Constitutional guarantees to health care in Spain

This analysis of the Spanish health care system is one in a series of such studies undertaken by the author, following a grid of factors that influence the delivery and financing of health care. The purpose of the national analyses is to facilitate a comparison of the United States' and other health care systems in terms of anticipated reform of the U.S. system. Analyses of the U.S. and nine other national systems are included in a book that has just been published by the College. Spain and nine additional countries will be studied in a book due for publication later this year. A final book with ten additional national analyses will appear in 1996.     

Public Administration and Organizational Theory: Prescribing the Proper Dose

Public Organization Review - Since the founding of the field of public administration, scholars have struggled with questions related to the “publicness” of public organizations...     

Modeling Insurer‐Homeowner Interactions in Managing Natural Disaster Risk

The current system for managing natural disaster risk in the United States is problematic for both homeowners and insurers. Homeowners are often uninsured or underinsured against natural disaster losses, and typically do not invest in retrofits that can reduce losses. Insurers often do not want to insure against these losses, which are some of their biggest exposures and can cause an undesirably high chance of insolvency. There is a need to design an improved system that acknowledges the different perspectives of the stakeholders. In this article, we introduce a new modeling framework to help understand and manage the insurer's role in catastrophe risk management. The framework includes a new game‐theoretic optimization model of insurer decisions that interacts with a utility‐based homeowner decision model and is integrated with a regional catastrophe loss estimation model. Reinsurer and government roles are represented as bounds on the insurer‐insured interactions. We demonstrate the model for a full‐scale case study for hurricane risk to residential buildings in eastern North Carolina; present the results from the perspectives of all stakeholders—primary insurers, homeowners (insured and uninsured), and reinsurers; and examine the effect of key parameters on the results.     

‘Problematising’ Australian policy representations in responses to the physical health of people with mental health disorders

Australia, like other jurisdictions, is recognising the poorer physical health of people with mental health disorders. This paper explores policy responses to this issue through discourse analysis of 22 Australian Federal and State government policy documents published in 2006–2011. The paper utilises Bacchi's ‘what's the problem represented to be?‘ approach to explore policy solutions in relation to the representation of the issue, enabling identification of issues which are not problematised and policy solutions that have not been considered. The poor physical health of people with mental health disorders is attributed in policy to poor lifestyle habits and limited access to monitoring of physical health care. Three policy solutions are offered: collaborative care delivery involving greater use of fee‐for‐service primary care to manage physical health; the monitoring of physical health status by mental health teams; and the promotion of lifestyle change. These solutions fail to address ongoing issues with collaboration between specialist mental health and primary care services. Reliance upon fee‐for‐service primary mental health care may, in fact, reduce rather than increase access to services. The strategies are discussed in light of neoliberal ideals of governance and personhood which are underpinned by informed consumer choice and personal responsibility for health.     

休闲的延伸观点:可能性与挑战

休闲内涵在美国学术界已经存在了50年.虽然当代的休闲概念来自于现代工业时代,但其定义和内涵仍在不断延展.本文主要从休闲时间、娱乐活动、心理状态,空间地点和文化背景五个方面来阐述休闲的历史与发展.其中一些观点从女权主义的角度为读者提供了西方文化对休闲的诠释.同时,本文还讨论了休闲研究有关的可能性与挑战,以及休闲在21世纪的含义.     

The Constitution of Risk Communication in Advanced Liberal Societies

This article aims to bring to the fore some of the underlying rationales that inform common conceptions of the constitution of risk communication in academic and policy communities. “Normative,”“instrumental,” and “substantive” imperatives typically employed in the utilization of risk communication are first outlined. In light of these considerations, a theoretical scheme is subsequently devised leading to the articulation of four fundamental “idealized” models of risk communication termed the “risk message” model, the “risk dialogue” model, the “risk field” model, and the “risk government” model, respectively. It is contended that the diverse conceptual foundations underlying the orientation of each model suggest a further need for a more contextualized view of risk communication that takes account not only of the strengths and limitations of different formulations and functions of risk communication, but also the underlying knowledge/power dynamics that underlie its constitution. In particular, it is hoped that the reflexive theoretical understanding presented here will help to bring some much needed conceptual clarity to academic and policy discourses about the use and utility of risk communication in advanced liberal societies.     

Doing time,filling time: Bureaucratic ritualism as a systemic barrier to youth reentry

This paper contributes to knowledge about the challenges of youth reentry by examining how transitional services can function as a barrier to – instead of a support for – healthy reintegration of youth. Using participant observation conducted in 2003–2004 at a juvenile aftercare program in Philadelphia, we explore a pervasive problem that Merton (1940) termed “bureaucratic ritualism.” Case workers and administrators became beholden to daily demands related to billing, paperwork, and meeting minimum standards, supplanting the larger goal of individualized care for young people returning from placements. Outputs, not outcomes, became the measure of success. We identify a number of reintegration activities that were ritualistic in nature and explore the features of the system that encouraged ritualistic responses by aftercare workers. Finally, we identify a group of aftercare workers, which we call “proactive caregivers” who resisted the organizational pressures to become bureaucratic ritualists.     

Costs of Treating Depression With Individual Versus Family Therapy

Depression is one of the most common concerns that bring clients to treatment. Although marriage and family therapy has been shown to be an effective treatment, little research exists regarding the cost‐effectiveness of related services. In this study, we examined claims data for 164,667 individuals diagnosed with depression to determine (a) differences in the cost of treating depression according to type of therapy and license type, (b) differences in recidivism rates by age, gender, type of therapy, and type of mental health professional, and (c) differences in cost‐effectiveness by therapy modality and type of professional. The results showed that services provided by marriage and family therapists resulted in the lowest recidivism rate, and family therapy services were the least expensive.     

Managing Care and Joined Up Thinking in the Curriculum

This paper discusses the curriculum development of a level three undergraduate course in managing care. It was produced and is presented by The Open University. The course is aimed at frontline managers in health and social care. The course team made consultation with service users, carers and managers a priority in developing the curriculum. The paper discusses this consultation process and the learning gained from it. A major contribution was to clarify debates about how far the course should have one core curriculum and how far it should offer specialist options for managers in different settings. Service users and carers had strong views on the need for better co‐ordination of services and recognition of individual needs rather than divisions into service‐led categories. Managers stressed the importance of reflecting the reality of frontline management. This helped the course team to develop a framework that stresses the commonality in the work and the importance of ‘practice‐led’ management. Service users and managers were involved as critical readers of course texts to ensure that the consultation process continued through the course development. A second strand is the need for the course to be accessible to those not yet in management positions, and extracts from an interactive CD‐ROM which presents case study material demonstrate the innovative joined up and accessible approach taken to student learning needs.