Monday, 17 December 2012

INTERESTING PhD STUDY – DIFFERENT

From the sub-discipline of health geography
 
Rae, Jacqueline (2005) Free for all? Processes of change in health care provision in Hungary from 1987-2002, unpublished dissertation, University of Durham
 
Available at Durham E-Theses Online
 
Abstract

Recent reforms in Hungarian health care delivery officially began when the Reform Secretariat was established in 1987. Broadly speaking, the reform process aims to restructure the hospital-centred curative system into one based on primary preventative health care with greater importance placed on individual responsibility. The reform process aims to "change" the centralised socialist ideology of health care delivery to a more pluralist model with various players becoming accountable and leading to the "retreat" of the government as the central supplier. In order to understand the "changing" health care delivery system in Hungary the roles of different actors (state, local government, international organisations, health care workers and voluntary civil organisations) and their complex interactions in health care provision and reform need to be taken into consideration. This thesis develops an understanding of health care provision change in the framework of academic discourse of welfare states, governance and civil society. In so doing, this thesis shows that implementing health care reforms formulated at the national level into local care sites is by no means a straightforward translation. Indeed, health care reforms can be undermined and obstructed or shaped and influence by a variety of health care actors beyond the state. For example, this thesis reveals how notions of change are contested at the local level and how prevailing political cultures and informal social practices of for example, parasolvencia can undermine and obstruct reforms. In addition, reforms strategies can also be influenced and shaped by actors beyond the state in the form of alternative processes of change. Alternative processes of change in the context of this research mean the innovative role of voluntary civil health organisations, which are addressing legacy gaps in care, left by the former socialist system. Thus, this research is set in the context of the complex roles and interactions of different health care actors located in a variety of health care sites in Hungary. This exploration considers not only the "changing" formal health care system but also alternative mechanisms of change such as the role of civil health organisations and the power they have to influence the reform process.
 
 
The full text of the dissertation is to be found at:
 
 
Written from the perspective of health geography this study offers an interesting, introductory background to some of the the processes of social change that swept up PAI over over the years, 1987-2002 – critical years during which it became clear to outsiders that all sorts of hopes and dreams were evaporating.
 
Note that the author was not a Hungarian-speaker, nor a Hungarianologist – nor a conductivist – all of which restricted the critical attention that she could bring to bear. That said, those with serious interest in the development of CE, could do with more such contextualising investigations from those outside the CE goldfish bowl, perhaps particularly now into its 'early-modern' years from the mid-eighties onwards. This one serves as a useful question-raiser for those concerned the social-welfare context of CE in Hungary over the period, 1987-2002. The years that it covers closely corresponds with the first generation of serious attempts at the internationalisation of Conductive Education.
 
Specifically...
 
The Pető Institute was one of three civil organisations that provided case studies for this investigation (the other two were the National Association of Cancer Patients and Ashoka). As far as the PAI was concerned, this involvement appears to have offered limited data:
 
No wonder perhaps, that the successor to the founding seat of Conductive Education did not apparently sway the author's presumption that she was dealing with an institution unproblematically within health care. Her three sources on CE and the PAI were: 
  • a single website
  • interview with an unnamed conductor
  • non-participatory observations during visits to the Institute

See Appendix 9 (pp. 311-2) for what she understood from this.

More generally...

Hungary is no longer the country that it was when this dissertation was completed, in 2005, and now the age of Fidesz is upon it! As ever, therefore, readers should remember the fast changing social context, and that any validity for the data presented here must be construed in terms of history as much as geography.

The website referred to

www.petoinstitute.hu

This site is an interesting period piece in its own right. It was at times little quaint and blinkered with respect to content but as far as non Hungarians are concerned it was the most accessible of the PAI's successive websites. It served at the time as a useful window into and useful window on to what many Hungarians understood about CE at the time (and possibly in some cases still do).

This website ran from May 2001 to February 2009. It is no longer directly accessible on line but much of it has been captured by the Web Archive's Wayback Machine, on which it remains open to all:

http://wayback.archive.org/web/*/http://www.petoinstitute.org

What else is out there?

I stumbled upon this dissertation altogether by chance when looking for something quite different. I consider it worth mentioning here in order to key its existence into the study of Conductive Education. I wonder how much other relevant material exists out there is out there, awaiting chance discovery!

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