Joseph L. Scarpaci

Patterns of Development on the Metropolitan Fringe: Urban Fringe Expansion in Bangkok, Jakarta, and Santiago

Abstract This paper revisits the question of how best to characterize settlements on the metropolitan fringe of developing countries. We examine the socioeconomic composition and structure of such urban fringe settlements, using three sets of household surveys undertaken in Bangkok (Thailand), Jakarta (Indonesia), and Santiago (Chile) during June-August 1990. The findings reveal the metropolitan fringe areas to be populated mainly by middle- and lower-middle-income households formally employed in service occupations. Informal economic activity exists, but is not significant. Micro-enterprises are the exception. Most fringe residents had moved from other neighborhoods within the capital city rather than from rural settlements. Linkages to rural areas and to agriculture are largely absent; the fringe is spatially and functionally well-integrated into the metropolitan economy. The paper recommends that foreign-assistance program officers and local planners resist global “common themes” or approaches to devel...

State terror: ideology, protest and the gendering of landscapes

This case study contributes to the literature on state terror, and political violence in general, by looking at the specific ways in which regimes of terror are mapped onto urban spaces and the ways in which that ’topography’ is contested by social movements physically redefining those spaces. The article moves between dimensions of how the meanings of urban spaces are culturally and historically evoked to an analysis of the ways in which women protesters challenge and transform those meanings through action. The article shows that the use of public and private spaces by state aggressors and human rights groups has followed a consistent logic in the Southern Cone (Argentina, Chile, and Uruguay). Specifically, the occupation of these spaces reveals a pattern based on the gender of the social actors involved, and forms a process we call the gendering of landscapes. Throughout the Southern Cone private spaces are conducive for the abduction of state enemies and for anti-state conspiracy. Public spaces serve as important landmarks for detention and torture as well as protesting state terror. The dialectic or resolution of these uses of the city offer distinct interpretations about the meaning of social justice which can enhance our understanding of this region’s transition to civilian rule: ’brutality knows no ideology because its goal is the same; to silence dissent through the destruction of healthy bodies and minds’ (Eric Stover and Elena Nightingale 1985, from The breaking of bodies and minds) .

PLANNING RESIDENTIAL SEGREGATION: THE CASE OF SANTIAGO, CHILE

Residential segregation in Santiago, Chile, has intensified as a result of urban planning and slum eradication projects under military rule. This paper draws on income data from a 1977 survey and documents segregation in metropolitan Santiago. A major actor in this segregation process is a new type of military government, the bureaucratic-authoritarian regime, which has adhered to a free-market development model and has forced political quiescence during its 14-year rule. Despite its authoritarian structure, however, the regime has sanctioned neighborhood organizations (Neighborhood Boards orluntas de Vecinos) for regulating zoning and for requesting social services. This paper identifies the processes of siting public housing projects at the urban fringe and shows how the current regime is deepening the pattern and process of residential segregation through its subsidization of lowincome housing and tacit approval of citizen participation in urban planning.

Health services privatization in industrial societies

The theory and practice of health services privatization, Joseph L.Scarpaci. Part 1 Hospital services: growth of proprietary hospitals in the United States an historical perspective, James Bohl and Paul Leslie Knox privatizing the health and welfare state - the Western European experience, John Eyles restructuring the welfare state - the growth and impact of private hospitals in New Zealand, J.Ross Barnett and Pauline Barnett rolling back the state? - privatization of the health services under the Thatcher governments, John Mohan the politics of privatization - state and local politics and the restructuring of hospitals in New York City, Sara L.McLafferty. Part 2 The restructuring of mental health care in the United States, Christopher J.Smith deinstitutionalization and privatization - community-based residential care facilities in Ontario, Glenda Laws. Part 3 Environmental health services: privatization, federalism and cancer prevention in the United States - abdicating a noble goal, Michael R.Greenberg. Part 4 Developing countries - privatization in the periphery: dismantling public health services in authoritarian Chile, Joseph L.Scarpaci the role of multinational pharmaceutical firms in health care privatization in developing countries, Wilbert Gesler. Conclusions: lessons in the methodological and conceptual issues of health services privatization, Joseph L.Scarpaci.

ON THE TRANSFORMATION OF SOCIALIST CITIES

The collapse of the Socialist bloc after 1989 has been a topic of inquiry in many of the social sciences. In urban geography, however, there has been little systematic review about the changing nature of socialist cities in an era of rapid globalization. This paper outlines some of the macroeconomic contours that have conditioned national and metropolitan economies since 1989. It then reviews some of the defining features of the socialist city as a backdrop to Warsaw, selected Chinese cities, Ho Chi Minh, and Havana, which are the case studies of this special issue. [Key words: socialism, uneven development, globalization, urban morphology, public spaces.]

Restructuring health care financing in Chile

The current Chilean government adopted a neoclassical model of development and subsequently introduced various incentives for the privatization of medical care. This paper analyzes health care financing in Chile during the last decade and evaluates government efforts to minimize state-financed medical care. In so doing, this paper provides a framework for analyzing private vs public medical care delivery systems in developing countries. For this reason, the first section discusses the major attributes and issues of public and private delivery systems followed by a case study examining the origins, effectiveness and impact of the restructured health system in Chile.

Decentralizing a Centralized State: Local Government Finance in Chile Within the Latin American Context

A major issue in Latin. America is the decentralization of public finances and the autonomy of local government. This article begins with a brief review of the ongoing decentralization debate. We then discuss key features of local government finance and autonomy among unitary and federal governments in Latin America. Against that backdrop, we focus on the Chilean case, which has been a widely celebrated success story in the economic development literature. We argue that despite major gains by municipal governments over the past two decades, financial decision making powers still rest with the national government. This creates financial complacency among local governments. To remedy this, we conclude with six proposals for promoting effective decentralization.

On the validity of language : speaking, knowing and understanding in medical geography

This essay examines methodological problems concerning the conceptualization and operationalization of phenomena central to medical geography. Its main argument is that qualitative research can be strengthened if the differences between instrumental and apparent validity are better understood than the current research in medical geography suggests. Its premise is that our definitions of key terms and concepts must be reinforced throughout the design of research should our knowledge and understanding be enhanced. In doing so, the paper aims to move the methodological debate beyond the simple dichotomies of quantitative vs qualitative approaches and logical positivism vs phenomenology. Instead, the argument is couched in a postmodernist hermeneutic sense which questions the validity of one discourse of investigation over another. The paper begins by discussing methods used in conceptualizing and operationalizing variables in quantitative and qualitative research design. Examples derive from concepts central to a geography of health-care behavior and well-being. The latter half of the essay shows the uses and misuses of validity studies in selected health services research and the current debate on national health insurance.

A decade of HMOs in Chile: market behavior, consumer choice and the state☆

Abstract The military government in Chile imposed laboratory-like conditions to restructure that nations health care system into one with greater free-market competition. The vanguard of this restructuring was the private medical market where HMO-like plans known as ISAPREs (Institutos de Salud Previsional), spearheaded these efforts. This paper analyzes the evolution of this first decade of these widely celebrated HMOs in Chile. The discussion centers on the changing role of the Chilean welfare state and the treatment of medical care as a culturally defined commodity. It concludes with a critical review of the pros and cons of HMOs by considering to what extent free-market conditions actually prevail.

DRG calculation and utilization patterns: A review of method and policy

This paper examines methodological and policy issues of interest to medical geographers who use diagnosis-related groups (DRGs) in their research. Methodological issues are studied in terms of the calculation of DRGs and variation in the utilization of surgical and medical DRGs. It is argued that a shift to a single DRG price system should first address the (i) regional disparities that currently exist and the need for large-scale indices of medical wages and labor costs; (ii) severity of illness measurements other than the present nominal ones; and (iii) wide variation among medical versus surgical procedures. The Department of Commerces Economic Analysis Area is recommended to remedy the problem of geographic scale. Policy issues of interest to medical geographers center around the shift to greater hospital specialization which is likely to continue across the country. Inner-city, rural and teaching hospitals may continue to be inadequately reimbursed by DRGs, treat more medically indigent, or both. Medical geographers should be aware of the policy and methodological issues involved not only in DRGs, but in proposed prospective payment systems for ambulatory and long-term care.