The architecture of organizations as missed opportunity in political research

Few scholars in political science or public administration deny that organization matters. However, the rare application of an organizational perspective in research suggests otherwise. To revive the awareness of organizations as unit or level of analysis, attributed and generic properties are distinguished. Attributed properties, which dominate research, assign functions and patterns of behaviour to an organization. In contrast, generic properties refer to the constitutive elements of organizations that take effect before attributed properties. This article takes a closer look at four generic properties by examining their often-implicit use in current political science and public administration research. The aim is to demonstrate that the formal dimension, the goals, the expertise of personnel and organizational boundaries exert an independent influence on the output of political or public sector organizations.     

Health care for the poor.

In the 1980s the convergence of a number of factors is causing government at all levels, industry, and labor to plan or initiate major reductions in health spending. Important among these are rising health care costs, a troubled national economy, mounting federal deficits and state revenue shortfalls, and the philosophical course and domestic policy of the Reagan administration. In this context government has been rethinking its capacity to finance health services for the poor, and new and sometimes controversial arrangements for delivering these services are being developed. The dilemma government officials face now is how to cut costs while still assuring that quality medical services are available. This article focuses on what these new policy developments and arrangements are and whether the significant gains in access and in health achieved over the past 20 years will be sustained. Because truly sweeping reforms are unlikely, whether government will maintain earlier commitments and established arrangements for financing and delivering health services to the poor will be worked out piecemeal over the next several years.     

Health in the United States.

On the whole, the American people consider themselves healthy and, according to the major health indicators, they are becoming healthier all the time. The expectation of life at birth is one and one-half times what it was at the beginning of the century. Many of the leading causes of death have experienced significant declines in rates in the last decade. Nevertheless, the minority populations frequently lag behind the white population with respect to health indicators. Prevention in the health field is being stressed through immunization programs and programs to influence individuals to change their habits. Nutrition is playing a larger role in public life; considerable publicity has been given to dietary goals for promotion of good health. The health service industry has grown rapidly. Health care has expanded and its costs have trebled since 1970. In the 1980s, interest will undoubtedly focus on minority populations and health, on how the economically disadvantaged may better be served, on the effects of an aging population on the health care system, and on how life-styles which undermine health care can be changed. The U.S. Surgeon General has established national health goals for the 1980s that will improve the nation's health if they are achieved.     

Health care and the elderly.

Western values have long emphasized an interventionist approach to problems of health and health care. Yet, as medical technology becomes increasingly expensive and as the number of older people grows, proposed changes often are now governed more by considerations of cost than by quality of services. This tension between cost and quality also affects public willingness to invest in social components of health care despite their importance in enhancing quality of life. The tension emerges in sharpest contrast as scarce resources are allocated by gatekeepers in health maintenance organizations and in the arrangements for long-term care. With respect to financing, what seems to be needed is a creative mix of voluntary inputs from the community, private initiatives, and new programs of public entitlements. With respect to quality of care, what has often been overlooked is the recognition that gains in the quality of life require programs that encourage older people's continued involvement and participation in social life and in active and healthy life-styles. This article discusses the evolving balance between these two types of interventions: the medical and the social.     

Health care. Way ahead of Bill

Unable to wait any longer for federal reform, states and companies are launching their own programs to cut costs and extend coverage to more of those now uninsured.     

Public organizations, stakeholders and the construction of publicness. Claims and defence of authority in public action

This article seeks to highlight the conditions in which organizations with different levels of 'publicness' interact in the framework of policy-making. In France, decision making and implementation is shared among public, semi-public and private organizations. The specific responsibility and influence of public organizations within institutional collective action however is a source of ambiguity. It becomes therefore a matter of political authority for public organizations to invest in the structuring of public problems and policies. The case analysed here shows that the publicness of implemented policies is a construction which stakeholders may try to influence. Responses by public organizations show that publicness does not only relate to the plurality of organizational forms but also to the existence of a form of hierarchy within systems of governance themselves.     

Chapter 7. Mental Health Intervention with Dominican Immigrants

Abstract

Dominicans are a significant force in the changing composition of Hispanic immigration in the United States, and all indications are that they will continue to be in the years to come. A framework has been applied in which Dominican culture, psychosocial strengths and risks, and treatment implications are explored in the context of how Dominicans appear to be similar to and different from other Hispanic groups in the U.S. Much more needs to be done in terms of elaborating this combination of homogeneity and heterogeneity. Mental health practitioners who are open to such inquiry, and to keeping an open mind regarding the possibilities of modifications in therapeutic techniques and modality choices, will find Dominicans to be a clinically responsive, and an enjoyable population to work with.     

Investigating the Refugee Health Disadvantage Among the U.S. Immigrant Population

Much health-disparities research focuses on race and ethnicity, but nativity has proved to be a crucial factor in explaining the immigrant health advantage. Foreign-born subgroups with certain immigration statuses, such as refugees, may have an initial disadvantage. Using nationally representative survey data, we explore differences in health outcomes by analyzing two visa category subgroups in the United States: refugees and nonrefugee immigrants. Our findings show that refugees have a significant disadvantage across multiple health outcomes. This suggests that current refugee health-screening practices should be changed to take into account broader issues, such as chronic disease and functional limitation.     

Chapter 3. Mental Health Care of Hispanic Immigrant Children

Abstract

This chapter addresses the mental health care of Hispanic immigrant children within a school-based context. The school system is presented as a natural support agent that is psychologically, culturally and geographically accessible for the delivery of culturally competent mental health services. The development of a multifaceted New York City public school-based program created, by the first author of this chapter, in response to the psychosocial needs of Hispanic immigrant children is discussed as a viable approach that may be used in the provision of ethnic-sensitive mental health care.     

Chapter 2. Mental Health in the Hispanic Immigrant Community

Abstract

This chapter addresses the mental health status of Hispanics in the United States. The prevalence and incidence of mental health disorders among different Hispanic ethnic subgroups is examined. Patterns of mental health services utilization and barriers to mental health care are also reviewed. Research specific to best mental health practices with Hispanics is stressed.