What could be achieved with greater public hospital autonomy? Comparison of public and PNFP hospitals in Uganda

The policy of hospital autonomy has been discussed for some time in Uganda. There is little evidence from Uganda or elsewhere that increased autonomy will improve hospital performance. This article compares the performance of three private not‐for‐profit (PNFP) and public hospital pairs to address this question. PNFP and public hospitals have similar management structures but PNFP hospitals had better trained managers and a church affiliated chair in the hospital management committee. Both types have problems with personnel management but these appear more pronounced in public hospitals. Drug supply management appears better in PNFP hospitals. Overall, workloads are similar, but analysis of patterns of utilisation and prices across services suggest that patient choice of facilities is influenced by relative price levels, and that willingness to pay is higher for PNFP services. PNFP hospitals are more successful at generating revenue. There are no clear differences in efficiency between PNFP and public hospitals but there is some evidence of higher quality levels in PNFP hospitals. PNFP hospitals' performance is plausibly related to three areas of managerial autonomy. First, better management of drug supply is facilitated by their freedom to purchase drugs from the open market. Second, greater success with personnel management is plausibly related to their greater autonomy over staffing. Third, higher levels of cost recovery are enabled by their freedom to set fees. However, differences in accountability and competence of hospital management, and population willingness to pay for services may also help to explain differences. Further, the use of PNFP financing strategy by public hospitals has implications for universal access to hospital services. Although there appear to be potential advantages from greater public hospital autonomy, the Ugandan government should ensure it has developed strategies to enhance public hospital management and to protect access to public hospitals before advancing further with hospital autonomy policy. Copyright © 2002 John Wiley & Sons, Ltd.     

Race and problem drug use in an English city

The primary aim of this article is to look at the impact of drugs on the drug-using Black population, and in doing so, the article draws comparative attention to drug use within the White community. The article is based on a research study of problem drug users registered with a London drugs project in 2000 and 2001. During the period of fieldwork, the vast majority of clients of the drug project were male, and the gap in the sex composition of the clients was more conspicuous in the Black group. For the sake of clarity in the use of statistical information, the article draws substance solely from information on the Black and White male clients. The findings present the Black community as a group who is also victimised by drugs but whose experiences of drug victimisation have often been undermined in the "war on drugs" rhetoric about drug trafficking.     

Some implications of the Human Rights Act 1998 for the medical treatment of children

Although the Gillick decision was hailed as an important step in the furtherance of respect for children's autonomy, subsequent judgments seemed to undermine this important principle. While it would be difficult to criticise the outcomes of some of the key cases, the reasoning by which these were achieved is rather more contentious. There have been some interesting discussions suggesting more constructive approaches but there is still a great deal of anecdotal evidence indicating that conservative assessments of children's ability to be involved in decisions about their medical treatment remain the norm. The new Department of Health consent forms should help to create a climate where assessment of a child's competence will become more sophisticated. This paper will argue that the Human Rights Act 1998 offers another opportunity to reassess more traditional approaches to children's capacity; indeed, this could be violation, inter alia, of the right not to be subject to inhuman and degrading treatment under Article 3 in extreme circumstances and the right to private and family life enshrined in Article 8. Clearly, it is not always practicable to carry out assessments rigorously and some health professionals may feel they do not have the expertise to do this, but some basic criteria could assist here; courts are not likely to expect more than a demonstration that best endeavors have been employed in reasoned decision-making. Additionally, other privacy rights may have implications for the medical decision-making process as it affects children and their carers particularly where conflict arises. Disputes may also ensue from the right to manifest religion and other beliefs",' under the Act. This paper will explore how such challenges to those responsible for the medical treatment of children may fare.     

Population data of nine Y-chromosomal STR loci in northern Poland

Allele and haplotype frequencies of nine Y-chromosome STR loci were determined from a sample of 508 unrelated males from north Poland. Three samples containing insertion polymorphism DYS19 (duplication) and DYS385I/II (triplications) were observed.     

Growing Up Young,Asian and Female in Britain: A Report on Self-harm and Suicide

It is now a well-documented statistic that Asian women between the ages of 15–35 are two to three times more vulnerable to suicide and self-harm than their non-Asian counterparts (Soni-Raleigh, 1996). The article will summarize the findings of the research report Growing Up Young, Asian and Female in Britain (Newham Asian Women's Project, 1998), which aimed to explore the reasons why young Asian women self-harmed and to evaluate the service responses they were given. It also made recommendations aimed at decreasing the high prevalence of suicide and self-harm among young Asian women. The article concludes by reflecting upon the impact and service developments that have been made since the report was published.     

Lineup Administrators' Expectations: Their Impact on Eyewitness Confidence

This research focuses on how lineup a administrators influence eyewitnesses' postidentification confidence. What happens to witness confidence when a witness makes an identification that confirms the lineup administrator's expectations; what happens when this expectation is not confirmed? In Experiment 1, participant interviewers (n = 52) administered target-absent photo lineups to participant witnesses (n = 52). The interviewers did not view the simulated crime, but were told the thief's position in the lineup. In every instance this information was false (we used a target-absent lineup). A one-way ANOVA revealed that eyewitness identification confidence was malleable as a function of interviewers' beliefs about the thief's identity. In Experiment 2, participant jurors (n = 80) viewed 40 testimonies of Experiment 1 witnesses (2 participants viewed each testimony). Participant jurors judged all participant witnesses as equally credible despite their varying levels of postidentification confidence.

     

Predictive Genetic Testing: Congruence of Disability Insurers' Interests with the Public Interest

This article argues that, under existing jurisprudence, the disability insurance business will be harmed, not benefited, from broad access to the results of genetic testing identifying people with higher than species-typical genetic propensities for illness.