Consumer-Driven Healthcare: Information,Incentives, Enrollment,and Implications for National Health Expenditures

We highlight the importance of information for consumerdriven healthcare (CDHC), describe barriers, display data on adoption rates and product features, and use a new health modeling approach to investigate the potential impact on national healthcare expenditures. We conclude with an assessment of the prospects for CDHC as a revolution of information, competition, and market orientation; and we discuss potential pitfalls, including concern regarding vulnerable populations. While the jury is out on the ultimate effects, enrollment in CDHC programs— while still small—is growing rapidly; utilization and costs for subscribers appear to be moderating; and creative benefit structures emphasize health promotion alongside previously unseen cost consciousness. JEL Classification I11     

An evaluation of consumer participation in hospital breast services

Community expectations and research demonstrate that consumers play an important role in shaping services for women with breast cancer. Consumer contribution has been mandated recently in Victoria, Australia, to ensure the inclusion of consumer involvement in the planning and decision‐making processes within health organizations. As part of the redevelopment of breast services in Victoria, Southern Health has been funded to plan local improvements to care co‐ordination for women diagnosed with breast cancer in the southern metropolitan area of Melbourne. The establishment of effective consumer participation in breast services is an integral aspect of this project and a range of initiatives has been undertaken to achieve meaningful consumer involvement including the appointment of a consumer advisor; appointment of staff with extensive knowledge in women's health and community development to the project; establishment of a consumer reference group; and plans made to improve the receptivity of health service systems to consumer input. A preliminary evaluation of this ongoing project has indicated that a productive role for consumers in service practice review and policy and planning activities has been established and some change and engagement of staff has occurred. There is still work to be done to promote the involvement of a wider range of health professionals and to increase the level of trust between consumers and staff.     

Understanding postorganic fresh fruit and vegetable consumers at participatory farmers’ markets in Ireland: reflexivity,trust and social movements

This paper examines how trusting relations between consumers and vendors of organic fresh fruits and vegetables (FFVs) in a particular type of farmers’ market (FM) in Ireland are established and maintained, and what the implications of this are. First, the food system is outlined, and then its attendant problems. These problems have led to various solutions, two of which are organic food and FMs. Then, the growth in these two areas is outlined, as is the accompanying growth in the academic literature on these two areas, some of which overlaps. Various pressures, including in particular the increasing distance food travels and disconnected stallholders and products at the FM, are suggested. In light of this, a need to apply an understanding of the reflexive consumer, trust and social movements is suggested. It is found that the consumers interviewed act reflexively by choosing to go to these FMs. They prioritize the trusting relationships built up through repeated personal contact at these FMs over and above organic certification. Along with and as part of this, they prioritize local, fresh, seasonal ‘chemical‐free’ FFVs over and above imported certified organic produce. Various aspects of collective identity formation, including modes of behaviour, objects and stories, and language, are involved in this process. These elements, to some extent, act as a buffer against the pressures of distance and disconnection. Along with this, the essential meaning of the word organic is, in this particular context, reconstructed to include various socio‐environmental values missing from some certified organic produce. The word postorganic is suggested. The main methodologies used are semistructured in‐depth interviews and participant observation.     

社会统筹养老金供给的两难困境与政策选择

在中国养老保险制度建立与完善过程中,其主要矛盾仍然是如何筹资和如何给付的问题。社会统筹主要通过提高缴费率和扩大覆盖面两条途径来增加基金供给,而现行制度却面临着养老金供给的两难困境。一是提高缴费率增加了基金收入,但不利于经济增长与扩大覆盖面;二是不同群体实行差别费率有利于扩大覆盖面,但加剧了养老金收支的失衡。经数理模型与实证分析,社会统筹缴费率应该保持适度水平,同时应该对不同群体实行差别费率的政策进行调整,以建立养老保障的长效机制。     

The morality of spending in Finnish youth consumer culture

This article discusses the morality of spending (i.e. the unnecessary spending) as well as the freedom of spending in Finnish consumer narratives written by 16‐ to 19‐ year‐old pupils. First, the study explores different meanings of the unnecessary spending discourse. Second, the study argues that young consumers are using a wastrel metaphor (i.e. a squanderer, a prodigal son/daughter) as a symbol of liberation from the shame of spending. A narrative research approach is applied for the collection and analysis of data and illustrating the results. The qualitative data were collected in five upper secondary schools between November 2001 and May 2002. The morality of spending comprises various significances, although the discourse is often pleasure‐oriented for youth. Some youngsters define the unnecessary spending as a criticism of the consumer society. Furthermore, the discourse strengthens self‐control as well as helps to arrange both positive and negative consumer experiences. Thus, the morality of spending is a part of the process of growing up as a consumer and constructing a consumer identity.     

Accommodating the elderly poor: almshouses and the mixed economy of welfare in England in the second millennium

This article provides an outline of the development of the English almshouse across the second millennium, and its place within the broader spectrum of social welfare. It discusses the evolution of the almshouse into its modern form, as privately endowed housing dedicated to the elderly poor. It presents the results of new research that provides a firmer quantitative foundation for consideration of the role of the almshouse in welfare history and revisits the issue of the mixed economy of welfare to demonstrate the complex relationship between public and private provision.     

优势视角下失独老人的养老困境及相应对策

失去独生子女的父母的养老问题逐渐成为一个日趋急迫的社会问题,也是老龄工作中的新问题。用优势视角基本理念分析失独老人的养老问题,研究他们年老时存在的精神、经济、生活等一系列养老困境及原因。个人、团体、社会应共同帮助他们抚平精神创伤,改变外部环境中的不利因素,使其融入社会,实现个人优势与其生活环境的整合,以逐步帮助他们走出困境,安享晚年。     

Verti-zontal differentiation in export markets

Many trade models of monopolistic competition identify cost efficiency as the main determinant of firm performance in export markets. To date, the analysis of demand factors has received much less attention. We propose a new model where consumer preferences are asymmetric across varieties and heterogeneous across countries. The model generates new predictions and allows for an identification of horizontal differentiation (taste) clearly distinguished from vertical differentiation (quality). Data patterns observed in Belgian firm–product level exports by destination are congruent with the predictions and seem to warrant a richer modelling of consumer demand.     

Like a member of the family: including and excluding paid caregivers in performances of family

Abstract

We explore the construction of family in contemporary families that employ professional providers of childcare and elder care. We find that families and caregivers at times construct family together, including the caregiver as a family member, while at other times, consumers construct family in ways that exclude the caregiver. Through our exploration of these various ways of constructing family, we offer three theoretical contributions. First, we challenge traditional distinctions between consumers and producers and highlight the fluid, contextualised nature of family by demonstrating that some contemporary constructions of family include paid service providers. Second, we elucidate the ways in which the provision and consumption of a service, everyday care, produces a liminal position for some service providers. Finally, we develop a broader understanding of the ways in which performances of family protect cultural values.