So-net無料ブログ作成

大阪市の生活保護対応(TVリポート)について [Social Policy]

まずあのTVリポートを見て,まったく異質に感じたのは,福祉事務所の職員をケースワーカーとして取り上げていたことです.公的扶助ケースワークは仲村優一さんが間違って紹介した言葉で,アメリカでもイギリスでも,ついぞ聞いたことのない用語です.

そもそも働ける男性は,アメリカでもイギリスでも1970年代まで,公的扶助の対象とはされてこなかったのです.アメリカではAid to Families with Dependent Children=AFDCという働くより育児に専念することを公認されていた母子家庭に対する公的扶助が中心でしたが,そこに失業男性が組み入れられたのは,やっと1970年代のAFDC-UPからです.

イギリスでも,Workhouse Principle と Less eligibility は福祉国家成立後も1970年代のFamily Allowance → Child Benefits まで存続したのです.
Beveridge Report は,同一労働,同一賃金の国々で,子供が増えれば,男性は賃金で生活するより公的扶助を受けた方が生活が楽になるwork incentive 問題について大いに苦慮し,公的扶助は子供の数とは中立であり得るように苦心してReport に含めたのがUniversal なFamily Allownce だったのです.
しかしUniversal Family Allowance の引き上げがなかなか困難だったので,実態としてPoor Law の2原則はChild Benefits への拡充まで存続されたのです.

景気後退が,stop & go 政策故にサイクルとして繰り返されましたから,まず働ける男性はTax credits (公的扶助の現在形)を受ける窓口と,就労活動をする窓口が一本化されたのです.

先日のTV番組で,ケースワーカーなる福祉事務所員が,就労指導としてハローワークに同行するというとんでもないおかしなことをやっていましたが,そんな無駄なケースワーカーは減員して,私が前のブログに書いたように,生活保護を唯一の最後のより所とする法体系を速やかに改善し,働ける男性の公的扶助と就労指導はハローワークに移管すべきです.

ケースワーカーもあのTV放送ではずいぶん無駄なことをやっていましたから,福祉事務所の生活保護業務は,国の社会保険事務所の後継者と税務署,ハローワークなどに分割移管すべきです.
ここで詳論はしませんが,Negative Income Tax ないしTax Credit が論理的にはベストな選択だというのが最近のヨーロッパ方式ですから,税務署への移管も真剣な検討に値すると考えます.

とにかく生活保護が最後のより所というごちゃ混ぜは,無駄な薬を貰って1万円で売るなどという事態を生み,どう考えても,Poverty Businessの絡む矛盾したやり方ですから,そこから大きく制度を組み替えることを切に探求すべきです.
世界に例を見ないやり方で,医療保険から介護保険を分離し,さらに後期高齢者医療をも分離した厚生労働省が,生活保護は,何故,年齢別にも分離,分割しないのでしょう.

国民健康保険に保険料を払わない人は,厳しく差別する厚生労働省が,今のままでいくと,国民年金保険料を払わない人が4割にも達するなかで,ほどなくその人達が高齢化,年金受給対象年齢に達した時,無条件で生活保護を給付する以外の選択肢はあり得るのでしょうか?その場合,生活保護給付は国民年金の満額給付額を上回るでしょうが,それで社会保障制度の基礎となるべき社会的公正は保たれるのでしょうか?
かけ声として叫ばれている年金制度一元化は,国民年金保険料支払者が60%を下回る中で,共済年金や厚生年金の加入者,受給者が,おいそれと承諾するとは到底思われませんが...

年金も医療も制度を細分化して,矛盾を積み重ねてきた厚生労働省は,その細分化の矛盾の大きさ故に,生活保護制度は全く分割しないで何でも受け入れられるごちゃ混ぜのまさに厚生労働省にとって最後のより所として,維持せざるを得なかったのでしょうが,最早,それも行き詰まってきたと自覚すべきでしょう.


nice!(1)  コメント(0)  トラックバック(0) 
共通テーマ:学問

U.S. 貧困率は6人に1人,2010年センサスで [Social Policy]

アメリカの国勢調査Censusは10年に1回なのですが,昨年2010年の結果で,近年のアメリカの経済不況(日本も同様ですが)の結果として,アメリカが国勢調査を取り始めて以来,最高水準の貧困率が記録されたようです.The poverty line in 2010 was at $22,113 for a family of four.

6人に1人,すなわち15.1%,全体に置き換えると, 46.2 million people in poverty in the United Statesというのですから,Obama の人気凋落も,もっともな話です.

さらに,in new evidence of economic distress among the middle class, real median household incomes declined by 2.3 percent in 2010 from the previous year, to $49,400.
the median annual income for a male full-time, year-round worker in 2010 — $47,715 — was virtually unchanged from its level in 1973, when the level was $49,065, in 2010 dollars  
というのですから,Obamaへの風当たりは厳しさを増しています.    

Obamaは,堪まりかねて,火曜日に,つい最近連邦政府を財政破綻から救うための$1.2 trillion のSpending cut を公約したばかりだったのに,俄に$447billion jobs planを発表して,大きな雇用創出を図るとぶち上げました.

しかし,その財源は高所得者への増税で賄うといっていますが,下院を共和党に牛耳られて,ねじれた中で,大いにその実現性が危ぶまれています.

最近,欧米では,「日本化してしまうのではないか?」という懸念をよく見かけますが,日本はことほど左様に成長から取り残されながら,なお赤字財政を積み重ねている経済的に行き詰まった国として,そうなってはならない実例にあげられていることを銘記すべきです.

U.S. Poverty Rate, 1 in 6, at Highest Level in Years

WASHINGTON — The portion of Americans living in poverty last year rose to the highest level since 1993, the Census Bureau reported Tuesday, fresh evidence that the sluggish economic recovery has done nothing for the country’s poorest citizens.        

And in new evidence of economic distress among the middle class, real median household incomes declined by 2.3 percent in 2010 from the previous year, to $49,400.

An additional 2.6 million people slipped below the poverty line in 2010, census officials said, making 46.2 million people in poverty in the United States, the highest number in the 52 years the Census Bureau has been tracking it, said Trudi Renwick, chief of the Poverty Statistic Branch at the Census Bureau. That represented 15.1 percent of the country.

The poverty line in 2010 was at $22,113 for a family of four.

“The figures we are releasing today are important,” said Robert Groves, the director of the Census Bureau. “They tell us how changing economic conditions have impacted Americans and their families.”

According to the Census figures, the median annual income for a male full-time, year-round worker in 2010 — $47,715 — was virtually unchanged from its level in 1973, when the level was $49,065, in 2010 dollars.

“That’s not about the poor and unemployed, that’s full time, year round,” said Sheldon Danziger, professor of public policy at the University of Michigan. Particularly hard hit, Professor Danziger said, have been those who do not have college degrees. “The median, full-time male worker has made no progress on average.”

The youngest members of households — those ages 15 to 24 — lost out the most, with their median income dropping by 9 percent. The recession continued to push Americans to double up in households with friends and relatives, especially those aged 25 to 34, a group that experienced a 25 percent rise in the period between 2007, when the recession began and 2011. Of that group, 45.3 percent were living below the poverty line, when their parents incomes were not taken into account.

This article has been revised to reflect the following correction:

Correction: September 13, 2011

An earlier version of this article gave an incorrect figure for the number of people the Census Bureau found to be in poverty in the Unites States. The number is 46.2 million people, not 56.2 million.


nice!(0)  コメント(0)  トラックバック(0) 
共通テーマ:学問

UKの予算削減(1/3)を含むthe Health and Social Care Bill の危機 [Social Policy]

前のブログで書いた the Health and Social Care Bill が俄に雲行きが怪しくなりました.

日本が二大政党制のモデルにしてきたイギリスの議会制が,今,連立政権という平時には珍しい姿をとっているのですが,その連立政党の小さい方(the Liberal Democrat)の上院議員が,政府は20前後の国営病院を民営化するつもりだという秘密文書をすっぱ抜いたのです.

よくやるもんだと思いますが,上院議員ですから,議席を失う心配は微塵もないのでしょう.連立政権の一方から批判の矢が放たれたというこどで,俄に成立が危うくなったようです.

本文は,ご自由なご渉猟に委ねます.

Shirley Williams plunges NHS reforms into fresh turmoil

Liberal Democrat peer in new battle over health and social care bill, while secret emails fuel privatisation fears for hospitals

Baroness Williams has raised fresh doubts over the health and social care bill following the publication of secret emails. Photograph: Murdo MacLeod

The future of the government's health reforms has been plunged into fresh doubt as the Liberal Democrat peer Shirley Williams raises new concerns, and secret emails reveal plans to hand over the running of up to 20 hospitals to overseas companies. The revelations come as MPs prepare to return to Westminster on Tuesday for what promises to be a crucial stage of the flagship health and social care bill.

Baroness Williams, one of the original leaders of a Lib Dem rebellion against health secretary Andrew Lansley's plans – who appeared to have been pacified after changes were made over the summer – said she had new doubts, having re-examined the proposals. "Despite the great efforts made by Nick Clegg and Paul Burstow [the Lib Dem health minister], I still have huge concerns about the bill. The battle is far from over," she said.

Writing in Sunday's Observer, Williams raises a series of issues that she says must be addressed. Chief among them is a legal doubt as to whether the secretary of state will any longer be bound to deliver "a comprehensive health service for the people of England, free at the point of need".

Some critics of Lansley believe the Tories are bent on a mission to privatise the NHS, gradually handing it to the private sector. They fear that moves to end the legal obligation on the secretary of state to deliver comprehensive services may be a deliberate part of the process.

Concerns that ministers want more private involvement will be strengthened by details of email exchanges involving senior health officials about handing the management of 10 to 20 NHS hospitals to international private companies. The emails, which were made public following a freedom of information request and were obtained by non-profit-making investigations company Spinwatch, show that officials have been planning since late last year to bring in international companies. This is despite repeated insistences by both David Cameron and Nick Clegg that there will be no privatisation of the NHS. On 16 May, Cameron said: "Let me make clear: there will be no privatisation." Clegg said: "Yes to reform of the NHS, but no to the privatisation of the NHS."

One of the emails released by the department shows that officials at the private sector firm McKinsey, which advises ministers, were in active discussion about bringing in overseas firms to take over up to 20 hospitals in return for contracts running into hundreds of millions of pounds. An email to Ian Dalton, head of provider development at the Department of Health, who is heavily involved in the reform programme, in November last year talks about "interest in new solution for 10-20 hospitals but starting from a mindset of one at a time with various political constraints".

The emails show that McKinsey is acting as a broker between the department and "international players" that are bidding to run the NHS. The documents even lay out some of the conditions required by "international hospital provider groups" for running NHS hospitals. "International players can do an initiative if 500 million revenue [is] on the table." They also need to have "a free hand on staff management". The NHS would be allowed to "keep real estate and pensions".

The Department of Health attempted to play down the significance of the emails, saying they were referring to what might be done if any one hospital trust asked for the private sector to become involved in running a failing hospital. A spokesman said: "It is not unusual for the Department of Health to hold meetings with external organisations. Any decisions to involve organisations, such as the independent sector or foundation trusts, in running the management of NHS hospitals would be led by the NHS locally and in all cases NHS staff and assets would remain wholly owned by the NHS."

But a spokesman for the public service union Unison said: "Regardless of what Cameron and Clegg say in public, it is clear that behind the scenes the government is planning to privatise the NHS. Private companies will only run hospitals if they see a profit in it. This, together with lifting the cap off the number of private patients NHS hospitals can treat, will completely change the culture of the NHS. It will be profits before patients.

"We demand that the government come clean on their plans. If this is true, patient choice is a complete sham. The move to any qualified provider is clearly about creating a market for private companies. Any MP who votes for the health and social care bill is voting for the end of the NHS."

Williams also raises worries about the extent to which the role of the private sector is being expanded. "I am not against a private element in the NHS, which may bring innovatory ideas and good practice, provided it is within the framework of a public service …" she writes. "But why have they tried to get away from the NHS as a public service, among the most efficient, least expensive and fairest anywhere in the world? Why have they been bewitched by a flawed US system that is unable to provide a universal service and is very expensive indeed?"

She adds: "The remarkable vision of the 1945 Attlee government, of a public service free at the point of need for all the people of England, should not be allowed to die."

John Healey, Labour's shadow health secretary, said: "As David Cameron's government railroads the health bill through parliament, MPs are being denied their constitutional role to properly scrutinise his plans for the NHS. The prime minister has already done a political fix with Nick Clegg on the health bill, and now he's trying to force it through with a procedural fix."


nice!(0)  コメント(0)  トラックバック(0) 
共通テーマ:学問

UKの予算削減(1/3)を含むthe Health and Social Care Bill [Social Policy]

今年の1月にイギリスの議会に提案された  the Health and Social Care Bill が,審議過程でいくつかの改正を織り込みながら,ほぼ夏休み前に下院の審議を終え,近く採決されそうな状況にあります.

前提として説明しておきますと,イギリスはドイツを例外とした欧州方式のNational Health Service (NHS)で,一貫して,社会医療保険制度はとっておらず,日本でいう『介護』も Long term care≒social care として,前者は国,後者は地方自治体の責任となっています.介護福祉士,社会福祉士国家試験制度が日本にユニークな愚策であることは,このブログで何度か繰り返してきたとおりです.

新規予算なしというより予算削減を目的に法改正するのですから,大変なことですが,強引に大きく包括的にまとめていいますと,
1.規制緩和による現場医療スタッフのInnovation に期待する.
(Administrative costの削減にもなる)
2.増加させてきた病院ベッドを削減し,social care in the community に期待する,
という2つの大きな柱にまとめられると思います.

以下に,原文のまま,the Health and Social Care Bill の趣旨説明を挙げておきます.昨年,法案に先駆けて白書,White Paper で問題点を整理して改革提案し,その反響を受けて法案化されたものです.

ごく最近,イギリスのいわば医師会長に相当する人が,「われわれに与えられた選択肢は,お金持ちの外国人の入院治療を引き受けて,自由になるお金を増やせばいいのか」という発言がニュースになっていました.日本でも聞いたことのある話ですね...

以下,原文抜粋を,御自由にご渉猟下さい.

125. The changes proposed in the Health and Social Care Bill, and in the White Paper in general, will:
•significantly increase transparency about the functions and objectives of all parts of the NHS;
•strengthen accountability to patients, the public and Parliament about the performance of the NHS and the quality of services;
•improve the feedback mechanisms, freedoms and incentives that enable patients, commissioners and providers to make better use of information to improve the quality and efficiency of services: for example, by exercising choice, or commissioning or providing services differently.
126. First, the reforms will improve transparency about functions and objectives. For example:
•The new NHS Outcomes Framework will set out the outcomes for which the NHS Commissioning Board will be held to account. In turn, the Board will develop a Commissioning Outcomes Framework to hold GP consortia to account for their contribution to improving outcomes.
•The Secretary of State will be required to publish a mandate, based on public consultation, setting objectives for the NHS Commissioning Board.
•The NHS Commissioning Board must produce and publish a business plan, specifying how it intends to achieve its objectives.
•At local level, health and wellbeing boards will be obliged to publish a joint strategic needs assessment and a joint health and wellbeing strategy, which local authority and NHS commissioners will be required to have regard to.
127. Second, accountability for performance will be significantly strengthened:
•The proposed information revolution aims to bring about improvements to information about health and care and how it is made available, backed by an enhanced role for the Health and Social Care Information Centre.
•The NHS Commissioning Board will be required to produce an annual report summarising its assessment of how it has performed its functions. This report is given to the Secretary of State, who must then lay it before Parliament.
•Each GP consortium must publish an annual report about how it has discharged its functions, including how it has improved the quality of its services over the year in question.
•The revised regulatory regime for providers, which includes the removal of some of the restrictions on providers as set out in Annex B, will be reviewed by the Competition Commission every 7 years, with the first review by 2019.
Coordinating document – page 34
•Directors of Public Health must produce an annual report, published by the local authority, about the health of the local population.
•The Secretary of State must report annually on the overall performance of the health service, both public health and NHS.
•HealthWatch England must produce and publish an annual report, including its views on standards of provision of health and social care.
128. Third, there will be more effective feedback mechanisms, incentives and freedom for the system to respond and improve. For example:
•The extension of choice policy will make it easier for patients (and clinicians) to opt for high-quality services. Coupled with the development of tariff pricing, so that money increasingly follows the patients, providers will need to respond to patient preferences or risk those patients going elsewhere.
•There will be greater freedoms for NHS providers to respond to the wishes of patients and develop their organisations and services. High quality providers will be able to attract greater numbers of patients and expand, and there will be greater scope for innovative new providers to compete on a fair playing field.
•A consistent regulatory regime will ensure that low-quality providers have clear incentives to improve their performance. Failing that, there are measures in place to deal with poor performance while safeguarding essential NHS services.
•Local HealthWatch will ensure that the views of patients, carers and the public are represented to commissioners, while the local authority scrutiny role will be extended to cover all publicly funded healthcare.
•The reduction in Secretary of State powers and duties will mean that there is significantly reduced potential for political interference within the system.
•The economic regulator will help to ensure that prices of NHS services are set to reflect true cost, and that there is no anti-competitive behaviour.
129. Therefore, rather than a series of static changes that can be reviewed in isolation, the Bill and White Paper describe a set of mutually-reinforcing reforms that will create a more dynamic, responsive and self-improving NHS.
130. Until the new system is fully functional, it is important to ensure that there is the scope for policy refinement. Therefore, as outlined in section F of chapter 7 of Liberating the NHS: Legislative framework and next steps, there will be a phased transition programme over four years, which allows freedom for enthusiasts to make progress early, and gives time to plan, test and learn.
131. At the heart of the transition is a pathfinder programme for emerging GP consortia. These early adopters will be modelling the new system and exploring key issues to inform wider national rollout. The NHS Commissioning Board and the Department will be pulling together analysis of the lessons learnt for
Coordinating document – page 35
publication. Similarly, there will be early implementers to explore the development of health and wellbeing boards in local authorities.
132. Alongside this, on the provider side it is important to make progress to ensure that providers are clinically and financially viable. Learning the lessons of other sectors is also very important – based on the experience within other sectors, full reform of the provider side and the introduction of greater competition will take time to embed. Following consultation, the Government has therefore allowed for a longer and more structured transition period for completing the reforms to providers.
133. In conclusion, because of the dynamic nature of the reforms and the phased approach to implementation, the Government does not believe that an overarching formal evaluation would be appropriate or necessary in this instance. However, in some cases there are particular risks and uncertainties that point towards a greater need for evaluation. For example, there are a number of implementation challenges and risks around moving commissioning responsibilities to GP consortia. Therefore, alongside the increased transparency within the system that will illustrate how well the reforms are meeting their objectives, greater accountability to make clear how well different organisations are performing, and the pathfinder programme to help refine policy direction as the reforms are introduced, there will be a specific evaluation project to examine this in more detail.


nice!(0)  コメント(0)  トラックバック(0) 
共通テーマ:学問