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Background Countries rely on out-of-pocket (OOP) spending to different degrees and employ varying techniques. The article examines trends in OOP spending in ten high-income countries since 2000, and analyzes their relationship to self-assessed barriers to accessing health care services. The countries are Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom, and the United States. Methods Data from three sources are employed: OECD statistics, the Commonwealth Fund survey of individuals in each of ten countries, and country-specific documents on health care policies. Based on trends in OOP spending, we divide the ten countries into three groups and analyze both trends and access barriers accordingly. As part of this effort, we propose a conceptual model for understanding the key components of OOP spending. Results There is a great deal of variation in aggregate OOP spending per capita spending but there has been convergence over time, with the lowest-spending countries continuing to show growth and the highest spending countries showing stability. Both the level of aggregate OOP spending and changes in spending affect perceived access barriers, although there is not a perfect correspondence between the two. Conclusions There is a need for better understanding the root causes of OOP spending. This will require data collection that is broken down into OOP resulting from cost sharing and OOP resulting from direct payments (due to underinsurance and lacking benefits). Moreover, data should be disaggregated by consumer groups (e.g. income-level or health status). Only then can we better link the data to specific policies and suggest effective solutions to policy makers.

In 2010, immediately before the United States of America (USA) implemented key features of the Affordable Care Act (ACA), 18% of its residents younger than 65 years lacked health insurance. In the USA, gaps in health coverage and unhealthy lifestyles contribute to outcomes that often compare unfavourably with those observed in other high-income countries. By March 2014, the ACA had substantially changed health coverage in the USA but most of its main features--health insurance exchanges, Medicaid expansion, development of accountable care organizations and further oversight of insurance companies--remain works in progress. The ACA did not introduce the stringent spending controls found in many European health systems. It also explicitly prohibits the creation of institutes--for the assessment of the cost-effectiveness of pharmaceuticals, health services and technologies--comparable to the National Institute for Health and Care Excellence in the United Kingdom of Great Britain and Northern Ireland, the Haute Autorité de Santé in France or the Pharmaceutical Benefits Advisory Committee in Australia. The ACA was--and remains--weakened by a lack of cross-party political consensus. The ACA's performance and its resulting acceptability to the general public will be critical to the Act's future.

Conflict between work and family is a human resource management issue that is particularly relevant for nurses. Nursing is a demanding profession, and a high proportion of nurses are women, who tend to have greater family responsibilities than men. Little is known regarding work-family conflict among nurses, and even less is known about how this affects newly licensed registered nurses (NLRNs), who can be stressed from their new jobs and careers. This study empirically tests a model of antecedents and outcomes of work-family and family-work conflict among a sample of NLRNs. We developed a model of the relationships between personal and work environment characteristics, work-family and family-work conflicts, job satisfaction, and intent to leave the job and profession. We used structural equation modeling (Amos, IBM SPSS) to test the model with data from.a survey of NLRNs. We examined a number of latent variables, as well as direct and mediating relationships. The measurement models for all latent variables were validated. The final model indicated that age, health, and family responsibilities are antecedents of family-work conflict; job demands lead to work-family conflict; family-work conflict contributes to job difficulties, which lowers job satisfaction, which, in turn, increases the intent to leave the job and profession; and work-family conflict increases the intent to leave the job and profession (but does not directly affect job satisfaction). Policies to help NLRNs with family responsibilities could reduce family-work conflict, which might reduce job difficulties and improve satisfaction and retention. In addition, policies to reduce job demands could reduce work-family conflict and improve retention.

In 2010, immediately before the United States of America (USA) Implemented key features of the Affordable Care Act (ACA), 18% of its residents younger than 65 years lacked health insurance. In the USA, gaps In health coverage and unhealthy lifestyles contribute to outcomes that often compare unfavourably with those observed In other high-income countries. By March 2014, the ACA had substantially changed health coverage in the USA but most of its main features–health insurance exchanges, Medicaid expansion, development of accountable care organizations and further oversight of insurance companies–remain works in progress. The ACA did not introduce the stringent spending controls found In many European health systems. It also explicitly prohibits the creation of institutes–for the assessment of the cost-effectiveness of pharmaceuticals, health services and technologies–comparable to the National Institute for Health and Care Excellence In the United Kingdom of Great Britain and Northern Ireland, the Haute Autorite de Sante In France or the Pharmaceutical Benefits Advisory Committee In Australia. The ACA was–and remains–weakened by a lack of cross-party political consensus. The ACA's performance and Its resulting acceptability to the general public will be critical to the Act's future.

Previous research cannot account for the discrepancy between registered nurse (RN) reports of understaffing and studies showing slight improvement. One reason may be that \"adjusted patient days of care\" (APDC) underestimates patient load. Using data from all Pennsylvania acute care general hospitals for the years 1994 through 1997, we found that APDC is underestimated by two hours. After adjusting APDC, we examined the difference in nurse staffing over the period 1991—2000 before and after the adjustment. We found a significant difference between unadjusted and adjusted measures. However, when applied to the changes in nurse staffing between 1991 and 2000, the difference was not enough to account for the discrepancy between reports and data. Other measurement and conceptual problems may exist in terms of patients' increasing acuity levels, patients' declining lengths of stay and the associated greater proportion of nurse time devoted to admission and discharge, and lack of recent data in some empirical studies.

Unruh presents evidence that one of the most significant issues of the nursing shortage is that difficult employment conditions make bedside nursing unattractive compared to other professions and other nursing occupations. Unstable demand, difficult working conditions and low wages are keeping individuals away and driving them from bedside nursing. Unruh presents policy measures for improvement.

Conflict between work and family is a human resource management issue that is particularly relevant for nurses. Nursing is a demanding profession, and a high proportion of nurses are women, who tend to have greater family responsibilities than men. Little is known regarding work-family conflict among nurses, and even less is known about how this affects newly licensed registered nurses (NLRNs), who can be stressed from their new jobs and careers. This study empirically tests a model of antecedents and outcomes of work-family and family-work conflict among a sample of NLRNs. We developed a model of the relationships between personal and work environment characteristics, work-family and family-work conflicts, job satisfaction, and intent to leave the job and profession. We used structural equation modeling (Amos, IBM SPSS) to test the model with data from a survey of NLRNs. We examined a number of latent variables, as well as direct and mediating relationships. The measurement models for all latent variables were validated. The final model indicated that age, health, and family responsibilities are antecedents of family-work conflict; job demands lead to work-family conflict; family-work conflict contributes to job difficulties, which lowers job satisfaction, which, in turn, increases the intent to leave the job and profession; and work-family conflict increases the intent to leave the job and profession (but does not directly affect job satisfaction). Policies to help NLRNs with family responsibilities could reduce family-work conflict, which might reduce job difficulties and improve satisfaction and retention. In addition, policies to reduce job demands could reduce work-family conflict and improve retention.

Background: Volunteers have been present in health care settings for centuries. However, there is little empirical evidence regarding the impact that volunteers make on hospital performance. Since the 1990s, hospitals in the United States have had a great deal of pressure to produce high-quality care at minimum expense. These pressures have enhanced the benefits of using volunteers in a hospital setting. Purpose: This study utilized multiple regression analysis to explore the impact of the use of volunteers and the level of professionalism of volunteer programs on cost effectiveness and patient satisfaction in hospitals. Methodology/Approach: Hospitals throughout the state of Florida were invited to participate in the study by completing a brief questionnaire about their volunteer programs. Performance indicators of volunteer cost savings and patient satisfaction scores for 50 Florida hospitals were analyzed using data sets from the American Hospital Association and Agency for Health Care Administration along with data obtained from a questionnaire. Findings: Results indicate that the use of volunteers offers significant cost savings to hospitals and enhances patient satisfaction scores. Discussion: Larger volunteer programs appear to enhance patient satisfaction while containing costs. Future research opportunities related to the impact of volunteers and volunteer professionalism on other hospital performance measures are suggested.

Now in its fourth edition, The Economics of Health Reconsidered presents an argument that still holds true: despite assertions to the contrary, neither economic theory nor evidence shows that reliance on market forces leads to superior outcomes in healthcare systems. Government plays a crucial role in making the healthcare sector not only more equitable but also more efficient. This book reconsiders the field of health economics as it is traditionally taught and practiced. It critically examines economic theory as applied to the health sector and questions the prevailing belief that a competitive healthcare marketplace results in the best outcomes. Fully revised and updated, this new edition incorporates information on the impact of the implementation of the Affordable Care Act as well as: A new chapter on healthcare expenditures, which examines healthcare spending in the United States and in other high-income countries, including the magnitude, growth, and causes of high expenditures and the different policies that have been used or proposed to help control them A new chapter that describes the various types of economic evaluation currently used in healthcare, discusses the issues that arise with the use of economic evaluations, and provides information on how to conduct an economic evaluation New and updated data throughout chapters and exhibits This book serves as an ideal stand-alone text for health economics and health policy courses and as a general reference for issues in health economics.