Privatisation: An attempt that failed

Throughout the twentieth century doctors in most western countries strongly resisted government attempts to intervene in private medical markets. The support for privatisation that has developed during the current economic recession is welcomed therefore by the medical profession. In several countries campaigns have been staged for a full or partial return to market forces in the health care field. This article traces the course of one such push in Canada where doctors and other advocates of privatisation demanded a larger role for the private sector in the funding and management of Medicare, the national health insurance system. The policy outcome is contrary to the general privatising tendency in many countries: after a period of intense controversy the federal government passed legislation to preserve and strengthen the public aspects of the scheme. The normally powerful medical profession lost its campaign for an infusion of private funds into the health system and for the retention of the right of doctors to set their own fees. Consumer and other non‐producer groups, which have not traditionally played a central role in health policy, mobilised in defense of Medicare and were able to achieve most of their aims.     

Tracing Issue Definition and Policy Change: An Analysis of Disability Issue Images and Policy Response

We examine the role of issue definition in disability policy change. Based on qualitative and quantitative evidence from media coverage and congressional hearings, we conclude that policy change was influenced by the redefinition of disability issues from medical and economic definitions to a new sociopolitical perspective. Specifically, we find evidence that media attention and tone influenced the number of congressional hearings and the tone of these hearings. The change in the congressional definition subsequently contributed to the passage of key legislation based on the sociopolitical/civil rights definition of disability. Importantly, our research supports previous studies that suggest problem definition helps to explain significant policy change.     

The New South Wales doctors' dispute 1984–85: An interpretation

The NSW doctors’ dispute 1984–85 has had a lasting effect on the Australian health care system. Militant surgeons were effective in securing some modifications to regulations and administrative arrangements governing the role and remuneration of certain groups of doctors in NSW public hospitals and some changes to the federal government's Medicare scheme.

This paper examines the causes, actors, issues and outcome of the dispute. The key to understanding the dispute is a knowledge of both the specific issues debated by militant doctors and the federal and NSW Labor governments and the broader historical forces that have shaped the politics of national health insurance throughout the twentieth century. In contrast to media reports, the outcome of the dispute is interpreted as a compromise rather than a victory for the doctors. It is further argued that a theoretical generalisation formulated by two American political scientists, Marmor and Thomas, about disputes between doctors and governments over payment methods is only partially useful in explaining the outcome.

Two prominent and well‐documented historical themes from the politics of national health insurance in Australia — namely, the resistance of sections of the medical profession to any contraction of the private market for medicine and the fragmentation of the organised medical profession during periods of disputation with governments at the state and federal level — are discussed. These themes, and some generalisations about the capacity of the medical profession to influence public policy outcomes, are illuminated by the study.     

Nearby,but Not Wanted? The Bypassing of Rural Hospitals and Policy Implications for Rural Health Care Systems

This study examines the underutilization of rural hospitals. The authors study hospital and patient characteristics to determine why and how rural patients bypass local rural hospitals despite the availability of comparable medical services. The general conditional logit analysis of data on patients and hospitals suggests that hospital characteristics (size, ownership, and distance) and patient characteristics (payment source, medical condition, age, and race) influence rural patients' decisions to bypass local rural hospitals. The study offers two suggestions (policy implications) to better utilize rural health care institutions: a market-centered approach, and more effective government intervention for horizontal and vertical hospital integration.     

Marketisation and democratisation in the Russian Federation: the case of Novosibirsk

The concurrent passage of the processes of democratisation and marketisation in the former communist world have attracted considerable attention throughout the social sciences. Less attention has been paid, however, to the local dimensions of change. Much of the literature lacks an understanding of the role of people and institutions at the local level in dismantling communism and building new structures and practices. This paper explicitly focuses on the local experiences of wider processes of transformation by exploring participation in and exclusion from debates over future strategies for local economic development in the Siberian city of Novosibirsk. Drawing on literatures on markets and democracy, this paper argues that the expected democratisation of post-Soviet politics and the pluralisation of political representation are limited, at least at the local scale, by the playing out of the processes of marketisation and democratisation in grounded contexts, both local and global, by the passage of those transformations at a particular moment in history, and by their concurrence.     

自养与本色之深入：1929年世界经济危机冲击下的华北基督教

1929年世界经济危机发生后,西方基督教差会被迫减少对华传教事业经费,裁减传教士人数,对华北基督教产生重要影响。华北教会为此提倡受托主义,鼓励教徒捐献,并减少职员薪金;同时,教会为减轻经济负担,还组织各种义工训练班,注意培养义务工作人员为教会服务;教会学校与医院在差会经费减少的形势下,通过裁员减支、增收学费与住院费及向政府、社会力量请求援助等多种形式维持运营。此次经济危机有利于增强中国教会及教会机构的自养,破除教徒的依赖心理,推动了中国教会的本色化进程,但不能从根本上使其摆脱对西方经费的依赖。     

基于GIS的农村医疗设施空间可达性分析——以河南省兰考县为例

针对农村医疗设施空间分布的公平性问题,提出了使用GIS技术和空间可达性指标评估医疗设施的区域分布特征。以兰考县乡级以上卫生院为例,建立人口分布、医疗设施位置、行政区域等地理数据库,选择人均医疗资源分配、就医的最近距离、选择医院的机会、重力模型及改进的重力模型5个空间可达性模型,计算了各乡镇、各行政村的医疗设施可达性指标,并制作了相应的专题地图;在此基础上对医疗设施的空间布局进行了分析。空间可达性指标全面地反映医疗设施的空间分布特征,鉴别出资源分配较薄弱的区位,是农村医疗改革中设施规划和资源分配的重要依据。     

Sermons,Preaching, and Liturgy: Practices,Research Methods,and the Case of Giordano da Pisa

This article analyses the relationship between sermons, preaching, and liturgy within the Order of the Friars Preachers in late thirteenth- and early fourteenth-century Italy. It provides an account of a specific method for the study of the medieval ‘modern sermon’ by investigating the reportationes of the sermons given by Giordano da Pisa, a Dominican friar who preached in Florence and Pisa between 1302 and 1309. The investigation using this method shows that the sermons’ subjects and arguments, often considered by historians to be a direct consequence and reflection of Florence’s social and economic reality, had in fact also much to do with the evangelical story or epistolary passage assigned to the specific date of the liturgical calendar: there are thus two principal influences rather than just one. This approach to Giordano’s sermons provides a new perspective on his work as a preacher by being more attentive to the internal construction mechanisms of sermon discourse.     

MULTIPLE DIMENSIONS OF URBAN WELL-BEING

This paper examines the trends and changes in medical assistance at birth among poor and non-poor mothers in the state of Uttar Pradesh, India. It also investigates the relative role of public and private health care providers, and social and economic correlates on the non-use of natal care, as well as reasons for this non-use. Data from three rounds of the National Family Health Survey (NFHS) conducted over the period 1992–2006 were used. The wealth indices are estimated separately for rural and urban areas, and state-specific poverty line cut-off points are used to demarcate the poor and non-poor. Results show that birth assistance by skilled health professionals remained at an abysmal level, particularly for the poor. There had been no significant increase in the use of natal care among poor mothers during the period 1992–2006. Moreover, the increase in birth assistance by medical professionals came largely from private health care providers, and the use of natal care from public health centres had stagnated over the years.     

晚清教会医院慈善医疗演变述论

教会医院的慈善医疗是基督教在华慈善事业的重要组成部分。在晚清特殊的社会背景下,教会医院的慈善医疗经历了一个发展变化的过程。19世纪30—60年代,教会医院作为基督教适应中国社会的产物,从一开始即进行免费的慈善医疗,其经费依赖于外国,医学传教士是慈善医疗的主体。19世纪70—90年代,有的教会医院继续实行免费的慈善医疗,有的教会医院在收费制度下进行不同形式的慈善医疗,中国人对教会医院的资助开始增加,一些中国人在慈善医疗中发挥了一定的作用。20世纪初,实行收费制度是教会医院的通行办法,教会医院在此情况下进行了不同形式的慈善医疗,来自中国的经费日益增加,中国人在慈善医疗中发挥的作用不断增强。上述变化不仅是教会医院适应中国社会的产物,也是中国人对其态度变化的结果。     

Reconsidering path creation in economic geography: aspects of agency,temporality and methods

The emergence of new industrial development paths is an important topic in economic geography. However, current perspectives emphasizing the constraining forces of historical trajectories on innovation and change have shortcomings in accounting for how and where new industries arise. This article argues that more attention needs to be paid to agency, and that agency must be seen as inter-temporal in the sense that actors’ activities and strategies are framed by combinations of experiences and expectations. As such, the article combines insights from economic geography, transitions studies and the sociology of expectations (SoE) literature to expand extant theory on path creation. A brief analysis of the emerging Norwegian offshore wind power (OWP) sector serves to illustrate how experience (the past) and different types of expectations (the future) have tangible effects on agency, and in effect on path creation processes. These insights have methodological implications, essentially favouring qualitative approaches over quantitative ones to understand formative phases in industrial development.     

三国时期的薄葬风俗述论

丧葬的厚与薄同伦理道德、政治经济状况、社会舆论、政府导向等因素密切相关。三国时期,丧葬风俗由两汉时的多为奢侈转为力求薄葬,具有范围广、已形成于律令、丧制、墓葬规制与明器皆有明显变化等鲜明的特点。经济的凋敝、老庄思想的流行以及对盗墓的恐惧是产生这种变化的主要原因。     

Dressing and Addressing the Mental Patient: The Uses of Clothing in the Admission,Care and Employment of Residents in English Provincial Mental Hospitals,c. 1860–1960

Scholars of insanity and its historical antecedents have paid very little attention to personal and institutional clothing. Such dress, distributed to patients in mental institutions, has always been inscribed with the conflicting narratives of the period in which it was made and worn. The language of civil and medical authority is more evident than personal choice in the shape and address of the attire. This article examines clothing worn by patients in three Devon mental hospitals during the century before 1960. We consider the ways in which institutional clothing formed part of a hospital regimen of overt control, as well as suiting considerations of economy and employment that figured in these institutions.     

REEVALUATING THE ‘PROCOMPETITIVE’ EFFECTS OF HMOs: A SPATIAL EQUILIBRIUM APPROACH*

ABSTRACT. .The growth of health maintenance organizations (HMOs) commonly has been viewed as a “procompetitive” change in the structure of the health care delivery system. Because HMOs collect a prepaid fee from subscribers, they serve a dual role as insurers and providers of health care. While HMOs may have competed directly with conventional insurance plans, their effect in health care markets is potentially quite different. A multisector spatial equilibrium model, which incorporates the optimizing behavior of consumers, independent fee-for-service(FFS)providers, and a centralized HMO, is used to explore the effects of an exogenous shift in market structure away from FFS delivery toward the provision of seivices by the HMO. As more physicians are diverted from FFS practice to enter the HMO, both the HMO membership fee and prices in the FFS sector tend to rise. This pattern is consistent with empirical trends in the United States during the 1980s where, despite the rapid growth in HMOs and other forms of prepaid care, both FFS prices and HMO membership fees have risen sharply.     

专业镇经济模式的形成机制、特征与发展策略研究--以佛山市为例

专业镇是我国沿海经济发达地区特有的一种经济现象,珠江三角洲是专业镇集中地之一,不仅数量众多、类型丰富,而且规模大,其“一镇一业,一村一品”的专业化生产方式与超10亿元的经济规模引起了政府与学术界的重视。本以佛山市为例,在对佛山市专业镇进行空间分析的基础上,探讨专业镇的产生及其本质,分析佛山市专业镇形成的动力机制、类型与发展阶段,总结了佛山市专业镇的特点及存在的问题,并针对政府与企业分别提出相应的发展策略。     

CHILD PATIENTS,HOSPITALS AND THE HOME IN EIGHTEENTH-CENTURY ENGLAND

Abstract

This article seeks to map out some of the principal pathways to medical care used by the parents of poor children. We focus on the most formal provider of healthcare in eighteenth-century towns, the voluntary general hospitals, but we use these institutions as a prism to consider the way that the treatment of child sickness was managed more generally in five local settings. Utilising eighteenth-century hospital admissions and discharge registers we find that not only were children consistently treated as patients; but that these institutions also operated as part of a wider medical network which included domiciliary care, poor law services, and other medical charities. The boundaries surrounding hospital treatment in eighteenth-century towns were thus considerably more porous than is usually thought, and suggests that they operated as part of a wider medical network accessed by poor families for their children.     

Regional development and technology policies: Some lessons from the German experience

The development of economic, ecological, social, cultural and political conditions has a lasting influence on the development of individual regions and economic areas, and is in turn influenced by them. Background conditions in Germany have changed over the last few years, with reunification and the upheavals in Eastern Europe, the prospective completion of the Singh European Market and the increasingly insistent new challenges in the areas of the environment and transport. This paper gives some examples of the changes taking place in some of these background conditions, and discusses their foreseeable future regional impacts in the FRG. In the last 10 years, Baden‐Württemberg in south‐west Germany has been considered as one of the most successful examples in Europe of regional structural adaptation combined with a dynamic innovation system. The characteristics of the economic development of this region and their causes are dealt with.     

The Danube‐Rhine water system as a European regional integration structure

This article explores the role of two large European rivers — the Rhine and the Danube — in the structured development of the European territorial system. The water resources of the Rhine river, the tributaries and connecting canals have created the greatest industrial megalopolis on the continent. In this process and under contemporary conditions, the area is connected with the Danube basin by the newly built Rhine‐Main‐Danube canal. As a result, new structures are forming, having the character of an ecological‐economic system. It is in this direction that part of the European territorial system connected with the Danube is developing. As physical‐geographical and ecological factors accelerate economic development and integrate new economic structures, new opportunities arise. With the link to ecological and water resources, development of the Danube as Europe's newest, prospective zone of expansion is predicted.     

Dimensions and dynamics of residential segregation by income in urban Canada, 1991–1996

This paper examines the trends in residential segregation by income (post-transfer, pretax income) in the thirty-nine largest Canadian urban areas between 1991 and 1996. The study is motivated by the relative lack of attention paid to residential segregation by income in the Canadian context and by conceptual arguments linking compromised life chances and increased social tensions for the populations of highly segregated cities. We investigated several dimensions of segregation using five different measures (we focus on three of these here given the correlation structure of the measures) to examine changes in segregation between 1991 and 1996, a period characterised by economic recession, cutbacks in social programs and a widening of inequality in market incomes at the national scale. Overall, income segregation increased in most urban areas across all dimensions of segregation during the time period, with particularly high degrees of segregation observed in prairie cities (Winnipeg, Saskatoon and Regina). Of the three largest metropolitan areas (Vancouver, Toronto and Montréal), Montréal was the most consistently segregated. We also find that increases in spatial separation and spatial concentration by income occurred despite the fact that at the national scale, the tax and transfer system appeared to be adequately redressing a rise in inequality in labour and market incomes (as demonstrated by the lack of change in post-transfer national income inequality measures during a period when inequality in market and labour incomes rose sharply). This implies that the lived experience of changes in income distribution are unlikely fully captured by aspatial, national-scale measures and that intra-urban measures with a spatial dimension are an important indicators of inequality in Canadian society.     

Gender and Organisational Restructuring in the National Health Service: Performance, Identity and Politics

Over the past decade, debates within economic geography and organizational sociology have shown that gender is embedded within economic discourses, organisational relations and processes of restructuring. The argument has been widely illustrated through reference to "identity", with examples offered of the ways in which organizations and organisational change draw on specific performances of masculine and feminine identities. However, whilst we now know a great deal about organisational expectations of gendered performance at work, we actually know little of how these required performances impact individual constructions of identity. This paper aims to explore this gap between organisational discourses of gender, on the one hand, and the construction of individual identities, on the other. The paper uses narrative analysis of interviews with five nurses working in two hospitals in the British National Health Service (NHS) to trace the place and articulations of organisation, profession and gender in the construction and presentation of self. The paper reveals complex processes of negotiation and resistance and both stable and shifting identifications as individuals actively construct gendered identities inter alia through their interpretations of organisational and professional change. This emphasis on agency, resistance and personal politics has important implications for thinking about the nature and form of workplace politics and may offer a missing piece of the puzzle in recent bids to build new forms of labour organisation.