The private health care market in the United Kingdom is a multi-billion pound industry whose dynamics remain largely unexamined. This is so even though the boundaries between the public and private sectors are becoming increasingly blurred, particularly in England. Given the growing importance of this sector, the policy community needs to know more about the nature of private health care in the UK, how well the private market operates and how successful have been the various attempts within it to improve value for money and health care quality, given that private health care has traditionally been seen by many citizens as unaffordable. In particular this thesis traces recent efforts by the British United Provident Association (Bupa) to reshape the UK private healthcare market. The account provided draws on the author's experience as a senior Bupa manager involved in planning and implementing such changes. The thesis describes a series of Bupa initiatives designed to change provider behaviour in pursuit of improved quality and value-for-money, and the difficulties and obstacles encountered. The latter often centred on tensions or confrontation between the insurer and professional providers that are discussed in relation to the wider literature on the social and economic organisation of health care markets. An attempt has been made to draw some general conclusions via an empirical study of the role and limitations of market-based changes within the UK private sector. The broad conclusion is that the private market in the UK exemplifies those features of health care seen throughout the developed world that create imperfect market conditions. As such the market is highly resistant to insurer initiatives that would reverse the longstanding trend for premiums to rise above the rate of inflation. It is considered unlikely given the current market structure that any insurer, including Bupa, can escape these constraints in the short term. However, Bupa has implemented some successful initiatives that suggest that longer-term incremental change is possible.

A thesis submitted in partial fulfillment for the requirement for the degree of Doctor of Philosophy in the Department of Psychology at the University of Zululand, South Africa, 2010. / This research project was undertaken to investigate workplace bullying and its effect on health service delivery. Research participants were drawn from Prince Mshiyeni Memorial and Mosvold Hospitals; the aim was to compare the experiences of public health employees in rural and urban areas of KwaZulu- Natal. The employees have a right to be treated with respect and dignity and, most importantly, to work in a harmonious and supportive environment. Bullying behaviour breaches the employer’s duty under common law to provide a safe and a secure work environment both physically and psychologically. What makes it difficult for managers to manage bullying is that it has no tangible results but it leaves the victim with psychological and emotional problems which lead to anxiety, stress and depression if not properly attended to. The results of this research project further reveal that the majority of bullied employees are reluctant to speak out or end up not reporting the incidences because when they do report problems they believe that they will not be taken seriously. The results also prove that bullying is not a once-off event but a continuous cycle aimed at humiliating and belittling the XVII victim and that it is present in both health institutions. Though many factors were indicated as contributing to bullying, the low–self-esteem and personality factors of the bully were mentioned as the main factors, followed by inadequate training for the managers. If managers are serious about combating bullying in their workplaces they need to be in touch with what their employees go through when they execute their daily duties and they need to devise some means of ensuring that the grievance procedure is adequate and that it caters for bullying problems.

A violência doméstica é um problema multicausal e de alta magnitude. O objetivo deste trabalho foi conhecer o perfil das mulheres e dos processos que tramitavam na Vara de Violência Doméstica e Familiar contra a Mulher da região Oeste da cidade de São Paulo (VVDF-Oeste); a forma como se distribuem os processos e a localização geográfica dos serviços de saúde, assistência social e justiça existentes na região de estudo. Trata-se de estudo transversal com uso de georreferenciamento. Foram coletados dados junto a 1.339 processos em tramitação perante VVDF-Oeste de mulheres maiores de 18 anos, entre janeiro e fevereiro de 2016. Os dados sociodemográficos do território de abrangência da VVDF-Oeste foram obtidos pelo IBGE (2010) e IDH (2012). Dados do sistema de notificação dos agravos de violência da saúde foram obtidos pelo sistema SIVVA (2010 e 2016). Foram também georreferenciados os serviços, gerais e especializados, de saúde e assistência social, assim como os serviços especializados de justiça existentes no território, composto por dezoito distritos. Observou-se que o perfil das mulheres que teve processo criminal é branco (60,7%), escolarizado (52,7% delas com onze ou mais anos de estudo) e relativamente jovem, sendo que 79,6% têm entre 20 e 44 anos. Porém, contrastando este perfil com as características da população feminina que reside no território do estudo, observa-se uma sobrerrepresentação de mulheres negras, com maior acesso à justiça. A violência por parceiro íntimo (VPI) foi predominante (91,1%) e as mulheres relatam em 58,8% dos casos já terem sofrido violência anterior, ainda que 19,3% registraram boletim de ocorrência anterior. Observa-se que o território de abrangência da VVDF-Oeste é heterogêneo, e os dois distritos com maior taxa de notificação no SIVVA também correspondem àqueles com maior taxa de processos, e devem ser analisadas à luz da escassa rede de serviços especializados presentes no território. Este trabalho sugere a necessidade de implantação de serviços específicos para o atendimento da mulher em situação de violência exatamente onde há maior vulnerabilidade social. Importante dizer que, ainda que existam nos distritos altas taxas de notificação SIVVA e taxas de processos, nem de longe chegam perto de retratar a real violência sofrida pelas mulheres, pois grande parte da violência sofrida é silenciada pela própria mulher, seja por medo, por vergonha, descrença nas autoridades ou mesmo falta de serviços específicos e acolhedores. Por fim, somente quando esses três eixos: existência de serviços especializados capilarizados, que trabalhem em rede e que haja serviços direcionados ao agressor forem efetivados é que poderemos pensar em uma vida livre de qualquer tipo de violência / Domestic violence is a multi-causal problem of high magnitude. This study aimed to understand the women\' profile as well as from the criminal process that they were involved in the Domestic and Family Violence Against Women court (VVDF), in the wet region of São Paulo city; and the way in which the cases and the geographical location of the health, social assistance and justice services are distributed in VVDF territory. It is a cross-sectional study using georeferencing. Data were collected along with 1,339 lawsuits filed from the VVDF of women over 18 years old, between January and February of 2016. The VVDF territory sociodemographic data were obtained by IBGE (2010) and IDH (2012). Data of the violence mandatory notification by the health services were obtained by the SIVVA system (2010 and 2016). General and specialized health and social assistance services were also georeferenced, as well as specialized judicial services in the territory, composed of eighteen districts. It was observed that the women profile who had criminal case in VVDF is white (60.7%), educated (52.7% of them with eleven or more years of schooling) and relatively young, with 79.6% are between 20 and 44 years old. However, contrasting this profile with the characteristics of the female population living in the study territory, there is an overrepresentation of black women, with higher access to justice. The intimate partner violence (IPV) was predominant (91.1%) and 58.8% of women reported that they suffered previous violence episode, although 19.3% recorded the have reported it previously to the police. It is observed that the territory of VVDF is heterogeneous, and the two districts with the highest reporting rate in SIVVA also correspond to those with the highest rate of processes and must be analyzed in the perspective of the scarce network of specialized services in the territory. This study suggests the need to implement specialized services for women undergoing domestic violence and in the areas of greater social vulnerability. It is important to highlight that even though there are high rates of SIVVA notification and a high process rate in the districts, it does not portray the real violence suffered by women, since much of the violence suffered is silenced by women themselves, by shame, disbelief at the authorities or even lack of specific and welcoming services. Finally, it is only when when we articulate the existence of quality specialized services for women, as well as the ones to the agressor\'s responsabilization, and get them to function as a network, that we can think of a life free from any type of violence