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PubMed2006

The right to health and the privatization of national health systems: a case study of the Netherlands.

Many countries have national health systems that cover all or part of the population. An aging population and advances in medical technology are making health insurance increasingly expensive, and governments are left seeking cost-effective options. The Dutch government is reorganizing its health care system and seeking to combine economic competition with a right to health in order to improve the health of its population. This article addresses privatization in terms of a right to health and asks whether governments can privatize their health care systems while also guaranteeing the availability, accessibility, acceptability, and quality of health care services. It is suggested that a "right to health impact assessment" can be a useful tool applicable also to the privatization processes in other countries.

Health Services Accessibility↗
PubMed1990

Free enterprise, professional ideology, and self-interest: an analysis of resistance by Canadian physicians to universal health insurance.

Under Canada's universal health care system, physicians are remunerated through government-run health insurance plans; a private market for physicians' services is virtually nonexistent. A proposal to ban the practice of extra-billing, whereby some physicians billed patients for amounts over and above insured rates, met with physicians' opposition. The particular constellation of legislative, social, and political events that followed the proposed ban presented a unique opportunity to explore the nature of the medical profession's resistance to encroachment on professional autonomy. The results of this survey of physicians in four specialties (N = 313) in metropolitan Toronto suggest that resistance to universal health insurance is complex; it involves a prevailing social ideology among physicians, which happens to be antiwelfare and conservative generally, entangled with economic self-interest and a specific set of beliefs about medical practice and physicians' rights and privileges.

Attitude of Health Personnel↗
PubMed1990

Rural nurses. Part I, Surviving cost containment.

Rural nurses from 13 small hospitals share their work lives and concerns. Five years of cost-containment have left them undaunted, but they worry about the financial viability of their hospitals. Their unique brand of nurse shortage has added an additional load that appears surmountable only through financial means, which have also disappeared through cost-containment. This is the story of "frontier nurses" and their fight to maintain an American institution.

Burnout, Professional↗
PubMed1990

For profits: a look at the bottom line.

This paper examines the expansion of for-profit health care organizations, focusing on hospitals. It argues that much of the support of for-profits derives from American market ideology and the assumption that the search for profits leads to efficiency in production. In the health field, there is no evidence, however, that such gains in efficiency exist or that, if they do, they are shared with patients in the form of lower costs of care or with employees in the form of higher wages. The paper presents a number of reasons for concluding that for-profits would not serve the needs of patients, care deliverers, local communities, or the health care system. Potential efficiency gains, even if realized, would be far outweighed by the damage that for-profits would cause.

Delivery of Health Care↗
PubMed1990

AIDS and its impact on medical work: the culture and politics of the shop floor.

AIDS, together with other institutional factors, is changing the "shop-floor" culture of house officers and students in urban, academic medical centers. These medical workers complained of powerlessness and exploitation prior to the epidemic, but they felt pride in scoring clinical coups and chagrin in their clinical defeats, characteristic of an adolescent sense of invulnerability. The HIV epidemic, dovetailing with the intensely competitive economic environment in medical settings, subjects house officers to increasingly demanding schedules, heightens their sense of powerlessness, and limits their sense of professional achievement. Fear of contagion, moreover, is erasing their perception of invulnerability.

Academic Medical Centers↗
PubMedDate not supplied

Going to market.

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Economic Competition↗
PubMedDate not supplied

The American way.

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Delivery of Health Care↗
PubMed1989

Young physicians and changes in medical practice characteristics between 1975 and 1987.

This article examines the proposition that an increasing representation in the total physician population has subjected young physicians to "baby boom" cohort effects seen in the general population. Analyzing comparative changes in income and other medical practice characteristics between 1975 and 1987, we find moderate evidence to support this proposition, particularly when specialty selection and changes in the income distribution are taken into account. Young male physicians experienced a significant income decline, as did certain specialties. Other characteristics also suggest that young physicians are working relatively harder now than a decade ago. However, the income decline for young physicians is smaller than for other baby boomers.

Adult↗
PubMed1989

Hospital antitrust liability in dealings with downstream providers.

As hospitals continue to offer an increasing number of post-discharge services to their patients, the risk of violating antitrust laws also increases. The author, an attorney, discusses the legal complexities of deciding when, if at all, an antitrust law may be violated.

Aftercare↗