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The National Health Service remains the sacred cow of British politics – any criticism is considered beyond the pale, guaranteed to trigger angry responses and accusations of bad faith. This book argues that the NHS should not be insulated from reasoned debate. In terms of health outcomes, it is one of the worst systems in the developed world, well behind those of other high-income countries. The NHS does achieve universal access to healthcare, but so do the health systems in every other developed country (with the exception of the US). Britain is far from being the only country where access to healthcare does not depend on an individual’s ability to pay. Author Kristian Niemietz draws on a wealth of international evidence to develop a vision for a universal healthcare system based on consumer sovereignty, freedom of choice, competition and pluralism. His roadmap for reform charts a path from the status quo to a more desirable and effective alternative.
The Social Security Administration (SSA) administers two programs that provide benefits based on disability: the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program. This report analyzes health care utilizations as they relate to impairment severity and SSA's definition of disability. Health Care Utilization as a Proxy in Disability Determination identifies types of utilizations that might be good proxies for "listing-level" severity; that is, what represents an impairment, or combination of impairments, that are severe enough to prevent a person from doing any gainful activity, regardless of age, education, or work experience.
Second in a series of publications from the Institute of Medicine's Quality of Health Care in America project Today's health care providers have more research findings and more technology available to them than ever before. Yet recent reports have raised serious doubts about the quality of health care in America. Crossing the Quality Chasm makes an urgent call for fundamental change to close the quality gap. This book recommends a sweeping redesign of the American health care system and provides overarching principles for specific direction for policymakers, health care leaders, clinicians, regulators, purchasers, and others. In this comprehensive volume the committee offers: A set of performance expectations for the 21st century health care system. A set of 10 new rules to guide patient-clinician relationships. A suggested organizing framework to better align the incentives inherent in payment and accountability with improvements in quality. Key steps to promote evidence-based practice and strengthen clinical information systems. Analyzing health care organizations as complex systems, Crossing the Quality Chasm also documents the causes of the quality gap, identifies current practices that impede quality care, and explores how systems approaches can be used to implement change.
This volume, developed by the Observatory together with OECD, provides an overall conceptual framework for understanding and applying strategies aimed at improving quality of care. Crucially, it summarizes available evidence on different quality strategies and provides recommendations for their implementation. This book is intended to help policy-makers to understand concepts of quality and to support them to evaluate single strategies and combinations of strategies.
How can health services in the UK and Europe be improved? And can costs be reduced at the same time? Over the years, many ideas have been put forward – from increased spending on preventive healthcare to the better use of technology to reduce bureaucracy and ‘pay for performance’ schemes. But author Nima Sanandaji says this is merely tinkering at the margins. What’s needed, he argues, is a completely new approach – one which embraces disruptive innovations from a new breed of entrepreneurs. Allowing true entrepreneurialism in healthcare might be considered extreme in a Western setting – but he points to a spectacular wave of success in the East to support his case. In India, Thailand, China and the Middle East, entrepreneurs have drawn inspiration from the motor industry to streamline procedures and create economies of scale. In areas such as heart surgery, they’ve dramatically driven down costs – and dramatically improved outcomes. So much so that the new market economies of the East are now, he contends, many steps of ahead of the West. In The Henry Fords of Healthcare Sanandaji outlines the lessons the West can now learn from the East, making a radical, compelling and controversial contribution to the debate on our own ailing health systems.
For many citizens primary health care is the first point of contact with their health care system, where most of their health needs are satisfied but also acting as the gate to the rest of the system. In that respect primary care plays a crucial role in how patients value health systems as responsive to their needs and expectations. This volume analyses the way how primary are is organized and delivered across European countries, looking at governance, financing and workforce aspects and the breadth of the service profiles. It describes wide national variations in terms of accessibility, continuity and coordination. Relating these differences to health system outcomes the authors suggest some priority areas for reducing the gap between the ideal and current realities.
This review incorporates the views and visions of 2,000 clinicians and other health and social care professionals from every NHS region in England, and has been developed in discussion with patients, carers and the general public. The changes proposed are locally-led, patient-centred and clinically driven. Chapter 2 identifies the challenges facing the NHS in the 21st century: ever higher expectations; demand driven by demographics as people live longer; health in an age of information and connectivity; the changing nature of disease; advances in treatment; a changing health workplace. Chapter 3 outlines the proposals to deliver high quality care for patients and the public, with an emphasis on helping people to stay healthy, empowering patients, providing the most effective treatments, and keeping patients as safe as possible in healthcare environments. The importance of quality in all aspects of the NHS is reinforced in chapter 4, and must be understood from the perspective of the patient's safety, experience in care received and the effectiveness of that care. Best practice will be widely promoted, with a central role for the National Institute for Health and Clinical Excellence (NICE) in expanding national standards. This will bring clarity to the high standards expected and quality performance will be measured and published. The review outlines the need to put frontline staff in control of this drive for quality (chapter 5), with greater freedom to use their expertise and skill and decision-making to find innovative ways to improve care for patients. Clinical and managerial leadership skills at the local level need further development, and all levels of staff will receive support through education and training (chapter 6). The review recommends the introduction of an NHS Constitution (chapter 7). The final chapter sets out the means of implementation.
This book delves into the intricate landscape of respiratory diseases among older people, shedding light on their biosocial encounters while grappling with chronic breathlessness. While respiratory ailments predominantly afflict older people, often stemming from lifestyle choices like smoking, contemporary factors such as the COVID-19 pandemic and escalating air pollution further exacerbate respiratory health challenges. Rooted in ethnographic research conducted in the UK, the narrative captures the quotidian struggles associated with abnormal breathing—an aspect typically overlooked despite its indispensability to life. Through poignant accounts, the book elucidates the profound transformations engendered by medical diagnoses, delving into their ripple effects on personal relationships and social engagements, while also offering insights into coping mechanisms. Chapters traverse the contours of patient identity, societal perceptions, community healthcare dynamics, advocacy endeavours, and the intrinsic link between health and human rights. Notably, the author delves into the pivotal role of support groups such as Breathe Easy, the empowering realm of “self-help”, and the organic formation of communities to address diverse social needs. With its multidisciplinary approach, this book appeals to a broad spectrum of scholars spanning anthropology, sociology, gerontology, and public health, offering a rich tapestry of insights into the complex interplay between health, society, and individual experiences.
George Selgin is one of the world's foremost monetary historians. In this book, based on the 2016 Hayek Memorial Lecture, he shows how a system of private banks without a central bank can bring about financial stability through self-regulation. If one bank stretches credit too far, it will be reined in by the others before the system as a whole gets out of control. The banks have a strong incentive to ensure an orderly resolution if a particular bank is facing insolvency or illiquidity. Selgin draws on evidence from the era of 'free banking' in Scotland and Canada. These arrangements enjoyed greater financial stability, with fewer banking crises, than the English system with its central bank and the US model with its faulty government regulation. The creation of the Federal Reserve appears to have increased the frequency of financial crises. The book also includes commentaries by Kevin Dowd and Mathieu Bédard. Dowd asks whether free-banking systems should be underpinned by a gold standard, which he regards as a tried-and-tested institution at the heart of their success. Bédard challenges the assumption that the banking sector is inherently unstable and therefore requires state intervention. He argues that increases in government control have made the banking system more prone to crisis.
Socialism is strangely impervious to refutation by real-world experience. Over the past hundred years, there have been more than two dozen attempts to build a socialist society, from the Soviet Union to Maoist China to Venezuela. All of them have ended in varying degrees of failure. But, according to socialism’s adherents, that is only because none of these experiments were “real socialism”. This book documents the history of this, by now, standard response. It shows how the claim of fake socialism is only ever made after the event. As long as a socialist project is in its prime, almost nobody claims that it is not real socialism. On the contrary, virtually every socialist project in history has gone through a honeymoon period, during which it was enthusiastically praised by prominent Western intellectuals. It was only when their failures became too obvious to deny that they got retroactively reclassified as “not real socialism”.