Men in hardhats were once the heart of America's working class; now it is women in scrubs. What does this shift portend for our future? Pittsburgh was once synonymous with steel. But today most of ...its mills are gone. Like so many places across the United States, a city that was a center of blue-collar manufacturing is now dominated by the service economy—particularly health care, which employs more Americans than any other industry. Gabriel Winant takes us inside the Rust Belt to show how America's cities have weathered new economic realities. In Pittsburgh's neighborhoods, he finds that a new working class has emerged in the wake of deindustrialization.As steelworkers and their families grew older, they required more health care. Even as the industrial economy contracted sharply, the care economy thrived. Hospitals and nursing homes went on hiring sprees. But many care jobs bear little resemblance to the manufacturing work the city lost. Unlike their blue-collar predecessors, home health aides and hospital staff work unpredictable hours for low pay. And the new working class disproportionately comprises women and people of color.Today health care workers are on the front lines of our most pressing crises, yet we have been slow to appreciate that they are the face of our twenty-first- century workforce. The Next Shift offers unique insights into how we got here and what could happen next. If health care employees, along with other essential workers, can translate the increasing recognition of their economic value into political power, they may become a major force in the twenty-first century.
This Element examines economic perspectives on improving quality and safety in healthcare. Though competition is generally recognised by economists as an important driver of improvement, it may not ...work so straightforwardly in healthcare – in part because some services are provided by very few organisations, but also because people are not always easily able to judge healthcare quality and rarely have to pay the full price for services. Different approaches for stimulating improvement are therefore needed, and the authors look at examples from the care home, primary care, and hospital sectors. They emphasise the need for economic evaluation of improvement efforts, based on the principle that improvement activities should only be undertaken if the benefits are worth at least the costs of implementing and running them. Using examples, they explain the economic approach to evaluating how benefits and costs of improvement efforts can be compared by applying cost-effectiveness analysis. This title is also available as Open Access on Cambridge Core.
This study investigated the impacts of various inclusion levels of dietary potential of fish protein hydrolysate (FPH) on the growth and reproductive performance, biochemical composition, blood ...parameters, and liver histology of Ompok pabda broodstock. About 600 pabda broods (11.00±0.05g) were distributed into 12 cages and fed twice in a day. For this, four experimental diets (crude protein: 30%; crude lipid: 9%) were prepared by incorporating FPH at different percentages (0%, 5%, 7%, and 9%). The FPH positively impacted (p<0.05) the durability index, water stability, and swelling rates of the experimental diets. Furthermore, significantly higher palatability (p<0.05) was recorded for pabda diets incorporated with 5% and 7% FPH. After 90 days, the growth performance of pabda in final weight, live weight gain, total biomass, specific growth rate, hepatosomatic index, visceral somatic index, and nutrient utilization indices, feed conversion ratio and protein efficiency ratio, was significantly (p<0.05) improved when fed with 7% FPH diet. Additionally, the ovipositor diameter (5.10±0.05mm), spawning response (98.48±2.4%), fecundity (13.28±0.23×10sup.4eggs/kg), and egg fertilization rate (87.09%±0.14%) were significantly higher (p<0.05) for the 7% FPH dietary group than other treatments. The fish group that received control diet experienced a marked (p<0.05) reduction in egg hatching rates, coupled with longer ovulation period as compared to FPH-treated groups. Dietary FPH inclusion at different levels also caused notable improvements (p<0.05) in most hematological and serum biochemical indices of pabda broodfish. The 7% FPH group also exhibited enhanced liver health, characterized by superior nuclei, erythrocyte, and cytoplasmic structure and boosted the farm economics efficiency. In summary, 7% dietary FPH is suitable and beneficial for O. pabda broodstock development in captivity by improving growth and reproductive performance, overall health, and farm economics.
Handing envelopes containing money or gifts to doctors in public health care is often seen as a remnant of socialism that continues as an integral part of the Lithuanian health care system. Rima ...Praspaliauskiene uses the envelope to explore complex doctor-patient interactions that go beyond notions of the gift or the bribe. She reshapes our definition of corruption and encourages seeing these practices as emerging forms of care that impede the neoliberal health care reforms effected in the post-Soviet era. Enveloped Lives extends the analytical categories of gift, care, money, and transparency, shifting attention away from material transactions by prioritizing relations and practices that transcend economic rationality. At a time when health care reforms and the costs of care are being widely debated, this book is a contribution to the larger discussion about the ethics and future of health care around the world.
The second decade of the twenty-first century has witnessed a surging interest in personalized medicine with the concomitant promise to enable more precise diagnosis and treatment of disease and ...illness, based upon an individual’s unique genetic makeup.In this book, my goal is to contribute to a growing body of literature on personalized medicine by tracing and analyzing how this field has blossomed in Asia. In so doing, I aim to illustrate how various social and economic forces shape the co-production of science and social order in global contexts. This book shows that there are inextricable transnational linkages between developing and developed countries and also provides a theoretically guided and empirically grounded understanding of the formation and usage of particular racial and ethnic human taxonomies in local, national and transnational settings.
Local setting Brazil has a universal health system that guarantees access to health for its 215 million population. Approche Le complexe economique-industriel de la sante a redefini les valeurs qui ...guident les politiques d'innovation et les politiques industrielles au Bresil. Ce complexe a reoriente la production et l'innovation dans le domaine de la sante vers un acces universel; le Ministere de la Sante a adopte une approche pangouvernementale; et enfin, les marches publics ont ete passes de maniere strategique afin de stimuler les investissements productifs dans les secteurs public et prive. Les capacites institutionnelles, technologiques et productives developpees par le complexe economique-industriel de la sante ont permis au pays d'etablir rapidement une production locale de vaccins contre la COVID-19 et d'en assurer l'acces a la population.
The issue of justice in the field of health care is becoming more central with concerns over access, cost and provision. Obamacare in the United States and the Health and Social Care Act 2012 in the ...United Kingdom are key examples illustrating the increasing pressure put on governments to find just and equitable solutions to the problem of health care provision. Justice and Profit in Health Care Law explores the influence of justice principles on the elaboration of laws reforming health care systems. By examining the role played by key for-profit stakeholders (doctors, employers and insurers), it tracks the evolution of distributive norms for the allocation of health care resources in western welfare states. Essentially, this book sheds light on the place given to justice in the health care law-making process in order to understand the place we wish to give these principles in future health care reforms.
Background In 2020, the Ministry of Health (MoH) in Ontario, Canada, introduced a virtual urgent care (VUC) pilot program to provide alternative access to urgent care services and reduce the need for ...in-person emergency department (ED) visits for patients with low acuity health concerns. Objective This study aims to compare the 30-day costs associated with VUC and in-person ED encounters from an MoH perspective. Methods Using administrative data from Ontario (the most populous province of Canada), a population-based, matched cohort study of Ontarians who used VUC services from December 2020 to September 2021 was conducted. As it was expected that VUC and in-person ED users would be different, two cohorts of VUC users were defined: (1) those who were promptly referred to an ED by a VUC provider and subsequently presented to an ED within 72 hours (these patients were matched to in-person ED users with any discharge disposition) and (2) those seen by a VUC provider with no referral to an in-person ED (these patients were matched to patients who presented in-person to the ED and were discharged home by the ED physician). Bootstrap techniques were used to compare the 30-day mean costs of VUC (operational costs to set up the VUC program plus health care expenditures) versus in-person ED care (health care expenditures) from an MoH perspective. All costs are expressed in Canadian dollars (a currency exchange rate of CAD $1=US $0.76 is applicable). Results We matched 2129 patients who presented to an ED within 72 hours of VUC referral and 14,179 patients seen by a VUC provider without a referral to an ED. Our matched populations represented 99% (2129/2150) of eligible VUC patients referred to the ED by their VUC provider and 98% (14,179/14,498) of eligible VUC patients not referred to the ED by their VUC provider. Compared to matched in-person ED patients, 30-day costs per patient were significantly higher for the cohort of VUC patients who presented to an ED within 72 hours of VUC referral ($2805 vs $2299; difference of $506, 95% CI $139-$885) and significantly lower for the VUC cohort of patients who did not require ED referral ($907 vs $1270; difference of $362, 95% CI 284-$446). Overall, the absolute 30-day costs associated with the 2 VUC cohorts were $18.9 million (ie, $6.0 million + $12.9 million) versus $22.9 million ($4.9 million + $18.0 million) for the 2 in-person ED cohorts. Conclusions This costing evaluation supports the use of VUC as most complaints were addressed without referral to ED. Future research should evaluate targeted applications of VUC (eg, VUC models led by nurse practitioners or physician assistants with support from ED physicians) to inform future resource allocation and policy decisions.
This volume contains an Open Access Chapter - This book provides a comprehensive understanding of the sustainability of health systems in Europe. Furthermore, it includes an introduction on how EU ...action in supporting health- care policies in the EU Member States, both looking at implemented actions and describing current priorities for the future.
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