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Public Care (public + care)

Distribution by Scientific Domains

Humanities and Social Sciences	60%
Medical Sciences	40%

Selected Abstracts

Redistribution or horizontal equity in Hong Kong's mixed public,private health system: a policy conundrum

HEALTH ECONOMICS, Issue 1 2009
Gabriel M. Leung
Abstract We examine the distributional characteristics of Hong Kong's mixed public,private health system to identify the net redistribution achieved through public spending on health care, compare the income-related inequality and inequity of public and private care and measure horizontal inequity in health-care delivery overall. Payments for public care are highly concentrated on the better-off whereas benefits are pro-poor. As a consequence, public health care effects significant net redistribution from the rich to the poor. Public care is skewed towards the poor in part not only because of allocation according to need but also because the rich opt out of the public sector and consume most of the private care. Overall, there is horizontal inequity favouring the rich in general outpatient care and (very marginally) inpatient care. Pro-rich bias in the distribution of private care outweighs the pro-poor bias of public care. A lesser role for private finance may improve horizontal equity of utilisation but would also reduce the degree of net redistribution through the public sector. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Between Endless Needs and Limited Resources: The Gendered Construction of a Greedy Organization

GENDER, WORK & ORGANISATION, Issue 5 2004
Bente Rasmussen
One of the strategies of the modernization of public services is the decentralization of responsibilities and organizing work in autonomous co- operative teams with varied tasks. The empowerment of the public service workers in the front line is therefore a strategy in local government in Norway today. Under the assumption that women have ,natural' skills in caring, workers on the lowest levels are given responsibility for care and nursing. A study of the decentralization of public care for the elderly in their homes showed that being given interesting tasks and increased responsibility mobilized the efforts of the care workers. However, since the power of resources has been centralized, this has led to an intensification of work. In gendering the relevant discourses by explaining women's experiences of an over-heavy workload as a result of their ,mothering' and their inability to set limits, women care workers were constructed by their managers as unprofessional and not to be taken seriously. This has made the public care organization a greedy organization for the women care workers. [source]

Creating and sustaining disadvantage: the relevance of a social exclusion framework

HEALTH & SOCIAL CARE IN THE COMMUNITY, Issue 2 2009
Amanda M. Grenier PhD MSW BSW
Abstract Over the last decade, public home-care services for elderly people have been subject to increased rationing and changes in resource allocation. We argue that a social exclusion framework can be used to explain the impacts of current policy priorities and organisational practices. In this paper, we use the framework of social exclusion to highlight the disadvantages experienced by elderly people, particularly those who cannot afford to supplement public care with private services. We illustrate our argument by drawing on examples from previous studies with persons giving and receiving care in the province of Québec. Our focus is on seven forms of exclusion: symbolic, identity, socio-political, institutional, economic, exclusion from meaningful relations, and territorial exclusion. These illustrations suggest that policy-makers, practitioners and researchers must address the various ways in which current policy priorities can create and sustain various types of exclusion of elderly people. They also highlight the need to reconsider the current decisions made regarding the allocation of services for elderly people. [source]

Redistribution or horizontal equity in Hong Kong's mixed public,private health system: a policy conundrum

,Seen but not heard', young people's experience of advocacy

INTERNATIONAL JOURNAL OF SOCIAL WELFARE, Issue 1 2005
Jane Boylan
This article draws on two pieces of empirical research undertaken in England with young people in public care. The research examined young people's experiences of a range of advocacy services, and the extent to which the involvement of an advocate facilitated young people's voices being heard in decision-making. The research responded to contemporary concerns about children's participatory rights, citizenship and social inclusion, set in the context of the United Nations Convention on the Rights of the Child. This article examines the strengths and limitations of advocacy for young people in public care and compares the different types of advocacy services that are available to young people and considers the extent to which adult perceptions of childhood and youth frame the services that are offered. It provides a comparison of the outcomes for young people who have had an advocate and those who have not. The concluding discussion argues that young people in public care feel excluded and marginalised from decision-making processes, and that advocacy has a pivotal role to play in placing at centre stage the wishes and feelings of young people. [source]

Pictures and silences: memories of sexual abuse of disabled people

INTERNATIONAL JOURNAL OF SOCIAL WELFARE, Issue 4 2002
Darja Zavir
The article de,individualises the debate about sexual abuse of disabled people, especially women, by showing that both the sexual and asexual identity of impaired persons are invariably fashioned within the institutional arrangement of domination and subjugation. It shows that if disabled persons are seen as asexual or if they are sexualised, they cannot escape sexual violence, which is not an aberration, but is intrinsic to the social construction of disability. The article includes personal testimonies of women with different disabilities from Slovenia, who were abused either at home or in public care and shows some responses of the professionals and caregivers who minimise the importance of abuse. It claims that ignoring the memories of sexual abuse is part of a subtle and unintentional discrimination, which reflects a continuity of prejudices and hatred toward disabled children and adults in the private realm as well as in public care. People from ethnic minorities, such as Roma, are still today more often diagnosed as mentally disabled, which shows that the disability diagnosis has to be seen as part of cultural responses towards an economically and socially marginalised group. The author uses different perspectives: historical, social work theories, cultural studies and feminist analysis. [source]

The need and total cost of Finnish eyecare services: a simulation model for 2005,2040

ACTA OPHTHALMOLOGICA, Issue 8 2009
Anja Tuulonen
Abstract. Purpose:, The aims of this study were: (i) to create a structural simulation model capable of predicting the future need and cost of eyecare services in Finland; and (ii) to test and rank different policy alternatives for access to care and the required physician workforce. Methods:, Using the system dynamics approach, the number and cost of patients with cataract, glaucoma, diabetic retinopathy and age-related macular degeneration (AMD) were described with causal-loop diagrams and were then translated into a set of mathematical equations to build a computer simulation model. Mathematically, the problem was formulated as a set of differential equations that were solved numerically with specialized software. The validity of the model was tested against prevalence and administrative historical data. The costs covered by the public sector in Finland were obtained from 2003 from the Finnish Hospital Discharge Register (including outpatient care), the Finnish Social Insurance Institution and a survey of hospital price lists. Different levels of access to public care were then simulated in four eye diseases, for which the model estimated the need for services and resources and their costs in the years 2005,2040. Results:, The model forecasted that the adoption of the 2005 national ,access to care' criteria for cataract surgery would shorten waiting lists. If the workload of Finnish ophthalmologists were kept at the 2003 level, the graduation rate of new ophthalmologists would have to increase by 75% from the current level. If all glaucoma patients were followed in the public sector in future, even this increase in training would not meet the demand for physician workforce. The current model indicated that the screening frequency of diabetes can be increased without large sacrifices in terms of costs. AMD therapy has a significant role in the allocation of future resources in eyecare. The modelling study predicted that ageing alone will increase the costs of eyecare during the next four decades in Finland by about 1% per year in real terms (undiscounted and without inflation of unit costs). The increases in total yearly costs were on average 8.6% between 2001 and 2003. Conclusions:, The results of this modelling study indicate that policy initiatives, such as defining criteria for access to care, can have substantial implications on the demand for care and waiting times whereas the effect of ageing alone was relatively small. Measures to control several other factors , such as the adoption and price level of new technologies, treatments and practice patterns , will be at least equally important in order to restrain healthcare costs effectively. [source]

Predictors of outcome for unrelated adoptive placements made during middle childhood

CHILD & FAMILY SOCIAL WORK, Issue 4 2005
Cherilyn Dance
ABSTRACT This paper reports on a follow-up to adolescence of two longitudinal prospective studies of children placed from public care with non-related adoptive families in the UK. Factors associated with outcome are presented for 99 children (one index child per adoptive family) who were between 5 and 11 years of age at placement. Information concerning the children's backgrounds and care histories was obtained shortly after placement (T1), from social workers. Adopters were interviewed at T1 and again at the end of the first year (T2). A further follow-up was conducted an average of six years after placement (T3). Outcomes at T3 were classified as either disrupted, which was true for 23%, continuing and ,positive' (49%) or continuing but ,difficult' (28%). Bivariate analyses revealed a number of attributes, related to both the child and the adoptive parents, which were associated with differential outcomes. Logistic regression produced five predictors of placement disruption: age at placement, behavioural problems, preferential rejection, time in care and the child's degree of attachment to the new mother. Differences were found between ,positive' and ,difficult' outcomes in continuing placements as well as between continuing and disrupted placements. The analysis suggests that adoption should certainly be considered as an option for children over 5 years of age while recognizing the need for both preparation and post-placement support. Evidence of differential outcome in continuing placements provides support for efforts to reduce the number of placements and returns home that a child at risk experiences. [source]

Investing in children's futures: enhancing the educational arrangements of ,looked after' children and young people

CHILD & FAMILY SOCIAL WORK, Issue 1 2000
Francis
This paper reports on selected findings of a small-scale study which examined the educational experiences of a group of children ,looked after' away from home in the former Lothian Regional Council. While it is claimed that the advent of a new Scottish parliament heralds an opportunity to construct a more inclusive society in Scotland, it is clear from all the research conducted to date that one excluded group, children who are in public care, experience significant educational disadvantages and that both the scale and persistence of the problem demand urgent measures. A brief review of the literature is offered and a number of explanations for the poor educational performance of this group of children are considered. It is argued that the difficulties experienced by looked after children arise from the interplay of a variety of social, structural and professional factors and that efforts to redress the disadvantages must take account of all these factors. The paper briefly considers the origins and philosophy of the Scottish Children's Hearings System and argues that it could fulfil a more proactive role in safeguarding and promoting looked after children's educational interests. Finally, the key features of a strategic approach are outlined, highlighting the need for effective collaboration in policy and practice. [source]

Statutory health assessments for looked-after children: what do they achieve?

CHILD: CARE, HEALTH AND DEVELOPMENT, Issue 1 2003
C. M. Hill
Abstract Objective To examine the outcomes of statutory health assessment of children looked after by an English City Council. Design Retrospective longitudinal documentary analysis. Setting and participants Health records of all children looked after by Southampton City Council who had attended at least two statutory health assessments within a designated paediatric service from 1996 to 1999. Main variables studied Demographic characteristics of the children; physical and mental health problems identified at assessment and extent to which health recommendations were implemented. Results Twenty-seven boys and 22 girls aged 6 months,15 years were identified who had attended at least two assessments. One-hundred and four physical and mental health needs were identified at care entry requiring further assessment or intervention. More health problems were identified for girls than boys. At care entry 15/49 of the children were not fully immunized. At review, on average 14 months later, recommendations had only been implemented in just over half of children. Conclusions In common with previous studies this work confirms that the statutory health assessment identifies health need and health neglect that may otherwise go unrecognized. Whereas children's needs and problems were diverse, many continued to suffer health neglect in the system of public care designed to help them. In order to be effective, statutory health assessments must be a health promoting rather than disease screening exercise delivered by professionals skilled to address diverse health needs. Crucially, the heath assessment can only succeed as a tool for health advocacy if complementary to and integrated with local authority care and review. [source]