Suchergebnisse

This timely book is the most comprehensive account yet of recent commissioning practice in the English NHS and its impact on health services and the healthcare system. Drawing on eight years of research, expert researchers in the field analyse crucial aspects of commissioning, including competition and cooperation, the development of Clinical Commissioning Groups and contractual mechanisms. They also consider the influence of recent commissioning reforms on public health infrastructure. For academics and policy makers in health services research and policy, this is a valuable collection of evidence that deepens understanding of how commissioning works.

BACKGROUND: Over the past three decades, a limited range of market like mechanisms have been introduced into the hierarchically structured English National Health Service ('NHS'), which is a nationally tax funded, budget limited healthcare system, with access to care for all, producing structures known as a quasi market. Recently, the Health and Social Care Act 2012 ('HSCA') has been enacted, introducing further market elements. The paper examines the theory and effects of these market mechanisms. METHODS: Using neo-classical economics as a primary theoretical framework, as well as new institutional economics and socio-legal theory, the paper first examines the fundamental elements of markets, comparing these with the operation of authority and resource allocation employed in hierarchical structures. Second, the paper examines the application of market concepts to the delivery of healthcare, drawing out the problems which economic and socio-legal theories predict are likely to be encountered. Third, the paper discusses the research evidence concerning the operation of the quasi market in the English NHS. This evidence is provided by research conducted in the UK which uses economic and socio-legal logic to investigate the operation of the economic aspects of the NHS quasi market. Fourth, the paper provides an analysis of the salient elements of the quasi market regime amended by the HSCA 2012. RESULTS: It is not possible to construct a market conforming to classical economic principles in respect of healthcare. Moreover, it is not desirable to do so, as goals which markets cannot deliver (such as fairness of access) are crucial in England. Most of the evidence shows that the quasi market mechanisms used in the English NHS do not appear to be effective either. This finding should be seen in the light of the fact that the operation of these mechanisms has been significantly affected by the national political (i.e. continuingly hierarchical) and budgetary context in which they are operating. CONCLUSION: The organisational structures of a hierarchy are more appropriate for the delivery of healthcare in the English NHS.

Female officials in ancient Egypt and Egyptian historians / V.G. Callender -- On the stage, behind the curtain : images of politically active women in the late Roman Republic / Tom Hillard -- Julia's jokes, Galla Placidia, and the Roman use of women as political icons / Amy Richlin -- Contemporary portrayals of the Byzantine Empress Theodora (A.D. 527-548) / Pauline Allen -- Women and power in the Scandinavian sagas / Margaret Clunies Ross -- Imperial women in the history of the Ming dynasty (1368-1644) / Ellen Soulli(c)·re -- Virago and Machiavelli / Lenore Coltheart -- Radical hens and vociferous ladies : representation and class in the Mid-Nineteenth Century / Barbara Garlick -- Schemers, dragons, and witches : criminal "Justice" and the fair sex / Jocelynne A. Scutt -- Enduring theme : domineering dowagers and scheming concubines / Suzanne Dixon

Many countries use state‐owned, for‐profit, and third sector organizations to provide public services, generating 'hybrid' organizational forms. This article examines how the hybridization of organizations in the public sector is influenced by interaction between regulatory change and professional communities. It presents qualitative data on three areas of the UK public sector that have undergone marketization: healthcare, broadcasting, and postal services. Implementation of market‐based reform in public sector organizations is shaped by sector‐specific differences in professional communities, as these groups interact with reform processes. Sectoral differences in communities include their power to influence reform, their persistence despite reform, and their alignment with the direction of change or innovation. Equally, the dynamics of professional communities can be affected by reform. Policymakers need to take account of the ways that implementation of hybrid forms interacts with professional communities, including risk of disrupting existing relationships based on communities that contribute to learning.

In England, 'policy experiments' are largely synonymous with the use of randomized controlled trials (RCTs) to test whether one policy 'works' better than another. While advocacy of the use of RCTs in public policy presents this as relatively straightforward, even common sense, the reality is different, as shown through analysis of three high profile policy pilots and their evaluations undertaken in health and social care in England in the mid/late 2000s. The RCTs were expected to confirm the direction of policy by resolving any remaining uncertainty about the effectiveness of the chosen path and their existence was used largely as instruments of persuasion. The findings from the analysis of the three pilots confirm the continuing relevance of Campbell's 1969 insight that governments struggle to experiment in the scientific sense and explain the limited effect of these policy experiments on policy decisions.

AbstractIn England, policy piloting has become firmly established in almost all areas of public policy and is seen as good practice in establishing 'what works'. However, equating piloting with evaluation can risk oversimplifying the relationship between piloting and policy-making.Using three case studies from health and social care – the Partnerships for Older People Projects (POPP) pilots, the Individual Budgets pilots and the Whole System Demonstrators (WSD) – the paper identifies multiple purposes of piloting, of which piloting for generating evidence of effectiveness was only one. Importantly, piloting was also aimed at promoting policy change and driving implementation, both in pilot sites and nationally. Indeed, policy makers appeared to be using pilots mainly to promote government policy, using evaluation as a strategy to strengthen the legitimacy of their decisions and to convince critical audiences. These findings highlight the ambiguous nature of piloting and thus question the extent to which piloting contributes to the agenda of evidence-based policy-making.

Preferences have been analyzed extensively in health care, but few studies have examined how culture driven preference formation may impact on resource allocation decisions in public and private health service delivery. This paper explores and develops a theoretical framework that distinguishes different approaches to institutionally and culturally informed preferences. The analysis shows that the appropriate approach depends on normative considerations and the particular health policy context which it is applied. In particular health policy cultures, mediating culture driven preferences (such as fatalism, hierarchism, individualism, egalitarianism and autonomy) which have not been used as part of health policy analysis before, challenge the roles of public and private health service providers. In view of the scarcity of studies in this field, the authors suggest a rationale for studies that enhance the understanding of how health policy cultures are embedded in normative health policy and propose a research agenda on cultural biases.