Social Security Programs Throughout the World: The Americas, 2011

[Excerpt] This fourth issue in the current four-volume series of Social Security Programs Throughout the World reports on the countries of the Americas. The combined findings of this series, which also includes volumes on Europe, Asia and the Pacific, and Africa, are published at six-month intervals over a two-year period. Each volume highlights features of social security programs in the particular region. The information contained in these volumes is crucial to our efforts, and those of researchers in other countries, to review different ways of approaching social security challenges that will enable us to adapt our social security systems to the evolving needs of individuals, households, and families. These efforts are particularly important as each nation faces major demographic changes, especially the increasing number of aged persons, as well as economic and fiscal issues

Social Security Programs Throughout the World: Africa, 2011

[Excerpt] This third issue in the current four-volume series of Social Security Programs Throughout the World reports on the countries of Africa. The combined findings of this series, which also includes volumes on Europe, Asia and the Pacific, and the Americas, are published at six-month intervals over a two-year period. Each volume highlights features of social security programs in the particular region. This guide serves as an overview of programs in all regions. A few political jurisdictions have been excluded because they have no social security system or have issued no information regarding their social security legislation. In the absence of recent information, national programs reported in previous volumes may also be excluded. In this volume on Africa, the data reported are based on laws and regulations in force in January 2011 or on the last date for which information has been received

On the relevance of the “genetics-based” approach to medicine for sociological perspectives on medical specialization

This paper draws on a study on the development of medical genetics as a medical specialism in the UK and Canada to reflect on how local and national contexts affect specialty formation. The paper begins by supporting earlier findings in the literature that stress, first, technological innovations as driving specialty formation, and, second, the domination of physicians in the division of medical labour. Beyond this, however, the paper explores the specific circumstances under which geneticists set about turning their work into a medical specialism based on a “genetics-based approach” to illness and how “medical genetics” as a specialism was assessed and configured to fit national and regional health service requirements

'I was just gobsmacked': care workers responses to BBC Panoramas 'Undercover care: the abuse exposed': invoking mental states as a means of distancing from abusive practices

This paper draws upon discourse analytic techniques and discursive psychology to examine how care workers build accounts of viewing the BBC Panorama programme “Undercover Care: The Abuse Exposed” which graphically documented the abuse of people with learning disabilities in a residential care setting. 56 interviews were conducted as part of a project concerning adult safeguarding. The analysis considers how careworkers report their reactions and the interactional strategies they use to construct themselves as shocked and disbelieving and thus, as oppositional to the extreme practices in the programme. Their role as careworkers, and therefore as ‘insiders’ of the industry that allowed such abuse to happen, makes matters of stake and agency live issues for this particular group; and constructions of ‘shock’ and ‘disbelief’ are potential ways for participants to distance themselves from the abuse shown in the programme. More broadly, these data show how the invocation of mental states contributes to the management of other discursive business, namely, that of fending off any association with the aforementioned extreme practices

Integration and continuity of primary care: polyclinics and alternatives - a patient-centred analysis of how organisation constrains care co-ordination

Background An ageing population, the increasing specialisation of clinical services and diverse health-care provider ownership make the co-ordination and continuity of complex care increasingly problematic. The way in which the provision of complex health care is co-ordinated produces – or fails to produce – six forms of continuity of care (cross-sectional, longitudinal, flexible, access, informational and relational). Care co-ordination is accomplished by a combination of activities by patients themselves; provider organisations; care networks co-ordinating the separate provider organisations; and overall health-system governance. This research examines how far organisational integration might promote care co-ordination at the clinical level. Objectives To examine (1) what differences the organisational integration of primary care makes, compared with network governance, to horizontal and vertical co-ordination of care; (2) what difference provider ownership (corporate, partnership, public) makes; (3) how much scope either structure allows for managerial discretion and ‘performance’; (4) differences between networked and hierarchical governance regarding the continuity and integration of primary care; and (5) the implications of the above for managerial practice in primary care. Methods Multiple-methods design combining (1) the assembly of an analytic framework by non-systematic review; (2) a framework analysis of patients’ experiences of the continuities of care; (3) a systematic comparison of organisational case studies made in the same study sites; (4) a cross-country comparison of care co-ordination mechanisms found in our NHS study sites with those in publicly owned and managed Swedish polyclinics; and (5) the analysis and synthesis of data using an ‘inside-out’ analytic strategy. Study sites included professional partnership, corporate and publicly owned and managed primary care providers, and different configurations of organisational integration or separation of community health services, mental health services, social services and acute inpatient care. Results Starting from data about patients’ experiences of the co-ordination or under-co-ordination of care, we identified five care co-ordination mechanisms present in both the integrated organisations and the care networks; four main obstacles to care co-ordination within the integrated organisations, of which two were also present in the care networks; seven main obstacles to care co-ordination that were specific to the care networks; and nine care co-ordination mechanisms present in the integrated organisations. Taking everything into consideration, integrated organisations appeared more favourable to producing continuities of care than did care networks. Network structures demonstrated more flexibility in adding services for small care groups temporarily, but the expansion of integrated organisations had advantages when adding new services on a longer term and a larger scale. Ownership differences affected the range of services to which patients had direct access; primary care doctors’ managerial responsibilities (relevant to care co-ordination because of their impact on general practitioner workload); and the scope for doctors to develop special interests. We found little difference between integrated organisations and care networks in terms of managerial discretion and performance. Conclusions On balance, an integrated organisation seems more likely to favour the development of care co-ordination and, therefore, continuities of care than a system of care networks. At least four different variants of ownership and management of organisationally integrated primary care providers are practicable in NHS-like settings. Future research is therefore required, above all to evaluate comparatively the different techniques for coordinating patient discharge across the triple interface between hospitals, general practices and community health services; and to discover what effects increasing the scale and scope of general practice activities will have on continuity of care

Hospital accounting and the history of health-care rationing

Focussing on the period from 1948 to 1997, this paper examines the history of rationing in the British National Health Service (NHS), with special reference to the role of hospital accounting in this context. The paper suggests that concerns regarding rationing first emerged in the 1960s and 1970s in response to the application of economic theories to the health services, and that rationing only became an issue of wider concern when the NHS increasingly came to resemble economic models of health services in the early 1990s. The paper moreover argues that, unlike in the USA, hospital accounting did not play a significant role in allocating or withholding health resources in Britain. Rudimentary information systems as well as resistance from medical professionals are identified as significant factors in this context

Working mothers, injury and embodied care work

In this article, we examine how mothers respond when injury interrupts maternal care, using the lens of embodied care, which we conceptualize as a form of ‘body work’. We draw on findings from a qualitative research project with two organizations in Australia that help people with injuries to return to work, examining the experiences of workers who are also mothers of dependent children. Mothers' inability to care for children during periods of injury was a significant concern for our interviewees; constraints on physical labour and physical affection were particularly troubling, indicating the importance of embodied maternal caregiving to maternal roles. Yet, while these mothers inhabited the spheres of paid work and unpaid care work simultaneously, service providers did not consider embodied care work or its relevance to injured women's ongoing needs for support. While our findings reflect the experiences of injured women, they also suggest the need for a materialist analysis of the ways that both paid work and care activities are deeply enmeshed in and through the bodies of those doing the work. Employers and service organizations still fail to recognize maternal ‘body work’, and this may be typical of social attitudes more widely

Latin American immigrants have limited access to health insurance in Japan: a cross sectional study

<p>Abstract</p> <p>Background</p> <p>Japan provides universal health insurance to all legal residents. Prior research has suggested that immigrants to Japan disproportionately lack health insurance coverage, but no prior study has used rigorous methodology to examine this issue among Latin American immigrants in Japan. The aim of our study, therefore, was to assess the pattern of health insurance coverage and predictors of uninsurance among documented Latin American immigrants in Japan.</p> <p>Methods</p> <p>We used a cross sectional, mixed method approach using a probability proportional to estimated size sampling procedure. Of 1052 eligible Latin American residents mapped through extensive fieldwork in selected clusters, 400 immigrant residents living in Nagahama City, Japan were randomly selected for our study. Data were collected through face-to-face interviews using a structured questionnaire developed from qualitative interviews.</p> <p>Results</p> <p>Our response rate was 70.5% (n = 282). Respondents were mainly from Brazil (69.9%), under 40 years of age (64.5%) and had lived in Japan for 9.45 years (SE 0.44; median, 8.00). We found a high prevalence of uninsurance (19.8%) among our sample compared with the estimated national average of 1.3% in the general population. Among the insured full time workers (n = 209), 55.5% were not covered by the Employee's Health Insurance. Many immigrants cited financial trade-offs as the main reasons for uninsurance. Lacking of knowledge that health insurance is mandatory in Japan, not having a chronic disease, and having one or no children were strong predictors of uninsurance.</p> <p>Conclusions</p> <p>Lack of health insurance for immigrants in Japan is a serious concern for this population as well as for the Japanese health care system. Appropriate measures should be taken to facilitate access to health insurance for this vulnerable population.</p

An epistemic community comes and goes? Local and national expressions of heart health promotion in Canada

<p>Abstract</p> <p>Background</p> <p>The objective of this study is to examine the existence and shape of epistemic communities for (heart) health promotion at the international, national, provincial and regional levels in Canada. Epistemic community may be defined as a network of experts with an authoritative claim to policy relevant knowledge in their area of expertise.</p> <p>Methods</p> <p>An interpretive policy analysis was employed using 60 documents (48 provincial, 8 national and 4 international) and 66 interviews (from 5 Canadian provinces). These data were entered into NUD*IST, a qualitative software analysis package, to assist in the development of codes and themes. These codes form the basis of the results.</p> <p>Results</p> <p>A scientific and policy epistemic community was identified at the international and Canadian federal levels. Provincially and regionally, the community is present as an idea but its implementation varies between jurisdictions.</p> <p>Conclusion</p> <p>The importance of economic, political and cultural factors shapes the presence and shape of the epistemic community in different jurisdictions. The community waxes and wanes but appears robust.</p