Competition and Quality: Evidence from the NHS Internal Market 1991-1999

Payer-driven competition has been widely advocated as a means of increasing efficiency in health care markets. The 1990s reforms to the UK health service followed this path. We examine whether competition led to better outcomes for patients, as measured by death rates after treatment following heart attacks. We exploit differences in competition over time and space to identify the impact of competition. Using data on mortality as a measure of hospital quality and exploiting the policy change during the 1990s, we find that the relationship between competition and quality of care appears to be negative.competition, health care, mortality, quality of care

Explaining differences in hospital performance: Does the answer lie in the labour market?

This paper examines the relationship between performance of English public sector hospitals (NHS trusts) and the quality of their nursing staff. Performance ratings of NHS trusts published in 2001 and 2002 indicate a clear regional divide. This divide is not explained by lower medical need. The gap between wages in the private and public sector (the private sector premium) has a regional divide similar to that of the performance ratings. Utilising cross sectional variation in the private sector premium, we find that performance against several of the individual targets that are aggregated into the NHS performance ratings is negatively associated with the private sector premium.performance ratings, private sector wage, premia, public sector performance

Adherence with NICE guidance on lifestyle advice for people with schizophrenia: a survey

Background Substantial weight gain is common in people taking antipsychotics. NICE recommends these patients are offered physical health screening and intervention. The STEPWISE trial is currently evaluating a lifestyle education programme in addition to usual care. However, it is difficult to define what constitutes “usual care”. Aims To define “usual care” for lifestyle management in people with schizophrenia, schizoaffective disorder and first episode psychosis in STEPWISE study sites. Method Ten NHS Mental Health Trusts participated in a bespoke survey based on NICE guidance. Results Eight trusts reported offering lifestyle education programmes. Nine Trusts reported offering smoking cessation support. Reported recording of biomedical measures varied. Conclusions No consistent lifestyle education programme is currently offered across UK NHS Mental Health Trusts. The survey benchmarks ‘usual care’ for the STEPWISE study on which changes can be measured

On Dads and Damages: Looking for the “Priceless Child” and the “Manly Modern” in Quebec’s Civil Courts, 1921-1960

This essay explores the legal rights and responsibilities of fathers as they were interpreted by Quebec’s civil courts between 1921 and 1960. The focus is on 59 published cases in which fathers were named as plaintiffs or defendants in actions where legal damages were sought in relation to incidents that involved their children, as either victims or authors of harmful acts. These lawsuits are analysed with specific reference to two key concepts, Viviana Zelizer’s Priceless Child (1985) and Christopher Dummitt’s Manly Modern (2007), with the latter found more useful for understanding the changing dynamics of masculine parenthood in this period.Ce texte traite des droits et responsabilités juridiques des pères tels que les ont interprétés les tribunaux civils du Québec de 1921 à 1960. L’analyse porte sur 59 litiges ayant fait jurisprudence où les pères sont impliqués soit comme demandeurs soit comme défendeurs. Il s’agit de causes dans lesquelles des dommages-intérêts légaux sont réclamés relativement à des incidents impliquant leurs enfants comme victimes ou comme auteurs d’actes préjudiciables. Ces poursuites sont analysées en faisant spécifiquement référence à deux notions clés : celle de Priceless Child, de Viviana Zelizer (1985), et celle de Manly Modern de Christopher Dummitt (2007), cette dernière s’avérant plus utile pour comprendre l’évolution de la dynamique de la parentalité masculine au cours de cette période

Family Formation and Age at Marriage in Saint-Hyacinthe Quebec, 1854-1891

This article attempts to understand linkages between structural economic change and patterns of family formation in Quebec in the second half of the nineteenth century. Its focus is on marriage age, a demographic variable which, as European studies have shown, is sensitive to economic conditions and opportunities, and an important determinant of family size and structure. Men and women who married for the first time in late nineteenth-century Saint-Hyacinthe married two to three years younger than the provincial average. This pattern echoes that of the early capitalist wage workers studied by the proponents of the proto-industrial model in Europe.Cet article cherche à élucider les relations entre les modifications structurelles de l'économie et les modalités de formation des ménages au Québec dans la deuxième moitié du l9e siècle. Il étudie plus particulièrement l'âge au premier mariage, une variable démographique qui, comme les historiens européens l'ont montré, est sensible aux conditions et aux possibilités de l'économie, et détermine largement la taille et la structure des ménages. Les hommes et les femmes qui se mariaient pour la première fois à Saint-Hyacinthe, vers la fin du l9e siècle, étaient en général deux à trois ans plus jeunes que la moyenne provinciale. Cette tendance est comparable à celle des premières générations d'ouvriers salariés étudiées par les tenants du modèle de la proto-industrialisation

On dads and damages: looking for the “priceless child” and the “manly modern” in quebec’s civil courts, 1921-1960

This essay explores the legal rights and responsibilities of fathers as they were interpreted by Quebec’s civil courts between 1921 and 1960. The focus is on 59 published cases in which fathers were named as plaintiffs or defendants in actions where legal damages were sought in relation to incidents that involved their children, as either victims or authors of harmful acts. These lawsuits are analysed with specific reference to two key concepts, Viviana Zelizer’s Priceless Child (1985) and Christopher Dummitt’s Manly Modern (2007), with the latter found more useful for understanding the changing dynamics of masculine parenthood in this period.Ce texte traite des droits et responsabilités juridiques des pères tels que les ont interprétés les tribunaux civils du Québec de 1921 à 1960. L’analyse porte sur 59 litiges ayant fait jurisprudence où les pères sont impliqués soit comme demandeurs soit comme défendeurs. Il s’agit de causes dans lesquelles des dommages-intérêts légaux sont réclamés relativement à des incidents impliquant leurs enfants comme victimes ou comme auteurs d’actes préjudiciables. Ces poursuites sont analysées en faisant spécifiquement référence à deux notions clés : celle de Priceless Child, de Viviana Zelizer (1985), et celle de Manly Modern de Christopher Dummitt (2007), cette dernière s’avérant plus utile pour comprendre l’évolution de la dynamique de la parentalité masculine au cours de cette période.