Suchergebnisse

1. Introduction : why regulate? -- 2. How safe is health care? -- 3. Regulatory actors : who governs health care? -- 4. Regulating the health professions -- 5. Safety cultures and safety systems -- 6. Regulating staff : internal management -- 7. Regulating organizations : external reviews -- 8. Regulation by enforcement : laws, money, and monitoring -- 9. Regulation by patients -- 10. Responsive regulation : trust and transparency.

Australia and the United Kingdom have tried various ways to contain the growth and cost of institutional care for older people. The Australian government adopted central planning strategies from the mid‐1980s that succeeded in limiting nursing home places and increasing community services. The United Kingdom government in the mid‐1990s required local governments to adopt quasi‐market strategies but with less success in containing the growth and cost of institutional care. The two countries changed political direction later in the 1990s but both the Australian Liberal (conservative) government and UK "New Labour" want people to pay more for their care in old age. Each country has something to learn from the policy experiences of the other, including the contentious issue of who should pay for aged care.

Small community centres have mushroomed in numbers during the 1980s. Most State welfare departments have announced policies and funding programs to support these centres. These policies espouse potentially conflicting purposes. They include the community development goal of mobilising the community through self help ventures, the reform of the social service delivery system via a local base for better services, and the devolution of welfare responsibilities from central government agencies to community groups.

Abstract: Public sector human service organisations are being restructured to produce new service delivery systems to fit new concepts of needs. Other major goals are the pursuit of greater ministerial control over policy and increased cost efficiency. This paper examines recent reshuffles, particularly in South Australia, in terms of the classic principles for grouping functions: purpose, process, people and place. There is no one prescription for restructuring, but the trend to bigger departments and block funding favours pu?ose and process groupings. A key factor in these restructures is the competition among occupational groups. It is much more difficult to evaluate the impact upon the supposed main beneficiaries, the service users.

Health-care systems in developed countries must respond to increasingly diverse populations given greater population movements in our globalized world. The chapters in this book discuss countries and population groups that illustrate different responses to claimant groups

Health ombudsmen (health complaints commissioners), an unusual entity internationally, exist only in England, New Zealand, and the Australian states and territories. Established to respond to complaints from patients, the intention is to make health services and professionals more accountable to the public. Most cases are handled around the softer base of a regulatory pyramid, such as advice to complainants and requests to providers for an explanation and/or apology. Few cases escalate to investigations and prosecutions. Although the legal powers of some health ombudsmen to redress individual grievances have been strengthened, most lack the independent power to initiate an inquiry into systemic problems. To produce quality improvements, health ombudsmen need powers to require compliance from providers and to initiate inquiries. With the advent of new health sector regulators, health ombudsmen must negotiate their role and function within expanding networks of governance.