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The purpose of this paper is to explore inter-organizational interactions that might result in prolonged decoupling between central governments' ideas and local governments' practices during the reform of an institutional field (i.e. healthcare).

The paper is based on a qualitative study of the centrally directed reform of the healthcare financing system in Ukraine and focusses on practices and reform ideas from 1991 to 2016.

The findings show that, for more than 25 years, local governments, as providers of healthcare services, faced two major problems associated with drawbacks of the healthcare financial system: line-item budgeting and fragmentation of healthcare funds. Over 25 years, central government's attempts to reform the healthcare financing system did not comprehensively or systematically address the stated problems. The reformers' ideas seemed to focus on creating reform agendas and issuing new laws, instead of paying attention to challenges in local practices.

This article has two main points that are relevant for practitioners. First, it calls for greater involvement from local actors during all stages of public sector reforms, in order to ensure the relevance of developed reform strategies. Second, it points to potential challenges that central governments may face when conducting healthcare financing system reforms in transitional economies.

The paper's contribution is twofold: it outlines reasons for problematic implementation of healthcare financing system reform in Ukraine and explains them through a “reverse decoupling” concept.

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.

The purpose of the paper is to examine the metaphors used by senior managers and clinicians in the delivery of healthcare reform.

A study of healthcare reform in England carried out a series of semi structured interviews with senior managers and clinicians leading primary and secondary care organisations. Qualitative data analysis examines instances where metaphorical language is used to communicate how particular policy reforms are experienced and the implications these reforms have for organisational contexts.

The findings show how metaphorical language is used to explain the interactions between policy reform and organisational contexts. Metaphors are used to illustrate both the challenges and opportunities associated with the reform proposals for organisational change.

The authors provide the first systematic study of patterns and meanings of metaphors within English healthcare contexts and beyond. The authors argue that these metaphors provide important examples of “generative” dialogue in their illustration of the opportunities associated with reform. Conversely, these metaphors also provide examples of “degenerative” dialogue in their illustration of a demarcation between the reform policy proposals and existing organisational contexts.

The desirability of having a more flexible workforce is emphasised across many health systems yet this goal is as ambiguous as it is ubiquitous. In the absence of empirical studies in healthcare that have defined flexibility as an outcome, the purpose of this paper is to draw on classic management and sociological theory to reduce this ambiguity.

The paper uses the Weberian tool of “ideal types”. Key workforce reforms are held against Atkinson’s model of functional flexibility which aims to increase responsiveness and adaptability through multiskilling, autonomy and teams; and Taylorism which seeks stability and reduced costs through specialisation, fragmentation and management control.

Appeals to an amorphous goal of increasing workforce flexibility make an assumption that any reform will increase flexibility. However, this paper finds that the work of healthcare professionals already displays most of the essential features of functional flexibility but many widespread reforms are shifting healthcare work in a Taylorist direction. This contradiction is symptomatic of a failure to confront inevitable trade-offs in reform: between the benefits of specialisation and the costs of fragmentation; and between management control and professional autonomy.

The paper questions the conventional conception of “the problem” of workforce reform as primarily one of professional control over tasks. Holding reforms against the ideal types of Taylorism and functional flexibility is a simple, effective way the costs and benefits of workforce reform can be revealed.

Physicians are instrumental in healthcare reform and their capacity to employ both leadership and management skills can affect change at all levels. This paper aims to present the challenges and opportunities for physicians in influencing system change and discuss how the two different but complementary skill sets may enable them to contribute to transformation of healthcare.

This is a conceptual paper and represents the viewpoints of both authors while incorporating current evidence through the literature.

Healthcare reform is important and underway in many Canadian provinces, yet it is difficult to achieve change. Leadership and management skills differ although these differences are often subtle in language. Physicians both lead and manage in the healthcare system; their capacity to do both is an advantage for healthcare reform.

This paper represents the opinions of both authors and is considered original as a conceptual paper.

The purpose of this paper is to provide an overview of post-Soviet and demographic challenges faced by the government in Moldova that have posed as challenges to reform of the healthcare system. Since independence from the Soviet Union in 1991, Moldova has undergone significant challenges and reforms throughout the society. Healthcare has been no exception. Changes in family structures due to migration, a decreased birthrate, and an aging population have placed strain on the healthcare system which is working to both modernize and provide specialized care. Legislation has helped to streamline and reform the healthcare system but systemic challenges are still faced by at-risk populations including the elderly, women, and rural populations.

Information presented in this paper is based on a review of independent research, United Nations and government reports.

Findings show that progress has been made through legislative reform, new government programming, and most recently volunteer/nonprofit involvement in healthcare reform. Currently, the government is working to establish holistic patient centered care and to bridge the healthcare divide between rural and urban populations. Healthcare reforms include basic universal health care services and family support programming. Additionally, there has been a renewed emphasis on how environmental factors, like housing and nutrition, interact with health quality.

Moldova faces an increasing challenge of caring for elderly populations at the family and societal level due to the increased number of elderly, shifts in family structures, and international migration for employment. A discussion of the developing role of nonprofit and nongovernment organizations is included.

The Obama’s reform of the US healthcare system has been a major topic of debate in the USA. The USA feels the need to provide 48 million residents with health insurance. The Affordable Care Act has this goal, but the several factors have limited its capacity and implementation. The purpose of this paper is to discuss this reform, paying attention to its potential implications for the human and economic development of both the USA and the rest of the world. The authors show that developed countries also need policies for enhancing human development and also the developing world may benefit from policy changes in the “first world.”

The methodology is based on discursive discussion. The argumentation first presents the reform, and highlights its advantages and its flaws for the citizens of both the USA and of developing countries.

The authors claim that the reform presents some flaws that render it still insufficient to cover all the health needs of the poor in the USA. However, the reform is likely to attract more immigrant workers to the USA, since it is likely to improve the living conditions of immigrants as well as those of their families.

The original point of the paper is the link between the reform and the benefits for non-US citizens. The extant literature has widely discussed the impact of the reform on the domestic market and on the US citizens. The authors widen this perspective showing that an important reform in a large country may be beneficial for people living elsewhere as well.

This study focuses on a particular type of public organization characterized by weak boundaries and strong informal relationships, elements that have assisted in driving the reform of an entire national public management system. The case is the Public Healthcare System of the Southern Italy in the period beginning in the early 1990s through the beginning of the new millennium, with particular emphasis on the Sicilian region, selected since it represents an extreme case of informal networks that affect organizational boundaries and governance functions.

The purpose of this paper is to explore recent healthcare reform in China. Reflecting on the current literature, the viewpoint argues that greater attention should be paid to healthcare reform in China as a public policy process, particularly one that is built on policy experimentation.

The viewpoint argues that while recent efforts to understand the impact of reform have brought significant understanding of key issues and processes, such interest tends to focus on pragmatic concerns rather than pose wider theoretical and methodological questions about the nature and pace of reform.

The authors suggest that the lens of public policy is particular relevant and insightful given what has been documented elsewhere regarding China’s unique policy process characterised by “policy experimentation”. The authors discuss how a policy experiment perspective can provide a useful heuristic for understanding healthcare reform in China.

The viewpoint concludes by outlining possible applications of this approach and looks forward at the emerging research agenda in this area.

The research topicality is stipulated by the need to study the legal regulation problems of the state financial guarantees of medical services for the population in Ukraine and to consider positive experience of the developed countries in this area. The aim of the article is to define the main trends in the legal regulation of healthcare in Ukraine; analyze the state financial guarantees of medical services for the population, and positive and negative aspects of the healthcare reform; to explore the international experience in medical services for its implementation to national law enforcement in the sphere of healthcare.

During the research, systematization and generalization of the positive international experience in the legal regulation of the state financial guarantees of medical services for the population were realized.

The analysis of the population's perception of healthcare innovations was carried out. The level of medical service was assessed. The results showed that in order to improve Ukrainian legislation on healthcare, it is necessary to remove absolute conflicts of normative legal acts; to establish public confidence in innovations and changes; to take into account international experience adapting it to specific features of Ukrainian legislation.

The defined theoretical and applied provisions constitute the practical significance for scholars and practicians, who deal with the legal regulation problems of the state financial guarantees of medical services for the population, university professors training highly qualified personnel, and all interested people concerned with healthcare.