What Does Non-standard Employment Look Like in the United States? An Empirical Typology of Employment Quality

Despite significant interest in the changing nature of employment as a critical social and economic challenge facing society—especially the decline in the so-called Standard Employment Relationship (SER) and rise in more insecure, precarious forms of employment—scholars have struggled to operationalize the multifaceted and heterogeneous nature of contemporary worker-employer relationships within empirical analyses. Here we investigate the character and distribution of employment relationships in the U.S., drawing on a representative sample of wage-earners and self-employed from the General Social Survey (2002–2018). We use the multidimensional construct of employment quality, which includes both contractual (e.g., wages, contract type) and relational (e.g., employee representation and participation) aspects of employment. We further employ a typological measurement approach, using latent class analysis, to explicitly examine how the multiple aspects of employment cluster together in modern labor markets. We present eight distinct employment types in the U.S., including one resembling the historical conception of the SER model (24% of the total workforce), and others representing various constellations of favorable and adverse employment features. These employment types are unevenly distributed across society, in terms of who works these jobs and where they are found in the labor market. Importantly, women, those with lower education, and younger workers are more likely to be in precarious forms of employment. More generally, our typology reveals limitations associated with binary conceptions of standard vs. non-standard employment, or insider–outsider dichotomies envisioned within dual labor market theories.

     

Devolution and Patient Choice: Policy Rhetoric versus Experience in Practice

Background: market reforms in England have been identified as making a clear distinction between English health policy and health policy in the devolved systems in Northern Ireland, Scotland and Wales. Patient choice is a high profile policy in the English National Health Service that constitutes significant changes to the demand side of health care. It is not clear what national differences this has led to regarding implementation of policy. This article presents the findings from a large UK‐wide study on the development and implementation of policies related to patient choice of provider. The findings reported here relate specifically to the policy development and organizational implementation of choice in order to examine the impact of devolution on health care policy. Aim: this study examines patient choice of provider across all four countries of the UK to understand the effect of differences in national policies on the organization and service how choice of provider presented to patients. Methods: at the macro‐level, we interviewed policymakers and examined policy and guidance documents to analyze the provenance and determinants of national policy in each UK nation. At the Primary Care Trust or Health Board level, we interviewed a range of public and private health service providers to identify the range of referral pathways and where and when choices might be made. Finally, we interviewed ear, nose and throat, and orthopaedics patients to understand how such choices were experienced. Findings: while we found that distinct rhetorical differences were identifiable at a national policy level, these were less visible at the level of service organization and the way choices were provided to patients. Conclusion: historical similarities in both the structure and operation of health care, coupled with common operational objectives around efficient resource use and waiting times, mediate how strategic policy is implemented and experienced in the devolved nations of the UK.     

Access, Choice and Travel: Implications for Health Policy

The UK National Health Service is introducing policies offering patients a choice of the hospital where they would like to be treated. ‘Patient choice’ policies form part of a wider debate about the access to health care and the interaction between providers (including information, provision, performance and reputation) and patients (including knowledge, resources and willingness to travel). As the hospital of ‘choice’ might not necessarily be the ‘local’ provider, such policy developments are predicated on an assumption that some patients will be willing to travel further. This will, in turn, affect patients’ access to services. In general, use of services decreases with distance but this is dependent on accessibility to services, the organization of those services, the socio‐economic characteristics of the patient, perceptions of the provider and the condition for which they are to be treated. This article reviews the evidence on patients’ willingness to travel in terms of access to health care and assesses the emerging implications of and for current UK policy on patient choice.     

Analysing Structural Interests in Primary Care Groups

Alford's theory of structural interests in health care has been used as a heuristic device both in the USA and the UK. Despite concerns about its heuristic power it provides a lucid analytical framework and is helpful in exposing the structural interests that underpin political processes in health systems. To date its application in the UK has been primarily in relation to an NHS dominated by health authorities and hospital providers. Recent reforms in the UK have created a new context dominated by primary care organizations. In this paper we identify the key players in English primary care groups as they relate to Alford's structural interest groups: the professional monopolizers, corporate rationalizers and community. The paper outlines the context of the involvement of the key groups and then analyses the relationships between them. In doing so it raises concerns about the structure and purpose of primary care groups and the probability that key tensions between general practitioners who adopt a corporate rationalizer role and those who retain a professional monopolizer role will be damaging to the progress and development of PCGs. Our analysis also highlights the continuing weakness of the community as an interest group despite the emphasis on involving patients and the public. Importantly, we would suggest that the professional monopolizers among GPs will retain a powerful voice, countering the new corporate rationalizers and continuing to claim that they represent the community's interests.     

Informing UK Policy Development on the Regulation of CAM Practitioners: Lessons from Hong Kong?

Public policy discussions on how to regulate acupuncture and herbal medical practitioners have reached a stalemate in the United Kingdom. After considerable activity in the first half of the current decade a wider review of professional regulation has re-opened the discussion as to the most appropriate way to regulate the practice of all health-care practitioners. In the meantime, the public continues to consult complementary and alternative medicine (CAM) practitioners in large numbers and self-medicate with herbal products and other natural remedies, posing challenges for policy-makers as to how to ensure public safety. In the NHS, providers and purchasers struggle to reconcile demands for access to CAM services with their clinical governance requirements. Hong Kong implemented new arrangements for the statutory regulation of traditional Chinese medical practitioners in the 1990s and has experienced the challenges of regulating a large established private market as well as integrating Chinese medicine further into the public health system. This experience is analysed in order to see whether the approach adopted there could address the public policy challenges faced in the UK. The article finds that, despite key cultural and historical differences related to the provision and use of CAM services, the similarities between the health-care systems and the reasons for moves to professional regulation in Hong Kong and the UK provide useful insights into what is happening in the UK in relation to service provision and the relationship with the NHS and the medical profession. These are discussed in the light of current health policy developments in the UK.     

Sexual orientation of human offspring may be altered by severe maternal stress during pregnancy

To test the hypotheses that maternal stress during pregnancy may alter the sexual orientation of offspring, 285 women with offspring 19 years of age and older provided retrospective accounts of stressful experiences they had, beginning 12 months prior to pregnancy up to the point of giving birth, and indicated how severe they recalled each event being. When weighted according to severity, stressful experiences helped to predict sexual orientation of male offspring. While most of the variance in sexual orientation remained unexplained, the data suggest that the most critical time in gestation for influencing human sexual orientation of male offspring is during the second trimester, although the first and possibly the third trimesters may be of secondary importance. For female offspring, no significant relationships between maternal stress and sexual orientation were found, although mothers of lesbians did report slightly higher average levels of stress throughout gestation than mothers of female heterosexuals.