Nursing Under the Old Poor Law in Midland and Eastern England 1780-1834.

This article uses data drawn from the overseers' accounts and supporting documentation in thirty-six parishes spread over four English counties, to answer three basic questions. First, what was the character, extent, structure, range of activities, and remuneration of the nursing labor force under the Old Poor Law between the late eighteenth century and the implementation of the New Poor Law in the 1830s? Second, were there regional and intra-regional differences in the scale and nature of spending on nursing care for the sick poor? Third, how might one explain such differences? The article suggests that nursing became an increasingly important category of spending for the poor law from the later eighteenth century, but that there were significant variations within and (particularly) between English counties in parochial attitudes toward the provision of nursing for the sick poor. These variations can be explained by applying a matrix of explanatory variables ranging from the minor (differences in how parishes defined "nursing") through to the major (long-standing cultural attitudes toward the responsibility of parishioners to their sick compatriots and the ingrained expectations of the sick poor). The article also throws new light on the hidden aspects of female labor force participation, pointing to the development of professional nursing networks long before the later nineteenth century.

Street-level workers' criteria for identifying indigents to be exempted from user fees in Burkina Faso.

OBJECTIVES: Universal healthcare coverage cannot be achieved in Africa as long as the indigent, the poorest, are unable to access healthcare systems. This study was carried out in Burkina Faso to obtain street-level workers' perspectives on what criteria should be used to select indigents to be exempted from user fees. METHODS: Two group consensus techniques were used (Delphi and Concept Mapping). The participants were nurses (CM; n = 24), midwives (CM; n = 23) from a rural district and Social Action agents (CM; n = 31) and healthcare workers (Delphi n = 23) in training at two national schools. RESULTS: Altogether, 446 criteria were proposed. The nurses put forward criteria related to being ill without support and being a victim of society. The midwives focused more on the disabled poor and those who were ill and unsupported. The healthcare workers in training mentioned disabled persons and the elderly with no family support. The Social Action agents spoke about vulnerability related to illness or disability and the fact of being excluded or being a disaster victim. CONCLUSIONS: These criteria proposed by street-level workers add to other studies conducted in Burkina Faso and should help the State to improve indigents' access to care.

Provider preference for payment method under a national health insurance scheme: A survey of health insurance-credentialed health care providers in Ghana.

BACKGROUND: Ghana introduced capitation payment method in 2012 but was faced with resistance from provider groups and civil society organizations for its perceived negative effects on quality care delivery. This study seeks to explore the views of providers to understand their preferred payment method for the various types of services they provide in order to inform the discussion and negotiations during this period of reform. Findings will not only aid the National Health Insurance Authority (NHIA) to improve the implementation arrangements but also provide useful inputs for other low and middle-income countries (LMICs) in their quest to reform their provider payment systems. MATERIALS AND METHODS: We conducted a cross-sectional survey of 200 credentialed health care providers' in the three regions of Ghana on providers' preference for payment method. We administered closed-ended questionnaires employing 5-point Likert scales for measurement of payment method preference. Descriptive and regression analysis were performed to examine healthcare providers' background characteristics and their association with preferred payment method for primary care. RESULTS: In general, health care providers prefer the Ghana-Diagnosis-Related Grouping (G-DRG) payment method to fee-for-service and capitation payment methods. Result of bivariate analyses showed that healthcare providers' preference for payment method for primary outpatient services differed significantly by their region of residence (p<0.001). The multinomial logic model showed that being a female (p = 0.013) or healthcare provider in the Volta region (p = 0.008) was significantly associated with health provider preference for G-DRG payment method relative to fee-for-service. Similarly, being a healthcare provider in the Volta region (p = 0.026) or Medical Assistant (p = 0.032) was significantly associated with capitation relative to fee-for-service payment method. CONCLUSION: We conclude that the most preferred payment method across all regions is the G-DRG. However, whereas providers in the Volta region are not willing to accept capitation as payment method, this was not the case in Ashanti and Central regions. Capitation payment method as an option for primary care services in Ghana should, therefore, not be ruled out of the discussion.

An early look at changes in employer-sponsored insurance under the Affordable Care Act.

Critics frequently characterize the Affordable Care Act (ACA) as a threat to the survival of employer-sponsored insurance. The Medicaid expansion and Marketplace subsidies could adversely affect employers' incentives to offer health insurance and workers' incentives to take up such offers. This article takes advantage of timely data from the Health Reform Monitoring Survey for June 2013 through September 2014 to examine, from the perspective of workers, early changes in offer, take-up, and coverage rates for employer-sponsored insurance under the ACA. We found no evidence that any of these rates have declined under the ACA. They have, in fact, remained constant: around 82 percent, 86 percent, and 71 percent, respectively, for all workers and around 63 percent, 71 percent, and 45 percent, respectively, for low-income workers. To date, the ACA has had no effect on employer coverage. Economic incentives for workers to obtain coverage from employers remain strong.

Use of subsidies to low-income people for coverage through small employers.

If tax credits or other public subsidies are made available only for health insurance that is not employment-based, serious erosion of employer coverage could result. To prevent this, public subsidies targeted to low-income workers and families could be applied in ways that broaden employer coverage for low-income workers and their families by encouraging small employers with largely low-wage workforces to offer and partially fund health coverage for their workers. To accomplish this, such employers--very few of which now provide health coverage--must be allowed to contribute much less than normally required in the commercial market.

The demand for health insurance coverage by low-income workers: can reduced premiums achieve full coverage?

OBJECTIVE: To assess the degree to which premium reductions will increase the participation in employer-sponsored health plans by low-income workers who are employed in small businesses. DATA SOURCES/STUDY SETTING: Sample of workers in small business (25 or fewer employees) in seven metropolitan areas. The data were gathered as part of the Small Business Benefits Survey, a telephone survey of small business conducted between October 1992 and February 1993. STUDY DESIGN: Probit regressions were used to estimate the demand for health insurance coverage by low-income workers. Predictions based on these findings were made to assess the extent to which premium reductions might increase coverage rates. DATA COLLECTION/EXTRACTION METHODS: Workers included in the sample were selected, at random, from a randomly generated set of firms drawn from Dun and Bradstreet's DMI (Dun's Market Inclusion). The response rate was 81 percent. FINDINGS: Participation in employer-sponsored plans is high when coverage is offered. However, even when coverage is offered to employees who have no other source of insurance, participation is not universal. Although premium reductions will increase participation in employer-sponsored plans, even large subsidies will not induce all workers to participate in employer-sponsored plans. For workers eligible to participate, subsidies as high as 75 percent of premiums are estimated to increase participation rates from 89.0 percent to 92.6 percent. For workers in firms that do not sponsor plans, similar subsidies are projected to achieve only modest increases in coverage above that which would be observed if the workers had access to plans at unsubsidized, group market rates. CONCLUSIONS: Policies that rely on voluntary purchase of coverage to reduce the number of uninsured will have only modest success.

Inequality as a basis for the U.S. emergence from the great stagnation.

A significant body of evidence suggests that capitalism entered an economic crisis phase in the late 1960s due to a fall in the rate of profit. With falling profits, corporations are compelled to find means of reducing costs by lowering wages and taxes and/or raising productivity. Attacks on the welfare state (in the form of the war on deficits and debts), unions, and government in general resulted in falling wages, longer hours of work, and increased poverty. Only in 1997, despite years of exaggeration about its macroeconomic recovery, did the United States finally have a true boom year, like something from the Golden Age of the 1950s or early 1960s: GDP, investment, productivity, employment, and even wages grew by reasonable historical standards. This article is an account of how this tentative recovery was accomplished--in part, by the state and corporate sectors' ability to generate inequality over the past quarter century--and how these changes in the macroeconomy changed the context for health and the health sector.

Mandating insurance offers for low-wage workers: an evaluation of labor market effects.

Employing a simultaneous model of part-time status, health insurance offers, and wages, we examine the impacts on employment and health insurance coverage of nondiscrimination rules in the tax code governing employer-sponsored health insurance. Using 1988 and 1993 Employee Benefits Supplements to the Current Population Surveys and variations in health insurance premiums and minimum wages, we find that health insurance coverage among low-wage primary earners is increased by at most 31 percent by the policy, at a cost of an estimated 0.8-5.4-percentage-point decrease in full-time employment for low-wage workers.

Salário mínimo, benefício previdenciário e as famílias de baixa renda / Minimum wage, social security benefits and low-income families

Este artigo tem foco nas famílias com rendimento per capita de até » do salário mínimo. São analisadas as condições de inserção no mercado de trabalho e a influência dos benefícios previdenciários para o padrão de renda auferido. A preocupação, portanto, volta-se para a importância dos benefícios da previdência, no sentido de atenuar a fragilidade de renda destas famílias e as conseqüências da desvinculação do valor do seu piso do salário mínimo para este padrão de rendimentos. Analisando-se as características dos componentes das famílias de baixa renda, observa-se que, diante das transformações estruturais no processo de produção e do cenário conjuntural da economia brasileira, aqueles com idade ativa não apresentam os pré-requisitos necessários para se inserirem de forma digna no mundo do trabalho. Dessa forma, o estudo da composição da renda das famílias mais pobres mostra que a renda dos inativos - aposentados e pensionistas - é fundamental para retirar tais famílias do limite da linha de pobreza. O perfil dos componentes das famílias será analisado a partir dos microdados da Pesquisa Nacional por Amostra de Domicílios - PNAD/IBGE - para 2004, segundo idade, nível de escolaridade, cor ou raça e inserção no mercado de trabalho propriamente dita: tipo de atividade exercida e posição na ocupação. A comparação do perfil dos componentes das famílias mais carentes com o do total das famílias mostrará que as rendas de aposentadoria e pensão tornam-se fundamentais não apenas para diminuição da desigualdade, mas, fundamentalmente, para redução da pobreza.

This article discusses families with per capita income of up to » of the minimum monthly wage in Brazil. The conditions of participation in the labor market and the influence of social security benefits on the pattern of income earned are analyzed. The concern, therefore, is with the importance of social security benefits in attenuating the fragility of the income of these families and the consequences of the gap between their income and the minimum wage for this pattern of income. Characteristics of the members of low-income families showed that, in view of the structural changes in the production process and the current juncture of the Brazilian economy, persons of active working age lack the pre-requisites for participating with dignity in the world of labor. A study of the composition of the income of the poorest families shows that the income of inactive members (retired persons and pension receivers) is essential in preventing these families from falling below the poverty line. The profile of the members of such families is analyzed on the basis of microdata from the National Household Survey by Sample (PNAD/IBGE) of 2004, according to age, educational level, color or ethnic group, and participation in the labor market, strictly speaking. Factors studied include the type of work exercised and the position in the occupation. The comparison of the profile of members of the poorest families with that of all families shows that the income of retired members and pension receivers are essential not only in reducing the fall in inequality, but basically in reducing poverty itself.

Salário mínimo e pobreza no Brasil: estimativas que consideram efeitos de equilíbrio geral / Minimum wage and poverty in Brazil: estimations that to consider the effects of general equilibrium

Estima o impacto do salário mínimo sobre a pobreza no Brasil, por meio de uma abordagem de equilíbrio geral, reunindo uma vasta gama de efeitos indiretos. Os resultados mostram que aumentos do salário mínimo têm efeitos negativos sobre o grau de pobreza, quando não se consideram os reajustes dos benefícios da previdência social. Relata que, no entanto, as estimativas do efeito sobre a pobreza passam a ser positivas quando incorporamos o aumento desses benefícios.

Efeitos informais do salário mínimo e pobreza / Informal effectsof minimum wage and poverty

Avalia a efetividade da política de salário mínimo nacional nos segmentos formais e informais do mercado de trabalho brasileiro. Mapeia soluções de canto produzidas pela política de salário mínimo, posteriormente utilizadas como mecanismo de focalização na simulação de limites superiores dos efeitos de reajustes do salário mínimo sobre medidas de pobreza no Brasil. Destaca dois "efeitos informais" do mínimo: a) a alta percentagem de trabalhadores sem carteira assinada ganhando exatamente um salário mínimo, o que potencializa os efeitos aliviadores de pobreza deste; e b) a observação de remunerações que utilizam o salário mínimo como numerário, em particular no setor formal.

Uma avaliaçäo dos impactos do salário mínimo sobre o nível de pobreza metropolitana no Brasil / A valuation of minimum wage impacts about the level of the metropolitan poverty in Brazil

Estima os impactos dos aumentos recentes no salário mínimo sobre o grau de pobreza do conjunto das seis principais regiões metropolitanas brasileiras. Emprega uma metodologia que decompõe as variações no grau de pobreza entre pares de meses próximos aos aumentos do salário mínimo ocorridos em maio dos anos, de 1995 a 1998. Procura identificar a parcela das variações no grau de pobreza que poderia ser atribuída aos aumentos do salário mínimo. Os resultados mostram que os aumentos recentes do salário mínimo tiveram um impacto significativo sobre o grau de pobreza metropolitano. Relata que a elasticidade média para o período analisado foi de cerca de -0,4, mostrando que um aumento de dez porcento no valor do salário mínimo reduziria o grau de pobreza em aproximadamente quatro porcento.