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Disillusionment among doctors is common. It is not uncommon for even highly successful doctors to say they wish they had gone into another field or that they would not encourage their children to go into medicine. In this chapter, I explore why this might be so. For many, medicine has become just another job dominated by technical skill and technology. I suggest that educating for professionalism as the remedy for this disillusionment is almost certain to fail as the issues are as much sociological as personal and professional. Perhaps disillusionment is a clue to a much more complex reality for modern medicine.

A healthcare system in any country is rarely the product of one logical policy-making experience, but rather a manifestation of many years of historical development. The purpose of this paper is to examine the characteristics, components, and variables of South Africa’s healthcare system in the context of global patterns. It leverages a dynamic period in South Africa since 1994, and applies a comparative health systems analysis to explain where the country’s healthcare system is, and where it is potentially going.

This paper reviews literature related to South Africa’s healthcare system, outlines its historical development, and discusses three fundamental challenges experienced in the country. This paper also reviews the literature on healthcare system typologies and identifies three framework models that have been used to categorise national healthcare systems since the 1970s. This paper then discusses the categorisation of South Africa’s healthcare system in these models, in comparison to Canada and the USA.

This paper finds that the framework models are useful tools for comparative analysis of healthcare systems. However, any use of such typologies should be done with the awareness that national healthcare systems are not isolated entities because they function within a larger context. They are not static, since they are constantly evolving with many nuances, even with very similar healthcare system categorisations.

This paper charts the trajectory of change in the South African healthcare system, and demonstrates that the change process must keep internal conditions in mind if the outcome is to be successful. Imitating policies of countries with well-functioning systems, without regard to local realities, may not work, as the government attempts to usher in changes within a short span of time.

This is the second part of a long investigation under the title of, Principia Oeconomica; the first having appeared in this journal in 1986. The substance of the argument in this contribution is in the form of a dialogue with Henri Guitton, member of l'Institut de France and author of a book in French, De l'Imperfection en Economie (1979). Guitton is leading a new French Economic School critical of a modern economy characterised by ‘Econosm” or “Economy of Counter‐sense”. Economism refers to the practice of conceiving problems of a modern society in strictly economic‐accounting terms and neglecting a host of social and human aspects. The second term means that the sole attention given to growth in production did not increase the happiness of man but on the contrary it created for him new problems (pollution, noise, atomic radiation and other hazards). To cope with these problems, the French school recommends wise policies which Guitton called “creative imperfection”. Guitton's presentation is followed step by step, with an interpretation in terms of stable equilibrium. The recommendation stresses structural reforms to solve the same problems but following a road of “creative perfection” leading to the same goal sought by Guitton: a better world of tomorrow.

The purpose of this paper is to support the claim that socialism is ineffective and inefficient, and that this insight applies to socialized medicine, as well as all other forms of socialism.

The main method utilized in this paper is the application of basic supply and demand analysis, based on private property rights and profit considerations, to healthcare.

It is found that the application of these basic elements of economics to healthcare demonstrates that free enterprise can better attain the ends of healthcare than can socialism.

Future research should focus on the anomaly that most people view socialism with great disdain, but not when it comes to health care. Why the logical disconnect?

The Soviet Union went through economic paroxysms in ridding itself of socialism. If the implications of this research are implemented, these can be avoided in our health care system.

The impact on society of this research will be very beneficial; under free enterprise, costs will be lower, and quality of care higher. But public attitudes are at present very much in favor of socialized medicine. Hopefully, one of the benefits of the present paper will be to change this.

The value of the paper is that, in some small way, it will help attain greater health for the entire population.

This paper aims to explore how historical context influences the content and selection of rhetorical legitimation strategies. Using case study method, this paper will focus on how insurance companies and labor tried to defend their legitimacy in the context of enactment of Medicare in the USA. What factors influenced the strategic (rhetorical) decisions made by insurance companies and labor unions in their institutional work?

The study is empirically grounded in archival research, involving an analysis of over 9,000 pages of congressional hearings on Medicare covering the period 1958–1965.

The authors show that rhetorical legitimation strategies depend significantly on the specific historical circumstances in which those strategies are used. The historical context lent credibility to certain arguments and organizations are forced to decide either to challenge widely held assumptions or take advantage of them. The authors show that organizations face strong incentives to pursue the latter option. Here, both the insurance companies and labor unions tried to show that their positions were consistent with classical liberal ideology, because of high respect of classical liberal principles among different stakeholders (policymakers, voters, etc.).

It is uncertain how much the results of the study could be generalized. More information about the organizations whose use of rhetorics the authors studied could have strengthened our conclusions.

The practical relevancy of the revised paper is that the authors should not expect hegemony challenging rhetorics from organizations, which try to influence legislators (and perhaps the larger public). Perhaps (based on the findings), this kind of rhetorics is not even very effective.

The paper helps to understand better how organizations try to advance their interests and gain acceptance among the stakeholders.

In this paper, the authors show how historical context in practice influence rhetorical arguments organizations select in public debates when their goal is to influence the decision-making of their audience. In particular, the authors show how dominant ideology (or ideologies) limit the options organizations face when they are choosing their strategies and arguments. In terms of the selection of rhetorical justification strategies, the most pressing question is not the “real” broad based support of certain ideologies. Insurance company and labor union representatives clearly believed that they must emphasize liberal values (or liberal ideology) if they wanted to gain legitimacy for their positions. In existing literature, it is often assumed that historical context influence the selection of rhetorical strategies but how this in fact happens is not usually specified. The paper shows how interpretations of historical contexts (including the ideological context) in practice influence the rhetorical strategies organizations choose.

The purpose of this paper is to assess the future of healthcare and quality.

The paper describes six future healthcare systems based on four archetypes.

Instead of dealing with process oriented practice, management participation, financial incentives and capacity management, the emphasis should be on communication, education, shared decisions and quality of life.

The paper makes it clear that quality improvement efforts should be centred on the needs and wishes of patients, recognising patients' expertise, values and preferences.

This paper aims to explore President Obama's leadership style during passage of this major and controversial piece of legislation. Specifically it addresses the historical development of healthcare reform in the USA, and provides an ethical analysis of President Obama's leadership in pursuing the health reform initiative.

Based on a review of the literature, speeches, and application of leadership and ethical theory, an analysis was done of President Obama's leadership and ethical approach to healthcare reform.

This analysis revealed that Obama's behavior was consistent with the full‐range leadership model articulated by Bass and Avolio. Moreover, his personal and strategic ethical approach to promulgating healthcare reform incorporated both deontological and teleological ethical principles.

This paper provides a current look at President Obama's leadership style and demonstrates how incorporating different ethical theories can result in the same outcome.

This paper examines how cultural holes that exist at the intersection of institutional fields influence the exploitation of entrepreneurial opportunities. Through an exploration of physician-founded ambulatory surgery centers in the United States, we examine how the presence of cultural holes presented doctors with alternative beliefs, values, and practices to overcome the cultural constraints around entrepreneurship within the medical profession. In doing so, this study extends cultural entrepreneurship research by bringing cultural holes to the forefront, empirically showing how they facilitate entrepreneurial action and proposing other contexts where cultural holes may affect entrepreneurial actions and outcomes.

Based upon the conformity of its ideals and economic policies with those of social economics and the performance of its economy, it is concluded that the Swedish economy exemplifies a viable social economy. This conclusion is reached following analysis of: the basic tenets and propositions of social economics; the origins of the modern Swedish economy; Sweden′s economic policies since 1932; the degree to which Swedish ideals and economic policies conform to those of social economics; and the performance of the Swedish economy.