BACKGROUND In the prenatal period, women can have sustained contact with nurses and other clinicians, forming relationships that are likely to be health enhancing for both the woman and her unborn child. Yet, first trimester care use in Oregon dropped noticeably over the past decade. In comparison with Washington state, Oregon has not shown substantial recovery. OBJECTIVE The aim of this stud...

f healthcare reform is not a political activity, it's going to be an economic o n e , " predic ted James Bentley, American Hospi ta l Association (AHA) senior vice president for policy, in a conversation. A look at recent hospital trends and an analysis from Wall Street bears this out. As competitive economic pressures increase in the healthcare system, in large part fueled by the growth of man...

OBJECTIVE To identify changes in nursing practice and the nursing-practice environment that have occurred with implementation of health sector reform in five countries in the Americas. METHODS An exploratory study of selected settings in Argentina, Brazil, Colombia, Mexico, and the United States of America was conducted between 1997 and 1999 to collect narrative data from 125 professional nur...

The methods for healthcare reform are strikingly underdeveloped, with much reliance on political power. A methodology that combined methods from sources such as clinical trials, experience-based wisdom, and improvement science could be among the aims of the upcoming work in the USA on comparative effectiveness and on the agenda of the Center for Medicare and Medicaid Innovation in the Centers f...

nancial crisis, there have been many calls to expand regulatory oversight in the fi nancial sector. Previously, regulation focused primarily on the health of individual fi nancial institutions. Since the crisis, however, regulatory reform eff orts, such as the 2010 DoddFrank Act, have focused more on stability in the fi nancial sector as a whole, a concept known as “macroprudential” or “systemi...

n engl j med 368;16 nejm.org april 18, 2013 1470 a loss of status and income as well as disdain from peers. Although leadership is making its way into clinical training, the workforce of the near future is already practicing. How can senior leaders enable and encourage front-line leadership among today’s clinicians? Surveys suggest that clinicians want a greater leadership role but feel unprepa...

A central problem in designing effective models of provider governance in health systems has been to ensure an appropriate balance between the concerns of public sector and/or government decision-makers, on the one hand, and of non-governmental health services actors in civil society and private life, on the other. In tax-funded European health systems up to the 1980s, the state and other publi...