Proposed appraisal system and political correctness. Consultant appraisals will be useful.
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Consultants↗
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The hospital financing system of the Federal Republic of Germany.
This paper deals with the present hospital financing system of the Federal Republic of Germany. The structure of the financing system is treated as well as the actual financing process, and, as far as possible, both are also quantitatively described. The first section contains a description of the structure, and is concerned with the major institutions participating in the hospital financing system:--the hospitals are described according to ownership, number of beds, specialization, personnel, regional distribution and utilization;--the health insurance system is illustrated by the two major institutions, i.e. statutory and private health insurance agencies, and its effect on hospital financing is explained;--the regulation of the hospital financing system by the federal political system is discussed;--finally, the major economic functions of the institutions involved are summarized; the interrelations of hospital care and the ambulatory sector are also mentioned. The second section contains a detailed description of the actual financing process, which can be classified according to the sections of financing:--the basic system of the German hospital financing law is introduced;--in the section on investment costs, public grants and their allocation, which are closely related to hospital planning, are discussed;--in the section on operating costs, full cost reimbursement as the basic principle, the structure of costs, the elements and the mechanism of operating cost financing, the actual prices, the financing of private patients' care and special services are described;--a short view of accounting balances, i.e. the differences between costs and financing of hospital services which result in profits or deficits, is given. A few considerations on the evaluation of the financing system conclude the paper.
Costs and Cost Analysis↗
Proposed appraisal system and political correctness. Correspondent rather than the royal college may have lost touch with reality.
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Consultants↗
[The era of the professional imperative in the Norwegian health care system: institutions, politics, and conflict topics].
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History, Modern 1601-↗
Back to the future: the animal health monitoring system--a political necessity being addressed in the United States.
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Agriculture↗
Reproductive rights and the state in Serbia and Croatia.
The global reproductive rights movement arose in the late 1980s and early 1990s as a challenge to the population control paradigm that has dominated family planning policy for almost half a century. The essence of the challenge is to place women into the center of population discussions as subjects, not objects of policy, and to reorient family planning and health programs toward meeting the broad reproductive health needs of individuals, rather than the narrow population control objectives of states. Reproductive rights advocates argue that the use of family planning programs for developmentalist-oriented population control objectives is illegimate, and inevitably relegates women to the status of depersonalized policy "targets". The cases of Croatia and Serbia, the two dominant partners in the former Federal Republic of Yugoslavia, offer interesting twists on these reproductive rights issues. In Croatia and Serbia, unlike in many nations, the governments are deliberately seeking to increase rather than decrease fertility levels. Moreover, the objective concerns identity politics, more so than development: the governments have encouraged increased fertility to safeguard the survival of their nations and to strengthen national power amidst threatening internal and external environments of ethnic conflict. In this paper, we examine the dynamics of pro-natalist fertility policy in Croatia and Serbia. We do so with a view to explaining why, despite similarities, the two have followed divergent paths. While reproductive rights violations have occurred in both nations, they have been markedly higher in Serbia than Croatia. To explain this divergence we look at a series of sociopolitical factors, including the space available for groups to mobilize in each political system; the degree of nationalistic extremism present in the discourse of central political leaders; and perceptions of threats and opportunities in external geopolitical environments. In conducting this analysis we seek to drive home the point that a nation's reproductive rights situation and prospects cannot be understood divorced from its sociopolitical context. We also raise an additional impetus for promoting the reproductive rights agenda--one largely unexplored in the family planning literature-that emerges from low fertility nations facing identity issues. Women's bodies must be protected not only against those states seeking to use their reproductive capacities for developmentalist-oriented fertility control, but also against those wanting their bodies for nationalistic-oriented fertility promotion.
Authoritarianism↗
Survey data collection: operationalizing the research design.
This article describes how indigenous interviewers were used to collect data about the health needs and resources in a black South African township. The survey was done during the dismantling of the apartheid political system of South Africa. The political unrest, distrust, and tension were barriers to carrying out a survey and threatened the quality of the data collection. A vulnerability of survey research is the difficulty in controlling the variables of the community and the interviewer during the process of data collection. How this survey was carried out, in this unstable setting, influenced the quality of the data and the validity and reliability of the research. The data-collection requirements were carried out in a way that was functional in the real-world setting while maintaining research standards. The criteria used for hiring interviewers and the content and delivery of training were effective in this tense, educationally disadvantaged community setting. Methods that were used to motivate and supervise interviewers were successful and are recommended for use in similar survey research.
Black or African American↗
[Health reform, equity and the right to health in Colombia].
The author develops a long-term perspective to assess advances in equity and the right to health in the Colombian health system reform. In a restricted political system, actors in the field of health in Colombia have chosen individualistic alternatives to legalize inequities in individual purchasing power for services. Despite the complex regulations established in the General System for Social Security in Health, there is a trend towards consolidating traditional inequities and to further restrict opportunities for achieving the right to health with full, equitable, universal guarantees.
Colombia↗
The political environment of HIV: lessons from a comparison of Uganda and South Africa.
Considerable interest has arisen in the role of governance or political commitment in determining the success or failure of HIV/AIDS policies in sub-Saharan Africa. During the 1990s, Uganda and South Africa both faced dramatic HIV/AIDS epidemics and also saw transformations to new political systems. However, their responses to the disease differed in many ways. This paper compares and contrasts the ways in which policy environments, particularly government structures, can impede or expedite implementation of effective HIV prevention. Four elements of these environments are discussed--the role of political leadership, the existing bureaucratic system, the health care infrastructure, and the roles assigned to non-state actors. Two common international strategies for HIV prevention, syndromic management of sexually transmitted infections and sexual behaviour change interventions, are examined in relation to these elements in Uganda and South Africa during the mid-to-late 1990s. During this period, Uganda's political system succeeded in promoting behaviour change interventions, while South Africa was more successful in syndromic management efforts. Interactions between the four elements of the policy environment were found to be conducive to such results. These elements are relatively static features of the socio-political environments, so lessons can be drawn for current HIV/AIDS policy, both in these two countries and for a wider audience addressing the epidemic.
Cross-Cultural Comparison↗
Pensioners' political parties in Israel.
Involvement and participation of older persons in politics and political systems reflect the extent to which they are integrated into their society. During the last two decades, political parties of pensioners have emerged in a number of countries, including Israel, and have run candidates in national elections. If only 10% of those aged 65 and older had voted for pensioners' parties in Israel, they would have qualified for two "pensioners" seats in the Knesset (Israel's parliament). However, they suffered complete defeat, as has been the case in most other countries. This article first describes the phenomenon of pensioners' political parties in Israel, examines the circumstances around their emergence, and presents their goals. Second, it identifies and analyzes the causes for their political defeat. Third, it discusses alternatives to political parties to promote the interests of the older population. Finally, implications for further research are raised.
Aged↗
The politics of childbirth in the context of conflict: policies or de facto practices?
The impact of warlike conditions on the lives of Palestinian women and children is far reaching. Beginning in September 2000, curfews, closures, siege and the parceling up of the country into small isolated entities have all led to a lack of access to basic maternity services, rendering pregnant women and their newborns a highly vulnerable group. Because any discussion of childbirth in the Occupied Palestinian Territories (OPT) cannot be separated from the larger historical context of international health politics, we begin with a brief review of international historical trends in childbirth policies, focusing on the relationship between discourse in the developed and developing world contexts to show how these models have intersected and diverged. We point to the similarities between the OPT and other developing countries, but also highlight the specificities that characterize the Palestinian experience today that include local political systems, medical dominance, professional group interests and the politics of gender, as well as the legacy of colonialism intertwined with an ongoing national conflict. We then provide a review of the history of childbirth in the OPT and analyze the various forces that led to the emergence of today's chaotic and contradictory de facto policies and practices. By assessing the health policy environment, we demonstrate the seeming impossibility of developing national level childbirth policies, given the current political conditions and a mix of other determinants that are not all within Palestinian control. Finally, we emphasize the importance of establishing a process as opposed to a blueprint of health policy-making based on people's immediate and long-term needs in all areas of the country. We also propose interim measures that rest on the notion of developing decentralized sub-strategies relevant to different zones of political reality and stages of system and human resource development, aiming at combining survival imperatives with those of improving women's birth experiences and women's health.
Arabs↗
Social contract and deterring famine: first thoughts.
The links between certain kinds of political systems and protection against famine are investigated in this paper. The starting-point is a critique of Amartya Sen's observation that famines are unknown in countries with a free press and competitive elections. This holds true only in India because of a unique political history in which freedom from famine became a right, upon which political legitimacy was founded: an anti-famine 'social contract'. The rise and decline of anti-famine systems in Africa is charted. Major reasons for decay include neo-liberalism and the international humanitarian system, both of which undermine relationships of domestic political accountability that underpin effective famine prevention. A number of politically regressive tendencies in 'actually existing humanitarianism' are identified that work against any nascent anti-famine social contracts in Africa. This is possible because famine prevention has not been established as a right in Africa.
Africa↗
The march of time: rigid or chaotic transactions, two different ways of living time.
In this paper the author shows that families do not live time in the same way. In families with rigid transactions, time is arrested; in families with chaotic transactions time is eventful. These different ways of living time are true of all systems, and parallels are drawn with political systems. Therapists must thus manage the therapeutic time in different ways, and this depends, among other factors, on their "personal equation." To achieve this, some guidelines are given, and two techniques that we call photograms and historiograms are described.
Family↗
Suicide and political regime in New South Wales and Australia during the 20th century.
STUDY OBJECTIVE: Australia has had a two party parliamentary political system for most of the period since its Federation in 1901, dominated either by a social democratic (Labor) or a conservative ideological perspective. This paper investigates whether such political differences at Federal and State levels have influenced suicide rates in the state of New South Wales (NSW) for the period 1901-1998. DESIGN: Federal government type, NSW State government type, and combinations of both Federal and NSW State government type were examined. Poisson regression models were stratified by sex and controlled for the effects of age, annual change in gross domestic product, sedative availability, drought, and both world wars. RESULTS: When both Federal and NSW State governments were conservative the relative risk of suicide for NSW men was 1.17 (p<0.001) and for women 1.40 (p<0.001) compared with both governments being Labor (1.00). A statistically significant linear trend (p<0.001) in suicide risk was evident across the continuum of Federal/State government combinations, from both Labor (lowest), to mixed (intermediate), to both conservative (highest). CONCLUSION: Significantly higher suicide risk was associated with conservative government tenures compared with social democratic incumbents. Results are discussed in terms of the differences underpinning conservative and social democratic government programme ideology, and their relevance to Durkheim's theories of suicide, social regulation, and integration.
Adolescent↗
The watershed empires.
Watershed empires, founded by states in the highlands on the upper reaches of river systems, conquered the flood plains and other regions around them. Three of these, Ch'in in ancient China, Assyria in the middle east, and the Inca of Peru, are described, with emphasis on the horrific socio-political systems which they developed. All, however, were eventually overthrown by a combination of internal revolt and external pressures.
Art↗
Psychiatric aspects of detention: illustrative case studies.
OBJECTIVE: Although the two political systems cannot be equated, the psychiatric and psychosocial issues raised by people detained under the migration regulations of the present Australian government, and those detained under the security legislation of the last apartheid government in South Africa, are similar in many aspects. METHOD: We present two case scenarios representative of the cumulative clinical experience of the authors in their work (as part of their routine clinical practice and medical school experience) with asylum seekers and political detainees in acute psychiatric units in both South Africa and Australia. RESULTS: Similar issues raised included the validity of a psychiatric diagnosis in these patients and the debate this conundrum provoked among the multidisciplinary teams. The pressures placed on clinicians by politicians in terms of clinical management of hospitalized detainees raised similar ethical questions across both countries. The clinical syndromes of depression and posttraumatic stress disorder were similar. The effect of the 'non-person' status conferred upon refugees by the 'temporary protection visa' could be equated with the effect of 'banning orders' imposed on opponents of the Apartheid regime. CONCLUSIONS: In South Africa, political detainees entered into the struggle expecting to face hardship and torture at the hands of the government of the time. Asylum seekers flee to Australia expecting support from a democratic system and generally had not prepared themselves for further incarceration and yet another political struggle. Despite this seemingly fundamental difference, the experiences of detainees across two very different political systems are remarkably similar.
Adult↗
[Between end of war and foundation of state--the Veterinary Faculty of the Humboldt-University of Berlin 1945-1949].
The city of Berlin and the Veterinary Faculty were occupied by the Red Army in the beginning of May 1945. After tidying up and first reconstruction as well as reorganisation of the academic stuff the University of Berlin was reopened in January 1946, the semester started in May 1946. At first the number of students at the faculty ranged under 200, the number of graduates was low as well. The numerous vacant chairs could only be filled little by little, in autumn 1949 four chairs were still vacant. Academic stuff, assistants and students were mostly refusing the political system in East Germany. The only slow development upwards was sensitively disturbed by the crisis-like events in 1950/51 and 1956/57.
Berlin↗
Managing the unmanageable: public hospital systems.
There are significant challenges to those who work in large public health care delivery systems: political imperatives; resource constraints; sometimes rigid personnel systems; and, the reality that everything occurs in a public forum. The fact that many nations are reviewing and, in some instances, restructuring their national health care systems, has added to the complexity and feeling of continual turbulence experienced by their managers. State run systems like that in the United Kingdom are introducing market forces to increase effectiveness and value for money; while market systems, like that in the United States, are increasing regulatory interventions to achieve the kind of cost control available to countries with large public systems which operate with global budgets. Public hospitals in the United States offer examples of public institutions operating in a highly competitive market environment. A decade of management changes undertaken to enhance the efficiency and effectiveness of the New York City Health and Hospitals Corporation (HHC), the largest public hospital system in the United States, is presented as a case study of public health services and public management in a market environment.
Community Health Centers↗