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The case of Universal Health Insurance – by competition

9 Cliona Loughnane Governing healthcare: the case of Universal Health Insurance – by competition Introduction One of the defining features of the Irish health system, since the establishment of Voluntary Health Insurance (VHI) in the 1950s, has been a heavy reliance by those who can afford it on private health insurance. Thus the Irish health system, which is three quarters funded by taxation (Wren, Connolly and Cunningham, 2015), is a strange mix of a national health system with high levels of private insurance cover (with up to 50% of the population holding

in Reframing health and health policy in Ireland

Athletes start the century as normal, healthy citizens, and end up as potentially unhealthy physiological 'freaks', while the general public are increasingly urged to do more exercise and play more sports. This book offers a comprehensive study, and social history, of the development of sports medicine in Britain, as practiced by British doctors and on British athletes in national and international settings. It describes how and why, in Britain, medicine applied to sport became first an area of expertise known as sports medicine, and then a formal medical specialty: Sport and Exercise Medicine. In the late nineteenth century, vigorous exercise was an acceptable, probably necessary, part of the moderate healthy lifestyle for the normal, healthy man. Consequently sports medicine was part and parcel of normal medical treatment, distinguishable only through its location or through its patient history. There was no wide-spread de facto scepticism about the value of vigorous exercise among physicians and scientists. The normality of the young male athlete is reconsidered between 1928 and 1952. At the end of the period, the athlete becomes an abnormal or supernormal human being who demands specialist medical interventions. The formation and work of British Association of Sport and (Exercise) Medicine, the Institute of Sports Medicine, the Sports Council, and the British Olympic Association's Medical Committee is discussed. The book finally discusses fitness. Normal life, war, elite competition gives us an insight into how athletic bodies are conceptualised, and how sports medicine has formed and reformed over a century.

A governmental analysis

Recent years have witnessed a burgeoning international literature which seeks to analyse the construction of health and health policy through an analytical lens drawn from post-Foucauldian ideas of governmentality. This book is the first to apply the theoretical lens of post-Foucauldian governmentality to an analysis of health problems, practices, and policy in Ireland. Drawing on empirical examples related to childhood, obesity, mental health, smoking, ageing and others, it explores how specific health issues have been constructed as problematic and in need of intervention in the Irish State. The book focuses specifically on how Jean Jacques Rousseau's critical social theory and normative political theory meet as a conception of childhood. The 'biosocial' apparatus has recently been reconfigured through a policy framework called Healthy Ireland, the purpose of which is to 'reduce health inequalities' by 'empowering people and communities'. Child fatness continues to be framed as a pervasive and urgent issue in Irish society. In a novel departure in Irish public health promotion, the Stop the Spread (STS) campaign, free measuring tapes were distributed throughout Ireland to encourage people to measure their waists. A number of key characteristics of neoliberal governmentality, including the shift towards a market-based model of health; the distribution of power across a range of agents and agencies; and the increasing individualisation of health are discussed. One of the defining features of the Irish health system is the Universal Health Insurance and the Disability Act 2005.

The policies of professionalisation in English mental hospitals from 1919 to 1959

Hospital and the Aberdeen Royal Cornhill Hospital) were in the Scottish Royal Hospitals, comparable to the English registered hospitals. The registered hospitals and nursing homes were also in competition with each other for business, and prided themselves on having higher standards of accommodation and staffing: the quality of their provision for occupation would have been part of their implicit advertising. None of the first training courses were in public mental hospitals, although they provided the overwhelming majority – over 95 per cent – of psychiatric beds in

in Work, psychiatry and society, c. 1750–2015

This chapter examines work and its uses – therapeutic, punitive and productive - in the Irish District Asylum system in the nineteenth and early twentieth centuries. Through a number of case studies, the chapter discusses the utilisation of work in a number of asylum settings, and evaluates its usage for specific patient cohorts. Labour, paid or unpaid, served several purposes within Irish institutions, and its status as well as the manner in which it was assigned changed, depending upon the individual patient. Indoor work was prized over outdoor agricultural labour, and an informal hierarchy of roles developed within the asylum, with often intense competition for especially valued occupations such as support for asylum staff. While the asylum physician frequently used a willingness to work as a test of sanity, it was also often embraced by patients themselves as a means of re-establishing a connection to their former life in the outside world, affirming their identity as a coherent, productive individual. The chapter also examines those who did not, or could not, work, and assesses the criteria applied by medical and nursing staff to determine whether any patient should be compelled to labour for their keep.

in Work, psychiatry and society, c. 1750–2015

. Deaf sport was similarly organised into various regional bodies who arranged leagues and competitions involving their member clubs. Outside the cities, such ties were more informally organised but whether formalised or ad hoc, there was a wide range of leisure activities taking place in and through the deaf clubs. the range of deaf communal leisure activities The first thing to note about deaf people’s leisure activities was that these were essentially the same as those of the hearing world. Deaf people were not spending their leisure time in ways that were markedly

in Deafness, community and culture in Britain
Abstract only

India, individual practitioners were discomfited and occasionally appalled by the necessary pursuit of money and the stratagems it demanded. Social and literal injunctions against advertising or self-promotion forced men quietly to submit to impecunious livelihoods, to go to the wall without protest, or to explore alternative methods to jostle for public attention and income. ‘Covert’ competition took a number of forms and could include private contracts between practitioners and their assistants to protect established medical practices, which only became public when

in Medical misadventure in an age of professionalisation, 1780–1890

national Road Safety Competition organised by the British Deaf Association.36 Thus even holidays could be utilised for educational purposes and the spirit of ‘rational recreation’ lived on in certain aspects of deaf leisure. By bringing deaf people together on these holidays, variety was introduced into deaf social life, as those taking part had the opportunity to meet new friends and renew existing acquaintances. This was particularly important before the introduction of technology such as the textphone, which now allows deaf people to communicate easily and quickly

in Deafness, community and culture in Britain
Children’s health and biosocial power

during the post-war period and – more Governing the future 37 specifically – how this took the form of a body of ideas that Foucault interprets as ‘state-phobia’ (2008: 116, 187). The German ordoliberals for example argued against the idea that the state should steer and manage the market in order to correct or ameliorate its negative social effects (such as unemployment and poverty). Instead, the state should be placed under the supervision of the market. In contrast to nineteenth-century laissez-faire liberalism, the ordoliberals did not perceive competition to be

in Reframing health and health policy in Ireland
Neglect, incompetence, and unintentional killing

pandered to in practice, as it forced into the open the sentiments that evolving medical ethics preferred to be hidden. At least one contemporary observer thought it created jealousy, when more probably it brought existing or latent rivalries to the fore. It set local colleagues against one another and pitched established men against interlopers, particularly the career-young.21 To some extent, tendering constituted a rude intrusion upon men otherwise intent on covert competition, although emergent professional bodies were not necessarily so coy as to deny that

in Medical misadventure in an age of professionalisation, 1780–1890