Perverse incentives, statesmanship, and the ghosts of reforms past

Article Abstract:

The current debate on health care reform has focused on increasing access to care and controlling costs but has ignored the central issue of how to change the attitudes behind the nation's skewed health care priorities. Several factors have contributed to the inefficiency of the health care system including the trend favoring acute hospital treatment and medical specialization over primary care and the public's unrealistic expectations and reliance on medical treatment or technological fixes. Previous efforts at reform have also left a legacy of unintended results. Medicare and Medicaid, because they involve payment for acute care and provide for long-term care only after all resources are depleted, do not meet the needs of a population that is increasingly older and chronically ill. Congressional acts to increase the number of primary care physicians have instead resulted in more specialists. More than laws, a change in statesmanship and a shift from self to societal interest, are needed to bring about health care reform.

Social aspects, Editorial, Analysis, Medical care, Medical care, Cost of, Health care costs, Health care reform

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Storm brewing

Article Abstract:

Strike action in the year 2000 would help nurses to persuade the government to invest more in the health service and pay them higher wages. Most people would back a nurses' strike if the reasons for taking action were clearly explained. The nursing profession has not been well treated by the government because it is dominated by women and because the government does not expect strike action from nurses. Striking is a last resort, but nurses ought to be brave enough to take action to ensure adequate investment in the sector.

Ethical aspects, Strikes

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Burnt out by reforms

Article Abstract:

The Polish government restructured the finance and administration of the health system in Jan 1999. Control of the health system has been devolved to 16 health authorities, but there have been problems with the transfer of budget control. Many nurses are being made redundant, but there is a serious shortage of nursing staff in many areas. Nurse wages are extremely low, and in Jun 1999 nurses staged a hunger strike to back up demands for the payment of their end-of-year bonus for 1998.

Poland, Social policy, Medical policy, Health policy

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