Devolution and Patient Choice: Policy Rhetoric versus Experience in Practice

Background: market reforms in England have been identified as making a clear distinction between English health policy and health policy in the devolved systems in Northern Ireland, Scotland and Wales. Patient choice is a high profile policy in the English National Health Service that constitutes significant changes to the demand side of health care. It is not clear what national differences this has led to regarding implementation of policy. This article presents the findings from a large UK‐wide study on the development and implementation of policies related to patient choice of provider. The findings reported here relate specifically to the policy development and organizational implementation of choice in order to examine the impact of devolution on health care policy. Aim: this study examines patient choice of provider across all four countries of the UK to understand the effect of differences in national policies on the organization and service how choice of provider presented to patients. Methods: at the macro‐level, we interviewed policymakers and examined policy and guidance documents to analyze the provenance and determinants of national policy in each UK nation. At the Primary Care Trust or Health Board level, we interviewed a range of public and private health service providers to identify the range of referral pathways and where and when choices might be made. Finally, we interviewed ear, nose and throat, and orthopaedics patients to understand how such choices were experienced. Findings: while we found that distinct rhetorical differences were identifiable at a national policy level, these were less visible at the level of service organization and the way choices were provided to patients. Conclusion: historical similarities in both the structure and operation of health care, coupled with common operational objectives around efficient resource use and waiting times, mediate how strategic policy is implemented and experienced in the devolved nations of the UK.     

Working to learn and learning to work: A profile of service-learning courses in university public relations programs

The purpose of this study was to use quantitative survey methodology triangulated with qualitative interviews to explore faculty perceptions in four key areas of service-learning in public relations programs: (1) conceptualization, (2) outcomes, (3) institutional support, and (4) instructional techniques. Results support findings in other disciplines. Public relations course goals reflect four different types of stated learning outcomes: (1) application to real-world settings, (2) teamwork, (3) interactions with PR clients, and (4) civic responsibility, but most educators include reflection opportunities only on public relations concepts and not on community engagement.     

On Not Being Supposed To

The beginning phase of analytic work with a woman consumed by fears that she might be lesbian is presented both to show how these fears were unpacked over time and to provide clinical material through which shifts in theoretical perspectives on gender, identity, and sexuality can be discussed.     

Extreme Financial Strain: Emergent Chores,Gender Inequality and Emotional Distress

This qualitative study examines the gendered division, and emotional effects, of household financial labor among severely indebted couples prior to filing consumer bankruptcy. Interviews with 19 newly bankrupt couples in Spokane, Washington, illustrate how, before bankruptcy, the peripheral and mundane chore of paying bills transforms into multiple arduous core chores: micro-management of money, debt collector negotiations, and researching and deciding to file bankruptcy. These newly emergent low-control chores are gendered and the wives’ responsibility. Gendering occurs for two reasons. Some women retain responsibility for emergent chores because husbands exhibit financial irresponsibility. Others request their husbands’ assistance, but the men refuse because the financial chores are upsetting or bothersome. Many wives who manage the newly emergent financial chores experience negative emotional effects.     

Dimensions of Intimacy: The Interrelationships between Gender and Listening

In the introduction to their text on intimate relationships, Perlman and Duck (1987, p. 9) note that psychologists, sociologists, family scientists and communication experts “are all making important contributions” to the study of personal relationships, thereby reflecting the recent multidisciplinary aspect of this field. However, in many important works on intimacy and intimate relationships, the gender differences that often create barriers to intimacy, and how these differences are reflected in the communication process, have, until recently, been notably absent.¹ While alluded to repeatedly, nowhere, in fact, is the connection directly made between intimacy and the listening behavior of women and men. This paper therefore attempts to fill this absence by integrating into the literature on intimacy the salient aspects of listening that affect the quality of intimate relationships between women and men. Hopefully, such understanding will contribute to our knowledge of the concept of intimacy in our culture and will facilitate razing the barriers to intimate relationships that are a product of cultural expectations.     

Supplemental Security Income recipients affected by Hurricanes Katrina and Rita: an analysis of two years of administrative data

Approximately 350,000 Supplemental Security Income (SSI) recipients—elderly and disabled individuals with low incomes and assets—lived in the areas directly affected by Hurricanes Katrina and Rita in August 2005. We show that recipients from affected areas were more likely to leave the program, have more volatile participation patterns, and leave the area in the 2 years following the hurricanes than were recipients from unaffected areas. Among recipients from more severely affected areas relative to those from unaffected states, the odds of dying were 40% greater and the odds of leaving SSI for other reasons were 23% greater. Additionally, 31% of recipients from more severely affected areas had experienced a non-payment month, with 46% subsequently returning to the rolls (compared with 23% and 41% of recipients from unaffected states). Nearly 60% of SSI recipients from more severely affected areas lived in a different county or parish 2 years after the hurricanes, compared with about 12% from unaffected areas. In all, our findings demonstrate that natural disasters such as Hurricanes Katrina and Rita can have large and persistent impacts on SSI recipients, including effects on program status, mortality, and geographic location.     

Reunifying families, cutting costs: housing-child welfare partnerships for permanent supportive housing

In the absence of an adequate supply of affordable, quality housing, child welfare agencies are placed in the unenviable position of separating families to protect children from the debilitating effects of homelessness. This article presents recommendations for costeffective housing-child welfare partnerships that will shift the burden of providing adequate housing back to housing agencies. These partnerships have the potential to move child welfare agencies closer to achieving permanence and well-being for all children.     

Resistive training and long-term function in older adults

The purpose of this study was to evaluate the effects of a 24-month moderate-intensity resistive-training intervention on strength and function in older adults. A repeated-measures experimental research design was employed as a sample of 55 apparently healthy, older, community-dwelling volunteers (30 exercisers- 25 women and 5 men; 25 comparisons- 16 women and 9 men) were evaluated for strength of 5 muscle groups that influence lower extremity movement and physical function. Strength and function were evaluated at 6-month intervals. The findings from this study indicate that a moderate-intensity resistive-training program increases strength in older adults and that the strength benefits are retained for the duration of the intervention. Furthermore, a long-term strength-training program can increase independent-function skills in older adults and might therefore aid in prolonging functional independence.