Health Care in Rural Texas

The purpose of this article is to assess the quality of health and health care services available to rural Texans. Specifically, we seek to answer two related questions. First, do people living in rural areas of Texas generally suffer from poorer health than people living in urban Texas? One undoubtedly would think so, given frequent references to the low quality of personal services in general for rural America. Moreover, the persistence of the congressional Rural Health Care Caucus over the past two decades points to a rural health care crisis. Second, to what extent are these differences in health conditions explained by differences in access to health care enjoyed by people living in the two different regions? Access certainly appears to be the problem alluded to above. Rural people apparently lack physician care. In addition to providing answers to these questions, we also examine the difference in the health conditions and access to care enjoyed by minority and non‐minority rural Texans. Is this a part of the rural health care problem given the high incidence of non‐whites in rural Texas? If so this may be minority rather than rural neglect. We briefly conclude the article with some recommendations for improving the problems we identify.     

The Integration of Mental Health Care in Rural Iran

Iran’s rural mental health care system emerged in a context that included experiments in health care prior to the 1979 Revolution and the establishment of a primary health care (PHC) system after the Revolution. Beginning in the 1980s, Iran integrated mental health care into the existing PHC system by treating mental illness much like a communicable disease. Iran advanced treatment options compatible with the existing system, added new training for existing care providers, and incorporated specialists. The integration of mental health care led to the rapid improvement of health outcomes. The integration also created the unintended consequence of privileging pharmaceutical treatments and overlooking mental illnesses affected by somatization.     

Factors Affecting Small Farmers' Access to Institutional Credit in Rural Orissa,India

This study uses original survey data from six villages to locate and analyse factors inhibiting small farmers' access to formal credit, including credit supply, bargaining strength, bureaucratic formalities, asset-based lending policies, informal tenancy contracts, extended processing procedures and caste barriers. The survey data confirm a correlation between higher overall transaction costs and smaller farm size, and also between arrearages and larger farm size. The analysis leads to the suggestion that policies should be directed both towards reducing the overall transaction costs of formal loans to small farmers, and towards improved collection processes.     

Eighteenth-Century Child Health Care in a Northampton Infirmary: A Provincial English Hospital

Abstract

For more than a century before the opening of Great Ormond Street Hospital for Children (1852) children in England were treated by and even admitted to Voluntary Hospitals. Amongst the earliest English 18th-century records to give the patient's age, are held in Northampton General Hospital, in an archive dating from its foundation as the Northampton Infirmary in 1744 afford a fascinating glimpse into in- and out-patient child health. The hospital archive has recently rediscovered the 1743 Statutes, contemporary patient literature, minute books, contemporary engravings of the outside and inside of the hospital and menus. Thus we can speculate with a high degree of certainty as to what would be the then current Infirmary environment and treatments for illustrative examples of the children seen in the period 1744–45.     

The Effects of Inter-generational Support on the Mortality of Older People in Rural China

As inter-generational support is the primary source of support for the Chinese elderly in rural areas, such support is likely to affect their physical and psychological health. This paper investigates the effects of four types of inter-generational support on the mortality risk of the elderly in Anhui Province. Results showed that mortality risk was influenced significantly only by receiving household support. Financial support and personal care had no effect. Results also indicated that household and emotional support were effective in reducing mortality when delivered at closer proximity, suggesting that quality of support may be enhanced by co-residence and ready access to children. Conclusions about the health benefits of tangible forms of support need to be tempered by an understanding that poor health predisposes inter-generational co-residence, and that the quality of household assistance and emotional support may be sensitive to the geographic distance between older parents and their adult children in rural China.     

A Spatial-Temporal Analysis of Health Care and Mortality Inequalities in China

Two geographers specializing in China TYalyze that country's health care inequality from 1990 to 2008, for the purpose of: (1) examining spatial-temporal variations of health care inequality at multiple scales (the regional, provincial, and county levels); (2) exploring whether economic growth and transition to a market economy have exacerbated the unevenness of health care; and (3) analyzing the impact of health care inequality on health outcomes, especially mortality. The authors apply GIS-based spatial statistical methods to detect spatial-temporal patterns of health care, and use multilevel regression to examine the linkages between health care, mortality, and regional economic inequality, and ultimately to assess the sensitivity of health care inequality to geographic scale and examine whether reforms implemented to date have resulted in more equitable access to health care. The paper also demonstrates how the concurrent transitions of decentralization, marketization, globalization, and urbanization in China have interactively contributed to health care inequality and mortality.     

战国时期韩国三大都城比较研究

宜阳故城、阳翟故城和新郑韩城是战国时期韩国在进军中原的过程中先后建立的三个都城,这三大都城在选址、宫城和宫殿区以及防御设施和体系的营建、陵区的规划等方面有着明显的相似性。同时,受不同历史条件的影响,也表现出了很大的差异性,比如都城性质、城郭布局、破郑风水等。这些异同的比较有助于我们探讨当时韩国的社会和历史面貌。     

The Challenge to the State in a Globalized World

Individual instances of state failure and collapse must be placed within a broader appreciation of the evolution of statehood within the international system. The idea that the inhabited area of the globe must be divided between sovereign states is a recent development, and likely to prove a transient one. Largely the product of European colonialism, and turned into a global norm by decolonization, it is threatened both by the inherent difficulties of state maintenance, and by processes inherent in globalization. States are expensive organizations to maintain, not only in economic terms but also in the demands that they make on their citizens and their own employees. Poor and dispersed peoples, and those whose values derive from societies without states, have found these demands especially burdensome. The end of the Cold War and the collapse of the Soviet Union revealed the hollowness of existing models of sovereign states, and challenged the triple narratives on which the project of global statehood has depended: the narratives of security, representation, and wealth and welfare. While individual cases of state failure and collapse may owe much to specific circumstances and the behaviour of particular individuals, they must also be understood within the context of a world in which maintaining states has become increasingly difficult.     

The Changing Health Care Behaviour of the Hmong Refugee Population in Sydney

Health care behaviour of Hmong refugees in Sydney was investigated after research in the United States had shown that, within the Southeast Asian refugee community in that country, Hmong refugees not only had the lowest rates of use of Western medicine but also were the most likely to assess their quality of health as only fair ( Brainard and Zaharlick, 1989 , 849). In contrast, this study found that the Sydney Hmong generally used Western medicine as a system of first choice. At the same time, most continued to use traditional medicines, albeit in a modified form. Minimal costs, freedom to choose their own doctor and appropriate, long term health education were the most important factors in Hmong using Western medicine in Sydney. Other contributing factors included the structure and size of the community, the presence of a long‐term Hmong resident in Sydney upon arrival and familiarity with Western medicine. Thus, the Sydney Hmong community was able to maintain a reasonable quality of health at an affordable price. An unexpected finding was the improved social, economic and health status of Hmong women. Such differentiated results are a powerful argument for not looking at refugees as a homogenous group, even when investigating a single, national, ethnic or cultural group. This study highlighted both the multidisciplinary and transdisciplinary nature of health care behaviour and the contribution that a small in‐depth case study can make to health and migrant policy.     

新时期农村合作医疗改革述论

新时期农村合作医疗经历了曲折的发展历程。随着家庭承包经营的推行,农村合作医疗迅速瓦解,覆盖率由20世纪70年代末的90%下降到1985年的5%。90年代初开始,党和政府努力恢复合作医疗,但重建工作一再受挫。农民自费医疗的境况带来了严重的社会问题。2003年初,新型农村合作医疗制度出台,这是又一项富有中国特色的社会主义制度创新。几年来的试点和推广实践证明,新型农村合作医疗制度符合我国的实际,对保障农民身体健康、维护社会和谐和促进经济发展具有重要意义。同时,建立完善的农村医疗保障制度需要各方力量的整合,任重而道远。     

The Impact of Program Design on Enrollment in State Children's Health Insurance Programs

The success of State Children's Health Insurance Programs (SCHIP) in expanding insurance coverage among low‐income children varies considerably across states. Scholars have looked to different program characteristics to explain this variation, but have arrived at disparate conclusions regarding the impact of one of the most significant design choices—the decision to create a new program or to pursue increased child health insurance rates through an expansion of the existing Medicaid program. This study suggests that understanding the impact of programmatic choices requires a more careful consideration of the mechanisms through which these different program designs might influence enrollment than has been offered in previous research. Employing a multilevel governance framework, it suggests that there is a hitherto unexplored indirect impact, where design choices influence administrative behavior, which in turn influences enrollment success in SCHIP programs. It is important to understand the effect of administrative design choices because this is one of the key areas in which states exercise discretion in the implementation of many federal programs.     

对贵州三都地区发现的一组铜鼓的初步识别

“铜鼓文化”是构成贵州少数民族文化的一个重要环节。在贵州世居少数民族聚居区,我们基本上都能发现铜鼓的踪迹。作为全国少数民族分布集中的地区之一,少数民族之间频繁的往来,使得贵州的民族文化呈现出多元化的特征。明清之后大量的汉族移民的涌入,丰富了贵州民族文化的内涵。“铜鼓”作为贵州少数民族生产和生活的一部分,客观上成为汉文化、贵州少数民族的文化和与其相毗邻的滇文化中的异域文化相融合的文化共同体。     

The Privatization of Health Care Cleaning Services in Southwestern British Columbia,Canada: Union Responses to Unprecedented Government Actions

This paper analyzes the political dynamics between a newly elected, right‐leaning provincial government and a left‐leaning public sector union that resulted in the privatization of 4000 health support housekeeping jobs in southwestern British Columbia in less than a year. The article documents how government set the stage for privatization, the struggle that ensued when the union resisted concessionary bargaining, and the new challenges that emerged for both union and management once housekeeping and other support services were taken over by multi‐national service corporations. This case is significant because the size and scope of this privatization and the legislation that facilitated it are unprecedented in Canadian history.     

从农村合作化运动看国家构造中的集体及集体产权

集体产权不是一个主流经济学的产权概念,它只在中国才有财产和法律上的双重意义。伴随着农业合作化运动的互助组、初级社、高级社三个阶段,集体及集体产权也经历了一个萌芽、雏形、形成的过程。     

宗教对抗国家——埃及现代化的难题

最近由于接触了埃及的现代化 ,发现在这个过程中 ,国家与宗教的冲突十分明显。冲突的最高潮表现为萨达特总统遇刺事件 ,在众目睽睽之下 ,萨达特在盛大的阅兵式上被伊斯兰激进分子刺杀。国家与宗教的冲突是埃及现代化的困境之一 ,本文即试图对这一问题做初步探讨。一、世俗主义与国家振兴埃及现代化过程中存在着两条平行的线 ,一条是显线 ,一条是隐线。显线是世俗主义——民族主义的线 ,隐线是伊斯兰现代主义——原教旨主义的线。埃及出现这种情况 ,是因为现代化从本质上说是世俗的运动 ,但埃及社会又浸透着宗教传统。在埃及现代化过程中 ,两…     

Building a Venture Capital Market in Vietnam: Diffusion of a Neoliberal Market Strategy to a Socialist State

Abstract

Vietnam’s venture capital (VC) industry took shape in the late 1990s during a period of exceptional economic growth in the country and the development of its high-technology sector. High growth rates and technological advances have typically coincided with both strong VC market activity and state support of equity financing. This, however, has not been the case in Vietnam. In this article a policy diffusion framework is used to investigate the international and domestic origins of Vietnam’s nascent VC policies, and how they became part of the agenda of the Communist Party of Vietnam (CPV) as credit-based, rather than equity-based, solutions. The article argues that Vietnam’s heterodox approach to VC policy results from both external forces from donors and from domestic factors. In particular, Vietnamese policymakers have a preference for credit-based SME financing solutions and Vietnam’s official development assistance providers diffuse expertise on loans, not equity investments, to the Socialist Republic. The only donors recommending VC and equity-based financing in Vietnam have gone “around the state” rather than through it by working directly with the private sector. As a result, Vietnam’s SME financing initiatives have significantly diverged from international VC policy patterns.     

Information Availability and Market Power in Export Competition: The Case of Regional Health Care Markets

In this paper I analyze the spatial-economic determinants of export competition. I develop a competing central place spatial interaction model to analyze the spatial availability of information, market power, distance, demand threshold, and interregional market variables. Model estimates are based on national data from The Dartmouth Atlas of Health Care, and I examine Medicare health exports from the Seattle hospital market to markets throughout the Pacific Northwest. Information availability and market power for the Seattle export hospitals have a significant effect on export sales of hospital Medicare services. Intra and interregional competition with other major hospital markets are significant determinants of export competition. Distance to the Seattle market has a strong, negative effect on export sales and on patient migration from other markets.