Costs and Benefits of Relational Contracting in China’s Transition

This paper is an attempt to account for the social foundations of China’s economic transition from central planning to a market economy which is a process of the completion and perfection of markets. In the early stage of China’s transition, relational contracts and interlinked arrangements constitute effective substitutes for missing and imperfect markets. However, relational contracting is becoming more costly as China’s economy develops. Its costs include, diseconomy of scale, undermining the development of arm-length transactions and formal institutions, among others. There are two possible future trajectories of China’s reform. One possibility is that the markets are so developed so that they are dis-embedded from sociopolitical powers. A second is that the markets are less developed and embedded in sociopolitical powers.     

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.     

Paying for the Health and Social Care of the Elderly

The aging population of Japan is causing serious concern among social policymakers. The most urgent issue is to find a way to pay for the health and social care of the frail elderly. After universal coverage of pension and health insurance was achieved, but just before the economic growth rate was considerably slowed, in part, because of the oil crisis, the Japanese government more than doubled pension benefits and made medical care for the elderly free. Since the early 1980s, the government has tried hard to cut and control these benefits, only with moderate success. With a consumption tax rate of only 5%, rather than the proposed 7%, the government is now considering establishing a new health and social care insurance scheme for the elderly to finance the increasing cost of their care.     

Global-market building as state building: China’s entry into the WTO and market reforms of China’s tobacco industry

This article analyzes how China’s increasing engagement in the global market induced significant institution-building in China’s tobacco industry and enabled a power shift from the local authorities to the central authority in controlling this market. During this process of “getting onto the international track,” the central government reorganized the industrial tobacco system and broke up the “monopolies” set up by local governments in order to enhance the competitive capacities of China’s tobacco industry in the global market. Given such a concrete institutional change in China’s tobacco industry, I propose the theory of “global-market building as state building” to explain the interactions among the global market, the nation-states, and the domestic market-building projects. I suggest that nation-states strategically seek to engage themselves in the global market and that, under certain circumstances by taking advantage of their global market engagement, the nation-states can enhance their abilities to govern the domestic market.

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China’s Developing Infrastructure: The Impact of Globalisation

Infrastructure in China is a key service provider, and the current priority accorded to it by the Chinese leaders reflects both the nation’s role as a global player and the commitments of accession to the World Trade Organization (WTO) in 2001. To date the creation of a Chinese nationwide market has been impeded by poor transportation infrastructure and provincial particularism. Accordingly, this paper will examine the development and shares of different transport modes since the beginning of economic reform in the 1980s as well as projections and forecasts for the period ending in 2050. In view of China’s domestic consumption aims and continuing, through changing, foreign trade priorities, there must be better coordination between different transport modes in passenger or freight movement. Finally, the potential for foreign direct investment participation reflects WTO commitments and the globalization of Chinese business. In summary, the institution of a coordinated comprehensive transportation system is crucial for China’s sustainable economic growth.     

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.     

Worthy? Crowdfunding the Canadian Health Care and Education Sectors

Crowdfunding, the practice of asking for money from others using the Internet, is a major private means through which Canadians are funding their health care and education. Crowdfunding has proliferated in Canada during the 2010s and continues to grow, approaching the revenues of Canada's major traditional charities. Proponents describe it as an empowering practice from which anyone can benefit. If its gains are inequitably distributed, however, increasing reliance on this private funding mechanism, especially in core areas of welfare state provision, can further exacerbate inequalities of opportunity and income. This study asks why Canadians turn to health care and education crowdfunding and how equitably funds are raised using this novel method. Based on a mixed methods analysis of 319 campaigns conducted on two prominent crowdfunding platforms between 2012 and 2014, we find that crowdfunding users’ needs frequently correspond to known gaps in the contemporary social safety net, including in the area of cancer care, and that campaigns for older and visible minority Canadians face a disadvantage. We argue that health care and education crowdfunding is a response to the shortcomings of Canadian welfare state provision, but one that reproduces offline inequalities with potentially perilous consequences for democratic life and individual suffering.     

Emotional Labor and Health Care

We examine the literature on emotional labor and health care to demonstrate the potential for emotional labor research to inform how social and medical scientists think about health care and how examining healthcare contexts has contributed to the scientific understanding of emotional labor processes. In doing so, we first review the key terms and definitions that are used within the emotion management perspective and evaluate the ways in which power differences have remained largely implicit features of research on emotional labor in healthcare settings. Finally, we explore how the increasing economic rationalization of health care may be influencing the emotional experiences of today's healthcare professionals and the implications of this trend for future research on emotional labor and the health and well-being of care providers and their patients.     

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.     

Coordinating Health,Extended Care,and Community Support Services

Abstract

Under pressure to maximize the cost-effectiveness of programs, efforts to improve coordination have become increasingly central to the development of the broader health and welfare service delivery system in Australia in the past few years. This article reviews recent experience in two related fields: (1) the coordination of different community care services for older people and people with disabilities, funded by the Home and Community Care program; and (2) the attempt to enhance links between community and residential care services, hospitals, and other health care providers. Why coordination has emerged as such an important issue in the field of community care and, increasingly, across the entire system of what the Australian government now terms health and family services is discussed. A number of measures that have been introduced or are proposed to improve a coordination of services are briefly reviewed. These range from individualistic approaches based on information and referral, through schemes involving gatekeeping, case management and brokerage of services, to models involving the reconfiguration of organizational structures, linkages, and finances. These measures are not mutually exclusive and are increasingly likely to be applied in more complex mixed models of service coordination. It is argued that coordination at the level of direct-service provision is difficult if government policies that direct services lack coordination.     

Issues in Multigenerational Families: Adolescents’ Perceptions of Grandparents’ Declining Health

The impact of declining health in grandparents on grandchildren is largely overlooked in the literature. Similar to their parents, grandchildren may feel pressured between their responsibilities to grandparents while also negotiating their own social and psychological needs (Baranowski (1982). Adolescents 25(67), 575–584). Limited attention is paid to the impact on children’s development when grandparents’ health declines (Baranowski (1982). Adolescents 25(67), 575–584; Mead (1970). Grandparents as educators. In Leichter H. J. (Ed.), The family as educators. Teacher College Press: New York). Narrative themes of adolescents reveal multi-determined reactions to grandparents’ illness through identifications with family members, cultural roles, and individual development. The authors will identify these relevant themes and discuss new interventions with multigenerational families who provide care for older adults in declining health.Marcia Spira and Jack Wall are affiliated with School of Social Work, Loyola University Chicago, Chicago     

Trust and Health Care

Trust is believed to be particularly salient to the provision of health care, and since the establishment of the National Health Service (NHS) in the UK, trust has played an important role in the relationships between its three key actors: the state, healthcare practitioners, and patients and the public. Service users trusted the judgement, knowledge and expertise of health professionals to provide a competent service that met their needs, and they trusted the state to ensure equity in the allocation of public goods and services. These implicit or taken-for-granted trust relationships have, it is claimed, been challenged as a result of the introduction of changes in the organisation and funding for the health service, in the regulation and performance assessment of health professionals, and in public attitudes to health care and scientific medicine. This paper considers the influences of social changes and recent policy and professional initiatives in health care on the structure of trust relations in health care in the UK. It presents a theoretical framework for examining trust relations using the NHS as a case study and concludes with an agenda for future research.     

Parents’ Health and Adult Children’s Subsequent Working Status: A Perspective of Intergenerational Transfer and Time Allocation

This paper frames how parents’ health problems may affect a child’s subsequent working status. Parental health problems occurring in their prime working years undermine an adult child’s resources and tend to affect the child’s preferences over time-allocations among leisure, market- and non-market-labor. Empirical applications in this paper focus on a situation with pervasive health problems, lack of social safety network, and a substantial gender gap in labor market return. Exploiting Russia Longitudinal Monitoring Survey (RLMS) for the period 1994–2004, empirical results indicate that a father’s poor health status is a significant predictor of lowering a daughter’s educational attainment and working probability during her subsequent, adulthood years.     

Medicare and Health Care Reform

Although Medicare constitutes one of the most popular programs of the federal government, even its most ardent supporters would likely agree that improvements could be made and likely should be part of any package of comprehensive health care reform. While some changes could be made as stand-alone reforms. it would be better to integrate changes for the under 65-population with those for the Medicare program. For example, cost-containment strategies would work best if they applied to the population as a whole rather than creating differences that lead to cost-shifting and possible discrimination across groups. The generosity of services covered also ought to be balanced between Medicare and whatever happens elsewhere. This would allow Medicare's cost-sharing structure to be less severe in terms of hospital and skilled nursing care, for example. Finally, while it is tempting to use reductions in spending on Medicare as a means for helping to finance other expansions, the impact of such changes needs to be carefully assessed before assuming that they would create no lasting problems. This essay examines some of the options and likely consequences for Medicare as part of comprehensive health reform.     

Why Has China’s Final Consumption Rate Declined Since 1978? Causes and Implications

Along with the rapid economic growth since 1978, there has been a remarkable trend in China, i.e. the steady decline of the share of final consumption expenditure in GDP that has made China one of economies with a low consumption rate in the world for a long time period. This phenomenon is concerned by economists since it is important for economic policies given the key role of consumption in the economic growth. This paper is to explore causes about decline in China’s final consumption rate since the economic reform. Evidence implies four causes: decrease of consumption propensity, adjustment of national income distribution structure, reform of urban housing system and slow growth of rural income.     

The China health and nutrition survey: an important database for poverty and inequality research

This paper examines the China Health and Nutrition Surveys (CHNS), an ongoing international collaborative project designed to investigate the effects of economic reforms, family planning policies, and other programs implemented by China’s central and local governments on the health and nutritional status of its population.     

Appropriate Therapeutic Care for Families with Pre-Pubescent Transgender/Gender-Dissonant Children

In recent years, a new phenomenon has been observed in U.S. culture, that of pre-pubescent children transitioning socially from one gender role to another, with the support of their families. As this phenomenon becomes more widespread, families, schools and other institutions will turn to mental health care professionals for guidance in navigating new territory. Such children have often been assessed for gender identity disorder; the traditional treatment plan for those so diagnosed included attempts to steer their gender behavior in more “gender-appropriate” directions. Allowing such children to self-actualize, viewing their behavior as indicative of innate identity, is a relatively new approach. This paper will focus on the social worker’s or therapist’s role in helping pre-pubescent children and their families, should the families decide identity actualization is the path they would prefer.     

Children's Rights and Health Care

SUMMARY. Health and health care are defined as rights in the UN Convention on the Rights of the Child. However, although the National Health Service offers universal coverage, it is hugely expensive with growing costs and growing demands made upon it. Rationing is inevitable and priorities must be set. This paper discusses the part that children's rights can play in influencing equitable provision and the quality of care.     

Health care reform: managed competition and beyond

Since the election, the health care reform debate has focused on three broad features: implementation of managed competition, changes in the tax treatment of health insurance, and the imposition of budget caps or targets. The basic element of managed competition is the creation of sponsors who act as collective purchasing agents for large groups of individuals. One of the potentially most politically difficult issues in implementing any health care reform proposal is likely to be defining the minimum standard benefit package. It will determine the costs society bears, the income of providers, the health of many individuals, and the attributes of a workable health care reform package. Managed competition is intended to foster competition among health plans on the basis of cost and quality. The measures of quality actually employed in the health care system will determine in large part the incentives faced by insurers, providers, and consumers. The problem of adverse selection is potentially the most important issue in reforming the health insurance market. If individuals can opt not to purchase health benefits, poorer risks will be more likely to purchase health insurance than good risks, and at minimum the price of these benefits will be higher than would otherwise be the case. Managed competition requires that individuals share at least some of the financial consequences of their choices among health plans. As a result, most managed competition proposals change the tax code by limiting the exclusion of employer contributions to health insurance from worker's taxable income. Changing the health insurance market, mandating employer health benefits, and changing the tax code may have significant effects on the health care delivery system, but they are unlikely to reduce health care cost inflation in the near term. One of the proposals for restraining the growth in health care costs is the imposition of a budget on the amount spent on health care services. The combination of the constraints placed on federal governmental action by the budget and the significant political problems involved in reaching a consensus on the important elements of health care reform may limit the ability of the federal government to implement national health care reform in the near term. As a result, individual states may be encouraged by the federal government to continue to experiment with their own health reform programs.     

Long-Term Care Funding in Canada

Summary

When Canada was founded, health care was delegated as a provincial responsibility. Although the federal government shares a portion of health care costs, it is not directly responsible for the planning, delivery, and governance of health services. The 1984 Canada Health Act set national standards for the provision of physician and hospital services, but it does not apply to home care and long-term care facilities. Consequently, each province has established a unique approach to long-term care, resulting in a health policy mosaic. This paper examines different approaches to funding long-term care with a particular emphasis on the impacts of regionalization and of the implementation of case-mix-based funding systems.