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There is constant pressure on hospitals to improve health care delivery and increase cost effectiveness. New initiatives are the order of the day in the dramatically different health care systems of the United States and Great Britain. Often these efforts are not successful. This book analyzes the successes and failures of efforts to improve hospitals and explains what factors make it likely that the implementation of reforms will be rewarded by positive transformation in a particular institution's day-to-day operation. The book's in-depth qualitative case studies of both top-down initiatives and changes first suggested by staff on the front lines of care point clearly to the importance of all hospital workers in effecting change and even influencing national policy. The book illuminates the critical role of workers, managers, and unions in enabling or constraining changes in policies and procedures and ensuring their implementation. It spotlights an Anglo-American model of hospital care and work organization, even while these countries retain their differences in access and payment. Entrenched professional roles, hierarchical workplace organization, and the sometimes-detached view of policymakers all shape the prospects for change in hospitals. The book provides important examples of how the dedication and imagination of the people who work in hospitals can make all the difference when it comes to providing quality health care even in a challenging economic environment.

To cut costs and maximize profits, hospitals in the United States and many other countries are outsourcing such tasks as cleaning and food preparation to private contractors. To examine this transformation in the healthcare industry, this book looks at the consequences of outsourcing from two perspectives: its impact on patient safety and its role in increasing socioeconomic inequality. The book argues that outsourcing has been disastrous for the cleanliness of hospitals—leading to an increased risk of hospital-acquired infections, a leading cause of severe illness and death—as well as for the effective delivery of other hospital services and the workers themselves. Interviews with the low-wage workers who keep hospitals running uncover claims of exposure to near-constant risk of injury and illness. Many report serious concerns about the quality of the work due to understaffing, high turnover, poor training and experience, inadequate cleaning supplies, and on-the-job injuries. The book also presents policy recommendations for improving patient safety by reducing the risk of hospital-acquired infection and ameliorating the work conditions and quality of life of hospital support workers. It makes the case that hospital outsourcing exemplifies the trend towards “low-road” service-sector jobs that threatens to undermine society's social health, as well as the physical health and well-being of patients in health care settings globally.

Infectious disease is the most common cause of illness and death in Africa, yet health practitioners routinely fail to identify causative microorganisms in most patients. As a result, patients often do not receive the right medicine in time to cure them promptly even when such medicine is available, outbreaks are larger and more devastating than they should be, and the impact of control interventions is difficult to measure. Wrong prescriptions and prolonged infections amount to needless costs for patients and for health systems. This book argues that laboratory diagnostics are essential to the effective practice of medicine in Africa. The diversity of endemic life-threatening infections and limited public health resources in tropical Africa make the need for basic laboratory diagnostic support even more acute than in other parts of the world. This book gathers compelling case studies of inadequate diagnoses of diseases ranging from fevers to respiratory infections and sexually transmitted diseases. The inherited and widely prevalent health clinic model, which excludes or diminishes the hospital laboratory, is flawed, to often devastating effect. Fortunately, there are new technologies that make it possible to inexpensively implement testing at the primary care level. The book makes clear that routine use of appropriate diagnostic support should be part of every drug-delivery plan in Africa and that diagnostic development should be given high priority.

This revealing look at home care illustrates how elderly and disabled people and the immigrant women workers who assist them in daily activities develop meaningful relationships even when their different ages, abilities, races, nationalities, and socioeconomic backgrounds generate tension. As the book shows, workers can experience devaluation within racialized and gendered class hierarchies, which shapes their pursuit of security. The book analyzes the tensions, alliances, and compromises between security for workers and flexibility for elderly and disabled people, and argues that workers and recipients negotiate flexibility and security within intersecting inequalities in varying ways depending on multiple interacting dynamics. What comes through from the book's analysis is the need for deeply democratic alliances across multiple axes of inequality. To support both flexible care and secure work, the book argues for an intimate community unionism that advocates for universal state funding, designs culturally sensitive labor market intermediaries run by workers and recipients to help people find jobs or workers, and addresses everyday tensions in home workplaces.

U.S. health care is a $2.5 trillion system that accounts for more than 17 percent of the nation's GDP. It is also highly susceptible to fraud. Estimates vary, but some observers believe that as much as 10 percent of all medical billing involves some type of fraud. In 2009, New York's Medicaid fraud office recovered $283 million and obtained 148 criminal convictions. In July 2010, the U.S. Justice Department charged nearly 100 patients, doctors, and health care executives in five states of billing the Medicare system out of more than $251 million through false claims for services that were medically unnecessary or never provided. These cases only hint at the scope of the problem. This book takes on medical fraud and its economic, psychological, and social costs. With dozens of cases, the book covers a wide variety of crimes: kickbacks, illicit referrals, overcharging and double billing, upcoding, unbundling, rent-a-patient and pill-mill schemes, insurance scams, short-pilling, off-label marketing of pharmaceuticals, and rebate fraud, as well as criminal acts that enable this fraud (mail and wire fraud, conspiracy, and money laundering). After assessing the effectiveness of the federal laws designed to fight health care fraud and abuse—the anti-kickback statute, the Stark Law, the False Claims Act, HIPAA, and the food and drug laws—the book suggests a number of ways that health care providers, consumers, insurers, and federal and state officials can bring health care fraud and abuse under control, thereby reducing the overall cost of medical care in America.