Suchergebnisse

As the social programmes of the postwar welfare state have been dramatically cut back and transformed, many have looked to the voluntary nonprofit sector as the 'beacon of hope' in terms of delivering support and services to citizens in need of assistance. But at the same time as these organizations have been under mounting pressure to deliver support and services, they have also been subject to forces of change which limit their capacities to play this vital social role. In this paper, we examine how disability organizations in two Canadian provinces have been faring in increasingly harsh neoliberal environments. We look, in particular, at the ways in which these organizations are struggling to negotiate the pressures of diminished and inadequate funding, rising demand for their services, and changing regulatory relations with the state. Drawing on mail surveys of sixty-two disability organizations in the provinces of Ontario and British Columbia, we discuss the impacts that organizational survival strategies are having on clients, staff, volunteers and volunteerism, and on the operation and structure of such organizations. We show how disability organizations are experiencing significant pressures to change how they deliver services and supports to disabled people in need. These include pressures to diminish levels of service provision to clients, particularly those in greatest need, to reduce staffing levels and institute survival strategies that negatively impact working conditions, to rely even more heavily upon volunteer labour, and to modify their operations and organizations in a struggle to cope with harsh neoliberal conditions.

BACKGROUND: Online crowdfunding platforms such as GoFundMe fundraise millions of dollars annually for campaigners. Medical crowdfunding is a very popular campaign type, with campaigners often requesting funds to cover basic health and medical care needs. Here we explore the ways that health needs intersect with housing needs in Canadian crowdfunding campaigns. In Canada, both health and housing needs may be addressed through legislative or policy intervention, are public health priorities, and are perceived as entitlements related to people's basic human rights. We specifically develop a classification scheme of these intersections. METHODS: We extensively reviewed Canadian crowdfunding campaigns on GoFundMe, the largest charitable crowdfunding platform, using a series of keywords to form the basis of the classification scheme. Through this process we identified five categories of intersection. We extracted 100 campaigns, 20 for each category, to ascertain the scope of these categories. RESULTS: Five categories form the basis of the classification scheme: (1) instances of poor health creating the need to temporarily or permanently relocate to access care or treatment; (2) house modification funding requests to enhance mobility or otherwise meet some sort of health-related need; (3) campaigns posted by people with health needs who were not able to afford housing costs, which may be due to the cost of treatment or medication or the inability to work due to health status; (4) campaigns seeking funding to address dangerous or unhealthy housing that was negatively impacting health; and (5) people describing an ongoing cyclical relationship between health and housing need. CONCLUSIONS: This analysis demonstrates that health and housing needs intersect within the crowdfunding space. The findings reinforce the need to consider health and housing needs together as opposed to using a siloed approach to addressing these pressing social issues, while the classification scheme assist with articulating the breadth of what ...

When Canadian medical tourists go abroad, they are often accompanied by friends and family, referred to as caregiver-companions, who provide informal care. These individuals play a role in patient decision-making and are stakeholders in medical tourism, yet little is known about their participation in this consumer health practice. To examine the roles that Canadian caregiver-companions play while accompanying medical tourists abroad, and to identify how multi-perspective qualitative data can augment our understanding of these roles, primary and secondary analysis was undertaken on datasets generated from multiple qualitative studies: semi-structured interviews with medical tourists, caregiver-companions, and international patient coordinators, and a survey with medical tourism facilitators. The findings from the triangulated analysis of these qualitative datasets serve to better understand the multiple, overlapping perspectives of different stakeholders in medical tourism. Results show that medical tourism caregivers act as companions, providing physical and emotional care; navigators, providing logistical assistance; and knowledge brokers, participating in decision-making and information exchange between medical tourists and professionals. Using data triangulation to examine the narratives of multiple stakeholders confirmed, altered, and augmented our knowledge of caregiver-companion roles. The unique perspectives offered by each participant group augment our understanding of caregiver roles and the practice of medical tourism.

Recent research has shown that social workers are particularly well placed to disseminate information about health-related social programs such as Canada's Compassionate Care Benefit (CCB). Low uptake of the CCB may be due, in part, to a lack of knowledge. In response to this, we report on the development of CCB knowledge tools aimed specifically at social workers. Social worker-specific tools about the CCB were developed through a multi-step process. Using a computer-based qualitative messaging survey ( n = 16), social workers chose what they determined to be the most important messages needed to gain knowledge about the CCB. Using these chosen messages, draft tools were created and then refined for content and aesthetics using a focus group ( n = 8) and information from key informant interviews ( n = 3). Further research is needed to evaluate tool implementation effectiveness and use in practice. This study contributes to the understanding of knowledge translation strategies specific to social workers, and particularly those working in end-of-life settings.

While significant research has been produced in the field of disability studies, little attention has been paid to experiences of chronic illness. This book emphasizes the workplace as an important site for understanding such experiences, as employment status has an enormous impact on social and economic standing in Canadian society.

Background: Caribbean offshore medical schools are for-profit, private institutions that provide undergraduate medical education to primarily international students, including from the United States or Canada. Despite the growing role that offshore medical schools play in training Canadian physicians, little is known about how these institutions are perceived by those in professional and decision-making positions where graduates intend to practice.Methods: The authors interviewed 13 Canadian medical education stakeholders whose professional positions entail addressing the medical education system or physician workforce. Participants were employed in academic, governmental, and non-governmental organizations in leadership roles.Results: Thematic analysis revealed three cross-cutting perceptions of offshore medical schools: (a) they are at the bottom of an international hierarchy of medical schools; (b) they are heterogeneous in quality of education and student body; and (c) they have a unique business model, characterized by profit-generating and serving international students.Conclusion: Consistent growth of the offshore medical school industry in the Caribbean may result in adverse reputational harms for well-established offshore or regional medical schools. Both comparative (e.g., USMLE pass rate) and intuitive factors (e.g., professional familiarity) informed participants' perceptions. Participants believed that core principles of social accountability in medical education are incompatible with the offshore medical school model.

Background: Regulation of the medical tourism and public health sectors overlap in many instances, raising questions of how patient safety, economic growth, and health equity can be protected. The case of Guatemala is used to explore how the regulatory challenges posed by medical tourism should be dealt with in countries seeking to grow this sector. Methods: We conducted a qualitative case study of the medical tourism sector in Guatemala, through reviews and analyses of policy documents and media reports, key informant interviews (n = 50), and facility site-visits. Results: Key informants were critical of the absence of effective public regulation of the emerging medical tourism sector, noting several regulatory gaps and the importance of filling them. These informants specifically expressed that: 1) The government should regulate medical tourism in Guatemala, thought there was disagreement as to which government sector should do so and how; 2) The government has not at this time regulated the medical tourism sector nor shown great interest in doing so; and 3) International accreditation could be used to augment domestic regulation. Conclusions: The intersection of domestic and international regulation of medical tourism has been largely unexplored. This case study advances new research in this area. It highlights the need for and dearth of regulatory protections in Guatemala and lessons for other, similarly situated countries. National regulatory models from Israel and Barbados could be adapted to the Guatemalan context. Global governance could help to protect national governments from any competitive disadvantages created by regulation. Underlying the concerns over growth in medical tourism, however, is how it contributes to the ongoing privatization of health care facilities worldwide. This trend risks undermining efforts to reach targets for Universal Health Coverage and exacerbating existing inequities in the global distribution of health and wealth.

Background Medical tourism has attracted considerable interest within the Latin American and Caribbean (LAC) region. Governments in the region tout the economic potential of treating foreign patients while several new private hospitals primarily target international patients. This analysis explores the perspectives of a range of medical tourism sector stakeholders in two LAC countries, Guatemala and Barbados, which are beginning to develop their medical tourism sectors. These perspectives provide insights into how beliefs about international patients are shaping the expanding regional interest in medical tourism. Methods Structured around the comparative case study methodology, semi-structured interviews were conducted with 50 medical tourism stakeholders in each of Guatemala and Barbados (n = 100). To capture a comprehensive range of perspectives, stakeholders were recruited to represent civil society (n = 5/country), health human resources (n = 15/country), public health care and tourism sectors (n = 15/country), and private health care and tourism sectors (n = 15/country). Interviews were transcribed verbatim, coded using a collaborative process of scheme development, and analyzed thematically following an iterative process of data review. Results Many Guatemalan stakeholders identified the Guatemalan-American diaspora as a significant source of existing international patients. Similarly, Barbadian participants identified their large recreational tourism sector as creating a ready source of foreign patients with existing ties to the country. While both Barbadian and Guatemalan medical tourism proponents share a common understanding that intra-regional patients are an existing supply of international patients that should be further developed, the dominant perception driving interest in medical tourism is the proximity of the American health care market. In the short term, this supplies a vision of a large number of Americans lacking adequate health insurance willing to travel for care, while in the long term, the Affordable Care Act is seen to be an enormous potential driver of future medical tourism as it is believed that private insurers will seek to control costs by outsourcing care to providers abroad. Conclusions Each country has some comparative advantage in medical tourism. Assumptions about a large North American patient base, however, are not supported by reliable evidence. Pursuing this market could incur costs borne by patients in their public health systems.