by Frances Kam Yuet Wong. / Thesis (Ph.D.)--Chinese University of Hong Kong, 1996. / Includes bibliographical references (leaves 276-290). / ACKNOWLEDGEMENTS --- p.i / LIST OF FIGURES --- p.ii / LIST OF TABLES --- p.iii / ABSTRACT --- p.iv / Chapter CHAPTER 1 --- THE RESEARCH PROBLEM AND RELATED LITERATURE / Chapter 1.1 --- The research problem --- p.1 / Chapter 1.2 --- Related literature review --- p.8 / Section I / Chapter 1.2.1 --- Sociology of work --- p.9 / Chapter 1.2.2 --- Sociology of profession --- p.11 / Chapter 1.2.3 --- Change of social structure in a post-industrial society --- p.17 / Chapter 1.2.4 --- A new labouring process and control of work --- p.23 / Section II / Chapter 1.2.5 --- The health care system --- p.26 / Chapter 1.2.6 --- The reconceptualization of nursing --- p.30 / Chapter 1.2.6.1 --- Proletarianization of nursing --- p.30 / Chapter 1.2.6.2 --- Professionalization in nursing --- p.32 / Chapter 1.2.7 --- Nursing education --- p.37 / Chapter 1.2.8 --- The nursing labour process --- p.43 / Chapter CHAPTER 2 --- RESEARCH METHODOLOGY / Chapter 2.1 --- Research methodology --- p.47 / Chapter 2.2 --- Data collection --- p.48 / Chapter 2.2.1 --- Documents --- p.50 / Chapter 2.2.2 --- Interviews --- p.50 / Chapter 2.2.3 --- Participant observation --- p.53 / Chapter 2.3 --- Data analysis --- p.54 / Chapter 2.3.1 --- Extended case method --- p.54 / Chapter 2.3.2 --- Participant observation --- p.56 / Chapter 2.3.3 --- Treatment of data --- p.60 / Chapter CHAPTER 3 --- MICROLEVEL -WORK OF FRONTLINE NURSES / Chapter 3.1 --- Introduction --- p.64 / Chapter 3.2 --- Areas of work of frontline nurses at ward level --- p.70 / Chapter 3.2.1 --- Patient care --- p.70 / Chapter 3.2.2 --- Student supervision --- p.74 / Chapter 3.2.3 --- Staff development --- p.75 / Chapter 3.2.4 --- Ward in-charge --- p.75 / Chapter 3.2.5 --- Ward projects --- p.77 / Chapter 3.2.6 --- Ward resource management --- p.78 / Chapter 3.3 --- Dynamics of work transformation at microlevel nursing practice --- p.78 / Chapter 3.3.1 --- A new division of nursing labour --- p.79 / Chapter 3.3.2 --- The HA policy --- p.84 / Chapter 3.3.3 --- Medical dominance --- p.87 / Chapter 3.3.4 --- Development of the profession of nursing in hospitals --- p.90 / Chapter 3.4 --- Discussion --- p.92 / Chapter 3.4.1 --- The nexus between profession and work --- p.92 / Chapter 3.4.2 --- Professionalization and proletarianization of nursing --- p.94 / Chapter 3.4.3 --- The changing scene of medical dominance --- p.98 / Chapter CHAPTER 4 --- MESOLEVEL - WORK OF NURSES IN MIDDLE MANAGEMENT / Chapter 4.1 --- Introduction --- p.102 / Chapter 4.2 --- Areas of work of nurse managers at mesolevel --- p.107 / Chapter 4.2.1 --- Patient care --- p.107 / Chapter 4.2.2 --- Student supervision --- p.108 / Chapter 4.2.3 --- Staff development --- p.109 / Chapter 4.2.4 --- Operational and resource management --- p.110 / Chapter 4.2.5 --- Communication --- p.112 / Chapter 4.2.6 --- Planning and quality improvement --- p.115 / Chapter 4.3 --- Dynamics involved in the work of nurses at the mesolevel --- p.119 / Chapter 4.3.1 --- A clear establishment of the status of nurse managers --- p.119 / Chapter 4.3.2 --- The nurse as a manager --- p.123 / Chapter 4.3.3 --- The attenuation of medical power by management forces --- p.129 / Chapter 4.3.4 --- Management practice based on negotiation and rationality --- p.134 / Chapter 4.4 --- Discussion --- p.137 / Chapter 4.4.1 --- The Professional-Managerial Class (PMC) --- p.140 / Chapter 4.4.2 --- The emergence of a new class of nurse elite - the nurse managers --- p.143 / Chapter 4.4.2.1 --- Production of nursing care and its reproduction --- p.144 / Chapter 4.4.2.2 --- Control of the means of production --- p.146 / Chapter 4.4.2.3 --- Ideological proletarianization --- p.148 / Chapter 4.4.2.4 --- Negotiation - guanxi and rational-legal authority --- p.149 / Chapter 4.4.2.5 --- The affinity between nursing and management --- p.152 / Chapter CHAPTER 5 --- MESOLEVEL - WORK OF NURSE SPECIALISTS / Chapter 5.1 --- Introduction --- p.156 / Chapter 5.2 --- Areas of work of nurse specialists (NS) at mesolevel --- p.160 / Chapter 5.2.1 --- Client care --- p.160 / Chapter 5.2.2 --- Project work --- p.164 / Chapter 5.2.3 --- Staff development --- p.165 / Chapter 5.2.4 --- Research --- p.166 / Chapter 5.2.5 --- Management and communication --- p.168 / Chapter 5.3 --- Dynamics involved in the work of nurses at this mesolevel --- p.169 / Chapter 5.3.1 --- Removal of NS's accountability from the management hierarchy --- p.170 / Chapter 5.3.2 --- The NS Referral --- p.173 / Chapter 5.3.3 --- The emergence of a new class of nurse elite - the Nurse Specialists --- p.180 / Chapter 5.4 --- Discussion --- p.185 / Chapter 5.4.1 --- Legitimation of the work of the Nurse Specialists in the hospital --- p.185 / Chapter 5.4.2 --- Differentiation of nursing practice - Advanced Nursing Practice --- p.192 / Chapter CHAPTER 6 --- MACROLEVEL - HOSPITAL AUTHORITY AT WORK / Chapter 6.1 --- Introduction --- p.197 / Chapter 6.2 --- The work of the nurse executive in hospital --- p.198 / Chapter 6.2.1 --- Human resource management and staff development --- p.202 / Chapter 6.2.2 --- Management of departments and hospitals --- p.203 / Chapter 6.2.3 --- Quality improvement --- p.205 / Chapter 6.2.4 --- Research and professional development --- p.207 / Chapter 6.2.5 --- Communication --- p.209 / Chapter 6.3 --- The direction of nursing work at the level of hospital authority --- p.210 / Chapter 6.3.1 --- Overall nursing direction and development --- p.213 / Chapter 6.3.2 --- Nursing role delineation and work redesign --- p.215 / Chapter 6.3.3 --- Recruitment and retention of Nurses --- p.223 / Chapter 6.3.4 --- New direction for nursing education --- p.225 / Chapter 6.4 --- Discussion --- p.228 / Chapter 6.4.1 --- Corporatization of health care system in Hong Kong --- p.229 / Chapter 6.4.2 --- The control of nursing labour process --- p.233 / Chapter 6.4.3 --- Regulation of nursing through education --- p.237 / Chapter CHAPTER 7 --- CONCLUSION AND DISCUSSION / Chapter 7.1 --- Introduction --- p.249 / Chapter 7.2 --- The nexus of profession and work --- p.250 / Chapter 7.3 --- Charting a pathway for nursing towards the twenty-first century --- p.258 / Chapter 7.4 --- A micro-meso-macro approach of social analysis --- p.269 / Chapter 7.5 --- Practical implications of the study --- p.271 / Chapter 7.6 --- Limitations of the study --- p.273 / REFERENCES --- p.276 / APPENDICES / Chapter 1 --- Abbreviations --- p.291 / Chapter 2 --- Interview guide --- p.292 / Chapter 3 --- A sample of appointment specification of HCA --- p.293 / Chapter 4 --- A sample of appointment specification of RN --- p.294 / Chapter 5 --- A sample of appointment specification of NO --- p.295 / Chapter 6 --- A sample of appointment specification of NS --- p.296 / Chapter 7 --- A sample of appointment specification of WM --- p.297 / Chapter 8 --- A sample of appointment specification of DOM --- p.298 / Chapter 9 --- A sample of appointment specification of GMN --- p.299 / Chapter 10 --- Nursing strategies: Towards the year2000 --- p.300

Many of the assumptions underlying health care issues appear to be taken for granted by policy makers, when if fact they ought to be examined for their relevance to today's problems. This research attempts to do so, by analysing the non-economic issues and factors involved in the financing and provision of health care. It will be argued that policy makers commonly have a unidirectional economic perspective in both policy making and in health care system reform directives, a situation which leaves issues such as the health status of the population and of equity in resource allocation to political rhetoric, while in practice, policies deal with the issue of cost reduction. Of major importance is the moral dimension in policies dealing with health and welfare, which is clearly either forgotten or is afforded too little consideration in policy making. This is particularly relevant to the issue of rationing of health care in publicly provided health care systems. While always quietly practised by clinicians in the past, rationing is now required to be overt because demand for health care has outstripped available resources.The substance of the argument comes from the analysis of a very large literature on the broader issues affecting health care policy, such as concepts of social justice, ethics of resource allocation and the physician-patient relationship, all of winch ought to underpin policies for the mechanisms of funding and provision of health care systems.A conceptual diagram of a health care system is offered to provide a framework for the discussion of how the issues are interrelated at micro, meso and macro levels in policymaking. Examples of reforms to health care systems are taken from five OECD countries which share a common social, political and economic heritage: Australia, United Kingdom, New Zealand, Canada and the United States of America.The conclusions ++ / from this research show that theoretical incoherence pervades this most complex of policy areas, allowing the economic imperative to take precedence over the substantive health care issues.

Abstract not available

Health care reform has been described as a global epidemic. This thesis deals with nature and experience of health care reform in developing countries. Increasing privatisation, economic transition, and structural adjustment have provided the context for health system changes. Different approaches to reform have been developed by international organisations such as the World Bank, WHO and UNICEF. What has driven national health care reforms? Are such policies really appropriate to developing countries? Has a consensus now emerged in relation to international health policy? Has a new health care ‘model’ appeared? The study of health care reform in Cambodia is a timely opportunity to investigate the implementation of health care reform under extreme conditions. These conditions include a legacy of genocide, long-term conflict, political isolation, and economic transition. This case study uses both qualitative and quantitative methods and multiple sources of data to analyse the reform program. The study reinforces the conclusion that, under conditions of extreme poverty, market based reforms are likely to have limited positive impact. Rather, understanding the cultural conditions that determine demand, delivering health care of a satisfactory quality, providing appropriate incentives for health practitioners, and supporting services with adequate public funding are the prerequisites for improved service delivery and utilisation. Cambodia's strategy of integrated district health service development and universal population coverage may provide an instructive example of reform. Emerging policy issues identified by this case study include the fundamental role of equity in service provision, the influence of the social determinants of health and illness and interest in the appropriate use of evidence in international health policy-making.

This thesis has two parts, each with a different subject. Part 1 studies the macroeconomic implications of alternative health care reforms. Part 2 studies the computation and simulation of dynamic competitive equilibria in models with heterogeneous agents and market frictions. In 2007, 44.5 million non-elderly in the U.S did not have health insurance coverage. Empirical studies suggest that there are serious negative consequences associated with uninsurance. Consequently, there is wide agreement that reforming the current health care system is desirable and several proposals have been discussed among economists and in the political arena. However, little attention has been paid to quantify the macroeconomic consequences of reforming the health insurance system in the U.S. The objective of this section is to develop a theoretical framework to evaluate a broad set of health care reform plans. I build a model that is capable of reproducing a set of key facts of health expenditure and insurance demand patterns, as well as key macroeconomic conditions of the U.S. during the last decade. Then, I use this model to derive the macroeconomic implications of alternative reforms and alternative ways of funding these reforms. The second part of this thesis studies the computation and simulation of dynamic competitive equilibria in models with heterogeneous agents and market frictions. This type of models have been of considerable interest in macroeconomics and finance to analyze the effects of various macroeconomic policies, the evolution of wealth and income distribution, and the variability of asset prices. However, there is no reliable algorithm available to compute their equilibria. We develop a theoretical framework for the computation and simulation of dynamic competitive markets economies with heterogeneous agents and market frictions. We apply these methods to some macroeconomic models and find important improvements over traditional methods.

Health care reform is important in order to modify health care systems so that they operate more efficiently. There are various studies that compare the reforms of different countries to understand how these countries adjust their systems. This capstone introduces the health care system in Taiwan, China, and the United States, discusses the challenges they meet, and offers a comparison of recent reforms. The health care systems are introduced through three sections: collection of funds, pooling of funds and purchasing of services, and providing of services and exemptions. All three countries face the financing burden of health expenditure. To offer universal coverage and comprehensive benefit to its citizens, these three countries makes changes to qualifications for those insured, services provided to beneficiaries and payment systems for physicians, and contributions to pooling of funds. These reforms address barriers in reaching universal coverage in the three dimensions which are indicated in a WHO issued paper, that explains how to remove financial risks and barriers to access, promote efficiency and eliminate waste, and raisie sufficient resources for health (WHO, 2010). Despite the research, reforming the health care system to offer the accessibility of affordable services to individuals and to maintain sustainability of the health care financing will continually to be an issue.

Research Project (M.A.) - Simon Fraser University, 2006. / Theses (Dept. of Political Science) / Simon Fraser University. Also issued in digital format and available on the World Wide Web.

Thesis (Ph. D.)--University of Washington, 2003. / Vita. Includes bibliographical references (leaves 184-200).

Health care reform is important in order to modify health care systems so that they operate more efficiently. There are various studies that compare the reforms of different countries to understand how these countries adjust their systems. This capstone introduces the health care system in Taiwan, China, and the United States, discusses the challenges they meet, and offers a comparison of recent reforms. The health care systems are introduced through three sections: collection of funds, pooling of funds and purchasing of services, and providing of services and exemptions. All three countries face the financing burden of health expenditure. To offer universal coverage and comprehensive benefit to its citizens, these three countries makes changes to qualifications for those insured, services provided to beneficiaries and payment systems for physicians, and contributions to pooling of funds. These reforms address barriers in reaching universal coverage in the three dimensions which are indicated in a WHO issued paper, that explains how to remove financial risks and barriers to access, promote efficiency and eliminate waste, and raisie sufficient resources for health (WHO, 2010). Despite the research, reforming the health care system to offer the accessibility of affordable services to individuals and to maintain sustainability of the health care financing will continually to be an issue.

Thesis (doctoral)--Göteborg University, 2004. / Errata slip inserted. Includes bibliographical references.