The Affordable Care Act and the Transformation of US Health Care

The neoliberal period was accompanied by a momentous transformation within the US health care system.  As the result of a number of political and historical dynamics, the healthcare law signed by President Barack Obama in 2010 ‑the Affordable Care Act (ACA)‑ drew less on universal models from abroad than it did on earlier conservative healthcare reform proposals. This was in part the result of the influence of powerful corporate healthcare interests. While the ACA expands healthcare coverage, it does so incompletely and unevenly, with persistent uninsurance and disparities in access based on insurance status. Additionally, the law accommodates an overall shift towards a consumerist model of care characterized by high cost sharing at time of use. Finally, the law encourages the further consolidation of the healthcare sector, for instance into units named “Accountable Care Organizations” that closely resemble the health maintenance organizations favored by managed care advocates. The overall effect has been to maintain a fragmented system that is neither equitable nor efficient. A single payer universal system would, in contrast, help transform healthcare into a social right.

Market reforms and privatisation in the English National Health Service

The article examines developments in the marketisation and privatisation of the English National Health Service, primarily since 1997. It explores the use of competition and contracting out in ancillary services and the levering into public services of private finance for capital developments through the Private Finance Initiative. A substantial part of the article examines the repeated restructuring of the health service as a market in clinical services, initially as an internal market but subsequently as a market increasing opened up to private sector involvement. Some of the implications of market processes for NHS staff and for increased privatisation are discussed. The article examines one episode of popular resistance to these developments, namely the movement of opposition to the 2011 health and social care legislative proposals. The article concludes with a discussion of the implications of these system reforms for the founding principles of the NHS and the sustainability of the service.

Health reforms in Latin America: processes and results

Two types of health reforms in Latin America are analysed: one based on insurance and service commodification and the one referred to the unified public systems of progressive governments. Health insurance with explicit service packages has not fulfilled their purposes of universal coverage, equal access to necessary health services and improvement of health conditions but has opened health as a field of profit making for insurance companies and private health providers. The national health services as a state obligation have developed territorialized health services and widened substantially timely access to the majority of the population. The adoption of an integrated and wide social policy has an impact on population well fare. It faces some problems derived from the old health systems and the power of the insurance and medical complex.

Economic crisis and national health system

The text analyzes the impact of the economic crisis in some critical aspects of the National Health System: outcomes, health expenditure, remuneration policy and privatization through Private Public Partnership models. Some health outcomes related to social inequalities are worrying. Reducing public health spending has increased the fragility of the health system, reduced wage income of workers in the sector and increased heterogeneity between regions. Finally, the evidence indicates that privatization does not mean more efficiency and better governance. Deep reforms are needed to strengthen the National Health System.

Commodification of health care systems: The Catalan case

Commodification of the public healthcare system has been a growing process in recent decades, especially in universal healthcare systems and in high-income countries like Spain.  There are substantial differences in the healthcare systems of each autonomous region of Spain, among which Catalonia is characterized by having a mixed healthcare system with complex partnerships and interactions between the public and private healthcare sectors.  Using a narrative review approach, this article addresses various aspects of the Catalan healthcare system, characterizing the privatization and commodification of health processes in Catalonia from a historical perspective with particular attention to recent legislative changes and austerity measures.  The article approximates, the eventual effects that commodification and austerity measures will have on the health of the population and on the structure, accessibility, effectiveness, equity and quality of healthcare services.

Asumiendo las consecuencias negativas de la adicción al juego

La adicción al juego no sólo se caracteriza por la pérdida de control ante el juego, sino que esta conducta tiende a generar problemas en los diferentes ámbitos de la vida del ludópata. Por ello, este aspecto se recoge en el Manual diagnóstico y estadístico de los trastornos mentales-5 (DSM-V) como uno de los criterios para realizar su valoración diagnóstica. Objetivo: describir y analizar los diferentes elementos que conforman la compleja problemática aparejada a esta adicción y que pueden terminar en situaciones de exclusión social. Método: Se opta por una metodología cualitativa que se ajusta mejor a los intereses del estudio. Como técnica se ha seleccionado la historia de vida, instrumento de evaluación que permite conocer la verdadera magnitud del problema desde el punto de vista de los afectados. Resultados. De manera general, se ha descubierto que ser ludópata tiene muchos más consecuentes que el problema económico evidente. No debemos despreciar las implicaciones de esta conducta a otros niveles: familiar, laboral, legal y social, que pueden considerarse, a medio plazo, como factores mucho más execrables que el del mero gasto económico. Conclusión. Es fácil avistar que los graves problemas que acarrea la adicción al juego son capaces de desmembrar el proyecto vital del ludópata y el de su familia. Todo vale, aunque para ello tenga que jugarse su puesto de trabajo, su casa, su familia, sus amistades, su estatus social y su propia dignidad.

From labelling to social aid for immigrants in the 21st Century

Migration is as old as humanity, but since the 1990s migration flows in Western Europe have led to societies that are not just multicultural but so-called «super-diverse». As a result, Western towns now have very complex social structures, with amongst others large amounts of small immigrant communities that are in constant change. In this paper we argue that for social workers to be able to offer adequate professional help to non-native residents in town, they will need balanced view of ‘culture’ and of the role culture plays in social aid. Culture is never static, but is continually changing. By teaching social workers about how to look at cultural backgrounds of immigrant groups and about the limitations of then role that culture plays in communication, they will be better equipped to provide adequate aid and will contribute to making various groups grow towards each other and to avoid people thinking in terms of ‘out-group-homogeneity’. Nowadays, inclusion is a priority in social work that almost every social worker supports. Social workers should have an open attitude to allow them to approach every individual as a unique person. They will see the other person as the person they are, and not as a part of a specific cultural group. Knowledge about the others makes them see the cultural heterogeneity in every group. The social sector, though, must be aware not to fall into the trap of the ‘inclusion mania’! This will cause the social deprivation of a particular group to be forgotten. An inclusive policy requires an inclusive society. Otherwise, this could result in even more deprivation of other groups, already discriminated against. Emancipation of deprived people demands a certain target-group policymaking. Categorized aid will raise efficiency of working with immigrants and of acknowledging the cultural identity of the non-natives group. It will also create the possibility to work on fighting social deprivation, in which most immigrants can be found.

Afectividad y creaciones estéticas: intervención social con jóvenes no cualificados

Los jóvenes no cualificados, que participan en los dispositivos educativos de segunda oportunidad, recorren itinerarios de transición al mercado laboral cada vez más complejos. Por lo que conocer sus expectativas y su capacidad de agencia resulta ineludible para mejorar nuestro acompañamiento como profesionales de la intervención sociolaboral. En este artículo exploramos la adaptación de esos jóvenes a una exigencia creciente de cualificación, que los está excluyendo laboralmente. Frente a este proceso, observamos que contraponen una resistencia basada en su capital simbólico, a través de la afectividad y la estética. Nuestro interés por estas respuestas nace de la desorientación percibida entre los profesionales de los programas educativos. Incapaces de comprender las trayectorias divergentes que estos jóvenes plantean, ante los itinerarios homogéneos que se les ofrecen para su inserción social. Tras el análisis de las creaciones artísticas y estéticas de los adolescentes, intuimos que hay dos factores que activan su resistencia a las limitaciones de sus expectativas de éxito. Por un lado, una variable institucional, que apunta a una deficiente planificación de los itinerarios formativos, que los jóvenes perciben que les aboca a la infracualificación y a un mercado laboral precario e inestable. Y por otro lado, una resistencia a la exclusión, que se enraíza en un imaginario de éxito y de movilidad social propio de una juventud globalizada.

The Art of Change Movement: an anti-oppressive Social Work initiative

This article presents the Art of Change Movement (Movimiento Arte del Cambio), which has developed out of a project of the Association of Social Workers Without Boundaries (Asociación Trabajadores/as Sociales Sin Fronteras), with the collaboration of the Faculty of Social Work at Universidad de Granada and of education professionals, incorporating theatrical creativity and musical expression as pedagogical and social intervention tools. The aim is for the initiative to become another instrument in the fight against oppression. Through a laboratory for collective creativity involving students and professionals from social work and other social science disciplines, the movement seeks social transformation through artistic expression, based on political commitment and sustainable development that empowers participants.

Estrategias resilientes ante la situación adversa de los desahucios

Los desahucios en España se han convertido en los últimos años en un fenómeno social emergente, de interés tanto para la investigación como para la intervención de los profesionales de la acción social. Aun así, no existen estudios suficientes relacionados con esta situación adversa, y menos aún centrados en las respuestas resilientes que las personas son capaces de ofrecer ante ella. Con el objetivo de identificar los factores internos y externos que se presentan en la experiencia de las familias que viven procesos de desahucios y que les están permitiendo desarrollar estrategias resilientes ante dicha adversidad, se lleva a cabo la presente investigación en la que participan 20 sujetos, pertenecientes a familias que acuden a la Plataforma de Afectados por las Hipotecas (PAH) de Málaga. A los participantes se les realiza una entrevista semi-estructurada y a través de ellas se han podido definir las características socio-familiares de las personas afectadas, las diferentes estrategias de afrontamiento desarrolladas, las principales fuentes de apoyo con las que han contado, así como las preocupaciones que les han acompañado. Los resultados muestran los principales factores internos y externos que están presenten en las estrategias resilientes que han desarrollado las familias afectadas por los desahucios durante el proceso vivido y destacan como fuente de apoyo informacional a la PAH. Se concluye con la necesidad de continuar con esta línea de investigación para tratar de diseñar intervenciones que refuercen y fomenten las estrategias de afrontamiento ante la situación adversa del desahucio.

Brazilian Social Segurity and Social Work: reflections on the Continuous Cash Benefit Programme

Guaranteed under the Federal Constitution of 1988, Brazilian social security covers rights relating to health, social welfare and social care. The Continuous Cash Benefit Programme (BPC) was approved as part of social care policy and is regulated under the Social Care Act (Ley Orgánica de Asistencia Social) of 1993. This benefit guarantees a minimum monthly income for persons with disabilities and for older adults. Certain requirements must be satisfied in order to obtain the assistance: medical and social assessment of disabled persons, a minimum age of 65 years for older adults, and, in both cases, the value of per capita income for the nuclear family in question, which must be lower than a quarter of the minimum wage. Regulation of the BPC has incorporated advances and setbacks in terms of legislation and implementation. In this framework, this article presents a theoretical reflection, an analysis of the legislation on the matter, and some reflections on the challenges that it poses for social workers.

Tipologías actuales de los trabajadores sociales en España

El objetivo del artículo es definir y explicar los tipos de profesionales del Trabajo Social existentes en España mediante una investigación descriptiva, cuantitativa y tipológica. Esta primera aproximación puede servir para iniciar la reflexión sobre la organización profesional del Trabajo Social en España y para identificar las características que definen su labor profesional. Los resultados muestran la existencia de doce tipos de profesionales del Trabajo Social en España.