Back to the future in NHS reform

PURPOSE - In the mid 1990s the NHS ‘did’ competition, in the mid 2000s the NHS is ‘doing’ choice. This paper aims to cut through the rhetoric, highlight the differences and parallels between then and now and identify if these differences will have a different or the same impact on local services. DESIGN/METHODOLOGY/APPROACH – Following a review of literature from the 1990s, a qualitative research study is used to examine the impact of competition and markets in the 1990s. The discussion examines the implications of this study for current system reform. FINDINGS - Patient choice recreates many of the features of the internal market, but despite concerns at the time, the internal market did not have a significant impact on services. It is likely that patient choice will similarly have a limited impact. RESEARCH LIMITATIONS/IMPLICATIONS - The research is a case study confined to Day Surgery in one part of the North of England. ORIGINALITY/VALUE - The paper reminds academics and practitioners what happened last time the NHS attempted to introduce a market-based system

Armenia after a decade of reform

Enrique Gelbar

The New Structure of Labor Relations: Tripartism and Decentralization

Tripartism, the national-level interaction among representatives of labor, management, and government, occurs infrequently in the United States. Based on the U.S. experience, then, such interactions might seem irrelevant to economic performance and policymaking. The essays in this volume reveal the falsity of that assumption. Contributors from eight industrialized countries examine the changing nature of labor management relations, with a particular focus on the role of tripartism and the decentralization of collective bargaining. The vibrancy of the coordinating mechanisms that help shape employment conditions and labor policy contradicts the traditional belief that an overpowering unilateral decentralizing shift is underway in labor-management interactions. The contributors show that these mechanisms are in fact increasing in the face of intensified pressures, promoting greater flexibility in work organization and working time

Power, Techno-economics, and Transatlantic Relations in 1987-1999

This essay suggests that in 1987-1999 European elites, in their efforts of asymmetric balancing against the United States hegemony, decided to trade-off military capability for economic competitiveness. Thus, it documents a correlation between a) the reluctance of especially France and Germany during the 1990s to fully embrace and pursue the US-led RMA; and, b) the European Union's efforts since the late 1980s to challenge America's technological and economic supremacy in the aerospace sector. Two projects (Airbus and Galileo) indicate that the quest for strategic independence and the fear of reduced influence in international affairs were the driving forces behind European efforts to challenge the US commercial and technological supremacy in the aerospace sector in 1987-99. Furthermore, the article tries to identify what role the RMA played in this context (focusing in particular on Germany and France). It argues also that since the late 1980s (and especially during the 1990s), the European Commission and countries such as France and Germany perceived US policies in high-technology sectors (accentuated also by vigorous pursuit of the RMA) as limiting Europe’s abilities to advance its own agenda in international economic and security affairs

The Veterans Health Administration: Taking Home Telehealth Services to Scale Nationally

Since the 1990s, the Veterans Health Administration (VHA) has used information and communications technologies to provide high-quality, coordinated, and comprehensive primary and specialist care services to its veteran population. Within the VHA, the Office of Telehealth Services offers veterans a program called Care Coordination/Home Telehealth (CCHT) to provide routine noninstitutional care and targeted care management and case management services to veterans with diabetes, congestive heart failure, hypertension, post-traumatic stress disorder, and other conditions. The program uses remote monitoring devices in veterans' homes to communicate health status and to capture and transmit biometric data that are monitored remotely by care coordinators. CCHT has shown promising results: fewer bed days of care, reduced hospital admissions, and high rates of patient satisfaction. This issue brief highlights factors critical to the VHA's success -- like the organization's leadership, culture, and existing information technology infrastructure -- as well as opportunities and challenges

New Zealand's Fiscal Policy Framework: Experience and Evolution

Fiscal policy in New Zealand has seen a consolidation of the Government’s position and continuing refinements to the institutional framework and Budget processes. The key institutional change has been the introduction of the Fiscal Responsibility Act 1994. The paper sets out the background to the fiscal policy framework, including fiscal history and various institutional changes in the public sector. This paper is a companion paper to Treasury Working Paper 01/24 by Angela Barnes and Steve Leith. The key elements of the fiscal policy framework are explained and compared to various “fiscal rules” used internationally. The New Zealand framework differs from that used elsewhere, especially in its use of legislated “principles of responsible fiscal management” as opposed to mandatory targets. However, the Fiscal Responsibility Act 1994 does require Governments to set short-term fiscal intentions and long-term fiscal objectives for a range of fiscal aggregates. The paper discusses the experience with the framework including a comparison of fiscal outcomes with fiscal objectives. The New Zealand experience has seen the evolution of specific operational targets (the fiscal provisions) to help improve the consistency of short-term intentions with longer-term fiscal objectives. The paper concludes with a set of challenges facing the framework, both short- and long-term.Fiscal policy, Fiscal Responsibility Act