The Search for New Governance: Corporatisation and Privatisation of Public Universities in Malaysia and Thailand

ERIC Educational Resources Information Center

Mok, Ka Ho

2007-01-01

This paper attempts to analyse how governments in Malaysia and Thailand have adopted indirect policy instruments along the lines of "corporatisation" and "privatisation" to reform higher education governance. By focusing on a few key issues related to changing state and education relationships and new regulatory arrangements…

Privatising the Public University: The Case of Law

ERIC Educational Resources Information Center

Thornton, Margaret

2011-01-01

"Privatising the Public University: The Case of Law" is the first full-length critical study examining the impact of the dramatic reforms that have swept through universities over the last two decades. Drawing on extensive research and interviews in Australia, New Zealand, the UK and Canada, Margaret Thornton considers the impact of the…

Redefining Competition Constructively: The Challenges of Privatisation, Competition and Market-Based State Policy in the United States

ERIC Educational Resources Information Center

Eckel, Peter D.

2007-01-01

In the United States, the relationship between state governments and public colleges and universities is being redefined with new notions of autonomy and accountability, and with funding policies that are highly market-driven (often referred to as "privatisation") as the centrepieces. Situations and institutional strategies unthinkable…

Privatising Educational Leadership through Technology in the Trumpian Era

ERIC Educational Resources Information Center

Courtney, Steven J.

2018-01-01

This article focuses on the changes that the election of Donald Trump enables in education policy domestically and in education discourse internationally. I argue that Trump's own charismatic leadership style is a distraction from the privatisation that it is facilitating through Betsy DeVos, Trump's appointment as US Education Secretary. I draw…

Privatisation of Higher Education in Uganda and the Global Gender Justice Ideal: Uneasy Bedfellows?

ERIC Educational Resources Information Center

Baine, Euzobia M. Mugisha

2010-01-01

This paper examines ways in which privatisation of education is affecting the search for gender justice through education focusing on Uganda's higher education institutions (HEIs). Since 1988 when the first private university was opened, the winds of change have swept Uganda's higher education sector to change how it is financed and managed. The…

Liberia's Experiment with Privatising Education: A Critical Analysis of the RCT Study

ERIC Educational Resources Information Center

Klees, Steven J.

2018-01-01

To experiment with the possible privatisation of its primary education system, Liberia initiated the Partnership Schools of Liberia (PSL), which turned over the management of 93 public schools to eight private contractors. A randomised controlled trial (RCT) study was initiated comparing the PSL schools with matched public schools and the results…

Democratisation or Management and Corporate Capture?: Theses on the Governance Crisis of Australia's Semi-Privatised Public Universities

ERIC Educational Resources Information Center

Bonnell, Andrew G.

2016-01-01

This paper proceeds from the view that managerial capture has already become a fundamental problem after a couple of decades of largely untrammelled managerialism in our public universities, and that this problem is likely to be compounded by further shifts towards deregulation and de facto privatisation, which is the direction that current…

Privatisation by the Back Door: The Case of the Higher Education Policy in Israel

ERIC Educational Resources Information Center

Gaziel, Haim H.

2012-01-01

The purpose of this study is to seek to understand the process of privatisation and deregulation of Israel's higher education system which had been until the late 20th century predominantly public. Since 1994, public and governmental agencies became major clients of private universities. Thus the public sector played a major role in the expansion…

Liberalisation and Privatisation of Higher Education in Flanders: Passing the Point of No Return? A Case Study

ERIC Educational Resources Information Center

Broucker, Bruno; De Wit, Kurt

2013-01-01

The higher education system in Flanders is characterised by tight regulation and a tradition of excluding private providers from the sector. However, as in other European countries, the Belgian public sector has been confronted with the principles of New Public Management (NPM) and trends of liberalisation and privatisation. The same goes for the…

Privatisation of Agricultural Advisory Services and Consequences for the Dairy Farmers in the Mantaro Valley, Peru

ERIC Educational Resources Information Center

Faure, G.; Huamanyauri, M. K.; Salazar, I.; Gómez, C.; de Nys, E.; Dulcire, M.

2017-01-01

Purpose: The private sector's presence in agricultural advisory services worldwide has been on the increase for over three decades. This trend has also been observed in the Mantaro Valley (Peru), in a context of dairy family farming. The objective of the article is to analyse the modalities of advisory services privatisation and assess the…

Response to "Reply to O'Neill: The Privatisation of Public Schooling in New Zealand"

ERIC Educational Resources Information Center

O'Neill, John

2011-01-01

This article presents the author's response to Strathdee's "Reply to O'Neill: The privatisation of public schooling in New Zealand." Strathdee has alerted the editors to a basic arithmetic error in the author's paper (O'Neill 2011, 24). He also makes substantive criticisms. Strathdee's criticisms focus on the two cases that are used to…

Towards a Human Rights Framework to Advance the Debate on the Role of Private Actors in Education

ERIC Educational Resources Information Center

Aubry, Sylvain; Dorsi, Delphine

2016-01-01

Part of the debate on the impact of privatisation in and of education lies in determining against which standards of evidence should the phenomenon be assessed. The questions "what impacts of privatisation in education are we measuring?" and its corollary "what education system do we wish to have?" are crucial to determining…

Reply to O'Neill: The Privatisation of Public Schooling in New Zealand

ERIC Educational Resources Information Center

Strathdee, Rob

2011-01-01

In a recent contribution to this journal, John O'Neill (2011) argues that recent privatisation practices in New Zealand public schooling are evidence of a small, but growing, influence of neo-liberalism on New Zealand's public education. The focus in his paper is on the active enablement of non-government provision of public education through, for…

Privatisation Policies and Postprivatisation Control Devices in India's Higher Education: Evidence from a Regional Study and Implications for Developing Countries

ERIC Educational Resources Information Center

Narayana, M. R.

2006-01-01

This article focuses on economic analysis of privatisation policies and postprivatisation control devices in India's higher education. As a case study, the experiences of Karnataka State in collegiate education under general higher education are emphasised. A change in public financing, rather than a shift of public ownership and management to…

Privatisation of veterinary services in Jamaica: a case study.

PubMed

Lopez, V; Alexander, F C; Bent, C L

2004-04-01

Clinical veterinary services were privatised in Jamaica in September 1992. Using the limited official data, the authors briefly examine the premise and logistics behind transferring the responsibility for clinical services, which may be regarded as 'a private good', to private veterinary practitioners. There are indications that this privatisation model can work for farmers, despite financial problems in the livestock industry and a decline in production, caused by trade liberalisation policies and the substitution of cheaper imports. In addition, other national fiscal problems, such as a downturn in the economy, have left veterinarians attempting to boost production in a livestock industry which lacks adequate financial structuring and resources. The authors express concern that various unpublished projections since the last official agricultural survey in 1996 indicate that the livestock industry in Jamaica is diminishing. It is possible that valuable genetic breeding stock may never recover. A comprehensive study of the future of the livestock industry and its associated services is strongly urged. Ten years after the event, the authors reflect on the privatisation of clinical veterinary services in Jamaica and offer some suggestions to improve on the quality of the services offered by private veterinary practitioners.

The Health Legislation Amendment Act 2013 (QLD) and Queensland's health assets privatisation dispute.

PubMed

Colton, Caroline; Faunce, Thomas

2014-09-01

'New legislation in Queensland has provided a "pathway" for the privatisation of health assets and services in Queensland, which effectively realigns the health care system to the financial market. This column explores how this legislation contained the antecedents of the Queensland doctors' dispute when doctors roundly rejected new employment contracts in February 2014. It also argues that such legislation and its attendant backlash provides a valuable case study in view of the federal government's 2014 budget offer to the States of extra funding if they sell their health assets to fund new infrastructure. The move to privatise health in Queensland has also resulted in a government assault on the ethical credibility of the opposing medical profession and changes to the health complaints system with the introduction of a Health Ombudsman under ministerial control. The column examines these changes in light of R (Heather) v Leonard Cheshire Foundation [2001] EWHC Admin 429, a case concerning the obligations of a private entity towards publically funded clients in the United Kingdom. In discussing concerns about the impact of privatisation on the medical profession, the column points to a stark conflict between the duty to operate hospitals as a business rather than as a duty to patients.

Quantum privacy and Schur product channels

NASA Astrophysics Data System (ADS)

Levick, Jeremy; Kribs, David W.; Pereira, Rajesh

2017-12-01

We investigate the quantum privacy properties of an important class of quantum channels, by making use of a connection with Schur product matrix operations and associated correlation matrix structures. For channels implemented by mutually commuting unitaries, which cannot privatise qubits encoded directly into subspaces, we nevertheless identify private algebras and subsystems that can be privatised by the channels. We also obtain further results by combining our analysis with tools from the theory of quasi-orthogonal operator algebras and graph theory.

Privatisation in reproductive health services in Pakistan: three case studies.

PubMed

Ravindran, T K Sundari

2010-11-01

Privatisation in Pakistan's health sector was part of the Structural Adjustment Programme that started in 1998 following the country's acute foreign exchange crisis. This paper examines three examples of privatisation which have taken place in service delivery, management and capacity-building functions in the health sector: 1) large-scale contracting out of publicly-funded health services to private, not-for-profit organisations; 2) social marketing/franchising networks providing reproductive health services; and 3) a public-private partnership involving a consortium of private players and the government of Pakistan. It assesses the extent to which these initiatives have contributed to promoting equitable access to good quality, comprehensive reproductive health services. The paper concludes that these forms of privatisation in Pakistan's health sector have at best made available a limited range of fragmented reproductive health services, often of sub-optimal quality, to a fraction of the population, with poor returns in terms of health and survival, especially for women. This analysis has exposed a deep-rooted malaise within the health system as an important contributor to this situation. Sustained investment in health system strengthening is called for, where resources from both public and private sectors are channelled towards achieving health equity, under the stewardship of the state and with active participation by and accountability to members of civil society. Copyright © 2010 Reproductive Health Matters. Published by Elsevier Ltd. All rights reserved.

New Provider Models for Sweden and Spain: Public, Private or Non-profit? Comment on "Governance, Government, and the Search for New Provider Models".

PubMed

Jeurissen, Patrick P T; Maarse, Hans

2016-06-29

Sweden and Spain experiment with different provider models to reform healthcare provision. Both models have in common that they extend the role of the for-profit sector in healthcare. As the analysis of Saltman and Duran demonstrates, privatisation is an ambiguous and contested strategy that is used for quite different purposes. In our comment, we emphasize that their analysis leaves questions open on the consequences of privatisation for the performance of healthcare and the role of the public sector in healthcare provision. Furthermore, we briefly address the absence of the option of healthcare provision by not-for-profit providers in the privatisation strategy of Sweden and Spain. © 2016 The Author(s); Published by Kerman University of Medical Sciences. This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Does transfer of work from a public sector organisation to a commercial enterprise without staff reductions increase risk of long-term sickness absence among the staff? A cohort study of laboratory and radiology employees.

PubMed

Kokkinen, Lauri; Virtanen, Marianna; Pentti, Jaana; Vahtera, Jussi; Kivimäki, Mika

2013-08-01

Privatisations of public sector organisations are not uncommon, and some studies suggest that such organisational changes may adversely affect employee health. In this study, we examined whether transfer of work from public sector hospital units to commercial enterprises, without major staff reductions, was associated with an increased risk of long-term sickness absence among employees. A cohort study of 962 employees from four public hospital laboratory and radiology units in three hospitals which were privatised during the follow-up and 1832 employees from similar units without such organisational changes. Records of new long-term sick leaves (>90 days) were obtained from national health registers and were linked to the data. Mean follow-up was 9.2 years. Age- and sex-adjusted HR for long-term sickness absence after privatisation was 0.83 (95% CI 0.68 to 1.00) among employees whose work unit underwent a change from a public organisation to a commercial enterprise compared with employees in unchanged work units. Further adjustments for occupation, socioeconomic status, type of job contract, size of residence and sick leaves before privatisation had little impact on the observed association. A sensitivity analysis with harmonised occupations across the two groups replicated the finding (multivariable adjusted HR 0.92 (0.70-1.20)). In this study, transfer of work from public organisation to commercial enterprise did not increase the risk of long-term sickness absence among employees.

Depoliticising the political: Market solutions and the retreat of Swedish institutional drug treatment from state management.

PubMed

Edman, Johan

2016-06-01

This article examines developments in the Swedish drug treatment services in 1982-2000 and explores the ways in which political initiatives and the state administration's management have contributed to the major privatisations of institutional drug treatment during this period. The empirical basis for the textual analysis lies in official reports, parliamentary material and archived records from the Stockholm County Administrative Board's management of treatment facilities. The major privatisations of drug treatment services in the 1980s were both unintentional and unwanted and mainly arose from a lack of bureaucratic control and ideological anchorage. The privatisations were, however, reinforced by ideologically driven NPM-oriented political initiatives in the 1990s. The market-oriented treatment services have failed to fulfil the needs for diversity and availability within a publicly financed sector, which deals with unevenly informed and often socio-economically weak citizens. New management models in this field must ensure that ideological considerations are taken into account to meet politically decided goals and means. Copyright © 2016 Elsevier B.V. All rights reserved.

The journals are full of great studies but can we believe the statistics? Revisiting the mass privatisation - mortality debate.

PubMed

Gerry, Christopher J

2012-07-01

Cross-national statistical analyses based on country-level panel data are increasingly popular in social epidemiology. To provide reliable results on the societal determinants of health, analysts must give very careful consideration to conceptual and methodological issues: aggregate (historical) data are typically compatible with multiple alternative stories of the data-generating process. Studies in this field which fail to relate their empirical approach to the true underlying data-generating process are likely to produce misleading results if, for example, they misspecify their models by failing to explore the statistical properties of the longitudinal aspect of their data or by ignoring endogeneity issues. We illustrate the importance of this extra need for care with reference to a recent debate on whether discussing the role of rapid mass privatisation can explain post-communist mortality fluctuations. We demonstrate that the finding that rapid mass privatisation was a "crucial determinant" of male mortality fluctuations in the post-communist world is rejected once better consideration is given to the way in which the data are generated. Copyright © 2012 Elsevier Ltd. All rights reserved.

The invisible hand: how British American Tobacco precluded competition in Uzbekistan

PubMed Central

Gilmore, Anna B; McKee, Martin; Collin, Jeff

2007-01-01

Background Tobacco industry documents provide a unique opportunity to explore the role transnational corporations (TNCs) played in shaping the poor outcomes of privatisation in the former Soviet Union (FSU). This paper examines British American Tobacco's (BAT's) business conduct in Uzbekistan where large‐scale smuggling of BAT's cigarettes, BAT's reversal of tobacco control legislation and its human rights abuses of tobacco farmers have been documented previously. This paper focuses, instead, on BAT's attitude to competition, compares BAT's conduct with international standards and assesses its influence on the privatisation process. Methods Analysis of BAT documents released through litigation. Results BAT secured sole negotiator status precluding the Uzbekistan government from initiating discussions with other parties. Recognising that a competitive tender would greatly increase the cost of investment, BAT went to great lengths to avoid one, ultimately securing President Karimov's support and negotiating a monopoly position in a closed deal. It simultaneously secured exclusion from the monopolies committee, ensuring freedom to set prices, on the basis of a spurious argument that competition would exist from imports. Other anticompetitive moves comprised including all three plants in the deal despite intending to close down two, exclusive dealing and implementing measures designed to prevent market entry by competitors. BAT also secured a large number of exemptions and privileges that further reduced the government's revenue both on a one‐off and ongoing basis. Conclusions BAT's corporate misbehaviour included a wide number of anticompetitive practices, contravened Organisation of Economic Cooperation and Development's and BAT's own business standards on competition and restricted revenue arising from privatisation. This suggests that TNCs have contributed to the failure of privatisation in the FSU. Conducting open tenders and using enforceable codes to regulate corporate conduct would help deal with some of the problems identified. PMID:17652239

A new inequality? Privatisation, urban bias, migration and medical tourism.

PubMed

Connell, John

2011-01-01

Access to health care in developing countries, the main destinations of medical tourists, is notoriously uneven, and often becoming more so. Medical tourism, urban bias and privatisation have combined to exacerbate this trend. This is exemplified in both Thailand and India, where regional areas have been disadvantaged by the migration of health-care workers to hospitals focusing on medical tourism, neo-liberal national financial provision for medical tourism (and related tourism campaigns) and evidence of trickle-down gains is lacking. Medical tourism challenges rather than complements local health care providers, distorts national health care systems, and raises critical national economic, ethical and social questions.

Ownership, control, and contention: challenges for the future of healthcare in Malaysia.

PubMed

Chee, Heng Leng

2008-05-01

The recent history of healthcare privatisation and corporatisation in Malaysia, an upper middle-income developing country, highlights the complicit role of the state in the rise of corporate healthcare. Following upon the country's privatisation policy in the 1980s, private capital made significant inroads into the healthcare provider sector. This paper explores the various ownership interests in healthcare provision: statist capital, rentier capital, and transnational capital, as well as the contending social and political forces that lie behind state interests in the privatisation of healthcare, the growing prominence of transnational activities in healthcare, and the regional integration of capital in the healthcare provider industry. Civil society organizations provide a small but important countervailing force in the contention over the future of healthcare in the country. It is envisaged that the healthcare financing system will move towards a social insurance model, in which the state has an important regulating role. The important question, therefore, is whether the Malaysian government, with its vested interests, will have the capacity and the will to play this role in a social insurance system. The issues of ownership and control have important implications for governance more generally in a future healthcare system.

Cost of privatisation versus government alcohol retailing systems: Canadian example.

PubMed

Popova, Svetlana; Patra, Jayadeep; Sarnocinska-Hart, Anna; Gnam, William H; Giesbrecht, Norman; Rehm, Jürgen

2012-01-01

Alcohol retail monopolies have been established in many countries to restrict alcohol availability and thus, minimise alcohol-related harm.The aim of this study was to estimate the impact of the privatisation of alcohol sales on the burden and direct health-care, law enforcement costs and indirect costs (lost productivity due to disability or premature mortality) in Canada. Simulation modelling. International Guidelines for the Estimation of the Avoidable Costs of Substance Abuse were used. All burden and costs were compared with the baseline taken from the aggregate Cost Study on Substance Abuse in Canada 2002. If all Canadian provinces and territories were to privatise alcohol sales we assume that consumption would increase from 10% to 20% based on available Canadian literature. Under the 10% scenario the costs would increase from 6% ($828 million) and under the 20% scenario costs would increase 12% ($1.6 billion).This increase is substantially greater than the tax and mark-up revenue gained from increased sales,and represents a net loss. Alcohol-attributable burden and associated costs will increase markedly if all Canadian provinces and territories gave up the government alcohol retailing systems.For public health and economic reasons, governments should continue to have a strong role in alcohol retailing.

Commissions of audit in Australia: health system privatisation directives and civil conscription protections.

PubMed

Colton, Caroline; Faunce, Thomas

2014-03-01

The use of commissions of audit as vehicles to drive privatisation policy agendas in areas such as health service delivery has become popular with conservative federal and State governments. Such commissions have characteristically been established early in the terms of such governments with carefully planned terms of reference and membership. The policy directions they advocate, unlike election policies, have not come under the intense scrutiny, wide public debate or the opportunities for (dis)endorsement afforded by the electoral process. Governments do, however, anticipate and often accept recommendations from these reviews, and use them as justification to implement policy based on their findings. This highlights the power entrusted to review bodies and the risks to the public interest arising from limited public consultation. An example can be seen in the proposed privatisation of important aspects of Australia's public sector, particularly including those related to health systems delivery, currently entering a new iteration through the work of the National Commission of Audit appointed in October 2013. The NCA follows on from various State audit commissions which in recent years have directed the divestment of government responsibilities to the private and not-for-profit sectors. Through a discussion on the formation of policy frameworks by the NCA and the Queensland Commission of Audit, this column examines the ideological thrust of the commissions and how they synergise to produce a national directive on the future of public sector health services. The practical impacts on health service procurement and delivery in critical areas are examined, using the case of the federally contracted out medical service for asylum seekers and two hospitals in Western Australia, a State which is well advanced in the privatisation of public hospitals. The column then examines the release to the media early in the NCA's process of the submission to introduce a $6 general practitioner co-payment as a means of testing the response of the medical profession and public. The column also examines how the civil conscription clause in s 51 (xxiiiA) of the Australian Constitution may serve to protect practitioner and patient rights should some of these privatisation changes to Australia's health system be challenged in the High Court of Australia.

Disintegrated care: the Achilles heel of international health policies in low and middle-income countries

PubMed Central

Unger, Jean-Pierre; De Paepe, Pierre; Ghilbert, Patricia; Soors, Werner; Green, Andrew

2006-01-01

Abstract Purpose To review the evidence basis of international aid and health policy. Context of case Current international aid policy is largely neoliberal in its promotion of commoditization and privatisation. We review this policy's responsibility for the lack of effectiveness in disease control and poor access to care in low and middle-income countries. Data sources National policies, international programmes and pilot experiments are examined in both scientific and grey literature. Conclusions and discussion We document how health care privatisation has led to the pool of patients being cut off from public disease control interventions—causing health care disintegration—which in turn resulted in substandard performance of disease control. Privatisation of health care also resulted in poor access. Our analysis consists of three steps. Pilot local contracting-out experiments are scrutinized; national health care records of Colombia and Chile, two countries having adopted contracting-out as a basis for health care delivery, are critically examined against Costa Rica; and specific failure mechanisms of the policy in low and middle-income countries are explored. We conclude by arguing that the negative impact of neoliberal health policy on disease control and health care in low and middle-income countries justifies an alternative aid policy to improve both disease control and health care. PMID:17006553

Mortality in Transition: Study Protocol of the PrivMort Project, a multilevel convenience cohort study.

PubMed

Irdam, Darja; King, Lawrence; Gugushvili, Alexi; Azarova, Aytalina; Fazekas, Mihaly; Scheiring, Gabor; Stefler, Denes; Doniec, Katarzyna; Horvat, Pia; Kolesnikova, Irina; Popov, Vladimir; Szelenyi, Ivan; Marmot, Michael; Murphy, Michael; McKee, Martin; Bobak, Martin

2016-07-30

Previous research using routine data identified rapid mass privatisation as an important driver of mortality crisis following the collapse of Communism in Central and Eastern Europe. However, existing studies on the mortality crisis relying on individual level or routine data cannot assess both distal (societal) and proximal (individual) causes of mortality simultaneously. The aim of the PrivMort Project is to overcome these limitations and to investigate the role of societal factors (particularly rapid mass privatisation) and individual-level factors (e.g. alcohol consumption) in the mortality changes in post-communist countries. The PrivMort conducts large-sample surveys in Russia, Belarus and Hungary. The approach is unique in comparing towns that have undergone rapid privatisation of their key industrial enterprises with those that experienced more gradual forms of privatisation, employing a multi-level retrospective cohort design that combines data on the industrial characteristics of the towns, socio-economic descriptions of the communities, settlement-level data, individual socio-economic characteristics, and individuals' health behaviour. It then incorporates data on mortality of different types of relatives of survey respondents, employing a retrospective demographic approach, which enables linkage of historical patterns of mortality to exposures, based on experiences of family members. By May 2016, 63,073 respondents provided information on themselves and 205,607 relatives, of whom 102,971 had died. The settlement-level dataset contains information on 539 settlements and 12,082 enterprises in these settlements in Russia, 96 settlements and 271 enterprises in Belarus, and 52 settlement and 148 enterprises in Hungary. In addition to reinforcing existing evidence linking smoking, hazardous drinking and unemployment to mortality, the PrivMort dataset will investigate the variation in transition experiences for individual respondents and their families across settlements characterized by differing contextual factors, including industrial characteristics, simultaneously providing information about how excess mortality is distributed across settlements with various privatization strategies.

Privatisation.

ERIC Educational Resources Information Center

Seales, Mike

1986-01-01

Reviews various aspects of the sale of state-owned assets to the private sector. Lists assets sold and those still awaiting sale. Reviews who benefits from this policy, and provides discussion questions and follow up work for secondary students. (Author/JDH)

Changes in health care utilisation following a reform involving choice and privatisation in Swedish primary care: a five-year follow-up of GP-visits

PubMed Central

2013-01-01

Background The organisation of Swedish primary health care has changed following introduction of free choice of provider for the population in combination with freedom of establishment for private primary care providers. Our aim was to investigate changes in individual health care utilisation following choice and privatisation in Swedish primary care from an equity perspective, in subgroups defined by age, gender and family income. Methods The study is based on register data years 2007 – 2011 from the Skåne Regional Council (population 1.2 million) regarding individual health care utilisation in the form of visits to general practitioner (GP). Health utilisation data was matched with data about individual’s age, gender and family income provided by Statistics Sweden. Multilevel, logistic regression models were constructed to analyse changes in health utilisation in different subgroups and the probability of a GP-visit before and after reform. Results Health care utilisation in terms of both number of individuals that had visited a GP and number of GP-visits per capita increased in all defined subgroups, but to a varying degree. Multilevel logistic regression showed that individuals of both genders aged above 64 and belonging to a family with an income above median had more advantage of the reform, OR 1.25-1.29. Conclusions Reforms involving choice and privatisation in Swedish primary health care improved access to GP-visits generally, but more so for individuals belonging to a family with income above the median. PMID:24171894

Schooling for Twenty-First-Century Socialism: Venezuela's Bolivarian Project

ERIC Educational Resources Information Center

Griffiths, Tom G.

2010-01-01

The global dominance of neoliberal policy prescriptions in recent decades has been well documented, with particular implications for educational systems. These include reduced public expenditure and provision, the promotion of individual (parental) choice, competition, increased user-pays and the privatisation of education. Against this…

Responsibilising Parents: The Nudge towards Shadow Tutoring

ERIC Educational Resources Information Center

Doherty, Catherine; Dooley, Karen

2018-01-01

This article considers moral agendas projected onto parents that mobilise them to supplement school literacy education with private tutoring. The theoretical frame draws on the concepts of responsibilisation as emerging market-embedded morality, 'nudge' social policies, edu-business and hidden privatisation in education. This framing is applied to…

Collisions of Culture: Academic Culture in the Neoliberal University

ERIC Educational Resources Information Center

LeCompte, Margaret D.

2014-01-01

This article describes how different constituencies in a major research university tried to initiate change despite disagreements over common goals, norms and principles. The context was a culture war. The university administration wanted to impose a corporatising and privatising philosophy which it felt was crucial to preserving the university's…

Freedoms and Perils: Academy Schools in England

ERIC Educational Resources Information Center

Heilbronn, Ruth

2016-01-01

Can Dewey's Moral Principles in Education throw light on a contemporary policy issue in education, namely the privatisation of education through the establishment of academy schools in England? The article first considers what the policy entails, in terms of its conception of education as a market commodity. The next section suggests an…

The Regional Warning Center Darmstadt (from the 1960s until 1993)

NASA Astrophysics Data System (ADS)

Damboldt, Thomas

2018-04-01

The work and achievements of the Regional Warning Center Darmstadt at the Research Institute of the Deutsche Bundespost in Darmstadt, Germany, are briefly reviewed. After privatisation of the Deutsche Bundespost (now Deutsche Telekom) in 1993, research in HF propagation and hence the RWC was disbanded.

Globalisation and Higher Education Funding Policy Shifts in Kenya

ERIC Educational Resources Information Center

Wangenge-Ouma, Gerald

2008-01-01

This paper identifies, examines and discusses higher education funding policy shifts that have taken place in Kenya. The paper argues that even though Kenya's higher education funding policy shifts, from free higher education to cost-sharing, and privatisation and commercialisation, are (to a greater extent) products of the country's encounter…

Private Higher Education in Russia: Capacity for Innovation and Investment

ERIC Educational Resources Information Center

Geroimenko, Vladimir A.; Kliucharev, Grigori A.; Morgan, W. John

2012-01-01

This article considers the potential role of private institutions in the development of Russian higher education. After decades of a government centralised higher education system, there is a clear trend towards the privatisation of education institutions and the diversification of education practices. Some commentators consider this to indicate…

Agnosis in the University Workplace

ERIC Educational Resources Information Center

Whelan, Andrew

2016-01-01

One significant, tangible and interesting challenge for the privatised university is its impedance of particular forms of effective engagement and action in teaching and research, notably with respect to inequities in the broader social context, and the position of the university within that context. In the face of significant resource constraints…

Futures for Schooling in Australia: Nationalisation, Privatisation or Unification? Occasional Paper No. 13.

ERIC Educational Resources Information Center

Connors, Lyndsay

An analysis of Australia's two conflicting trends in school governance and their effectiveness in meeting two major educational challenges is the purpose of this paper. Nationalization, which refers to greater centralization and increased national regulation; and privatization, which refers to decentralization, deregulation, and increased local…

A Space for Memory

ERIC Educational Resources Information Center

Charman, Karen

2015-01-01

In this article I examine the possibilities of reparation in an era of privatisation and de-industrialisation. I examine the effect of a recent project Sunshine Memory Space, a space, designed to evoke memories of a de-industrialised urban Melbourne suburb Sunshine. This project offered the opportunity for the effects of industrial change to be…

Personalisation and the Education Commodity: A Meta-Ethnographic Analysis

ERIC Educational Resources Information Center

Beach, Dennis

2017-01-01

This article is based on a meta-ethnography of research about schools, school experiences and learning following the recent (post-market) introduction of personalisation policies in Swedish schools. It pays particular attention to issues of equity. Tensions between personalisation, privatisation and equity are discussed and it is noted that…

The Bologna Process and Private Providers

ERIC Educational Resources Information Center

Dima, Ana-Maria

2009-01-01

Privatisation in higher education is not a new phenomenon for Western European countries. Authors like Geiger (1986), Levy (2008) and Altbach (1999) made challenging predictions in the 1970s and early 1980s that the private sector would inexorably diminish in size and significance. These predictions were triggered by globalisation and the…

Outsourcing in Higher Education: The Known and Unknown about the Practice

ERIC Educational Resources Information Center

Wekullo, Caroline Sabina

2017-01-01

Outsourcing or privatising services in higher education is a common practice, but what do we really know about it? Is outsourcing effective? It is imperative that these questions be addressed since outsourcing is becoming a norm in higher education institutions. Scholars, institutional administrators and policymakers need to understand the…

Laboring to Relate: Neoliberalism, Embodied Policy, and Network Dynamics

ERIC Educational Resources Information Center

Ball, Stephen J.

2017-01-01

This paper builds on previous research (Ball, 2012, Ball & Junemann, 2012) to explore some aspects of the embodiment of policy. The author draws on Larner and Laurie's (2010) work on technocratic expertise and how, as she puts it, "privatisation ideas and practices are transferred in embodied forms," and in particular her argument…

Physical Education PLC: Neoliberalism, Curriculum and Governance. New Directions for PESP Research

ERIC Educational Resources Information Center

Evans, John; Davies, Brian

2014-01-01

How might Physical Education and Sport Pedagogy (PESP) communities in the UK, Europe, Australasia and elsewhere go about researching the implications of neoliberalism and increasing privatisation of Education for the entitlements of young people to a common, comprehensive, high quality, equitable Physical Education (PE)? Our analyses suggest that…

Public by Day, Private by Night: Examining the Private Lives of Kenya's Public Universities

ERIC Educational Resources Information Center

Wangenge-Ouma, Gerald

2012-01-01

This article examines the emergence of the public university in Kenya as a key provider of private higher education, characterised mainly by the phenomenon of the "private public university student." It probes the broader socio-economic reforms circumscribing the privatisation of Kenya's public universities and the local and global…

Moral Aspects of Therapeutic Education: A Case Study of Life Competence Education in Swedish Education

ERIC Educational Resources Information Center

Aldenmyr, Sara Irisdotter

2012-01-01

Educational philosophers and sociologists have pointed out the potential risks of an educational trend of therapy, which seems to have connotations with Western macro-discourses of individualisation, popularised psychology and privatisation of the public room. The overall purpose of this article is to discuss potential risks and possibilities…

When Marketisation and Privatisation Clash with Socialist Ideals: Educational Inequality in Urban China

ERIC Educational Resources Information Center

Mok, Ka Ho; Wong, Yu Cheung; Zhang, Xiulan

2009-01-01

In the last two decades, China's education has experienced significant transformations and restructuring on account of privatization and marketization. Unlike the Mao era when the state assumed the major responsibilities in financing and providing education, individuals and families have now to bear increasing financial burdens in paying for…

Bullying: An Element Accentuating Social Segregation

ERIC Educational Resources Information Center

Sreekanth, Y.

2009-01-01

Universalisation of elementary education is an important goal for a democratic and welfare state like India. In the post-reform period of 1990s, the rapid processes of liberalisation, privatisation and globalisation have brought in a shift from caste to class divisions not only across society, but also even among schools catering to different…

Private Actors and the Right to Education

ERIC Educational Resources Information Center

Balsera, Maria Ron; Dorsi, Delphine; Termes, Andreu; Bonal, Xavier; Verger, Antoni; Gonzalez Diaz, Javier

2016-01-01

Privatisation of education is on the rise, being offered as the best alternative to achieve universal education and improve its quality and cost-efficiency. However, the benefits of the entry of private providers in education are highly controversial and tend to be judged in terms of market criteria such as choice and efficiency, neglecting the…

An Expanded Model of Careers Professional Identity: Time for Change?

ERIC Educational Resources Information Center

Hughes, Deirdre

2013-01-01

The careers profession is challenged significantly by government, employers and potential consumers to articulate its added value to society. Neoliberal discourses such as privatisation, deregulation, flexicurity and a self-help culture are impacting upon arrangements for the design and delivery of all-age careers provision across the UK. In this…

Privatisation of Public Education? The Emergence of Independent Upper Secondary Schools in Sweden

ERIC Educational Resources Information Center

Arreman, Inger Erixon; Holm, Ann-Sofie

2011-01-01

This article explores the upper secondary (or post-16) school market. The study on which it is based, funded by the Swedish Research Council, was entitled "Upper-secondary education as a market". Empirical data include official statistics, policy documents, school publications, company reports and school visits. Printed and other news…

NAPLAN and the Role of Edu-Business: New Governance, New Privatisations and New Partnerships in Australian Education Policy

ERIC Educational Resources Information Center

Hogan, Anna

2016-01-01

This paper provides a critical analysis of the edu-businesses currently working in partnership with the Australian Curriculum, Assessment and Reporting Authority to deliver the Commonwealth government policy initiative of the National Assessment Program--Literacy and Numeracy (NAPLAN). These emerging public--private partnerships (PPPs) exemplify…

Japan's Higher Education Incorporation Policy: A Comparative Analysis of Three Stages of National University Governance

ERIC Educational Resources Information Center

Hanada, Shingo

2013-01-01

A number of countries with public higher education systems have implemented privatisation policies. In Japan, the national government introduced the National University Corporation Act (NUCA) in 2004 and changed the legal status of national universities from that of government-owned public institutions to independent administrative agencies. Its…

Mr. Gove's Road to Privatisation: Forcing Primary Schools to Become Academies

ERIC Educational Resources Information Center

Mansfield, Melian

2012-01-01

Not content with the response to his offer to outstanding schools to become academies, Michael Gove's next move has been to force schools to become academies. Resistance from parents and the local community has made no difference. This article explains what happened in Haringey and how undemocratic the whole process has been.

The Growth of Private Education in Argentina: Evidence and Explanations

ERIC Educational Resources Information Center

Narodowski, Mariano; Moschetti, Mauro

2015-01-01

During the second half of the twentieth century, the Argentine education system went through a clear process of privatisation expressed in the increasing enrolment and state funding of the private sector. Especially in the 1990s, when the country implemented neoliberal economic policies, the academic literature had found in neoliberalism (in…

Liberalisation, Privatisation, Modernisation, and Schooling in India: An Interview with Krishna Kumar

ERIC Educational Resources Information Center

LaDousa, Chaise

2007-01-01

In 2004, India's Congress Party wrested control of parliament from the Hindu nationalist Bharatiya Janata Party. I present below an interview conducted with Professor Krishna Kumar, Delhi University, the new Government's choice for Director of the National Council of Educational Research and Training. Professor Kumar discusses the ways that…

Private Schooling in Less Economically Developed Countries: Asian and African Perspectives

ERIC Educational Resources Information Center

Srivastava, Prachi, Ed.; Walford, Geoffrey, Ed.

2007-01-01

The increased marketisation and privatisation of schooling in economically developing countries struggling to achieve Education for All and Millennium Development Goals warrants a focused examination of the phenomenon. However, there is little work on the nature and extent of private provision in countries that, on the one hand, are striving to…

What Price Free Schools? The Continued Insidious Privatisation of UK State Education

ERIC Educational Resources Information Center

Kitchener, David

2013-01-01

A review of American charter schools and Swedish free-school research is outlined, providing strong evidence that both free-market models are flawed in their claims of enhancing young people's educational experience. A substantial body of work is included that strongly indicates charter and free schools increase social segregation and lower…

School Evaluation and Consultancy in Italy. Sliding Doors towards Privatisation?

ERIC Educational Resources Information Center

Serpieri, Roberto; Grimaldi, Emiliano; Vatrella, Sandra

2015-01-01

This article focuses on the increasing centrality assumed by non-educational consultants in the processes of policy design and knowledge production about education in Italy. We identify the recent establishment of the National School Evaluation System as a key policy trajectory and we focus on the case of the last policies to evaluate Italian…

Challenging Educational Injustice: "Grassroots" Privatisation in South Asia and Sub-Saharan Africa

ERIC Educational Resources Information Center

Tooley, James

2013-01-01

The phenomenon of low-cost private schools "mushrooming" in poor areas of sub-Saharan Africa and South Asia, and elsewhere, is now well-documented. Findings from research by the author's teams and others show that these schools are serving a majority (urban and peri-urban) or significant minority (rural) of the poor, including…

Global Agenda, Local Responses: Changing Education Governance in Hong Kong's Higher Education

ERIC Educational Resources Information Center

Chan, David K. K.

2007-01-01

Hong Kong has undergone a series of educational reforms since the mid 1990s in response to the tidal wave of globalisation. This article tries to examine the recent education reforms in Hong Kong's higher education within the global context, by putting into perspective a discussion of its policy implications of marketisation, privatisation and…

Educating Ethics: The Probity of School Governance

ERIC Educational Resources Information Center

Gann, Nigel

2014-01-01

The privatisation of state education in a variety of ways has introduced a range of risks to school governance and management which have not previously existed in the public service. State-funded education is in danger of losing its standing on the moral high ground as a public good delivered almost exclusively by individuals committed to ethics…

"The Centre Is My Business": Neo-Liberal Politics, Privatisation and Discourses of Professionalism in New Zealand

ERIC Educational Resources Information Center

Duhn, Iris

2010-01-01

Over the past decade, professionalism has become a keyword in early childhood education in New Zealand. The emphasis on "professionalism" in education often refers to increased accountability and outcome-focused approaches to teaching. The push to managerial performativity as a new hallmark of professionalism has led to arguments that…

The Struggle for the Soul of Teaching and Teacher Education in the USA

ERIC Educational Resources Information Center

Zeichner, Ken

2014-01-01

This paper discusses changes over the last 40 years in teacher education in the USA that have resulted in two very different strategies for improving the preparation of teachers and in substantial inequities in the distribution of the teaching force. The strengths and limitations of promoting greater deregulation and privatisation versus investing…

"Intensive Mothering" in the Early Years: The Cultivation and Consolidation of (Physical) Capital

ERIC Educational Resources Information Center

Stirrup, Julie; Duncombe, Rebecca; Sandford, Rachel

2015-01-01

Growing pressure on parents to equip their children with the skills required for future success, coupled with an increased focus on providing quality learning experiences in the early years, has contributed to an upsurge in the enrolment of young children in formal (often privatised) activities. Moreover, in response to growing societal concerns…

Inspection Judgements on Urban Schools: A Case for the Defence

ERIC Educational Resources Information Center

Gorton, Julian; Williams, Melanie; Wrigley, Terry

2014-01-01

This article is co-authored by two urban school Heads in the north of England with the support of an academic partner. The article begins with the phenomenon of official judgements of urban schools, made by the Office for Standards in Education, Children's Services and Skills, a semi-privatised and supposedly independent arm of government. The…

Improving Schools in Poor Areas: It's Not about the Organisation, Structures and Privatisation, Stupid!

ERIC Educational Resources Information Center

Smyth, John

2014-01-01

In this article, the author presents a review of his extended research engagement with disadvantaged young people and their education. He challenges the dominant neoliberal model of school reform based on business values and the "managerial school" as alien to educational values. He introduces various stages of research he and his…

Water Security and Farming Systems: Implications for Advisory Practice and Policy-Making

ERIC Educational Resources Information Center

Nettle, Ruth; Paine, Mark

2009-01-01

Water issues are a feature of public debate in Australia. The increasing privatisation of water and changes to water allocation systems are resulting in change, often referred to as water "wars" (de Villiers, 1999). The Australian dairy industry uses 25% of the surface irrigation water in Australia. How does a rural industry like…

Academies in England and Independent Schools ("Fristående Skolor") in Sweden: Policy, Privatisation, Access and Segregation

ERIC Educational Resources Information Center

West, Anne

2014-01-01

Academies (and free schools) in England and independent grant-aided schools, "fristående skolor" (or "friskolor"), in Sweden have been the subject of much academic debate, but there is a paucity of comparative research relating to policy development or outcomes. This paper adopts a comparative perspective, outlining the…

Privatising Public Schooling in Post-Apartheid South Africa: Equity Considerations

ERIC Educational Resources Information Center

Motala, Shireen

2009-01-01

Through an analysis of quantitative and qualitative data on school funding in South Africa, this paper aims to analyse the user fee policy option in public schooling in South Africa. Debate is ongoing about the role of private input into public schooling and whether this practice affects access (and the constitutional right) to basic education,…

Neoliberal Universities and the Education of Arts, Humanities and Social Sciences in Bangladesh

ERIC Educational Resources Information Center

Anwaruddin, Rdar M.

2013-01-01

In this article, the author explores the neoliberal impacts on higher education in Bangladesh, how market-driven policies might limit the education of arts, humanities and social sciences, and whether or not this phenomenon may have consequences for the future of democracy in the country. First, the author focuses on the privatisation of higher…

Mass Education, Privatisation, Compensation and Diversification: Issues on the Future of Public Education in Mexico.

ERIC Educational Resources Information Center

Martin, Christopher; Solorzano, Cristian

2003-01-01

Claims that public education in Mexico is in severe crisis. Indicates the wealthy have opted out of public education and the poor are dropping out. Argues that reforms to address poor quality and inequalities are being sidestepped. Proposes a more inclusive educational approaches to provide quality education for all. (CAJ)

Childcare in the Netherlands: Lessons in Privatisation

ERIC Educational Resources Information Center

Akgunduz, Yusuf Emre; Plantenga, Janneke

2014-01-01

In 2005 the Child Care Act was introduced in the Netherlands. The explicit objective of the childcare reform has been to stimulate the operation of market forces so that childcare services are provided in an efficient way. The change towards a demand-driven financing system implies that there is no longer public provision of childcare services in…

HPE in Aotearoa New Zealand: The Reconfiguration of Policy and Pedagogic Relations and Privatisation of Curriculum and Pedagogy

ERIC Educational Resources Information Center

Penney, Dawn; Petrie, Kirsten; Fellows, Sam

2015-01-01

This paper centres on research that investigated the contemporary policy, curriculum and pedagogical landscape of Health and Physical Education (HPE) in Aotearoa New Zealand, in the light of increasing impressions that provision was moving to an "open market" situation. Publicly available information sourced via the Internet was used to…

Against Neoliberal Assault on Education in India: A Counternarrative of Resistance

ERIC Educational Resources Information Center

Kumar, Ravi

2008-01-01

The Indian State has been demonstrating its unwavering commitment to private capital and its neoliberal offensive. The education and health sector reflect its anti-people orientation along with other anti-working class measures such as the doing away with old pension scheme, privatisation of airports, neglect of farmers resulting in over 1.5 lakh…

Turning around Low-Performing Private Universities in China: A Perspective of Organisational Ecology

ERIC Educational Resources Information Center

Li, Xiaofan

2012-01-01

While China has a long history of private institutions of higher learning, they disappeared almost entirely after the founding of the People's Republic of China in 1949 and did not re-emerge until the 1980s. Their reappearance is one of the ramifications of economic marketisation and privatisation in China. But private higher education…

Austerity-Privacy & Fossil Fuel Divestment Activism at Canadian Universities

ERIC Educational Resources Information Center

McGray, Robert; Turcotte-Summers, Jonathan

2017-01-01

Austerity has signalled several political and cultural changes in the past ten years. One frequent and highly criticised change has been the increasing privatisation that has occurred as part of the agenda. This has occurred in most levels of formal education. One related, but under-investigated, aspect of austerity has been the feature of privacy…

What if Privatising Higher Education Becomes an Issue? The Case of Chile and Mexico

ERIC Educational Resources Information Center

Gregorutti, Gustavo; Espinoza, Oscar; González, Luis Eduardo; Loyola, Javier

2016-01-01

Over the last 30 years, Chile and Mexico have been implementing neoliberal policies to reform their higher education systems. This report compares the development and impact of those policies within three main areas in both countries, namely: (1) trends and characteristics of the growing private higher education sector, (2) commercialisation and…

"They Know They're Getting the Best Knowledge Possible": Locating the Academic in Changing Knowledge Economies

ERIC Educational Resources Information Center

Gard, Michael

2015-01-01

As the discussant of this special issue, I focus on two related ideas: choice and self-interest. First, I explore the idea of choice and its relevance within research that concerns itself with a heavily loaded concept like "social justice". My proposal here is that future scholarship that explores the consequences of privatised health…

The Shifting Politics of the Private in Education: Debates and Developments in Researching Private School Outreach in India

ERIC Educational Resources Information Center

Ashley, Laura Day

2013-01-01

This paper addresses the politics of researching private education with special reference to the Indian context. Due to a recent increase in privatised forms of education globally and recognition of the private sector by governments, international agencies and researchers as a policy and academic interest, this is shifting ground. The evolving…

Education Management Organisations and the Privatisation of Public Education: A Cross-National Comparison of the USA and Britain.

ERIC Educational Resources Information Center

Fitz, John; Beers, Bryan

2002-01-01

British government policies promoting public-private partnerships enabled the privatization of failing schools. In the U.S., the private sector has drawn upon a political network of well-financed institutions to advance privatized education, most recently among charter schools. Privatization has not yet been very successful, but promises to be…

Credential Inflation and Employment in "Universal" Higher Education: Enrolment, Expansion and (In)Equity via Privatisation in Japan

ERIC Educational Resources Information Center

Kariya, Takehiko

2011-01-01

The emergence of a global knowledge-based economy has given rise to drastic changes in both higher education and employment. On one hand, governments in advanced societies have launched policies to expand higher education to compete internationally in educating and attracting highly skilled workers. At the same time, both global economic…

Transforming of Educational Institutions after GATS--Consequences in Social Relations as Corporation, Competition and State Regulation

ERIC Educational Resources Information Center

Jensen, Knud; Michel-Schertges, Dirk

2010-01-01

This article presents aspects of the regulatory reform work in public sectors was guided by the OECD in the 1990's manifested in GATS ( 1995 ) strategically planned by and through the Bologna Process and eagerly elaborated by boards and power holders of universities and university colleges. The tendency is privatisation which has as a consequence…

Education Maintenance Organisations and the Privatisation of Public Education: A Cross National Comparison of the USA and the UK.

ERIC Educational Resources Information Center

Fitz, John; Beers, Bryan

Although making profits from public education is not new, what is new is the recent development of corporate interest in taking over the organization and management of public education specifically for profit-making purposes. The study reported in this paper focuses on the intrusion of "big business" into an educational arena that…

Transforming the Public Provision of Training: Reorganisation or Privatisation? Long-Term Changes in Sweden and the Netherlands. CEDEFOP Discussion Dossier.

ERIC Educational Resources Information Center

Brandsma, Jittie; Noonan, Richard; Westphalen, Sven-Age

The public sector is becoming less concerned with who is providing a given service but more concerned about the quality, reliability, accessibility, and price of the service. In vocational education and training (VET), one consequence of this transformation is that the various public stakeholders involved with funding, purchasing, and providing…

The Ideological Construction of a New Form of Digital Exclusion: Computer Science as Latin or Total Deus Ex Machina?

ERIC Educational Resources Information Center

Rudd, Tim

2013-01-01

This paper offers a critical analysis of the UK coalition Government's educational computing policies. It argues that such policies must be viewed in relation to the broader ideological intent underpinning their development and the neo liberal orientation that seeks to further privatise and marketise education. In examining the related…

All the Lonely People: The Struggle for Private Meaning and Public Purpose in Education

ERIC Educational Resources Information Center

Goodson, Ivor

2007-01-01

This paper argues that the "new world order" achieved at the end of the cold war is in crisis, not generated from the threat of "war" between Christian and Islamic worlds but from "within" western societies, specifically from the growing commercialisation and "privatisation" of social and community life which has uncoupled the systems and…

Distinct Pathways: Tracing the Origins and History of Private Higher Education in South Africa

ERIC Educational Resources Information Center

Kruss, Glenda

2005-01-01

In much of the literature on the privatisation of higher education, it appears as both a relatively recent phenomenon, and one that is homogenous in its causes, forms and effects. Drawing on the case of South Africa, this study challenges these assumptions, suggesting that without a sense of the long history of private provision and its interwoven…

Public Private Business Models for Defence Acquisition

DTIC Science & Technology

2014-04-30

Initiatives (PFIs), franchising , concessions, Joint Ventures (JVs) and outright privatisation (Grimsey & Lewis, 2004, p. 54); Off-The-Shelf (OTS...Design (D), Finance (F), Buy (B)/Rent (R)/Lease (L), Construct (C) (Build (B)), Develop (D), Own (O), Operate (O), Manage (M), Maintain (M) and Transfer...Logistics Logistics Infrastructure, and Locistics Other affected None None Equipment Eql..ipment OLoOs Finance- Buy - Desig~ - Buy - Private sector

Nepali Private Schools and Tolerated Illegality: A Foucauldian Analysis of Privatisation of Education in Nepal

ERIC Educational Resources Information Center

Sharma Poudyal, Chandra

2017-01-01

The Education Act 1971 is the main policy document under which schools in Nepal are operated. With the change in political regime, this policy has been amended as per the ideology of the incoming regime. Although private schools started to show their influence in Nepal in the late 1980s, excessive growth of private schools began with the…

Globalisation and Privatisation: The Impact on Childcare Policy and Practice. Working Papers in Early Childhood Development, No. 38

ERIC Educational Resources Information Center

Vanderbroeck, Michel

2006-01-01

This paper concentrates on the impact of globalisation on childcare since the late 1970s, particularly in the last two decades. It looks at how our views about children, parents and public services have changed as a result. In particular, the paper examines the case in Belgium, where the consequences of globalisation are also analyzed in terms of…

Nigeria’s Roadmap for Power Sector Reform -- Will It Succeed?

DTIC Science & Technology

2012-11-02

transmission, distribution), fix fuel-to-power constraints, 18 clean up and strengthen regulatory structure , and develop human capital. Additionally, the plan...27 Newswatch Magazine, “A Postponed New Day.” 28 Oxford Analytica Daily Brief Service, “Nigeria: Tariff changes will ease power privatisation...pricing structure , improving infrastructure, reducing or eliminating flaring, and resolving the fuel-to-power issues for the power sector. However, as

Academic freedom and global health.

PubMed

Evans, Donald

2012-02-01

There is a tension between the preservation of academic freedom and the economic context in which the university currently finds itself. This tension embodies serious threats to global health as a result of three overlapping phenomena which impede the production and diffusion of valuable knowledge about health. These phenomena, the privatisation, commercialisation and instrumentalisation of knowledge are identified and examined in this paper in relation to human rights and international morality.

The Testimony of Neoliberal Contradiction in Education Choice and Privatisation in a Poor Country: The Case of a Private, Undocumented Rural Primary School in Uganda

ERIC Educational Resources Information Center

Mayengo, Nathaniel; Namusoke, Jane; Dennis, Barbara

2015-01-01

With international momentum to achieve "Education for All" by 2015, global attention is being paid to those parts of the world where mass formal primary schooling is relatively new. Uganda is such a place. In the context of ethnographic fieldwork at a poor, undocumented, private primary school in rural Uganda, parents were interviewed in…

[Success factors in the German healthcare market. Hospitals between cluster formation and privatisation].

PubMed

Schmidt, C; Möller, J; Hardt, F; Gabbert, T; Bauer, M

2007-12-01

The German hospital market is in a state of transition due to the introduction of diagnosis-related groups (DRGs) and a constant change of the reimbursement, demographic, economical and technical framework. To date mainly public hospitals were bought by private hospital chains, but this trend has currently reached university hospitals. During recent months a consolidation within the market of private hospitals took place, while new market players such as foreign hospital chains, US universities and private equity firms emerged on the scene. The target of the privatisation process, however, turns more and more to larger hospitals. Central key values remain the cluster formation and centralisation of key competences such as food supply, purchasing and pharmacy. Within a network of clinics the representation of different care components (basic, regular and maximum care provider) and care levels (low, normal, intermediate and intensive care) remain important elements of efficient hospital management. Today, successful hospital operation is based on the successful competition for patients and even more for qualified staff. In this aspect, university hospitals could play a decisive role, because of their combination of maximum acute care provision and educational mandate. No such network has yet been formed due to the different interests of the owners, however, given the new market situation this alternative concept could become more attractive.

Choice and privatisation in Swedish primary care.

PubMed

Anell, Anders

2011-10-01

In 2007, a new wave of local reforms involving choice for the population and privatisation of providers was initiated in Swedish primary care. Important objectives behind reforms were to strengthen the role of primary care and to improve performance in terms of access and responsiveness. The purpose of this article was to compare the characteristics of the new models and to discuss changes in financial incentives for providers and challenges regarding governance from the part of county councils. A majority of the models being introduced across the 21 county councils can best be described as innovative combinations between a comprehensive responsibility for providers and significant degrees of freedom regarding choice for the population. Key financial characteristics of fixed payment and comprehensive financial responsibility for providers may create financial incentives to under-provide care. Informed choices by the population, in combination with reasonably low barriers for providers to enter the primary care market, should theoretically counterbalance such incentives. To facilitate such competition is indeed a challenge, not only because of difficulties in implementing informed choices but also because the new models favour large and/or horizontally integrated providers. To prevent monopolistic behaviour, county councils may have to accept more competition as well as more governance over clinical practice than initially intended.

Sell, Sell, Sell or Learn, Learn, Learn? The EdTech Market in New Zealand's Education System--Privatisation by Stealth?

ERIC Educational Resources Information Center

Wright, Noeline; Peters, Michael

2017-01-01

An article in "The Atlantic" "Quantifying the Ed-Tech Market" (2015), which draws on a review by the Education Technology Industry Network, reports that the U.S. Ed-tech market totalled $8.38 billion in the 2012-2013 academic year, which is up from $7.9 billion the year before, and up 11.7 per cent from 2009. K-12 online course…

Harnessing the privatisation of China's fragmented health-care delivery.

PubMed

Yip, Winnie; Hsiao, William

2014-08-30

Although China's 2009 health-care reform has made impressive progress in expansion of insurance coverage, much work remains to improve its wasteful health-care delivery. Particularly, the Chinese health-care system faces substantial challenges in its transformation from a profit-driven public hospital-centred system to an integrated primary care-based delivery system that is cost effective and of better quality to respond to the changing population needs. An additional challenge is the government's latest strategy to promote private investment for hospitals. In this Review, we discuss how China's health-care system would perform if hospital privatisation combined with hospital-centred fragmented delivery were to prevail--population health outcomes would suffer; health-care expenditures would escalate, with patients bearing increasing costs; and a two-tiered system would emerge in which access and quality of care are decided by ability to pay. We then propose an alternative pathway that includes the reform of public hospitals to pursue the public interest and be more accountable, with public hospitals as the benchmarks against which private hospitals would have to compete, with performance-based purchasing, and with population-based capitation payment to catalyse coordinated care. Any decision to further expand the for-profit private hospital market should not be made without objective assessment of its effect on China's health-policy goals. Copyright © 2014 Elsevier Ltd. All rights reserved.

Selim v Lele and the civil (industrial) conscription prohibition: constitutional protection against federal legislation controlling or privatising Australian public hospitals.

PubMed

Faunce, Thomas

2008-08-01

Selim v Lele (2008) 167 FCR 61; [2008] FCAFC 13 was a decision of the Federal Court which interpreted s 51(xxiiiA) of the Australian Constitution. This section accords the federal government, among other things, power to make laws with respect to the provision of "medical and dental services (but not so as to authorise any form of civil conscription)". The Federal Court decided that the phrase "civil conscription" was analogous to "industrial conscription". In that sense the Federal Court held that the prohibition was designed to preserve the employment autonomy of Australian medical practitioners or dentists, preventing federal laws that required them, either expressly or by practical compulsion, to work for the federal government or any industrial employer nominated or permitted by the federal government. The specific question in Selim v Lele was whether the imposition of standards and prohibition of "inappropriate practice" under the Health Insurance Act 1973 (Cth), ss 10, 20, 20A and Pt VAA, amounted to civil conscription. The court held they did not. The Federal Court also discussed in that context the sufficiency of "practical compulsion" in relation to the s 51(xxxiiiA) prohibition, The constitutional prohibition on "any form" of civil conscription provides one of the few rights protections in the Australian Constitution and may have an important role to play in shaping the limits of health care system privatisation in Australia.

The consequences of health service privatisation for equality and equity in health care in South Africa.

PubMed

Price, M

1988-01-01

The trend towards the privatisation of health services in South Africa reflects a growing use of private sources of finance and the growing proportion of privately owned fee-for-service providers and facilities. Fee-for-service methods of reimbursement aggravate the geographical maldistribution of personnel and facilities, and the competition for scarce personnel resources aggravates the difference in the quality of the public and private services. Thus the growth in demand for these types of providers may be expected to increase inequality of access in these two respects. The potential expansion of medical scheme coverage is shown to be limited to well under 50% of the population, leaving the majority of the population without access to private sector health care. Even for members of the medical schemes, benefits are linked to income, thus clashing with the principle of equal care for equal need. The public funds needed to overcome financial obstacles to access to private providers could be more efficiently deployed by financing publicly owned and controlled health services directly. Taxation also offers the most equitable method of financing health services. Finally, attention is drawn to the dilemma resulting from the strengthening of the private health sector; while in the short term this can offer better care to more people on a racially non-discriminatory basis, in the long term, health care for the population as a whole may become more unequal and for those dependent on the public sector it may even deteriorate.

The effect of healthcare delivery privatisation on avoidable mortality: longitudinal cross-regional results from Italy, 1993-2003.

PubMed

Quercioli, Cecilia; Messina, Gabriele; Basu, Sanjay; McKee, Martin; Nante, Nicola; Stuckler, David

2013-02-01

During the 1990s, Italy privatised a significant portion of its healthcare delivery. The authors compared the effectiveness of private and public sector healthcare delivery in reducing avoidable mortality (deaths that should not occur in the presence of effective medical care). The authors calculated the average rate of change in age-standardised avoidable mortality rates in 19 of Italy's regions from 1993 to 2003. Multivariate regression models were used to analyse the relationship between rates of change in avoidable mortality and levels of spending on public versus private healthcare delivery, controlling for potential demographic and economic confounders. Greater spending on public delivery of health services corresponded to faster reductions in avoidable mortality rates. Each €100 additional public spending per capita on NHS delivery was independently associated with a 1.47% reduction in the rate of avoidable mortality (p=0.003). In contrast, spending on private sector services had no statistically significant effect on avoidable mortality rates (p=0.557). A higher percentage of spending on private sector delivery was associated with higher rates of avoidable mortality (p=0.002). The authors found that neither public nor private sector delivery spending was significantly associated with non-avoidable mortality rates, plausibly because non-avoidable mortality is insensitive to healthcare services. Public spending was significantly associated with reductions in avoidable mortality rates over time, while greater private sector spending was not at the regional level in Italy.

The future of urban water services in Latin America.

PubMed

Wade, Jeffry S

2012-01-01

In recent decades, problems with the provision of drinking water and sanitation services around the world have increasingly been addressed by attempts at privatisation, recasting clean water as an essentially economic, rather than public, good. This approach gained particular acceptance in Latin America, but with limited success. In order to address the full range of social, economic and environmental values necessary to sustain water resources over time, public and governmental involvement in establishing integrated water management, pursuing ‘soft path’ approaches, assuring stakeholder input and setting policy will be essential to the process.

Manufacturing’s Contribution to Pakistan’s Economic Expansion: Commodity - or Service-Led Growth

DTIC Science & Technology

1994-12-01

private sector from regulation and artificial price distortions. In addition, a complementary privatisation programme was launched with the aim of reducing the role of the public sector in manufacturing and services. As a side benefit, the programme was seen as alleviating the government’s financial and administrative burden and creating new opportunities for the private sector . While growth in large-scale manufacturing output has not accelerated in recent years (nor has its overall contribution to GDP growth increased), there is hope

Mergers and acquisitions in Western European health care: exploring the role of financial services organizations.

PubMed

Angeli, Federica; Maarse, Hans

2012-05-01

Recent policy developments in Western European health care - for example in the Netherlands - aim to enhance efficiency and curb public expenditures by strengthening the role of private sector. Mergers and acquisitions (M&As) play an important role in this respect. This article presents an analysis of 1606 acquisition deals targeting health care provider organizations in Western Europe between 1990 and 2009. We particularly investigate the role of financial services organisations as acquirers. Our analysis highlights (a) a rise of M&As in Western Europe since 2000, (b) an increase of M&As with financial service organisations acting as acquirer in absolute terms, and (c) a dominant role of the latter type of M&As in cross-border deals. To explain these developments, we make a distinction between an integration and a diversification rationale for M&As and we argue that the deals with financial services organisations in the role of acquirer are driven by a diversification rationale. We then provide arguments why health care, from the acquirer's perspective, can be considered as an interesting target in a diversification strategy and we advance reasons why health care providers may welcome this development. Although caution in drawing conclusions is needed, our findings suggest a penetration of private capital into health care provision that may be interpreted as a specific form of privatisation. Furthermore, they point to a rising internationalisation of health care. Both findings may entail far-reaching implications for health care, as they may induce both cultural privatisation and cultural internationalisation. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Class and gender in twentieth-century British psychiatry: shell-shock and psychopathic disorder.

PubMed

Busfield, Joan

2004-01-01

This chapter explores the ways in which class and gender permeated psychiatric practice in twentieth-century Britain. It first outlines the historical context and changing character of psychiatric ideas and practice, dividing the century into four main periods - Custodialism under attack, 1890-1929; Integration and Medical Innovation, 1930-1953; Community Care and Public Sector Expansion, 1954-1973; and Privatisation and Commercialisation, 1974 to the Present. The chapter then uses the prism of two psychiatric categories - shell-shock and psychopathic disorder to examine in some detail the ways in which class and gender are embedded in psychiatric work.

Exploring the impact of foreign direct investment on tobacco consumption in the former Soviet Union

PubMed Central

Gilmore, A; McKee, M

2005-01-01

Background: Tobacco is the single largest cause of morbidity and mortality in the developed world; in the former socialist bloc tobacco kills twice as many men as in the west. Although evidence shows that liberalisation of the cigarette trade through the elimination of import barriers leads to significant increases in consumption, far less is known about the impact of foreign direct investment on cigarette consumption. This paper seeks to explore the impact that the substantial transnational tobacco company investments have had on patterns of tobacco trade and consumption in the former Soviet Union. Design: Routine data were used to explore trends in cigarette trade and consumption in the 15 countries of the former Soviet Union from the 1960s to the present day. Comparisons were made between trends in countries that have received substantial investment from the tobacco transnationals and countries that have not. Results: Between 1991 and 2000 cigarette production increased by 96% in countries receiving industry investment and by 11% in countries that did not. Over the same period cigarette consumption increased by 40%; the increase was concentrated in countries receiving investments. Despite these investments, cigarette imports still outweigh exports and no trade surplus has yet to result. Conclusions: The findings suggest that liberalisation of inward investment has a significant and positive impact on cigarette consumption and that without appropriate safeguards, market liberalisation may have long term negative impacts on health. Specific trade rules are needed to govern trade and investment in this uniquely harmful product. Implementation of effective tobacco control policies should precede tobacco industry privatisation. International financial organisations pressing for privatisation should ensure this occurs. PMID:15735295

Exploring the impact of foreign direct investment on tobacco consumption in the former Soviet Union.

PubMed

Gilmore, A B; McKee, M

2005-02-01

Tobacco is the single largest cause of morbidity and mortality in the developed world; in the former socialist bloc tobacco kills twice as many men as in the west. Although evidence shows that liberalisation of the cigarette trade through the elimination of import barriers leads to significant increases in consumption, far less is known about the impact of foreign direct investment on cigarette consumption. This paper seeks to explore the impact that the substantial transnational tobacco company investments have had on patterns of tobacco trade and consumption in the former Soviet Union. Routine data were used to explore trends in cigarette trade and consumption in the 15 countries of the former Soviet Union from the 1960s to the present day. Comparisons were made between trends in countries that have received substantial investment from the tobacco transnationals and countries that have not. Between 1991 and 2000 cigarette production increased by 96% in countries receiving industry investment and by 11% in countries that did not. Over the same period cigarette consumption increased by 40%; the increase was concentrated in countries receiving investments. Despite these investments, cigarette imports still outweigh exports and no trade surplus has yet to result. The findings suggest that liberalisation of inward investment has a significant and positive impact on cigarette consumption and that without appropriate safeguards, market liberalisation may have long term negative impacts on health. Specific trade rules are needed to govern trade and investment in this uniquely harmful product. Implementation of effective tobacco control policies should precede tobacco industry privatisation. International financial organisations pressing for privatisation should ensure this occurs.

Land tenure reform and grassland degradation in Inner Mongolia, China

NASA Astrophysics Data System (ADS)

Liu, Min; Dries, Liesbeth; Heijman, Wim; Huang, Jikun; Zhu, Xueqin; Deng, Xiangzheng

2017-04-01

Since the start of the land tenure reform in the pastoral areas of China in the 1980s, grassland use rights have increasingly been assigned to individual households and subsequently more grasslands have been in private use. However, in the same period, most of the grasslands in China have experienced degradation. The question that this paper tries to address is whether the land tenure reform plays a significant role in grassland degradation. It is answered by an empirical analysis of the impact of land tenure reform on the changes in grassland condition, using data from 60 counties in Inner Mongolia between 1985 and 2008. Grassland condition is presented by grassland quantity and quality using spatial information based on remote sensing. The timing of the assignment of grassland use rights and the timing of the actual adoption of private use by households differ among counties. These timing differences and differences in grassland condition among counties allow disentangling the impact of the land tenure reform. A fixed effects model is used to control for climate, agricultural activity and the time-invariant heterogeneity among counties. The model results show that the private use of grasslands following the land tenure reform has had significantly negative effects on grassland quality and quantity in Inner Mongolia. Moreover, the negative effects did not disappear even after several years of experience with private use. In conclusion, our analysis reveals that the land tenure reform, namely privatisation of grassland use rights, is a significant driver of grassland degradation in Inner Mongolia in a long term, which presents "a tragedy of privatisation", as opposed to the well-known "tragedy of the commons".

Death and bereavement in the First World War: the Australian experience.

PubMed

Jalland, Pat

2014-06-01

The First World War was a turning point in the cultural history of death and bereavement in Australia. The mass deaths of some 60,000 soldiers overseas led to communal rituals of mourning for the war dead and minimal public expressions of private grief. The mass slaughter of so many young men and the interminable grief of so many families devalued the deaths of civilians at home and helped to create a new cultural model of suppressed and privatised grieving which deeply constrained the next two generations. Emotional and expressive grieving became less common, mourning ritual was minimised and sorrow became a private matter. Copyright © 2014. Published by Elsevier Ltd.

The effect of public or private structures in wastewater treatment on the conditions for the design, construction and operation of wastewater treatment plants.

PubMed

Grünebaum, T; Bode, H

2004-01-01

Organised in public or private structures, wastewater services have to cope with different framework conditions as regards planning, construction, financing and operation. This leads quite often to different modes of management. In recent years there has been a push for privatisation on the water sector in general, the reasons for which are manifold, ranging from access to external know-how and capital to synergistic effects through integration of wastewater treatment into other tasks of similar or equal nature. Discussed are various models of public/private partnership (PPP) in wastewater treatment, encompassing for example the delegation of partial tasks or even the proportional or entire transfer of ownership of treatment facilities to private third parties. Decisive for high performance and efficiency is not the legal or organisational form, but rather the clear and unmistakable definition of tasks which are to be assigned to the different parties, customers and all other partners involved, as well as of clear-cut interfaces. On account of the (of course legitimate) profit-oriented perspective of the private sector, some decision-making processes in relation to project implementation (design and construction) and to operational aspects will differ from those typically found on the public sector. This does apply to decisions on investments, financing and on technical solutions too. On the other hand, core competencies in wastewater treatment should not be outsourced, but remain the public bodies' responsibility, even with 'far-reaching' privatisation models. Such core competencies are all efforts geared to sustainable wastewater treatment as life-supporting provision for the future or as contribution to the protection of health and the environment and to the development of infrastructure. Major areas of wastewater treatment and other related tasks are reviewed. The paper concludes with a list of questions on the issue of outsourcing.

[A paradigm change in German academic medicine. Merger and privatization as exemplified with the university hospitals in Marburg and Giessen].

PubMed

Maisch, Bernhard

2005-03-01

1. The intended fusion of the university hospitals Marburg and Giessen in the state of Hessia is "a marriage under pressure with uncalculated risk" (Spiegel 2005). In the present political and financial situation it hardly appears to be avoidable. From the point of the view of the faculty of medicine in Marburg it is difficult to understand, that the profits of this well guided university hospital with a positive yearly budget should go to the neighboring university hospital which still had a fair amount of deficit spending in the last years.2. Both medical faculties suffer from a very low budget from the state of Hessia for research and teaching. Giessen much more than Marburg, have a substantial need for investments in buildings and infrastructure. Both institutions have a similar need for investments in costly medical apparatuses. This is a problem, which many university hospitals face nowadays.3. The intended privatisation of one or both university hospitals will need sound answers to several fundamental questions and problems:a) A privatisation potentially endangers the freedom of research and teaching garanteed by the German constitution. A private company will undoubtedly influence by active or missing additional support the direction of research in the respective academic institution. An example is the priorisation of clinical in contrast to basic research.b) With the privatisation practical absurdities in the separation of research and teaching on one side and hospital care on the other will become obvious with respect to the status of the academic employees, the obligatory taxation (16%) when a transfer of labor from one institution to the other is taken into account. The use of rooms for seminars, lectures and bedside with a double function for both teaching, research and hospital care has to be clarified with a convincing solution in everyday practice.c) The potential additional acquisition of patients, which has been advocated by the Hessian state government, may be unrealistic, when the 4th biggest university hospital in Germany will be created by the merger. University hospitals recrute the patients for high end medicine beyond their region because of the specialized academic competence and advanced technical possibilities. Additional recruitment of patients for routine hospital can hardly be expected.d) A private management will have to consider primarily the "shareholder value", even when investing in infrastructure and buildings, as it can be expected for one partner. On the longterm this will not be possible without a substantial reduction of employees in both institutions. There are, however, also substantial efforts of some private hospital chains in clinical research, e. g. by Helios in Berlin and Rhön Gmbh at the Leipzig Heart Center.e) There is a yet underestimated but very substantial risk because of the taxation for the private owner when academic staff is transferred from the university to hospital care in their dual function as academic teachers and doctors. This risk also applies for the university if the transfer should come from hospital to the university. These costs would add to the financial burden, which has to be carried in addition to the DRGs.

Developing a funding model for an after-hours primary medical care service in a rural town.

PubMed

O'Meara, P; Hall, R H; Strasser, R; Speck, V

1998-01-01

The study described in this paper aimed to determine a funding model for an after-hours primary medical care service in the rural town of Moe, a socioeconomically disadvantaged area of Victoria suffering the rigours of industry restructuring and privatisation. It has 12.5 equivalent full-time general practitioners servicing 21,966 persons. A break-even analysis of the financial viability compared the expected costs of providing the service with the anticipated income. A mixed funding model is recommended. This would incorporate a general practitioner incentive scheme and State Government underwriting of infrastructure and basic non-medical staffing costs during the business development phase to supplement the income from the Health Insurance Commission.

British American Tobacco's failure in Turkey.

PubMed

Lawrence, S

2009-02-01

Transnational tobacco companies (TTCs) considered Turkey an important, potential investment market because of its high consumption rates and domestic commitment to tobacco. This paper outlines how British American Tobacco (BAT) attempted to establish a joint venture with the government monopoly TEKEL, while waiting for privatisation and a private tender. Analysis of tobacco industry documents from the Guildford Depository and online tobacco document sources. BAT failed to establish a market share in Turkey until 2000 despite repeated attempts to form a joint venture with Turkey's tobacco monopoly, TEKEL, once the market liberalised in the mid 1980s. BAT's failure in the Turkish market was due to a misguided investment strategy focused solely on acquiring TEKEL and is contrasted with Philip Morris success in Turkey despite both TTCs working within Turkey's unstable and corrupt investing climate.

Tobacco industry efforts to erode tobacco advertising controls in Hungary.

PubMed

Szilágyi, T; Chapman, S

2004-12-01

To review strategies of transnational tobacco companies (TTCs) at creating a favourable advertising environment for their products in Hungary, with special regard to efforts resulting in the liberalisation of tobacco advertising in 1997. Analysis of internal tobacco industry documents relevant to Hungary available on the World Wide Web. Transcripts of speeches of members of the Parliament during the debate of the 1997 advertising act were also reviewed. The tobacco companies not only entered the Hungarian market by early participation in the privatisation of the former state tobacco monopoly, but also imported theirsophisticated marketing experiences. Evasion and violation of rules in force, creation of new partnerships, establishment and use of front groups, finding effective ways for influencing decision makers were all parts of a well orchestrated industry effort to avoid a strict marketing regulation for tobacco products.

Political economy of tobacco control in Thailand

PubMed Central

Chantornvong, S.; McCargo, D.

2001-01-01

Thailand has some of the world's strongest anti-tobacco legislation. This paper examines the political economy of tobacco control in Thailand, emphasising the identification of forces which have supported and opposed the passage of strong anti-tobacco measures. It argues that while a powerful tobacco control coalition was created in the late 1980s, the gains won by this coalition are now under threat from systematic attempts by transnational tobacco companies to strengthen their share of the Thai cigarette market. The possible privatisation of the Thailand Tobacco Monopoly could threaten the tobacco control cause, but the pro-control alliance is fighting back with a proposed Health Promotion Act which would challenge the tobacco industry with a hypothecated excise tax dedicated to health awareness campaigns.


Keywords: anti-tobacco legislation; political economy; Thailand; transnational tobacco companies PMID:11226361

Opening the oyster: the 2010-11 NHS reforms in England.

PubMed

Reynolds, Lucy; McKee, Martin

2012-04-01

This opinion paper briefly considers the credibility of the announced rationale behind the current extensive reform of the NHS in light of recent research evidence about performance of the system. The paper outlines the authors' views of the history of the reform, which originates in a set of documents, produced in the late 1980s by the Centre for Policy Studies, which aimed to introduce private sector involvement throughout the NHS, and a brief report by a consultant for a health maintenance organisation in the USA. Tracking of the pro-private sector changes in the NHS demonstrates that the bill is a major step in the implementation of NHS privatisation and also delineates a roadmap for coming developments, which have been explained to corporate providers and investors seeking new profit opportunities but have not yet been debated openly with the electorate in the UK.

Ethics, advertising and the definition of a profession.

PubMed Central

Dyer, A R

1985-01-01

In the climate of concern about high medical costs, the relationship between the trade and professional aspects of medical practice is receiving close scrutiny. In the United Kingdom there is talk of increasing privatisation of health services, and in the United States the Federal Trade Commission (FTC) has attempted to define medicine as a trade for the purposes of commercial regulation. The Supreme Court recently upheld the FTC charge that the American Medical Association (AMA) has been in restraint of trade because of ethical strictures against advertising. The concept of profession, as it has been analyzed in sociological, legal, philosophical, and historical perspectives, reveals the importance of an ethic of service as well as technical expertise as defining characteristics of professions. It is suggested that the medical profession should pay more attention to its service ideal at this time when doctors are widely perceived to be technically preoccupied. PMID:4009637

Narrative accounts of tracking the rural domestic violence survivors' journey: a feminist approach.

PubMed

Davis, K; Taylor, B; Furniss, D

2001-06-01

This research represents the first stage of a project to determine the level of use and effectiveness of informal support networks utilised by Australian rural women. We used a feminist narrative approach with semistructured interviews and a convenience sample of 26 rural women. Only 9 out of 12 women's stories are presented. We found that poverty and geographical, social, and emotional isolation resulted in the privatisation of abuse. Women were triggered to leave the family home when their children, friends, or family became victims of the abuse. They planned their escape by telephone with support of friends and family. Although they used these informal supports, the participants paradoxically expected a high level of expertise in domestic violence knowledge and skills. We recommend an integrated multilevel model of support for rural women in violent intimate relationships and their informal supporters.

Ethics, advertising and the definition of a profession.

PubMed

Dyer, A R

1985-06-01

In the climate of concern about high medical costs, the relationship between the trade and professional aspects of medical practice is receiving close scrutiny. In the United Kingdom there is talk of increasing privatisation of health services, and in the United States the Federal Trade Commission (FTC) has attempted to define medicine as a trade for the purposes of commercial regulation. The Supreme Court recently upheld the FTC charge that the American Medical Association (AMA) has been in restraint of trade because of ethical strictures against advertising. The concept of profession, as it has been analyzed in sociological, legal, philosophical, and historical perspectives, reveals the importance of an ethic of service as well as technical expertise as defining characteristics of professions. It is suggested that the medical profession should pay more attention to its service ideal at this time when doctors are widely perceived to be technically preoccupied.

British American Tobacco’s failure in Turkey

PubMed Central

Lawrence, S

2009-01-01

Background and objectives Transnational tobacco companies (TTCs) considered Turkey an important, potential investment market because of its high consumption rates and domestic commitment to tobacco. This paper outlines how British American Tobacco (BAT) attempted to establish a joint venture with the government monopoly TEKEL, while waiting for privatisation and a private tender. Methods Analysis of tobacco industry documents from the Guildford Depository and online tobacco document sources. Results BAT failed to establish a market share in Turkey until 2000 despite repeated attempts to form a joint venture with Turkey’s tobacco monopoly, TEKEL, once the market liberalised in the mid 1980s. Conclusions BAT’s failure in the Turkish market was due to a misguided investment strategy focused solely on acquiring TEKEL and is contrasted with Philip Morris success in Turkey despite both TTCs working within Turkey’s unstable and corrupt investing climate. PMID:18845622

The international right to health: state obligations and private actors in the health care system.

PubMed

O'Brien, Paula

2013-09-01

Most health systems have historically used a mix of public and private actors for financing and delivering care. But the last 30 years have seen many rich and middle-income countries moving to privatise parts of their health care systems. This phenomenon has generated concerns, especially about equitable access to health care. This article examines what the international right to the highest attainable standard of health in Art 12 of the International Covenant on Economic, Social and Cultural Rights says about the obligations of states which use private actors in health care. The article involves a close study of the primary documents of the key institutions responsible for interpreting and promoting Art 12. From this study, the article concludes that in mixed public-private health care systems, states not only retain primary responsibility for fulfilling the right to health but are subject to a range of additional specific responsibilities.

Funding medical education: should we follow a different model to general higher education? Commentary.

PubMed

Walsh, Kieran

2015-01-01

There has been much recent discussion on the funding of medical education. There has also been much discussion about the funding of higher education more generally. The topics of discussion have included the rising costs of education; who should pay; the various potential models of funding; and how best to ensure maximum returns from investment. Medical education has largely followed the emerging models of funding for higher education. However there are important reasons why the funding models for higher education may not suit medical education. These reasons include the fact that medical education is as important to the public as it is to the learner; the range of funding sources available to medical schools; the strict regulation of medical education; and the fact that the privatisation and commercialisation of higher education may not been in keeping with the social goals of medical schools and the agenda of diversification within the medical student population.

Changing household responses to drought in Tharaka, Kenya: vulnerability, persistence and challenge.

PubMed

Smucker, Thomas A; Wisner, Ben

2008-06-01

Drought is a recurring challenge to the livelihoods of those living in Tharaka District, Kenya, situated in the semi-arid zone to the east of Mount Kenya, from the lowest slopes of the mountain to the banks of the Tana River. This part of Kenya has been marginal to the economic and political life of Kenya from the colonial period until the present day. A study of more than 30 years of change in how people in Tharaka cope with drought reveals resilience in the face of major macro-level transformations, which include privatisation of landownership, population growth, political decentralisation, increased conflict over natural resources, different market conditions, and environmental shifts. However, the study also shows troubling signs of increased use of drought responses that are incompatible with long-term agrarian livelihoods. Government policy needs to address the challenge of drought under these new macro conditions if sustainable human development is to be achieved.

Marketing medicine.

PubMed

Mellsop, G

1988-02-10

Medical etiquette has always discouraged advertising. Indeed, the profession as a whole has tended to view the idea of marketing medicine as at best, a trifle infra dig. Maintenance of this attitude has been helped by an ostrich like approach to the realities of private practice, and to the activities of drug companies, which have contributed significantly to our therapeutic abilities. The moves to corporatise and privatise institutions have raised the level of concern of our New Zealand medical profession. It is not self evident that the marketing concept as currently understood by the business community and by politicians is familiar to the medical profession. There must also be at least a level of suspicion that the business and financial world is insufficiently sensitive to the nuances and complexities of health service delivery. This paper will briefly explore those two viewpoints and consider the feasibility of any attempt to marry them.

Shifting subjects of health-care: placing "medical tourism" in the context of Malaysian domestic health-care reform.

PubMed

Ormond, Meghann

2011-01-01

"Medical tourism" has frequently been held to unsettle naturalised relationships between the state and its citizenry. Yet in casting "medical tourism" as either an outside "innovation" or "invasion," scholars have often ignored the role that the neoliberal retrenchment of social welfare structures has played in shaping the domestic health-care systems of the "developing" countries recognised as international medical travel destinations. While there is little doubt that "medical tourism" impacts destinations' health-care systems, it remains essential to contextualise them. This paper offers a reading of the emergence of "medical tourism" from within the context of ongoing health-care privatisation reform in one of today's most prominent destinations: Malaysia. It argues that "medical tourism" to Malaysia has been mobilised politically both to advance domestic health-care reform and to cast off the country's "underdeveloped" image not only among foreign patient-consumers but also among its own nationals, who are themselves increasingly envisioned by the Malaysian state as prospective health-care consumers.

Outsourcing: two case studies from the Victorian public hospital sector.

PubMed

Young, Suzanne

2007-02-01

Outsourcing was one process of privatisation used in the Victorian public health sector in the 1990s. However it was used to varying degrees and across a variety of different services. This paper attempts to answer the questions: Why have managers outsourced? What have managers considered when they have decided to outsource? The research was carried out in a rural hospital and a metropolitan network in Victoria. The key findings highlight the factors that decision makers considered to be important and those that led to negative outcomes. Economic factors, such as frequency of exchange, length of relationships between the parties, and information availability, were often ignored. However, other factors such as outcome measurability, technology, risk, labour market characteristics and goal conflict, and political factors such as relative power of management over labour were often perceived as important in the decision-making process. Negative outcomes from outsourcing were due to the short length of relationships and accompanying difficulties with trust, commitment and loyalty; poor quality; and excessive monitoring and the measurement of outcomes.

The public health implications of world trade negotiations on the general agreement on trade in services and public services.

PubMed

Pollock, Allyson M; Price, David

2003-09-27

Trade ministries from the World Trade Organization's (WTO's) 144 member states are presently deciding which public services to open to foreign competition under the complex liberalisation rules of the general agreement on trade in services (GATS). A frequent criticism of the WTO system is that it reduces national autonomy over public policy. However, respect for national sovereignty is asserted in the GATS treaty. Here, we examine claims made by the WTO and others that GATS exempts public services and does not require their privatisation. We discuss trade treaty processes that can subject public services to commercial rules, the treaty's flexibility with respect to national autonomy, and the effect of GATS in situations in which national autonomy is not protected. We conclude that national autonomy over health policy is not preserved under GATS, and that accordingly, there is a role for international standards that protect public services from the adverse effect of trade and market forces.

HIV scale-up in Mozambique: Exceptionalism, normalisation and global health

PubMed Central

Høg, Erling

2014-01-01

The large-scale introduction of HIV and AIDS services in Mozambique from 2000 onwards occurred in the context of deep political commitment to sovereign nation-building and an important transition in the nation's health system. Simultaneously, the international community encountered a willing state partner that recognised the need to take action against the HIV epidemic. This article examines two critical policy shifts: sustained international funding and public health system integration (the move from parallel to integrated HIV services). The Mozambican government struggles to support its national health system against privatisation, NGO competition and internal brain drain. This is a sovereignty issue. However, the dominant discourse on self-determination shows a contradictory twist: it is part of the political rhetoric to keep the sovereignty discourse alive, while the real challenge is coordination, not partnerships. Nevertheless, we need more anthropological studies to understand the political implications of global health funding and governance. Other studies need to examine the consequences of public health system integration for the quality of access to health care. PMID:24499102

Lifelong learning: Foundational models, underlying assumptions and critiques

NASA Astrophysics Data System (ADS)

Regmi, Kapil Dev

2015-04-01

Lifelong learning has become a catchword in almost all countries because of its growing influence on education policies in the globalised world. In the Organisation for Economic Cooperation and Development (OECD) and the European Union (EU), the promotion of lifelong learning has been a strategy to speed up economic growth and become competitive. For UNESCO and the World Bank, lifelong learning has been a novel education model to improve educational policies and programmes in developing countries. In the existing body of literature on the topic, various models of lifelong learning are discussed. After reviewing a number of relevant seminal texts by proponents of a variety of schools, this paper argues that the vast number of approaches are actually built on two foundational models, which the author calls the "human capital model" and the "humanistic model". The former aims to increase productive capacity by encouraging competition, privatisation and human capital formation so as to enhance economic growth. The latter aims to strengthen democracy and social welfare by fostering citizenship education, building social capital and expanding capability.

Making medicine a business in Japan: Shimadzu Co. and the diffusion of radiology (1900-1960).

PubMed

Donzé, Pierre-Yves

2010-01-01

This contribution focuses on the role of the firm Shimadzu in the marketing of X-ray machines in Japan during the first part of the 20th century, viewed from a business history perspective. It attempts to further understanding of the process of technology diffusion in medicine. In a global market controlled by American and German multinational enterprises, Japan appears to have been a particular country, where a domestic independent firm, Shimadzu, succeeded in establishing itself as a competitive company. This success is the result of a strategy based on both the internalisation of technological capabilities (recruitment of university graduate engineers, subcontracting of research and development activities) and an original communication policy towards the medical world. Finally, the specific structure of the Japanese medical market, composed of numerous and largely privatised small healthcare centres, facilitated the rapid diffusion of X-ray machines, a new technology which conferred a comparative advantage on its holders.

HIV scale-up in Mozambique: exceptionalism, normalisation and global health.

PubMed

Høg, Erling

2014-01-01

The large-scale introduction of HIV and AIDS services in Mozambique from 2000 onwards occurred in the context of deep political commitment to sovereign nation-building and an important transition in the nation's health system. Simultaneously, the international community encountered a willing state partner that recognised the need to take action against the HIV epidemic. This article examines two critical policy shifts: sustained international funding and public health system integration (the move from parallel to integrated HIV services). The Mozambican government struggles to support its national health system against privatisation, NGO competition and internal brain drain. This is a sovereignty issue. However, the dominant discourse on self-determination shows a contradictory twist: it is part of the political rhetoric to keep the sovereignty discourse alive, while the real challenge is coordination, not partnerships. Nevertheless, we need more anthropological studies to understand the political implications of global health funding and governance. Other studies need to examine the consequences of public health system integration for the quality of access to health care.

A new Pan African polyspecific antivenom developed in response to the antivenom crisis in Africa.

PubMed

Laing, G D; Renjifo, J M; Ruiz, F; Harrison, R A; Nasidi, A; Gutierrez, J-M; Rowley, P D; Warrell, D A; Theakston, R D G

2003-07-01

Currently there is a crisis in the supply of antivenom for treatment of snake bite in sub-Saharan Africa. Commercial pressures have resulted in the reduction or even cessation of production of antivenom by European manufacturers while continued production of antivenom in Africa has been threatened by the privatisation of the only remaining company based in Africa. As a consequence, there has been an increase in snake bite morbidity and mortality in many African countries. Two Latin American antivenom manufacturers have agreed to produce antivenom suitable for Africa, using venoms from the species which are of the greatest medical importance in sub-Saharan Africa. Preclinical in vivo assays of neutralising potency demonstrated that a new Pan African antivenom produced in Colombia compared favourably with the existing commercial monospecific and polyspecific antivenoms. This new antivenom, and a similar product being manufactured in Costa Rica, are now candidates for clinical testing at an appropriate site in Africa.

Germ-line engineering, freedom, and future generations.

PubMed

Cooke, Elizabeth F

2003-02-01

New technologies in germ-line engineering have raised many questions about obligations to future generations. In this article, I focus on the importance of increasing freedom and the equality of freedom for present and future generations, because these two ideals are necessary for a just society and because they are most threatened by the wide-scale privatisation of GLE technologies. However, there are ambiguities in applying these ideals to the issue of genetic technologies. I argue that Amartya Sen's capability theory can be used as a framework to ensure freedom and equality in the use of GLE technology. Capability theory articulates the goal of equalising real freedom by bringing all people up to a threshold of basic human capabilities. Sen's capability theory can clarify the proper moral goal of GLE insofar as this technology could be used to bring people up to certain basic human capabilities, thereby increasing their real freedom. And by increasing the freedom of those who lack basic human capabilities, GLE can aid in decreasing the inequalities of freedom among classes of people.

[The end of discrimination in social security for the elderly? Some remarks on the consequences of the paradigm shift in a life course perspective on gender].

PubMed

Fachinger, Uwe

2008-10-01

Trying to analyse the effects of the paradigm shift in the old age social security system in Germany (GRV) from a life cycle gender perspective yields light and shade - it is a conglomeration of individual- and family-specific transfers, financed by a mix of contributions and taxes, and with measures of explicit and implicit, intended and not intended ex-post and ex-ante redistribution and discrimination.The paradigm shift has increased the complexity of the system and created additional elements of gender specific discrimination as well as reduced established elements of the so called "social compensation". Furthermore, the relevance of complementary private and occupational pensions will increase absolute and relative due to the reduction of the pension level. This will raise the importance of earnings in old age especially those that are without any elements of social security compensation or without elements of recognition of activities beside employment. Overall the paradigm shift has intensified the discrimination of women in two ways and the pension privatisation has caused redistribution from the bottom to the top. In other words, there is an increase in inter- and intra-gender discrimination. Due to the changes and the emphasis of aspects of an independent old age security savings for women the norm of the "male breadwinner model" has increased. The importance of "providing one's own pension" additionally creates distribution conflicts within a partnership. Because of the necessity of constant payments over time within a private insurance and the changes of an individual income and gender-specific life cycle, conflicts may occur time and again. The dependence of life-long partnerships on each other is not reduced or abolished with the strengthening of the individualistic model of protection, but is qualitatively and quantitatively improved. Against this background, the measures of the statutory pension system which are aimed towards the situation of a woman's life are important factors to combat the disadvantages of private funded pension systems of which mainly women are affected in building up rights to future benefits. The analysis shows that the paradigm shift primarily brings disadvantages to women. They disproportionally depend on statutory pension system benefits, and therefore also on compensating benefits of the negative consequences of private and occupational pension systems. For the future an increase in poverty of older people - and especially women - can be seen to emerge because of pension privatisation and the reduction of the pension level in the German social security system.

The distribution of housing wealth in 16 European countries: accounting for institutional differences.

PubMed

Wind, Barend; Lersch, Philipp; Dewilde, Caroline

2017-01-01

Housing wealth is the largest source of household wealth, but we know little about the distribution of housing wealth and how institutions have shaped this distribution. Subsidies for homeownership, privatisation of social housing and mortgage finance liberalisation are likely to have influenced the distribution of housing wealth in recent decades. To examine their impact, we describe housing wealth inequalities across occupational classes for two birth cohorts aged fifty and older. The analysis is conducted across 16 European countries with divergent welfare states and housing systems using the fourth wave of the survey of health, ageing and retirement in Europe (SHARE; 2011/2012). Our results indicate that the expansion of homeownership in a market-based housing system is associated with a more unequal distribution of housing wealth across occupational classes, as an increasing number of 'marginal' owners are drawn into precarious homeownership. Such a pattern is not found in housing wealth accumulation regimes with a less market-based provision of housing. When the state or the family drive homeownership expansion, a de-coupling of labour market income and housing consumption results in a more equal distribution of housing wealth.

The reactions to macro-economic crises in Nordic health system policies: Denmark, Finland and Sweden, 1980-2013.

PubMed

Lehto, Juhani; Vrangbæk, Karsten; Winblad, Ulrika

2015-01-01

Denmark, Finland and Sweden have experienced two major recessions during the last 25 years. The adjustments to the earlier crisis in the late 1980s (Denmark) and early 1990s (Finland and Sweden) resembled the policies in many other European countries during the present crisis. The analysis of relationship of deep economic crises and growth period between them to the health system policies and institutions in the three countries from the 1980s to 2013 is based on a categorisation of reactions to external shocks as path conforming or path breaking. The results of the empirical long-term trends show that the reactions to deep recessions have been mainly temporary adjustments and acceleration of changes already prepared before economic crisis. The economic crisis in the three countries has not been 'good enough' to enable paradigmatic changes in the Nordic public, decentralised and equity-oriented health systems. Changes such as the slow privatisation in care funding and production and the adoption of new management practices indicate an ongoing paradigmatic change related to longer-term societal, ideological and political developments rather than directly to economic crises or growth.

Perspectives of displaced Syrian women and service providers on fertility behaviour and available services in West Bekaa, Lebanon.

PubMed

Kabakian-Khasholian, Tamar; Mourtada, Rima; Bashour, Hyam; Kak, Faysal El; Zurayk, Huda

2017-10-01

Prior to the conflict, Syria had relatively high fertility rates. In 2010, it had the sixth highest total fertility rate in the Arab World, but it witnessed a fertility decline before the conflict in 2011. Displacement during conflict influences fertility behaviour, and meeting the contraceptive needs of displaced populations is complex. This study explored the perspectives of women and service providers about fertility behaviour of and service provision to Syrian refugee women in Bekaa, Lebanon. We used qualitative methodology to conduct 12 focus group discussions with Syrian refugee women grouped in different age categories and 13 in-depth interviews with care providers from the same region. Our findings indicate that the displacement of Syrians to Lebanon had implications on the fertility behaviour of the participants. Women brought their beliefs about preferred family size and norms about decision-making into an environment where they were exposed to both aid and hardship. The unaffordability of contraceptives in the Lebanese privatised health system compared to their free provision in Syria limited access to family planning services. Efforts are needed to maintain health resources and monitor health needs of the refugee population in order to improve access and use of services.

A cost and performance comparison of Public Private Partnership and public hospitals in Spain.

PubMed

Caballer-Tarazona, Maria; Clemente-Collado, Antonio; Vivas-Consuelo, David

2016-12-01

Public-private partnership (PPP) initiatives are extending around the world, especially in Europe, as an innovation to traditional public health systems, with the intention of making them more efficient.There is a varied range of PPP models with different degrees of responsibility from simple public sector contracts with the private, up to the complete privatisation of the service. As such, we may say the involvement of the private sector embraces the development, financing and provision of public infrastructures and delivery services.In this paper, one of the oldest PPP initiatives developed in Spain and transferred to other European and Latin American countries is evaluated for first time: the integrated healthcare delivery Alzira model.Through a comparison of public and PPP hospital performance, cost and quality indicators, the efficiency of the PPP experience in five hospitals is evaluated to identify the influence of private management in the results.Regarding the performance and efficiency analysis, it is seen that the PPP group obtains good results, above the average, but not always better than those directly managed. It is necessary to conduct studies with a greater number of PPP hospitals to obtain conclusive results.

The problematization of medical tourism: a critique of neoliberalism.

PubMed

Smith, Kristen

2012-04-01

The past two decades have seen the extensive privatisation and marketisation of health care in an ever reaching number of developing countries. Within this milieu, medical tourism is being promoted as a rational economic development strategy for some developing nations, and a makeshift solution to the escalating waiting lists and exorbitant costs of health care in developed nations. This paper explores the need to problematize medical tourism in order to move beyond one dimensional neoliberal discourses that have, to date, dominated the arena. In this problematization, the paper discusses a range of understandings and uses of the term 'medical tourism' and situates it within the context of the neoliberal economic development of health care internationally. Drawing on theory from critical medical anthropology and health and human rights perspectives, the paper critically analyzes the assumed independence between the medical tourism industry and local populations facing critical health issues, where social, cultural and economic inequities are widening in terms of access, cost and quality of health care. Finally, medical tourism is examined in the local context of India, critiquing the increasingly indistinct roles played by government and private sectors, whilst linking these shifts to global market forces. © 2012 Blackwell Publishing Ltd.

Sexuality and mental health nursing in Ireland: weaving the veil of socialised inhibition.

PubMed

Higgins, Agnes; Barker, Philip; Begley, Cecily M

2009-04-01

The World Health Organisation first identified, in 1975, the need for health professionals to be educated in the area of sexuality. Since then, studies exploring aspects of educational preparation of general nurses in relation to sexuality, found that there was an 'absence' of education in this area of practice. This paper reports findings on the educational discourses that shape mental health nurses' understandings of sexuality. Unstructured interviews were conducted with 27 consenting mental health nurses working in the Republic of Ireland. Data were analysed using the principles of Grounded Theory. Findings suggest that participants were exposed to a subtle network of legitimised sexual discourses during primary, secondary, and professional socialisation. These discourses provided participants with a view of sexuality that emphasised taboo, privatisation, pathology, and control. Social, political, or rights-based discourses that could have provided participants with the knowledge and clinical competence necessary to include sexuality in an open and confident manner within the horizons of nursing practice were absent. These findings challenge educators involved in curriculum development to rethink the fundamental philosophy that is shaping mental health nursing curricula. They also challenge educators to rethink their ideas around the meaning of 'absence' in relation to education.

How the World Trade Organisation is shaping domestic policies in health care.

PubMed

Price, D; Pollock, A M; Shaoul, J

1999-11-27

High up on the agenda of the World Trade Organisation (WTO) is the privatisation of education, health, welfare, social housing and transport. The WTO's aim is to extend the free market in the provision of traditional public services. Governments in Europe and the US link the expansion of trade in public services to economic success, and with the backing of powerful medico-pharmaceutical, insurance, and service corporations, the race is on to capture the share of gross domestic product that governments currently spend on public services. They will open domestic European services and domestic markets to global competition by government procurement agreements, dispute-settlement procedures, and the investment rules of global financial institutions. The UK has already set up the necessary mechanisms: the introduction of private-sector accounting rules to public services; the funding of public-sector investment via private-public partnerships or the private finance initiative; and the change to capitation funding streams, which allows the substitution of private for public funds and services. We explain the implications of these changes for European public-health-care systems and the threat they pose to universal coverage, solidarity through risk-pooling, equity, comprehensive care, and democratic accountability.

Rewriting the regulations: how the World Trade Organisation could accelerate privatisation in health-care systems.

PubMed

Pollock, A M; Price, D

2000-12-09

The World Trade Organisation (WTO) is drawing up regulatory proposals which could force governments to open up their public services to foreign Investors and markets. As part of the General Agreement on Trade in Services (GATS) negotiations, the WTO working party on reform of domestic regulation is developing a regulatory reform agenda which could mark a new era of compulsion in international trade law. Article VI.4 of the GATS is being strengthened with the aim of requiring member states to show that they are employing least trade-restrictive policies. The legal tests under consideration would outlaw the use of non-market mechanisms such as cross-subsidisation, universal risk pooling, solidarity, and public accountability in the design, funding, and delivery of public services as being anti-competitive and restrictive to trade. The domestic policies of national governments will be subject to WTO rules, and if declared illegal, could lead to trade sanctions under the WTO disputes panel process. The USA and European Union, with the backing of their own multinational corporations, believe that these new powers will advantage their own economies. Health-care professionals and public-health activists must ensure that this secretive regulatory reform process is opened up for public debate.

Privatizing the welfarist state: health care reforms in Malaysia.

PubMed

Khoon, Chan Chee

2003-01-01

In Malaysia, the shifting balance between market and state has many nuances. Never a significant welfare state in the usual mold, the Malaysian state nonetheless has been a dominant social and economic presence dictated by its affirmative action-type policies, which eventually metamorphosed into state-led indigenous capitalism. Privatisation is also intimately linked with emergence of an indigenous bourgeoisie with favored access to the vast accumulation of state assets and prerogatives. Internationally, it is conditioned by the fluid relationships of converging alliances and contested compromise with international capital, including transnational health services industries. As part of its vision of a maturing, diversified economy, the Malaysian government is fostering a private-sector advanced health care industry to cater to local demand and also aimed at regional and international patrons. The assumption is that, as disposable incomes increase, a market for such services is emerging and citizens can increasingly shoulder their own health care costs. The government would remain the provider for the indigent. But the key assumption remains: the growth trajectory will see the emergence of markets for an increasingly affluent middle class. Importantly, the health care and social services market would be dramatically expanded as the downsizing of public-sector health care proceeds amid a general retreat of government from its provider and financing roles.

Divided care and the Third Way: user involvement in statutory and voluntary sector cancer services.

PubMed

Tritter, J Q; Barley, V; Daykin, N; Evans, Simon; McNeill, Judith; Rimmer, James; Sanidas, M; Turton, Pat

2003-07-01

In health care, as in much of the public sphere, the voluntary sector is playing an increasingly large role in the funding, provision and delivery of services and nowhere is this more apparent than in cancer care. Simultaneously the growth of privatisation, marketisation and consumerism has engendered a rise in the promotion of 'user involvement' in health care. These changes in the organisation and delivery of health care, in part inspired by the 'Third Way' and the promotion of public and citizen participation, are particularly apparent in the British National Health Service. This paper presents initial findings from a three-year study of user involvement in cancer services. Using both case study and survey data, we explore the variation in the definition, aims, usefulness and mechanisms for involving users in the evaluation and development of cancer services across three Health Authorities in South West England. The findings have important implications for understanding shifts in power, autonomy and responsibility between patients, carers, clinicians and health service managers. The absence of any common definition of user involvement or its purpose underlines the limited trust between the different actors in the system and highlights the potentially negative impact of a Third Way health service.

The Role of Capital Productivity in British Airways' Financial Recovery

NASA Technical Reports Server (NTRS)

Morrell, Peter

1999-01-01

British Airways (BA) was privatised in 1987, but its financial recovery occurred a number of years earlier. This recovery was sustained throughout the early 1990s economic recession, a period when few major airlines were operating profitably. This paper examines the role of productivity developments at British Airways from the early 1980s through 1996. The emphasis is on capital productivity and investment, but changes in capital intensity and labour productivity are also evaluated. Various measures are considered for both capital and labour productivity: outputs are measured in available tonne-kms (ATKS) and revenue tonne-kms (RTKs), with the former preferred over the latter two measures, after adjustment for work performed by BA for others. Capital inputs are measured in equivalent lease costs adjusted to constant prices with a different treatment of flight and ground equipment or assets. Labour inputs are derived from total payroll costs deflated by a UK wage price index. The airline made considerable capital investments over the period and at the same time went through two major processes of labour restructuring. This resulted in a gradual increase in capital intensity, relative high labour productivity growth, but poor capital productivity performance. However, capital investment played an important role in the airline's sustained labour and total factor productivity over the whole period.

The economics of hospital reform from hierarchical to market-based incentives.

PubMed

Preker, Alexander S; Harding, April

2005-01-01

Heavy investment over the past 30 years has made the hospital sector the largest expenditure category of the health system in most developed and developing countries. In most countries hospitals remain a critical link to health care, providing both advanced and basic care for the population. Often, they are the provider 'of last resort' for the poor and critically ill. This article provides insights into recent hospital reforms undertaken throughout the world, with an emphasis on organisational changes such as increased management autonomy, corporatisation, and privatisation. It provides some insights about these popular reform modalities from a review of the literature, reform experiences in other sectors and empirical evidence from hospital sector itself. The material presented tries to answer three questions: (a) what problems did this type of reform try to address; (b) what are the core elements of their design, implementation and evaluation; and, (c) is there any evidence that this type of reform is successful in addressing problems for which they were intended? While this paper focuses on issues related to the design of the reforms, the paper also reports the findings from a larger study that examined the implementation and evaluation of such reforms so that they will be available to countries that are considering venturing down this reform path.

Health economists, tobacco control and international development: On the economisation of global health beyond neoliberal structural adjustment policies

PubMed Central

Reubi, David

2013-01-01

This article addresses the increasing influence of economic rationalities in global health over the past 30 years by examining the genealogy of one economic strategy – taxation – that has become central to international anti-smoking initiatives in the global South. It argues that this genealogy sits uncomfortably with the usual story about economics and global health, which reduces the economisation of international health to neoliberal structural adjustment policies aimed at stabilisation, liberalisation and privatisation and laments their detrimental effect on health. While not disputing these policies' importance and damaging impact, the genealogy of tobacco taxes outlined in this article shows that the economisation of global health is not only about neoliberal structural adjustment policies but also about sin taxes, market failures and health economics. By stressing how changes in health like the global South's epidemiological transition can impact on economics and how beneficial taxation can be for health, it also shows that the relation between economics and health is not always unidirectional and detrimental to the latter. In doing so, the article contributes to the critique of the often mechanical use of neo-liberalism to explicate change and calls for other stories about the economisation of global health to be told. PMID:23750175

Work disability following major organisational change: the Whitehall II study.

PubMed

Virtanen, M; Kivimäki, M; Singh-Manoux, A; Gimeno, D; Shipley, M J; Vahtera, J; Akbaraly, T N; Marmot, M G; Ferrie, J E

2010-05-01

Privatisation and private sector practices have been increasingly applied to the public sector in many industrialised countries. Over the same period, long-term work disability has risen substantially. We examined whether a major organisational change--the transfer of public sector work to executive agencies run on private sector lines--was associated with an increased risk of work disability. The study uses self-reported data from the prospective Whitehall II cohort study. Associations between transfer to an executive agency assessed at baseline (1991-1994) and work disability ascertained over a period of approximately 8 years at three follow-up surveys (1995-1996, 1997-1999 and 2001) were examined using Cox proportional hazard models. In age- and sex-adjusted models, risk of work disability was higher among the 1263 employees who were transferred to an executive agency (HR 1.90, 95% CI 1.46 to 2.48) compared with the 3419 employees whose job was not transferred. These findings were robust to additional adjustment for physical and mental health and health behaviours at baseline. Increased work disability was observed among employees exposed to the transfer of public sector work to executive agencies run on private sector lines. This may highlight an unintentional cost for employees, employers and society.

Synergies between veterinarians and para-professionals in the public and private sectors: organisational and institutional relationships that facilitate the process of privatising animal health services in developing countries.

PubMed

Woodford, J D

2004-04-01

The delivery of veterinary services in most developing countries was, until recently, considered to be the responsibility of the public sector. However, over the past four decades, economic constraints and the imposition of structural adjustment policies (SAPs) have led to a gradual decline in public sector investment in real terms and thus a reduction in the quality and quantity of services available to livestock keepers. Many governments acknowledged that they were no longer able to provide services that were essentially of a 'private good' nature and introduced radical policy changes which sought to introduce the concepts of a market orientated approach towards agriculture and livestock production in particular. The role of government, in the future, would be to provide a reduced range of essential 'public good' services and to create a favourable environment in which the private sector could become established as a provider of 'private good' services and at the same time act as a partner in carrying out certain public functions under contract or 'sanitary mandates'. In almost all developing countries, however, these policy changes were not accompanied by appropriate development strategies. The reasons for this are complex. Firstly, SAPs may be considered to have been foisted upon governments by donors and are thus perceived by many policy-makers as the cause of financial problems, rather than a solution to them. Secondly, most animal health senior policy-makers in the public sector have been trained as veterinarians and lack the required management skills to plan change effectively. Furthermore, as regards clinical veterinary service delivery, especially in rural or more remote areas, the solution fostered by donor investment, which involves deregulation and the deployment of privately operating para-professionals, is often perceived as a threat to the veterinary profession and might result in limiting access to international markets for the trade of livestock and livestock products. An informal delivery system has gained a foothold in many developing countries in the absence of a well-planned strategy for the privatisation of animal health services. Most governments would now acknowledge that this presents a greater risk than the deployment of well-regulated and effectively supervised para-professionals. This paper explores some of the principal challenges facing policy-makers in their efforts to bridge the transition from full state provision of animal health services to the formation of a partnership with the private sector. Governments and donors need to take active steps to facilitate the process of privatisation of animal health services, especially those targeting the poorer rural subsistence and pastoralist farming systems. This would entail an initial investment in developing the necessary management skills at all levels in the delivery system. Thereafter, further investment would be required to allow the changes to be managed using tools such as the strategic planning cycle. Should sufficient resources be made available to allow the full participation of all stakeholders in the delivery of animal health services, appropriate institutions and effective organisational relationships addressing all the more important issues will have to be identified. The paper then proceeds to describe how different livestock production systems determine the level of demand for animal health services. If these services are to be provided on a financially sustainable basis, they must be tailored to meet actual rather than perceived demand. Identifying an appropriate model for animal health service delivery thus requires careful analysis of the production system to be targeted. Governments and donors can play a useful role in providing resources for this type of study as well as for appropriate market studies, business planning, training and access to soft loans. Finally, as regards regulation, as the law stands today, many activities currently practised by para-professionals are classified as 'acts of veterinary medicine or surgery' and may only legally be performed by qualified and registered veterinarians. The concept of 'principal' and 'subsidiary' legislation provides the necessary flexibility in the regulation of the delivery of animal health services to accommodate the rapid changes taking place in this environment today. Deregulation involves the delegation of responsibility for the performance of a defined range of veterinary interventions to para-professionals under the 'supervision' or 'direction' of a registered veterinarian. The author illustrates how the experiences of a number of projects in Tanzania were used to propose a definition of 'supervision' in law. The definition offers an opportunity to overcome the fear of compromising standards of delivery of animal health services through the deployment of para-professionals. In addition, such functioning provides employment opportunities for private veterinarians in rural areas where access to formal primary animal health services would otherwise be denied and may contribute to the process of quality assurance of national veterinary services in developing countries.

Transformation by stealth: the retargeting of home care services in Finland.

PubMed

Kröger, Teppo; Leinonen, Anu

2012-05-01

This paper analyses the trends and changes that home care services for older people have undergone during the last two decades in Finland. The data used come from national social care statistics, covering the time period from 1990-2010. The results show that, in contrast to many other European nations that have expanded their home care provisions, the coverage levels in Finland have dropped dramatically during this period. Those with the highest needs do receive increased amounts of support, but others have become excluded from publicly funded home care provisions and often need to rely on family members. In most localities, public service provision is focused on personal care, and no longer covers household tasks. This major change of the character of the service is connected to three other recent trends that structure current provisions: the amalgamation of home-based social and healthcare services, the marketisation and emerging privatisation of care and the integration of informal family care into the formal care system. Overall, the changes represent weakening defamilisation, that is, decreasing public responsibility for the needs of many older people and, correspondingly, an increasing reliance on family carers. This full-scale transformation of home care has taken place without any real policy debate or major modification of legislation. No actual decision was ever made to thoroughly alter the character of home care in Finland: the transformation happened by stealth. © 2011 Blackwell Publishing Ltd.

People and the labour market: integration and differences.

PubMed

Fattorini, E; Campo, G

2006-01-01

This survey aims at identifying methods and procedures to prevent possible gender discrimination at the workplace. It is intended to: a) establish whether mobbing is present in the companies involved in this survey; b) verify whether the aetiology and mobbing dynamics are the same for men and women. This survey involved 887 persons in eight companies, operating in different economic sectors, and located in the VIII, IX and X Municipalities, in the south east area of Rome. The collected data seem to exclude the presence of evident psychological terrorism, even though there can be sound reasons for it to develop: bad job organization, lack of personnel policy and an increase in the stress level, all of which are the most common elements paving the way for mobbing. The results of the survey reveal a highly dysfunctional working situation even though they do not comply with the characteristic criteria of psychological violence, known as mobbing. In Italy, a major organizational restructuring (privatisation, mergers, etc), as well as the introduction of new types of jobs, has contributed to turn mobbing from an occasional phenomenon into a social problem about which everyone is concerned (anti-mobbing centres, specialized clinics, bills, etc). This study focuses on some aspects of the organizational work structure which would otherwise usually be disregarded at the risk of causing uneasiness and/or stress pathologies.

From a global crisis to the 'end of AIDS': New epidemics of signification.

PubMed

Kenworthy, Nora; Thomann, Matthew; Parker, Richard

2018-08-01

In the past decade, discourses about AIDS have taken a remarkable, and largely unquestioned, turn. Whereas mobilisations for treatment scale-up during the 2000s were premised on perceptions of an 'epidemic out of control', we have repeatedly been informed in more recent years that an end to AIDS is immanent. This new discourse and its resulting policies are motivated by post-recession financial pressures, a changing field of global institutions, and shifting health and development priorities. These shifts also reflect a biomedical triumphalism in HIV prevention and treatment, whereby shorter term, privatised, technological, and 'cost-effective' interventions are promoted over long-term support for antiretroviral treatment. To explore these changes, we utilise Treichler's [(1987). How to have theory in an epidemic: Cultural chronicles of AIDS. Durham, NC: Duke University Press] view of AIDS as an 'epidemic of signification' to develop a review of 'End of AIDS' discourses in recent years. We use this review to investigate the political and philanthropic interests served by efforts to rebrand and re-signify the epidemic. We also hold up these discourses against the realities of treatment access in resource-poor countries, where 'Ending AIDS' has not heralded the end of an epidemic per se, but rather the end of external support for treatment programmes, highlighting new difficulties for sustaining treatment in this new era of the epidemic.

The difference biocultural "place" makes to community efforts towards sustainable development: Youth participatory action research in a marine protected area of Colombia

NASA Astrophysics Data System (ADS)

McRuer, Jennifer; Zethelius, Margarita

2017-12-01

The Latin American concept of "(collective) biocultural heritage" arose from Indigenous knowledge and practices with respect to local natural resources and environment, including the food being hunted, the crops being grown, and the landscapes being created. The term is now used more widely to describe community practices, goals and priorities that are determined, maintained and managed by diverse cultural relationships with "place". The study presented in this article investigated biocultural place relationships in connection with well-being and sustainability. In the context of learning and action for sustainability in Isla Grande, an island in a marine protected area of Colombia, this study targeted the significance of place to the everyday lives of Afro-Colombian youth - from their perspective. Beyond aiming to merely observe and collect data, the methodology included a research design which actively involved local youth and incorporated the aspect of place. The authors describe and reflect on the processes, learning and action that emerged throughout the research, as well as the study's limitations. They discuss broad implications in terms of how place relationships influence research, and how research influences place relationships. Local implications include supporting the voice of youth in community efforts to re-imagine and transform place relationships in response to critical place issues such as climate change, top-down resource management, privatisation, commodification and growing environmental injustice.

Quantitative option analysis for implementation and management of landfills.

PubMed

Kerestecioğlu, Merih

2016-09-01

The selection of the most feasible strategy for implementation of landfills is a challenging step. Potential implementation options of landfills cover a wide range, from conventional construction contracts to the concessions. Montenegro, seeking to improve the efficiency of the public services while maintaining affordability, was considering privatisation as a way to reduce public spending on service provision. In this study, to determine the most feasible model for construction and operation of a regional landfill, a quantitative risk analysis was implemented with four steps: (i) development of a global risk matrix; (ii) assignment of qualitative probabilities of occurrences and magnitude of impacts; (iii) determination of the risks to be mitigated, monitored, controlled or ignored; (iv) reduction of the main risk elements; and (v) incorporation of quantitative estimates of probability of occurrence and expected impact for each risk element in the reduced risk matrix. The evaluated scenarios were: (i) construction and operation of the regional landfill by the public sector; (ii) construction and operation of the landfill by private sector and transfer of the ownership to the public sector after a pre-defined period; and (iii) operation of the landfill by the private sector, without ownership. The quantitative risk assessment concluded that introduction of a public private partnership is not the most feasible option, unlike the common belief in several public institutions in developing countries. A management contract for the first years of operation was advised to be implemented, after which, a long term operating contract may follow. © The Author(s) 2016.

Private health care.

PubMed

Uplekar, M W

2000-09-01

During the last decade there has been considerable international mobilisation around shrinking the role of States in health care. The World Bank reports that, in many low and middle-income countries, private sources of finance comprise the largest share of total national health expenditures. Private sector health care is ubiquitous, reaches throughout the population, preferred by the people and is significant from both economic as well as health perspective. Resources are limited, governments are weak, and a new approach is needed. This paper provides a broad overview and raises key issues with regard to private health care. The focus is on provision of health care by private medical providers. On the background of the world's common health problems and interventions available to tackle them, the place of private health care in the overall context is first discussed. The concept of privatisation within the various forms of health care systems is then explained. The paper then describes the genesis and key elements of rapidly enhancing role of the private sector in health care and points to the paucity of literature from low and middle-income countries. Common concerns about private health care are outlined. Two illustrative examples--tuberculosis, the top infectious killer among the poor and coronary heart disease, the top non-infectious killer among the rich--are presented to understand the current and possible role of private sector in provision of health care. Highlighting the need to distinguish between health care as a public good or a market commodity, the paper leaves it to the reader to draw conclusions.

Developing a sustainable energy strategy for a water utility. Part I: A review of the UK legislative framework.

PubMed

Zakkour, P D; Gaterell, M R; Griffin, P; Gochin, R J; Lester, J N

2002-10-01

Increasing political effort to improve water quality across the UK and Europe has led to water and sewerage companies investing heavily in high-tech wastewater treatment plants capable of producing high quality effluents. Consequently, amounts of bought-in electricity used for wastewater treatment has and will continue to increase significantly over coming years, while greater provision of enhanced sewage treatment also produces greater volumes of sewage sludge requiring treatment and disposal. Over the same period, tougher controls on the quality of biosolids applied to agricultural land have also been introduced, while there has been an international attempt to reduce the use of fossil-fuel derived power sources because of concerns over global warming. The latter has brought about the introduction of financial instruments, such as the Climate Change Levy, to curb energy use, promote energy efficiency and encourage the development of renewable energy technologies. These factors are set to drive-up the costs of providing adequate sewage treatment services, while at the same time, a tough regulatory line taken to control profits on regional monopolies held by the UK water companies will significantly reduce their revenues over the period 2000-05. The result is that, financially, UK water and sewerage companies face their most challenging period since privatisation in 1989. This paper briefly outlines the current regulations relating to water quality and energy use that will affect water company operations over coming years.

Changes in per capita alcohol sales during the partial privatization of British Columbia's retail alcohol monopoly 2003-2008: a multi-level local area analysis.

PubMed

Stockwell, Tim; Zhao, Jinhui; Macdonald, Scott; Pakula, Basia; Gruenewald, Paul; Holder, Harold

2009-11-01

To investigate the independent effects on liquor sales of an increase in (a) the density of liquor outlets and (b) the proportion of liquor stores in private rather than government ownership in British Columbia between 2003/4 and 2007/8. The British Columbia Liquor Distribution Branch provided data on litres of ethanol sold through different types of outlets in 89 local health areas of the province by beverage type. Multi-level regression models were used to examine the relationship between per capita alcohol sales and outlet densities for different types of liquor outlet after adjusting for potential confounding social, economic and demographic factors as well as spatial and temporal autocorrelation. Liquor outlets in 89 local health areas of British Columbia, Canada. The number of private stores per 10,000 residents was associated significantly and positively with per capita sales of ethanol in beer, coolers, spirits and wine, while the reverse held for government liquor stores. Significant positive effects were also identified for the number of bars and restaurants per head of population. The percentage of liquor stores in private versus government ownership was also associated significantly with per capita alcohol sales when controlling for density of liquor stores and of on-premise outlets (P < 0.01). The trend towards privatisation of liquor outlets between 2003/04 and 2007/08 in British Columbia has contributed to increased per capita sales of alcohol and hence possibly also to increased alcohol-related harm.

'The industry must be inconspicuous': Japan Tobacco's corruption of science and health policy via the Smoking Research Foundation.

PubMed

Iida, Kaori; Proctor, Robert N

2018-02-04

To investigate how and why Japan Tobacco, Inc. (JT) in 1986 established the Smoking Research Foundation (SRF), a research-funding institution, and to explore the extent to which SRF has influenced science and health policy in Japan. We analysed documents in the Truth Tobacco Industry Documents archive, along with recent Japanese litigation documents and published documents. JT's effort to combat effective tobacco control was strengthened in the mid-1980s, following privatisation of the company. While remaining under the protection of Japan's Ministry of Finance, the semiprivatised company lost its 'access to politicos', opening up a perceived need for collaboration with global cigarette makers. One solution, arrived at through clandestine planning with American companies, was to establish a third-party organisation, SRF, with the hope of capturing scientific and medical authority for the industry. Guarded by powerful people in government and academia, SRF was launched with the covert goal of influencing tobacco policy both inside and outside Japan. Scholars funded by SRF have participated in international conferences, national advisory committees and tobacco litigation, in most instances helping the industry to maintain a favourable climate for the continued sale of cigarettes. Contrary to industry claims, SRF was never meant to be independent or neutral. With active support from foreign cigarette manufacturers, SRF represents the expansion into Asia of the denialist campaign that began in the USA in 1953. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Adapting Agricultural Water Use to Climate Change in a Post-Soviet Context: Challenges and Opportunities in Southeast Kazakhstan.

PubMed

Barrett, Tristam; Feola, Giuseppe; Khusnitdinova, Marina; Krylova, Viktoria

2017-01-01

The convergence of climate change and post-Soviet socio-economic and institutional transformations has been underexplored so far, as have the consequences of such convergence on crop agriculture in Central Asia. This paper provides a place-based analysis of constraints and opportunities for adaptation to climate change, with a specific focus on water use, in two districts in southeast Kazakhstan. Data were collected by 2 multi-stakeholder participatory workshops, 21 semi-structured in-depth interviews, and secondary statistical data. The present-day agricultural system is characterised by enduring Soviet-era management structures, but without state inputs that previously sustained agricultural productivity. Low margins of profitability on many privatised farms mean that attempts to implement integrated water management have produced water users associations unable to maintain and upgrade a deteriorating irrigation infrastructure. Although actors engage in tactical adaptation measures, necessary structural adaptation of the irrigation system remains difficult without significant public or private investments. Market-based water management models have been translated ambiguously to this region, which fails to encourage efficient water use and hinders adaptation to water stress. In addition, a mutual interdependence of informal networks and formal institutions characterises both state governance and everyday life in Kazakhstan. Such interdependence simultaneously facilitates operational and tactical adaptation, but hinders structural adaptation, as informal networks exist as a parallel system that achieves substantive outcomes while perpetuating the inertia and incapacity of the state bureaucracy. This article has relevance for critical understanding of integrated water management in practice and adaptation to climate change in post-Soviet institutional settings more broadly.

Integrating global animal health, public health and tropical animal health issues into the veterinary curriculum: a South African/African perspective.

PubMed

Swan, G E; Coetzer, J A W; Terblanche, H M

2009-08-01

The globalisation of trade and food, the increased volume and speed of international travel, climate change, and the related escalation of emerging and re-emerging infectious diseases mean that countries are now more interconnected and interdependent than ever before. Africa is beleaguered by a range of endemic infectious and parasitic tropical diseases which, due to its diverse wildlife populations and indigenous livestock, can serve as a reservoir of high-impact or transboundary diseases and play a role in the emergence of disease, particularly at the wildlife, domestic animal and human interfaces. It is therefore essential to integrate animal and public health issues into the veterinary curriculum. Veterinary training in most parts of sub-Saharan Africa has focused on producing veterinarians to serve the livestock sector although socio-economic changes and privatisation of Veterinary Services have caused curriculum adjustments, as have globalisation and the increased risk of the spread of transboundary diseases. In South Africa, undergraduate veterinary training is more clinically oriented than in other regions. Animal and public health issues are covered in the curriculum, although their global relevance is not emphasised. The authors describe the undergraduate veterinary curriculum and summarise post-graduate programmes in South Africa. They also discuss a more comprehensive core-elective approach to the current curriculum and the need to adapt to new challenges facing the profession. Finally, they examine the potential use of innovative technology in undergraduate and post-graduate training and professional development, the importance of regional and international collaboration and the accreditation and recognition of veterinary training.

Any qualified provider: a qualitative case study of one community NHS Trust's response

PubMed Central

Walumbe, Jackie; Swinglehurst, Deborah; Shaw, Sara

2016-01-01

Objective To examine how those managing and providing community-based musculoskeletal (MSK) services have experienced recent policy allowing patients to choose any provider that meets certain quality standards from the National Health Service (NHS), private or voluntary sector. Design Intrinsic case study combining qualitative analysis of interviews and field notes. Setting An NHS Community Trust (the main providers of community health services in the NHS) in England, 2013–2014. Participants NHS Community Trust employees involved in delivering MSK services, including clinical staff and managerial staff in senior and mid-range positions. Findings Managers (n=4) and clinicians (n=4) working within MSK services understood and experienced the Any Qualified Provider (AQP) policy as involving: (1) a perceived trade-off between quality and cost in its implementation; (2) deskilling of MSK clinicians and erosion of professional values; and (3) a shift away from interprofessional collaboration and dialogue. These ways of making sense of AQP policy were associated with dissatisfaction with market-based health reforms. Conclusions AQP policy is poorly understood. Clinicians and managers perceive AQP as synonymous with competition and privatisation. From the perspective of clinicians providing MSK services, AQP, and related health policy reforms, tend, paradoxically, to drive down quality standards, supporting reconfiguration of services in which the complex, holistic nature of specialised MSK care may become marginalised by policy concerns about efficiency and cost. Our analysis indicates that the potential of AQP policy to increase quality of care is, at best, equivocal, and that any consideration of how AQP impacts on practice can only be understood by reference to a wider range of health policy reforms. PMID:26908521

Any qualified provider: a qualitative case study of one community NHS Trust's response.

PubMed

Walumbe, Jackie; Swinglehurst, Deborah; Shaw, Sara

2016-02-23

To examine how those managing and providing community-based musculoskeletal (MSK) services have experienced recent policy allowing patients to choose any provider that meets certain quality standards from the National Health Service (NHS), private or voluntary sector. Intrinsic case study combining qualitative analysis of interviews and field notes. An NHS Community Trust (the main providers of community health services in the NHS) in England, 2013-2014. NHS Community Trust employees involved in delivering MSK services, including clinical staff and managerial staff in senior and mid-range positions. Managers (n=4) and clinicians (n=4) working within MSK services understood and experienced the Any Qualified Provider (AQP) policy as involving: (1) a perceived trade-off between quality and cost in its implementation; (2) deskilling of MSK clinicians and erosion of professional values; and (3) a shift away from interprofessional collaboration and dialogue. These ways of making sense of AQP policy were associated with dissatisfaction with market-based health reforms. AQP policy is poorly understood. Clinicians and managers perceive AQP as synonymous with competition and privatisation. From the perspective of clinicians providing MSK services, AQP, and related health policy reforms, tend, paradoxically, to drive down quality standards, supporting reconfiguration of services in which the complex, holistic nature of specialised MSK care may become marginalised by policy concerns about efficiency and cost. Our analysis indicates that the potential of AQP policy to increase quality of care is, at best, equivocal, and that any consideration of how AQP impacts on practice can only be understood by reference to a wider range of health policy reforms. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Analysis of the spatio-temporal and semantic aspects of land-cover/use change dynamics 1991-2001 in Albania at national and district levels.

PubMed

Jansen, Louisa J M; Carrai, Giancarlo; Morandini, Luca; Cerutti, Paolo O; Spisni, Andrea

2006-08-01

In the turmoil of a rapidly changing economy the Albanian government needs accurate and timely information for management of their natural resources and formulation of land-use policies. The transformation of the forestry sector has required major changes in the legal, regulatory and management framework. The World Bank financed Albanian National Forest Inventory project provides an analysis of spatially explicit land-cover/use change dynamics in the period 1991-2001 using the FAO/UNEP Land Cover Classification System for codification of classes, satellite remote sensing and field survey for data collection and elements of the object-oriented geo-database approach to handle changes as an evolution of land-cover/use objects, i.e. polygons, over time to facilitate change dynamics analysis. Analysis results at national level show the trend of natural resources depletion in the form of modifications and conversions that lead to a gradual shift from land-cover/use types with a tree cover to less dense tree covers or even a complete removal of trees. Policy failure (e.g., corruption, lack of law enforcement) is seen as the underlying cause. Another major trend is urbanisation of areas near large urban centres that change urban-rural linkages. Furthermore, after privatisation agricultural areas increased in the hills where environmental effects may be detrimental, while prime agricultural land in the plains is lost to urbanisation. At district level, the local variability of spatially explicit land-cover/use changes shows different types of natural resources depletion. The distribution of changes indicates a regional prevalence, thus a decentralised approach to the natural resources management could be advocated.

Occupational exposure to magnetic fields in relation to mortality from brain cancer among electricity generation and transmission workers.

PubMed Central

Harrington, J M; McBride, D I; Sorahan, T; Paddle, G M; van Tongeren, M

1997-01-01

OBJECTIVE: To investigate whether the risks of mortality from brain cancer are related to occupational exposure to magnetic fields. METHODS: A total of 112 cases of primary brain cancer (1972-91) were identified from a cohort of 84,018 male and female employees of the (then) Central Electricity Generating Board and its privatised successor companies. Individual cumulative occupational exposures to magnetic fields were estimated by linking available computerised job history data with magnetic field measurements collected over 675 person-workshifts. Estimated exposure histories of the case workers were compared with those of 654 control workers drawn from the cohort (nested case-control study), by means of conditional logistic regression. RESULTS: For exposure assessments based on arithmetic means, the risk of mortality from brain cancer for subjects with an estimated cumulative exposure to magnetic fields of 5.4-13.4 microT.y v subjects with lower exposures (0.0-5.3 microT.y) was 1.04 (95% confidence interval (95% CI) 0.60 to 1.80). The corresponding relative risk in subjects with higher exposures (> or = 13.5 microT.y) was 0.95 (95% CI 0.54 to 1.69). There was no indication of a positive trend for cumulative exposure and risk of mortality from brain cancer either when the analysis used exposure assessments based on geometric means or when the analysis was restricted to exposures received within five years of the case diagnosis (or corresponding period for controls). CONCLUSIONS: Although the exposure categorisation was based solely on recent observations, the study findings do not support the hypothesis that the risk of brain cancer is associated with occupational exposure to magnetic fields. PMID:9072027

Patient participation: causing moral stress in psychiatric nursing?

PubMed

Jansen, Trine-Lise; Hanssen, Ingrid

2017-06-01

The aim of this study was to explore psychiatric nurses' experiences and perspectives regarding patient participation. Patient participation is an ambiguous, complex and poorly defined concept with practical/clinical, organisational, legal and ethical aspects, some of which in psychiatric units may cause ethical predicaments and moral stress in nurses, for instance when moral caring acts are thwarted by constraints. An explorative quantitative pilot study was conducted at a psychiatric subacute unit through three focus group interviews with a total of nine participants. A thematic analytic approach was chosen. Preliminary empirical findings were discussed with participants before the final data analysis. Ethical research guidelines were followed. Patient participation is a difficult ideal to realise because of vagueness of aim and content. What was regarded as patient participation differed. Some interviewees held that patients may have a say within the framework of restraints while others saw patient participation as superficial. The interviewees describe themselves as patient's spokespersons and contributing to patients participating in their treatment as a great responsibility. They felt squeezed between their ethical values and the 'system'. They found themselves in a negotiator role trying to collaborate with both the doctors and the patients. Privatisation of a political ideal makes nurses vulnerable to burn out and moral distress. Nurses have a particular ethical responsibility towards vulnerable patients, and may themselves be vulnerable when caught in situations where their professional and moral values are threatened. Unclear concepts make for unclear division of responsibility. Patient participation is often a neglected value in current psychiatric treatment philosophy. When healthcare workers' ethical sensibilities are compromised, this may result in moral stress. © 2016 Nordic College of Caring Science.

Conflicts, security and marginalisation: institutional change of the pastoral commons in a 'glocal' world.

PubMed

Haller, T; Van Dijk, H; Bollig, M; Greiner, C; Schareika, N; Gabbert, C

2016-11-01

This paper argues that pastoral commons are under increasing pressure not just from overuse by pastoralists themselves, but from land management policies. Since colonial times, these have been based on a persistent misconception of the nature of pastoral economies and combined with increasing land alienation and fragmentation through government policies and covert privatisation of pastures. The paper focuses especially on pastoral populations in African drylands and is based on long-term research by independent researchers summarising some of their experiences in western, eastern and southern Africa. Most of them are organised in the African Drylands Dialogue, trying to shed some light on the developments in these areas. Before discussing the actual situation of African pastoralists, the authors focus on basic institutional features of the political and economic management of common grazing lands. This is followed by an overview of land alienation processes in colonial times, which serves as a basis for understanding the current land alienation constellations. The paper then moves on to explain how and why pastoralists are framed by the national discourses as the 'other' and the 'troublemaker', even being labelled as terrorists in nation state contexts. This goes hand in hand with a new wave of land alienation in the form of large-scale land acquisitions or 'land grabbing' (including water grabbing and 'green grabbing' processes). The paper then outlines different coping and adaptation strategies adopted by pastoral groups in a context in which a range of different global and local political, economic and ecological situations interrelate ('glocal'). Finally, the paper discusses the way in which pastoralism could be reframed in a participatory way in the future.

[Are privately owned hospitals more efficient? Results of a survey of the international literature].

PubMed

Sibbel, R; Nagarajah, B

2012-06-01

In no other European country has the privatisation of hospitals taken such dimensions in the last 15 years as in Germany. Thereby a higher efficiency of private ownership is often assumed as a potential driver. The aim of this study is to analyse the current state of research on the question of whether private hospitals are more efficient, or whether the public ones are just plain worse operators of clinics. As a contribution to answering the relevant question, a systematic review of the international literature on benchmarking the performance of hospitals as a function of ownership on the basis of the efficiency measurement using DEA (data envelopment analysis) was conducted. In the closer analysis 8 studies were accepted; of which 3 refer to the U.S.A., 3 to the German and one to the Taiwanese and South Korean health-care sector. These studies compare private hospital operators with other types of ownership, where they differ considerably in their methodological approaches. 5 studies reveal that public and not-for-profit hospitals are more efficient than those in private ownership. One study concludes the opposite, and 2 could not demonstrate any significant differences between the different hospital ownerships. This result is a surprise taking into consideration the development and discussion in Germany in recent years and in comparison to studies based on alternative approaches to efficiency measurement. The detailed analysis of the studies shows that because of weaknesses and a variety of differences in the methodological structure of the studies a really convincing answer regarding the first question ultimately cannot be derived from the results. Georg Thieme Verlag KG Stuttgart · New York.

State-ownership of tobacco industry: a 'fundamental conflict of interest' or a 'tremendous opportunity' for tobacco control?

PubMed

Hogg, Scott L; Hill, Sarah E; Collin, Jeff

2016-07-01

Despite state-owned tobacco companies (SOTCs) accounting for over 40% of global production, the significance of state-ownership for tobacco control strategies has received limited academic and policy attention. The complex interests associated with SOTCs present diverse challenges for tobacco control policy, particularly in implementing Article 5.3 of WHO's Framework Convention on Tobacco Control (FCTC). Based on a review of existing literature, this paper examines current challenges and potential opportunities presented by governmental participation in the tobacco industry, identifying three contrasting perspectives from academic and policy sources. The first two perspectives centre on recognising that economic interests inherent in an SOTC are in tension with a government's public health responsibilities. This conflict can be perceived as either fundamental and fixed ('intrinsic conflict') or as amenable to either exacerbation or amelioration via organisational mechanisms ('institutionally-mediated conflict')-as suggested by the contrasting examples of China and Thailand. A third, less prominent perspective (which we refer to as 'interest alignment') suggests that it may be possible to radically alter the objectives and behaviour of SOTCs in order to advance tobacco control. Finally, we draw on this analysis to consider policy options for advancing tobacco control in countries with SOTCs. Guidance on implementation of Article 5.3 demonstrates strategic ambiguity by including elements of all three perspectives described above. We argue that legislative separation of tobacco control from SOTC oversight provides a desirable alternative to industry privatisation, and that radically realigning the goals of SOTCs to reduce tobacco consumption could make an important contribution to endgame strategies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Risk management in waste water treatment.

PubMed

Wagner, M; Strube, I

2005-01-01

With the continuous restructuring of the water market due to liberalisation, privatisation and internationalisation processes, the requirements on waste water disposal companies have grown. Increasing competition requires a target-oriented and clearly structured procedure. At the same time it is necessary to meet the environment-relevant legal requirements and to design the processes to be environment-oriented. The implementation of risk management and the integration of such a management instrument in an existing system in addition to the use of modern technologies and procedures can help to make the operation of the waste water treatment safer and consequently strengthen market position. The risk management process consists of three phases, risk identification, risk analysis/risk assessment and risk handling, which are based on each other, as well as of the risk managing. To achieve an identification of the risks as complete as possible, a subdivision of the kind of risks (e.g. legal, financial, market, operational) is suggested. One possibility to assess risks is the portfolio method which offers clear representation. It allows a division of the risks into classes showing which areas need handling. The determination of the appropriate measures to handle a risk (e.g. avoidance, reduction, shift) is included in the concluding third phase. Different strategies can be applied here. On the one hand, the cause-oriented strategy, aiming at preventive measures which aim to reduce the probability of occurrence of a risk (e.g. creation of redundancy, systems with low susceptibility to malfunction). On the other hand, the effect-oriented strategy, aiming to minimise the level of damage in case of an undesired occurrence (e.g. use of alarm systems, insurance cover).

Primary healthcare in transition – a qualitative study of how managers perceived a system change

PubMed Central

2013-01-01

Background Primary healthcare in Sweden has undergone widespread reforms in recent years, including freedom of choice regarding provider, freedom of establishment and increased privatisation. The key aims of the reforms were to strengthen the role of the patient and improve performance in terms of access and responsiveness. The aim of this study was to explore how managers at publicly owned primary healthcare centres perceived the transition of the primary healthcare system and the impact it has had on their work. Methods In this qualitative study, 24 managers of publicly owned primary healthcare centres in the metropolitan region of Gothenburg were recruited. Semi-structured interviews were conducted and data were analysed using content analysis inspired by Silverman. Results The analysis revealed two core themes: The transition is perceived as a rapid change, enforced mainly through financial incentives and Prioritisation conflicts arise between patient groups with different needs, demands and levels of empowerment. The transition has produced powerful and rapid effects that were considered to be both positive and negative. While the new financial incentives were seen as a driving force and a tool for change, they also became a stress factor due to uncertainty, competition with other primary healthcare centres and negative feelings associated with staff cutbacks. The shift in power towards the patient improved access and service but also led to more patients with unreasonable demands. Managers found it difficult to prioritise correctly between patient groups with different needs, demands and levels of empowerment and they were concerned about potentially negative effects on less empowered patients, e.g. multi-morbid patients. Managers also experienced shortcomings in their change management skills. Conclusions This qualitative study shows the complexity of the system change and describes the different effects and perceptions of the transition from a manager’s perspective. This suggests a need for improved follow-up and control in order to monitor and govern system changes and ensure development towards a more effective and sustainable primary healthcare system. PMID:24090138

Implementation of the semi-aerobic landfill system (Fukuoka method) in developing countries: a Malaysia cost analysis.

PubMed

Chong, Theng Lee; Matsufuji, Yasushi; Hassan, Mohd Nasir

2005-01-01

Most of the existing solid waste landfill sites in developing countries are practicing either open dumping or controlled dumping. Proper sanitary landfill concepts are not fully implemented due to technological and financial constraints. Implementation of a fully engineered sanitary landfill is necessary and a more economically feasible landfill design is crucial, particularly for developing countries. This study was carried out by focusing on the economics from the development of a new landfill site within a natural clay area with no cost of synthetic liner up to 10 years after its closure by using the Fukuoka method semi-aerobic landfill system. The findings of the study show that for the development of a 15-ha landfill site in Malaysia with an estimated volume of 2,000,000 m(3), the capital investment required was about US 1,312,895 dollars, or about US 0.84 dollars/tonne of waste. Assuming that the lifespan of the landfill is 20 years, the total cost of operation was about US 11,132,536 dollars or US 7.15 dollars/tonne of waste. The closure cost of the landfill was estimated to be US 1,385,526 dollars or US 0.89 dollars/tonne of waste. Therefore, the total cost required to dispose of a tonne of waste at the semi-aerobic landfill was estimated to be US 8.89 dollars. By considering an average tipping fee of about US 7.89 dollars/tonne of waste in Malaysia in the first year, and an annual increase of 3% to about US 13.84 dollars in year-20, the overall system recorded a positive revenue of US 1,734,749 dollars. This is important information for the effort of privatisation of landfill sites in Malaysia, as well as in other developing countries, in order to secure efficient and effective landfill development and management.

Globalisation of birth markets: a case study of assisted reproductive technologies in India

PubMed Central

2011-01-01

The escalation of Assisted Reproductive Technologies (ARTs) in India into a veritable fertility industry is the result of a multitude of reasons. This paper places the bio-genetic industry within the larger political economy framework of globalisation and privatisation, thus employing a framework that is often omitted from discussions on ARTs, but has direct and significant bearings on the ART industry in India. As markets for human organs, tissues and reproductive body parts experience unprecedented growth, the limits of what can or should be bought and sold continue to be pushed. As such, bodies have emerged as sale-worthy economic capital. Commercial flows of reproductive material create and deploy the division of the body into parts over which ownership is claimed, in the process following 'modern routes of capital' and raising issues of structural inequality. This paper presents a brief picture of India's fertility industry with specific focus on its ground-level operation, nature and growth. It aims to explore the industry dimensions of ARTs, by highlighting the macro picture of health care markets and medical tourism in India, the proliferation of the ART industry, market features such as the social imperative to mother, costs, promotion and marketing, unverified claims, inflated success rates, deals and offers, actors and collaborations in the field, and finally, the absence of standards. This paper presents findings from the research 'Constructing Conceptions: The Mapping of Assisted Reproductive Technologies in India', by Sama, a Delhi-based resource group working on gender, health and rights. This research was conducted from 2008 to 2010 in the three states of Uttar Pradesh, Orissa and Tamil Nadu in India, and is one of the first of its kind, highlighting unethical medical practices and making a case for the regulation of the ART industry. As such, it forms a significant part of Sama's ongoing work on women and technologies, particularly policy-level advocacy. PMID:21838866

Haïti and the health marketplace: the role of the private, informal market in filling the gaps left by the state.

PubMed

Durham, J; Michael, Marcos; Hill, P S; Paviignani, E

2015-09-28

In most societies the health marketplace is pluralistic in character, with a mix of formal and informal providers. In high-income countries, state regulation of the market helps ensure quality and access and mitigate market failures. In the present study, using Haiti as a case study, we explore what happens to the functioning of the pluralistic health marketplace in severely disrupted environments where the informal sector is able to flourish. The overall research design was qualitative. Research methods included an extensive documentary and policy analysis, based on peer-reviewed articles, books and "grey" literature--government policy and program reports, unpublished research and evaluations, reviews and reviews from key multilateral and bilateral donors, and non-government organisations, combined with field site visits and in-depth key informant interviews (N = 45). The findings show that state fragility has resulted in a privatised, commoditised and largely unregulated and informal health market. While different market segments can be identified, in reality the boundaries between international/domestic, public/private, for profit/not-for-profit, legal/illegal are hazy and shifting. The lack of state capacity to provide an enabling environment, establish, and enforce its regulatory framework has resulted in a highly segmented, heterogeneous and informal health market. The result is deplorable health indices which are far below regional averages and many other low-income countries. Working in fragile states with limited capacity to undertake the core function of securing the health of its population requires new and innovative ways of working. This needs longer time-frames, combining incremental top-down and bottom-up strategies which recognize and work with state and civil society, public and private actors, formal and informal institutions, and progressively facilitate changes in the different market functions of supply, demand, regulation and supporting functions.

Globalisation of birth markets: a case study of assisted reproductive technologies in India.

PubMed

Sarojini, Nadimpally; Marwah, Vrinda; Shenoi, Anjali

2011-08-12

The escalation of Assisted Reproductive Technologies (ARTs) in India into a veritable fertility industry is the result of a multitude of reasons. This paper places the bio-genetic industry within the larger political economy framework of globalisation and privatisation, thus employing a framework that is often omitted from discussions on ARTs, but has direct and significant bearings on the ART industry in India. As markets for human organs, tissues and reproductive body parts experience unprecedented growth, the limits of what can or should be bought and sold continue to be pushed. As such, bodies have emerged as sale-worthy economic capital. Commercial flows of reproductive material create and deploy the division of the body into parts over which ownership is claimed, in the process following 'modern routes of capital' and raising issues of structural inequality.This paper presents a brief picture of India's fertility industry with specific focus on its ground-level operation, nature and growth. It aims to explore the industry dimensions of ARTs, by highlighting the macro picture of health care markets and medical tourism in India, the proliferation of the ART industry, market features such as the social imperative to mother, costs, promotion and marketing, unverified claims, inflated success rates, deals and offers, actors and collaborations in the field, and finally, the absence of standards. This paper presents findings from the research 'Constructing Conceptions: The Mapping of Assisted Reproductive Technologies in India', by Sama, a Delhi-based resource group working on gender, health and rights. This research was conducted from 2008 to 2010 in the three states of Uttar Pradesh, Orissa and Tamil Nadu in India, and is one of the first of its kind, highlighting unethical medical practices and making a case for the regulation of the ART industry. As such, it forms a significant part of Sama's ongoing work on women and technologies, particularly policy-level advocacy.

Primary healthcare in transition--a qualitative study of how managers perceived a system change.

PubMed

Maun, Andy; Nilsson, Kerstin; Furåker, Carina; Thorn, Jörgen

2013-10-03

Primary healthcare in Sweden has undergone widespread reforms in recent years, including freedom of choice regarding provider, freedom of establishment and increased privatisation. The key aims of the reforms were to strengthen the role of the patient and improve performance in terms of access and responsiveness. The aim of this study was to explore how managers at publicly owned primary healthcare centres perceived the transition of the primary healthcare system and the impact it has had on their work. In this qualitative study, 24 managers of publicly owned primary healthcare centres in the metropolitan region of Gothenburg were recruited. Semi-structured interviews were conducted and data were analysed using content analysis inspired by Silverman. The analysis revealed two core themes: The transition is perceived as a rapid change, enforced mainly through financial incentives and Prioritisation conflicts arise between patient groups with different needs, demands and levels of empowerment. The transition has produced powerful and rapid effects that were considered to be both positive and negative. While the new financial incentives were seen as a driving force and a tool for change, they also became a stress factor due to uncertainty, competition with other primary healthcare centres and negative feelings associated with staff cutbacks. The shift in power towards the patient improved access and service but also led to more patients with unreasonable demands. Managers found it difficult to prioritise correctly between patient groups with different needs, demands and levels of empowerment and they were concerned about potentially negative effects on less empowered patients, e.g. multi-morbid patients. Managers also experienced shortcomings in their change management skills. This qualitative study shows the complexity of the system change and describes the different effects and perceptions of the transition from a manager's perspective. This suggests a need for improved follow-up and control in order to monitor and govern system changes and ensure development towards a more effective and sustainable primary healthcare system.

Assessing the impact of care farms on quality of life and offending: a pilot study among probation service users in England

PubMed Central

Elsey, Helen; Farragher, Tracey; Tubeuf, Sandy; Bragg, Rachel; Elings, Marjolein; Brennan, Cathy; Gold, Rochelle; Shickle, Darren; Wickramasekera, Nyantara; Richardson, Zoe; Cade, Janet; Murray, Jenni

2018-01-01

Objectives To assess the feasibility of conducting a cost-effectiveness study of using care farms (CFs) to improve quality of life and reduce reoffending among offenders undertaking community orders (COs). To pilot questionnaires to assess quality of life, connection to nature, lifestyle behaviours, health and social-care use. To assess recruitment and retention at 6 months and feasibility of data linkage to Police National Computer (PNC) reconvictions data and data held by probation services. Design Pilot study using questionnaires to assess quality of life, individually linked to police and probation data. Setting The pilot study was conducted in three probation service regions in England. Each site included a CF and at least one comparator CO project. CFs are working farms used with a range of clients, including offenders, for therapeutic purposes. The three CFs included one aquaponics and horticulture social enterprise, a religious charity focusing on horticulture and a family-run cattle farm. Comparator projects included sorting secondhand clothes and activities to address alcohol misuse and anger management. Participants We recruited 134 adults (over 18) serving COs in England, 29% female. Results 52% of participants completed follow-up questionnaires. Privatisation of UK probation trusts in 2014 negatively impacted on recruitment and retention. Linkage to PNC data was a more successful means of follow-up, with 90% consenting to access their probation and PNC data. Collection of health and social-care costs and quality-adjusted life year derivation were feasible. Propensity score adjustment provided a viable comparison method despite differences between comparators. We found worse health and higher reoffending risk among CF participants due to allocation of challenging offenders to CFs, making risk of reoffending a confounder. Conclusions Recruitment would be feasible in a more stable probation environment. Follow-up was challenging; however, assessing reconvictions from PNC data is feasible and a potential primary outcome for future studies. PMID:29550778

Can we halt health workforce deterioration in failed states? Insights from Guinea-Bissau on the nature, persistence and evolution of its HRH crisis.

PubMed

Russo, Giuliano; Pavignani, Enrico; Guerreiro, Catia Sá; Neves, Clotilde

2017-02-07

Guinea-Bissau is one of the world's poorest and least developed countries. Amid poverty, political turmoil and state withdrawal, its health workforce (HW) has been swamped for the last four decades in a deepening crisis of under-resourcing, poor performance and laissez-faire. The present study aimed at analysing the human resources for health (HRH) situation in Guinea-Bissau in light of the recent literature on distressed health systems, with the objective of contributing to understanding the ways health workers react to protracted turmoil, the resulting distortions and the counter-measures that might be considered. Through document analysis, focus group discussions, 14 semi-structured and 5 in-depth interviews, we explored patterns as they became visible on the ground. Since independence, Guinea-Bissau experienced political events that have reflected on the healthcare arena and on the evolution of its health workforce, such as different coup attempts, waves of diaspora and shifting external assistance. The chronic scarcity of funds and a 'stable political instability' have lead to the commercialisation of public health services and to flawed mechanisms for training and deploying health personnel. In absence of any form of governance, health workers have come to own and run the health system. We show that the HRH crisis in Guinea-Bissau can only be understood by looking at its historical evolution and at the wider socio-economic context. There are no quick fixes for the deterioration of HRH in undergoverned states; however, the recognition of the ingrained distortions and an understanding of the forces determining the behaviour of key actors are essential premises for the identification of solutions. Guinea-Bissau's case study suggests that any policy that does not factor in the limited clout of health authorities over a effectively privatised healthcare arena is doomed from the start. Improving health system governance and quality of training should take precedence over expanding HRH. A bloated and ineffective workforce must be managed through incentives rather than administrative orders, in order to improve skills and productivity against higher remuneration and better working conditions. Donor support might be crucial to trigger positive changes, through realistic and sustained investments.

Pollen, People and Place: Multidisciplinary Perspectives on Ecosystem change at Amboseli, Kenya

NASA Astrophysics Data System (ADS)

Githumbi, Esther N.; Kariuki, Rebecca; Shoemaker, Anna; Courtney-Mustaphi, Colin J.; Chuhilla, Maxmillian; Richer, Suzi; Lane, Paul; Marchant, Rob

2017-12-01

This study presents a multidisciplinary perspective for understanding environmental change and emerging socio-ecological interactions across the Amboseli region of southwestern Kenya. We focus on late Holocene (<5000 cal yr. BP) changes and continuities reconstructed from sedimentary, archaeological, historical records and socio-ecological models. We utilize multi-disciplinary approaches to understand environmental-ecosystem-social interactions over the longue durée and use this to simulate different land use scenarios supporting conservation and sustainable livelihoods using a socio-ecological model. Today the semi-arid Amboseli landscape supports a large livestock and wildlife population, sustained by a wide variety of plants and extensive rangelands regulated by seasonal rainfall and human activity. Our data provide insight into how large-scale and long-term interactions of climate, people, livestock, wildlife and external connections have shaped the ecosystems across the Amboseli landscape. Environmental conditions were dry between 5000–2000 cal yr. BP, followed by two wet periods at 2100–1500 and 1400–800 cal yr. BP with short dry periods; the most recent centuries were characterised by variable climate with alternative dry and wet phases with high spatial heterogeneity. Most evident in palaeo and historical records is the changing woody to grass cover ratio, driven by changes in climate and fire regimes entwined with fluctuating elephant, cattle and wild ungulate populations moderated by human activity, including elephant ivory trade intensification. Archaeological perspectives on the occupation of different groups (hunter-gatherers, pastoralists and farmers) in Amboseli region and the relationships between them are discussed. An overview of the known history of humans and elephants, expanding networks of trade, and the arrival and integration of metallurgy, livestock and domesticated crops in the wider region is provided. In recent decades, increased runoff and flooding have resulted in the expansion of wetlands and a reduction of woody vegetation, compounding problems created by increased enclosure and privatisation of these landscapes. However, most of the wetlands outside of the protected area are drying up because of the intensified water extraction by the communities surrounding the National Park and on the adjacent mountains areas, who have increased in numbers, become sedentary and diversified land use around the wetlands.

Privatisation & marketisation of post-birth care: the hidden costs for new mothers.

PubMed

Benoit, Cecilia; Stengel, Camille; Phillips, Rachel; Zadoroznyj, Maria; Berry, Sarah

2012-10-15

Retrenchment of government services has occurred across a wide range of sectors and regions. Care services, in particular, have been clawed away in the wake of fiscal policies of cost containment and neoliberal policies centred on individual responsibility and market autonomy. Such policies have included the deinstitutionalisation of care from hospitals and clinics, and early discharge from hospital, both of which are predicated on the notion that care can be provided informally within families and communities. In this paper we examine the post-birth "care crisis" that new mothers face in one region of Canada. The data are drawn from a larger study of social determinants of pregnant and new mothers' health in Victoria, Canada. Mixed methods interviews were conducted among a purposive sample of women at three points in time. This paper reports data on sample characteristics, length of stay in hospital and health service gaps. This data is contextualised via a more in-depth analysis of qualitative responses from Wave 2 (4-6 weeks postpartum). Out results show a significant portion of participants desired services that were not publically available to them during the post-birth period. Among those who reported a gap in care, the two most common barriers were: cost and unavailability of home care supports. Participants' open-ended responses revealed many positive features of the public health care system but also gaps in services, and economic barriers to receiving the care they wanted. The implications of these findings are discussed in relation to recent neoliberal reforms. DISCUSSION & CONCLUSIONS: While Canada may be praised for its public provision of maternity care, mothers' reports of gaps in care during the early postpartum period and increasing use of private doulas is a worrying trend. To the extent that individual mothers or families rely on the market for care provision, issues of equity and quality of care are pivotal. This paper concludes with suggestions for further research on the impact of recent changes in post-birth care on new fathers and on inequities in pre and post-birth care in less-resourced regions of the world.

Developments in oral health policy in the Nordic countries since 1990.

PubMed

Widström, Eeva; Ekman, Agneta; Aandahl, Liljan S; Pedersen, Maria Malling; Agustsdottir, Helga; Eaton, Kenneth A

2005-01-01

There is a number of systems for the provision of oral health care, one of which is the Nordic model of centrally planned oral health care provision. This model has historically been firmly based on the concept of a welfare state in which there is universal entitlement to services and mutual responsibility and agreement to financing them. This study reports and analyses oral health care provision systems and developments in oral health policy in the Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) since 1990. Descriptions of and data on the oral health care provision systems in the Nordic countries were obtained from the Chief Dental Officers of the five countries, and contemporary scientific literature was appraised using cross-case analyses to identify generalisable features. It was found that in many respects the system in Iceland did not follow the 'Nordic' pattern. In the other four countries, tax-financed public dental services employing salaried dentists were complemented by publicly subsidised private services. Additional, totally private services were also available to a variable extent. Recently, the availabilty of publicly subsidised oral health care has been extended to cover wider groups of the total population in Finland and Sweden and, to a smaller extent, in Denmark. Concepts from market-driven care models have been introduced. In all five countries, relative to the national populations and other parts of the world, there were high numbers of dentists, dental hygienists and technicians. Access to oral health care services was good and utilisation rates generally high. In spite of anticipated problems with increasing health care costs, more public funds have recently been invested in oral health care in three of the five countries. The essential principles of the Nordic model for the delivery of community services, including oral health care, i.e. universal availability, high quality, finance through taxation and public provision, were still adhered to in spite of attempts at privatisation during the 1990 s. It appeared that, in general, the populations of the Nordic countries still believed that there was a need for health and oral health care to be paid for from public funds.

Pollen, People and Place: Multidisciplinary Perspectives on Ecosystem change at Amboseli, Kenya

NASA Astrophysics Data System (ADS)

Githumbi, Esther N.; Kariuki, Rebecca; Shoemaker, Anna; Courtney-Mustaphi, Colin J.; Chuhilla, Maxmillian; Richer, Suzi; Lane, Paul; Marchant, Rob

2018-01-01

This study presents a multidisciplinary perspective for understanding environmental change and emerging socio-ecological interactions across the Amboseli region of southwestern Kenya. We focus on late Holocene (<5000 cal yr. BP) changes and continuities reconstructed from sedimentary, archaeological, historical records and socio-ecological models. We utilize multi-disciplinary approaches to understand environmental-ecosystem-social interactions over the longue durée and use this to simulate different land use scenarios supporting conservation and sustainable livelihoods using a socio-ecological model. Today the semi-arid Amboseli landscape supports a large livestock and wildlife population, sustained by a wide variety of plants and extensive rangelands regulated by seasonal rainfall and human activity. Our data provide insight into how large-scale and long-term interactions of climate, people, livestock, wildlife and external connections have shaped the ecosystems across the Amboseli landscape. Environmental conditions were dry between 5000–2000 cal yr. BP, followed by two wet periods at 2100–1500 and 1400–800 cal yr. BP with short dry periods; the most recent centuries were characterised by variable climate with alternative dry and wet phases with high spatial heterogeneity. Most evident in palaeo and historical records is the changing woody to grass cover ratio, driven by changes in climate and fire regimes entwined with fluctuating elephant, cattle and wild ungulate populations moderated by human activity, including elephant ivory trade intensification. Archaeological perspectives on the occupation of different groups (hunter-gatherers, pastoralists and farmers) in Amboseli region and the relationships between them are discussed. An overview of the known history of humans and elephants, expanding networks of trade, and the arrival and integration of metallurgy, livestock and domesticated crops in the wider region is provided. In recent decades, increased runoff and flooding have resulted in the expansion of wetlands and a reduction of woody vegetation, compounding problems created by increased enclosure and privatisation of these landscapes. However, most of the wetlands outside of the protected area are drying up because of the intensified water extraction by the communities surrounding the National Park and on the adjacent mountains areas, who have increased in numbers, become sedentary and diversified land use around the wetlands.

Privatisation & marketisation of post-birth care: the hidden costs for new mothers

PubMed Central

2012-01-01

Retrenchment of government services has occurred across a wide range of sectors and regions. Care services, in particular, have been clawed away in the wake of fiscal policies of cost containment and neoliberal policies centred on individual responsibility and market autonomy. Such policies have included the deinstitutionalisation of care from hospitals and clinics, and early discharge from hospital, both of which are predicated on the notion that care can be provided informally within families and communities. In this paper we examine the post-birth "care crisis" that new mothers face in one region of Canada. Method The data are drawn from a larger study of social determinants of pregnant and new mothers' health in Victoria, Canada. Mixed methods interviews were conducted among a purposive sample of women at three points in time. This paper reports data on sample characteristics, length of stay in hospital and health service gaps. This data is contextualised via a more in-depth analysis of qualitative responses from Wave 2 (4-6 weeks postpartum). Results Out results show a significant portion of participants desired services that were not publically available to them during the post-birth period. Among those who reported a gap in care, the two most common barriers were: cost and unavailability of home care supports. Participants' open-ended responses revealed many positive features of the public health care system but also gaps in services, and economic barriers to receiving the care they wanted. The implications of these findings are discussed in relation to recent neoliberal reforms. Discussion & conclusions While Canada may be praised for its public provision of maternity care, mothers' reports of gaps in care during the early postpartum period and increasing use of private doulas is a worrying trend. To the extent that individual mothers or families rely on the market for care provision, issues of equity and quality of care are pivotal. This paper concludes with suggestions for further research on the impact of recent changes in post-birth care on new fathers and on inequities in pre and post-birth care in less-resourced regions of the world. PMID:23061517

The role of pesticide fate modelling in a prevention-led approach to potable water quality management

NASA Astrophysics Data System (ADS)

Dolan, Tom; Pullan, Stephanie; Whelan, Mick; Parsons, David

2013-04-01

Diffuse inputs from agriculture are commonly the main source of pesticide contamination in surface water and may have implications for the quality of treated drinking water. After privatisation in 1991, UK water companies primarily focused on the provision of sufficient water treatment to reduce the risk of non-compliance with the European Drinking Water Directive (DWD), under which all pesticide concentrations must be below 0.1µg/l and UK Water Supply Regulations for the potable water they supply. Since 2000, Article 7 of the Water Framework Directive (WFD) has begun to drive a prevention-led approach to compliance with the DWD. As a consequence water companies are now more interested in the quality of 'raw' (untreated) water at the point of abstraction. Modelling (based upon best available estimates of cropping, pesticide use, weather conditions, pesticide characteristics, and catchment characteristics) and monitoring of raw water quality can both help to determine the compliance risks associated with the quality of this 'raw' water resource. This knowledge allows water companies to prioritise active substances for action in their catchments, and is currently used in many cases to support the design of monitoring programmes for pesticide active substances. Additional value can be provided if models are able to help to identify the type and scale of catchment management interventions required to achieve DWD compliance for pesticide active substances through pollution prevention at source or along transport pathways. These questions were explored using a simple catchment-scale pesticide fate and transport model. The model employs a daily time-step and is semi-lumped with calculations performed for soil type and crop combinations, weighted by their proportions within the catchment. Soil properties are derived from the national soil database and the model can, therefore, be applied to any catchment in England and Wales. Various realistic catchment management intervention scenarios were explored (including changes to land use and pesticide usage) with the aim of providing a useful input to the debate between water companies, their regulators and pesticide users over the scale of catchment management required to support both DWD and WFD Article 7 compliance.

Assessing the impact of care farms on quality of life and offending: a pilot study among probation service users in England.

PubMed

Elsey, Helen; Farragher, Tracey; Tubeuf, Sandy; Bragg, Rachel; Elings, Marjolein; Brennan, Cathy; Gold, Rochelle; Shickle, Darren; Wickramasekera, Nyantara; Richardson, Zoe; Cade, Janet; Murray, Jenni

2018-03-17

To assess the feasibility of conducting a cost-effectiveness study of using care farms (CFs) to improve quality of life and reduce reoffending among offenders undertaking community orders (COs). To pilot questionnaires to assess quality of life, connection to nature, lifestyle behaviours, health and social-care use. To assess recruitment and retention at 6 months and feasibility of data linkage to Police National Computer (PNC) reconvictions data and data held by probation services. Pilot study using questionnaires to assess quality of life, individually linked to police and probation data. The pilot study was conducted in three probation service regions in England. Each site included a CF and at least one comparator CO project. CFs are working farms used with a range of clients, including offenders, for therapeutic purposes. The three CFs included one aquaponics and horticulture social enterprise, a religious charity focusing on horticulture and a family-run cattle farm. Comparator projects included sorting secondhand clothes and activities to address alcohol misuse and anger management. We recruited 134 adults (over 18) serving COs in England, 29% female. 52% of participants completed follow-up questionnaires. Privatisation of UK probation trusts in 2014 negatively impacted on recruitment and retention. Linkage to PNC data was a more successful means of follow-up, with 90% consenting to access their probation and PNC data. Collection of health and social-care costs and quality-adjusted life year derivation were feasible. Propensity score adjustment provided a viable comparison method despite differences between comparators. We found worse health and higher reoffending risk among CF participants due to allocation of challenging offenders to CFs, making risk of reoffending a confounder. Recruitment would be feasible in a more stable probation environment. Follow-up was challenging; however, assessing reconvictions from PNC data is feasible and a potential primary outcome for future studies. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Cost analysis of options for management of African Animal Trypanosomiasis using interventions targeted at cattle in Tororo District; south-eastern Uganda.

PubMed

Muhanguzi, Dennis; Okello, Walter O; Kabasa, John D; Waiswa, Charles; Welburn, Susan C; Shaw, Alexandra P M

2015-07-22

Tsetse-transmitted African trypanosomes cause both nagana (African animal Trypanosomiasis-AAT) and sleeping sickness (human African Trypanosomiasis - HAT) across Sub-Saharan Africa. Vector control and chemotherapy are the contemporary methods of tsetse and trypanosomiasis control in this region. In most African countries, including Uganda, veterinary services have been decentralised and privatised. As a result, livestock keepers meet the costs of most of these services. To be sustainable, AAT control programs need to tailor tsetse control to the inelastic budgets of resource-poor small scale farmers. To guide the process of tsetse and AAT control toolkit selection, that now, more than ever before, needs to optimise resources, the costs of different tsetse and trypanosomiasis control options need to be determined. A detailed costing of the restricted application protocol (RAP) for African trypanosomiasis control in Tororo District was undertaken between June 2012 and December 2013. A full cost calculation approach was used; including all overheads, delivery costs, depreciation and netting out transfer payments to calculate the economic (societal) cost of the intervention. Calculations were undertaken in Microsoft Excel without incorporating probabilistic elements. The cost of delivering RAP to the project was US$ 6.89 per animal per year while that of 4 doses of a curative trypanocide per animal per year was US$ 5.69. However, effective tsetse control does not require the application of RAP to all animals. Protecting cattle from trypanosome infections by spraying 25%, 50% or 75% of all cattle in a village costs US$ 1.72, 3.45 and 5.17 per animal per year respectively. Alternatively, a year of a single dose of curative or prophylactic trypanocide treatment plus 50% RAP would cost US$ 4.87 and US$ 5.23 per animal per year. Pyrethroid insecticides and trypanocides cost 22.4 and 39.1% of the cost of RAP and chemotherapy respectively. Cost analyses of low cost tsetse control options should include full delivery costs since they constitute 77.6% of all project costs. The relatively low cost of RAP for AAT control and its collateral impact on tick control make it an attractive option for livestock management by smallholder livestock keepers.

Conflict of interest: use of pyrethroids and amidines against tsetse and ticks in zoonotic sleeping sickness endemic areas of Uganda

PubMed Central

2013-01-01

Background Caused by trypanosomes and transmitted by tsetse flies, Human African Trypanosomiasis and bovine trypanosomiasis remain endemic across much of rural Uganda where the major reservoir of acute human infection is cattle. Following elimination of trypanosomes by mass trypanocidal treatment, it is crucial that farmers regularly apply pyrethroid-based insecticides to cattle to sustain parasite reductions, which also protect against tick-borne diseases. The private veterinary market is divided between products only effective against ticks (amidines) and those effective against both ticks and tsetse (pyrethroids). This study explored insecticide sales, demand and use in four districts of Uganda where mass cattle treatments have been undertaken by the ‘Stamp Out Sleeping Sickness’ programme. Methods A mixed-methods study was undertaken in Dokolo, Kaberamaido, Serere and Soroti districts of Uganda between September 2011 and February 2012. This included: focus groups in 40 villages, a livestock keeper survey (n = 495), a veterinary drug shop questionnaire (n = 74), participatory methods in six villages and numerous semi-structured interviews. Results Although 70.5% of livestock keepers reportedly used insecticide each month during the rainy season, due to a variety of perceptions and practices nearly half used products only effective against ticks and not tsetse. Between 640 and 740 litres of insecticide were being sold monthly, covering an average of 53.7 cattle/km2. Sales were roughly divided between seven pyrethroid-based products and five products only effective against ticks. In the high-risk HAT district of Kaberamaido, almost double the volume of non-tsetse effective insecticide was being sold. Factors influencing insecticide choice included: disease knowledge, brand recognition, product price, half-life and mode of product action, product availability, and dissemination of information. Stakeholders considered market restriction of non-tsetse effective products the most effective way to increase pyrethroid use. Conclusions Conflicts of interest between veterinary business and vector control were found to constrain sleeping sickness control. While a variety of strategies could increase pyrethroid use, regulation of the insecticide market could effectively double the number of treated cattle with little cost to government, donors or farmers. Such regulation is entirely consistent with the role of the state in a privatised veterinary system and should include a mitigation strategy against the potential development of tick resistance. PMID:23841963

Conflict of interest: use of pyrethroids and amidines against tsetse and ticks in zoonotic sleeping sickness endemic areas of Uganda.

PubMed

Bardosh, Kevin; Waiswa, Charles; Welburn, Susan C

2013-07-10

Caused by trypanosomes and transmitted by tsetse flies, Human African Trypanosomiasis and bovine trypanosomiasis remain endemic across much of rural Uganda where the major reservoir of acute human infection is cattle. Following elimination of trypanosomes by mass trypanocidal treatment, it is crucial that farmers regularly apply pyrethroid-based insecticides to cattle to sustain parasite reductions, which also protect against tick-borne diseases. The private veterinary market is divided between products only effective against ticks (amidines) and those effective against both ticks and tsetse (pyrethroids). This study explored insecticide sales, demand and use in four districts of Uganda where mass cattle treatments have been undertaken by the 'Stamp Out Sleeping Sickness' programme. A mixed-methods study was undertaken in Dokolo, Kaberamaido, Serere and Soroti districts of Uganda between September 2011 and February 2012. This included: focus groups in 40 villages, a livestock keeper survey (n = 495), a veterinary drug shop questionnaire (n = 74), participatory methods in six villages and numerous semi-structured interviews. Although 70.5% of livestock keepers reportedly used insecticide each month during the rainy season, due to a variety of perceptions and practices nearly half used products only effective against ticks and not tsetse. Between 640 and 740 litres of insecticide were being sold monthly, covering an average of 53.7 cattle/km(2). Sales were roughly divided between seven pyrethroid-based products and five products only effective against ticks. In the high-risk HAT district of Kaberamaido, almost double the volume of non-tsetse effective insecticide was being sold. Factors influencing insecticide choice included: disease knowledge, brand recognition, product price, half-life and mode of product action, product availability, and dissemination of information. Stakeholders considered market restriction of non-tsetse effective products the most effective way to increase pyrethroid use. Conflicts of interest between veterinary business and vector control were found to constrain sleeping sickness control. While a variety of strategies could increase pyrethroid use, regulation of the insecticide market could effectively double the number of treated cattle with little cost to government, donors or farmers. Such regulation is entirely consistent with the role of the state in a privatised veterinary system and should include a mitigation strategy against the potential development of tick resistance.

Hospital accounting and information systems: a critical assessment.

PubMed

Macintosh, N B

1991-01-01

Public sector organisations seem to be caught up in the global wave of 'neo-Thatcherism'. As such, they are being held 'accountable' today by their respective government finance departments for the costs and benefits of the services they provide to the general public. As the public purse tightens, hospitals (and related health service units) more and more compete with other public sector organisations (old-age pensions and services, post-secondary education, day-care centres, port authorities, unemployment insurance, parks and recreation, elite sport programs, aboriginal peoples aid and development, and so on) for a diminishing piece of what seems a smaller and smaller pie. In this 'fight-for-funding', hospitals seem particularly vulnerable. Sky-rocketing costs, public resentment of doctors' high income and a deliberate restriction and limiting of medical school places, among other things, contribute to general public antagonism. The message for hospitals is that cost-effective accountability will loom large when hospitals come begging at the public trough. Even left-wing politicians today seem to be heeding the words of free-market economists like Freedman of Chicago. 'Privatisation' is the constant threat for those deemed inefficient. As a consequence, hospital administrators around the world, caught up in this trend, seem to be stampeding to 'boot-up' some kind of new accounting information system. For example, at my own university hospital (Queen's University, Kingston, Canada), the hospital administrators are in the process of introducing a version of the Johns Hopkins Hospital (Baltimore, Maryland) case-mix-loading cost-accumulation system. In other parts of the world they are known by other fancy names such as 'patient-costing', 'diagnosis-related-groups' (or DRGs). Trendy accounting systems seem to be the order of the day, a sort of panacea for the current plague of problems hospitals face. As the new systems become operational, however, traditional management accounting issues will likely surface. Particular departments, wards and surgeons will be fingered by the system for excessive costs, inefficiency, and under-utilisation of equipment. When this happens, the medical professionals will begin to pay attention to these systems. They will discover that the accounting decisions (which cast them in an unfavourable light) are subjective, arbitrary, and problematic. The old debates, such as incremental versus full-costing, transfer pricing and cost of capital, will be played out again; but now on the turf of hospitals. As the debates drag on, it seems likely that in the interim the new accounting systems could do more harm than help. The rest of the paper attempts to explain why.

The history, development and the present status of the radon measurement programme in the United States of America.

PubMed

George, A C

2015-11-01

The US radon measurement programme began in the late 1950s by the US Public Health Service in Colorado, New Mexico and Utah during the uranium frenzy. After the 1967 Congressional Hearings on the working conditions in uranium mines, the US Atomic Energy Commission (AEC) was asked to conduct studies in active uranium mines to assess the exposure of the miners on the Colorado Plateau and in New Mexico. From 1967 to 1972, the Health and Safety Laboratory of the US AEC in New York investigated more than 20 uranium mines for radon and radon decay product concentrations and particle size in 4 large uranium mines in New Mexico. In 1970, the US Environmental Protection Agency (EPA) was established and took over some of the AEC radon measurement activities. Between 1975 and 1978, the Environmental Measurements Laboratory of the US Department of Energy conducted the first detailed indoor radon survey in the USA. Later in 1984, the very high concentrations of radon found in Pennsylvania homes set the wheels in motion and gave birth to the US Radon Industry. The US EPA expanded its involvement in radon issues and assumed an active role by establishing the National Radon Proficiency Program to evaluate the effectiveness of radon measurement and mitigation methods. In 1998, due to limited resources EPA privatised the radon programme. This paper presents a personal perspective of past events and current status of the US radon programme. It will present an update on radon health effects, the incidence rate of lung cancer in the USA and the number of radon measurements made from 1988 to 2013 using short-term test methods. More than 23 million measurements were made in the last 25 y and as a result more than 1.24 million homes were mitigated successfully. It is estimated that <2 % of the radon measurements performed in the USA are made using long-term testing devices. The number of homes above the US action level of 148 Bq m(-3) (4 pCi l(-1)) may be ∼8.5 million because ∼50 million homes were added since 1990 to the home inventory. This paper will discuss the current instruments and methods used to measure radon in the USA, and what is the effectiveness of radon resistant new construction, the current status of mitigation standards and the proposed testing protocols in schools and large buildings. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The safety and quality of childbirth in the context of health systems: mapping maternal health provision in Lebanon

PubMed Central

DeJong, Jocelyn; Akik, Chaza; El Kak, Faysal; Osman, Hibah; El-Jardali, Fadi

2010-01-01

Objective to provide basic information on the distribution (public/private and geographically) and the nature of maternity health provision in Lebanon, including relevant health outcome data at the hospital level in order to compare key features of provision with maternal/neonatal health outcomes. Design a self-completion questionnaire was sent to private hospitals by the Syndicate of Private Hospitals in collaboration with the study team and to all public hospitals in Lebanon with a functioning maternity ward by the study team in cooperation with the Ministry of Public Health. Setting childbirth in an institutional setting by a trained attendant is almost universal in Lebanon and the predominant model of care is obstetrician-led rather than midwife-led. Yet due to a 15-year-old civil war and a highly privatised health sector, Lebanon lacks systematic or publically available data on the organisation, distribution and quality of maternal health services. An accreditation system for private hospitals was recently initiated to regulate the quality of hospital care in Lebanon. Participants in total, 58 (out of 125 eligible) hospitals responded to the survey (46% total response rate). Only hospital-level aggregate data were collected. Measurements the survey addressed the volume of services, mode of payment for deliveries, number of health providers, number of labour and childbirth units, availability of neonatal intensive care units, fetal monitors and infusion rate regulation pumps for oxytocin, as well as health outcome data related to childbirth care and stillbirths for the year 2008. Findings the study provides the first data on maternal health provision from a survey of all eligible hospitals in Lebanon. More than three-quarters of deliveries occur in private hospitals, but the Ministry of Public Health is the single most important source of payment for childbirth. The reported hospital caesarean section rate is high at 40.8%. Essential equipment for safe maternal and newborn health care is widely available in Lebanon, but over half of the hospitals that responded lack a neonatal intensive care unit. The ratio of reported numbers of midwives to deliveries is three times that of obstetricians to deliveries. Key conclusions and implications for practice there is a need for greater interaction between maternal/neonatal health, health system specialists and policy makers on how the health system can support both the adoption of evidence-based interventions and, ultimately, better maternal and perinatal health outcomes. PMID:20691519

Meadow degradation, hydrological processes and rangeland management in Tibet

NASA Astrophysics Data System (ADS)

He, Siyuan; Richards, Keith

2013-04-01

Alpine meadow dominated by species of Kobresia is widely distributed in the Tibetan Plateau. Kobresia pygmaea is often a main species and the meadow has evolved as a result of long-term trampling, being a main rangeland resource for livestock grazing. This alpine meadow also plays an important role in regulating the water and energy balance through land-atmosphere interaction, leaving an impact on local hydrological processes and beyond. Therefore, alpine meadow degradation is detrimental to both the health of the ecosystems, and to pastoralism. This research therefore studies the hydrological process with regard to degradation of Kobresia pygmaea meadow, tracing the possible causes, detecting the impacts on soil and biological properties, and further considering the herders' role in future rangeland management. The study area is around the Kema village of the Nagqu Prefecture in Northern Tibet, where human population depends on livestock grazing for livelihood. Main driving factors of alpine meadow degradation are climatic variations and human disturbance. The periodical change in local climate may be related to quasi-oscillatory atmospheric circulations in this monsoon dominated area and the climatic trends with extreme weather conditions can make the whole system hard to recover. Along with climatic variations, overgrazing is predominant with an exceeding of the carrying capacity by almost every household in this village. This is related to the change of rangeland management by the policies of privatisation of pasture and sedentarisation. The acceleration of degradation since the 1980s results in a series of distinct soil-vegetation combination classified in this research as the normal meadow, compact crust and bare soil. The species composition, soil physical and chemical properties and the vertical water movement along the soil-plant-atmosphere continuum are significantly different at the sites representing stages of degradation, revealed by multiple methods including field sampling and monitoring, model simulation and stable isotope analysis. The understanding of regional hydrological processes and water partitioning under different surface conditions is crucial to an integrated, interdisciplinary study with regard to sustainable use of rangeland resources. Therefore a further consideration of rangeland management under the current condition is proposed. Herders have witnessed some degradation processes and have noticed some climatic variations. However, they do not naturally link meadow degradation to climate change nor do they tend to blame overgrazing. There may be conflicts between scientific knowledge and indigenous experience when the local people are trying to keep their tradition during modernisation, imposed sometimes without thorough consideration. The dependency on weather conditions is turning to dependency on government subsidies when the rangeland management violates practical traditions and is lack of integrated measures to promote local economy. This case in Tibet shows that a sound knowledge of the ecological status of rangeland and an understanding of local people's perspective towards development should be considered together, so that holistic measures, with flexible implementation of policies, can be taken to realise long-term benefit, ecologically and socio-economically.

[Limitations to the physician's discretionary and therapeutic freedom and to the provision of health care for the general population by a shortage of financial and human resources--the rules of Section 2 Para. 1 and 4 of the Medical Professional Code of conduct and how much they are really worth].

PubMed

Hoppe, Jörg-Dietrich

2007-01-01

Up to the early 1990's the health care system was essentially characterised through:--the insured' right of choice of therapist,--therapeutic freedom of patients and physicians, and--the freedom of establishment for medical doctors.--In accordance with the Hospital Funding Act the hospital system was--in compliance with federal constitutional law using capacity requirements--based on the "fire-fighting" principle, i.e. that if required, every patient should have access to a suitable hospital bed within about 15 minutes.--The responsibility for ensuring the provision of general and specialist health care services had been conferred by the government to the National Association of Statutory Health Insurance Physicians (1955) in the legal form of a public corporation. In the face of a foreseeable rise in expenses as a result of advances in medicine and a higher demand for health care services because of the demographic development (long-life society) the Advisory Council for Concerted Action in Health Care concludes in its Annual Report that maintaining this level of health care for all people is not financially viable any longer. This is why the state--on the basis of the Health Care Reform Act of 2002 and the Statutory Health Insurance System Modernisation Act of 2004--retreated from the provision of services in the ambulatory and inpatient setting by privatising these sectors and by proclaiming competition (introduction of diagnosis-related groups). Presently, the once liberal performance tradition is more and more turning into a centrally planned system in the spirit of "From Therapeutic Freedom to Therapeutic Programmes". The guidelines that on the basis of the methods of evidence-based medicine were developed by the international community of physicians for the treatment of patients with defined diagnoses and intended to be decision aids for individual treatment decisions are now used to implement disease management programmes for the provision of health care to people with certain chronic diseases. Another steering instrument of the above mentioned Modernisation Act is the definition of a list stating all the benefits available under the statutory health insurance system. The assessment of the health gain of new medical drugs and other medical procedures has been assigned to the Institute for Quality and Efficiency in Health Care (IQWiG) specifically founded to that purpose. With regard to the assessment of diagnostic and therapeutic procedures the Joint Federal Committee (Gemeinsamer Bundesausschuss, G-BA) in the summer of 2005 gave itself a Code of Procedures that defines uniform cross-sector criteria for the appraisal of diagnosis and treatment. In Germany the principle of evidence-based health care has by law--and this is unique as compared to other countries--fully penetrated everyday health care where the decisions of the Joint Federal Committee in the form of directives have mandatory effect for health care providers and hence for the insured, too. This is why the German Medical Association and the National Association of Statutory Health Insurance Physicians have embarked on the implementation of the "National Programme for Disease Management Guidelines" and the "Health Services Research" Project as a means of continuously evaluating health care provision which are intended to guide the future political control of the system of statutory health insurance in terms of target-performance comparisons and for the purpose of identifying health care deficits.

Legal and Political Implications of Offensive Actions from and Against the Space Segment

NASA Astrophysics Data System (ADS)

de Angelis, Iole M.

2002-01-01

Hundreds of satellites now present in space benefit the people of the world economically, scientifically and by their contribution to international security. So far, activities in space have proceeded without much conflict. Means have been found for regulation and agreement to minimize interference in the radio spectrum, while making more efficient use of limited spectrum resources. The Outer Space Treaty bars the stationing of nuclear weapons in space, or other weapons of mass destruction. Nations are responsible for damages that their space activities may cause to others, perhaps including destruction of the space assets of another nation. Today, maintaining the peaceful use of space is becoming more complicated by the privatisation of the notion of security by commercial actors and by the emerging of high technology non-state threats, that are not bind by international treaties. SPACE WEAPONS The Outer Space Treaty had been adopted to avoid the possible denial of peaceful uses of outer space, and because, technically speaking, jeopardizing a satellite was a difficult task to perform. For example, an orbiting laser might take hours or days for the Earth to rotate and the laser to be at an appropriate point in its orbit to threaten a target on the ground or in the air. Conversely, a substantial number of such weapons in space might be able to destroy targets within minutes of the command to do so, if the targets were visible and not below clouds. It is currently very difficult to oppose space weapons. For this reason, they could be significantly effective against an adversary. However, there are several obvious ways to counter nation controlled space-based weapons: anti-satellite systems, economic and technological blockade and an international legal system that forbids/restricts such weapons. The problem remains for non-state international actors which are not bound by international treaties. For this reason, the principle established by the United States to tie a common responsibility among the non state-actor Al-Quaida and the State of Afghanistan - that supported and hosted such organisation - is an exemple that deserves special consideration. ANTISATELLITE WEAPONS In a world in which Russia and the United States are no longer enemies, no individual nation has a strong motivation to develop and deploy space weapons for solely military purposes. Such weapons could be seen as inextricably tied to the purpose of achieving space dominance not only for military reasons - achieving full spectrum dominance thanks to a superior information management - but also for economical and political reasons. It is important to remind that the military use of outer space has both stabilizing and destabilizing potential. Military and civilian satellites perform functions that contribute to treaties verification, transparency, confidence building and nuclear deterrence. Putting weapons in space - that is a military use of outer-space - would threaten the instruments and sensors deployed into orbit to monitor potential enemies, control the compliance to disarmament treaties, detect ballistic missile launches, and maintain reliable communications. A sudden attack against such systems would lead to a main international crisis. In this context, in February 2000 the Chinese delegation to the United Nations Conference on Disarmament circulated a paper identifying a present and pressing necessity to prevent an arms race in outer space. A treaty forestalling the use of any kind of weapons in space, argued the delegation, would greatly support global peace and security." Moscow agreed with Beijing on this subject. CONCLUSIONS The deployment of space weapons will bring negative consequences to the international image of the country that does so, but is it an inevitable process? What tools can the international community do to prevent the escalation of conflicts into the outer space? From an international legal perspective, the development and the deployment of strategic weapons, kinetic energy weapons and directed energy weapons are already contained within existing rules and such issues are being actively addressed by the international community. At the same time, the use of cyberwar and electronic warfare to counter space technology not only encounters a void of international rules, but it is a question that is very rarely taken into consideration while addressing to the issues of preventing space warfare. Finally, these techniques are easily available to non-state organisations - terrorist organisations and commercial companies - and individuals. In conclusion, the issues related to offensive actions towards and from space shall be taken into consideration not only in a military perspective, but also in a political perspective - terrorist actions against the space segment - and from an economical point of view.