Exploring sustainable healthcare: Innovations in health economics, social policy, and management.

The healthcare sector faces several challenges, such as rising costs, rising demand, and the need for sustainability. A new area of healthcare has emerged due to these problems, focusing on long-term improvements in management, social policy, and health economics. This research explores the cutting edge of healthcare, concentrating on long-term advancements in management, social policy, and health economics. To better understand the problems affecting the healthcare sector and to pinpoint the areas where sustainable solutions are most required, a survey of 2000 healthcare professionals and policymakers was performed. The data were analyzed using structural equation modeling (SEM), and a thorough sustainable healthcare model was created. According to the survey's findings, the healthcare sector now faces three significant challenges: growing prices, increased demand, and the need for sustainability. According to the respondents, the three main areas where sustainable innovations are most required are management, social policy, and health economics. These conclusions were supported by the (SEM) analysis, which also showed that sustainable practices in these fields significantly impact the sustainability of the healthcare system. These findings lead this research to conclude that to guarantee the accessibility and affordability of healthcare for everyone, a move towards sustainable practices in health economics, social policy, and management is needed. Cooperation between healthcare providers, policymakers, and other stakeholders is required to create creative solutions that support sustainability in the healthcare sector. This study offers a thorough framework for sustainable healthcare that may act as a guide for further research and the formulation of new regulations.

Resolving conflict and promoting coordination for an integrated old-age healthcare service system in China: GMCR-AHP based decision analysis approach.

China faces a healthcare challenge due to its aging population, necessitating an integrated old-age healthcare system considering multiple stakeholders' interests. Conflict and inequality may arise from varying stakeholder interests. This study develops a conflict resolution strategy for the coordination of stakeholders involved in the old-age healthcare service system, promoting harmonization and minimizing conflict to establish an equitable system meeting elderly needs. It contributes to a robust healthcare system for comprehensive, quality care. The focus of the study is to identify relevant stakeholders and decision-makers involved in developing an integrated old-age healthcare service system and explore a feasible solution through stakeholder analysis using the Mitchell score-based technique and stakeholder theory. Decision-makers' preferences are estimated using the Analytic Hierarchy Process (AHP). Solution strategies are developed through multiple stability concepts within the graph model for conflict resolution (GMCR). The conflict resolution analysis based on the integrated AHP-GMCR approach reveals that the development of an integrated old-age healthcare system is feasible by addressing potential conflicts among the stakeholders. Considering the current predicament of comprehensive medical services in China, governments should distribute authority, simplify procedures, and improve the insurance system. Furthermore, medical institutions should explore funding options, expand services, and enhance accessibility. Elderly individuals should prioritize healthy aging and seek suitable healthcare providers. Stakeholder participation is crucial for effective implementation. These recommendations enable China to advance integrated elderly care successfully, addressing challenges posed by the aging population.

Experiences of Parents Earning Low Wages in Raleigh, North Carolina: Compounding Effects of Caretaker Responsibility, Piecemeal Resources, and Lack of Economic Opportunities.

We conducted interviews with parents earning low wages to understand their experiences related to financial responsibilities and use of government and informal resources in Raleigh, North Carolina. Inadequate economic opportunities and assistance programs, and high costs of living, compounded into cycles of playing catch up on expenses. Assistance programs aimed at alleviating hardships related to poverty were described as piecemeal. We found that social and economic systems failed to support parents earning low wages. Our findings suggest that ordinances that assure a livable minimum wage paired with expansions of safety net programs could better meet the needs these parents.

The Role of Single Motherhood in America's High Child Poverty.

Many claim a high prevalence of single motherhood plays a significant role in America's high child poverty. Using the Luxembourg Income Study, we compare the "prevalences and penalties" for child poverty across 30 rich democracies and within the United States over time (1979-2019). Several descriptive patterns contradict the importance of single motherhood. The U.S. prevalence of single motherhood is cross-nationally moderate and typical and is historically stable. Also, child poverty and the prevalence of single motherhood have trended in opposite directions in recent decades in the United States. More important than the prevalence of single motherhood, the United States stands out for having the highest penalty across 30 rich democracies. Counterfactual simulations demonstrate that reducing single motherhood would not substantially reduce child poverty. Even if there was zero single motherhood, (1) the United States would not change from having the fourth-highest child poverty rate, (2) the 41-year trend in child poverty would be very similar, and (3) the extreme racial inequalities in child poverty would not decline. Rather than the prevalence of single motherhood, the high penalty for single motherhood and extremely high Black and Latino child poverty rates, which exist regardless of single motherhood, are far more important to America's high child poverty.

Transitioning to adulthood: Are conventional benchmarks as protective today as they were in the past?

More young adults in the United States are studying beyond high school and working full-time than in the past, yet young adults continue to have high poverty rates as they transition to adulthood. This study uses longitudinal data on two cohorts of young adults from the 1979 and 1997 National Longitudinal Study of Youth to assess whether conventional benchmarks associated with economic success-gaining an education, finding stable employment, and delaying childbirth until after marriage-are as predictive of reduced poverty today as they were in the past. We also explore differences in the protective effect of the benchmarks by race/ethnicity, gender, and poverty status while young. We find that, on average, the benchmarks associated with economic success are as predictive of reduced poverty among young adults today as they were for the prior generation; however, demographics and features of the economy have contributed to higher poverty rates among today's young adults.

The State of Family Caregiving Policy.

As the population ages and supportive services are increasingly delivered in home- and community-based settings, greater demands are placed on family caregivers. This essay introducing the special issue of the Journal of Aging and Social Policy discusses signs of progress on policies to ease the burden on family caregivers. It introduces a series of articles that reflect the growing body of research on caregiver-related policy actions. These actions range from expanding access to paid family leave and payment for providing care, to ensuring access to better data about family caregivers and improving the post- hospital discharge experiences of rural and underserved caregivers. It also explores a major conundrum around caregiving policy - why progress on family caregiving policy has been so slow, despite its clear importance to the health and welfare of those who receive supports, as well as to those providing supports. In addition, the essay discusses developments, such as Biden administration actions and the RAISE Family Caregiver Advisory Council, indicating that the political dynamic around caregiving has changed, concluding that this is a uniquely hopeful time for family caregiver-related policy.

Bread or roses? Trade unions, female employment and the expansion of work-family policies.

In the Fordist era, trade unions promoted welfare state expansion and coverage against risks for the broader workforce. With the shift to the post-industrial economy, however, new economic groups have been left without representation. This is particularly evident for women: despite a rapid increase in female employment since the 1980s, unions' membership base remains anchored in the male, old and industrial working class. Without the crucial pressure of labour, welfare systems have failed to enhance the reconciliation of work and family life. Under which conditions do unions support the expansion of work-family policies? Marshalling evidence from 20 OECD countries in the 1980-2010 period, this paper investigates the role of political actors in family policy reform. Findings suggest that unions promote the expansion of work-family packages when they are gender-inclusive and have institutional access to policy-making.

Marital status, State policy environment and Foregone healthcare of same-sex families during the COVID-19 period.

Sexual minorities in the United States have often reported a higher likelihood of forgoing healthcare than heterosexuals, but whether this occurred during the COVID-19 pandemic remains underexplored. This study applies and extends the Andersen model to examine different-sex and same-sex families' likelihood of forgoing healthcare during the pandemic using nationally representative data from the 2020 (May-October) Current Population Survey (N = 139,636). Results are that during the early stage of the pandemic (1) same-sex families overall are more likely than different-sex families to forgo medical care, (2) cohabitating same-sex families were less likely to forgo healthcare than their married counterparts, and (3) state policy environments will moderate only some of the differences in healthcare utilization by family types. Findings provide partial support for hypotheses and suggest a more careful consideration of the role of partnership and state policy in the Andersen model. Policy implications are also discussed.

Evaluation of Active Labor Market Policy Reform: Employment Outcomes of Vocational Rehabilitation Services.

PURPOSE: The purpose of this study is to examine the effect of the Estonian active labor market reform in 2016, which introduced a new policy concerning vocational rehabilitation services. As a research question, we investigate how such services may have affected the employment outcomes of people with mental and/or physical impairments. METHODS: Our sample includes 9244 people from 2016 to 2020, with a mean age of 46 years. Due to multiple entries to the services, we have more than 11,000 cases with over 100,000 monthly observations. We use propensity score matching in combination with fixed effects panel regressions to analyze how the completion of the scheduled rehabilitation plan affected monthly employment duration. RESULTS: Our findings indicate that completing the rehabilitation service results on average in 2.6 months longer post-rehabilitation employment, compared to matched individuals who discontinued the service. This effect was larger when already employed and male participants entered the service, while weaker effects were observed in the case of individuals with only mental disabilities. CONCLUSIONS: Overall, we conclude that while completing the scheduled rehabilitation plan has a positive effect on employment outcomes, still maintaining employment status seems to remain a challenge, based on the relatively modest effect sizes. Thus, we question the economic arguments behind the reform.

The Effect of the Earned Income Tax Credit on Physical and Mental health-Results from the Atlanta Paycheck Plus Experiment.

Policy Points The Paycheck Plus randomized controlled trial tested a fourfold increase in the Earned Income Tax Credit (EITC) for single adults without dependent children over 3 years in New York and Atlanta. In New York, the intervention improved economic, mental, and physical health outcomes. In Atlanta, it had no economic benefit or impact on physical health and may have worsened mental health. In Atlanta, tax filing and bonus receipt were lower than in the New York arm of the trial, which may explain the lack of economic benefits. Lower mental health scores in the treatment group were driven by disadvantaged men, and the study sample was in good mental health. CONTEXT: The Paycheck Plus experiment examined the effects of an enhanced Earned Income Tax Credit (EITC) for single adults on economic and health outcomes in Atlanta, GA and New York City (NYC). The NYC study was completed two years prior to the Atlanta study and found mental and physical benefits for the subgroups that responded best to the economic incentives provided. In this article, we present the findings from the Atlanta study, in which the uptake of the treatment (tax filings and EITC bonus) were lower and economic and health benefits were not observed. METHODS: Paycheck Plus Atlanta was an unblinded randomized controlled trial that assigned n = 3,971 participants to either the standard federal EITC (control group) or an EITC supplement of up to $2,000 (treatment group) for three tax years (2017-2019). Administrative data on employment and earnings were obtained from the Georgia Department of Labor and survey data were used to examine validated measures of health and well-being. FINDINGS: In Atlanta, the treatment group had significantly higher earnings in the first project year but did not have significantly higher cumulative earnings than the control group overall (mean difference = $1,812, 95% CI = -150, 3,774, p = 0.07). The treatment group also had significantly lower scores on two measures of mental health after the intervention was complete: the Patient Health Questionnaire 8 (mean difference = 0.19, 95% CI = 0.06, 0.32, p = 0.005) and the Kessler 6 (mean difference = 0.15, 95% CI = 0.03, 0.27, p = 0.012). Secondary analyses suggested these results were driven by disadvantaged men, but the study sample was in good mental health. CONCLUSIONS: The EITC experiment in Atlanta was not associated with gains in earnings or improvements in physical or mental health.

Making un/equal: reassessing inequality and mental health through a praxeographic approach on welfare categorization processes.

PURPOSE: In recent decades, Europe has seen a steady increase in psychiatric diagnoses, which, besides affecting the population in many ways, also challenges the organization of welfare. This paper explores how welfare classification processes impact the contemporary production of mental (ill) health and social inequality in the German welfare state. METHODS: Based on comprehensive ethnographic research in the public mental healthcare landscape in Berlin between 2011 and 2017, this paper discusses in detail the case of a mandatory prescription of a psychosocial rehabilitation measure for Ms Reisch, a psychiatric service user and ethnographic research partner. The analysis draws on the methodological approach of praxeography to examine how this case challenges the social determinants of mental health framework and the conceptual work of the sociology of inequality on which the categories of welfare are largely built. RESULTS: The paper highlights the essentializing properties of social categories, whether in the sociology of inequality or in social and mental health policy. It also demonstrates the strength of praxeography to expose how multiple welfare categorization processes shape experiences and events of dis/ability in practice, potentially contradicting the stated intentions of social policy. CONCLUSION: The results suggest that the attachment of categories to people in public welfare needs to be changed to make public administration more flexible to responding to the situated processes that bring about differentiations of equal and unequal in practice. The paper, therefore, encourages social inquiry into the potentialities of a post-categorical social policy framework.

Perpetration-Focused Prevention: The Perceptions of Victim-Survivors.

Policymakers are increasingly calling on victim-survivors of child sexual abuse to consult on prevention initiatives, including perpetration-focused prevention efforts like Stop it Now! However, very little is known about the perspectives of victim-survivors on perpetration-focused prevention and whether they support such initiatives. This study was informed by the research question: How do victim-survivors of child sexual abuse perceive perpetration-focused prevention, including the Stop it Now! program? Sixteen Australian victim-survivors participated in an individual, one-hour interview and the data were analysed according to thematic analysis. Four themes emerged through the data analysis: Core of repulsion; Doubt and dismissal; Conditions for congruence; and Arriving at acceptability. These themes are represented as a spiral from the first theme at the centre to the last at the outer edge, reflecting a process of rationalisation. Their initial reaction was a sense of revulsion to perpetration-focused prevention, but their final position was one of conditional support.

Food Insecurity and Social Policy: A Comparative Analysis of Welfare State Regimes in 19 Countries.

We sought to determine whether a country's social policy configuration-its welfare state regime-is associated with food insecurity risk. We conducted a cross-sectional study of 2017 U.N. Food and Agriculture Organization individual-level food insecurity survey data from 19 countries (the most recent data available prior to COVID-19). Countries were categorized into three welfare state regimes: liberal (e.g., the United States), corporatist (e.g., Germany), or social democratic (e.g., Norway). Food insecurity probability, calibrated to an international reference standard, was calculated using a Rasch model. We used linear regression to compare food insecurity probability across regime types, adjusting for per-capita gross domestic product, age, gender, education, and household composition. There were 19,008 participants. The mean food insecurity probability was 0.067 (SD: 0.217). In adjusted analyses and compared with liberal regimes, food insecurity probability was lower in corporatist (risk difference: -0.039, 95% CI -0.066 to -0.011, p = .006) and social democratic regimes (risk difference: -0.037, 95% CI -0.062 to -0.012, p = .004). Social policy configuration is strongly associated with food insecurity risk. Social policy changes may help lower food insecurity risk in countries with high risk.

Debate: Social media content moderation may do more harm than good for youth mental health.

Most social media platforms censor and moderate content related to mental illness to protect users from harm, though this may be at the expense of potential positive outcomes for youth mental health. Current evidence does not offer strong support for the relationship between censoring mental health content and preventing harm. In fact, existing moderation strategies can perpetuate negative consequences for mental health by creating isolated and polarized communities where at-risk youth remain exposed to harmful content, such as pro-eating disorder communities that use lexical variants to evade censorship. Social media censorship of content related to mental illness can also silence positive discourse about mental health, create barriers to accessing online support and resources, and hinder research efforts on youth well-being. Social media content about mental health can have important positive impacts on youth mental health by facilitating help-seeking, depicting positive coping strategies, and promoting a sense of belonging for struggling youth, but these benefits are minimized under existing moderation and censorship practices. This article presents a call to action for evidence-based social media policies and for practitioners to consider the clinical implications of social media engagement when connecting with young patients.

Understanding food insecurity risk in the United States: A longitudinal analysis.

Background: Food insecurity, lack of consistent access to the food needed for an active, healthy life, harms population health. Although substantial biomedical evidence examines the connections between food insecurity and health, fewer studies examine why food insecurity occurs. Methods: We propose a conceptual understanding of food insecurity risk based on institutions that distribute income-the factor payment system (income distribution stemming from paid labor and asset ownership), transfers within households, and the government tax-and-transfer system. A key feature of our understanding is 'roles' individuals inhabit in relation to the factor payment system: child, older adult, disabled working-age adult, student, unemployed individual, caregiver, or paid laborer. A second feature is that the roles of others in an individual's household also affect an individual's food insecurity risk. We tested hypotheses implied by this understanding, particularly hypotheses relating to role, household composition, and income support programs, using nationally-representative, longitudinal U.S. Current Population Survey data (2016-2019). Results: There were 16,884 participants (year 1 food insecurity prevalence: 10.0%). Inhabiting roles of child (Relative Risk [RR] 1.79, 95% Confidence Interval [95%CI] 1.67 to 1.93), disabled working age-adult (RR 3.74, 95%CI 3.25 to 4.31), or unemployed individual (RR 3.29, 95%CI 2.51 to 4.33) were associated with a greater risk of food insecurity than being a paid laborer. Most food insecure households, 74.8%, had members inhabiting roles of child or disabled working age-adult, and/or contained individuals who experienced job loss. Similar associations held when examining those transitioning from food insecurity to food security in year 2. Conclusions: The proposed understanding accords with the pattern of food insecurity risk observed in the U.S. An implication is that transfer income programs for individuals inhabiting roles, such as childhood and disability, that limit factor payment system participation may reduce food insecurity risk for both those individuals and those in their household.

Multisector Collaboration vs. Social Democracy for Addressing Social Determinants of Health.

Policy Points Multisector collaboration, the dominant approach for responding to health harms created by adverse social conditions, involves collaboration among health care insurers, health care systems, and social services organizations. Social democracy, an underused alternative, seeks to use government policy to shape the civil (e.g., civil rights), political (e.g., voting rights), and economic (e.g., labor market institutions, property rights, and the tax-and-transfer system) institutions that produce health. Multisector collaboration may not achieve its goals, both because the collaborations are difficult to accomplish and because it does not seek to transform social conditions, only to mitigate their harms. Social democracy requires political contestation but has greater potential to improve population health and health equity.

Reflection on the application of the Consolidated Framework for Implementation Research to a national policy to improve inclusion of people with disabilities.

People with disabilities face many barriers in the built environment impacting their mobility, health, and social participation. In the US, under the Americans with Disabilities Act (ADA), municipalities were required to develop and implement barrier-removal plans for pedestrian infrastructure, called ADA transition plans, but very few have done so. Many communities know they need a plan but do not know how to get it done because of a lack of understanding of the many different implementation considerations. Implementation science offers a useful approach for understanding complex policy implementation such as ADA plans. This paper provides a reflection on the adaptation of the Consolidated Framework for Implementation Research (CFIR) to evaluate the implementation of ADA transition planning. To apply the CFIR, we tailored the construct definitions and modified them to fit the specific context of the ADA transition planning process. We documented the constructs that were more challenging to apply, those that were not relevant, and those that were particularly useful. This paper can serve as a valuable example that other researchers can use when considering adapting the CFIR or other implementation frameworks for the evaluation of complex social policy beyond the ADA.

Austeridade e financeirização: a construção do discurso reformista no campo previdenciário brasileiro / Austeridad y financiarización: la construcción del discurso reformista en el campo de la seguridad social brasileña / Austerity and financialization: the construction of the reformist discourse in the Brazilian social security field

Resumo O artigo busca traçar um panorama na construção dos discursos reformistas no campo previdenciário brasileiro pós-Constituição Federal de 1988. Para tanto, estabelece uma análise das exposições de motivos anexadas às Propostas de Emendas Constitucionais (PECs) e que justificam os projetos submetidas ao Parlamento brasileiro. O estudo tem como pressupostos teórico-metodológicos a análise de discurso crítica (ADC), buscando responder em que medida as concepções de austeridade e financeirização permeiam o processo de construção dos discursos que justificam a proposição das reformas previdenciárias. É também objetivo deste trabalho desvelar as ideologias presentes nos discursos. Os resultados apontam que os ideais capitalistas pautados pela lógica da financeirização e da austeridade aparecem na construção dos discursos das reformas, o que demonstra sua influência sobre a construção discursiva de seus autores, inferindo uma filiação das reformas a essas concepções hegemônicas. Conclui-se que a ADC é um importante meio para compreender os processos que envolvem as políticas públicas, desde sua formulação até sua avaliação.

Resumen El artículo busca esbozar un panorama en la construcción de discursos reformistas en el campo de la seguridad social brasileña después de la Constitución Federal de 1988. Con este fin, establece un análisis de las exposiciones de motivos adjuntas a las propuestas de enmiendas constitucionales y que justifican los proyectos sometidos al Parlamento brasileño. Sus supuestos teóricos y metodológicos son el análisis crítico del discurso (ADC), que busca responder en qué medida las concepciones de austeridad y financiarización impregnan el proceso de construcción de los discursos que justifican la proposición de las reformas de la seguridad social brasileña. También es el objetivo de este trabajo develar las ideologías presentes en los discursos. Los resultados indican que los ideales capitalistas guiados por la lógica de la financiarización y la austeridad aparecen en la construcción de los discursos de las reformas, lo que demuestra su influencia en la construcción discursiva de sus autores, infiriendo una afiliación de las reformas a estas concepciones hegemónicas. Se concluye que la ADC es un medio importante para comprender los procesos que involucran políticas públicas, desde su formulación hasta su evaluación.

Abstract This article seeks to outline a panorama in the construction of reformist discourses in the Brazilian social security field after the 1988 Federal Constitution, unveiling the ideologies present in such discourses. The study conducted an analysis of the explanatory statements that justify constitutional amendment proposals submitted to the Brazilian parliament. The theoretical and methodological method was critical discourse analysis (CDA), seeking to answer to what extent the conceptions of austerity and financialization permeate the process of construction of the discourses that justify the proposition of the Brazilian social security reforms. The results indicate that capitalist ideologies guided by the logic of financialization and austerity appear in the construction of the reformist discourses, which demonstrates their influence on the authors and suggests the affiliation of the reforms to these hegemonic conceptions. It is concluded that CDA is an important tool to understand the processes that involve public policies, from its formulation to its evaluation.

Conservacionismo ambiental, assistência social e o atendimento a populações tradicionais / Environmental conservationism, social assistance in serving traditional populations

Resumo: O artigo elucida o conservacionismo e a questão ambiental na Política de Assistência Social, em pesquisa de doutorado no Serviço Social. Objetiva identificar o trato às populações tradicionais ribeirinhas, que habitam unidades de conservação. A pesquisa exploratório-descritiva apresenta a prática profissional de assistentes sociais na Amazônia. Entre os resultados, aponta as limitações da Política Social com sua concepção impregnada pelo "fator amazônico", desconsiderando a importância do bioma.

Abstract: The article elucidates conservationism and the environmental issue in Social Assistance Policy, in PhD research in Social Work. It aims to identify the treatment of traditional riverine populations, who inhabit conservation units. The exploratory-descriptive research presents the professional practice of social workers in the Amazon. Among the results, it points out the limitations of Social Policy with its conception impregnated by the "Amazon factor", disregarding the importance of the biome.

The Relationship Between State Level Policy, Insurance and Health Care Engagement for LGBTQ+ Foster Alumni.

Minority stress theory posits that external environmental factors such as state level policies around equity and inclusion of LGBTQ+ people can have a significant impact on the health and wellness of those identifying as part of the larger LGBTQ+ community, as well as on their decisions to seek needed physical or mental health care. This secondary data analysis explored the relationship between state level policies related to LGBTQ+ equity and inclusion and physical and mental health care engagement for foster care alumni. Using data from the Jim Casey Opportunity Passport Survey (n = 2,420), the research team conducted a longitudinal analysis of youth's engagement with healthcare professional as needed physical and mental health care, using sociodemographic characteristics of the respondents and state level policies, such as Medicaid expansion and state level protections for LGBTQ+ citizens as predictors. Results indicate obtaining health insurance increased the likelihood that the youth would seek physical health care. LGBTQ+ young adults assigned female at birth had higher odds of not receiving physical health care relative to non-LGBTQ+ peers. Compared with non-LGBTQ+ youth, LGBTQ+ youth showed higher odds of not seeing mental health professionals when they needed to. Implications for practice, policy and advocacy are presented.