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Social policy linked to child poverty, welfare programs and needs of children has been undergoing major change in the United States. In 1996, major welfare reform was passed that eliminated the old cash assistance program of AFDC (Aid to Families of Dependent Children Program) and replaced it with a new block grant program, TANF (Temporary Assistance to Needy Families). Advantages of the new TANF program were that it provided more flexibility to States, made the time period for which funds could be received much shorter, and therefore strongly encouraged adult welfare recipients to enter the workforce (Sherman & Sandfort, 1998; Watts, 1997). As part of this change, along with changes enacted earlier from 1984 to 1990, Medicaid eligibility for low-income children was expanded by gradually delinking Medicaid eligibility from welfare eligibility (Kronebusch, 2001). As part of a continued policy goal of expanding access to health care services to children at lower ends of the income spectrum, Congress in 1997 passed the Balanced Budget Act of that year. That act created the Children’s Health Insurance Program (CHIP). This program provided an opportunity for States to participate in CHIP and thus acquire funding from the federal government to expand their health care coverage to uninsured, lower-income children. This program was particularly aimed at children of the working poor, whose parents were often in the labor force but worked for an employer who did not provide health care insurance. The numbers of these parents were expected to increase in future years, as the TANF welfare reforms decreased the number of parents on welfare who were receiving cash benefits and increased the number of parents who accepted jobs. Many of these jobs will not provide the full set of benefits that are common in many white-collar and middle income jobs (Seccombe & Amey, 1995). The legislation allowed States to expand their Medicaid programs, create a separate CHIP program, or combine the two options (Shi, Oliver & Huang, 2000).

Recent reports by the Institute of Medicine (IOM) signal a substantial yet unrealized deficit in patient safety innovation and improvement. With the aim of reducing this dilemma, we provide an introductory account of clinical error resulting from poorly designed systems by reviewing the relevant health care, management, psychology, and organizational accident sciences literature. First, we discuss the concept of health care error and describe two approaches to analyze error proliferation and causation. Next, by applying transdisciplinary evidence and knowledge to health care, we detail the attributes fundamental to constructing safer health care systems as embedded components within the complex adaptive environment. Then, the Health Care Error Proliferation Model explains the sequence of events typically leading to adverse outcomes, emphasizing the role that organizational and external cultures contribute to error identification, prevention, mitigation, and defense construction. Subsequently, we discuss the critical contribution health care leaders can make to address error as they strive to position their institution as a high reliability organization (HRO). Finally, we conclude that the future of patient safety depends on health care leaders adopting a system philosophy of error management, investigation, mitigation, and prevention. This change is accomplished when leaders apply the basic organizational accident and health care safety principles within their respective organizations.

Although much is known about inequalities in the prevalence of CHD, less is known about the barriers experienced in self-managing it. Questionnaires, focus groups, and Internet forums were analyzed to explore obstacles in self-managing CHD. Most people found it difficult and costly to maintain a healthy lifestyle. Gender inequalities included women being more likely to live on their own and with a lower income. Marital status was an issue as several were either caring for an ill spouse or were coping with their recent death. Socio-demographic factors played a key role in influencing people's ability to manage their CHD.

Purpose – This chapter investigates the role that mandatory genetically modified (GM) labeling versus voluntary labeling has played in the split between those countries with small GM markets and those with large GM markets.

Methodology/approach – Data on product introductions and other market evidence are used to examine market outcomes and identify the likely drivers of GM market bifurcation.

Findings – Labeling has negligible effects on consumer choice or on GM differentiation costs and therefore does not explain the split in GM market outcomes. Other factors have driven market outcomes: namely, consumer confidence in government and the safety of the food supply, competition among manufacturers and retailers, market momentum, and most importantly, the affordability of a non-GM strategy. Ultimately, a non-GM market strategy is feasible only if consumers are willing to cover the additional costs associated with non-GM production and marketing. The two elements composing the cost/price wedge between GM and non-GM products – the cost-reducing benefits of the GM technology and the costs of differentiating non-GM products – therefore play an important role in market outcomes. In the mid-1990s, when producers, manufacturers, and retailers were determining their strategies, neither element was very large. As a result, both GM and non-GM marketing strategies were economically feasible.

Practical implication – Regardless of the labeling regime, changes in the cost/price wedge between GM and non-GM products could change the mix of GM and non-GM products on the market.

Originality/value of paper – This analysis extends the literature by focusing on the impact of labeling regime on both consumer behavior and the cost/price wedge between GM and non-GM products.