Int J Health Serv
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Britain's National Health Service (NHS) has been the subject of unprecedented market reforms, which have failed to solve its problems. The New Labour government elected in 1997 has halted the drive toward the marketization of health care and replaced cost with quality as the central concern of NHS administration and policy. Major changes are occurring in the regulation of professional activity, with profound implications for the medical profession and the health service. The authors discuss these changes and possible future problems for the NHS.
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Randomized Controlled Trial Comparative Study Clinical Trial
Home or hospital? An evaluation of the costs, preferences, and outcomes of domiciliary chemotherapy.
This study compares the costs and outcomes of domiciliary and hospital-based chemotherapy, using a prospective randomized cross-over design. Eighty-seven eligible patients were recruited from oncology services at two metropolitan hospitals in Sydney, Australia. Forty patients completed study evaluation requirements, having two months of chemotherapy in each location (home and hospital). ⋯ Patient needs were well met in either location, and no differences were found in quality of life. At current throughput rates, providing chemotherapy in the home was more expensive than providing it in hospital. However, if the demand for chemotherapy were to exceed ward capacity by up to 50 percent, moving chemotherapy into the home could provide a less costly strategy for the expansion of a chemotherapy service without compromising patient outcomes.
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This study looks at the health consequences of the social distress caused by perceived levels of job insecurity. Through interviews with full- and part-time employees drawn from a random sample (N = 2,024) of the Swiss general population, the authors measured prevalence rates of ten self-reported indicators of health and health-related behavior according to three levels of perceived job insecurity (low, middle, high), and estimated odds ratios using logistic regression adjusted for relevant respondent characteristics. ⋯ Fear of unemployment had a stronger unfavorable effect on health for highly educated employees than for the less educated. The authors make some recommendations for raising awareness about the health effects of job insecurity and taking these effects into account in policies and legislation affecting the labor market and work environment.
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In Australia, as in Canada and to a lesser extent the United States, the vocational rehabilitation of injured workers is an integral part of workers' compensation arrangements. An essential feature of the return-to-work process is the provision of suitable employment by employers for workers able to resume work following a work-related injury. ⋯ The author examines the major approaches adopted by the various Australian jurisdictions, critically reviews the issue of compliance with employment security legislation, and suggests a number of proposals for reform. Given the number of similarities between Australian and North American workers' compensation schemes, policy lessons drawn from the Australian experiences may be relevant to the labor movement and legislators in Canada and the United States.