The Grass Is Not Always Greener: A Look at National Health Care Systems Around the World

Critics of the U.S. health care system frequently point to other countries as models for reform. They point out that many countries spend far less on health care than the United States yet seem to enjoy better health outcomes. The United States should follow the lead of those countries, the critics say, and adopt a government- run, national health care system. However, a closer look shows that nearly all health care systems worldwide are wrestling with problems of rising costs and lack of access to care. There is no single international model for national health care, of course. Countries vary dramatically in the degree of central control, regulation, and cost sharing they impose, and in the role of private insurance. Still, overall trends from national health care systems around the world suggest the following: Health insurance does not mean universal access to health care. In practice, many countries promise universal coverage but ration care or have long waiting lists for treatment. Rising health care costs are not a uniquely American phenomenon. Although other countries spend considerably less than the United States on health care, both as a percentage of GDP and per capita, costs are rising almost everywhere, leading to budget deficits, tax increases, and benefit reductions. In countries weighted heavily toward government control, people are most likely to face waiting lists, rationing, restrictions on physician choice, and other obstacles to care. Countries with more effective national health care systems are successful to the degree that they incorporate market mechanisms such as competition, cost sharing, market prices, and consumer choice, and eschew centralized government control. Although no country with a national health care system is contemplating abandoning universal coverage, the broad and growing trend is to move away from centralized government control and to introduce more market-oriented features. The answer then to America's health care problems lies not in heading down the road to national health care but in learning from the experiences of other countries, which demonstrate the failure of centralized command and control and the benefits of increasing consumer incentives and choice

Readiness for Hospital Discharge Scale for older people: psychometric testing and short form development with a three country sample

Aim To develop and psychometrically test Readiness for Hospital Discharge Scale for older people and to reduce the scale to a more practical short form. Background The Readiness for Hospital Discharge Scale is the only available and validated scale measuring patients\u27 perceived readiness just prior to discharge. Design Secondary analysis of hospital studies data from three countries. Method Data were collected between 2008–2012. The study sample comprised 998 medical-surgical older patients. Factor analysis was undertaken to identify the factor structure of the Readiness for Hospital Discharge Scale. Group comparisons for construct validity and predictive validity for readmission were also conducted. Results The Readiness for Hospital Discharge Scale original four factor solution does not appear to be consistent with the observed data of older people in the three countries. Confirmatory factor analysis revealed that a 17-item scale with three factors produced the best model fit. Nine items, three from each factor, loaded consistently on their respective factors in each country sample. Confirmatory factor analysis of this short form model indicated that the model adequately fit the data. Patients who lived alone, were older, or who indicated ‘not ready’ for discharge had lower Readiness for Hospital Discharge Scale for Older People scores, which were also associated with readmission risk. Conclusion The revised three factor structure of the Readiness for Hospital Discharge Scale for Older People in long and short forms more adequately assesses core components of discharge readiness in the older adult population than the original adult form

Barnes Hospital Bulletin

https://digitalcommons.wustl.edu/bjc_barnes_bulletin/1220/thumbnail.jp

Health and place in historical perspective: medicine, ethnicity, and colonial identities

Introduction to special issue. This Special Issue includes articles first presented as papers at a two-day symposium held at the University of Waikato, New Zealand, in February 2011. The event was designed to highlight a large Royal Society of New Zealand Marsden-funded research project, and to showcase current scholarly work in the field of the colonial and postcolonial histories of medicine, with a focus on histories of insanity. We also included the themes of medical migration in New Zealand’s national history, the movement of medical ideas and personnel across empire, a close study of the uses of the term ‘neurasthenia’ in French-colonial Vietnam, and the relationship between place, plants, and health across South Asia and Australia in the nineteenth century

Enhancing the Effectiveness of Social Dialogue Articulation in Europe (EESDA) Project No. VS/2017/0434 Social Dialogue Articulation and Effectiveness: Country Report for France

This report presents a country study analysing the articulation and effectiveness of social dialogue in France. The methodological approach relies on desk research and semi-structured interviews with social partners in France, aiming at obtaining deeper insights into how issues are articulated in French social dialogue, actors are interacting, and how social dialogue outcomes are achieved – and ultimately implemented. Following a brief historical background on the industrial relations system and the evolutions in the French context after a series of reforms, the report then provides both a cross-sectoral overview of social dialogue articulation and the interaction with European-level social dialogue. It also offers a sectoral perspective by looking at four sectors with a particular focus on four occupations within these sectors: commerce (sales agents), construction (construction workers), education (teachers) and healthcare (nurses). The research suggests a diversity of experiences both in cross-sectoral and sectoral social dialogue articulation and their effectiveness depending on the type of actor (e.g. trade unions, employer organisations, etc.) and on the sector of focus. The perceptions of social dialogue effectiveness are mixed in the face of continuous reforms over the last decades. Interactions with European-level social dialogue and social partners is considered as important (particularly in some sectors), but the intensity of the interaction is limited when it comes to involvement in the European Semester process

Regional disparities in mortality by heart attack: evidence from France

This paper studies the determinants of the regional disparities in the mortality of patients treated in a hospital for a heart attack in France. These determinants can be some differences in patient characteristics, treatments, hospital charateristics, and local healthcare market structure. We assess their importance with an exhaustive administrative dataset over the 1998-2003 period using a stratified duration model. The raw disparities in the propensity to die within 15 days between the extreme regions reaches 80%. It decreases to 47% after controlling for the patient characteristics and their treatments. In fact, a variance analysis shows that innovative treatments play an important role. Remaining regional disparities are significantly related to the local healthcare market structure. The more patients are locally concentrated in a few large hospitals rather than many small ones, the lower the mortality.spatial health disparities ; stratified duration model

The use of computer-based learning tools for teaching and clinical purposes: Interactive computing strategy for Iraq

Medical universities and teaching hospitals in Iraq are facing a lack of professional staff due to the ongoing violence that forces them to flee the country. The professionals are now distributed outside the country which reduces the chances for the staff and students to be physically in one place to continue the teaching and limits the efficiency of the consultations in hospitals. A survey was done among students and professional staff in Iraq to find the problems in the learning and clinical systems and how Information and Communication Technology could improve it. The survey has shown that 86% of the participants use the Internet as a learning resource and 25% for clinical purposes while less than 11% of them uses it for collaboration between different institutions. A web-based collaborative tool is proposed to improve the teaching and clinical system. The tool helps the users to collaborate remotely to increase the quality of the learning system as well as it can be used for remote medical consultation in hospitals

Executive Compensation in American Unions

[Exerpt] Studying compensation in the nonprofit sector is difficult. In nonprofit organizations, it is not always clear what the objectives of the organization are and, therefore, perhaps even more difficult to consider how to compensate managers than in the for-profit sector. This paper investigates the determinants of executive compensation of leaders of American labor unions. We use panel data on more than 75,000 organization-years of unions from 2000 to 2007 which allows us to examine within union differences over time. We specifically concentrate on two issues of importance to unions – the level of membership and the wages of union members. Both measures are strongly related to the compensation of the leaders of American labor unions, even after controlling for organization size and individual organization fixed-effects. That is, within the same union, higher levels of membership size and average member wage over time are associated with higher levels of pay for union leaders. Additionally, the elasticity of pay with respect to membership for unions is very similar to the elasticity of pay with respect to employees in for-profit firms over the same period