Search results

Objective – This chapter assesses health equity achievements of the Thai health system before and after the introduction of the universal coverage (UC) policy. It examines five dimensions of equity: equity in financial contributions, the incidence of catastrophic health expenditure, the degree of impoverishment as a result of household out-of-pocket payments for health, equity in health service use and the incidence of public subsidies for health.

Methodology – The standard methods proposed by O’Donnell, van Doorslaer, and Wagstaff (2008b) were used to measure equity in financial contribution, healthcare utilization and public subsidies, and in assessing the incidence of catastrophic health expenditure and impoverishment. Two major national representative household survey datasets were used: Socio-Economic Surveys and Health and Welfare Surveys.

Findings – General tax was the most progressive source of finance in Thailand. Because this source dominates total financing, the overall outcome was progressive, with the rich contributing a greater share of their income than the poor. The low incidence of catastrophic health expenditure and impoverishment before UC was further reduced after UC. Use of healthcare and the distribution of government subsidies were both pro-poor: in particular, the functioning of primary healthcare (PHC) at the district level serves as a “pro-poor hub” in translating policy into practice and equity outcomes.

Policy implications – The Thai health financing reforms have been accompanied by nationwide extension of PHC coverage, mandatory rural health service by new graduates and systems redesign, especially the introduction of a contracting model and closed-ended provider payment methods. Together, these changes have led to a more equitable and more efficient health system. Institutional capacity to generate evidence and to translate it into policy decisions, effective implementation and comprehensive monitoring and evaluation are essential to successful system-level reforms.

Amidst the backlash against gay rights in the U.S., a rapidly expanding number of companies are instituting inclusive policies. While in 1990 no major corporations provided health insurance for the partners of lesbian and gay employees, by early 2004, over 200 companies on the Fortune 500 list (approximately 40%) had adopted domestic partner benefits. This study of Fortune 1000 corporations reveals that the majority of adopters instituted the policy change only after facing pressure from groups of lesbian, gay, and bisexual employees. Despite such remarkable success, scholars have yet to study the workplace movement, as it is typically called by activists. Combining social movement theory and new institutional approaches to organizational analysis, I provide an “institutional opportunity” framework to explain the rise and trajectory of the movement over the past 25 years. I discuss the patterned emergence and diffusion of gay employee networks among Fortune 1000 companies in relation to shifting opportunities and constraints in four main areas: the wider sociopolitical context, the broader gay and lesbian movement, the media, and the workplace. Next, using the same wide-angle lens, I explain the apparent decline in corporate organizing since 1995. My multimethod approach utilizes surveys of 94 companies with and without gay networks, intensive interviews with 69 networks and 10 corporate executives, 3 case studies, field data, and print and virtual media on gay-related workplace topics. By focusing on not simply political but also broader institutional opportunities, I provide a framework for understanding the emergence and development of movements that target institutions beyond the state.

The processual ordering branch of symbolic interaction has long recognized the importance of rhetoric and power to the social constitution of reality. However, little systematic effort has been devoted to probing their intertwined effects in the public policy arena.

The purpose of this paper is to employ the processual ordering perspective to examine the dramaturgical styles used in shaping public policy – expressed in terms of the “public administration” and “realpolitik” forms of rhetoric – among contending political factions as they negotiate mental health public policy. A latent content analysis of the minutes of key U.S. congressional debates, augmented with secondary archival material from the press is employed. It is concluded that both forms of rhetoric play a role in shaping public mental health policy and that both factions modify their rhetorical form as the debate progresses. Those modifications strengthen the position of one faction while weakening that of the other. Theoretical implications are discussed.

The Models of Child Health Appraised (MOCHA) project identified the different models of primary care that exist for children, examined the particular attributes that might be different from those directed at adults and considered how these models might be appraised. The project took the multiple and interrelated dimensions of primary care and simplified them into a conceptual framework for appraisal. A general description of the models in existence in all 30 countries of the EU and EEA countries, focusing on lead practitioner, financial and regulatory and service provision classifications, was created. We then used the WHO ‘building blocks’ for high-performing health systems as a starting point for identifying a good system for children. The building blocks encompass safe and good quality services from an educated and empowered workforce, providing good data systems, access to all necessary medical products, prevention and treatments, and a service that is adequately financed and well led. An extensive search of the literature failed to identify a suitable appraisal framework for MOCHA, because none of the frameworks focused on child primary care in its own right. This led the research team to devise an alternative conceptualisation, at the heart of which is the core theme of child centricity and ecology, and the need to focus on delivery to the child through the life course. The MOCHA model also focuses on the primary care team and the societal and environmental context of the primary care system.

This chapter demonstrates the ways in which digital inclusion functions as a super social determinant of health, particularly within the arena of family carework and healthcare for vulnerable disabled US communities. The focus on vulnerable populations, including the elderly, chronically ill, young disabled, neurodivergent, and/or medically complex children and the families that care for them, is a useful case to present a compelling argument for the need to take seriously digital inclusion to maximize health, safety, and well-being for growing populations of Americans today. The authors argue that digital inclusion is an increasingly influential social determinant of health and a key dimension of health equity that offers important benefits and potentials, especially for vulnerable patient populations, for whom in-home and family-centered care are necessary parts of health maintenance, prevention, and well-being. The chapter ends with a discussion of ways that the US government can mitigate digital barriers and facilitate equitable access to broadband internet and e-health resources that address the intersections of digital, health, and care inequalities, with significant impacts in all three dimensions.

Objective – The aim of the paper is to bring evidence and lessons from two low- and middle-income countries (LMIs) of the former USSR into the global debate on health financing in poor countries. In particular, we analyze the introduction of social health insurance (SHI) in Kyrgyzstan and Moldova. To some extent, the intent of SHI introduction in these countries was similar to that in LMIs elsewhere: increase prepaid revenues for health and incorporate the entire population into the new system. But the approach taken to universality was different. In particular, the SHI fund in each country was used as the key instrument in a comprehensive reform of the health financing system, with the new revenues from payroll taxation used in an explicitly complementary manner to general budget revenues. From a functional perspective, the reforms in these countries involved not only the introduction of a new source of funds, but also the centralization of pooling, a shift from input- to output-based provider payment methods, specification of a benefit package, and greater autonomy for public sector health care providers. Hence, their reforms were not simply the introduction of an SHI scheme, but rather the use of an SHI fund as an instrument to transform the entire system of health financing.

Methodology/approach – The study uses administrative and household data to demonstrate the impact of the reforms on regional inequality and household financial burden.

Findings – The approach used in these two countries led to improved equity in the geographic distribution of government health spending, improved financial protection, and reduced informal payments.

Implications for policy – The comprehensive approach taken to reform in these two countries, and particularly the redirection of general budget revenues to the new SHI funds, explain much of the success that was achieved. This experience offers potentially useful lessons for LMIs elsewhere in the world, and for shifting the global debate away from what we see as a false dichotomy between SHI and general revenue-funded systems. By demonstrating that sources are not systems, these cases illustrate how, in particular by careful design of pooling and coverage arrangements, the introduction of SHI in an LMI context can avoid the fragmentation problem often associated with this reform instrument.

The disparities of COVID-19 vaccination rates between the rural and urban areas have become apparent during this pandemic. There is a need to understand the root causes of vaccine hesitancy demonstrated by the rural population to increase coverage and to contain the disease spread throughout the United States. This study aimed to explore other factors influencing vaccine hesitancy among rural dwellers besides the geography-related barriers such as poor health care access and individuals having no or suboptimal insurance coverage.

By reviewing existing data and literature about vaccination, health literacy, and behaviors, and prevailing ideologies, we discuss the potential causes of vaccine hesitancy in rural areas that could create barriers for successful public health efforts related to vaccine coverage and provide suggestions to ameliorate the situation.

Geography-related barriers, health literacy, and preconceived notions are key determinants of adopting healthy behaviors and complying with public health authorities' recommendations among rural individuals during a public-health crisis. We argue that ideology, which is much deeper than preconception or misconception on vaccination, should be incorporated as a key factor to redefine the term “vulnerable populations” in public health research.

The limitation of our study is that we have not found an effective way to encourage the populations who hold conservative religious and political ideologies to join the efforts for public health. Even though geography-related barriers may strongly impact the rural dwellers in achieving optimal health, the various forms of ideologies they have toward certain health behaviors cannot be discounted to understand and address vaccine-related disparities in rural areas. There is a need to redefine the term “vulnerable population” particularly as it relates to rural areas in the United States. During large-scale public health disasters, scholars and public health authorities should consider the ideologies of individuals, in addition to other factors such as race/ethnicity, area of residence (rural vs. urban), and socioeconomic factors influencing the existing vulnerabilities and health disparities.

This chapter focuses on the Trump administration's health policies, with an emphasis on its efforts to repeal the Affordable Care Act and its response to the COVID-19 pandemic. It assesses those policies both in the context of the administration's broader goals and motivations, and in the context of systemic deficits and deficiencies in American health policy. I argue that failures of health policy and health security in the face of the pandemic reflect those longstanding weaknesses, much more so than the administration's actions (or inaction).