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Decentralization of Health Care: Understanding the Relationship Between Values, Social Interaction and Health Policy

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Abstract:

Existing literature on decentralized health care (DHC) policy has extensively evaluated its role in effecting rural health care. In this context it has concentrated on factors such as approved patterns of written rules and objectives, administrative delegation of authority and management and planning of tasks. I refer to such a role of DHC as administrative, technical and material one that is easily observable and measurable. My argument is that while it is undoubtedly important to study this role, such a perspective is, however, incomplete in some respects. A major omission has been role of non-material, not directly observable resources. One of the primary aims of the ethnographic study I conducted was hence, to explore the non-material role that DHC might be playing in effecting rural health care. This was thus one of the points of departure of my study. In this context I have explored the relationship between values, interaction and DC policy. Based on preliminary analyses I have argued in this paper that different kinds of values of principal actors who embody the DHC system play a very crucial role in effecting rural health care. Role of values corresponds to the non-material role. I have demonstrated that such effects of values become evident in social interaction among different actors. Additionally, I have argued that DHC also effects' values by providing a context for emergence and reinterpretations of values. In the final section I have analyzed the reciprocal significance of values and DHC for enriching the understanding of one another.
My study has both empirical as well as theoretical significance: (a) It expands the scope of the literature regarding the relationship between value paradigms and policy making by emphasizing the role of values in influencing the functioning as well as "outcomes" of a health care policy in particular (and any policy in general)and not just the enacting of it; (b) As the study brings to light the diffused, not easily observable impact of the health policy, it contributes to the broadening of criteria for assessing impacts of a health policy in particular, and any policy in general; (c) Functioning of DHC policy provides a social context for values to gain resonance. By demonstrating this, it brings home two important points: One, health and health care policies are deeply and intricately related to the context in which they are embedded. Two, health care policies provide a window to the understanding of larger societal processes and enrich their understanding of such processes (d) It speaks to Sociology's longstanding difficulty in specifying the relationship between values and behavior

Most Common Document Word Stems:

valu (138), health (88), polici (72), dhc (64), local (45), decentr (41), one (38), care (36), effect (33), role (29), system (28), context (28), understand (27), studi (26), social (24), medic (23), differ (23), kulkarni (21), vanik@ssc.upenn.edu (21), vani (21), sociolog (18),

Author's Keywords:

Decentralized Health Care, Values, Social Interaction, Health Policy
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Name: American Sociological Association
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MLA Citation:

Kulkarni, Vani. "Decentralization of Health Care: Understanding the Relationship Between Values, Social Interaction and Health Policy" Paper presented at the annual meeting of the American Sociological Association, Hilton San Francisco & Renaissance Parc 55 Hotel, San Francisco, CA,, Aug 14, 2004 <Not Available>. 2009-05-26 <http://www.allacademic.com/meta/p109938_index.html>

APA Citation:

Kulkarni, V. S. , 2004-08-14 "Decentralization of Health Care: Understanding the Relationship Between Values, Social Interaction and Health Policy" Paper presented at the annual meeting of the American Sociological Association, Hilton San Francisco & Renaissance Parc 55 Hotel, San Francisco, CA, Online <.PDF>. 2009-05-26 from http://www.allacademic.com/meta/p109938_index.html

Publication Type: Conference Paper/Unpublished Manuscript
Review Method: Peer Reviewed
Abstract: Existing literature on decentralized health care (DHC) policy has extensively evaluated its role in effecting rural health care. In this context it has concentrated on factors such as approved patterns of written rules and objectives, administrative delegation of authority and management and planning of tasks. I refer to such a role of DHC as administrative, technical and material one that is easily observable and measurable. My argument is that while it is undoubtedly important to study this role, such a perspective is, however, incomplete in some respects. A major omission has been role of non-material, not directly observable resources. One of the primary aims of the ethnographic study I conducted was hence, to explore the non-material role that DHC might be playing in effecting rural health care. This was thus one of the points of departure of my study. In this context I have explored the relationship between values, interaction and DC policy. Based on preliminary analyses I have argued in this paper that different kinds of values of principal actors who embody the DHC system play a very crucial role in effecting rural health care. Role of values corresponds to the non-material role. I have demonstrated that such effects of values become evident in social interaction among different actors. Additionally, I have argued that DHC also effects' values by providing a context for emergence and reinterpretations of values. In the final section I have analyzed the reciprocal significance of values and DHC for enriching the understanding of one another.
My study has both empirical as well as theoretical significance: (a) It expands the scope of the literature regarding the relationship between value paradigms and policy making by emphasizing the role of values in influencing the functioning as well as "outcomes" of a health care policy in particular (and any policy in general)and not just the enacting of it; (b) As the study brings to light the diffused, not easily observable impact of the health policy, it contributes to the broadening of criteria for assessing impacts of a health policy in particular, and any policy in general; (c) Functioning of DHC policy provides a social context for values to gain resonance. By demonstrating this, it brings home two important points: One, health and health care policies are deeply and intricately related to the context in which they are embedded. Two, health care policies provide a window to the understanding of larger societal processes and enrich their understanding of such processes (d) It speaks to Sociology's longstanding difficulty in specifying the relationship between values and behavior

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Document Type: .PDF
Page count: 21
Word count: 6489
Text sample:
Vani S. Kulkarni vanik@ssc.upenn.edu Decentralized Health Care: Understanding the Relationship Between Values Interaction and Health Policy Introduction What roles do values – political ethical religious and communitarian play in the functioning of a public health policy namely in the decentralization of health and health care1 (DHC)? Based on preliminary analyses of findings of my comparative ethnographic 2 study of two districts in Karnataka where the policy has been implemented this paper investigates the relationship between values interaction and policy
(1990): Basics of Qualitative Research: Grounded Theory Procedures and Techniques. London: Sage Publications. Swidler Ann (1989): “Culture in Action: Symbols and Strategies”. American Sociological Review 51: 273-289. Turner Jonathan (1987): “Toward a Sociological Theory of Motivation” American Sociological Review 52: 15-27. United States Catholic Conference (1975): “Ethical and Religious Directives for Catholic Health Facilities”. Washington DC World Bank (1993): “Investing in Health”. World Bank Development Paper. Washington DC. World Bank (2000): “Overview of Rural Decentralization in India” World Bank


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