Care Security Research Articles

Broadmoor, Rampton and Ashworth: Can good practice prevent potential future disasters in high‐security hospitals?

Broadmoor, Ashworth and Rampton hospitals are the three special hospitals providing psychiatric care and treatment in high security for people in England and Wales who have a mental disorder and who are judged to pose a substantial risk of serious violence or other dangerous behaviour. As total institutions, each has been the subject of a number of scandals and consequent enquiries, despite a number of changes in management. While some would consider that the only way of preventing future disasters is closure, it is argued that, although further radical change remains necessary, the adoption of clear objectives and in‐service enthusiasm for open and reliable monitoring of their attainment could reduce risks to an acceptable level.

The competition vogue and its outcomes

Social security and comprehensive health care financing were developed to protect all citizens and to redistribute money to cover costs. Their inspiration was social solidarity rather than pecuniary self-interest. The United States differed from other countries by continuing a private market in health, with many self-centred and competing providers and insurers; and its prevailing school of health economics deplored the national heath insurance and national health services that were universal in other countries and recommended devices that would eliminate "market failure" in health. When health economics grew in Europe during the 1970s and 1980s, the reformers' first presumption was that the voluminous American market-oriented literature must offer answers; but much of it proved superfluous, since European health care systems still had much competition and consumer choice, and they worked better than the reality in the United States. The United States itself has paid a heavy price for turning over health financing policy to the devotees of microeconomics and free markets, and today its serious problems in health are unsolved.So powerful is the pro-competitive ideology that it has now been adopted by the Democratic Clinton Administration, contradicting the heritage of Roosevelt, Truman, and Johnson.

Carol Baines, Patricia Evans and Sheila Neysmith (eds), Women's Caring: Feminist Perspectives on Social Welfare, McLelland and Stewart, Toronto, 1991. 310 pp. paper £18.95. - Eithne McLaughlin, Social Security and Community Care: The Case of the Invalid Care Allowance, Department of Social Security Research Report No. 4, HMSO, London, 1991. 67 pp. paper £9.70

Carol Baines, Patricia Evans and Sheila Neysmith (eds), Women's Caring: Feminist Perspectives on Social Welfare, McLelland and Stewart, Toronto, 1991. 310 pp. paper £18.95. - Eithne McLaughlin, Social Security and Community Care: The Case of the Invalid Care Allowance, Department of Social Security Research Report No. 4, HMSO, London, 1991. 67 pp. paper £9.70

America's Misunderstood Welfare State: Myths and Realities

To listen to the critics, one would think that the nation's social welfare programs were an abject failure–ungovernable, unaffordable, and undesirable. But though widely believed by Americans of every political persuasion, the perception of failure is false. As the authors demonstrate, America today has all the institutions of a mature welfare state, while still regarding “welfare statism” with deep suspicion. The authors seek to explain this paradox and to set the record straight about the actual workings and accomplishments of the nation's welfare programs – social security, public assistance, and medical care –and it shows that the gloom and doom that surround so much public discussion in this area stems from simple, attractive–and false–ideas about what these programs are and how they work. Above all, they argue that American social welfare policy has been shaped by certain enduring commitments which most Americans believe in whether they realize it or not.

The marginal cost of public funds with an aging population.

"As populations in the United States and other advanced economies grow older, the burden of social security and health care financing is expected to rise markedly. Payroll, income, and other taxes on working populations are projected to rise accordingly. The marginal welfare cost to workers of social security and other public expenditures is analyzed within the context of a two-period life cycle model. By relaxing separability assumptions that have become common in the literature, the theoretical structure properly incorporates the effect of these public expenditures on labor supply. Comparative statics results indicate that changing age structure is likely to raise the marginal welfare to workers of social security, education, and other public expenditures. Illustrative calculations for the United States confirm this result, suggesting that the cost to workers of incremental social security benefits may easily double by 2025-2050."

Older Women in the Post-Reagan Era

This article explores the social, economic, and institutional factors that affect older women throughout the life cycle, and recent policy and ideological changes that will continue to affect older women in the decades ahead. The situation of the older woman is shown to result from lifelong patterns of socioeconomic and gender stratification in the larger society. The consequences for women flow from the complex and often subtle relationships in the social institutions of the family, the labor market, and the state and its social policy. The female roles of worker, unpaid caregiver, and beneficiary of public policies continue to be systemically unequal to those of men. The patriarchal structure of (and control over) the labor market and policy-making promotes the informalization of long-term care, ageism and sexism toward older women attempting to reenter the labor market, and the devaluing of female work that is not economically remunerated. The failure of social problems to address the underlying structural inequities of women perpetuates their disadvantaged economic and health situation throughout old age. Changes in social policies are required to address the problem of access to basic resources, including Social Security, housing, health, and long-term care, but most importantly, to abridge and compensate for the gendered division of labor and the lifelong discrimination that women experience.

Retirement Prospects of the Baby Boom Generation: A Different Perspective

We examine the average economic status of baby boom cohorts as they approach retirement chiefly using data on their life cycle income experience to date. Contrary to popular impression, baby boomers are likely to enter old age in an even better economic position than pre-boom cohorts. Economic and demographic adjustments that they made, such as deferred marriages, reduced childbearing, and increased labor force participation of wives, have compensated for their relatively low wage rates. Potential downside effects of reduced childbearing regarding Social Security and health care prospects are discussed.

Q-Sort security and first-year nonmaternal care

Can a Q-Sort measure of attachment security take the place of a Strange Situation Assessment to study infant day care? Apparently not, but it can be used in conjunction with the more traditional measurement strategy.

S. Baldwin, G. Parker and R. Walker (eds), Social Security and Community Care, Avebury, Aldershot, 1988. 205 pp. £8.50.

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Political Values and Health Care: The German Experience

These nineteen original essays explore the ways in which political and social values help to shape health care systems by analyzing what happened to the German health care system when it split after World War II into communist and noncommunist sectors. Since both systems evolved from the same foundation they form a natural experiment in history where the same phenomenon becomes divided into an experimental and control group. The book is the first to take advantage of this unique opportunity for comparative analysis; it is also the first social history of the German health care system from Bizmarck to the present.Donald Light's introduction, "State, Profession, and Political Values," is followed by eighteen essays grouped in four parts which cover the state and society, the social history of German health care, structural aspects of health care in the two Germanies, and healers and their patients.Essays in Part I compare structures and values of state and society, the medical-industrial complex, and sociological patterns in the two Germanies. Those in Part II take up the origin and development of compulsory health insurance, the consequences of the National Socialist takeover for the administration of sick funds and for panel doctors, public health policy following the war, and political values and reconstruction. Part III focuses on comparisons of social security and health care systems, political values and the regulation of hospital care, ideological influences on the organization of ambulatory and hospital medical care, state control and drug supply, and the organization of tuberculosis prevention. Essays in Part IV discuss qualification and professionalization in the health care professions, legal aspects of the physician-patient relationship, the problem of induced abortion, mother and child care, occupational health and the older worker, and ideology and psychotherapy.All but two of the contributors are West German scholars. Donald W. Light is Professor of Social Medicine and Psychiatry at the University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine and Senior Fellow at the Leonard Davis Institute of Health Economics. Alexander Schuller is Professor of Sociology at the Free University of Berlin.

Political Values and Health Care: The German Experience

These nineteen original essays explore the ways in which political and social values help to shape health care systems by analyzing what happened to the German health care system when it split after World War II into communist and noncommunist sectors. Since both systems evolved from the same foundation they form a natural experiment in history where the same phenomenon becomes divided into an experimental and control group. The book is the first to take advantage of this unique opportunity for comparative analysis; it is also the first social history of the German health care system from Bizmarck to the present.Donald Light's introduction, "State, Profession, and Political Values," is followed by eighteen essays grouped in four parts which cover the state and society, the social history of German health care, structural aspects of health care in the two Germanies, and healers and their patients.Essays in Part I compare structures and values of state and society, the medical-industrial complex, and sociological patterns in the two Germanies. Those in Part II take up the origin and development of compulsory health insurance, the consequences of the National Socialist takeover for the administration of sick funds and for panel doctors, public health policy following the war, and political values and reconstruction. Part III focuses on comparisons of social security and health care systems, political values and the regulation of hospital care, ideological influences on the organization of ambulatory and hospital medical care, state control and drug supply, and the organization of tuberculosis prevention. Essays in Part IV discuss qualification and professionalization in the health care professions, legal aspects of the physician-patient relationship, the problem of induced abortion, mother and child care, occupational health and the older worker, and ideology and psychotherapy.All but two of the contributors are West German scholars. Donald W. Light is Professor of Social Medicine and Psychiatry at the University of Medicine and Dentistry of New Jersey School of Osteopathic Medicine and Senior Fellow at the Leonard Davis Institute of Health Economics. Alexander Schuller is Professor of Sociology at the Free University of Berlin.

Carmelo Mesa-Lago (ed.): The Crisis of Social Security and Health Care Latin American Experiences and Lessons (Latin American Monograph & Document Series, no. 9, Center for Latin American Studies, University Center for International Studies, University of Pittsburgh, 1985, p.b. $9.50). Pp. ix + 365.

Carmelo Mesa-Lago (ed.): The Crisis of Social Security and Health Care Latin American Experiences and Lessons (Latin American Monograph & Document Series, no. 9, Center for Latin American Studies, University Center for International Studies, University of Pittsburgh, 1985, p.b. $9.50). Pp. ix + 365.

Board and care housing. An analysis of state differences.

Interest in board and care arrangements designed to provide food, shelter, and protective and personal care for chronically impaired adults has increased in recent years. Most of the authority for licensing and regulating such supportive housing arrangements resides with the states. The results of a regression analysis of state board and care supply for 1983 suggest that Supplemental Security Income Program (SSI) policy, specific board and care regulations, Medicaid nursing home rates, and the percentage of elderly are particularly important in explaining about two-thirds of the variance in state bed supply.

The Federal Government in the Year 2000: Administrative Legacies of the Reagan Years

Historians writing in the future are likely to regard the two terms of the Reagan administration as a watershed period in the development of the American administrative state. This period is likely to be seen as a time when some issues of governance and public administration that had been brewing for quite a while were finally brought to the surface of political debate. At the center of this debate is the issue of the desirability of government intervention in the nation's social and economic affairs. An airing of this issue in the 1980s is particularly compelling because it is obvious to even the most casual observer that the United States is in the midst of a longterm technological, economic, and demographic transformation that is creating problems and opportunities for its people and government at a rapid pace. The technical and economic changes are closely interwoven. The nation is moving from an industrial era where the United States dominated the world economy through durable goods manufacturing and financial dealing toward what some have labeled a postindustrial, technoservice, or knowledgeintensive society. I In this new era, the world economic system is quickly becoming considerably more complex than before, with the movement of money and the production of goods and services more internationalized than in the past. In the process, the economic dominance of the United States has become more problematic than at any time since World War II reflecting a change in America's ability to control international markets and their importance in the economic health of the nation. To further complicate this picture, the demographic shape of the nation itself is changing. At least four dimensions of this demographic shift are cause for concern: (1) the growth in our aged population-the population of people over age 65 is expected to rise from 27 million in 1983 to about 35 million by the year 2000that will generate new demands on private resources and the federal treasury by way of pension, social security, and health care costs; (2) the aging of the baby boom generation-those born between 1945-1959-who will also be expected to place heavy demands on government but may also produce pressure for conservative social

Do we need competition legislation? The view of an advocate. Interview by John K. Iglehart.

Prologue: The political fortunes of Richard A. Gephardt have been rising rapidly since he won his first congressional election in 1976, a nearly two-to-one victory over a well-known Republican. A practicing attorney for eleven years and a city alderman for five in his native St. Louis before his 1976 victory, Gephardt has gravitated quickly to the power centers on Capitol Hill. As a freshman, he was appointed to the powerful House Ways and Means Committee. As a second-term legislator, he won appointment to the House Budget Committee. And in his latest term, Gephardt was named to the House Democratic leadership as chief of task forces and a member of the Democratic Steering and Policy Committee, his party's chief political arm in the House. Gephardt's principle policy interests revolve around economics, particularly as the dismal science relates to macropolicy questions, social security and health care. Though respected by his party's leaders, Gephardt is not a conventional Democrat. For example, working c...

Creating the Welfare State: The Political Economy of Twentieth-Century Reform

The business community has been the Number One Enemy of welfare programmes according to most historians. History credits liberals and bureaucrats with bravely forging our social welfare system in the face of pressure and strident protest from businessmen. Edward Berkowitz and Kim McQuaid disagree. They argue that instead of resisting social programmes, businesssmen initiated them. In Creating the Welfare State, Berkowitz and McQuaid aim to show how private businessmen played leading roles in shaping the nation's social security, welfare, and health care programmes. They demonstrate how progressive businessmen like Edward A. Filene and Gerard Swope worked with their opposite numbers in the federal government, from Franklin D. Roosevelt to Arthur Altmeyer, to fashion a social welfare system tailored to an industrialized work force. Creating the Welfare State combines the perspectives of two disciplines: policy history and business history. The resulting synthesis suggests a new way to view the progressive era, the new era, and the New Deal. The new preface and afterword add a current focus to this revised edition and help a new generation of readers place the debates over national health insurance and social security financing into historical perspective.

Social security and health care patterns in Chile.

This paper is divided into three parts. The first traces the evolution of health care under social security in Chile from 1918 to the present. The early period saw the unplanned proliferation of almost 50 funds, each with its own unique characteristics. This was followed by a period of consolidation and reform highlighted by passage of the Preventive Medicine Law (1938), the creation of the National Health Service (1952), and passage of the Curative Medicine Law for Employees (1968). The significance of these legislative milestones is discussed. The second section examines the degree to which social security coverage affects the utilization of health services. Based on the results of the 1968 health survey it may be concluded that a strong positive correlation exists between social security coverage and the utilization of medical and dental services, along with an inverse correlation between coverage and the unmet demand for care and on health expenditures. The paper concludes with a discussion of the tasks facing the new government as it seeks to integrate Chile's different systems of publicly sponsored health care so as to improve efficiency and to make comprehensive services available to all Chileans.

1944-1945 Programs for Postwar Social Security and Medical Care

S OCIAL SECURITY and employment' are looked upon, in all Allied Nations and also in most neutral countries, as the keys to economic well-being in the postwar era. Improved labor standards, economic advancement and social are the economic objectives of the Atlantic Charter. All these terms are somewhat vague in meaning, but they express the hopes of hundreds of millions of people and are central in all postwar planning. Even while the war was in progress, considerable improvement was made in the social security legislation of many countries.2 This is not true of the United States, in which there was no social security legislation whatsoever on the national level during the five years between the enactment of the Social Security Act Amendments of I939 and the passage of the Servicemen's Readjustment Act (the G. I. Bill of Rights) in I944, except for the adoption of annual riders to appropriations acts which provided for freezing of the old-age insurance tax rates. Some advances were made in the states, particularly in the liberalization of unemployment compensation benefits. But the only law in this country which broke new ground was the Rhode Island Act of 194I for cash disabilitv benefits. In many other countries, in contrast, the war period brought forth much new social security legislation. The advances in this respect have been greatest in the Latin American countries. Very significant new social-security legislation also has been enacted in England, Canada, and Australia, while in New Zealand the comprehensive national health insurance and medical-care program adopted shortly before the outbreak of hostilities has been put into full operation. More important even than the new legislation are the comprehensive programs for social security which were developed during the war. Prior to I 944, such postwar programs were formulated and publicized in England, the United States, Canada, Australia, and South Africa all of them under governmental auspices.3 The most famous of these was the Beveridge Plan in England, which made its appearance late in I942.4 Beyond question, this has been the most widely-discussed social security program ever advanced anywhere in the world. In this country it has brought forth far more articles than were written about the Social Security Act during the entire year that this major American social security measure was in preparation and under consideration in Congress. Almost immediately after its publication, the