Health Policy Commons^™

Mass Shootings And Mental Health Policy, Jessica Rosenberg

The Journal of Sociology & Social Welfare

Research suggests that mass shootings can increase mental health stigma, reinforce stereotypes that people with mental illness are violent, and influence public policy. This article examines mental health policy initiatives resulting from the mass shootings in Sandy Hook, Connecticut and Aurora, Colorado within the context of existing research about mental illness, suicide, substance abuse and gun violence. Previous legislation that restricts access to firearms among persons with mental illness is reviewed. The article suggests that gun control legislation that focuses on persons with mental illness is not supported by research, may create barriers to treatment, and may have limited efficacy …

Health Inequalities And The Welfare State In European Families, Simone Sarti, Marco Alberio, Marco Terraneo

The Journal of Sociology & Social Welfare

Using EU-Silc data from 2005, our aim in this article is to estimate how self-assessed health and the gradient between education and health vary among individuals in different European countries, considering their contextual socioeconomic vulnerability. In order to do this, we use a hierarchical model with individuals nested in households at the second level, and in various European countries at the third level. Our main research interest is on the modelling variables associated with better health conditions and their improvement or worsening according not only to micro/ individual and macro/national levels but also to the household: a level on which …

Long Term Care Insurance Beyond The Class Program, Amy Restorick Roberts, David B. Miller, Merl C. "Terry" Hokenstad Jr.

The Journal of Sociology & Social Welfare

The Community Living Assistance and Supports (CLASS) program, created under the Patient Protection and Affordable Care Act, established a federally-administered, voluntary insurance program that allows for working adults to purchase insurance to cover the cost of long term support services. The CLASS program is the first step towards moving away from a welfare-based system, improving consumer choice, and creating a stable funding source for long term care needs. Enrollees in the CLASS program who meet benefit eligibility requirements and need care assistance will receive a cash benefit to pay for supportive services such as home health care, adult day services, …

A Social Justice Perspective On Medicare Part D In An Age Of Reform: Critical Implications Of Trends In Health Care Policy And Advocacy, Louanne Bakk, Marya R. Sosulski

The Journal of Sociology & Social Welfare

This article examines the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) in its current form and explains why a critical perspective is useful when analyzing the policy and reform efforts. Using this approach, we consider the development of the policy and describe ways that gender and racial differences may hinder equal access to medications for some of the most vulnerable older adults. This article explores the implications of gender and racial disparities under the MMA and ramifications of health care reform efforts that could potentially impede, rather than promote, a social justice agenda. Beyond the political advantage …

The President's Emergency Plan For Aids Relief (Pepfar): A Social Work Ethical Analysis And Recommendations, Robert J. Barney, Stephan L. Buckingham, Judith M. Friedrich, Lisa M. Johnson, Michael A. Robinson, Bibhuti K. Sar

The Journal of Sociology & Social Welfare

The President's Emergency Plan for AIDS Relief (PEPFAR) is the most recent international social program instituted by the U.S. Government to combat HIV/AIDS. Since its inception in 2003, this foreign policy initiative has dedicated $63 billion for HIV/AIDS prevention and treatment in foreign countries. Despite PEPFAR's many accomplishments, it continues to promote controversial prevention strategies. This paper analyzes these prevention strategies, utilizing social work values as described in the NASW Code of Ethics. Policy, practice, and research implications are discussed.

The Development Of An Unequal Social Safety Net: A Case Study Of The Employer-Based Health Insurance (Non) System, H. Luke Shaefer, Elizabeth D. Sammons

The Journal of Sociology & Social Welfare

The U.S. social safety net exacerbates labor market inequalities rather than ameliorating them. This paper traces this theme within an important historical case study: the emergence of the employer-based health insurance system. Employers became the dominant and tax-preferred provider of health insurance in the United States without any federal legislative action. Understanding how this happened may inform current reform efforts. This case study highlights two important factors. The first is path dependency, discussed by Skocpol (1992) and Pierson (2000). They argue that the ambiguous divisions of power and a pluralistic governance framework favor incremental processes of social policy formation in …

Political Economy, Moral Economy And The Medicare Modernization Act Of 2003, Judie Svihula

The Journal of Sociology & Social Welfare

Through the lens of political and moral economy, I examined the dominant values and actors in the legislative process of the Medicare Modernization Act of 2003. In my content analysis of federal hearings, I found that witnesses from government agencies, Congress and think tanks had almost equal presence at the hearings. Witnesses who were invited by Congress to testify at the hearings expressed twice as much support for private interests than for the general Medicare population or low-income beneficiaries. Few expressed concern for the uninsured population. Witnesses offered almost four times as many expressions of support for market rationalism than …

Tracing The History Of Medicare Home Health Care: The Impact Of Policy On Benefit Use, Joan K. Davitt, Sunha Choi

The Journal of Sociology & Social Welfare

We trace key policy changes that affected use of the Medicare home health benefit from the 1980s through the prospective payment system implemented in 2000, analyzing the impact on three measures of home care use: expenditures, users and visits. We demonstrate the impact of policies generated in the legislative, the judicial, and the executive branches of government and the gaming behavior of home health agencies in response to policy changes. Our analysis suggests that the policy itself and the implementation process are critical to understanding benefit use. The incentives in the policies and agency reactions had the potential to generate …

Review Of The Rise And Fall Of Hmos: An American Health Care Revolution. Jan Gregoire Coombs. Reviewed By Lisa S. Patchner., Lisa S. Patchner

The Journal of Sociology & Social Welfare

Book review of Jan Gregoire Coombs, The Rise and Fall of HMOs: An American Health Care Revolution. Madison, WI: University of Wisconsin Press, 2005. $35.00 hardcover.

Fairness Issues In Law And Mental Health: Directions For Future Social Work Research, Jose B. Ashford, Jane Holschuh

The Journal of Sociology & Social Welfare

Concepts from the procedural justice literature in social psychology are examined that offer useful guidance for social work researchers with interests in investigating informal adjudications, speciality treatment courts, and other areas of the administrative process previously neglected in mental health services research. These theoretical concepts are offered as an alternative to the therapeutic jurisprudence framework being adopted by some social workers in the field of law and mental health. The issues outlined in this paper also draw on the health services and psychotherapy literature to highlight issues involving process and procedure as social justice and their significance for advancing a …

Ethiopian Language Policy And Health Promotion In Oromia, Begna Dugassa

The Journal of Sociology & Social Welfare

In the time of HIV/AIDS, epidemics for which we have no vaccination or cure, public health is bound entirely to depend on the traditional health education strategies to stop or contain this disease. This reality demands that we travel extra miles and thoroughly employ every health promotion tool at our disposal. The Ottawa Charter for health promotion stressed the need for public policy to create supportive social conditions for health. This necessitates a commitment to enduring social conditions for health and raises topics that have been neglected by the traditional public health scholars. A close examination of the colonial language …

Health Care Poverty, Lisa Raiz

The Journal of Sociology & Social Welfare

This paper introduces and describes health care poverty. Underinsurance and its consequences for access to health care are highlighted. Definitions of underinsurance and its prevalence are presented. Groups that experience disproportionate barriers to obtaining medical care are identified. Manifestations of underinsurance are explicated and their relationship to receipt of medical care, such as vaccinations and medications is discussed. A refraining of the health care debate is suggested with emphasis moving from uninsurance to access to health care.

Review Of Medicare Reform: Issues And Answers. Andrew J. Rettenmaier And Thomas R. Saving (Eds.). Reviewed By Deborah Schild Wilkinson, University Of Michigan., Deborah Schild Wilkinson

The Journal of Sociology & Social Welfare

Book review for Andrew J. Rettenmaier and Thomas R. Saving (Eds.), Medicare Reform: Issues and Answers. Chicago, IL.: University of Chicago Press, 2000. $25.00 hardcover, $17.00 papercover.

The Demise Of The Catastrophic Coverage Act: A Reflection Of The Inability Of Congress To Respond To Changing Needs Of The Elderly And Their Families, Linda Boise

The Journal of Sociology & Social Welfare

This paper considers the recent demise of the Medicare Catastrophic Coverage Act of 1988 in the context of the needs of the elderly and their families. Although the surtax imposed on middle and upper income elderly was the ostensible reason for the anger this Act generated among the elderly, other factors related to the concerns and needs of the elderly and of their families also prevented it from being supported. This article discusses the characteristics of the Catastrophic Coverage Act as a continuation of the historical bias of Medicare in favor of acute medical care and as an effort by …

The Politics Of Mental Health After Care, Steve Rose

The Journal of Sociology & Social Welfare

Essential to the development of a positive practice in mental health after-care is a precise formulation of clients' needs. Clarity about a statement of needs provides added information about anticipated obstacles to meeting those needs, both at the client and systemic levels. To accomplish this preliminary task, it becomes necessary to create what we refer to as a "problem definitional" level of theory. Problem defining theory mediates between more global theory, which establishes a larger context for understanding the broad policy issues and direct implications,* and the articulation of practice theory.

Family Health Policy Formulation: A Problematic Definitional Process, H. Hugh Floyd Jr.

The Journal of Sociology & Social Welfare

The family has become a focus of much concern over the past two decades as a variety of family related problems have become major social issues. These social-psychological problems are considered to have negative consequences at three analytical levels: individual, family and society. Therefore, considerable discussion has been raised about the establishment of family policy. Family policy is discussed in this paper as a definitional problematic process. Several problems of a conceptual and logistical nature are cited and some guidelines for family policy construction are made.

The Public And Care By Non-Physicians: Health Policy Consideration, Bebe F. Lavin

The Journal of Sociology & Social Welfare

In an effort to resolve what some define as a crisis in health care, medical paraprofessionals have become an increasing part of the primary care scene. As the training and use of paraprofessionals expands there has been growing insistence that much of what office-based physicians do could be handled as well or better by these non-physicians. If it is health policy to encourage the use of paraprofessionals to alleviate the shortages and maldistribution of primary care doctors, acceptance of these personnel by the public is a critical issue.

A study of the public in a Midwest area suggests considerable variability …

Organizational Structure And Professional Norms In An Alternative Health Care Setting: Physicians In Health Maintenance Organizations, Judith K. Barr, Marcia K. Steinberg

The Journal of Sociology & Social Welfare

The development of new organizational forms for the delivery of health and medical care in the U.S. includes health maintenance organizations (HMOs), designed to provide a set of comprehensive basic health services to a defined population for a fixed prepaid premium. As complex organizations, HMOs have the potential for limiting the autonomy of professionals working in them. This paper describes the legal requirements and organizational mechanisms under which physicians practice in HMOs and considers the potential for conflict between the organization and professional norms.

On the basis of document and interview data from nine HMOs, it appears that mechanisms developed …

Veterans' Medical Care: The Politics Of An American Government Health Service, Judith Lasker

The Journal of Sociology & Social Welfare

The history of veterans' benefits and services in the United States is reviewed; it demonstrates their responsiveness to dominant political, economic, military and medical interests. The ideological position that social services must be "deserved" is also seen to be an important influence on the V.A. system. The consequent inaccessibility of V.A. medical care to most veterans and almost all non-veterans raises questions about the appropriateness of the V.A. system as a model for national health care.

American Health Care: Paradigm Structures And The Parameters Of Change, Allen W. Imershein

The Journal of Sociology & Social Welfare

Recent commentary on the health care scene in the U.S. has moved increasingly toward explanations of why little or no change has occurred despite many declarations of "crisis." From Alford's (1975) elitist analysis in Health Care Politics to Navarro's (1976) marxist analysis in Medicine Under Capitalism, critics in and out of the social sciences have tried to make sense of the array of current problems and the apparent lack of response to or change in them. These analyses are in striking contrast to earlier commentaries (e.g., Schwartz, 1971; Garfield, 1970; Anderson, 1972; Citizens Board, 1972) which, while highly critical of …

The Paradoxes Of Health Planning, Bonnie Morel Edington

The Journal of Sociology & Social Welfare

The National Health Planning Act of 1974 designated 200 Health Systems Agencies (HSAs) nationally and a State Health Planning and Development Agency in each state. Components of the law are analyzed to illustrate its ambiguities and contradictions. The components analyzed are: the findings which led to the passage of the law; the law's purpose; the ten national health priorities; the National Guidelines for Health Planning; the purposes of the HSAs and the data they are to assemble and analyze. The major contradiction is that agencies designated to focus on cost containment in health care are expected to make health care …

Mission Neighborhood Health Center: A Case Study Of The Department Of Health Education And Welfare As A Counterinsurgency Agency, Thomas S. Bodenheimer

The Journal of Sociology & Social Welfare

In the 1960's, working class communities all over the country, particularly minority inner city neighborhoods, exploded in violent anger. The federal government responded with a pacification or cooling-out program: the War on Poverty. The War on Poverty provided federal funds to bring a few programs into the community, to create a few jobs, and to buy off working class leaders who were a threat to those in power. In the course of this program of counterinsurgency, the War on Poverty took over a slogan of the 1960's, "community control," and turned it into its opposite; rather than control by the …

The Impact Of Consumerism On Health Care Change: Alternatives For The Future?, Allen W. Imershein, Eugenia T. Miller

The Journal of Sociology & Social Welfare

The quest for consumer participation in the management of health care delivery may have experienced its first signs of success, but the implications of that success are as yet unclear. The establishment of consumer majorities on the newly developed health systems agency (HSA) boards was seen as an important milestone in the development of the consumer movement in America over the last ten years. The initial wave of optimism over the Great Society programs that in part gave birth to the consumer movement has long since vanished, but some of the organizational results of those attempts at innovation have become …

Lessons From Private Health Insurance, Martha N. Ozawa

The Journal of Sociology & Social Welfare

All across the country there is a sense of urgency, and even of crisis over what is happening in the health industry. Of special concern are the rapid rate of increase in the cost of health care services and the increasing national expenditures for health care. For fiscal year 1976, the total U.S. spending for health care reached $149.8 billion, or a per capita expenditure of $638. Expressed as a percentage of the gross national product (GNP), the national spending for health care reached a record-breaking 8.6 percent.1 From the early 1960s--except during the period from August 1971 through April …