State Pharmaceutical Assisstance for the Elderly and Disabled: Planning Issues for Program and Non-Program States

The Medicare Catastrophic Coverage Act (MCCA) would have mandated federal assistance for Medicare beneficiaries who have high annual prescription medication costs, High national expenditures for such drugs have encouraged the development of private and state insurance programs to help with these costs. Ten state pharmaceutical assistance programs (SPAPs), designed to help certain elderly, low income, or disabled people, exist for those ineligible for Medicaid or unable to purchase coverage privately. Coordination of state and federal benefits was a consideration for established programs, and programs being planned needed to determine the feasibity of integration of federal assistance. But the enactment and subsequent appeal of the Act affected both planning and policy implications for these SPAPs. All U.S. states and territories were surveyed before the bill's repeal to collect data on the effects of MCCA for those with prescription drug programs and those without. The repeal of the federal program places pressure on the nonprogram states to proceed, perhaps more cautiously, to initiate program; for their own residents, given increasing out-of-pocket and insurance costs, and no federal program.

A Comparative Study of Central and Eastern European Social Policy Concernig Mental Disability

The main goal of this project was to identity whether an imported system of social policy can be suitable for a host country, and if not why not. Romanian social policy concerning the mentally disabled represents a paradoxical situation in that while social policy is designed to ensure both an institutional structure and a juridical environment, in practice it is far from successful. The central question which Ms. Ciumageanu asked therefore was whether this failure was due to systemic factors, or whether the problem lay in reworking an imported social policy system to meet local needs. She took a comparative approach, also considering both the Scandinavian model of social policy, particularly the Danish model which has been adopted in Romania, and the Hungarian system, which has inherited a similar universal welfare system and perpetuated it to some extent. In order to verify her hypothesis, she also studied the transformation of the welfare system in Great Britain, which meant a shift from state responsibility towards community care. In all these she concentrated on two major aspects: the structural design within the different countries and, at a micro level, the societal response. Following her analyses of the various in the other countries concerned, Ms. Ciumageanu concluded that the major differences lie first in the difference between the stages of policy design. Here Denmark is the most advanced and Romania the most backwards. Denmark has a fairly elaborate infrastructure, Britain a system with may gaps to bridge, and Hungary and Romania are struggling with severe difficulties owing both to the inherited structure and the limits imposed by an inadequate GDP. While in Denmark and Britain, mental patients are integrated into an elaborate system of care, designed and administered by the state (in Denmark) or communities (in Britain), in Hungary and Romania, the state designs and fails to implement the policy and community support is minimal, partly due to the lack of a fully developed civil society. At the micro level the differences are similar. While in Denmark and Britain there is a consensus about the roles of the state and of civil societies (although at different levels in the two countries, with the state being more supportive in Denmark), in Romania and to a considerable extent in Hungary, civil society tends to expect too much from the state, which in its turn is withdrawing faster from its social roles than from its economic ones, generating a gap between the welfare state and the market economy and disadvantaging the expected transition from a welfare state to a welfare society and, implicitly, the societal response towards those mentally disabled persons in it. On an intermediate level, the factors influencing social policy as a whole were much the same for Hungary and Romania. Economic factors include the accumulated economic resources of both state and citizens, and the inherited pattern of redistribution, as well as the infrastructure; institutional resources include the role of the state and the efficiency of the state bureaucracy, the strength and efficiency of the state apparatus, political stability and the complexity of political democratisation, the introduction of market institutions, the strength of civil society and civic sector institutions. From the standpoint of the societal response, some factors were common to all countries, particularly the historical context, the collective and institutional memories and established patterns of behaviour. In the specific case of Romania, general structural and environmental factors - industrialisation and forced urbanisation - have had a definite influence on family structure, values and behavioural patterns. The analysis of Romanian social policy revealed several causes for failure to date. The first was the instability of the policy and the failure to consider the structural network involved in developing it, rather than just the results obtained. The second was the failure to take into account the relationship between the individual and the group in all its aspects, followed by the lack of active assistance for prevention, re-socialisation or professional integration of persons with mental disabilities. Finally, the state fails to recognise its inability to support an expensive psychiatric enterprise and does not provide any incentive to the private sector. This creates tremendous social costs for both the state and the individual. NGOs working in the field in Romania have been somewhat more successful but are still limited by their lack of funding and personnel and the idea of a combined system is as yet utopian in the circumstances in the country.

Slovak Policy, 1956-1960

The project looked at crucial political events in Slovakia between 1956 and 1960. 1956 saw the first attempt by Slovak intellectuals to reform the communist regime by increasing the degree of democracy and 1960 was the culmination of the strengthening of the political persecution that began after 1957. The period was characterised by the partial replacement of the informal-political instruments of control over society by formal measures, and the gradual weakening of the role of terror in people's daily life. Marusiak studied the gradual accommodation of the communist regime by the people, analysing the social and political history against the background of political development and of specific aspects such as the conflict of youth and intellectuals with the regime, the collectivisation of agriculture and the liquidation of the rest of the private sector in the economy, public opinion and the changes in the political system, the relations between state and churches, and ethnic problems in Czechoslovakia. He concludes that there was a continuity between the aims and methods used by the communist regime before and after 1953 (or 1956) and that the communist regime in this period remained fundamentally totalitarian.

Standard Language in Bosna and Hercegovina - in Language Policy Documents

From the beginning of the standardisation of language in Bosnia and Herzegovina, i.e. from the acceptance of Karadzic's phonetic spelling in the mid-19th century, to the present day when there are three different language standards in force - Bosniac (Muslim), Croatian and Serbian, language in Bosnia and Herzegovina has been a subject of political conflict. Documents on language policy from this period show the degree to which domestic and foreign political factors influenced the standard language issue, beginning with the very appellation for the specific norm regulation. The material analysed (proclamations by political, cultural and other organisations as well as corresponding constitutional and statutory provisions on language use) shows the differing treatment of the standard language in Bosnia and Herzegovina in different historical periods. During the period of Turkish rule (until 1878) there was no real political interest in the issue. Under Austro-Hungarian rule (1878-1918) there was an attempt to use the language as a means of forming a united Bosnian nation, but this was later abandoned. During the first Yugoslavia (1918-1941) a uniform solution was imposed on Bosnia and Herzegovina, as throughout the Serbo-Croatian language area, while under the Independent State of Croatia (1941-1945), the official language of Bosnia and Herzegovina was Croatian. The period from 1945 to 1991 had two phases: the first a standard language unity of Serbs, Croats, Muslims and Montenegrins (until 1965), and the second a gradual but stormy separation of national languages, which has been largely completed since 1991. The introductory study includes a detailed analysis of all the expressions used, with special reference to the present state, and accompanies the collection of documents which represent the main outcome of the research.

Social Policy Facing the Problems of Youth Employment

Rumiana Stoilova (Bulgaria). Social Policy Facing the Problems of Youth Employment. Ms. Stoilova is a researcher in the Institute of Sociology in Sofia and worked on this project from October 1996 to September 1998. This project involved collecting both statistical and empirical data on the state of youth employment in Bulgaria, which was then compared with similar data from other European countries. One significant aspect was the parallel investigation of employment and unemployment, which took as a premise the continuity of professional experience where unemployment is just a temporary condition caused by external and internal factors. These need to be studied and changed on a systematic basis so as to create a more favourable market situation and to improve individuals' resources for improving their market opportunities. A second important aspect of the project was an analysis of the various entities active on the labour market, including government and private institutions, associations of unemployed persons, of employers or of trade unions, all with their specific legal powers and interests, and of the problems in communication between these. The major trends in youth unemployment during the period studied include a high proportion of the registered unemployed who are not eligible for social assistance, a lengthening of the average period of unemployment, an increase in the percentage of people who are unemployed for the first time and an increasing percentage of these who are not eligible for assistance, particularly among newly registered young people. At the same time the percentage of those for who work has been found is rising and during the last three years an increasing number of the unemployed have started some independent economic activity. Regional differences are also considerable and in the case of the Haskovo region represent a danger of losing the youngest generation, with resulting negative demographic effects. One major weakness of the existing institutional structure is the large scale of the black labour market, with clear negative implications for the young people drawn into it. The role of non-governmental organisations in providing support and information for the unemployed is growing and the government has recently introduced special preferences for organisations offering jobs to unemployed persons. Social policy in the labour market has however been largely restricted to passive measures, mostly because of the risk that poverty poses to people continuously excluded from the labour market. Among the active measures taken, well over half are concerned with providing jobs for the unemployed and there are very limited programmes for providing or improving qualifications. The nature of youth employment in Bulgaria can be seen in the influence of sustained structures (generation) and institutions (family and school). Ms. Stoilova studied the situation of the modern generation through a series of profiles, mostly those of continuously unemployed and self-employed persons, but also distinguishing between students and the unemployed, and between high school and university students. The different categories of young people were studied in separate mini-studies and the survey was carried out in five town in order to gather objective and subjective information on the state of the labour market in the different regions. She conducted interviews with several hundred young people covering questions of family background, career plans, attitudes to the labour situation and government measures to deal with it, and such questions as independence, mobility, attitude to work, etc. The interviews with young people unemployed for a long period of time show the risk involved in starting work and its link with dynamics of economic development. Their approval of structural reforms, of the financial restrictions connected with the introduction of a currency board and the inevitability of unemployment was largely declarative. The findings indicate that the continuously unemployed need practical knowledge and skills to "translate" the macroeconomic realities in concrete alternatives of individual work and initiative. The unemployed experience their exclusion from the labour market not only as a professional problem but also as an existential threat, of poverty, forced mobility and dependence on their parents' generation. The exclusion from the market of goods and services means more than just exercising restraint in their consumption, as it places restrictions on their personal development. Ms. Stoilova suggests that more efficient ways of providing financial aid and mobilisation are needed to counteract the social disintegration and marginalisation of the continuously unemployed. In measuring the speed of reform, university students took both employment opportunities and the implementation of the meritocratic principle in employment into account. When offered a hypothetical choice between a well-paid job and work in one's own profession, 62% would prefer opt for the well-paid job and for working for a company that offered career opportunities rather than employment in a family or own company. While most see the information gained during their studies as useful and interesting, relatively few see their education as competitive on a wider level and many were pessimistic about employment opportunities based on their qualifications. Very similar attitudes were found among high school students, with differences being due rather to family and personal situations. The unemployed, on the other hand, placed greater emphasis on possibilities of gaining or improving qualifications on a job and for the opportunities it would offer for personal contacts. High school students tend to attribute more significance to opportunities for personal accomplishment. A significant difference that five times fewer high school students were willing to work for state-owned companies, and many fewer expected to find permanent employment or to find a job in the area where they lived, Within the family situation, actual support for children seems to be higher than the feelings of confidence expressed in interviews. The attitudes of the families towards past experience seems to be linked with their ability to cope with the difficulties of the present, with those families which show an optimistic and active attitude towards the future having a greater respect for parents experience and tolerance in communication between parents and children.

Switzerland: Think Tanks and Vested Interests in Swiss Policy Making

This paper analyses the role of think tanks in Swiss policy making. Starting from the relationship between interest groups and the state, which has been shaping Swiss policy making for a long time, we hypothesize that these structures offer good possibilities for scientific arguments and ideas to influence the process of policy making. Our observations from a recent example indeed illustrates that think tanks can use the same channels as vested interests to bring in their know-how. Furthermore, we conclude that the characteristics of the political system, e.g. direct democracy and the consensual alignment particularly influence the chances of think tanks to intervene. In this exchange vested interests and think tanks do not really interfere with each other, but rather they complement each other both having.

Work in Progress: Social Work, the State and Europe

Social work has had varying relationships with the nation state both over time and between different countries. From its early stages the occupation had both state sanctioned and voluntary streams. Its international dimension has been enhanced in the European context through policy and funding measures over the past few decades. During this period we have also seen the rise of globalising trends leading to questions about the ongoing powers of nation states. This paper examines some aspects of the relationship between social work and the state, taking into account the emergence of European and also international policies and frameworks. The paper focuses initially on migration as an example of a common trend; an area of policy with both national and European dimensions; and a field in which social professionals are engaged to varying degrees. Secondly, it considers the progress of the ‘professional project’ in Europe, using developments in five countries to illustrate some of the issues associated with ‘professionalization’. European and international frameworks may lead to some convergence in national understandings of the key roles of social workers and an enhanced sense of professional identity across nation states, despite very different starting points and current forms of organisation.

An Australian Perspective on Singaporean Welfare Policy

From a Western perspective, Singapore appears to be an overt example of a neo-liberal welfare regime based on low social expenditure, and limited and discretionary social assistance. But the true picture is arguably more complex. Singapore’s welfare policy is driven by strong cultural assumptions around individual and family self-reliance, and the inappropriateness of state welfare provision. However, there is also a strong emphasis on communal responsibility for supporting the disadvantaged. Some conclusions are drawn about the limitations of existing policies, and possible new directions for the future.

Different levels of policy change: A comparison between the public discussion on social security in Sweden and in Finland

The deep economic recession that hit Sweden and Finland at the beginning of the 90s, and the fall in public revenues and rapidly growing public debts that followed on it, triggered a development of cutbacks and restructuring measures which has resulted in a scientific debate over what this has meant for these countries’ systems of social policy, traditionally resting on the Nordic welfare state paradigm. In this connection, questions of to what extent changes made can be ascribed mainly to the economic constraints posed by the recession at all, or rather, to other more long-term societal trends or phenomena, including globalisation, European integration and/or ideational or ideological shifts among influential (elite) groups, have often been touched upon. Applying an ideas-centred approach, this paper attempts to contribute to the knowledge on the reasoning of influential elite societal groups in social policy issues before, during and after the 90’s recession, by empirically analysing their statements on social security made in the press. A distinction is made between three different levels of proposed policy changes, reaching from minor alterations of single programs to changes of the policy paradigm. Results show that the 1990s did not only mean the emergence of suggestions for minor cutbacks in and alterations of prevailing programmes. The share of suggestions implying de facto a (further) departure from the basic features of the social security system also showed that the model was under continuous pressure throughout the 90s. However, many of the changes suggested were not justified by any clear references to a policy paradigm in either country (or not justified at all). Instead, references to “purely” structural justifications did become more common over time. In this respect, as regards social security, our results cannot confirm the fairly popular notion among many researchers of a clearly ideological attack on the welfare state. However, it remains uncertain whether and to what extent the increased proportion of references to “structural realities” in the 90s should be interpreted as an indication of a change in the idea of what the welfare state is and what the goals behind it are. Results further show that the patterns of the discussion in the two countries studied bore a remarkable resemblance at a general level, whereas there are indications of differences in the driving forces behind suggestions for similar reforms in these two countries.

Resisting Postmodernity: Swedish social policy in the 1990s

The purpose of this paper is to introduce ideas that have emerged during the course of writing a book on Swedish welfare in the 1990s. The book is the result of many years of writing about two subjects: Swedish drug policy and the Swedish welfare state. The one very specialised, the other, more general. I first became interested in Swedish drug policy on a research visit to Örebro Län in 1986. A social worker showed me a copy of the county's drug policy programme and explained the significance of the 'restrictive line'. I have spent the years since that visit, trying to understand and explain the Swedish goal of a drug-free society (Gould 1988, 1994, 1996b). I only began to write about the welfare state in Sweden in the early 1990s, just as things were beginning to go wrong for the economy (Gould 1993a, 1993b, 1996a, 1999). For the last few years I have intended to write a book on the events covered by the period 1991-1998 - the years of a Bourgeois and a Social Democratic Government -which would bring the two halves of my work together. Material for this study has been accumulated over many years. A number of research visits have been made; large numbers of academics, politicians, civil servants, journalists, unemployed people, social workers and their clients have been interviewed; and extensive use has been made of academic, administrative and public libraries. Since September 1991 I have systematically collected articles from Dagens Nyheter about social services, social insurance, health care, employment, social issues and problems, the economy and politics. The journal Riksdag och Departement (Parliament and Ministry), which summarises a wide range of public documents, has been invaluable. Friends and informal contacts have also given me insights into the Swedish way of life. The new book is based upon all of these experiences. This paper will begin with a brief account of major global social and economic changes that have occurred in the last twenty years. This is intended to provide a background to the more recent changes that have occurred in Swedish society in the last decade. It will be suggested that the changes in Sweden, particularly in the field of welfare, have been less severe than elsewhere and that this is due to political, institutional and cultural resistance. The paper will conclude by arguing that Sweden, as an exemplar of an Apollonian modern society, has had much to fear from the Dionysian characteristics of postmodernity.

Three Decades of Social Work in France: from Security within the Welfare State to a State of «Disembedded Modernity»

This article gives an overview of trends in policy on the functions and role of social work in French society over the past twenty years. The author suggests several reasons for the current feeling of crisis of professional identity among professionals and the complexities of the political demands made on social work. These are analysed as a consequence of the specific French context of decentralisation of the State and of the multitude of approaches to organisation and to professional training programs. On a broader level, it seems that French social work reflects many characteristics of “modernity” being concerned with difficulties in defining a clear identity, lack of a clear territorial and institutional base (or “disembeddedness” to borrow Giddens term) and difficulties in finding a clear voice to make its values heard in an increasingly politicised arena of public debate.

Equality and Diversity in the Dutch Welfare State

Under the Constitution, the equality principle is very important in the Netherlands. This article argues that there is little evidence for equal citizenship in the Netherlands. There is anti-discrimination legislation in the Netherlands, but it is not very robust. The core argument in this article is that the equality principle must be supplemented by the diversity principle. Diversity is multi-dimensional and can refer to religion, philosophy of life, political persuasion, race (ethnicity), gender, nationality, sexual orientation, age, disability and chronic illness. In this paper multi-culturalism and disability are taken into account and we make a comparison of the social position of disabled people and people from ethnic minorities. Policies on diversity are needed to arrive at diverse citizenship in a varied society. This implies that a distinction has to be made between political citizenship and cultural citizenship. The former has to do with equality, and the latter with diversity.

Iowa State Daily (April 19, 2012)

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