Renovating the Commons: Swedish health care reforms in perspective

Recent reform experience in Sweden supports the premise that key dimensions of a country's health care system reflect the core social norms and values held by its citizenry. The fundamental structure of the Swedish health system has remained notably consistent over the past half century, that is, tax-based financing and publicly operated hospitals. Yet on other, nearly as important, parameters, there has been substantial change, for example, the persistent pursuit for thirty years of a stronger primary care framework and the effort to allow patient choice of doctor, health center, and hospital within the publicly operated system. This particular combination of continuity and change has occurred as traditional Swedish values of jamlikhet (equality) and trygghet (security) have been challenged in an environment shaped by an aging population, changing medical technology, and Sweden's integration into the European Single Market. This article explores the ongoing process of health system development in Sweden in the context of the country's broader social and cultural characteristics.     

Hospital policy in The Netherlands: the parameters of structural stalemate

The Dutch hospital sector has recently been the subject of two divergent national policy initiatives. Following a mixed experience with regulation in the mid-1980s, the national government has now taken the first steps in a radical shift toward market-based competition. This article suggests that neither official strategy can address the fundamental structural and cultural factors that shape institutional behavior in the Dutch hospital system. Drawing upon empirical evidence from two 1987 hospital case studies, this article contends that Dutch hospital management reflects a precentralized insularity which, in turn, sharply reduces the likelihood that either publicly or privately framed decentralized strategies can be successfully implemented.     

National planning for locally controlled health systems: the Finnish experience

The World Health Organization considers Finland's health planning system to be among the most successful in the developed world. Despite tight resource constraints--symbolized by total health expenditures held consistently to less than 7 percent of gross domestic product--the Finns have built up a strong primary care sector and dramatically improved the overall availability and accessibility of needed services. This article compares the official health planning system with the actual planning process as experienced within one Finnish central hospital district. The official planning system seeks to integrate national strategic goals with local municipal ownership, administration, and funding of service delivery. The actual planning process within the studied district suggests that technically oriented civil servants at the regional level may be at least as important in the overall decisionmaking structure. The article concludes with a brief exploration of this finding's potential consequences for the long-term development of the Finnish health care system and for national health planning efforts generally.     

ATTORNEYS' BELIEFS AND OPINIONS ABOUT CHILD CUSTODY EVALUATIONS

We surveyed a national sample of family law attorneys (N = 192) regarding their beliefs and opinions about child custody evaluations, particularly those performed by independent/private practitioners. Findings revealed participants' strongly preferred court‐ordered evaluations performed by doctoral‐level psychologists who assumed a neutral position. The participants expressed concern regarding procedures used by evaluators, the application of evaluation data to the Best Interests of the Child Standard, and certain report components. A clear majority supported evaluators making recommendations about custody and parenting time, but their satisfaction with these evaluations varied widely. Specific concerns and suggestions noted by the participants are highlighted; we conclude with recommendations.     

Power and cost containment in a Danish public hospital

The assumption that hospital decision-making is hierarchical in character underpins the policy formulation process in public as well as pluralist national health care systems. This article's analysis of decision-making in a Danish public hospital reinforces the contrary assertion: that effective authority in acute-care hospitals rests in an amorphous power relationship among the hospital's several occupational groups, in which physicians clearly have the upper hand. After a brief introduction to this Danish hospital, the article develops a detailed portrait of its informal power structure and of the different occupational groups' permanent power-maximizing strategies. Subsequently, the article assesses the impact of these strategies upon two recent efforts to contain the hospital's costs: a decision to close an expensive specialty clinic, and an attempt to shrink the hospital's size by transferring less sick elderly patients to a newly created rehabilitation facility. The study's findings suggest that efforts to impose hospital cost containment by exclusively political means are unlikely to succeed.     

Kokwet

Johnny Gibb of Gushetneuk, by William Alexander with an Introduction and an Appreciation by Ian Carter. Towie Barclay Castle, Turriff, Aberdeenshire: Heritage Press (Scotland), 1979. Pp. x + 285, glossary, illustrations. No price.

Farm Life in Northeast Scotland, 1840–1914, by Ian Carter. Edinburgh: John Donald Ltd, 1979. Pp. xiv + 258. £12.50

In this review article two books are considered: Johnny Gibb of Gushetneuk, by William Alexander, a reprint of a novel concerned with the peasantry of the northeast of Scotland, which was written in the late 1860s; and a new book by Ian Carter, Farm Life in Northeast Scotland, 1840–1914. The former is seen as part of a rich, older tradition of study of the countryside of the northeast, that existed outside of the universities; the latter as a highly original contribution to a newer enterprise, based within the universities; and it is suggested that both transcend the little ‘orthodox’ economic history that has been written. Carter's great merit is to show that in the northeast of Scotland, unlike other parts of the lowlands, the peasantry had not been eliminated by 1840, but remained, in significant articulation with capitalist agriculture in the area, until 1914.     

PARTNERS IN THE PROCESS: HOW ATTORNEYS PREPARE THEIR CLIENTS FOR CUSTODY EVALUATIONS AND LITIGATION

We surveyed 113 family attorneys regarding what they did to prepare their clients for child custody evaluations and litigation. Findings revealed that participants saw child custody evaluations as useful on a variety of levels and effective in settling cases. In general, participants reported using professionally acceptable procedures, appropriately advocated for their clients, and dealt with complaints in a reasonable fashion. Referrals to mental health professionals in advance of a child custody evaluation were generally made to provide support rather than for evaluation or test preparation. Work product reviews by mental health consultants were infrequent, although such reviews were seen as highly useful by those who used them. Lastly, participants reported that allegations of parental alienation and domestic violence were often used to gain leverage in custody cases. Implications for practice are discussed for both attorneys and evaluators.