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As a relatively new profession, the North American Muslim chaplaincy (NAMC) has seen significant growth since the mid 1970s the hiring of the first paid Muslim chaplains in the United States approximately twenty-five years ago. There are three observable waves of chaplains to consider as the NAMC has developed: the first wave with the hiring of the first paid prison chaplain; the second with the founding of the Islamic Chaplaincy Program at the Hartford Seminary; and the third which began shortly thereafter as chaplains develop an Islamic approach to pastoral care, create networks, and cultivate a public persona. The Muslim women and men who serve as chaplains in secular North American institutions such as prisons, the military, educational institutions, hospitals, and community centers, among others, have made it their goal to serve Muslims and non-Muslims in these North American institutions. From humble beginnings, this profession grew out of the desire to provide needed services and care to Muslims in these institutions and has evolved into a uniquely North American profession suited to the needs of all religious communities served by these institutions. North American Muslim chaplains represent an Islamic American voice, one that speaks to American cultural and legal norms. To varying degrees, these chaplains have challenged and embraced North American traditions, such as pluralism, interfaith relations, freedom of religion, and non-establishment. In addition, as they move into the third decade of the profession, chaplains have been moving into leadership roles within American communities. These roles have created an alternate form related to, but significantly different from, the role of the imam. This provides a space for a distinctly North American engagement with the Islamic tradition. It has also opened new spaces for women’s leadership within the North American Muslim community, adjusting and reaffirming traditional practice. These chaplains perform their profession, and their “ministry of presence,” in ways closely connected to institutional, regional, and personal contexts. Because of this multitude of sites, identifying points of connection, when desired, can be difficult. As such, there is no monolithic approach to the chaplaincy or how chaplains envision their Muslim identities. This diversity, which extends to a diversity in gender, race, ethnicity, and branch of Islam, is not without its challenges.

Falls in hospital and residential care settings are common events that can have major impacts for the older person, their families, and staff and also at an organizational level. They are a major trigger event for those with chronic health problems to advance to greater levels of care because they often result in traumatic injuries while they provide a signal event for declining health that may have gone unobserved before injury. Falls among older people in hospital and residential care settings are often caused by a complex mix of risk factors and have proved difficult to prevent. There is growing research evidence that a mix of universal falls prevention interventions that are applied to all patients or residents, as well as targeted interventions addressing one or more identified personal and environmental falls risk factors (often based on a falls risk factor assessment and environmental assessment) can help to reduce risk of future falls in hospitals and residential care. Preventing falls among older people in hospitals and residential care settings requires a complete staff and organizational focus.

The concept of soft budget constraint, describes a situation where a decision maker finds it impossible to keep an agent to a fixed budget. In healthcare it may refer to a (nonprofit) hospital that overspends, or to a lower government level that does not balance its accounts. The existence of a soft budget constraint may represent an optimal policy from the regulator point of view only in specific settings. In general, its presence may allow for strategic behavior that changes considerably its nature and its desirability. In this article, soft budget constraint will be analyzed along two lines: from a market perspective and from a fiscal federalism perspective. The creation of an internal market for healthcare has made hospitals with different objectives and constraints compete together. The literature does not agree on the effects of competition on healthcare or on which type of organizations should compete. Public hospitals are often seen as less efficient providers, but they are also intrinsically motivated and/or altruistic. Competition for quality in a market where costs are sunk and competitors have asymmetric objectives may produce regulatory failures; for this reason, it might be optimal to implement soft budget constraint rules to public hospitals even at the risk of perverse effects. Several authors have attempted to estimate the presence of soft budget constraint, showing that they derive from different strategic behaviors and lead to quite different outcomes. The reforms that have reshaped public healthcare systems across Europe have often been accompanied by a process of devolution; in some countries it has often been accompanied by widespread soft budget constraint policies. Medicaid expenditure in the United States is becoming a serious concern for the Federal Government and the evidence from other states is not reassuring. Several explanations have been proposed: (a) local governments may use spillovers to induce neighbors to pay for their local public goods; (b) size matters: if the local authority is sufficiently big, the center will bail it out; equalization grants and fiscal competition may be responsible for the rise of soft budget constraint policies. Soft budget policies may also derive from strategic agreements among lower tiers, or as a consequence of fiscal imbalances. In this context the optimal use of soft budget constraint as a policy instrument may not be desirable.

Quality competition between alternative providers is an increasingly important topic in the health economics literature. This literature includes theoretical and empirical studies that have been developed in parallel to 21st-century policies to increase competition between doctors or hospitals. Theoretical studies have clarified how competitive markets can give healthcare providers the incentive to improve quality. Broadly speaking, if providers have an incentive to attract more patients and patients value quality, providers will raise quality until the costs of raising quality are equal to the additional revenue from patients attracted by the rise in quality. The theoretical literature has also investigated how institutional and policy parameters determine quality levels in equilibrium. Important parameters in models of quality competition include the degree of horizontal differentiation, the level of information about provider quality, the costs of switching between providers, and the time-horizon of quality investment decisions. Empirical studies have focused on the prerequisites of quality competition (e.g., do patients choose higher quality providers?) and the impact of pro-competition policies on quality levels. The most influential studies have used modern econometric approaches, including difference-in differences and instrumental variables, to identify plausibly causal effects. The evidence suggests that in most contexts, quality is a determinant of patient choice of provider, especially after greater patient choice is made available or information is published about provider quality. The evidence that increases in competition improve quality in healthcare is less clear cut. Perhaps reflecting the economic theory of quality competition, showing that different parameter combinations or assumptions can produce different outcomes, empirical results are also mixed. While a series of high-quality studies in the United Kingdom appear to show strong improvements in quality in more competitive areas following pro-competition reforms introducing more choice and competition, other studies showed that these quality improvements do not extend to all types of healthcare or alternative measures of quality. The most promising areas for future research include investigating the “black box” of quality improvement under competition, and behavioral studies investigating financial and nonfinancial motivations for quality improvements in competitive markets.

Interest in health care resilience began in the mid-1940s, but it took approximately two decades for researchers to realize its importance. By the early 2000s, the body of knowledge reached a level of maturity, with details of international case studies about the performance of health facilities and systems in responding to multiple hazards and also guidance and regulations to secure the minimum level of resilience of health systems. However, the failure of health systems to respond effectively to COVID-19 indicates that preparedness was not adequate and that there is a gap between this body of knowledge and practice. This gap is driven by many factors but mostly the Lost in Translation (LiT) Effect. The LiT Effect occurs when the application of guidelines is done in a mechanical, “paper filing” manner, without understanding their goal and the knowledge behind them. There are many contributors to the LiT Effect, including appropriate knowledge of disaster resilience, an individual’s workload and motivation and capability to acquire new knowledge, let alone the difference between agendas and organizational priorities. Some of these have been investigated and concluded that more work is needed to translate strategic evidence at operational levels. This will enhance the further learning of professionals and enable them to develop adequate plans. The way disaster resilience is approached is one of the key issues of health care vulnerability. Health systems struggle with the large number of day-to-day challenges. Disaster resilience is low on decision-makers’ lists of priorities, specifically when risks are moderate or low, because it is viewed as a burden instead of an obligation, a moral and a legal requirement. The analogy of the human body, specifically the immune system, can help us understand how health care facilities’ internal systems operate. Immunity is integrated throughout the body; it detects and manages most external hazards such as bacteria and viruses without affecting daily activities. The immunity of the human body is comparable to the resilience of health care facilities and health systems and perhaps should operate in a similar way. Resilience needs to be embedded in the daily operations of health systems and facilities. The Jigsaw Concept is a simplified approach to enhance understanding of the complexity of health care facilities and systems without overlooking details. It applies structured thinking to reduce the LiT Effect by identifying the components of health care facilities and systems, their interconnectivity and interdependency, and predicting and mitigating the impact of the failure of each of these on the overall functionality in a continuous and integrated way. This functionality depends on six internal interconnected components, namely building integrity, lifeline systems, equipment, supplies, workforce, and management and governance to regulate the way all these operate. Externally, it depends on interdependent components such as suppliers and infrastructure (e.g., transportation, power, water, internet, and gas networks). Failure of one of these could cause direct or indirect failure of the continuity of health care service. Each of these components plays a unique role in the system, similar to pieces of a jigsaw puzzle that must be assembled in a specific way to provide a clear picture and clarity is affected when one piece is missing. Advanced and smart technologies might play a role in dealing with this compounded complexity; however, many questions must be answered before this technology is applied, including questions regarding ethics and ownership of used and generated data.

The spatial dimension of supply and demand factors is a very important feature of healthcare systems. Differences in health and behavior across individuals are due not only to personal characteristics but also to external forces, such as contextual factors, social interaction processes, and global health shocks. These factors are responsible for various forms of spatial patterns and correlation often observed in the data, which are desirable to include in health econometrics models. This article describes a set of exploratory techniques and econometric methods to visualize, summarize, test, and model spatial patterns of health economics phenomena, showing their scientific and policy power when addressing health economics issues characterized by a strong spatial dimension. Exploring and modeling the spatial dimension of the two-sided healthcare provision may help reduce inequalities in access to healthcare services and support policymakers in the design of financially sustainable healthcare systems.

Payment systems based on fixed prices have become the dominant model to finance hospitals across OECD countries. In the early 1980s, Medicare in the United States introduced the diagnosis-related group (DRG) system. The idea was that hospitals should be paid a fixed price for treating a patient within a given diagnosis or treatment. The system then spread to other European countries (e.g., France, Germany, Italy, Norway, Spain, the United Kingdom) and high-income countries (e.g., Canada, Australia). The change in payment system was motivated by concerns over rapid health expenditure growth and replaced financing arrangements based on reimbursing costs (e.g., in the United States) or fixed annual budgets (e.g., in the United Kingdom). A more recent policy development is the introduction of pay-for-performance (P4P) schemes, which, in most cases, pay directly for higher quality. This is also a form of regulated price payment but the unit of payment is a (process or outcome) measure of quality, as opposed to activity, that is admitting a patient with a given diagnosis or a treatment. Fixed price payment systems, either of the DRG type or the P4P type, affect hospital incentives to provide quality, contain costs, and treat the right patients (allocative efficiency). Quality and efficiency are ubiquitous policy goals across a range of countries. Fixed price regulation induces providers to contain costs and, under certain conditions (e.g., excess demand), offer some incentives to sustain quality. But payment systems in the health sector are complex. Since its inception, DRG systems have been continuously refined. From their initial (around) 500 tariffs, many DRG codes have been split in two or more finer ones to reflect heterogeneity in costs within each subgroup. In turn, this may give incentives to provide excessive intensive treatments or to code patients in more remunerative tariffs, a practice known as upcoding. Fixed prices also make it financially unprofitable to treat high cost patients. This is particularly problematic when patients with the highest costs have the largest benefits from treatment. Hospitals also differ systematically in costs and other dimensions, and some of these external differences are beyond their control (e.g., higher cost of living, land, or capital). Price regulation can be put in place to address such differences. The development of information technology has allowed constructing a plethora of quality indicators, mostly process measures of quality and in some cases health outcomes. These have been used both for public reporting, to help patients choose providers, but also for incentive schemes that directly pay for quality. P4P schemes are attractive but raise new issues, such as they might divert provider attention and unincentivized dimensions of quality might suffer as a result.

The transformation of post-industrial American life in the late 20th and early 21st centuries includes several economically robust metropolitan centers that stand as new models of urban and economic life, featuring well-educated populations that engage in professional practices in education, medical care, design and legal services, and artistic and cultural production. By the early 21st century, these cities dominated the nation’s consciousness economically and culturally, standing in for the most dynamic and progressive sectors of the economy, driven by collections of technical and creative spark. The origins of these academic and knowledge centers are rooted in the political economy, including investments shaped by federal policy and philanthropic ambition. Education and health care communities were and remain frequently economically robust but also rife with racial, economic, and social inequality, and riddled with resulting political tensions over development. These information communities fundamentally incubated and directed the proceeds of the new economy, but also constrained who accessed this new mode of wealth in the knowledge economy.

In Guatemala, experiences, meanings, and impacts of disability differed depending on one’s race, ethnicity, gender, social class, education, and location, among other factors. They also changed over time. Pre-Hispanic Mayan art indicates physical disability did not exclude people from the elite. In the colonial period (1521–1821), an important charity hospital system emerged. Some Guatemalans who might be identified as disabled today lived with widows and orphans in charity hospices and asylums. Disabled Guatemalans underwent cutting-edge treatments, for better or worse, owing to avid medical research by the protomedicato and faculty at the University of San Carlos. After independence in the early 19th century, Catholic charity endured and worked in tandem with state-building projects, even as disputes between the Conservative and Liberal parties churned. Guatemala’s growing hospital system relied upon this cooperation. The new century brought explosive growth in infrastructure and an expanded role of the state in everyday life. Reforms in policing, public health, and education transformed the lives of some disabled Guatemalans, often expanding confinement and surveillance alongside medical resources. The period of democratic florescence, known as the “Ten Years Spring” (1944–1954), brought reforms, including the creation of the Guatemalan Social Security Institute (IGSS) in 1946 and work-injury, illness, and maternity-benefits laws. Between 1946 and 1948, the Guatemalan and US governments conducted syphilis experiments on disabled residents of the Insane Asylum (Asilo de Alienados), as well as on soldiers, incarcerated people, orphans, and commercial sex workers. By the mid-20th century, decades—or even centuries—of inequality debilitated poor Guatemalans. Chronic illness, workplace injury, malnutrition, and other endemic conditions created temporary and permanent disabilities. Civil war (1960–1996) erupted and revolutionary groups argued that they fought to end the inequality that caused debilitating conditions. The war itself created new disabled people. Combat, torture, and trauma transformed Guatemalans. Yet the Historical Clarification Commission report neglected this topic and the experiences of disabled people in the war. Unlike their peers in El Salvador, Guatemalan veterans did not form influential advocacy organizations after the war. Since the 1990s, disability has been a serious cause and effect of widespread migration to the United States. Migrants have fled Guatemala because of inadequate access to disability-related healthcare and education. Some people have been disabled by dangerous conditions en route to the United States.

George Brager (1922–2003) was a social work educator, administrator, and social activist who worked primarily in New York City. He developed innovative community programs which had national impact and was a founding director of Mobilization for Youth.

Dorothea Lynde Dix (1802–1887) was a writer and pioneer in the mental health movement. She lobbied national and internationally on behalf of the deaf and insane and was responsible for the establishment of 32 public and private mental health institutions.

Gordon Hamilton (1892–1967) was a practitioner, an educator, a consultant, and writer whose works, including Theory and Practice of Social Casework, profoundly influenced the development of casework theory. She was editor in chief of Social Work from 1956 until 1962.

Mary Cromwell Jarrett (1876–1961) delineated the specialty of psychiatric social work in mental hospitals and worked to alleviate problems associated with chronic illness while at the Welfare Council of New York City. She also founded the Psychiatric Social Workers' Club.

Elizabeth Ann Bayley Seton (Mother Seton) (1774–1821) founded the religious order of the Sisters of Charity, which operated the first Catholic orphanage. She established free schools for poor children in Philadelphia, forming the core of the parochial school system.

Fusa Asaga (1894–1986) was a hospital social work pioneer in Japan. After finishing an MSW program in the United States, she returned to Japan and worked as a social worker in a hospital in Tokyo city. After World War II, she served as an officer of the Japanese government to develop a new child welfare system. She then took a teaching job as a social work professor. She also had been engaged in a variety of social action such as Japanese women’s suffrage and opposition to nuclear testing throughout her life.

Margaret Daniel (1908–1997) provided outstanding leadership and left an indelible mark on the social work profession in both social work education and practice through her work at the Veterans’ Administration (VA) and through her contributions at the National Institute of Mental Health (NIMH), leading to high standards in social work education.

Richard Clarke Cabot (1865–1939) was a physician and educator from Massachusetts, who initiated the first social work department at a US medical school. He instituted home visits to gain information about patients and make medicine more efficient through social work.

Ida Maud Cannon (1877–1960) was director of the Social Service Department at Massachusetts General Hospital, where she defined and developed medical social work. She moved medical social work into the community and provided social workers with specialized medical knowledge.