[Ownership in public health]

The authors attempt to bind the known theoretical concepts on the property to their interpretation and realization in actual public health. They specify and offer examples of their perception from a modern viewpoint and analyze their significance for further reforms in public health.

Legislation concerning management of medical institutions in China's health reform

The establishment of China's socialist market economy has called for the management legislation of China's medical institutions. This article gives a brief introduction of the main contents China's legislation concerning management of medical institutions, which includes regional health program, licensing system, and quality management system of medical institutions and systems concerning evaluation and assessment of medical institutions. Besides, the article also put forward some suggestions on further improving the legislation concerning management of medical institutions.

Is there a third way? A response to Giddens's the Third Way

Since the early 1990s, there has been in the United Kingdom and the United States a new political position referred to as the Third Way that claims to be intermediate between neoliberalism and social democracy, transcending both. This new position represented by the Clinton administration in the United States and the Blair Government in the United Kingdom, assumes that both social democracy and neoliberalism are obsolete and calls instead for a new set of public policies that are defined as the Third Way. This article analyzes the most detailed account of the Third Way in the English-speaking world, written by Professor Giddens. It shows that Giddens stereotypes both the neoliberal and the social democratic positions to an unrecognizable degree, failing to portray the varieties of social democratic policies in existence today in developed capitalist countries. The author shows how the Third Way is merely a recycling of liberal positions in some social policy areas and Christian democratic positions in others. Where the Third Way intends to be innovative--as in the U.K. New Deal program--the programs are pale copies of successful labor market policies carried out by northern European social democratic parties. The author concludes that the Third Way, with its questioning of the universalistic welfare state and its preference for assistential and means-tested programs, signifies a break with the social democratic tradition, transforming it into a hybrid between Christian democracy and neoliberalism.

Deciphering "integrated Chinese and Western medicine" in the rural Lijiang basin: state policy and local practice(s) in socialist China

Based on ethnographic research during an eighteen-month period in 1989-90, this article explores the rural practice of "integrated Chinese and Western medicine" (integrated medicine) in southwest China's Lijiang basin. Integrated medicine is a consciously formulated hybrid medical practice that was introduced by Chairman Mao during the Cultural Revolution as the cornerstone of national health policy. It was originally envisioned as the epistemological handmaiden of the "cooperative health care" system (of "barefoot doctor" fame). The relationship between the respective People's Republic of China (PRC) practices of "Chinese medicine" and "Western medicine" embedded in integrated medicine is explored here on two levels. Integrated medicine is analyzed both as a state policy and as an everyday practice engaged in by village practitioners and lay villagers alike. During the Maoist period, integrated medicine in the rural Lijiang basin was particularly receptive to local interpretation and experimentation by "the masses." This local license in interpreting state policy represented a point of contrast between integrated medicine and other state-sanctioned medical practices. During the ensuing first decade of the post-Mao period, a popular cultural influence on integrated medicine persisted. Integrated medicine is thus examined here both in terms of how state/urban/elite agencies have enacted processes of "syncretism from above" as well as how local/rural/peasant agencies have enacted processes of "syncretism from below" in shaping it as a therapeutic practice. Rural Lijiang basin explanatory models reveal a pattern whereby afflictions are classified according to either "medicine of systematic correspondence" criteria or "stigmatized affliction" criteria. Both types of criteria reflect distinctive interpretations and appropriations of theories rooted in Chinese therapeutic practices and "Western medicine," respectively. The rural basin practice of integrated medicine thus reflects a local appropriation and mediation of state policy, and provides some insight into the nature of a "circularity" that operates between local (or popular) knowledge and state policy in the PRC.

Regional disparities in health care supply in eleven European countries: does politics matter?

There are large differences both among and within European countries in the supply of health care facilities and personnel. In 1979 Smith posed the hypothesis that spatial disparities in health care supply will be smaller in countries with socialist (or social-democratic) governments. The aim of this paper is to examine this hypothesis by analysing whether or not regional disparities in health care supply within countries are smaller in countries that have been governed predominantly by socialist governments. We have collected regional data on the number of hospital beds and the number of physicians for 211 regions in 11 European countries for 1970 and 1990. Countries were classified according to the political composition of governments in the post-war era. It is concluded that: (1) the amount of regional variation is greater for hospital beds than for doctors; (2) for both aspects of supply, regional disparities decreased over time; (3) the decrease in regional disparities between 1970 and 1990, both for beds and for doctors in hospitals, was stronger for countries that had more years of socialist government in that period and (4) there is no relation between the number of years of socialist government between 1945 and 1990 and regional variation in health care supply in 1970, nor for government participation between 1970 and 1990 and variation in supply in 1990.

Reconstructing silenced biographical issues through feeling-facts

The undiscussible within daily discourse can have intentional and unintentional forms. The first occurs when someone intentionally gears the discourse so that it will not reveal certain facts which have happened (such as being an abused child, or a perpetrator during the Holocaust). We assume that even if they were difficult to reconstruct as part of one's biography, these facts could be verified externally (not only through the feelings of the victim). In the first part of the paper, we analyze the paradoxical nature of such discourse, and show how difficult it is to work through intentional undiscussibility. In the second part, we discuss what happens when the undiscussible facts can not be verified, meaning that there is doubt if events have taken place. By presenting a case study of a German woman who tried to construct a biography in face of certain undiscussibility in her family, we discuss the different social reactions evolving in such reconstruction of feeling-facts. We thereby hope to confront the psychoanalytic approach to narrative analysis with the constructivist hermeneutic one.

Socialism and the British National Health Service

This paper examines some of the key characteristics of a socialist health care system using the example of the British National Health Service (NHS). It has been claimed that the NHS has socialist principles, and represents an island of socialism in a capitalist sea. However, using historical analysis, this paper argues that while the NHS claims some socialist ends, they could never be fully achieved because of the lack of socialist means. The socialist mechanisms which were associated with earlier plans for a national health service such as salaried service, health centres, elected health authorities and divorcing private practice from the public service were discarded in negotiation. Moreover, even these would have achieved socialism merely in the sense of distributing health care, without any deeper transformation associated with doctor-patient relationships and prevention. In short, the NHS is more correctly seen as nationalised rather than socialised medicine, achieving the first three levels of a socialist health service identified here. It can be said to have socialist principles in the limited distributional sense and has some socialist means to achieve these. However, it lacks the stronger means to fully achieve its distributional goals, and is very distant from the third level of a radical transformation of health care.

What would a socialist health care system look like? A sketch

In this paper I argue that, since institutions must reflect the societies in which they are placed, a socialist health-care system cannot be understood unless democratic socialism--which would assure all of basic necessities of existence, full education and health-care to all members of the community--is not incompatible with a flourishing market for other products. In contrasting single with multiple tiered health care systems, I suggest that a single tiered system in which all have equal access to health care and none can buy more, is most consistent with the ideals of democratic socialism.

What would a socialist health service look like?

A socialist health service cannot be a socialist island in a sea of capitalism, as the record of the British National Health Service shows. Nonetheless, since health is a basic need, it can be a key component of the advocacy of socialism. I propose two central socialist principles. On the basis of these I suggest that a socialist health system would emphasise care rather than service; insist on democratic structures and control of resources; and require the prohibition of private medicine.

Necessary conditions for a socialist health service

A socialist health service in a non-socialist society may be forced to stress care and rescue rather than prevention, health maintenance or the promotion of better health and more equal health status. A socialist health service ought to be 'integrated'. A socialist health service ought to provide universal and comprehensive care.

Bioethics and political ideology: the case of active voluntary euthanasia

In different countries responses to important bioethical issues are different, as exemplified by the attitudes towards the voluntary and active forms of medical euthanasia. But why is this the case? My suggestion is that the roots of the variety are, to be considerable degree, ideological. The most important present-day political ideologies all have their roots in the prevailing doctrines of moral and social philosophy. In the paper these doctrines are outlined and the predicted response towards active voluntary euthanasia within each model is sketched. The conclusion reached is that while it would in some countries be dangerous to allow euthanasia in the prevailing circumstances, the solution is not to hinder the legalization process but to alter the circumstances.

Disease ecology and a reformist alternative: the case of infant mortality

This paper attempts to shed some light on the recent debate between those who advocate a reformed medical geography and those who respond that reform is not necessary. We show that disease ecology and a reformist alternative display certain tendencies in the ways in which they address issues of health and disease. We use the example of geographic variations in infant mortality rates to show how two non-positivist perspectives from social theory, political economy and humanism, support a reformist viewpoint, while also acknowledging the value of a complementary disease ecology approach. Two concepts, the social construction of health and illness and social relevance, are used to portray the political economy approach; humanism is described in terms of the meaning of individual experience and the importance of place. The paper concludes with a discussion of the respective roles of disease ecology and a reformist approach in models of infant mortality and a summary of the main differences between the two perspectives.

Interregional migration in socialist countries: the case of China

"This paper analyzes changing interregional migration in China and reveals that the recent eastward migration reverses patterns of migration under Mao. It finds that investment variables are more important than the conventional variables of income and job opportunities in determining China's recent interregional migration. It suggests that both state policy and the global force influence interregional migration, challenging the popular view that the socialist state is the only critical determinant. This paper also criticizes Mao's approach to interregional migration and discusses the impact of migration on development."

Urbanisation in China: a review of its causal mechanisms and spatial relations

This article reviews "the forces underpinning Chinese urbanization.... This paper is divided into two main parts. The first addresses the (non-spatial) causal mechanisms between 1949 and 1977. Neither the ideological, the class, nor the economic formulation has touched on the more systemic mechanisms related to the socialist state and the shortage economy. This paper attempts to redress the imbalance by examining the advantages of combining Kornai's shortage model with Foucault's concept of governmentality. By drawing on concepts of spatial contingency, spatial boundary and locality effects, the second part of the paper argues that spatial relations do play significant roles in revealing Chinese urbanisation policies and patterns."

Class differences and traffic deaths

The transition of the East European countries from socialist to capitalist economies is marked by an exponential rise in traffic-related deaths. This increase is routinely ascribed to the rising numbers of privately owned cars; however, this explanation does not take into account the fact that, while in the Western societies the number of cars on the road and number of traffic deaths are positively correlated, in the postcommunist countries this correlation is negative. This finding is discussed within the framework of an hypothesis that class differences and related feelings of superiority contribute to homicides related to moving vehicles.