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The Operating Engineers installed a managed care program that focuses on reducing costs by putting controls on key areas like patient length-of-stay and physician unbundling. But it also attempts to maximize quality of care.
The history of union organizing efforts in the hospital field is discussed in this article, along with the factors judged necessary for successful union organizing. The role played by labor legislation in the unionization of hospital workers is shown, and the influences of the National Labor Relations Act, the Taft-Hartley amendments, and labor legislation at the local level are described. Management has largely resisted unionization because of the social nature of hospitals. Competitive market forces do not confront the not-for-profit hospitals, which are dependent upon third-party reimbursement. While strikes are an integral and essential part of collective bargaining in industry, they are, in fact, detrimental to hospitals because of these institutions' concern with human life. Despite laws and assurances from labor leaders that strikes will not occur, strikes have been used as a method for resolving disputes, through they are basically inconsistent with the economic characteristics and objectives of the hospital. The authors conclude that arbitration awards should be made by arbitrators appointed from outside of the local region of the hospital involved, ant that, because of the catastrophic effect of strikes upon patients as well as employees, arbitration awards should be required, should be binding upon both parties, and should be federally enforced.
The health care industry in the United States has undergone many changes in recent years. One problem facing employers in this industry is the threat of unionization. The article examines union election activity since 1980 in hospitals, nursing homes, and other types of health care employers. Variance in the union victory rate was found over time and across the different sectors of the industry, types of employees involved, union involved, and sizes of the bargaining unit. The effects of geographic location and type of ownership are investigated. Decertification elections are also examined.
A survey of 89 public health nurses in a California county explored factors that might account for the growing support of unions and subsequent militancy among nurses. As predicted, changes in the backgrounds of public health nurses have occurred over time: 1) older nurses are more likely to have graduated from a diploma program and to have parents of lower educational and occupational attainment than younger nurses; 2) older nurses are more likely to view nursing as a calling and less likely to desire representation in collective bargaining by the union or to believe striking professional; 3) older nurses and those from lower social class backgrounds were less likely to belong to the union and less likely to participate in a county-wide strike. Because age and parental background factors are independently related to our indicators of militancy--union membership and participation in a strike--the results are interpreted as a change in nurses' images of professionalism.
A retirement crisis looms in the United States due to a number of recent and emerging trends that affect government retirement programs, employer- and union-sponsored retirement benefits and personal savings arrangements. The crisis can be averted, but only with well-thought-out action on a number of issues, particularly Social Security and Medicare reform.
Demand management is an approach to providing health care benefits that is designed to help beneficiaries receive the appropriate level of care at the appropriate time. When this is accomplished, health care expenditures are reduced. This case study shows how a large union health plan implemented a demand management program that has been well received by its members and has been effective in helping to control plan costs.
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Prevention and health defence at working places are important issues in organizational change. Professionals by Legislative Decree 626/94 become and take an active part of the organization. Participation is seen as a bill of rights and responsibility of workers. In the article, a local experience is reported.
Unionization presents a potential source of cost escalation for hospitals, particularly involving health benefits. The best way to minimize chances that staff members will opt for union representation is to develop personnel practices that demonstrate management's commitment to treating employees fairly, such as providing competitive salaries and benefits, scheduling regular meetings to address worker questions, and developing detailed policy handbooks.
The authors investigated the hypothesis that paternal occupational exposures at the time of conception may affect the risk of postconception events by linking records from Oslo, Norway, printers' unions and the Medical Birth Registry of Norway. The linkage yielded 6,251 infants born during the period 1967-1986. On the basis of job classification, fathers were categorized as to their exposure to lead and solvents. Odds ratios were estimated by simple and stratified analysis of tabular data and logistic regression analysis, with children whose fathers were not in lead- or solvent-exposed categories being used as the reference group. In addition, all Oslo births taking place during the same period served as an external reference for computation of standardized morbidity ratios. The adjusted odds ratio for early preterm birth (16-27 weeks) was 5.4 (95% confidence interval (CI) 1.7-17.4) for infants with paternal exposure to solvents and 8.6 (95% CI 2.7-27.3) for children whose fathers were in the lead plus solvents category. The adjusted odds ratio for all perinatal deaths was 2.4 (95% CI 1.2-4.9) for children with fathers in the lead-exposed group and 1.9 (95% CI 0.96-3.7) for children with fathers in the lead plus solvents group. An increased risk of cleft lip was demonstrated, with interaction between sex and paternal exposure to lead: The standardized morbidity ratio for boys in the two subgroups with lead exposure was 4.1 (95% CI 1.8-8.1). Paternal exposure had little impact on birth weight, intrauterine growth, or total number of birth defects. The main problems of the study were the potential for nondifferential misclassification of exposure and the fact that it was not possible to control for potentially confounding life-style factors.
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PURPOSE: A resolution in support of physicians' unionization was recently approved by the American Medical Association's House of Delegates. This study investigated the factors associated with young physicians' approval of unionization. METHOD: A survey was mailed to all 1987-1992 Jefferson Medical College graduates (n = 1,272); 835 (66%) responded. RESULTS: Of the respondents, 43% supported unionization, 31% did not support unionization, and 26% expressed no opinion. Surgeons, medical subspecialists, pediatricians, and hospital-based specialists were more likely to support unionization than were family physicians. Significant predictors of support for unionization were negative views of the changes in the health care system, negative perceptions of the quality of care provided by managed care, the belief that physicians' independence had been impaired by changes in the health care system, and the belief that physicians' personal satisfaction should take precedence over societal needs in determining the future of health care. Support for unionization correlated with physicians' perceptions that mental health patients should be referred to psychiatrists, physician-assisted suicide should be legalized, and the involvement of nurse practitioners in diagnosis and treatment could compromise the quality of care. CONCLUSIONS: Young physicians' support for unionization is a function of frustration with market-driven policies that compromise the quality of care and negatively affect physicians' autonomy and personal satisfaction.
The health service industry is unusual in that most of the skilled as well as unskilled workers are women, although the industry is largely controlled by men. Women are hired because they constitute an inexpensive, available, and seemingly powerless work force. Women enter health service because they have few alternatives to the low-paying, dead-end jobs found there. Health service occupations are organized like craft unions, with rigid hierarchical separations and control by the top occupation. Conflicts between men and women-between management and workers-are often played out as conflicts between occupations. Challenges to physicians come from various nursing specialties as well as from technical professions. Physicians in turn create lower-level occupations which challenge the nurses' status. Increasing industrialization alters the pattern of conflict, creating opportunities for individual bureaucratic mobility as well as favorable conditions for unionization drives. Unionism is often held back by sex, race, and professional conflicts, which must be overcome if the status of women is to be changed in the industry.
The Medical Practitioners' Union is the latest group to call for changes in junior doctors' career structures. These would entail a shift in emphasis away from the consultant's traditional role and reliance on inpatient care. Here, Brian Watkin discusses the MPU's policy document.
The objectives of this study were to estimate the incidence of receiving an early retirement pension among a group of skilled workers and to examine the pattern of the major categories of diagnoses for which pensions were awarded. During the period April 1, 1971 to March 31, 1976, 589 union members were awarded disability pensions and 361 were awarded early old-age pensions. The incidence density of disability pensions is very low among young union members but is observed to increase with age. The Standard Disability Ratio also increases with age, indicating that the age-specific disability pensioning rate increases more rapidly among union members than among the standard population of all men in Denmark. The low rate of pensioning observed among young union members is probably due to healthy worker selection. Low Standard Disability Ratios are found for early old-age pensioners when a standard population of all men in Denmark is used. An examination was made of the diagnoses for which disability pensions were awarded in the two largest occupational sub-groups of the union, cabinet makers and carpenters. Carpenters were found to have high Standard Proportional Ratio for the category "accidents" while cabinet makers have high ratio for the category "diseases of the nervous system".
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When the Howard Government gains total control of Parliament in July this year, it has announced it will introduce legislation which will dismantle Australia's industrial relations system. The Australian Nursing Federation (ANF) and the Queensland Nurses' Union (QNU) expect the new legislation will reduce the role of unions, put downward pressure on wages and conditions and dilute the power of the Australian Industrial Relations Commission (AIRC) to hear and resolve disputes. The changes will not only affect nurses' wages and conditions, but threaten to undermine the profession itself.
One-hundred and sixty-nine social workers, assistance payments technicians and clerical workers in a human service agency in the Northeast completed a questionnaire two times with a nine-month period between the two administrations. Thirty-one of the respondents joined the union between the two administrations of the questionnaire. A comparison of the responses on the first questionnaire of thirty-one employees who eventually joined the union with the one hundred thirty-eight who retained their nonmember status, indicated that the union members reported significantly lower levels of satisfaction with work, lower levels of clarity about agency objectives, and lower levels of clarity about the agency's reward system. The implications of these findings for human service agencies are discussed.