Neighborhood Organization and Local Social Action:

This case study examines the history, structure and social, economic, and political changes of an urban neighborhood in Ohio, and how local social actors and organizations affect those changes. The data are based on personal interviews, meeting minutes, newsletters, newspaper articles, and other documentation and materials. The analysis shows that (1) individual social actors are the most important factors in bringing about change consistent with the local social action system, (2) there is a significant and positive relationship between the economic condition of the neighborhood and the success of the changes in the neighborhood, (3) changes consistent with the local social action system are most effectively induced when various organizations and social groups are organized independently of each other but at the same time associated through coalition activities, and (4) the larger urban system (both political and economic systems) in which the neighborhood is located can have strong influence on the neighborhood change.     

Hospital response to the legalization of abortion in New York State: an analysis of program innovation

The reorientation of hospital services in the state of New York to accommodate women's constitutional right to elective abortion was investigated. Market and resource constraints, the social orientations of the organization, and the values of physicians were examined in the effort to evaluate hospital response between 1971 and 1973. Analysis indicates that program innovation in obstetrical and gynecological services to include elective abortion was inhibited by economic factors that generally determined the feasibility of diverting finite resources to a new service and social orientations and values that determined the compatibility of elective abortions with the dominant values underlying hospital operations. The reform of New York abortion statutes and the subsequent ruling by the Supreme Court reiterating the right of women to terminate pregnancy failed to standardize the delivery of health care so that individual rights to service could be obtained everywhere in the state. The social changes ultimately realized through legislative and judicial action were essentially conditional upon the responsiveness of local health care providers. Legal action that failed to specifically address the administrative role of hospitals in social change qualified local access and could not be completely effective in legitimizing the redefinition of abortion in society.     

Toward Health Reform for Seniors in Bermuda: Historical Constraints on Political Possibilities

In 2009, as the United States moved toward health care reform, the government of Bermuda implemented its FutureCare program to make health care for seniors more affordable. This article investigates how preferences for reform and its eventual design were shaped by the country's social history and commitment to free market values. Data derive from 36 in-depth interviews with key stakeholders deemed knowledgeable about health care financing and delivery in Bermuda, including government officials, provider representatives, insurance executives, and consumer advocates. Data also derive from a variety of documentary sources. Results indicate that although a clear need for health care and the ability to finance it for seniors exists in Bermuda, the scope of reform was circumscribed by preferences for prior policy decisions, creating a favorable tax and business environment for international corporations and a minimalist social welfare state for addressing racial and economic inequality. This suggests that widespread agreement on the challenges in meeting the health and long-term care needs of the elderly does not necessarily lead to equally commensurable solutions to addressing it.     

The Development and Challenges in Health Care Policy and Health Care Financing in Contemporary China

China’s market-oriented reform has had great success in the past few decades. Along with the rapid economic growth of the country, the economic development also influenced various aspects of China’s social, economical, and political life. Recent debate has criticized the overheated market reform in social provision, thus arguing for the return of government interventions. However, in the health care sector, it is inappropriate to attribute all distortions to market imperfection. It is rather the design of the health care system and the lack of government interventions in regulating the health care market that obstruct the functions of health care provision. To examine the proposed hypotheses, the paper focuses on China’s medical care provision, evaluating the actual performance of China’s medical care provision in the environment of economic transition from a multidimensional analysis, hence providing forward-looking suggestions for the design of China’s health care provision. Findings from this study indicate that government interventions are indispensable in regulating the health care market as well as ensuring health care delivery.      

Toward health reform for seniors in Bermuda: historical constraints on political possibilities

In 2009, as the United States moved toward health care reform, the government of Bermuda implemented its FutureCare program to make health care for seniors more affordable. This article investigates how preferences for reform and its eventual design were shaped by the country's social history and commitment to free market values. Data derive from 36 in-depth interviews with key stakeholders deemed knowledgeable about health care financing and delivery in Bermuda, including government officials, provider representatives, insurance executives, and consumer advocates. Data also derive from a variety of documentary sources. Results indicate that although a clear need for health care and the ability to finance it for seniors exists in Bermuda, the scope of reform was circumscribed by preferences for prior policy decisions, creating a favorable tax and business environment for international corporations and a minimalist social welfare state for addressing racial and economic inequality. This suggests that widespread agreement on the challenges in meeting the health and long-term care needs of the elderly does not necessarily lead to equally commensurable solutions to addressing it.     

Closing the Loophole: A Case Study of Organizing for More Equitable and Affordable Access to Health Care in San Francisco

This paper presents in-depth case study of a successful hybrid political and community organizing campaign to ensure equitable access to health care through the perspective of a grassroots San Francisco community-based organization, the Chinese Progressive Association (CPA), which has been organizing low-income Chinese immigrants for over four decades. First, it outlines the Health Care Security Ordinance (HCSO), which, since its passage in 2006, has established a near-universal health care access program, helping to make health care accessible and affordable to individuals living and working in San Francisco. Then it presents the campaign to save the HCSO, focusing on CPA’s participation in the HCSO coalition. Finally, it discusses health care as it relates to the San Francisco’s affordability crisis and the political economic context in which it is taking place. Despite the limitations inherent in small case studies like this one, it nevertheless provides a valuable opportunity to better understand how one politically progressive city attempted to address the problem of grossly inequitable health care access through the lens of community organizing, advocacy, and coalition building. San Francisco, like many major American cities today, is being confronted with rapid gentrification and growing economic inequality—the backdrop to the HCSO. Through innovative experiments in social responsibility like the HCSO, however, the city has made leaps in health care access. It concludes with lessons learned from local organizing and advocacy to save the HCSO as these may inform other local efforts to promote health care for all.     

Health care reform and older adults: notes from the Polish experience

Poland enacted in 1997 legislation that founded a health care system in which health insurance societies contract with providers to deliver health services to the insured population. Through a review of the new statutes, interviews with key informants, analysis of public opinion polls and surveys of insurance administrators and health care workers, we examined the impact of reform on Poland's older citizens. The findings indicate that older adults are likely to be adversely affected by the inadequacies of insurance premiums as a source of finance, the lack of emergent private medical enterprise, and the failure to eradicate private health in its earlier, black market incarnation.     

Seven years later: effects of a neighborhood mobility program on poor Black and Latino adults' well-being

This study explored program effects on adults' well-being seven years following the implementation of a court-ordered neighborhood mobility program. Low-income black and Latino adults residing in poor, segregated neighborhoods in Yonkers, New York were randomly selected to relocate to publicly funded townhouses in middle-class neighborhoods within the city. Adults who moved (n = 141) and demographically similar adults who were not selected to move (n = 106) were interviewed. Data indicate that 85 percent of adults who moved to the new housing remained there at follow-up. Results revealed that adults who moved resided in neighborhoods with higher collective efficacy and less disorder and danger but had fewer neighborhood social ties than adults who stayed in poor neighborhoods. Movers were also more likely to work and less likely to receive welfare than nonmovers. Adults who remained in low-poverty neighborhoods at the time of the follow-up reported better physical health than adults residing in poor neighborhoods, but mental health did not vary by neighborhood.     

Oral health in long-term care: The implications of organizational culture

When an investigation designed to compare extant models of delivering oral health and dental services to the institutionalized elderly revealed that structural variables explained very little of the difference between effective and ineffective programs, secondary analytic techniques were employed to consider alternative explanations. The original study was a program evaluation based on a comparative case study of 12 long-term care (LTC) facilities. Data for each case included interviews with administrators, care providers, family members, and residents, administrative documentation, and clinical measures of oral health from the residents. The secondary analysis revealed the mechanisms through which the organizational context of each facility influenced the effectiveness of the oral health services. In addition, it revealed how administrative and leadership issues influenced the quality of care.     

Computer-Based Case Management for the Elderly

A combination of economic, demographic, and political factors is pressuring health care providers into improving discharge planning and long-term care services for their clients, particularly the elderly and poor. Case management, with its emphasis on patient assessment, monitoring, and program evaluation, is one tool increasingly adopted to accomplish these goals. This paper examines the application of computer technology to case management and describes a computerized, hospital-based case management program for the elderly.     

The logic of social policy expansion in a neoliberal context: health insurance reform in Korea after the 1997 economic crisis

In the aftermath of the economic crisis of the late 1990s, the Korean government reformed health insurance system to enhance social equity and solidarity. This article identifies the institutional features and political dynamics involved in completing the reform. The Korean case suggests a model of counter-movement that differs from the historical experiences of both democratic corporatist and liberal welfare states. Two institutional conditions within the politics of crisis contributed to the reform. A legacy of limited state welfare was critical in providing the impetus for reforming health insurance system. More importantly, the crisis maximized the state’s coordination capacity by mobilizing a coherent bureaucracy under the presidential authority, and by limiting interest politics. The Korean experience has important implications for the study of economic crisis and social policy response. The way in which a crisis provides new contexts for welfare and policy making institutions, rather than the institutions themselves, should be the main focus in analyzing policy responses. The focus on the political dynamics of an economic crisis helps us acknowledge the limit of ideological forces of a crisis in facilitating a particular policy response.     

Comparative influence of political, cost/benefit, and statistical information on administrative decision making.

The influence of three types of evaluation information was studied in simulated decisionmaking situations within a community mental health center setting. Twelve administrators reviewed one of two decision problems (direct services or indirect services funding) and were then presented political, cost/benefit and statistical information. After each presentation, the administrators rated the importance of each type of information for decision making. Only the cost/benefit data were rated as significantly influencing their decisions. The influence of each type was not dependent upon the decision problem, nor to length of time in administrative positions. The results were interpreted in terms of “who says what, how, and to whom. ” If evaluators desire a greater impact on the decision making behavior of community health administrators, they should consider employing a pay off-based evaluation strategy and providing cost/benefit information.     

The growth of the sociology graduate program at Kent State University

The initial growth of the graduate program in sociology at Kent State University was dominated by the interests, academic training and career goals of particular people who participated in it. Moreover, in 1939, when the program was initiated, its growth closely mirrored the principal concerns of the discipline. Today the program is responsive less to the discipline or particular faculty, and more to political, economic and demographic factors. As a state-funded institution, this university and graduate program are more likely to react to state needs and those of its other public, the students. Her interests include professional socialization and organizational change, particular in the field of health care. His most recent work is research on “belief in a just world” and in the social psychological aspects of gender roles.     

"Put your money where your mouth is!": the need for public investment in women's organisations

This article explores the inadequate funding of women's organizations, cites examples of their contribution to political processes, and argues the implementation of the political rhetoric of supporting women's organizations. Information was taken from the 1996-99 research, which employed in-depth interviews and gender analysis of records of public funds. At the start of the 21st century, women's organizations have emerged to address the health care, law, child care, education and employment legislation. However, failure of social policy in addressing the priorities of women could be attributed to the lack of acknowledgement among male leaders when making peace agreements. A call for public funding for women's organizations from government agencies was deemed important. Moreover, insufficient funds, understaffing, and marginality to mainstream economic and social development undermines organizational development and capacity to influence political agendas and development policies. In conclusion, monitoring of public investment, deemed as important in realizing women's equality, is necessary in offering opportunity to expose the inadequacy of the investment and find solutions for these problems.     

The Hidden Costs of Informal Elder Care

Demographic, socio-economic, and political trends throughout the developed world have contrived to make elder care an issue of utmost policy importance. They also have led to sharp reductions in health and social program expenditures. Policymakers are looking to communities to help meet growing care needs because community care is believed to be better and cheaper than institutional care. However, these beliefs become untenable when costs beyond public sector costs are considered. In fact, informal care carries a number of hidden costs that seldom are considered in health and social policy discussions. This article introduces a taxonomy of the costs of informal elder care, which can be categorized as out-of-pocket expenditures, foregone employment opportunities, unpaid labor, and emotional, physical and social well-being costs. Then, an illustration is provided regarding how the taxonomy can be applied to understanding the incidence, magnitude, and distribution of these costs among stakeholder groups. This taxonomy can help inform ongoing debate about health and social policy reform.     

Against all odds: Revitalization of local self-help alternatives by longterm mental health consumers

The article presents a grounded theory case study of a consumer-run alternative services organization, operated by and for people labeled chronically mentally ill in Michigan. We analyze the organization's emergence and development as a process of revitalization through which participants mobilized to transform their private and public identities. Innovations, including self-disclosure rituals and advocacy strategies, were developed by the group's founder during a period of social dislocation following deinstitutionalization. Subsequently, through their advocacy efforts for and with other consumers, group members laid the foundation for a unique form of locally-based political activism, blending innovative self-advocacy strategies with a critique of conventional mental health care. Active participants' efforts have created a mental health consumer organization that members perceive as an empowering and sometimes rehabilitative alternative within Michigan's public mental health care system.     

Lesbians Leaping Out of the Intergenerational Contract:

Changing demographics and economic models in modern industrial countries have led to changes in the nature of the intergenerational contract, repositioning of the family as the site for care, and increasing privatization of welfare, housing and health services for the aged. These shifts have important implications for access to services for lesbians and gays as they age and enter their third age, often in the absence of traditional family support. The needs and desires of some older lesbians in Australia in relation to housing and health care were explored via focus group interviews. The results are discussed in relation to the intergenerational contract, policy shifts and the social organization of aged care in Australia.     

“Would You Do That in Your Home?” Making Nursing Homes Home-like in Culture Change Implementation

Qualitative interviews with nursing home administrators reveal innovative and cost-conscious ways to physically modify facilities that help institute culture change practices. Telephone interviews were conducted following a national survey of nursing home nursing directors and administrators. In this cross-sectional snapshot of administrator experiences, motivations for making facilities more home-like and less institutional and creative responses to challenges are described. State and corporate support and regulator encouragement are noted that help their reform efforts. Administrators note that small steps to create a more home-like environment can result in a positive impact that minimizes disruption to existing care processes. They describe how they respond to challenges, such as the physical plant and high costs, and note how comparative shopping, cost-conscious physical improvements, and continuous involvement of staff and residents contribute to successful efforts. Their examples illustrate novel ways to humanize long-term care facilities that other nursing homes can emulate.     

Ideologies and Forms of Domination in the Organization of the Global Production and Consumption of Goods in the Emerging Postmodern Era: A Case Study of Nike Corporation and the Implications for Gender

This paper uses a case study of Nike Corporation to examine some of the contradictory gender-based ideologies involved in the two main processes of the production and consumption of athletic footwear: manufacturing and advertising. It uses the newly developing paradigm within world-system theory, a commodity chain analysis, to compare and contrast the social relations of gender within each of these two segments at both the micro- and macro-level. Noting the increasing importance of advertising and consumption patterns accompanying emerging post-industrial, postmodern trends, this paper highlights the need for political economy analyses to address more cautiously cultural, political and social factors involved in the production and consumption of goods. This study employs an exploratory approach, using gender as a variable to detect linkages between the economic and cultural realms at the individual and global level. Drawing on some of the post-Marxist literature, it points to new potential for alliances in forging social change. The main attempt is to expand upon development theory which tends to neglect the role of gender, while also expanding studies of gender by investigating gender issues within the framework of the global political economy.     

Consensus or contention: an exploration of multidisciplinary team functioning in an Irish mental health context

Multidisciplinary teams (MDTs) are conventionally recommended in mental health care literature as an important way to offer holistic treatment provision to patients. This study aims to explore multidisciplinary teamwork in contemporary mental health settings, particularly what aids and hinders the process of multidisciplinary teamworking, and the social work contribution in such teams. In order to attain an in-depth exploration of these phenomena, a single case study design was employed. Within this design, data were generated through semi-structured interviews and structured observation of a mental health MDT in Ireland. These data were analysed using interpretative phenomenological analysis. The research highlights how the concept of mental illness is contested within this MDT, with the medical model dominant within an environment of fluid working arrangements. Professional role blurring and stereotyping were found to impact the division of labour on this team, with role negotiation found to be an integral part of retaining a professional's practice identity. This research raises concerns for social work's capacity to function within mental health MDTs in Ireland, and highlights ways in which social work educators might respond in order to empower Irish social workers to meet the challenges of mental health multidisciplinary teamworking.