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.

Commodification of retirement and the emergence of rural gated communities: The associated challenges for rural planning

Abstract:
This paper combines demographic ageing and retirement lifestyles with rural in-migration processes and suggests the emergence of a specific rural form of gated community; namely, park homes. All year round or permanent (as opposed to seasonal) residential mobile homes (resembling detached bungalows in design and appearance) are commonly referred to as 'park homes'. With a growing proportion of the UK population aged 65 and over, combined with increasing longevity, meeting the residential preferences and lifestyle aspirations of an ageing population is potentially 'big business' for the private sector. Park home living, with their resident age restrictions (normally 50 years and over), is increasingly marketed as a retirement option in rural and coastal locations of the UK. However, many areas are often remote with declining populations and limited community services. Operators have sought to tap into retiree aspirations for a 'place in the country' and 'sell' the concept of park home living as a specific form of housing, community and lifestyle. Park homes are frequently marketed as a means to release equity from the sale of a large family home to fund a retirement lifestyle and as friendly communities of like-minded people, always willing to lend support or provide assistance if required. The physical and social composition of such sites represent a form of rural gated community. This paper seeks to identify the rural planning issues which emerge from such developments and asks: who are moving to park home sites and why? do park homes provide those who otherwise could not afford a 'place in the country' the option of rural living? does park home living live-up to residents' expectations of the rural idyll or retirement lifestyle? do they give rise to issues of gentrification and geriatrification of the countryside? what are the prospects for residents to 'age in place'? might ageing residents become financially trapped in such developments giving rise to park ghettoization? what are the associated challenges for rural policy-makers and public service providers?

From brown envelopes to community benefits: the co-option of planning gain agreements under deepening neoliberalism

The provision of physical and social infrastructure in the form of roads, green spaces and community facilities has traditionally been provided for by the state through the general taxation system. However, as the state has been transformed along more neoliberal lines, the private sector is increasingly relied upon to deliver public goods and services. Planning gain agreements have flourished within this context by offering another vehicle through which local facilities are privately funded. Whilst these agreements reflect the broader dynamics of neoliberalism, they are commonly viewed as a tool which can be employed to challenge these very dynamics by empowering local communities to secure more just planning outcomes. This paper counters such claims. Based on evidence gathered from 80 interviews with planners, councillors, developers and community groups in Ireland, the paper demonstrates how planning gain agreements have been strategically redeployed by the holders of political and economic power to serve their own ends. In seeking to understand why and how this has occurred, specific consideration is given to the changing power dynamics between the state and private capital under neoliberalism. The paper highlights how institutional arrangements have enabled developers to infiltrate the political sphere in more subtle and implicit ways than ever before. We conclude by arguing that planning gain must be understood as a mechanism which has been manipulated in ways which essentially work to preserve and enhance, rather than redress, existing power imbalances in the planning system by facilitating large scale transfers of wealth upwards in society.

Uppföljning och utvärdering av det balanserade styrkortet : Är balanserat styrkort ett värdeskapande och strategiskt instrument inom den kommunala verksamheten?

The need to steer economic development has always been great and as management model has the balanced scorecard has been popular since the mid- 1990s, mainly in the private sector but also in the municipal sector. The introduction of the balanced scorecard has been primarily to organizations to see more than economic dimensions. The Balanced Scorecard was originally a measurement system, and today it works more as a strategic instrument. In our study is a case study to evaluate a municipality and how they make use of the balanced scorecard as a tool for strategic and value-adding work in municipal activities. In the local business is it important that the organization adapts the balanced scorecard, so it fits on the basis that it is a politically driven organization, with mandates, committees and administrations. In our study, we used a qualitative method with a deductive approach. In the study, we have gathered information through a case study where we interviewed 7 people in leading positions. In our analysis and results section, we came to the conclusion that the municipality does not use the balanced scorecard correctly. We also found that the balanced scorecard as a tool for value creation and strategic planning does not work in a favorable way. In our study, we see difficulties with the implementation of the balanced scorecard. If the municipality has invested in implementing the balanced scorecard at all levels of the business so the municipality would be able to use it on one of the activities more adequately. When the municipality is a politically driven organization, it is important that vision alive and changing based on the conditions that reflect the outside world and the municipality in general. Looking at a vivid vision, goals and business ideas, it's balanced scorecard in line with how a balanced scorecard should look like. The municipality has a strategic plan in terms of staff and employees at large. In the study, we have seen that the strategic plan is not followed up in a good way and for the business favorably, the municipality chooses the easy way out for evaluation. Employee participation to changes and ongoing human resources management feels nonexistent. However, as has been the vision of creating empowered and motivated employees. In our conclusion, we describe how we in our study look at the use of the balanced scorecard in municipal operations. We can also discern that a balanced scorecard as a tool for value creation and strategic work is good if it is used properly. In the study, we have concluded that the municipality we have chosen to study should not use the balanced scorecard when you have not created the tools and platforms required for employees, civil servants and politicians to evaluate, monitor and create a living scorecard change over time. The study reveals major shortcomings in the implementation, evaluation and follow-up possibilities, and the consequence of this is that the balanced scorecard is not - 4 - preferable in municipal operations as a strategic instrument for value creation and long-term planning.

Décentralisation et allocation des ressources : les détours de la municipalisation du système de santé brésilien.

Dans cette thèse, nous avons analysé le déroulement d’un processus de municipalisation du système de santé, effectué au Rio Grande do Norte (RN), un des états fédérés du nord-est du Brésil. En tenant compte des contextes historiques d’implantation, nous avons centré notre attention sur la contribution des acteurs impliqués dans ce processus, spécialement dans l’allocation des ressources financières du système. Les croyances, perceptions, attentes, représentations, connaissances, intérêts, l’ensemble des facteurs qui contribuent à la constitution des capacités cognitives de ces acteurs, favorise la réflexivité sur leurs actions et la définition de stratégies diverses de façon à poursuivre leurs objectifs dans le système de santé. Ils sont vus ainsi comme des agents compétents et réflexifs, capables de s’approprier des propriétés structurelles du système de santé (règles et ressources), de façon à prendre position dans l’espace social de ce système pour favoriser le changement ou la permanence du statu quo. Au cours du processus de structuration du Système unique de santé brésilien, le SUS, la municipalisation a été l’axe le plus développé d’un projet de réforme de la santé. Face aux contraintes contextuelles et de la dynamique complexe des espaces sociaux de la santé, les acteurs réformistes n’ont pas pu suivre le chemin de l’utopie idéalisée; quelques détours ont été parcourus. Au RN, la municipalisation de la santé a constitué un processus très complexe où la triade centralisation/décentralisation/recentralisation a suivi son cours au milieu de négociations, de conflits, d’alliances, de disputes, de coopérations, de compétitions. Malgré les contraintes des contextes successifs, des propriétés structurelles du système et des dynamiques sociales dans le système de santé, quelques changements sont intervenus : la construction de leaderships collectifs; l’émergence d’une culture de négociation; la création des structures et des espaces sociaux du système, favorisant les rencontres des acteurs dans chaque municipalité et au niveau de l’état fédéré; un apprentissage collectif sur le processus de structuration du SUS; une grande croissance des services de première ligne permettant d’envisager une inversion de tendance du modèle de prestation des services; les premiers pas vers la rupture avec la culture bureaucratique du système. Le SUS reste prisonnier de quelques enjeux institutionnalisés dans ce système de santé : la dépendance du secteur privé et de quelques groupes de professionnels; le financement insuffisant et instable; la situation des ressources humaines. Les changements arrivés sont convergents, incrémentiels, lents; ils résultent d’actions normatives, délibérées, formalisées. Elles aussi sont issues de l’inattendu, de l’informel, du paradoxe; quelques-unes plus localisées, d’autres plus généralisées, pour une courte ou une plus longue durée.

The Impact of Global English in Xinjiang, China: Linguistic Capital and Identity Negotiation among the Ethnic Minority and Han Chinese Students

Thesis (Ph.D.)--University of Washington, 2016-08

Betydelsen av socialt ansvar : En kvalitativ studie om ideella elitidrottsföreningars sociala samhällsengagemang

De ideella elitidrottsföreningarna börjar till stor del bli kommersialiserade och gränsen mellan dem och vinstdrivande företag är på väg att suddas ut. De är dock fortfarande en ideell idrottsförening till formen som ska vara allmännyttig, demokratisk, ha folkrörelsekaraktär, vara jämlik och jämställd – de ska med andra ord genom sin huvudsakliga verksamhet bidra till samhället. Trots det tenderar elitidrottsföreningarna att ta ytterligare samhällsansvar genom att bedriva olika projekt och verksamheter med syfte att på olika sätt hjälpa till exempel utsatta grupper i samhället. Syftet med studien är att förstå vilken betydelse de sociala samhällsengagemangen har för ideella elitidrottsföreningar i förhållande till deras intressenter. Genom att utföra semistrukturerade intervjuer med representanter från fem olika ideella elitidrottsföreningar har vi skapat en förståelse kring deras sociala ansvarstagande för att därefter tolka vilken betydelse detta har för föreningarna och för vilka de arbetar med socialt ansvarstagande. Uppsatsen bidrar till att förstå att det finns nya strategier att använda sig av när det handlar om att bedriva en ideell elitidrottsförening. Vi önskar att uppsatsen kan bidra till att inspirera personer inom föreningsvärlden att våga gå nya vägar när det kommer till att leda och utveckla Sveriges idrottsföreningar.

O processo de criação do programa Universidade para Todos - PROUNI

From the end of the 80s, the Brazilian higher education experience strong growth, coming from the private sector, which would intensify further in the late 90th Higher education has become a lucrative business. With a drop in the number of students entering and strong competition, the number of idle places in private institutions of higher education reached 49.5% in 2004. That same year, by Measure, was the University for All Program (PROUNI) program, to include high school students from public higher education, offering scholarships to those students in private HEIs. In exchange, the IES gain tax exemption. The objective of this research is to investigate the game of interest occurred in the formulation of this program and identify the model and the political game and has led to the creation of PROUNI, analyzing the process occurred since the wording of a bill, the issue of Measure Law and that the legitimacy PROUNI, with the most important changes made initial model. Since the first draft of the Law to the final Act, the PROUNI was disfigured in its main points, as the percentage of stock for paying students, the process of selection of stock and bond of the IES program. Throughout the process of creating the program, it is quite clear the performance of the institutions representing the private higher education. As reference for the analysis was based on Rational Choice Theory of Political Science. The basic argument of the methods based on rational choice is the maximization of the benefit will be the main motivation of individuals, but they can give that your goals can be achieved more effectively through institutional action and thereby discover that their conduct is shaped by institutions. Thus, individuals rationally choose to get to a certain extent constrained to join in certain institutions, whether voluntarily or not. The PROUNI was submitted by government and public policy covered by the mystical aura of the discourse of social justice and economic development, as in higher education includes a stratum of people who would not have access to the university, due to restrictions in the supply network public higher education. However, the greatest benefit from the program are the private HEIs, which through a difficult time in a scenario marked by high competition and idleness of nearly half of the vacancies offered. The PROUNI became a program that prioritizes access and not the residence of the student to higher education. More serious than a supporting program for students Fellows is a program supporting the institutions of private education

Public Protection? The Implication of Grayling's 'Transforming Rehabilitation' Agenda on the Safety of Women and Children

Abstract The Coalition Government's new Transforming Rehabilitation (TR) agenda jeopardises the work undertaken with perpetrators of domestic abuse by highly skilled, qualified probation staff. Under new changes outlined by Grayling, Lord Chancellor and Secretary of State for Justice, probation clients who are assessed as posing a medium/low risk of causing harm will be assigned to private sector/voluntary organisations rather than come under the remit of the National Probation Service. This article argues that victims of domestic abuse, primarily women and children, will be placed at an increased risk of harm given this latest TR strategy. The majority of domestic abuse cases will be assessed as posing a medium risk of causing harm and will receive lower levels of intervention by a variety of disparate agencies and organisations. The Ministry of Justice states that the National Probation Service will directly manage offenders who pose a high risk of serious harm to the public, this article will argue that all perpetrators of domestic abuse should be considered as an important exception to this stance, and should remain under the auspices of Probation supervision, irrespective of statistical risk assessment, as has sex offender case management and sex offender treatment programme delivery.

Jatropha cultivation in Malawi and Mozambique: impact on ecosystem services, local human well-being, and poverty alleviation

Jatropha-based biofuels have undergone a rapid boom-and-bust cycle in southern Africa. Despite strong initial support by governments, donors, and the private sector, there is a lack of empirical studies that compare the environmental and socioeconomic impacts of Jatropha’s two dominant modes of production: large plantations and smallholder-based projects. We apply a rapid ecosystem services assessment approach to understand the impact of two Jatropha projects that are still operational despite widespread project collapse across southern Africa: a smallholder-based project (BERL, Malawi) and a large plantation (Niqel, Mozambique). Our study focuses on changes in provisioning ecosystem services such as biofuel feedstock, food, and woodland products that can have important effects on human well-being locally. Qualitative information is provided for other regulating and cultural ecosystem services. Although at this stage no impact is tremendously positive or negative, both projects show some signs of viability and local poverty alleviation potential. However, their long-term sustainability is not guaranteed given low yields, uncertain markets, and some prevailing management practices.

Standard Essential Patent in Telecommunication Standard: United States and China Comparison

Thesis (Ph.D.)--University of Washington, 2016-08

Professionalizing school governance: the disciplinary effects of school autonomy and inspection on the changing role of school governors

Since the 1980s, state schools in England have been required to ensure transparency and accountability through the use of indicators and templates derived from the private sector and, more recently, globally circulating discourses of ‘good governance’ (an appeal to professional standards, technical expertise, and performance evaluation as mechanisms for improving public service delivery). The rise of academies and free schools (‘state-funded independent schools’) has increased demand for good governance, notably as a means by which to discipline schools, in particular school governors – those tasked with the legal responsibility of holding senior leadership to account for the financial and educational performance of schools. A condition and effect of school autonomy, therefore, is increased monitoring and surveillance of all school governing bodies. In this paper, I demonstrate how these twin processes combine to produce a new modality of state power and intervention; a dominant or organizing principle by which government steer the performance of governors through disciplinary tools of professionalization and inspection, with the aim of achieving the ‘control of control’. To explain these trends, I explore how various established and emerging school governing bodies are (re)constituting themselves to meet demands for good governance.

Can You Hear the Eco? : A Study of How Swedish Municipalities Can Market their CSR-Activities

Background: In an increasingly globalised world, municipalities more than ever have to compete with each other. Thus, the need to create a brand image has become vital for municipalities. Place branding is the tool that has enabled municipalities to create a brand image in order to attract stakeholders such as potential visitors, residents and businesses. The sustainability phenomenon Corporate Social Responsibility (CSR) has recently become an attractive factor within place branding. Although, the concept of CSR is most commonly implemented within the private sector, CSR initiatives within the public sector are recognised as an integral part. Therefore, the issue of how municipalities can market and communicate their CSR-actives has arisen.  Purpose: The aim of this research is to explore how Swedish municipalities can market their CSR-activities, in order to gain competitive advantages as attractive cities. In further details, this research focuses on how municipalities can use place branding to market their CSR-activities and how they can communicate this to current and potential stakeholders. Method: In order to fulfil this purpose, an interpretivist methodology was adopted with an abductive approach. In regard to this, an exploratory design was developed. More specifically, it was conducted with a mixed method, using a quantitative content analysis and qualitative indepth interviews with knowledgeable experts within CSR from the most relevant departments in the municipalities. Conclusion: The findings indicate that the use of place branding can help municipalities with a sustainable profile to gain competitive advantages. Furthermore, it became apparent that the use of place branding strategies, such as slogan, logotypes, events and cooperation with stakeholders, could enhance the brand image of municipalities and enable them to attract potential stakeholders. In regards to the communication channels, the findings suggest municipalities to communicate their CSR-activities through websites, social media, press conferences, seminars and events.

Utilização do “cheque-dentista” por parte de crianças de 10 e 13 anos no ano letivo 2013/2014 em duas escolas no agrupamento de Vizela

Introdução: Uma grande parte de todas as consultas de medicina dentária realizadas em Portugal ocorre em prestadores de natureza privada, consequentemente a acessibilidade, principalmente entre os estatutos socioeconomicamente mais desfavorecido é dificultada. As crianças e os jovens são um grupo especial da população que necessita de particular atenção e proteção por parte dos serviços governamentais, investir na sua saúde e no seu bem‐estar garante ganhos de saúde ao longo das suas vidas. Tendo isto em conta, foi criado o Programa Nacional de Promoção de Saúde Oral (PNPSO). Os objetivos principais deste programa consistem na redução da incidência de doenças orais, melhoria dos conhecimentos e comportamentos sobre saúde oral e a promoção da equidade na prestação de cuidados de saúde oral. Desta forma são emitidos cheques-dentista para determinados grupos populacionais, sendo eles crianças e jovens com idade inferior a 16 anos, gravidas a ser seguidas no SNS, beneficiários do complemento solidário para idosos, portadores de Sida/VIH, e consultas no âmbito da prevenção do cancro oral. Participantes e Métodos: Realizou-se um estudo observacional transversal onde a população em análise foi constituída pelos responsáveis dos alunos de 10 e 13 anos abrangidos pelo PNPSO que no ano letivo 2013/2014 frequentaram o Colégio de Vizela e o Instituto Silva Monteiro. A recolha de dados foi feita através de um inquérito realizado por escrito com questões relativas à utilização dos documentos no âmbito do PNPSO. Em ambas as situações esteve presente o consentimento informado e garantiu-se a total confidencialidade dos dados. Os dados recolhidos neste estudo foram submetidos a uma análise estatística recorrendo ao software IBM SPSS Statistics v22. Resultados: Na população analisada quando questionados “O seu educando já tinha tido alguma consulta de medicina dentária?” 88,5% responderam “sim”, desses a maioria referiu que o médico dentista onde essas consultas foram realizadas estava incluído no programa (81,5%). Uma grande parte dos inquiridos referiu a escola como fator que lhes deu a conhecer o programa (sendo que 90,2% incluíram essa opção nas suas respostas). Quando questionados se fizeram tratamentos fora do programa 54,9% responderam que não. Em relação à utilização do(s) cheque(s)-dentista a que tiveram direito, 86,1% dos beneficiários referiu ter utilizado, desses, 67,6% mencionou a conclusão dos tratamentos com as consultas no âmbito do programa. Quando questionados o que os levou a escolher o consultório onde os tratamentos incluídos no PNPSO foram realizados, 57,9% do total de respostas foram para o “conhecimento prévio do médico dentista”. Na opinião de grande parte dos inquiridos (97,5%), o cheque-dentista é um incentivo para cuidados de saúde oral. No futuro, 99,2% dos beneficiários referiram que irão realizar os tratamentos a que tenham direito com o PNPSO. Conclusão: Com este estudo foi possível observar que grande parte dos beneficiários analisados utilizou o(s) cheque(s)-dentista a que tiveram direito. É possível observar que a maioria dos utentes referiram ter beneficiado com o programa, e afirmam que este constitui um meio de promoção e prevenção de doenças orais futuras e um incentivo para os cuidados de saúde oral. O processo de divulgação do PNPSO foi na sua maioria realizado pelas escolas, em que ambas se revelaram competentes a dar a conhecer o programa aos beneficiários.