Thesis (doctoral)--University of Toronto, 2002. / Includes bibliographical references (p. 345-377).

Thesis (Ph.D)--Brandeis University, 2010. / "UMI:3391164." Includes bibliographical references

The NHS is the centrepiece of the UK welfare state. For fifty years it has provided the majority of health-care in the UK. However the running of the service has not been marked by a smooth operation. Repeated reforms have occurred since 1948 in attempts to increase the efficiency and effectiveness of the service. These reforms have been credited with varying degrees of success. Even the most radical reforms, initiated in 1990, have been marked by some failures - particularly in respect to the provision of services to 'at risk' groups such as the elderly, leading to criticisms of a lack of coherent policy making. The reasons that underlie the success of the NHS in the midst of failure are complicated, but one hypothesis is that the structure of the NHS does not reflect its basic functions. Those functions can be broken down into 2. First is the relief of suffering from illness; second is the support of the industrial and economic base of the UK. The existence of this pluralistic purpose implies that the management of the service requires balancing the forces of economic, state and civil society requirements for the NHS. This management is embodied in a complicated institutionalisation of care, covered in chapter 1. The empirical evidence gathered in the thesis, in chapters 2 and 3 both from literature and case studies, would indicate that at least part of the problems seen in the NHS result from a failure to balance this institutionalisation. However, the situation is made more complex as the result of this imbalance creates further increased demands from some of the elements in the management of the service. Therefore the failure to balance the interactions that surround the NHS increases the pressures on it which in turn increases the imbalance leading to a feedback loop magnifying the problem. The source and problems of this feedback are best exemplified by a case study of the most recent reforms -covered in chapters 4-11 of this thesis. This case study demonstrates that the way in which the 1990 reforms were formulated and implemented took little notice of the impact of the changes on the street level NHS managers - with the results that the reforms did not represent a coherent policy. The result of the lack of coherence is that the changes have not generated efficiency gains, and in some cases have diverted resources away from those most in need. The underlying cause of this is the predominance of non- market forces in the decision making process - i.e. the values of the purchasers and the power of the providers to influence decision making. The linkages between these features of the post reform NHS are described in chapter 12. It is likely that the only way in which the circle of problems in the NHS can be addressed is re-establishing the corporate relationship that surrounds health care. However unlike previous relationships the evidence suggests that the relationship should be established at a policy level, rather than the current trends for a local level relationship. The NHS is not unique in this aspect, as this is the pattern of change seen in many European Countries.

The Affordable Care Act (ACA), passed on March 23rd, 2010, contains widesweeping legislation aimed at reforming the current U.S. healthcare system. The ACA has been lauded by its proponents and deeply criticized by its opponents. The current paper included two experimental studies designed to test if the individual insurance mandate requirement is a specific source of the psychological and behavioral resistance displayed toward the ACA. In study 1 the individual insurance mandate requirement did not produce greater negative attitudes towards the ACA or the current Presidential administration and it did not predict attitudes towards the longevity of the ACA. Democrats were found to have significantly less negative attitudes towards the ACA and towards the longevity of the ACA and Democrats also reported a lower likelihood of the ACA being repealed in comparison to Independents, Republicans or Libertarians. In study 2, the non-significant individual insurance mandate findings from study 1, were replicated in study 2. However, Democrats again were found to have significantly less negative attitudes towards the ACA and towards the longevity of the ACA in comparison to Independents, Republicans and those with no political affiliation. Democrats also indicated that they were less likely to vote for a political candidate who supports the repeal of the ACA in comparison to Independents, Republicans and those with no political affiliation. Implications and future research directions are discussed.

Made available in DSpace on 2012-05-07T14:46:37Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 000012.pdf: 1560676 bytes, checksum: 29adfc7fffabe8144562be8d54884a91 (MD5) Previous issue date: 2008 / Esta tese focaliza a emergência dos movimentos sociais na Reforma Psiquiátrica, um fato novo na história da psiquiatria contemporânea brasileira. A construção dos movimentos sociais como objeto de pesquisa foi estruturada no tempo diacrônico e sincrônico. No tempo diacrônico cotejaram-se autores de épocas diversas, cuja visão crítica sobre a história da psiquiatria foi confrontada com textos literários autobiográficos, sobretudo daqueles que passaram por internações psiquiátricas ou que assumem perante os leitores sua doença mental. Além de servir como parâmetro da história social, tais textos registram os frêmitos da mentalidade e sensibilidade coletiva de uma longa época da psiquiatria. No tempo sincrônico e curto da história contemporânea, trabalhou-se com o testemunho oral dos militantes usuários de serviços de saúde mental e familiares. Após registrar as histórias de vida, privilegiou-se a trajetória de militância nos movimentos sociais, captando as rupturas e instabilidades do campo psiquiátrico através das mudanças na sensibilidade coletiva. Objetiva-se captar essas mudanças centradas no saber leigo, fora do âmbito técnico. Esta pesquisa é permeada pela seguinte interrogação: com o surgimento dos movimentos sociais e diante das transformações evidentes no campo da assistência em saúde mental, como interpretar e analisar a “mentalidade manicomial” ainda fortemente arraigada no tecido social?

Made available in DSpace on 2013-01-07T15:54:59Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 45.pdf: 1317474 bytes, checksum: b38b65c060b6eeefd673dfdd34c21f62 (MD5) Previous issue date: 2004 / Analisa as consequências que a reforma implantada por Pedro Ernesto Baptista na Assistência Municipal, em 1933, trouxe para o mercado de trabalho médico. Observa as manifestações da sociedade às medidas adotadas, mas sobretudo as reações provocadas no meio médico, buscando avaliar com isto as alterações no âmbito do mercado de trabalho daquela categoria profissional.

Made available in DSpace on 2013-01-07T15:54:59Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 9.pdf: 3228830 bytes, checksum: 8b715c27348617242506252373b3870e (MD5) Previous issue date: 2007 / Trata das ações de saúde e saneamento na Amazônia durante o Primeiro Governo Vargas (1930-1945) e tem como foco compreender de que forma a região se localiza nos discursos da época sobre a integração nacional. No período, ocorreu a criação de instituições científicas que tinham como foco a saúde e saneamento da região amazônica, como o Instituto de Patologia Experimental (IPEN), e o Serviço de Estudo das Grandes Endemias (SEGE), capitaneados por Evandro Chagas.

D.Cur. / Nurse educators have a multifaceted and ambiguous professional as well as personal role. They teach nursing theory, accompany student nurses in the clinical area and are expected to carry out research. Very few — in the nursing colleges — are actually involved in scientific study and relate this to unavailability of resources like sponsorship and time, to support such efforts. Added to this is their personal role as spouse or partner, as parent, as significant other and as friend. Faced with the challenges of the change from curative to the primary health care approach to health services delivery, and according to provincial legislation, the restructuring and rationalisation of health services, induding rationalisation of nursing colleges, the nurse educator is negatively affected by these changes and gets stressed. As a result of the complex and changing social, economic and political dimate, these challenges pose a threat to the nurse educator, who perceived herself as being unable to cope. Change occurs continuously in nursing, and therefore in nursing education, because of the dynamic health care system. Change, for better or for worse, can be stressful. It puts big demands on a person's ability to cope. The nurse educator in this changed climate, being unable to cope, gets stressed, and if any stressful situation is allowed to progress to distress, the health — mental, physical and spiritual — of the nurse educator might be adversely affected. Supporting the nurse educator to cope with this change may help her to accept the dynamic changes taking place around her. Learning to cope will not only give nurse educators control over their lives and well-being, but would leave them free to concentrate on helping themselves and others and teaching student nurses. The purpose of this research was to generate and describe a support approach and to describe guidelines to operationalise the support approach, for the psychiatric nursing clinical specialist to utilise for the nurse educator who is working in a nursing college that is earmarked for rationalisation, in order to promote, maintain and restore mental health as an integral part of health. Based on the above discussion, the following questions were addressed in this research: How do nurse educators experience life in all its dimensions? What support do they think they should receive? What approach can be described to support the nurse educator? What guidelines can be described to operationalise the support approach? A qualitative, explorative, descriptive and contextual research design was followed. The research was conducted in four phases with a pilot study preceding the first phase of the research. In phase one, phenomenological interviews were conducted with seven nurse educators to explore their experience of life in all its dimensions. Data was analysed according to Tesch's method. Based on the results of analysed data, fear and uncertainty, anger and hope/hopefulness were the identified themes. In phase two, focus group discussions were held with the same group of nurse educators to explore their views on what could be done to support them. Selfmanagement, justice and fairness and enrichment were the identified themes. In phase three themes from phase one and phase two were utilised to form a bridge, leading to the description of an approach to support nurse educators. Phase four dealt with the description of guidelines to operationalise the support approach. Recommendations and limitations of the research were also discussed.

Master of Public Health / This study aimed to contribute to the current debate around equity in health care resource allocation by measuring the current allocation of resources, relative to need in the Northern Cape. It also discussed the level of inequities in health financing expenditure and staffing at the primary health care level between different districts of the Northern Cape. / South Africa

Master of Public Health - MPH / The aim of this thesis was to conduct a situational assessment of human resources planning at one local health authority, in order to determine how decentralisation has impacted the effectiveness of human resources planning. / South Africa