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This dissertation examines the success of the National Health Service in Scotland in achieving the goal of regional equality. An historical analysis provides some indication that regional disparities have characterised the Scottish Health Service in the twentieth century. The data from 1951 to 1976 demonstrate the failure of the SHS to meet the policy objective in the recent past. An output policy model is developed to facilitate an explanation of persistent regional variation. The government structure, socio-economic and health status variables successfully explain a large percentage of the variation which exists between Health Board Regions. The most powerful of the independent variables is the nature of the policy process. The evidence presented in the thesis indicates clearly that the predominant policy process in existence within the SHS over time is incrementalism.

Thesis (Ph.D.)--University of the Witwatersrand, Faculty of Commerce, Law and Management, School of Law, 2014. / The proposed National Health Insurance (‘NHI’) is the most extensive health policy initiative proposed by the South African government since 1994, to bridge the divide between the private and public health sectors. It is intended that the NHI will fund health care services for the entire population. Yet, despite its laudable goals, the implementation of NHI might be stalled by litigation concerning its constitutionality. In this thesis, I construct a constitutional paradigm within which such challenges can be understood. Departing from the premise that the Constitution places a positive obligation on the state to implement redistributive policies in the health sector in order to progressively realise the right to have access to health care services, the thesis identifies the tensions underlying the proposed implementation of NHI and aligns these to liberty-based and equality-based understandings of the right to health, respectively. This analysis takes place after having considered the history of health care reform in South Africa and debates on the desirability of NHI. The thesis then investigates and sets out the constitutional principles, values and standards embodied by the rights to equality, freedom and security of the person, and access to health care services, and considers the extent to which current the formulation of the proposed NHI adheres to these principles. Potential constitutional challenges to NHI by private sector interest groups are identified. These challenges are primarily concerned with adverse effects that the implementation of NHI may cause to current beneficiaries of private sector health services. It is argued that these adverse consequences will, for the most part, not justify a finding that relevant features of NHI are unconstitutional. This is either because they will not amount to an infringement of the relevant constitutional rights or because such an infringement will be capable of reasonable justification in terms of the general limitations clause. Only where the impairment of existing rights is disportionate or is related to some extraneous purpose inconsistent with constitutional rights and values will NHI not pass constitutional muster. Ultimately, the constitutionality of different features of NHI will depend on how the rights of those who already have access to health care services under the current health financing system are balanced with those who currently lack such access.

Hospitals worldwide are under pressure to perform and models abound to remedy poor performance. Reform, however, is contested, uneven and slow. One reason is that few models address a core issue in reform: the management of clinical work. A further reason is that stakeholder groups, specifically policymakers, managers and clinicians, limit opportunities for collaborative problem solving as they seek to impose their own frame of reference in the struggle for control. I hypothesise that performance will be relatively better in hospitals that have in place strategies of agreement to set the objectives of reform, such as participative problem identification, problem solving and decision making, together with a method to manage clinical work. This hypothesis was tested in twelve public hospitals in three Australian states between 1999 and 2001 using both quantitative and qualitative research methods. Government and hospital policy documents were assessed and semi-structured interviews were conducted to gauge the attitudes and practices of managers and clinicians regarding health care reform. The results of the research show that hospitals with inclusive strategies for change, principally strategies of agreement, joint education and skills development, team-based incentives to direct and reward effort and a method of clinical work management, performed better than those without. Findings indicate that policy was developed and communicated as a rational top-down process that tended to exclude diverse views. Although the effect of different jurisdictional policy processes on hospital performance was not clear, they had considerable impact on the environment of reform. Cost containment and patient safety dominated as policy objectives. These alone did not engage clinician interest or address service quality. The connection between the quality of care and its cost did not appear to be understood. Organisational structures and processes necessary to support reform, that is communication forums for objective setting and performance review, integrated clinical and corporate accountability systems and organisational capacity building were not in place in the majority of hospitals studied. An organisational model of clinical work management was developed to improve cost-effectiveness by balancing clinical autonomy and clinical accountability based on the research results.

Thesis (LL. M.)--York University, 2001. Graduate Programme in Law. / Typescript. Includes bibliographical references (leaves 205-237). Also available on the Internet. MODE OF ACCESS via web browser by entering the following URL: http://wwwlib.umi.com/cr/yorku/fullcit?pMQ66408.

published_or_final_version / Politics and Public Administration / Master / Master of Public Administration

Typescript. / Thesis (Ph. D.)--University of Hawaii at Manoa, 1984. / Bibliography: leaves 109-114. / Microfiche. / xii, 114 leaves, bound ill. 29 cm

Thesis (Ph. D.)--University of Chicago, the Committee on the Conceptual Foundations of Science, June 1999. / Includes bibliographical references. Also available on the Internet.

Thesis (Ph. D.)--University of New South Wales, 2002. / Also available online.

Thesis (Ph.D.)--Australian National University, 2003.