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PubMed2004

[The political and administrative context of the implementation of Health Districts in the State of Bahia, Brazil].

This investigation was conducted in order to determine the political and administrative context prevailing during the implementation of health districts in the state of Bahia, Brazil. The documentary review includes laws, agreements, and contracts at the State and Federal levels from 1987 to 1989. This period corresponded to the first phase of the State government after the 1986 elections. Information was also obtained from key informants and former directors of the State Secretariat of Health at the central level. We describe how the policy for regionalization by territory and population was formulated, and we review both State and national planning procedures, identifying the events leading to the decision to create health districts. We list the political instruments related to this decision and analyze the positions of the various actors in the Brazilian Health System in relation to this strategic choice. Brief comments are given about the difficulties faced by this proposal during the period studied.

English Abstract↗
PubMed1980

Gaining control: reform, reimbursement and politics in New York's community hospitals, 1890--1915.

This is an historical study of an early twentieth century political struggle regarding hospital reimbursement in New York City. During a period called the "Progressive Era" (1895--1915), administrators in the City's Comptroller's office sought to gain control over small, locally run community hospitals by dismantling the long-standing practice of flat-grant payments to institutions. Central office planners felt that these payments gave too much control to trustees. In its place, the Comptroller initiated a system of per-capita, per-diem reimbursement. Inspectors now judged for the institutions which services and which clients were appropriate for municipal reimbursement. From the perspective of the Comptroller's office, this change was an attempt to put rationality into the system of municipal support for charitable institutions. From the perspective of trustees and community representatives, however, this change was a political attack on the rights of institutions and local communities to control their own fate. Within the context of the larger Progressive Era "good government" movement to centralize decision-making in the hands of experts who believed strongly in the efficiency of larger institutions, it was generally the smallest, most financially troubled community institutions which felt the brunt of these changes.

Economics, Hospital↗
PubMed1990

Designing fee schedules by formulae, politics, and negotiations.

Fee-for-service cannot be used successfully by organized health insurance without a fee schedule. America first tried to pay doctors under Medicare by an involved formula system without a fee schedule, but the effort has failed. The United States has now commissioned a research project to design a unique fee schedule that will precisely reflect physicians' effort and practice costs and that will represent the prices produced by a perfectly competitively market. The primary goal is the same as that pursued recently by reformers in all countries: viz., narrow the spread in fees and income between surgical and cognitive fields. There are serious technical limitations on this effort, despite the talent of the research team. An additional difficulty lies in the nature of the subject: paying the doctor involves conflicts of interest between payers and all doctors as well as among the medical specialties, and the conflicts cannot be resolved by any formulae calculated by any single research team. Methodological and political compromises will be necessary, in order to adopt a reform. The new method may be just as politically driven, complicated, and disputed as the old one, despite America's pretenses that it prefers free markets and opposes excessive government.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1992

Toward a political and moral economy of aging: an alternative perspective.

A conceptual framework for empowerment of the elderly is proposed, using variations on Gramsci's hegemony and Thompson's moral economy to complement recent political economic and social psychological theories. The political economy and social psychology of aging highlight structural constraints and actors' reactions without articulating a model for empowerment. Gramsci's idea of hegemony as new moral and philosophical leadership calls for principles of social and economic organization deserving assent because they maximize people's chances for a decent life at all ages. Hegemony, as normalizing dominance, reveals ways in which the elderly may be disempowered as well as possibilities for intervention. Underlying diverse forms of hegemony are economic arrangements and an array of cultural norms. In contrast to Thompson, the authors argue that norms implicit in moral economy vary with changes in social context. In the process, two ideal types of moral economy are elaborated, grounded in exchange value and use value, respectively. Empowerment may be found through a moral economy grounded in use value appropriate to advanced industrial society that is consonant with Gramsci's new hegemony. Implications for health and income maintenance policies are explored.

Aged↗
PubMed1992

The political and moral economy of aging: not such strange bedfellows.

The authors develop E.P. Thompson's concept of moral economy as a useful complement to contemporary political economic analysis in problem areas involving moral conflict. Defined as the shared assumptions underlying norms of reciprocity in which an economic system is grounded, moral economy is seen as holding particular relevance for the study of aging. The evolution of pension systems, the "senior revolt" against catastrophic coverage in the United States, and debates over the allocation of health resources between generations are used to illustrate the utility of a combined political and moral economy for enriching our understanding in these areas. Marx's concept of a "morality of emancipation" is described as holding particular promise for the development of a new moral economy of old age that would move beyond alienation by giving broad attention to quality of life issues at each stage of the life course.

Aged↗
PubMed2005

The iron law of politics.

Political philosophers have doubted the compatibility of various major values, such as equality and freedom. Ethnographic and historical evidence has indicated the presence of (1) economic equality and individual freedom in the absence of civil peace in segmentary societies based on self-help; (2) economic equality and civil peace in the absence of individual freedom in corporate societies; and (3) individual freedom and civil peace in the absence of economic equality in mercantile and capitalist societies. However, little if any evidence has documented all three -- economic equality, individual freedom, civil peace -- in stable coexistence. By way of delineating the relations between and among the values in question, I offer "The Iron Law of Politics," which asserts that economic equality, individual freedom, and civil peace cannot all exist simultaneously in any society, although any two of the three can.

Journal Article↗
PubMedDate not supplied

The new rules of leadership and organizational politics.

As the health care industry continues to experience unprecedented change, organizational politics are also evolving. Major changes are underway in the rules of engagement and how management and workers behave on the job. The new rules of the game include: Practice leadership, not management; practice inclusion with a vengeance; practice modesty and consideration and demand both; act on rumor, don't await confirmation; aggressively collect allies; understand the politics of voice mail; and know that position power isn't personal power.

Leadership↗
PubMed2001

Dorothea Dix. An inspirational crusader for political reform and provision of mental health care services.

Traditionally nursing history, that is nurses' collective memory, unique skills and collective experiences, was passed down in a fragmented way throughout training and career. Now nurses are beginning to recognise how vital the study of nursing history is, not only as a tool of unification, but also as a source of pride. Nurses as individuals need to expand their breadth of nursing history knowledge in order to achieve a conscious identity for nursing in the future, not least politically where the future absolutely depends on a sense of collective achievement in the past. The life and works of Dorothea Linde Dix provide a foundation in the political history of nursing and an inspiration for its future.

Health Care Reform↗
PubMed1975

[Psychiatry and sectorial politics].

The organization in "sectors" of psychiatric assistance represents one answer to the need to perfect the treatment of mental illnesses and to promote an effective prophylaxis. "Sectorial politics" derive at the same time from the broad principles of community psychiatry as well as from a necessary evolution of hospital assistance. Faced with the perspectives the psychiatrist may experience difficulties regarding his own "situation" and fears concerning the manner in which he will be "utilised". He tends to amplify in order to better denounce, the various risks of deviation of "sectorial politics": demedicalisation, abusive "psychiatrisation", threats to individual liberties, etc... However, the effective participation of all psychiatrists constitutes the best guarantee that these risks will be avoided.

Community Mental Health Services↗
PubMed1994

Canada's unemployment-immigration linkage: demographic, economic, and political influences.

"This paper rejects Veugelers and Klassen's initial suggestion that greater concern with demographic considerations might provide a useful explanation for their empirical finding of a post-1989 change in the unemployment-immigration linkage [in Canada] and offers alternative explanations consistent with economic and, especially, sociological-political theories. It shows how elements of Hawkins's (1988) ¿bureaucratic control' and Simmons and Keohane's (1991) ¿political legitimacy' theories can be combined to explain both continuity and change in Canada's postwar immigration policy."

Americas↗
PubMed1992

Migration policy and politics in the receiving states.

"This article explores the politics of migration policies in the receiving states." The author finds that "a survey of the politics of immigration in the major receiving states shows a strong pattern of restrictionism in the face of unprecedented pressures for entry, but also amnesties, exceptions on humanitarian grounds, and hesitation to enforce the law. As individual states founder, multilateral strategies abound, but with scant success....Ironically, the failure of states to deal with the crisis may reinforce national prerogatives and capacities with respect to immigration and strengthen rather than erode the distinction between economic migrants and refugees."

Demography↗
PubMed1997

Difference or defect? Intersexuality and the politics of difference.

Under current medical practice, when a child is born with ambiguous genitalia, sex is assigned and medical/surgical intervention undertaken. This practice is criticized by the Intersex Society of North America and by feminist scholars. Together they are creating a "politics of difference" approach in which differences are not seen as "defects" to be corrected. This paper analyzes the reasons offered in support of current medical practice and of the politics of difference, and argues for a move toward the latter. Crucial to the determination that this move is warranted are justice concerns and the emergence of support groups and technologies that allow geographically separated individuals to form a relevant "group."

Child Welfare↗
PubMed2003

Social, economic, and political determinants of child health.

This article presents a brief overview of the effects of social, economic, and political factors on child health. It starts by highlighting child poverty in rich nations, in particular the United Kingdom and the United States, and identifies the economic and political factors underlying this phenomenon. The evidence linking socioeconomic status and child health is briefly reviewed with particular attention to birth weight and child mental health-2 of the most important public health challenges in the 21st century. The implications for pediatricians of high levels of child poverty and the effect that these have on children are discussed.

Birth Weight↗
PubMed2000

Neuropsychology, the patient's experience, and the political forces within our field.

This article emphasizes the importance of both scientific and phenomenological approaches to the practice of clinical neuropsychology. Paying attention to patients experiences while they receive neuropsychological services is stressed because this aspect is often neglected in the training of clinical neuropsychologists. Finally, the reality of "hostile" forces within the politics of neuropsychology is considered briefly. Neuropsychologists need to consider three major issues that are important to our field and to the National Academy of Neuropsychology. First, neuropsychology is a scientific enterprise that deserves continued efforts at scholarship and clinically relevant research. The second issue concerns how scientific information is applied to patient care and the need for clinical neuropsychologists to understand both personal suffering and empirical data. The third issue is more delicate. It concerns the political forces in our field and my related personal observations.

Journal Article↗
PubMedDate not supplied

[Croatian Medical Association, Andrija Stampar and public health politics in the Kingdom of Serbs, Croats and Slovenians (Kingdom of Yugoslavia)].

The research on work of doctor Andrija Stampar (1888-1958) as the head of the Hygienic division of The Ministry of Public Health of the Kingdom of Serbs, Croats and Slovenians from 1919 till 1929-1931 is presented, as well as the influence of the Health Section of the League of Nations and Rockefeller Foundation. Special attention is also given to the resistance of practicing physicians around the Croatian Medical Association in Zagreb to Stampar's project of socialization of medicine. In addition, I will elaborate on the changing of the official public health politics after Stampar's dismissal from the Ministry in 1931, as well as the new changes connected with the founding of politically more independent province - Banovina Hrvatska in 1939. The article is mostly based on unpublished archival sources about the life and work of A. Stampar, as well as the documentation of Rockefeller Foundation.

Health Policy↗
PubMedDate not supplied

[About possible differences between the tables of the Minister of Labor and Social Politics and Insurances Companies regarding differences in estimating health impairment].

The aim of this paper was to pay attention to the difficulties and possible differences between the experts in medico-legal opinions. The problems are due to the lack of equality in opinion criteria about the extent of impairment. According to the authors the enclosure available to the Minister of Labor and Social Politics needs modifications. The document gives too much freedom to the experts in defining the extent of permanent or long lasting impairment. The amount of damages paid has forced the Insurances Companies to make the table more detailed. Considering the existing differences between the enclosure available to the Minister of Labor and Social Politics and tables of Insurances Companies we propose a possible direction of changes. The modification of the table will make the unification and objectivity easier.

Disability Evaluation↗
PubMed2006

Rethinking political correctness.

Legal and cultural changes over the past 40 years ushered unprecedented numbers of women and people of color into companies' professional ranks. Laws now protect these traditionally underrepresented groups from blatant forms of discrimination in hiring and promotion. Meanwhile, political correctness has reset the standards for civility and respect in people's day-to-day interactions. Despite this obvious progress, the authors' research has shown that political correctness is a double-edged sword. While it has helped many employees feel unlimited by their race, gender, or religion,the PC rule book can hinder people's ability to develop effective relationships across race, gender, and religious lines. Companies need to equip workers with skills--not rules--for building these relationships. The authors offer the following five principles for healthy resolution of the tensions that commonly arise over difference: Pause to short-circuit the emotion and reflect; connect with others, affirming the importance of relationships; question yourself to identify blind spots and discover what makes you defensive; get genuine support that helps you gain a broader perspective; and shift your mind-set from one that says, "You need to change," to one that asks, "What can I change?" When people treat their cultural differences--and related conflicts and tensions--as opportunities to gain a more accurate view of themselves, one another, and the situation, trust builds and relationships become stronger. Leaders should put aside the PC rule book and instead model and encourage risk taking in the service of building the organization's relational capacity. The benefits will reverberate through every dimension of the company's work.

Commerce↗
PubMed1990

[Preliminary study of an interdisciplinary examination of the body height proportions of Germans in the 19th century and of the influence of living conditions. I. Introductory justification, problems and preliminary studies based on authentic sources from the political districts from northern Germany to Württemburg].

Researches about the influences of the nutritional conditions on body-height need interdisciplinary co-operation of Anthropology, History, and Dietetics. Such a team will be difficult succeed in joining. Especially interesting for human sciences are nutritional-constitutional researches on German populations in the 19th century, because in this century multifarious varieties exist within the German settlement. Author hopes, that preliminary original researches and first trends in results facilitate the joining of such an interdisciplinary team. In part I of this inquiry, the necessity for nutritional-constitutional researches are justified, problems are treated and mustering-statistics, the most important data-material, are collected for the political regions of that time from North to the kingdom Württemberg. The kingdom Württemberg of course is the political region with the most continuous data-series, but the data-material is poor on body-height-means and needs new statistical treatments. Less data are particularly available from the middle of the German settlement.

Anthropometry↗