Search results

Purpose – To identify the key success factors in a change process and to demonstrate how adherence to the phases of large-scale change contributed to the successful reform of the Irish cancer services and is critical to the sustainability of this large-scale change.

Design – In-depth retrospective analytical case study drawing from face- to-face semi-structured interviews with key stakeholders and players.

Findings – The Irish health care reform had been continually thwarted by local politics. The Irish government confronted this trend by bringing in an outside expert to head the cancer services reform project who, with government support, managed both clinician and public resistance and, based on the evidence of international best practice, led the reform. Sustainable change was achieved by attention to how large-scale change works. The leadership of the project is an important element in overcoming the path dependency that is dogged in most health care reforms.

Value – This chapter provides evidence that the four key phases of large system change: understanding the need for change, framing the change, undertaking the change and sustaining the change, coupled with key success factors in relation to timing, financial viability, political will and leadership, public support, well-managed process, and technical infrastructure and capacity are critical to the implementation and sustainability of large-scale change.

Many individuals are concurrently eligible for multiple sources of government-reimbursed health care services (e.g. Department of Veterans Affairs (VA) and Medicare). Unclear is whether combined eligibility translates into increased access to care and/or improved outcomes of care. Alternatively continuity of care may suffer, promoting health inequalities when patients receive health services from multiple unrelated sources of care. The current study examines the impact of dual eligibility for government-reimbursed care on long-term outcomes of care for a population of veterans diagnosed with colorectal cancer and initially treated surgically at Department of Veterans Affairs Medical Centers.

The health industry is rapidly adopting digital services and face-to-face offerings are being replaced by e-services. One example is peer-to-peer survivor networks for cancer patients. This study investigates the virtual exchanges in survivor networks and whether these exchanges are valued for economic, symbolic, or expressive worth. The research seeks to address whether the alleviation of loneliness is possible.

The qualitative work in this study utilizes netnographic explorations and in-depth interviews with cancer survivors, average age 62, to investigate the social exchange continuum in peer-to-peer online patient survivor networks.

This study shows that technological innovations can aid survivorship when the exchanges are meaningful. Meaningful interactions within gift systems are valued for expressive worth and are established upon the notion of selfless gifts where the giver expects nothing in return. For networks to operate via expressiveness, informants must be open and vulnerable to others. Findings show that biographical narratives are useful tools for creating an expressive environment and givers become more giving after engaging in selfless acts. The intangibility and immaterial nature of virtual gifts creates a collective identity and fosters an aggregate extended self.

Implications emphasize the need among survivors of trauma to connect with others. Digital technologies allow connections on a global scale, so survivors can find others with similar needs. Peer-to-peer networks provide a way for survivors to meet, interact with, and extend their aggregate selves through other survivors, while experiencing a transcendent sense that they are part of something bigger than self alone.

In a number of recent multi-billion dollar cases brought against cigarette manufacturers, plaintiffs have in part alleged that the cigarette manufacturers (1) conspired not to compete on the basis of health claims or the introduction of potentially safer cigarettes since the 1950s, and (2) engaged in fraudulent advertising by making implied health claims in advertisements selling ‘low tar’/‘light’ cigarettes. In this type of litigation, defendants’ actions could be due to alleged illegal behaviour as asserted by plaintiffs, or be the result of market forces that may have nothing to do with allegedly inappropriate acts. We examine the economic evidence relating to these allegations, taking into account some of the major influences on cigarette company behaviour. In particular, our analyses show that much of the cigarette manufactures’ behaviour can be explained by Federal Trade Commission and related government actions, rather than conspiracy or fraudulent acts. We find the economic evidence is inconsistent with an effective conspiracy to suppress information on either smoking and health or the development and marketing of potentially safer cigarettes. Regarding ‘lower tar’ and ‘light’ cigarettes, the economic evidence indicates that the cigarette manufacturers responded to government and public health initiatives, and that disclosing more information on smoking compensation earlier than the cigarette companies did would not have had any significant impact on smoking behaviour.

In current economic systems, the role played by non-profit and voluntary organisations is relevant. Several studies analyse the development of these organisations and suggest reasons related to the dissemination of policies that first consider public intervention and then ‘the third way’ of the economy as a way to increase wealth and support economic development. In this context, it should be noted that:

• Modern non-profit organisations (NPOs) take the form of enterprises encouraging the development of capabilities to satisfy human needs in terms of production of goods and utilities.

• A systematic cooperation with the local context (i.e. enterprises and Public Administration) is becoming increasingly more important for the survival and development of NPOs.

• Excellent opportunities for economic and social growth and for mutual development can develop from this type of cooperation.

• Starting from this premise, the purpose of the research is to suggest some insight on the theme of cooperation between for-profit and non-profit world in the light of the thought of Church’s Social Doctrine, and in particular, of the Encyclical Letter of Benedict XVI, Caritas in Veritate – On Integral Human Development in Charity and Truth. In this sense, the contribution is a conceptual work; the study could improve with empirical research concerning the level of diffusion and the form of collaborations for-profit/non-profit in the Italian context.

Modern non-profit organisations (NPOs) take the form of enterprises encouraging the development of capabilities to satisfy human needs in terms of production of goods and utilities.

A systematic cooperation with the local context (i.e. enterprises and Public Administration) is becoming increasingly more important for the survival and development of NPOs.

Excellent opportunities for economic and social growth and for mutual development can develop from this type of cooperation.

Starting from this premise, the purpose of the research is to suggest some insight on the theme of cooperation between for-profit and non-profit world in the light of the thought of Church’s Social Doctrine, and in particular, of the Encyclical Letter of Benedict XVI, Caritas in Veritate – On Integral Human Development in Charity and Truth. In this sense, the contribution is a conceptual work; the study could improve with empirical research concerning the level of diffusion and the form of collaborations for-profit/non-profit in the Italian context.

From a methodological point of view, after a literature review on NPOs and corporate social responsibility, the chapter analyses reasons, strategies and tools of collaborations between non-profit and for-profit worlds (the role of Public Administration and hybrid organisation is excluded). Then, focus moves up on Church’s Social Doctrine and Encyclical Letter Caritas in Veritate with particular attention to the topic analysed in this chapter (collaboration for-profit/non-profit enterprises). The vision emerging from the Encyclical is that the dichotomy between for-profit and NPOs should be resolved by striving for the development of a ‘civil economy’ with the capacity to promote the overall development of the human being. The research highlights the importance of dissemination of initiatives promoted predominantly by NPOs, with the objective of stimulating and supporting the implementation of forms of structured collaboration; we are sure that a ‘connection point’ between for-profit and non-profit is now necessary.

Purpose – The goal of this chapter is to understand the role of nonprofit voluntary health organizations (VHOs) in the lives of Canadian women coping with breast cancer.

Methodology – Through qualitative interviews with breast cancer survivors and records of VHOs active in this field, we assess the level and nature of their interactions and impact on women's quality of life.

Findings – Our findings suggest that at the micro-level, VHOs are venues for women to receive auxiliary services such as information, counseling, and support that complement the mainstream health care provision. While VHO services empower women as health care consumers, we show that they also serve as venues for women to reciprocate by volunteering. This process of reciprocity helps women cope with their own healing and allows them to be not only consumers but also producers of health services.

Research limitations – The non-random nature and the small sample size make our findings not easily generalizable to the larger population of breast cancer survivors; rather they are indicative of the experiences of Canadian women in one large urban metropolitan area.

Value of the chapter – We demonstrate the role of VHOs as venues of health consumerism as well as places for consumers to become involved in the production of services by volunteering.

Risk notification is part of a focus on preventive medicine that is dominant in contemporary Western biomedicine. Genomics has forecasted great advances in alleviating disease and prolonging human life, moving from a reactive to a preventative practice. However, in doing so, genomics redraws boundaries, potentially classifying all people as possible carriers of malfunctioning genes. This chapter presents a critical review of the practice of ‘risk notification’ as undertaken by familial cancer genetic testing services, focusing on the right to be informed or not to be informed and implications of knowing.

With backgrounds in anthropology, psychology and public health, the authors draw upon literature around risk notification from a range of disciplines.

In the context of familial cancer, clients may be asked to provide contact information for biological family members to inform them of their potential genetic risk. Through these processes a number of tensions and issues may emerge that relate to fundamental bioethical principles. The ability and decision whether to know, or conversely, to not know, is ethically fraught. We consider the roles and rights of family members and clients, as well as the broader goal of population health.

While much attention has been devoted to clients’ right to know in the context of medical research and treatment, relatively little work has examined the right not to know and adverse consequences of knowing. This review addresses concerns which have rarely been critically examined and debated in the context of risk notification of biological family members.

The Abdur Razzaque Ansari Memorial Weavers Hospital (ARAM) came into effect on 7 April 1996, and is dedicated to the people of Jharkhand and weavers. To deal with the issues of inequity in healthcare services, ARAM was founded for the extension of affordable healthcare services to the needy in and around the area of Jharkhand. Visualised by a great social worker and legend Abdur Razzaque Ansari, it has been successfully run by his eldest son Mr Sayeed Ahmad Ansari for 28 years. This research uses mainly a case-study approach through secondary data from the hospital website and other websites citing ARAM and its functions. Consent to use data for the study was obtained from Mr. Sayeed Ahmad Ansari. Primary information was collected through the patients who availed facilities from the hospital. They were interviewed through a semi-structured questionnaire each taking 30-40 minutes. Taken over by Medanta Group on 8 July 2015 (earlier being managed by Apollo Hospitals Group for 20 years), it is the first super speciality community hospital in Eastern India. Treating over 50,000 patients yearly with state-of-the-art medical equipment and providing discounts to lower-income groups, people from the weaver’s community, freedom fighters and members of ICSI have intrigued people from these sections for affordable treatment and facilities in and near Jharkhand. With a 200 bed-capacity, nine different disciplines and 12 departments spread across the city of Ranchi, the hospital caters to a massive population at a much-subsidised rate. Reaching out to rural villages through free medical camps and awareness campaigns, the hospital showcases how a successful model of healthcare cooperative can be replicated accordingly in similar developing and underdeveloped regions.

The Norwegian health care system is semi-decentralized. Primary care and long-term care (LTC) are the responsibilities of the municipalities. Specialist care is the responsibility of the central government and is organised through four Regional Health Authorities (RHA). Resource use, health outcomes and severity are the three main pillars for priority setting, regularly applied in reimbursement decisions for pharmaceuticals.

The sustainability of health care is challenged in Norway. The main factors are a growing elderly population with high need of complex, coordinated services, an increasing demand for newly approved drugs and advanced technology and a potential shortage of health care personnel.

We present recent trials and policy reforms in Norway aimed at improving care pathways combined with cost containment. Reforms in the pharmaceutical market, both with regard to market access and reimbursement (cost-effectiveness), and regulation of prices, have resulted in cost containment. The primary care sector awaits reform initiatives to recruit and retain physicians as general practitioners. No reform in the hospital sector has had cost containment as a main focus. The sector is characterized with low productivity growth, and expenditures that have increased more than the GDP growth. Waiting times are long, and coordination between sub-sectors of health care has been poor, although the Coordination reform of 2012 has alleviated some of the challenges related to intersectoral coordination. Still, the divided responsibility for health care between the central government and the municipalities creates tensions between national ambitions and local decisions in the financing and provision of health services.

Health social movements address several issues: (a) access to, or provision of, health care services; (b) disease, illness experience, disability and contested illness; and/or (c) health inequality and inequity based on race, ethnicity, gender, class and/or sexuality. These movements have challenged a variety of authority structures in society, resulting in massive changes in the health care system. While many other social movements challenge medical authority, a rapidly growing type of health social movement, “embodied health movements” (EHMs), challenge both medical and scientific authority. Embodied health movements do this in three ways: (1) they make the body central to social movements, especially with regard to the embodied experience of people with the disease; (2) they typically include challenges to existing medical/scientific knowledge and practice; and (3) they often involve activists collaborating with scientists and health professionals in pursuing treatment, prevention, research, and expanded funding. We present a conceptual framework for understanding embodied health movements as simultaneously challenging authority structures and allying with them, and offer the environmental breast cancer movement as an exemplar case.