The interplay between economic and political logics: path dependency in health care in England

The purpose of this article is to use the ideas of path dependency to understand why policies implemented by governments for health care in England were and are suboptimal in terms of the control of total costs, the equitable distribution of hospital services, and efficiency in delivery. We do this by relating the economic logic of achieving these objectives to the political logic of a state-hierarchical system in which ministers are accountable for the effects of policies and doctors largely decide the supply and demand of health care. The initial policy path of the National Health Service (NHS) controlled costs but lacked systems to achieve equity and efficiency in the funding of hospitals. Policies were introduced to achieve equity, but not efficiency, in the 1970s. The Thatcher government sought efficiency through a budgetary squeeze in the 1980s, which culminated in the NHS funding crisis of 1987 - 1988. The result was the policies of the NHS internal market, which promised efficiency by introducing a purchaser-provider split and a system of provider competition in which money would follow the patient. These promises justified an injection of extra funds for three years, but only a pallid model of the internal market was implemented. The Blair government abandoned the rhetoric of competition but maintained the purchaser-provider split and continued to constrain total NHS costs, which resulted in the funding crisis of 1998 - 1999. Current policies are to substantially increase spending on health care and reintroduce a system of provider competition in which money will follow the patient.     

Towards a Feminization of Agricultural Labour in Northwest Syria

Smallholdings in the rural areas of northwest Syria are a result of land fragmentation that is due to inheritance. Because of rapid population growth combined with land fragmentation, these smallholdings are increasing and cannot sustain the rural households whose sizes and needs are also increasing rapidly This situation has led to increasing numbers of males migrating to urban areas in Syria and to neighbouring countries looking for work opportunities. In addition, recent agricultural intensification trends seem to have led to the emergence of a waged labour force which, in the absence of male workers owing to significant rates of migration, is now predominantly female. Agricultural labour use depends upon household characteristics and resources (type of labour used, gender of labour waged/exchanged/familial). The article attempts to present a comprehensive analysis of household labour use in distinctive farming systems in one region of Syria that has undergone great change in recent decades, and examines the changes in the composition of the agricultural labour force. Secondary information, rapid ural appraisals and formal farm surveys were used to gather information on the households in a study area where different farming systems coexist. The results show that the decrease in landholding size, the resulting male migration, and land intensification have resulted in the expansion offemale labour in agriculturalproduction, which has been termed in this research a 'feminization of agricultural labour'. This suggests that agricultural research and extension services will have to work more with women farmers and farm workers, seek their wisdom and involve them in technology and transfer. This is not easy in conservative societies but requires research and extension institutions to take this reality into consideration in their programmes.     

Adolescents' evaluations of Peers' motives for helping

Four groups of high-school students (N=92) were each informed about a pair of helpers, either male or female, who independently helped a sameor opposite-sex peer. Within each pair of same-sex helpers, one was presented as having helped for empathic reasons and the other was presented as having helped for nonempathic reasons. The adolescents' ratings of the helpers indicated that they generally favored empathically motivated helping in both male and female peers. However, a female helper who did not express sensitivity and emotional responsiveness to the feelings of the needy other in her prosocial moral reasoning tended to be judged more harshly by the adolescents than did a male helper who failed to express such sentiments.Received Ph. D. from Northwestern University. Research interests include empathy and prosocial behavior.All received B.S. in psychology from Kansas State University in 1987.     

Why hasn't integrated health care developed widely in the United States and not at all in England?

There have been influential advocates for financing and organizing health care in the United States and England based on the model of integrated health care delivery systems (IHCDSs). Despite good evidence that a few IHCDSs provide high-quality health care economically, such organizations are rare and localized in a few market areas in the United States and are absent in the English National Health Service (NHS). The explanation of why this is so includes various contributory factors: the way the development of the medical profession in each country pursued specialization; the division in British medicine between general practitioners and specialists; and the characteristics that we identify of established successful IHCDSs, which created formidable barriers to entry for a new IHCDS. This explains why currently the most promising organizational developments in U.S. health care are hybrids resulting from vertical integration. In England government policies of an "internal market," as adopted in the 1990s and currently, were and are based on a purchaser-provider split with the objectives that providers would compete and be funded by a system in which "money follows the patient." These policies recognize the division in British medicine, which also means that it is difficult to implement a reorganized English NHS based on high-performing IHCDSs.