The Brazilian National Health Agency and the Mental Health Policy in the Context of the Private Health System: developments and challenges

This work analyses the mental health policy-making activity of the Brazilian National Health Agency (ANS), responsible for controlling health insurance companies. Three points are discussed: a) the framework of an economic and private health assistance regulatory activity, b) the ANS and its regulation activity and c) the rules produced by ANS in the mental health care field. It was concluded that, despite advances like the legal obligation to ensure medical treatment to all the diseases listed in ICD-10, the inclusion of suicidal patient damage and self-inflicted damage care, care provided by a multiprofessional team, the increase in the number of sessions with a psychologist, with an occupational therapist and of psychotherapy sessions, and mental health day hospitals included as part of the services offered, the authors identified specific regulatory gaps in this area. Some issues that ANS has to solve so that it can really play its institutional role of defending the public interest in the private health system are: the regulation of co-participation and franchise mechanisms, the increasing co-participation as a limitation of psychiatric hospitalization, and the limited number of crisis intervention psychotherapy sessions.

The Effects of Processing Non-Timber Forest Products and Trade Partnerships on People's Well-Being and Forest Conservation in Amazonian Societies

This study evaluated whether processing non-timber forest products (NTFPs) and establishing trade partnerships between forest communities and companies enhance the outcomes of NTFP commercialization. In particular, we evaluated whether product processing, partnerships, or their combination was associated with a number of outcomes related to the well-being of forest inhabitants and forest conservation. We based our analyses on ethnographic and quantitative data (i.e., survey and systematic observations) gathered at seven communities from five societies of the Brazilian and Bolivian Amazon. Our results indicated that product processing and partnerships do not represent a silver bullet able to improve the results of NTFP commercialization in terms of well-being and conservation indicators. Compared with cases without interventions, households adopting partnerships but not product processing were most often associated with improved economic proxies of well-being (total income, NTFP income, food consumption and gender equality in income). In comparison, the combination of product processing and partnerships was associated with similar outcomes. Unexpectedly, product processing alone was associated with negative outcomes in the economic indicators of well-being. All of the investigated strategies were associated with less time spent in social and cultural activities. With respect to forest conservation, the strategies that included a partnership with or without processing produced similar results: while household deforestation tended to decrease, the hunting impact increased. Processing alone was also associated with higher levels of hunting, though it did not reduce deforestation. Our results indicate that establishing partnerships may enhance the outcomes of NTFP trade in terms of the financial outcomes of local communities, but practitioners need to use caution when adopting the processing strategy and they need to evaluate potential negative results for indicators of social and cultural activities. With respect to conservation, the three strategies are promising for reducing deforestation, but more pervasive impacts, such as hunting, might increase.

Formal planning rationality in public sector professional work: between discourse and practice

Although rational models of formal planning have been seriously criticized by strategy literature, they not only remain a widely used organizational practice in private firms, but they have increasingly been entering public, professional organizations too, as part of public sector managerial reforms. This research addresses this apparent paradox, exploring the meaning of formal planning in public sector professional work. Curiously, this is an issue that remains under-investigated in the literature: the long debate on formal planning in strategy research devoted scant attention to its diffusion in the public sector, and public sector studies have scrutinized the introduction of other management tools in professional work, but very limitedly formal planning itself. In fact, little is known on the actual meaning of formal planning in public, professional services. This research is based upon a case of adoption of formal planning tools in a public hospital. Embracing a discourse analytical lens, it examines which formal planning discourse entered professional work, to what extent, and how professionals interpret it and engage with it in their practice. The analysis uncovers dynamics of social construction of meaning where, eventually, a formal planning discourse both shapes and is shaped by professional practice. In particular, it is found that formal planning rationality largely penetrated professional work, but not to the detriment of professional values. Morevover, formal planning ‘fails’ as a tool for rational decision making, but it takes up a knowledge work and a social value in professional work, as a tool for explicitation of action courses and for dialogue between otherwise more disconnected parts of the organization.

'Defending the rights'. An integrated model of collective action for "public water" in Italy

In many communities, supplying water for the people is a huge task and the fact that this essential service can be carried out by the private sector respecting the right to water, is a debated issue. This dissertation investigates the mechanisms through which a 'perceived rights violation' - which represents a specific form of perceived injustice which derives from the violation of absolute moral principles – can promote collective action. Indeed, literature on morality and collective action suggests that even if many people apparently sustain high moral principles (like human rights), only a minority decides to act in order to defend them. Taking advantage of the political situation in Italy, and the recent mobilization for "public water" we hypothesized that, because of its "sacred value", the perceived violation of the right to water facilitates identification with the social movement and activism. Through five studies adopting qualitative and quantitative methods, we confirmed our hypotheses demonstrating that the perceived violation of the right to water can sustain activism and it can influence vote intentions at the referendum for 'public water'. This path to collective action coexists with other 'classical' predictors of collective action, like instrumental factors (personal advantages, efficacy beliefs) and anger. The perceived rights violation can derive both from personal values (i.e. universalism) and external factors (i.e. a mobilization campaign). Furthermore, we demonstrated that it is possible to enhance the perceived violation of the right to water and anger through a specifically designed communication campaign. The final chapter summarizes the main findings and discusses the results, suggesting some innovative line of research for collective action literature.

Partnership fra terzo Settore e Istituzioni Locali nelle Politiche Family Friendly: Il "Distretto famiglia"

L’idea fondamentale da cui prende avvio la presente tesi di dottorato è che sia possibile parlare di una svolta nel modo di concettualizzare e implementare le politiche sociali, il cui fuoco diviene sempre più la costruzione di reti di partnership fra attori pubblici e privati, in cui una serie di soggetti sociali plurimi (stakeholders) attivano fra loro una riflessività relazionale. L’ipotesi generale della ricerca è che, dopo le politiche improntate a modelli statalisti e mercatisti, o un loro mix, nella politica sociale italiana emerga l’esigenza di una svolta riflessiva e relazionale, verso un modello societario, sussidiario e plurale, e che di fatto – specie a livello locale – stiano sorgendo molte iniziative in tal senso. Una delle idee più promettenti sembra essere la creazione di distretti sociali per far collaborare tra loro attori pubblici, privati e di Terzo settore al fine di creare forme innovative di servizi per la famiglia e la persona. La presente tesi si focalizza sul tentativo della Provincia di Trento di distrettualizzare le politiche per la famiglia. Tramite l’analisi del progetto “Trentino – Territorio Amico della Famiglia” e di una sua verticalizzazione, il Distretto Famiglia, si è studiato l’apporto delle partnership pubblico-privato nella formazione di strumenti innovativi di governance che possano determinare una svolta morfogenetica nell’elaborazione di politiche per la famiglia. Le conclusioni del lavoro, attraverso una comparazione tra esperienze territoriali, presentano la differenziazione delle partnership sociali, in base ad alcuni variabili (pluralità di attori, pluralità di risorse, shared project, capitale sociale, decision making, mutual action, logiche di lavoro relazionale, sussidiarietà). Le diverse modalità di gestione delle partnership (capacitante, professionale e generativa) sintetizzano i portati culturali, strutturali e personali coinvolti nelle singole costruzioni. Solo le partnership che interpretano il loro potenziale regolativo e promozionale secondo la riflessività relazionale tendono a generare beni comuni nel contesto sociale.

The informal market of education in Egypt: Private tutoring and its implications /// Arbeitspapiere / Institut für Ethnologie und Afrikastudien ; 88

Education is generally perceived as a public good which should be provided by the state. In Egypt, free and equal access to education has been guaranteed to all citizens since President Nasser’s socialist reforms in the 1950s. However, due to high population growth rates and a lack of financial resources, the public education system has been struggling to accommodate rapidly increasing numbers of students. While enrolment rates have risen steadily, the quality of state-provided services has deteriorated. Teachers and students have to cope with high class densities, insufficient facilities, a rigid syllabus and a centralized examination system. Today, teaching is among the lowest-paying occupations in the public sector. One strategy to cope with this situation is the widespread practice of private tutoring, which usually takes place at students’ homes or in commercial tutoring centers. Based on research carried out in Cairo in 2004/05 and 2006, I use an actor-centered approach to analyze the motivations of Egyptian teachers and students for participating in private tutoring and the impact that this practice has on the relationship between teachers and students. Students of all socio-economic backgrounds resort to tutoring in order to succeed in a highly competitive and exam-oriented education system. However, the form and quality of tutoring that can be accessed depends on the financial means of the family. For teachers, tutoring provides a good opportunity not only to supplement their income, but also, in the case of renowned “star teachers”, to improve their professional status and autonomy. On the informal “market of education” that has developed in Egypt during the last decades, the educational responsibilities of the state are increasingly being taken over by private actors, i.e. the process of teaching and learning is dissociated from the direct control of the state and from school as an institution. At the same time, education is turned into a marketable commodity. Despite the government’s efforts to provide free education to all citizens, the quality of social services that can be accessed in Egypt, thus, depends mainly on the financial means of the individual or the family.

Sicurezza privata e sicurezza partecipata. Le imprese private del settore sicurezza in Italia tra subalternità e sussidirietà

La ricerca esamina il ruolo delle imprese che svolgono attività di sicurezza privata in Italia (oggi definita anche "sussidiaria" o "complementare") in relazione allo sviluppo delle recenti politiche sociali che prevedono il coinvolgimento di privati nella gestione della sicurezza in una prospettiva di community safety. Nel 2008/2009 le politiche pubbliche di sicurezza legate al controllo del territorio hanno prodotto norme con nuovi poteri “di polizia” concessi agli amministratori locali e la previsione di associazione di cittadini per la segnalare eventi dannosi alla sicurezza urbana (“ronde”). Nello stesso periodo è iniziata un’importante riforma del settore della sicurezza privata, ancora in fase di attuazione, che definisce le attività svolte dalle imprese di security, individua le caratteristiche delle imprese e fissa i parametri per la formazione del personale. Il quadro teorico del lavoro esamina i concetti di sicurezza/insicurezza urbana e di società del rischio alla luce delle teorie criminologiche legate alla prevenzione situazionale e sociale e alla community policing. La ricerca sul campo si basa sull’analisi del contenuto di diverse interviste in profondità con esponenti del mondo della sicurezza privata (imprenditori, dirigenti, studiosi). Le interviste hanno fatto emergere che il ruolo della sicurezza privata in Italia risulta fortemente problematico; anche la riforma in corso sulla normativa del settore è considerata con scarso entusiasmo a causa delle difficoltà della congiuntura economica che rischia di compromettere seriamente la crescita. Il mercato della sicurezza in Italia è frastagliato e scarsamente controllato; manca un’azione di coordinamento fra le diverse anime della sicurezza (vigilanza privata, investigazione, facility/security management); persiste una condizione di subalternità e di assenza di collaborazione con il settore pubblico che rende la sicurezza privata relegata in un ruolo marginale, lontano dalle logiche di sussidiarietà.

Design the support for granting required sla in public cloud environments based on cloud foundry

Through the use of Cloud Foundry "stack" concept, a new isolation is provided to the application running on the PaaS. A new deployment feature that can easily scale on distributed system, both public and private clouds.

La natura del contratto di societa' mista in relazione alle prestazioni del socio privato

Il lavoro mira a fornire un complessivo inquadramento dell'istituto della società mista, identificato in primo luogo quale strumento di diritto privato a cui partecipano soggetti pubblici e soggetti privati. L'indagine si svolge su differenti piani di valutazione. Si dà ragione delle caratteristiche peculiari di tale contratto associativo e dei limiti che il nostro ordinamento impone allo sviluppo della figura. L'attenzione si sposta poi sulla specifica declinazione che il modello di società mista ha assunto in ambito europeo attraverso l'analisi del partenariato pubblico privato istituzionalizzato. L'istituto è di particolare interesse perchè individua nella società mista un modello organizzativo dai tratti specifici, all'interno del quale il ruolo del socio privato assume connotazioni e forme non comuni a tutti i modelli societari. La ricerca mira a mostrare come tale figura ha trovato riscontro nell'ordinamento interno e quali possibili sviluppi la stessa possa trovare in differenti campi della vita economica. In questi termini, si cerca di valutare quale sia l'incidenza delle procedure competitive nella costituzione e nella vita della società mista ed in che termini lo svolgimento delle attività affidate al socio privato debba essere inquadrato all'interno del rapporto di partenariato. Sul punto è centrale la declinazione fornita all'istituto in relazione ad uno specifico ambito di attività: i servizi pubblici locali di rilevanza economica. In questo contesto, particolarmente rilevante sul piano sistematico è la ricerca di un equilibrio tra il rispetto delle disciplina posta a tutela della concorrenza, ed il perseguimento delle finalità che hanno portato alla scelta di costruire una società mista. La scelta in favore di tale modello organizzativo pare infatti giustificata solo qualora essa apporti un reale vantaggio nella gestione del servizio e la realizzazione di concrete sinergie positive.

Medical Malpractice in Public Healthcare Systems: An Empirical Investigation of Scheduled Damages

In the last decades, medical malpractice has been framed as one of the most critical issues for healthcare providers and health policy, holding a central role on both the policy agenda and public debate. The Law and Economics literature has devoted much attention to medical malpractice and to the investigation of the impact of malpractice reforms. Nonetheless, some reforms have been much less empirically studied as in the case of schedules, and their effects remain highly debated. The present work seeks to contribute to the study of medical malpractice and of schedules of noneconomic damages in a civil law country with a public national health system, using Italy as case study. Besides considering schedules and exploiting a quasi-experimental setting, the novelty of our contribution consists in the inclusion of the performance of the judiciary (measured as courts’ civil backlog) in the empirical analysis. The empirical analysis is twofold. First, it investigates how limiting compensations for pain and suffering through schedules impacts on the malpractice insurance market in terms of presence of private insurers and of premiums applied. Second, it examines whether, and to what extent, healthcare providers react to the implementation of this policy in terms of both levels and composition of the medical treatments offered. Our findings show that the introduction of schedules increases the presence of insurers only in inefficient courts, while it does not produce significant effects on paid premiums. Judicial inefficiency is attractive to insurers for average values of schedules penetration of the market, with an increasing positive impact of inefficiency as the territorial coverage of schedules increases. Moreover, the implementation of schedules tends to reduce the use of defensive practices on the part of clinicians, but the magnitude of this impact is ultimately determined by the actual degree of backlog of the court implementing schedules.

Regulating State Aid: Inter-jurisdictional competition, public choice, and corporate governance

Depending on the regulatory regime they are subject to, governments may or may not be allowed to hand out state aid to private firms. The economic justification for state aid can address several issues present in the competition for capital and the competition for transfers from the state. First, there are principal-agent problems involved at several stages. Self-interested politicians might enter state aid deals that are the result of extensive rent-seeking activities of organized interest groups. Thus the institutional design of political systems will have an effect on the propensity of a jurisdiction to award state aid. Secondly, fierce competition for firm locations can lead to over-spending. This effect is stronger if the politicians do not take into account the entirety of the costs created by their participation in the firm location race. Thirdly, state aid deals can be incomplete and not in the interest of the citizens. This applies if there are no sanctions if firms do not meet their obligations from receiving aid, such as creating a certain number of jobs or not relocating again for a certain amount of time. The separation of ownership and control in modern corporations leads to principal-agent problems on the side of the aid recipient as well. Managers might receive personal benefits from subsidies, the use of which is sometimes less monitored than private finance. This can eventually be to the detriment of the shareholders. Overall, it can be concluded that state aid control should also serve the purpose of regulating the contracting between governments and firms. An extended mandate for supervision by the European Commission could include requirements to disincentive the misuse of state aid. The Commission should also focus on the corporate governance regime in place in the jurisdiction that awards the aid as well as in the recipient firm.

Public Attitudes Toward Social Spending in the United States: The Differences Between Direct Spending and Tax Expenditures

This paper uses a survey experiment to examine differences in public attitudes toward 'direct' and 'indirect' government spending. Federal social welfare spending in the USA has two components: the federal government spends money to directly provide social benefits to citizens, and also indirectly subsidizes the private provision of social benefits through tax expenditures. Though benefits provided through tax expenditures are considered spending for budgetary purposes, they differ from direct spending in several ways: in the mechanisms through which benefits are delivered to citizens, in how they distribute wealth across the income spectrum, and in the visibility of their policy consequences to the mass public. We develop and test a model explaining how these differences will affect public attitudes toward spending conducted through direct and indirect means. We find that support for otherwise identical social programs is generally higher when such programs are portrayed as being delivered through tax expenditures than when they are portrayed as being delivered by direct spending. In addition, support for tax expenditure programs which redistribute wealth upward drops when citizens are provided information about the redistributive effects. Both of these results are conditioned by partisanship, with the opinions of Republicans more sensitive to the mechanism through which benefits are delivered, and the opinions of Democrats more sensitive to information about their redistributive effects.

[Effects of tobacco use on systemic health: relevant information for dentistry (II)--part 2: cardiovascular diseases and public health issues]

This is the sixth and concluding part of a series of publications from the Swiss task force named "Smoking - Intervention in the private dental office" on the topic "tobacco use and dental medicine". The focus of this review is the effects of smoking for the development of atherosclerosis as pathohistological correlate for acute coronary syndrome (ACS), arterial occlusive disease, and cerebrovascular diseases (stroke). Additionally, a causal relationship between tobacco use and an increased rate for complications during pregnancy and child birth will be discussed. Next to causal therapy of local and systemic diseases in general, an emphasis must be given to tobacco use prevention and cessation. Finally, important public health issues concerning smoking and tobacco use will be demonstrated, and options to improve the current situation will be presented.

Balancing wildlife and bioenergy values on private forestlands in the eastern Upper Peninsula of Michigan

There is interest in developing a reliable, sustainable, domestic U.S. biofuels industry. A domestic biofuels industry has the potential to provide economic, environmental, and national security benefits on a local, regional, national, and global level. The Mascoma Corporation plans to develop a cellulosic ethanol facility in Michigan’s eastern Upper Peninsula. The primary feedstock of the plant site would be trees sourced within a 150 mile supply radius. In the eastern Upper Peninsula, this radius encompasses Alger, Chippewa, Delta, Luce, Mackinac, and Schoolcraft counties. In these six counties there are 1,320,500 acres of NIPF (non-industrial private forestlands). These acres account for 40% of the total timberland in these six counties. Thus it is likely that in order for the successful implementation of a cellulosic ethanol facility the support of local NIPF owners will be necessary. This thesis presents research on how eastern Upper Peninsula forest landowners think about and manage their land. It is based on 48 in-depth interviews with these landowners. The goal was to determine how landowner values and beliefs, on a variety of issues including wildlife management, land management, biofuels development, and climate change, are expressed through both their current management decisions, and possibly their future land management decisions. Some of the values articulated by the landowners in this study included biodiversity protection, conservation of healthy game populations, and the production of high-value timber. Understanding the values and beliefs of landowners in the eastern Upper Peninsula of Michigan is critical for successfully developing a sustainable regional woody bioenergy.

Visualisierung und Virtualisierung von Erinnerung: Geschichtspolitik in der medialen Erlebnisgesellschaft. Skizze des Teilprojekts E 11 im Sonderforschungsbereich "Erinnerungskulturen" an der Justus-Liebig-Universität Gießen

Erinnerungen sind abhängig von der gesellschaftlichen Organisation ihrer Weitergabe und von den dabei genutzten Medien. Deshalb stehen jetzt vermehrt Einflüsse und Wirkungen auf der Tagesordnung, die neue, computervermittelte Medien auf Erinnerungskulturen haben. Die mnemotechnische Relevanz bildhafter Darstellungen von historischen Ereignissen wird in jüngster Zeit verstärkt analysiert; Visualisierung, vor allem in elektronischen Massenmedien, ist dabei als grundlegende Tendenz einer 'ikonisch' geprägten Öffentlichkeit und (politischen) Kultur herausgestrichen worden. Die Digitalisierung stellt eine neue Dimension dar, die bisher meist nur im Hinblick auf ihre technischen Grundlagen und erhöhte Speicherkapazitäten von Erinnerungs-Informationen thematisiert worden ist. Wenig bearbeitet worden sind ihre dynamischen, multimedialen und interaktiven Dimensionen, die eine neue Qualität der Inszenierung und Fiktionalisierung historischer Ereignisse herstellen. Die bisher erzielten Ergebnisse legen nahe, dass es dabei auch zu einer marktförmigen Strukturierung der Erinnerungskulturen kommt und man etwa unter Gesichtspunkten der Finanzierung von einer (globalen) Wettbewerbssituation im Rahmen von 'public-private-partnerships' ausgehen muss.