Mongolian experiences with health insurance: are success factors unique?

We describe the health insurance model implemented in Mongolia after the Soviet Bloc collapsed in 1990, and note some of its good features. We then discuss the structural weaknesses that became evident over the first ten years of use, and some current proposals for reform. Finally, we consider the factors that appear to have affected success. We argue that the main constraints are much the same as in other countries including Australia--and relate more to confusion and disagreement over broad policy issues than to detailed knowledge of technical aspects or the research evidence.

Health lifestyles in Russia and the socialist heritage

This study examines the relationship between socialist ideology and the current negative health lifestyles of the Russian population. We explore the possibility that Soviet-style socialism with its negation of individuality and individual initiative in health matters promoted the development of a passive orientation toward healthy living. Using a national sample, we compare the health practices of those Russians who wish to return to socialism as it was before Gorbachev to those of Russians who favor staying with the present political and economic course or adopting other reforms. If a socialist ideology has indeed fostered a lack of responsibility for individual health promotion in Russia today, those persons wishing to return to socialism would be less likely to adopt a positive health lifestyle. Our data show that this is indeed the case, as pro-socialist respondents demonstrate less activity toward achieving health than antisocialists--although neither group collectively practices a healthy way of life.

Green politics in Germany: what is Green health care policy?

For the first time ever, a Green party has governed in Germany. From September 1998 to January 2001 the German Green party, Bündnis 90/Die Grünen, held the Federal Ministry of Health. Little has been said so far about Bündnis 90/Die Grünen and its relation to health policy. This article is intended to fill that void. An analysis of the health policy program of the Greens reveals that it centers around moving the health sector toward more comprehensiveness and decentralization, strengthened patients' rights, increased use of preventive and alternative medicine, and a critique of the German cost-containment debate and policy. The current health policy program of the Greens is closest to that of the Party of Democratic Socialism, and to a lesser extent it has affinities to the program of the Social Democratic Party. The health policy program of Bündnis 90/Die Grünen is furthest from those of the Christian Democratic Union and the Free Democratic Party. The health care reforms passed in 1998 and 1999 were not a shift toward a "Green paradigm" of health care policy, because they included no fundamental changes. In addition, cost-containment is still a major political goal in German health care policy.

Testing the modernization hypothesis and the socialist ideology hypothesis: a comparative sibling analysis of educational attainment and occupational status

In this study, we present a comparative sibling analysis. This enables us to test two major social mobility hypotheses, i.e. the modernization hypothesis and the socialist ideology hypothesis. We employ survey data on brothers in England, Hungary, the Netherlands, Scotland, Spain, and the USA, covering a historical period from 1916 till 1990. Results show that the effects of parental social class on educational attainment are smaller in technologically advanced societies, and that the effects of parental social class on occupational status are smaller in social-democratic and communist societies. In addition, the total family impact on occupational status declines with modernization. But overall, we observe that the family of origin has not lost its importance for its sons' educational attainment and occupational status yet.

Modernization, globalization and the welfare state: a comparative analysis of old and new convergence of social insurance since 1930

Convergence of policies and institutions across countries has been a recurrent theme within social sciences. 'Old' and 'new' convergence hypotheses have been associated with changing concepts and catchwords, such as modernization, logic of industrialism, post-industrialism, post-Fordism and globalization, but share some underlying theoretical perspectives. The purpose of this paper is to analyse tendencies towards convergence of social insurance systems in 18 OECD countries between 1930 and 1990, a period which has seen our sample of countries develop from predominantly agricultural societies to industrial or post-industrial market democracies. Data from the Social Citizenship Indicator Program (SCIP) are used to examine the development of institutional variables within the various national social insurance systems. Sub-samples of larger and smaller countries are examined separately, in order to test the open-economy hypothesis that smaller countries, being more exposed to international pressures than larger ones, could be expected to show higher degrees of social protection and also more convergence. Hypotheses on differentiated institutional barriers against pressures from the processes of transnationalization of the economy, as well as possible convergence effects of the supra-national policy making within the European Union, are discussed in the last section.

Child care in Slovenia: an example of a successful transition

Slovenia is a country which has managed to retain most of its advantages and achievements in preschool child care attained in the socialist period, while, during the transition years, rather successfully reforming services according to principles of the market economy. The female activity rate has been high since the mid 1940s, and female employment has been the main factor influencing the demand for preschool child care services. Slovenian mothers work full-time and after 1 year of paid maternity and parental leave they mostly stay in the labour market. Child care facilities, 70% of them constructed in the period 1971-1985, are sufficient for almost 60% of the preschool population, and just a very small percentage of demand remains unmet. Child care services are traditionally highly subsidised. On average, parents finance up to a quarter of the current costs, so that the average in-kind transfer for a child in child care amounts to about 30% of the average net salary. Social assistance recipients are exempt from paying fees altogether, while the rest of the parents pay from 15% to 80% of the current costs. The highest fee is paid by families with a per capita income > 110% of the average salary in Slovenia. Research into the burden of parental fees for child care in Ljubljana in 1994 has shown that three-quarters of families spent between 5 and 15% of their total net income on child care (for one or more children). For three-quarters of families, the total of fees paid did not exceed 30% of their net income per family member. The lower middle income group was relatively most burdened by child care fees.

Development and quality of life: a critique of Amartya Sen's Development as freedom

Presented here is a critical analysis of some of the major theses of Amartya Sen, as presented in his seminal work Development As Freedom. The author suggests that Sen's work, while representing a major break with the dominant neoliberal position reproduced in most national and international development agencies, is insufficient to explain the key relationship between freedom and development. The absence of an analysis of the power relations that cause and reproduce underdevelopment through national and international political institutions leaves Sen's work wanting. The author shows how Sen's interpretation of events and the conclusions derived from them, such as an explanation of famine in Bangladesh, are insufficient--when not faulty. The author also critically analyzes the United Nations Development Program reports, which, while documenting the nature and consequences of underdevelopment, barely touch on the political context in which underdevelopment occurs.

Socialist psychotherapy and its dissidents

This article focuses on the history of psychotherapeutic theory and practice in socialist East Germany before the fall of the Berlin Wall in 1989. The "official" pre-1989 socialist history of East German psychology is juxtaposed to psychotherapists' post-1989 oral history of the development of Socialist psychological theory and practice. These reconstructive histories draw on embryonic therapeutic practices that diverged from the dominant socialist paradigm. Their existence exemplifies how a state-driven high modernist scheme for remaking society can fail as it does not account for the complex relationship between a state's abstract knowledge and local practices. Moreover, the emphasis therapists put on the prevalence of these alternative practices also reveals how the present post-socialist context becomes an interpretative resource for reconstructing their past. By emphasizing these practices they try to bridge the gap between their past and current practices so as to minimize the transformation that has taken place.

[Public health in the central and eastern European countries]

During the last two decades, the countries of Central and Eastern Europe have been transforming their health systems and built an intermediate model between market and socialised economies. At the same time, they have been trying to establish a system of observed in public health between the countries of the European Union and those of Central and Eastern Europe widened in the last decade. In view of accessing the European Union, this article develops the different points in a context where public health represents a topic of extreme importance for the European Commission.

Electoral democracy, revolutionary politics and political violence: the emergence of Fascism in Italy, 1920-21

This study examines the determination of the Italian Fascists' extra-parliamentary, para-military, violent strategy. What were the effects of the socialists' political strategy, relying on electoral democracy, on the creation and strategy of the Fascist Action Squads? A comparison among Italy's 69 provinces, based on quantitative and qualitative historical evidence reveals a distinct pattern in the Fascists' violence. They attacked mainly provinces where the Socialists enjoyed the greatest electoral support. This pattern was a product of two historical processes: (a) the threat of the Socialist party to the landlords' economic and political hegemony, and (b) the landlords' tradition of militant anti-worker organization which culminated in their alliance with the Fascists. The Fascists' struggle for, and takeover of, political power was not an immanent historical necessity. It was first and foremost an anti-socialist reaction. It was shaped both 'from below', by the political power and radicalism of the PSI and the para-military capacity of the Fascist Squads; and 'from above', by the active support the Fascists received from the landlords and the state. Supported by organized landlords and blessed with the authorities' benevolence, the Squads were able to destroy - physically and politically - the legitimately constituted provincial governments of the Socialists. The alliance with the landlords determined the Squads' almost exclusive attacks on Socialist provincial strongholds that constituted the greatest threat to the landlords' interests, while provinces dominated by the ruling Liberal party were excluded from the Squads' path of 'punitive expeditions'.

Self rating of health is associated with stressful life events, social support and residency in East and West Berlin shortly after the fall of the wall

STUDY OBJECTIVE

To compare the health status and factors influencing the health of populations that had previously lived under different political systems.

DESIGN

Cross sectional health and social survey using postal interviews. The relation between self reported health and psychosocial factors (stressful life events, social support, education, health promoting life style and health endangering behaviour) was investigated. To determine East-West differences a logistic regression model including interaction terms was fitted.

SETTING

East and West Berlin shortly after reunification 1991.

PARTICIPANTS

Representative sample of 4430 Berlin residents aged 18 years and over (response rate 63%).

RESULTS

Of all respondents, 15.4% rated their health as unsatisfactory. Residents of East Berlin rated their health more frequently as unsatisfactory than residents of West Berlin (Or(age adjusted)= 1.29, 95%CI 1.08, 1.52), these differences occurred predominantly in the over 60 years age group. Logistic regression showed significant independent effects of stressful life events, social support, education, and health promoting life style on self rated health. The effects of education and health promoting life style were observed to be more pronounced in the western part of Berlin. Old age and female sex showed a stronger association with unsatisfactory health status in the eastern part of Berlin.

CONCLUSIONS

For subjects aged over 60 years there was evidence that living in the former East Berlin had an adverse effect on health compared with West Berlin. The impact of education and a health promoting lifestyle on self rated health seemed to be weaker in a former socialist society compared with that of a Western democracy. This study supports an "additive model" rather than a "buffering model" in explaining the effects of psychosocial factors on health.