Obamacare and the Politics of Universal Health Insurance Coverage in the United States

In the USA, universal coverage has long been a key objective of liberal reformers. Yet, despite the enactment of the Patient Protection and Affordable Care Act (PPACA) (commonly known as ‘Obamacare’) in 2010, the USA is not set to provide health care coverage to all, even if and when that reform is fully implemented. This article explores this issue by asking the following question: Why was a clear commitment to universal coverage, the norm in other industrialized countries, excluded as a core objective of the PPACA and how has post‐enactment politics at both the federal and the state level further shaped coverage issues? The analysis traces the issue of universal coverage prior to the debate over the PPACA, during the 2008 presidential race, and during consideration of the bill. The article then looks at the post‐enactment politics of coverage, with a particular focus on how states have responded to the planned use of the Medicaid programme to expand access to care. The article concludes by discussing how an explanation of the limits of the PPACA, in terms of both its commitment to universal coverage and, more importantly, the failure to provide comprehensive health insurance to all, requires an understanding of complex institutional and policy dynamics.     

试论人力资本投资理论与我国高等教育

利用人力资本理论探讨高等教育的发展以及中国现代化建设,提出高等教育投入产出的实质是人力资本投资过程。针对人力资本投资过程中所面临的问题,首先要确定高等教育的主体地位,其次根据国家、个人、企业团体的权益,建立起完善的高等教育成本分担理论。     

Minimum Divergence,Generalized Empirical Likelihoods,and Higher Order Expansions

This article studies the minimum divergence (MD) class of estimators for econometric models specified through moment restrictions. We show that MD estimators can be obtained as solutions to a tractable lower dimensional optimization problem. This problem is similar to the one solved by the generalized empirical likelihood estimators of Newey and Smith (2004 Newey , W. K. , Smith , R. J. ( 2004 ). Higher order properties of GMM and Generalized Empirical Likelihood estimators . Econometrica 72 : 219 – 255 .[Crossref], [Web of Science ®] , [Google Scholar]), but it is equivalent to it only for a subclass of divergences. The MD framework provides a coherent testing theory: tests for overidentification and parametric restrictions in this framework can be interpreted as semiparametric versions of Pearson-type goodness of fit tests. The higher order properties of MD estimators are also studied and it is shown that MD estimators that have the same higher order bias as the empirical likelihood (EL) estimator also share the same higher order mean square error and are all higher order efficient. We identify members of the MD class that are not only higher order efficient, but also, unlike the EL estimator, well behaved when the moment restrictions are misspecified.     

中国人口年龄结构与居民医疗保健消费

本文借助中国2001—2010年的省级面板数据,运用动态面板GMM估计方法,考察了中国人口年龄结构(少儿和老年抚养系数)变化对居民医疗保健消费支出的影响。结果发现,中国少儿抚养系数对居民医疗保健消费支出的影响不显著;老年抚养系数对居民医疗保健消费支出有正影响,即老年抚养系数的上升会带动居民人均医疗保健消费支出的增加。此外,本文还发现,医疗保健消费支出的滞后一期系数都为正,系统GMM两步估计系数为0.51,表明居民医疗保健消费支出存在较强的惯性;人均收入增长对居民医疗保健消费支出有正向的显著影响。     

高等职业技术教育概念术语辨析

关于高等职业技术教育的概念术语有“高职”、“高职教育”、“高等职业教育”、“高等职业技术教育”等,术语的紊乱势必影响我们对概念的科学认识。因此有必要进行术语的厘清。这些术语中关键是要分辨清楚“高等职业教育”和“高等职业技术教育”。对这两个术语可以围绕“技术”、“职业”作扩词式的研究。从“技术”和“职业”到“技术教育”和“职业教育”到“职业技术教育”到“高等职业技术教育”是一种值得尝试的研究思路。     

Suicide prevention and community-level indictors

This study sought to develop a set of easily obtainable, relevant measures of a community's condition that could be used to guide its suicide prevention efforts. Existing data were gathered across 159 Georgia counties for nine potential social indicators (rates of net migration, divorce, unemployment, violent crimes reported, driving under the influence of alcohol or drugs [DUI] crashes, high school dropouts, Temporary Assistance for Needy Families [TANF], percentage of population aged 65 or older, and percentage of population who are white males) that had been chosen by the communities. Data on the social indicators from 1995 through 1999 were averaged and analyzed to determine their correlation with aggregated 5-year county suicide rates. Results of multivariate modeling procedures showed number of DUI crashes and percentage of the population aged 65 or older to be significant correlates of the suicide rate, controlling for other potential indicators. These preliminary data may provide a useful model of a county's 5-year suicide rate among counties reporting 20 or more suicides. Research with additional indicators and in other states will help determine the generalizability of these findings to other communities.     

Social work and Nordic welfare policies for children—present challenges in the light of the past1

The aim of this article is to explore welfare policies for children in five Nordic countries—Denmark, Finland, Iceland, Norway and Sweden—and in that context identify what kinds of issues and challenges social work is currently facing. The data reviewed consist of policy documents, law texts, official reports, statistics, professional texts, and previous research. Policies and laws on children's protection; provisions, including policies on state benefits and care for children; and the autonomous integrity of children in terms of the norms and policies concerning their participation, in particular in public everyday life, are analysed from a historical perspective. Hence, future challenges for social work are analysed in light of the past. Our conclusion is that social workers have a unique opportunity, based on their close encounters with children as clients, to work for the realisation of children's rights. Furthermore, by applying a holistic perspective to issues of childhood and parenthood, social workers can contribute to the development of knowledge on how welfare systems can meet the challenges brought about by the new ideas of children's rights, social changes, globalisation, and the new ideological concepts of risk that have arisen in child welfare.

Artikkeli tarkastelee lasten hyvinvointipolitiikan kehitystä viidessä Pohjoismaassa—Tanskassa, Suomessa, Islannissa, Norjassa ja Ruotsissa—ja sen valossa sitä millaisia kysymyksiä ja haasteita tämän päivän lasten hyvinvoinnin parissa tehtävä sosiaalityö kohtaa. Artikkelissa on käytetty aineistona erilaisia politiikkadokumentteja, lakeja, julkisia raportteja,tilastoja, professionaalisia kirjoituksia sekä aiempaa tutkimusta. Artikkelissa analysoidaan historiallisesta näkökulmasta lastensuojelun, sosiaalipalvelujen, lapsille suunnattujen sosiaalisten tukien sekä lasten osallistumista koskevia normeja ja toimintapolitiikkaa. Sosiaalityön tulevaisuushaasteita analysoidaan menneisyyden valossa. Johtopäätöksemme on, että sosiaalityöntekijöillä on ainutlaatuinen mahdollisuus, joka perustuu heidän läheisiin työskentelysuhteisiinsa vaikeissa elämäntilanteissa olevien lasten kanssa, olla lasten oikeuksien todellisia toimeenpanijoita. Lisäksi lapsuuden ja vanhemmuuden näkökulmat yhdistävästä toimintapaikastaan käsin juuri sosiaalityöntekijät voivat vaikuttaa tutkimukseen ja kehittämiseen niin, että hyvinvointipalvelut ja –etuudet kohtaisivat nykyistä joustavammin lasten oikeuksien, yleisen yhteiskuntamuutoksen, globalisaation ja kovin ideologisena pitämämme riskiajattelun haasteet.     

新型农村合作医疗的参合补助——悖论及路径优化

新农合的财政补助水平与农民需求存在较大缺口,客观上需要政府提高补助水平。但由于农民有限理性的存在,在个人缴费在先且与财政补助同比增长的制度安排下,形成了农民既需要参合补助,又不愿因增加个人缴费以获得补助的悖论,且此情况会因制度供给缺陷而激化。因此,需要对新农合的参合补助路径进行优化。设计灵活的参合缴费模式,调整农民缴费与政府补助的增长幅度,提高农民医疗补偿的比例都是可行的选择。     

Validating a Behavioral Health Instrument for Adults: Exploratory Factor Analysis

ABSTRACT

Increasingly, social workers and behavioral health practitioners use assessment instruments to support service planning and to monitor progress. Following statewide implementation of the Adult Needs and Strengths Assessment (ANSA) to identify behavioral health symptoms, related functional challenges, risks, and strengths, this validation study explored the underlying structure of the instrument. An exploratory factor analysis used routinely collected information for Midwestern adults with diagnosed behavioral health disorders who participated in community-based services (N = 46,013). Five factors with adequate to good internal consistency (α = 0.733?0.880) emerged: personal recovery, trauma and stress related problems, substance use risks, self-sufficiency, and cultural-linguistic considerations. Validation of the ANSA supports use of the instrument to engage individuals and families, to plan services, to monitor progress, and to conduct research. Implications for social work education, supervision, and practice include the importance of understanding culture, holistic assessment, and services supporting personal recovery for individuals living with mental illness or substance use disorders. Confirmation of findings requires additional research.     

Older Persons’ Views on Using Cash‐for‐Care Allowances at the Crossroads of Gender,Socio‐economic Status and Care Needs in Vienna

The article aims to contribute to understanding social inequalities resulting from familization (or de‐familization) tendencies among cash‐for‐care beneficiaries in a Conservative welfare state. It highlights justifications for choices in accessing and using care in a cash‐for‐care scheme from the perspective of care recipients aged 80 years and older in Vienna. Along key dimensions characterizing care recipients’ experiences, we identify four different user groups, which reflect recipients’ individual characteristics, particularly gender, socio‐economic status (SES), and care needs, and the respective care arrangement. The groups are dubbed: (1) the self‐confident; (2) the illiterate; (3) the dependent; and (4) the lonely. Narrative interviews with 15 frail older people were held in 2014 and analyzed using the framework analysis method. Results show that familiarity with support structures associates with higher SES, while those who depend on others for acquiring information or organizing care express ambivalence in choosing between formal and informal care. Engagement in deciding which care type to use is limited among people of lower SES or with complex care needs, but own experience as informal caregiver for a family member increases care recipients’ long‐term care (LTC) system literacy. Gender differences among care recipients were limited, yet middle‐class female recipients often expressed normative claims for family care from female relatives. We conclude that unconditional care allowance schemes may reinforce existing gender relations, particularly among informal caregivers, as well as underpin socio‐economic differences among LTC users in old‐age. Results also partly question the assumptions of choice and empowerment implicit in many cash‐for‐care schemes.