Cette thèse inscrite dans la tradition intellectuelle de l’American Political Development analyse les liens dialectiques entre l’entrepreneuriat des présidents des États-Unis sur la question de l’assurance maladie, l’essor du système de santé américain contemporain et son produit le plus récent, le Patient Protection and Affordable Care Act (2010). Il s’agit d’analyser les influences réciproques entre un exécutif qui subit de très fortes contraintes institutionnelles dans ce champ précis des politiques publiques et un système de santé dont les fondements et les contours sont en perpétuelle mutation. Les réformes de santé, de par leur nature transversale et polémique, leur complexité mais aussi leur poids dans l'économie américaine, agissent directement sur les équilibres de la gouvernance publique. Elles doivent être considérées comme un laboratoire et un accélérateur d’innovations pour la présidence, dans un système politique où sa sphère d’action est limitée, tant par les freins et des contre-pouvoirs que par l’influence d’autres entrepreneurs politiques dotés d’une légitimité d’action égale voir supérieure à se saisir de la question épineuse de la santé. L’adoption du PPACA, sa promulgation par un président démocrate après un siècle de rendez-vous manqués avec les réformes ambitieuses de l’assurance maladie, ainsi que sa mise en œuvre compliquée, offrent un cas d’étude de premier plan sur les évolutions de l'exécutif étasunien et sur la normalisation d’un entrepreneuriat présidentiel hétérodoxe. / This dissertation which falls within the intellectual tradition of American Political Development explores the dialectical links between the entrepreneurship of US presidents on health care reform, the development of the American health care system and its latest product, the Patient Protection and Affordable Care Act (PPACA), which was signed into law in 2010. This work analyses the mutual forces of influence at work between a deeply constrained executive in this particular field of public policy and a health care system whose foundations and contours are in constant mutation. Given its controversial nature, its complexity and its weight in the US economy, health care reform directly affects the dynamics of public governance. Health care reform must therefore be considered as a laboratory and an accelerator of innovations for the presidency, in a political system in which its sphere of action is limited, as much by checks and balances as by the influence of other entrepreneurs who enjoy equivalent if not greater legitimacy than the executive branch to take action on the thorny issue of health care. The passage of the PPACA, the fact that it was signed into law by a democratic president after a century of failed attempts at ambitious reform as well as its arduous implementation, are a picture perfect case study on the evolutions of the presidential institution and on the routinization of heterodox presidential entrepreneurship.

Thesis (M Social Work)--Stellenbosch University, 2002. / ENGLISH ABSTRACT: This study is concerned with children and youths in conflict with the law, who are additionally at risk of becoming or being in need of care. The study eventuated from concern for neglected children and youths from poor, disadvantaged and violent communities in the Western Cape Province, who inevitably lapsed into crime. Child and youth care, including juvenile justice, in South Africa is presently in a process of transformation, managed by the inter-ministerial committee on young people at risk. As an outcome of the transformation of the juvenile justice system, assessment centres were established at juvenile courts. Probation officers were appointed in terms of the Probation Services Act (Act 116 of 1991) to assess arrested children and youths before their first court appearance in view of a suitable awaiting trial placement and possible diversion of the criminal case. The researcher investigated how arrested children and youths, being in need of care, are managed within the criminal justice system. The research study showed that in spite of the implementation of policies and legislation to protect children and youths from detention in prison, the number of children and youths in prisons awaiting trial have steadily increased. A continuous shortage of vacancies in awaiting trial places of safety exists. It has further been established that professionals such as magistrates, prosecutors and probation officers recognize the needs of arrested children and youths who are additionally at risk of being or becoming in need of care. Factors such as the existing lack of vacancies in awaiting trial places of safety however result in children and youths not being protected in terms of care in all instances. The research study also indicated that arrested children and youths who are current subjects of the Child Care Act (Act 74 of 1983) as amended are often not effectively managed within the criminal justice system. A lack of sufficient knowledge of the said Child Care Act by especially prosecutors appears to be a contributing factor. A comprehensive criminal justice system for children and youths in South Africa is being envisaged, as contained in the draft Bill (Bill B), which will enable individualized but holistic services in respect of children and youths in conflict with the law. The role and tasks of probation officers carrying out assessments have as such become a key element in the management of arrested children and youths, as contained in the draft Bill (Bill B). Probation officers therefore playa significant role in advising the court regarding the appropriate management of arrested children and youths who are at risk of becoming or being in need of care. / AFRIKAANSE OPSOMMING: Hierdie studie het betrekking op kinders en jeudiges in botsing met die gereg, wat bykomend in gevaar is om sorgbehoewend te raak of sorgbehoewend is. Die studie het voortgevloei uit besorgdheid oor verwaarloosde kinders en jeugdiges van arm, agtergeblewe en geweldadige gemeenskappe in die Wes-Kaap Provinsie, wie noodwendig in misdaad verval het. Kinder- en jeugsorg, insluitend jeugreg in Suid-Afrika is tans in 'n proses van transformasie, wat deur die inter-ministeriële komitee vir jong persone in gevaar, bestuur word. As 'n uitkoms van die transformasie van die jeugregsisteem, is asseseringsentrums by jeughowe tot stand gebring. Proefbeamptes is in terme van die Wet op Proefdienste (Wet 116 van 1991) aangestel om gearresteerde kinders en jeugdiges te asseseer voor hulle eerste hofverskyning in die lig van 'n geskikte aanhouding terwyl verhoofafwagtend en moontlike afwending van die kriminele saak. Die navorser het ondersoek ingestel na die wyse waarop gearresteerde kinders en jeugdiges wat sorgbehoewend is, binne die kriminele jeugregstelsel hanteer word. Die navorsingstudie het getoon dat ten spyte van die implementering van beleid en wetgewing om kinders en jeugdiges van aanhouding in gevangenisse te beskerm, die hoeveelheid kinders en jeugdiges verhoorafwagtend in gevangenisse voortdurend toegeneem het. 'n Deurlopende tekort aan vakatures in plekke van veiligheid kom voor. Dit is verder vasgestel dat die behoeftes van gearresteerde kinders en jeugdiges wat bykomend in gevaar is om sorgbehoewend te raak of sorgbehoewend is, deur professionele persone soos landdroste, aanklaers en proefbeamptes erken word. Faktore soos die bestaande tekort aan vakatures in plekke van veiligheid veroorsaak egter dat kinders en jeugdiges nie ten alle tye beskerm word nie. Die navorsingstudie het ook aangedui dat gearresteerde kinders en jeugdiges wat steeds onderhewig is aan die Wet op Kindersorg (Wet 74 van 1983) soos gewysig dikwels nie doeltreffend binne die kriminele jeugregsisteem hanteer word nie. Gebrek aan voldoende kennis van die genoemde Wet op Kindersog deur veral aanklaers, blyk 'n bydraende faktor te wees. 'n Omvattende kriminele jeugregsisteem vir kinders en jeugdiges in Suid-Afrika word beoog, soos vervat in die konsep Wetsontwerp (Wetsontwerp B), wat die geleentheid vir individuele maar holistiese dienste ten opsigte van kinders en jeugdiges in botsing met die gereg sal bied. Die rol en take van proefbeamptes wat assesserings uitvoer het as sulks 'n sleutel element geword in die hantering van gearresteerde kinders en jeugdiges, soos vervat in die konsep Wetsontwerp (Wetsontwerp B). Proefbeamptes speel gevolglik 'n belangwekkende rol ten einde die hof te adviseer oor die gepaste hantering van gearresteerde kinders en jeudiges wat in gevaar is om sorgbehoewend te raak of sorgbehoewend is.

The Patient-Centered Medical Home (PCMH) is an innovative, team-based health care model that was applied during the implementation of the Affordable Care Act (ACA). However, the competencies for PCMH health care social worker team members are not identified within this model. Thus, the purpose of this phenomenological study focused on identifying the core competencies that will enable social workers to perform competently in PCMHs. This study also explored the roles and training needs as related to improving the competence of social workers. Sandberg’s and Parry’s conceptualization of the competency model was used as the theoretical framework. Data were acquired through interviews with 10 PCMH social workers. These data were then inductively coded and analyzed using a modified Moustakas method. Key findings indicated that these social workers believed that improvements in competencies may include training and knowledge with mental health and physical health knowledge which consist of diagnoses, interventions, medications, symptoms, and terminology. It was also noted that knowledge of evidence-based practices for mental health interventions and patient-centered, team-based principles were essential to ACA policy implementation. The positive social change implications of this study include recommendations to health care leadership, educational institutions, and other PCMH providers to develop competency-based training for social workers. Recommendations are also put forth to adapt social work curriculum to ensure the effective implementation of the principles of the ACA policy and to improve social work practice in PCMH health care settings.

This research focuses on obesity and other major risk factors for chronic diseases such as Type II Diabetes Mellitus, Heart Disease, and Stroke. Worksite wellness programs have been successful in this realm of health promotion and disease prevention for heart disease and stroke, but their effectiveness in treating diabetes has been uncertain partially due to poor patient compliance, lack of stress reduction strategies, poor diet and lack of persuasive health education on the risk of being obese. Published peer-reviewed articles were reviewed, coded and analyzed to determine best practices, using a modified systematic review approach. The findings from these studies yield results that were used to develop a new employer-sponsored wellness program that is in accordance with the recently passed Affordable Care Act. / Includes bibliography. / Thesis (M.S.)--Florida Atlantic University, 2014. / FAU Electronic Theses and Dissertations Collection

The Diploma work "Health care reform in the United States of America" is the sequel of the Bachelor work of 2008 called "The liberal health care system of the United States of America". The work is focused on the financial means and changes which has been effective since singing The Patient Protection and Affordable Care Act (acronym PPACA) into the United States law on 23rd March 2010 by the democratic president Barack Obama. The special attention is drawn to permanently increasing health care costs and defrauding of money within the social heath care program Medicare that is designated for seniors 65 and over as well as handicapped people. This work deals with Massachusetts Mandatory Health Insurance Program of 2006, which has been used like a model for the new federal law PPACA. The practical part presents the particular changes brought by the new law, including their impact on the chosen social groups -- the uninsured, the employers, the families and their kids, the seniors and the people with "pre-existing conditions". Since the Health care reform is the political issue as well, at the end there are mentioned some pros and cons opinions.

隨著社會變遷，近一二十年來，我國醫療糾紛有大幅增加之現象，而經由媒體的報導，醫療糾紛在我國亦經常成為眾所矚目、備受爭議的社會焦點。由於醫療行為所導致的損害，直接侵害病人之身體權、健康權、甚至生命權，對於病人及其家屬生活所造成之影響，難謂非為鉅大，故醫療糾紛之妥善處理，實係吾人從事醫療法律之研究者，應予正視並深入探討之議題。 我國醫療糾紛之處理，向以刑事訴訟為主要之救濟途徑，惟晚近醫界、法界均已達成共識，認為醫療糾紛應回歸至以民事程序為主之處理模式。惟吾人若欲藉由民事法律關係妥善處理醫療糾紛，則須注意醫療民事訴訟之特殊性，亦即，因醫病雙方專業知識上之落差，導致雙方在民事程序上處於武器不平等之地位。為衡平此一武器不平等，我國實務上部分法官在審理醫療民事訴訟時，曾打破傳統民事過失歸責原則，將消費者保護法無過失責任與民法第191條之3一般危險責任之規定適用於醫療行為，惟自民國93年醫療法第82條第2項修正之後，該法既規定「醫療機構及其醫事人員因執行業務致生損害於病人，以故意或過失為限，負損害賠償責任。」邇近之實務判決遂多採醫療行為過失責任之見解，也多排除民法第191條之3之適用。我國醫療訴訟醫病爭執之重點，乃於近年由實體法之無過失責任之採擇與否，轉換至程序法之舉證責任分配。 於醫療訴訟等現代型訴訟事件中，被害人時常發生舉證上之困難，倘若依照僵化固定的舉證責任分配規則，則不免有失公平正義。因此，舉證責任分配於醫療訴訟上應如何操作方屬適當，實為醫療民事訴訟中值得觀察的重點所在。基於上述之問題意識，本論文的研究架構共分為七章，其內容綱要如下： 第一章 緒論：闡釋說明研究動機，並指明目前民事醫療糾紛事件之問題重心在於「程序法」，特別係在「舉證責任之分配」。進而說明本論文之研究動機、研究目的、研究範圍與研究方法。 第二章 醫療糾紛之發生及其處理：本章由醫療糾紛之發生談起，進而說明醫療糾紛之法律關係，探討不同法領域下醫療提供者違反義務時之法律責任，包括民事責任、刑事責任及行政責任等，並論證醫療糾紛實應回歸至以民事程序為主之處理模式。最後，介紹醫療糾紛發生後，國內外現今法制上之醫療糾紛處理機制，並分析其優缺點。 第三章 醫療糾紛之民事法律關係與醫療民事訴訟之特殊性：本章聚焦於醫療糾紛之民事法律關係，探討醫療提供者之契約責任、醫療無因管理與醫療提供者之侵權責任等。同時，討論醫療民事訴訟之特殊性，分析醫療民事訴訟被害人舉證困難之原因，並分析加重醫療提供者民事責任之法理基礎、以及過度加重醫療提供者民事責任所可能導致之反效果。 第四章 民事訴訟舉證責任分配之學說：按我國關於民事舉證責任之立法明文，係規定於民事訴訟法第277條：「當事人主張有利於己之事實者，就其事實有舉證之責任。但法律別有規定，或依其情形顯失公平者，不在此限。」學者乃認為，在我國法制下，所謂舉證責任分配法則係一總體概念，而可區分為「舉證責任分配一般原則」與「舉證責任分配減輕」二者，而以前者為原則，後者為例外。本章即由舉證責任之基礎觀念出發，藉由介紹國內外之學說，而分別處理「舉證責任分配之一般原則」與「舉證責任分配之減輕」等概念。 第五章 醫療民事訴訟舉證責任分配規則之具體適用：本章集中討論醫療民事訴訟之舉證責任。本章前半段介紹醫療民事訴訟舉證責任分配之一般規則、以及比較法上(包括德國、美國與日本)醫療糾紛舉證責任減輕之具體規則，後半段則分析我國實務操作醫療糾紛舉證責任分配之問題。本文一共歸納出實務判決於適用舉證責任分配時共六個問題，並分別找出判決加以闡釋。於本章末，則提出將醫療糾紛類型化，應有助於解決我國實務之問題。 第六章 醫療糾紛之類型化與舉證責任分配體系之建構：本章先試從「法學思維」、「醫學思維」、以及「綜合醫學思維與法學思維」出發，分別建立三套操作模組，以將醫療糾紛類型化，並建構其各別之舉證責任分配體系。關於純粹由「法學思維」或「醫學思維」所建立之操作模組，本文將分析其操作上之侷限，而針對本文所建議「綜合醫學思維與法學思維」之操作模組，亦將於各醫療糾紛分類，舉實務案例諸例實際操作之，以驗證本文所建議操作流程之可行性。章末則另提出法院於適用舉證責任分配規則時，其他與客觀舉證責任分配無直接相關，但應予考量之事項，以助於更正確地適用舉證責任分配規則。 第七章 結論、建議與展望：綜合前開章節討論，針對醫療民事爭訟程序中之舉證責任分類體系與操作模式，做出總結。並提出其他相關建議，以終極落實醫療需求者憲法上基本權之保障。 / The number of malpractice claims filed in Taiwan against physicians has increased significantly in the recent decades. Medical malpractice litigations are characterized by a huge gap in medical knowledge between physicians and patients, leading to an unequal status between both parties in the trials. To ensure that the principle of equality of arms is upheld in civil procedures, the courts applied the strict liability embodied in Article 7 of the Consumer Protection Law and Article 191-3 of the Civil Code to malpractice cases. However, since the amendment and promulgation of Article 82 of the Medical Care Act, there has been a consensus that strict liability is no longer applicable in medical litigations, and negligence becomes an essential element for establishing the liability of medical practitioners. In addition to modifying liability rules, an alternative for achieving equality of arms is to relieve the plaintiffs from the burden of proof. However, the burden of proof should be adjusted with precaution, because an excessive shift might contribute to defensive medicine. Accordingly, this study aims to standardize the algorithm for allocating the burden of proof by classifying medical malpractice disputes. The thesis is composed of the following seven chapters: Chapter 1 Introduction: This chapter outlines the background of the present study, with a special emphasis on the pivotal role of the burden of proof in medical litigations. Also delineated in this chapter are the objectives and methodology of the present study. Chapter 2 The occurrence and resolution of medical malpractice disputes: In this chapter, the incidence of medical injury and medical malpractice is discussed first, followed by an analysis of the civil, criminal, and administrative liabilities of medical professionals. The plethora of resolutions for settling medical malpractice disputes are summarized at the end of the chapter. Chapter 3 Civil liabilities of medical malpractice and characteristics of medical litigations: This chapter focuses on the civil liabilities of medical malpractice, which arise from failure to undertake contractual duties or tort liabilities. The characteristics of medical litigations, such as the unequal status in arms between plaintiffs and defendants and the difficulties in concluding negligence or deciphering causation, are discussed in the second half of the chapter. Chapter 4 Theories and rules in allocating the burden of proof: The allocation of the burden of proof is determined according to Article 277 of the Taiwan Code of Civil Procedure: A party bears the burden of proof with regard to the facts which he/she alleges in his/her favor, except either where the law provides otherwise or where the circumstances render it manifestly unfair. Consequently, in principle, the burden of proof is allocated according to the “Normentheorie,” with specific rules applied to ease the plaintiff’s burden of proof under exceptional and unfair circumstances. Chapter 5 Rules for allocating the burden of proof in medical litigations: German, American, and Japanese rules for allocating or relieving plaintiffs from the burden of proof in medical litigations are introduced. The current problems in applying these rules to medical litigations in Taiwan are inspected. The solution to these problems relies on a precise classification of medical malpractice disputes. Chapter 6 Establishing the algorithm for allocating the burden of proof by classifying medical malpractice disputes: Three models for allocating the burden of proof are created on the basis of three classification systems: classification from a legal perspective, classification from a medical perspective, and classification from a combined medical-and-legal perspective. A comparison of these three models reveals that the last might be the best algorithm. Specific tips for an accurate application of this algorithm are also provided. Chapter 7 Conclusions: This chapter highlights the importance of an appropriate allocation of the burden of proof in medical litigations, as well as the algorithm for allocating the burden of proof established in the present study. Also included are suggestions on how to ameliorate Taiwan’s medical litigation system in the future.

This item contains the agenda, minutes, and attachments for the Faculty Senate meeting on this date. There may be additional materials from the meeting available at the Faculty Center. / Minutes originally posted on Dec. 3rd, 2013; correction made to minutes and reposted on Feb. 3rd, 2014.

Syftet med studien är att ta reda på hur anknytningen med familjehemsföräldrarna och kontakten med socialtjänsten påverkar ett barn vid en familjehemsplacering och vidare in i vuxenlivet. Dessutom studeras även hur god anknytning främjar en familjehemsplacering och kontakten med socialtjänsten. Studien har en kvalitativ ansats och fem intervjuer med vuxna personer som bott i familjehem har genomförts. Delar av Bowlbys anknytningsteori och Antonovskys (2010) föreställning om KASAM användes vid analys av uppsatsens empiri. Resultatet visar att samtliga intervjupersoner har upplevt en trygg anknytning till familjehemsföräldrarna när de var placerade som barn. En trygg anknytning i familjehemmet grundar sig på regler, rutiner, engagemang och samhörighet mellan det placerade barnet och familjehemsföräldrarna. Barn med en otrygg anknytning får det svårare att skapa nya relationer och utveckla en trygg relation till familjehemsföräldrarna vid en familjehemsplacering. I socialtjänstlagen står det att alla barn som placeras i familjehem ska ha en socialsekreterare som kontaktperson (2015:982). Familjehemsplacerade barn behöver en socialsekreterare som de känner tillit till, för att öka möjligheterna till att utveckla bra relationer i familjehemmet och att upptäcka eventuella missförhållanden. / The purpose of this study is to examine how the connection with the foster parents and the contact with the social services affects a child during a foster care placement and later in life. Furthermore, it also examines how good connection favours a foster care placement and the contact with the social services. For the study, a qualitative method was used. Five interviews took place with adults who have, at some point during their childhood, been in foster care. Parts of Bowlbys attachment theory and Antonovskys (2010) idea of KASAM was used to analyze the study’s empirics. The result shows that all adults who got interviewed in this study felt they had good relations with the foster parents and felt safe in their presence during the time they spent in foster care. Four guidelines for a good relationship between a child and their foster parents has showed to be rules, structure, commitment and affinity. Children who feel insecure with their current relations have a harder time building new relations and will have a tough time creating good relations within the foster home. The Social Service Act demands that every child in foster care shall be assigned a social secretary (2015:982). Children who has been placed in foster care needs a social secretary that they feel they can trust, this will increase the possibility of good relations within the foster home.

Essay in Political Science, C-level, by Camila Alvarez Cea, spring semester 2010.   Tutor: Alf Sundin “Reality or a Political Mirage? – A Study of the Swedish Press Views on the Health Insurance Reform in the USA”   The purpose of this essay is partly to examine whether the picture that Swedish press presents of the health insurance reform in the US, which is part of the Patient Protection and Affordable Act bill, will be of crucial importance to the possibilities that the American population has to receive health insurance. The main research question is accordingly: “Does the picture that Swedish press presents of the health insurance reform in the USA, seem like something that will be of radical importance to the possibilities of the population to receive healthcare?” The purpose is also to examine in which model (demand or market) the opinions of the Swedish press fits. This purpose will be answered by using three specific questions asking whether their opinions differ when it comes to three criterions: organization, financing/resources and delivery systems. These criterions come from a model from Milton I. Roemer’s book “National health systems of the world,” which also is the theoretical foundation of this essay.   The methodological approach of this essay is a qualitative text analysis along with an analysis chart, where the three criterions have been examined from the reporting of the four Swedish newspapers chosen for this essay. The conclusions that have been reached from the analysis chart are that the opinions differ greatly within Swedish press, and that the picture that Swedish press presents of the health insurance reform is that it will become easier for the American population to receive health care.

No abstract available. / Dissertation (LLM)--University of Pretoria, 2012. / gm2014 / Centre for Human Rights / unrestricted