Power rather than path dependency? The dynamics of institutional change under health care federalism

Proposals for government decentralization rank high on the political reform agenda of health systems worldwide. Their impact on welfare state performance and change, however, is still under theoretical scrutiny. This article examines the impact of devolution on the construction of the Spanish National Health Service (NHS) in an attempt to shed some light on this debate. Against widespread claims of path dependency, we argue that the specific nature of the devolution model developed in Spain, given the more egalitarian sociopolitical structure that resulted from democratization, fostered policy innovation and institutional change. Consolidation of an NHS system was compatible with some regional diversity and apparently prevented the rise of significant territorial inequalities. The Spanish case also suggests that policy change depends more on the distribution of social power than on institutions. It underlines the key role of financial and knowledge transfers vis-à-vis institutional reforms in effecting social change as well as the potential for state intervention in supporting the development of collective action resources by social groups.     

Regulation and the paramedical professions: an interest group study

Abstract. This article exmines the relationship between government regulation and interest group activity of two paramedical groups in Ontario: chiropractors and physiotherapists. These disciplines occupy positions vis-à-vis the provincial medical insurance plan opposite to those which their relationships with the medical profession would suggest. It will be argued that the employment of sophisticated pressure group tactics can be highly effective as a surrogate for medical recognition. This, in conjunction with the difficulties inherent in the exercise of lay judgment in the development of public policy toward the professions, can lead to controversial policy outputs. It will also become apparent that a close and legitimate association with the medical profession is not necessarily of benefit in the pursuit of professional recognition. Sommaire: Cet article examine les rapports entre les règlements gouvernementaux et les activités poursuivies par deux groupes pararnédicaux en Ontario pour défendre leurs intétrêts: les chiropraticiens et les physiothérapeutes. Du point de vue du traitement qui leur est accordé dans le cadre du Régime provincial d'assurance maladic, ces disciplines occupent des position? qui sont diamétralement opposées à ce que l'on s'attendrait à trouver compte tenu des rapports qu'ils entretiennent avec les médecins. On peut faire valoir que l'utilisation de tactiques perfectionnées propres à promouvoir les objectifs des groupes de pression peut être hautement efficace comme moyen de remplacer les avantages que confère la reconnaissance par le corps médical. Le recours a de telles tactiques, dans un contexte caractérisé par les difficultés inhérentes à la tâche que doivent accomplir des profanes chargés d'émettre un jugement lors de l'élaboration d'une politique publique à. l'égard de ces professions, peut aboutir à des résultasts qui, considérés du point de vue de cette politique, peuvent donner lieu à controverse. On pourra également constater qu'une association étroite et légitime avec le corps médical ne constitue pas nécessairement un avantage pour un groupe qui s'efforce d'obtenir la reconnaissance de son statut professionnel.     

FAMILY MEDIATION AND NEVER-MARRIED PARENTS

Parents who were never married to each other are increasingly court-ordered to mediate disputes over their children. The author reviewed 441 cases of divorcing and never-married parents to compare their experiences with family mediation. Client situations, adjustments in mediator behavior, and outcomes of mediation such as mediation did occur and agreements reached were compared. Factors external to mediation had a different impact on never-married parents than on divorcing parents. The review indicated never-married parents had a higher no-show rate than that of divorcing parents, yet when never-married parents did appear for court-ordered mediation, they reached agreements at the same rate as divorcing parents. Surprisingly, the never-married parents with a history of violence were more likely to appear for appointments and reach agreements. Overall, with modifications in mediator assumptions and behavior, divorce/family mediation appears to be useful to never-married parents.     

Relationship between depressed mood and sex-typed personality characteristics in adolescents

The current study investigated the relationship between self-reports of depressed mood, self-esteem, and endorsement of sex-typed personality characteristics in a normal adolescent population. For positively valenced (socially desirable) sex-typed characteristics, masculinity was inversely related to depression while femininity was not significantly related. In contrast, for negatively valenced sex-typed characteristics the masculine and feminine scales showed similar effects: all were positively correlated with depression. Self-esteem was the best single predictor of depression and none of the sextyped characteristics contributed significantly beyond that accounted for by self-esteem. The results support previous findings with younger children and high school students by demonstrating that sex-typed characteristics in adolescents are significantly associated with depression, although this relationship is accounted for by the variance shared with self-esteem, a more general measure of mental health. However, the presence of negative feminine-typed characteristics was as highly correlated with depression as the absence of positive masculine characteristics and both relationships were stronger for females than males. Thus the linkages between sex-role socialization, sex-typed characteristics, self-esteem, depressed mood, and clinical depression bear further investigation, and may prove useful in understanding the development of depression in males and females.Received Ph.D. in clinical psychology from the Pennsylvania State University in 1976. Current research interests include the development of depression and eating disorders.Received Ph.D. in Counseling Psychology from the Pennsylvania State University in 1981. Current research interest is childhood depression.     

Objectivity and truth: Problems in doing feminist research

This paper examines principles of feminist research and discusses the authors' attempts to use these principles in a systematic way in their own research. Three principles of feminist research are identified: research should contribute to women's liberation through producing knowledge that can be used by women themselves; should use methods of gaining knowledge that are not oppressive; should continually develop a feminist critical perspective that questions dominant intellectual traditions and can reflect on its own development.Consciously applying these principles in a research study of the relation between changes in consciousness and the changes in the structural situation of individuals raised several methodological issues and dilemmas. These include the impossibility of creating a research process that completely erases the contradictions in the relationship between the researcher and the researched; the difficulties in analysing change as a process; the tension between the necessity of organizing the data and producing an analysis which reveals the totality of women's lives; and problems of validity, particularly those raised when the research process becomes part of the process of change.