The Association Between the New Rural Cooperative Medical System and Health Care Seeking Behavior Among Middle-Aged and Older Chinese

The new rural cooperative medical system (NCMS) is the primary form of social insurance in rural China. This study aims to explore how the NCMS influences the health care seeking behaviors of middle-aged and older Chinese, considering the family and community contexts. A series of multi-level (three-level) models using data from the first wave of the China Health and Retirement Longitudinal Study (CHARLS) are used. We find that the presence of NCMS coverage has a statistically significant association with seeking inpatient and outpatient care but not physical checkups among middle-aged and older rural Chinese: Rural residents insured by NCMS were more likely to seek inpatient and outpatient care than people who were not insured. Other factors at the individual level (such as self-perceived health and number of doctor-diagnosed chronic diseases), the family level (such as living arrangements and household expenditures), and the community level (such as the presence of township hospitals within the community) are also significant predictors of health care seeking behaviors.     

The Impact of In-Home Services Utilization on the Institutionalization of Older People in Korea

As a result of aging populations, institutionalization of older people is creating an increasing financial burden in many countries. The purpose of the present study was to explore the impact of in-home service utilization on institutionalization. The subjects were newly certified as eligible for long-term care insurance between January and February 2009 in Korea. The follow-up period was 40 months, to April 2012. We used logistic regression models to identify factors influencing the transition to institutional service, adjusting for gender, age, living status, income level, activities of daily living, and chronic disease. The institutionalization rate was estimated to be 17.3% over 40 months. The interval from transitional living to institutionalization was 36 ± 8 months. Risk factors of transition to institutional services are being female, having advanced age, living with friends or cousins, getting dementia, and not using in-home services. We determined that institutionalization is mitigated by use of in-home services. Therefore, supplying appropriate in-home services to current nonusers would help to greatly reduce the rate of institutionalization of older people.     

Engaging Experts: Expanding Participation and Enhancing Research in Chinese Eldercare Institutions

Due to the myriad factors straining China’s traditional family-based eldercare system, today unprecedented numbers of older adults are turning to institutions for caregiving needs. As researchers and policy makers organize conferences, analyze trends, and allocate resources, the subjective experiences of elders themselves are often forgotten or ignored. While providers recognize that institutionalized elders are at an increased risk for mental health issues, most cite personnel and resource shortages as insurmountable barriers to provision. Using examples from ethnographic research in Chinese eldercare institutions, this article examines the link between participation and mental health for contemporary Chinese elders and makes a case for expanding the role of elders in research in order to improve both the experience and understanding of institutional eldercare.     

Domesticating insurance,financializing family lives: the case of private health insurance for children in Finland

This article explores the domestication of a financial instrument that is much used in contemporary Finland, but that most of its users do not primarily think about in terms of being a financial instrument: the private health insurance for children. In Finland, all children are covered by social insurance and are entitled to free public health service with very low costs, if any. Yet, some 40 percent of families want to supplement this service with private products. Many fear that the popularity of the private health insurance for children contributes to a vicious circle that ends up weakening the legitimacy of, and the service given by, the public health sector; inequality in the face of health risks threatens to be aggravated, as well. Therefore, this financial instrument has become an object of political controversy. The main question of the article is: how do economic, political and moral valuations become intertwined in the domestication of insurance? The concept of ‘domestication’ is found helpful for analysing the pragmatics of valuation and for appreciating the dynamics and the heterogeneity of forces at play when financialization influences everyday life. The study argues that when financial instruments are appropriated they are also transformed; thus, they should not be viewed as homogeneous tools that have similar effects in all contexts of use. The main empirical materials studied are interviews with families with and without private health insurance policies for their children.     

‘There’s a lot of places I’d like to go and things I’d like to do’: the daily living experiences of adults with mild to moderate intellectual disabilities during a time of personalised social care reform in the United Kingdom

Adult social care services in the United Kingdom have undergone a period of transformation over recent years, characterised by a drive towards personalised care. Concurrently, social care budgets have been significantly reduced. This study aimed to explore the daily living experiences of adults with mild/moderate intellectual disabilities, who are at risk of no longer meeting eligibility criteria for statutory support. Focus group discussions, which included both people with intellectual disabilities and support workers, were analysed thematically. Two broad themes are presented: independence and agency; and social capital and well-being. While some participants echoed ideas central to the personalisation narrative, a number of contextual barriers to achieving greater independence and agency were discussed. Moreover, greater independence was not a desired goal for all participants. The findings highlight the potential mismatch between personalised social care, as delivered within significant budget constraints, and the needs of adults with intellectual disabilities.     

Care in a Time of Austerity: the Electronic Monitoring of Homecare Workers’ Time

Austerity places intense pressures on labour costs in paid care. In the UK, electronic monitoring technology has been introduced to record (and materially reduce) the working time and wages of homecare workers. Based on empirical findings, we show that, in a ‘time of austerity’, care is reductively constructed as a consumption of time. Service users are constructed as needy, greedy, time‐consumers and homecare workers as resource‐wasting time‐takers. We point to austerity as a temporal ideology aimed at persuading populations that individual deprivation in the present moment, self‐sacrifice and the suppression of personal need in the here and now is a necessary requirement to underpin a more secure national future. Accordingly, women in low‐waged care work are required to eschew a rights‐bearing, present‐tense identity and are assumed willing to suppress their entitlements to lawful wages as a sacrifice to the future. By transforming our understandings of ‘care’ into those of ‘time consumption’, and by emphasizing the virtue of present‐tense deprivation, a politics of austerity appears to justify time‐monitoring in care provision and the rationing of homecare workers’ pay.     

Named social workers – better social work for learning disabled people?

In 2016, the Department of Health in England announced that it would pilot the role of Named Social Worker. We chose to be part of the pilot because we regularly witness too many people’s lives being defined by restrictions imposed by professionals. Erroneous associations between the concepts of risk and danger have become the norm in how learning disabled people’s decision-making is perceived and managed. However, we believe social workers educated in the social model of disability and grounded more generally in disability studies offer an alternative perspective. The pilot is an opportunity to test our hypothesis that social work practice rooted in social model thinking can successfully challenge oppressive practice and disabling barriers, thus providing the opportunity for social workers to genuinely be ‘servants not masters’ in the lives of disabled people.     

The Extent and Nature of Practitioners,Encounters with Alcohol and Other Drug Use in Social Work and Social Care Practice

This article considers the extent and nature of social work and social care practitioners' experience of working with service users whose lives are affected by the problematic use of alcohol or other drugs (AOD). It draws on the findings of a national study of ‘working with alcohol and drug use’ which was conducted in England in 2010–2011. The study reported here comprised an online survey of front-line practitioners (n = 597), complemented by 12 practitioner focus groups and interviews with 21 key informants from participating local authorities and substance use treatment services. This paper focuses primarily on data from one element of the survey. Findings indicate that the great majority of staff encountered service users who are affected by AOD problems at some level, although there were differences between groups of practitioners in the extent and nature of AOD problems for different groups of service users. The differential experiences of staff according to their client groups underlines the need for education and professional development not only to provide training on working with AOD but to ensure that training is contextualised and relevant to practitioners across the range of social work and social care services.     

Dialogic communication in the health care context: A case study of Kaiser Permanente's social media practices

This case study examines how one of the largest not-for-profit health care organizations in the US, Kaiser Permanente, uses social media to communicate with its stakeholders. Through content analysis and interviews, this study identifies the communication models reflected in a sample of social media posts and examines the organization's approach to using social media. The study finds evidence of both one-way and two-way communication models, as well as principles of dialogic communication. The implications of these findings are discussed.