparing health indicators with those before the intervention and with those in the third village where this approach was not used in conjunction with introduction of primary health care services.     

国家汲取能力、政策导向和中国城镇卫生保健的筹资与服务不公平

改革以后,中国政府在承担卫生保健职能方面的意愿和能力发生了变化,本文考察了这些变化对城镇卫生保健筹资和服务公平性的影响。文章着重分析了两个相关问题：在多大程度上,卫生保健的筹资具有累进性？在多大程度上,医疗服务的利用是公平的？第一节解释为什么在改革开放期间中国政府承担卫生保健的意愿与能力都有所下降,并探讨这些变化对卫生总费用的结构产生了什么样的影响。接下来的两节分别对中国城市卫生保健筹资和服务利用的不平等程度进行了实证分析。第四节进一步指出,筹资与服务方面的不平等将本来就处于弱势的社会群体置于更加不利的地位。总之,以市场为导向的卫生体制改革不但没有解决医疗费用上涨问题,反而加剧了这一问题;它因此损害了卫生保健筹资的公平性,降低了弱势人群对卫生服务的获取,增加了因病致贫的几率。     

The nature of child protection practices: an Irish case study

Child protection social work in Ireland has been expanding at a significant pace over the past decade, particularly since the implementation of the 1991 Child Care Act and the emergence of a number of child abuse 'scandals' since the early 1990s. One health board area in Ireland, itself subject to one of the most controversial child abuse inquiries, commissioned a research study into the nature of child protection practices in the area. The aim of the research was to evaluate the overall child protection system and to consider what impact, if any, new practice guidelines and procedures, implemented in the aftermath of the inquiry, had made on the service. This paper considers some of the key findings from the research and considers these in the context of the overall Irish child protection system. Three particular aspects of the research are focused on: the use of procedures and guidelines, the nature of interagency cooperation and the position of social workers within this, and the overall nature and direction of the child care system.     

Fairness, Equality and Legitimacy: A Qualitative Comparative Study of Germany and the UK

The pressures of globalization and shifts towards post‐industrialism are producing policies that increasingly emphasize the common themes of activation and of individual responsibility for outcomes. Such approaches suggest normative principles of equality of opportunity rather than of outcome, and of individual rather than collective responsibility for the outcomes achieved. Does this imply a shift towards a common normative framework for European welfare states, with implications for future policy developments? This article reports a recent qualitative study examining ideas about fairness and social provision in the very different regimes of Germany and the UK. The analysis shows that while respondents in both countries value equality of opportunity as a normative principle, those in Germany are much more likely to argue that an equal opportunity approach requires government to guarantee equal access to basic services. They are also more likely to express concerns about market freedoms which allow those who can afford it better access to health care and education. Real differences in welfare values remain, loosely following differences of regime type, despite the greater emphasis on activation and individual responsibility across European welfare states.