OBJECTIVE To identify changes in nursing practice and the nursing-practice environment that have occurred with implementation of health sector reform in five countries in the Americas. METHODS An exploratory study of selected settings in Argentina, Brazil, Colombia, Mexico, and the United States of America was conducted between 1997 and 1999 to collect narrative data from 125 professional nur...

The methods for healthcare reform are strikingly underdeveloped, with much reliance on political power. A methodology that combined methods from sources such as clinical trials, experience-based wisdom, and improvement science could be among the aims of the upcoming work in the USA on comparative effectiveness and on the agenda of the Center for Medicare and Medicaid Innovation in the Centers f...

nancial crisis, there have been many calls to expand regulatory oversight in the fi nancial sector. Previously, regulation focused primarily on the health of individual fi nancial institutions. Since the crisis, however, regulatory reform eff orts, such as the 2010 DoddFrank Act, have focused more on stability in the fi nancial sector as a whole, a concept known as “macroprudential” or “systemi...

n engl j med 368;16 nejm.org april 18, 2013 1470 a loss of status and income as well as disdain from peers. Although leadership is making its way into clinical training, the workforce of the near future is already practicing. How can senior leaders enable and encourage front-line leadership among today’s clinicians? Surveys suggest that clinicians want a greater leadership role but feel unprepa...

Jo Ivey Boufford, a paediatrician and formerly President of New York City public hospital system spent almost four years working in the UK, 20 months as Director of the King's Fund College. She returned to the United States in September 1993 and now has a pivotal role in developing and implementing the public health care sector as part of the Clinton reforms. Below are some of her reflections o...

On June 6, 2016, as a mode expected to open a new prospect for tiered system of medical care in China, family physicians contracted healthcare was officially launched, intending to facilitate such healthcare be universal coverage by 2020.There are some doubts as to whether this goal is possible. The role of family physicians contracted healthcare in China should also be carefully identified. We...

Health reform is the outcome of dispersed policy initiatives in different sectors, at different levels and across time. Policy work which can drive coherent health reform needs to operate across the governance structures as well as the institutions that comprise healthcare systems. Building policy capacity to support health reform calls for clarity regarding the nature of such policy work and t...