. Latin@ immigrants face many obstacles to affordable healthcare that push them to disproportionately rely on the primary safety-net for their healthcare needs. This system is mostly funded with public monies that will be significantly reduced when Affordable Care Act is fully implemented. Since undocumented Latin@ immigrants are prohibited from accessing federally funded healthcare, they will be left out of the health care reform. This thesis examines two community-based clinics in the Greater New Orleans area that serve this population, and have developed linguistically and culturally appropriate programs that address its needs. The New Orleans Faith Health Alliance and Common-Ground Health Clinic are cases used to explore the impact that the Affordable Care Act will have in the already unstable safety-net in New Orleans. Through the analysis of other models around the nation, this thesis presents viable recommendations to both clinics and the City of New Orleans Health Department.

Made available in DSpace on 2016-04-29T14:16:18Z (GMT). No. of bitstreams: 1 Luciana Villela Junqueira.pdf: 463468 bytes, checksum: b26bc41782505aebd65730a7db993c22 (MD5) Previous issue date: 2012-11-23 / This dissertation is part of a prospect of recognition of rights and safeguards of children and adolescents in protective measure of institutional care. The aim is thus to explore the point of view of each one of these subjects, using the resources of the privileged Oral History, as well as some legal frameworks, such as the implementation of Individual Service Plans (IAP) and the realization of Concentrated Audiences. Therefore, based on a qualitative approach, 06 (six) interviews took place in 03 (three) Host Institutions located in the city of São Paulo. In these meetings, the children and teenagers selected for the study were able to rescue a few moments of their lives, besides expressing opinions and impressions about their relationships with family, the shelter and the Judiciary. The basis of the study approached concepts such as the formation and breakup of affective bonds, the listening space, the importance of safety nets and transdisciplinary movement that seeks to transcend the closed universe of the science of law and to bring out the multiplicity of other ways of knowledge as key aspects for the recognition and expansion of the rights of children and adolescents in protective measure of institutional care. The analysis of these interviews revealed the importance of ethics the care in relationships and the look that not only sees, but sees these children as authentic, once these children and adolescents are not only seen as objects to be known, but as subjects recognized and legitimized, the relationship established with them goes up to a new level, supported by the realization of true human experience, endowed with social and cultural experiences that are so rich in meanings. The research also indicated that the Individual Service Plans and Concentrated Audiences really can bring important contributions to the promotion of the rights and guarantees of these children and adolescents, once the professionals who support its implementation do so in an integrated, linear and mainly humanized way / Esta dissertação se insere em uma perspectiva de reconhecimento de direitos e garantias de crianças e adolescentes em medida protetiva de acolhimento institucional. Buscase, assim, explorar o ponto de vista de cada um desses sujeitos de direitos, utilizando-se os recursos privilegiados da História Oral, bem como alguns marcos legais, tais como a implementação dos Planos Individuais de Atendimento (PIA) e a realização das Audiências Concentradas. Assim, com base em uma abordagem qualitativa, foram realizadas 06 (seis) entrevistas em 03 (três) instituições de acolhimento localizadas na cidade de São Paulo. Nesses encontros, as crianças e os adolescentes selecionados para a pesquisa puderam resgatar alguns momentos de suas trajetórias, além de expressarem opiniões e impressões sobre suas relações com a família, o abrigo e o Poder Judiciário. O embasamento teórico do estudo abordou conceitos como a formação e o rompimento dos vínculos afetivos, o espaço de escuta, a importância das redes de proteção e o movimento transdisciplinar que visa transcender o universo fechado da ciência do Direito e trazer à tona a multiplicidade dos demais modos de conhecimento como aspectos fundamentais para o reconhecimento e a ampliação dos direitos das crianças e dos adolescentes em medida protetiva de acolhimento institucional. A análise dos referidos depoimentos mostrou a importância da ética do cuidado nas relações e do olhar que não apenas vê, mas enxerga esses sujeitos como legítimo outro, uma vez que, na medida em que essas crianças e adolescentes não são vistos apenas como objetos a serem conhecidos, mas enquanto sujeitos reconhecidos e legitimados, a relação que se estabelece com eles assume um novo patamar, balizado pela compreensão da verdadeira experiência humana, dotada de vivências sociais e culturais tão ricas em significados. A pesquisa indicou também que os Planos Individuais de Atendimento e as Audiências Concentradas podem sim trazer importantes contribuições para o fomento dos direitos e garantias dessas crianças e adolescentes, desde que os profissionais que corroboram para sua implementação o façam de maneira integrada, linear e, principalmente, humanizada

The objective of this research was to determine if healthcare access disparities exist across race and gender in a publically funded safety-net healthcare system in Texas. Data were examined from a representative random sample of 1468 adults aged 18-64 who were patients in this safety-net system in July and August of 2000 and were analyzed using binary logistic regression and chi-square measures of significance. Major Findings: On measures of health status - overall health rating (p =.051), limited employment (p =.000), energy level (p =.001), and worry (p =.012) - Anglos reported the worst health; Mexican Americans, the best health; with African Americans intermediate. Mexican Americans were more likely to have never had health insurance, and to also have had insurance in the past year; Anglos were least likely to have ever had insurance (p =.015) or to have had insurance in the past year (p =.000). On use of EDs (p =.028), problems getting prescription medicines (p =.029), and foregoing other necessities of life to pay for healthcare, Mexican Americans were least disadvantaged with African Americans reporting greatest use of EDs among both men and women, and Anglos the most problems with prescription medicines and foregoing care, especially among women. Logistic regression revealed that health status was the strongest predictor of problems accessing healthcare in all groups; the poorer health status of safety-net patients, the more problems they had accessing care. Patterns of poor reported health status and greater problems accessing care among Anglos relative to other groups is discussed in terms of social drift and relative deprivation.

This study operationalized the five dimensions of health care access in the context of contraceptive service provision and used this framework to examine access to contraceptive care at health department (HD) (Title X funded) and federally qualified health center (FQHC) (primarily non-Title X funded) clinics in South Carolina and Alabama. A cross-sectional survey was conducted in 2017/18 that assessed clinic-level characteristics, policies, and practices related to contraceptive provision. Provision of different contraceptive methods was examined between clinic types. Survey items were mapped to the dimensions of access and internal consistency for each scale was tested with Cronbach's alpha. Scores of access were developed and differences by clinic type were evaluated with an independent t-test. The overall response rate was 68.3% and the sample included 235 clinics. HDs (96.9%) were significantly more likely to provide IUDs and/or Impants on-site than FQHCs (37.4%) (P < 0.0001). Scales with the highest consistency were Availability: Clinical Policy (24 items) (alpha = 0.892) and Acceptability (43 items) (alpha = 0.834). HDs had higher access scores than FQHCs for the Availability: Clinical Policy scale (0.58, 95% CL 0.55, 0.61) vs (0.29, 95% CL 0.25, 0.33) and Affordability: Administrative Policy scale (0.86, 95% CL 0.83, 0.90) vs (0.47, 95% CL 0.41, 0.53). FQHCs had higher access scores than HDs for Affordability: Insurance Policy (0.78, 95% CL 0.72, 0.84) vs (0.56, 95% CL 0.53, 0.59). These findings highlight strengths and gaps in contraceptive care access. Future studies must examine the impact of each dimension of access on clinic-level contraceptive utilization.

Federally qualified health centers (FQHCs) provide essential contraceptive services to low-income individuals; yet, access to all method options, notably intrauterine devices (IUDs) and implants, may be limited at non-Title X FQHCs. The South Carolina (SC) Choose Well initiative is a statewide contraceptive access initiative that was launched in 2017 and extends into 2022. Choose Well established a collaborative network between training and clinical partners and is aimed at facilitating implementation of contraceptive care best practices through capacity-building and training of clinical and administrative staff in partner organizations. The initiative provided funding for workforce expansion and contraceptive methods. We examined perceptions of staff from Choose Well-participating FQHCs regarding contraceptive access during the first 2 years of the initiative, including factors that facilitated or posed access challenges as well as sustaining factors. This study informs the process evaluation of Choose Well while providing data critical for uncovering and scaling up contraceptive access initiatives. Interviews were conducted with FQHC staff ( = 34) in 2018 and 2019 to assess Choose Well implementation and were recorded, transcribed, and double-coded at least 80% interrater reliability or consensus coding. Data were analyzed according to clinical and administrative factors influencing contraceptive access. Increased capacity for contraceptive counseling and provision through training and external funding for IUDs and implants were the most noted clinical factors facilitating access. Streamlining workflow processes was also a facilitator. Buy-in and engagement among staff and leadership emerged as a facilitator at some clinics and as a barrier at others. Policy/structural factors related to costs of devices and insurance coverage were identified as threats to sustainability. The Choose Well initiative contributed to the perception of an increase in contraceptive access at participating FQHCs in SC. Statewide contraceptive access initiatives have the potential to support FQHCs in meeting their clients' contraceptive needs. Organizational buy-in, sustainability of funding, and training are key to realizing the full potential of these initiatives.

Contemporary health care systems in the United States are not equitable. Indeed, as the literature indicates, there are substantial differences in the variety and scope of service delivery based on age, income, and other socio-economic indicators. The recent passage of health care reform in the United States illustrates that Americans are seeking to bring balance and equity to health care. However, as learned in this study, county governments across the country have been working in their communities to ensure some balance and equity, by making a safety net available for those citizens who are unable to access health care. Perhaps this is because health care quickly becomes a local government problem. In this current economic climate, county governments are being pinched between declining revenues and rising demands for services (Eaton, 2009; Phaup, 2009). The Orange County Primary Care Access Network is one example studied here that provides clear evidence of how organizations can work together to develop and maintain a sustainable health care safety net for the underinsured and uninsured. This study is the first of its kind to examine county government influences, environmental pressures, and community resources in the context of health care network performance. The methodological research question for this study is what determinants (exogenous constructs) contribute to a health care network and its performance (endogenous construct) within the framework of county government participation? Further, is the model supported by the data and can prediction, direction, and strength of relationships among the variables be identified? The simple answer is yes. For this study, the responses from 123 counties were analyzed with a variety of statistical techniques, culminating in structural equation modeling. The outcome of these analyses provided a reasonable explanation for the variation among the variables leading to network performance improvement in meeting the health care needs of uninsured and underinsured people. These quantitative data were also supported in their results with the inclusion of a case study analysis of a particular health care safety-net, the Orange County Primary Care Access Network in Orange County, Florida. Ultimately, this study learned three valuable lessons that can be used by county government decision-makers and health care providers alike. First, county involvement in community based health care networks results in a benefit that reverberates during economic stress- the leveraging of resources. Second, public-private initiatives are fundamental to reducing disparities in health care access. Third, health care networks improve access to health care for uninsured and underinsured people. Ultimately, county government participation is the largest predictor of network performance in this study.

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Text in Afrikaans / Social security is an important instrument of government to reduce the risks of economic insecurity to indivi~uals and the community. Social security usually consists of social insurance (for example pensions, unemployment insurance and workmen's compensation) and social assistance (for example social pensions, disability grants and maintenance grants). In view of South Africa's low economic growth, high and rising unemployment, widespread poverty, skew distribution of income and the disintegration of the family, social security requires urgent attention. This issue is even more pressing during the political transition since most policy measures and institutions are reconsidered, while pressure on government expenditure increases. This study commences with a discussion of basic aspects of social security, such as its definition, the rationale for social security in a market economy, the possible influence on economic behaviour, targeting, the financing of social security through a payroll tax and general taxation and the financing of a national pension fund. One of the sources of information of social security is the experience of other countries in this regard. The second part, which constitutes the core of the study, involves a comparative study of social security. After a general discussion on comparative studies, the origin and development of social security in welfare states (the USA, Britain and the Netherlands) and developing countries (Chile, Mexico, Guatemala, Cuba and Sri Lanka) are studied. African countries and the "miracle" countries of the East also receive brief attention. The main emphasis is on equity and efficiency, and aspects such as affordability, financing, targeting, the extension of coverage, a negative income tax, traditional social security and specific programmes that could be of importance to South Africa. In the last section the origin and development of and the fiscal scope for social security are discussed. Besides social insurance and assistance, programmes such as in-kind transfers, public works programmes and tax expenditure receive attention. Aspects of social security such as poverty alleviation, means testing, take-up rates, administration and corruption are discussed, while recommendations are made on topics such as a "voluntarily" national pension scheme, employment creation programmes and food stamps. / Bestaansbeveiliging is 'n belangrike instrument in die hande van die owerheid om die risiko' s van ekonomiese onsekerheid vir individue en die gemeenskap te verminder. Bestaansbeveiliging bestaan gewoonlik uit maatskaplike versekering (waaronder pensioene, werkloosheidsversekering en ongevalleversekering) en maatskaplike bystand (byvoorbeeld maatskaplike pensioene, ongeskiktheidstoelaes en onderhoudstoelaes). In die lig van Suid-Afrika se lae ekonomiese groei, hoe en stygende werkloosheid, wydverspreide armoede, skewe verdeling van inkome en gesinsverbrokkeling, verg bestaansbeveiliging dringende aandag. Die aangeleentheid is des te dringender gedurende die politieke oorgangsperiode waartydens die meeste beleidsmaatreels en instellings in heroorweging geneem word en daar voortdurend druk op die owerheid is om meer van die land se skaars bronne te gebruik. Ter inleiding word enkele kemaspekte van bestaansbeveiliging bespreek, waaronder die definisie daarvan, die rasionaal vir bestaansbeveiliging in 'n markekonomie, die moontlike invloed van bestaansbeveiliging op ekonomiese gedrag, die rol van teikenstelling, die finansiering van bestaansbeveiliging deur middel van 'n loonstaatbelasting en algemene belastings en die finansiering van 'n nasionale pensioenfonds. Een bron van inligting oar bestaansbeveiliging is die ervaring van ander lande op hierdie terrein. Die tweede gedeelte, wat die kern van die studie is, behels 'n vergelykende studie van bestaansbeveiliging. Na 'n inleidende bespreking oar vergelykende studies in die algemeen, word die ontstaan en ontwikkeling van bestaansbeveiliging in welvaartstate (die VSA, Brittanje en Nederland) en in ontwikkelende lande (Chili, Mexiko, Guatemala, Kuba en Sri Lanka) bestudeer. Afrikalande en die "mirakel-lande" van die Coste kry oorsigtelik aandag. Die nadruk in die gedeelte val veral op billikheid en doeltreffendheid en aspekte soos bekostigbaarheid, finansiering, teikenstelling, uitbreiding van dekking, negatiewe inkomstebelasting, tradisionele bestaansbeveiliging en programme wat vir Suid-Afrika van betekenis kan wees. In die laaste gedeelte word die ontstaan en ontwikkeling van en die fiskale ruimte vir bestaansbeveiliging in Suid-Afrika bespreek. Benewens maatskaplike versekering en bystand, kry programme soos in natura oordragte, openbare werke-programme (werkskeppingsprogramme) en belastinguitgawes aandag. Aspekte van bestaansbeveiliging soos armoedeverligting, die middeletoets, opneemkoerse, administrasie en korrupsie word bespreek en aanbevelings word onder me er gemaak ten opsigte van 'n "vrywillige" nasionale pensioenskema, werkskeppingsprogramme en voedselkoepons. / Sociology / D. Litt. et Phil. (Ekonomie)