When tinkering is not enough: provincial reform to manage health care resources

Abstract: Prompted by fiscal deficits and guided by recommendations of provincial review commissions, a number of provinces are restructuring their health care systems to iniprove resource management. British Columbia, Saskatchewan, Manitoba, Quebec, New Brunswick, and Nova Scotia have published comprehensive plans for health care reforms. The plans reveal a diversity of management approaches, including devolved structures in British Columbia, Saskatchewan, and Nova Scotia, strongly centralized, technocratic structures in Manitoba, and variations on these in the other provinces. Though impossible to judge a priori which approaches are most likely to improve management, a number of limitations can be observed in the newly created institutions that decrease the chances of achieving the stated goals. The changes represent a potential watershed in medicare's history as the provinces embark down divergent paths for planning and managing health care resources. They will provide an interesting natural experiment regarding the effectiveness of the alternative approaches to organizing health care systems as well as challenge some of medicare's principles and the concept of a national system. Sommaire: Sous la pression des déficits fiscaux et face aux recommandations de commissions d'enquête provinciales, plusieurs provinces restructurent actuellement leurs systêmes de santé pour améliorer la gestion des resources. La Colombie-Britannique, la Saskatchewan, le Manitoba, le Québec, le Nouveau-Brunswick et la Nouvelle-Éosse ont publié des plans détaillés de réforme de ces systèmes. Les plans adoptent toute une gamme de méthodes de gestion: des structures déléguées en Colombie-Britnnnique, en Saskatchewan et en Nouvelle-Écosse, des structures technocratiques fortement centralisées au Manitoba, et diverses variantes des deux dans les autres provinces. II est impossible de décider a priori quelles sont les méthodes les mieux adaptées pour améliorer la gestion, mais on peut d'ores et déjà noter, dans le cadre des institutions nouvellement créées, des limitations qui entravent la possibilité d'atteindre les objectifs énoncés. Ces changenients pourraient constituer un tournant critique dans l'évolution des systèmes d'assurance-maladie car les provinces empruntent maintenant des chemins divergents en ce qui concerne la planification et la gestion des ressources consacrées aux soins de santé Cela constituera une expérience empirique intéressante pour déterminer l'efficacité des diverses façons d'organiser les systèmes de soins de santé, tout en mettant en question certains principes de l'assurance-maladie ainsi que l'idée même d'un système national.     

Scientific,Institutional and Personal Rivalries among Soviet Geographers in the Late Stalin Era

Scientific, institutional and personal rivalries between three key centres of geographical research and scholarship (the Academy of Sciences Institute of Geography and the Faculties of Geography at Moscow and Leningrad State Universities) are surveyed for the period from 1945 to the early 1950s. It is argued that the debates and rivalries between members of the three institutions appear to have been motivated by a variety of scientific, ideological, institutional and personal factors, but that genuine scientific disagreements were at least as important as political and ideological factors in influencing the course of the debates and in determining their final outcome.     

HELPING CLIENTS TRANSITION TO INDEPENDENT LIVING

There is growing recognition and concern that too many of the 20,000 foster youth who age out of the child welfare system each year 1 in this country do so without the basic necessities of housing, education, employment, and health care. The purpose of this article is to outline the problems facing foster youth as they leave care and to detail, as a case study, the steps taken by KidsVoice, a Pittsburgh legal services organization representing almost 5,000 dependent children each year, to help youth in foster and substitute care transition more successfully to adulthood and independent living.     

Good and Evil in Indian Buddhism: The five Sins of Immediate Retribution

Indian Buddhist sources speak of five sins of immediate retribution: murder of mother, father, an arhat, drawing the blood of a buddha, and creating a schism in the monastic community. This category provides the paradigm for sinfulness in Buddhism. Yet even these sins can and will, be expiated in the long run, demonstrating the overwhelmingly positive nature of Buddhist ethics     

Ethics at Phase 0: Clarifying the Issues

The Food and Drug Administration (FDA) and the European Agency for the Evaluation of Medicinal Products (EMEA) recently issued documents encouraging sponsors to consider microdose testing before launching Phase I trials, and many commentators predict that such methodologies will be applied more routinely in drug development. However, exploratory testing has provoked several ethical criticisms. Skeptics question the value and validity of microdose trials, and whether they present a reasonable balance of risks and benefits for subjects. Another major criticism is that such studies serve mainly commercial ends. The present article explores these and other ethical concerns for studies conducted in the oncology setting. It concludes that microdosing is not inconsistent with prevailing practices in Phase I research, and that in principle, such studies could strengthen the ethical basis for Phase I trials by providing them better evidentiary justification.