Int J Health Serv
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The governance and management of global health institutions, such as the World Health Organization (WHO), are under increasing critical scrutiny. This management case study explores the first year of transformation at the WHO under Director-General Dr. ⋯ This is a story about transition in a difficult, politically fraught, and management-resource-constrained environment. In the search for appropriate management paradigms, organizations such as the WHO may believe that the answers lie in harsh reengineering and the search for high-profile "success stories." Ironically, global business has moved away from such approaches and is far more focused on collaboration, empowerment, and knowledge sharing.
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Britain's New Labour government has consolidated its reform of the National Health Service with an ambitious NHS Plan that links investment in staff, new buildings, and new technology to delivery of a modernization agenda combining consumerist and public health agendas. The fundamental principles of the NHS are preserved, but within a regulatory structure of a managed market. The author outlines the changes proposed and the possible responses of different stakeholders.
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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.