Development of Social Health Insurance in Mongolia: Successes, Challenges and Lessons

This paper examines the process of developing social health insurance in Mongolia, and its successes, challenges and lessons. The government of Mongolia introduced social health insurance in 1994, which is compulsory for all public and private sector employees and low-income and vulnerable population groups. The scheme also provided voluntary insurance for unemployed people of working age. About 95 per cent of the population was covered by health insurance within the first two years thanks to a high level of government subsidy for vulnerable population groups. The insurance benefit initially covered nearly all inpatient services except the treatment of some specified chronic and infectious diseases, which were directly funded by the government. The scheme not only had many successes but also faced challenges in maintaining universal coverage. The new financing arrangement has provided little financial incentive for healthcare providers to contain health expenditure, contributing to rapid health cost inflation. In addition to reforming the payment system for providers, there has been an increasing need to expand benefits into ambulatory care. The development of compulsory health insurance in Mongolia shows that a prepaid health insurance mechanism based on risk sharing and fund pooling is feasible in low-income countries given political commitment and government financial support for vulnerable population groups.     

‘Management Standards’ and work-related stress in the UK: policy background and science

In the late 1990s, the Health and Safety Commission, as the lead authority in the UK responsible for Health and Safety at Work, conducted an extensive consultation exercise to elicit views about how work-related stress should be tackled. The Commission subsequently decided that regulation was not justified and opted for an approach with four strands. One of these was to work with stakeholders to develop clear, agreed standards of good management practice. This paper describes and discusses the rationale behind a standards-based approach that is essentially based on a method of controlling hazards. The Management Standards approach uses a taxonomy of six stressors that has evolved out of extensive research carried out on behalf of the UK's Health and Safety Executive (HSE) and in conjunction with stakeholders, and a three-phase risk assessment methodology. Further developmental work on the standards (which are to be subjected to public consultation) and associated measurement tools is described in a companion paper in this issue of Work & Stress (Cousins, Mackay, Clarke, Kelly, Kelly, & McCaig, ). The emphasis is on prevention towards reducing stress in the UK working population. We review current thinking on models of work stress, consider evidence linking workplace psychosocial factors and various health and organizational outcomes, and examine the effectiveness of organizational interventions. We argue that the literature supports an approach that aims to move organizational states (represented by the current situation) to more desirable ones (represented by the six Management Standards), and that this is an effective ‘population’ based approach to tackling workplace stress and promoting individual and organizational health.     

‘Management Standards’ work-related stress in the UK: practical development

Research commissioned for the UK's Health & Safety Executive (HSE) supports the view that a preventative, risk-assessment based approach would be more effective than case-based methods in achieving a nationwide reduction in work-related stress. The background to this approach is described and discussed in a companion paper in this issue (Mackay, Cousins, Kelly, Lee, & McCaig, ). The present paper describes the development of HSE's new stress Management Standards—which offer organizations continuous improvement through a three-phase stress preventative process—and the development of a supporting ‘Indicator Tool’ (a two-phase questionnaire to assess employee perceptions of working conditions). The Management Standards comprise a series of ‘states to be achieved’, which are statements of good practice in six key stressor areas: demands, control, support, relationships, role and organizational change. For each stressor area there is also a ‘platform statement’ that outlines the main aims to be achieved by the organization. This statement may include a target percentage of employees finding that the organization meets the standard: this matter will be settled after the standards have been assessed in a public consultation campaign. To use the new process, an organization's state can first be assessed using the Indicator Tool; liaising with workers in focus groups enables a further exploration of issues raised; finally, there may be formulation of interventions and subsequent review. It is not intended that the standards will be legally enforceable. HSE's aim is that they and the associated methodology will enable organizations to effectively tackle work-related stress, and subsequently reduce both its incidence and prevalence.     

Globalization and its impact on global managers' decision processes

Globalization of business can have a profound impact on the decision-making processes of managers responsible for making these complex interrelated decisions. This paper explores the global decision-making processes of global managers. The first element examined is the multiple intelligences that global managers need to be able to address the issues associated with global decisions. These eight IQs are considered critical elements in the decision-making capabilities of global managers. Following this discussion, the composition of global groups and their impact on the decision-making process is explored to determine how the composition of the group inhibits/supports the global manager. The next step in the decision-making process discussed in the paper is that of the nature of the task(s). The type of task can have a direct impact on the effectiveness as well as the efficiency of global manager's decision-making. The crux of the issue is that a global orientation to decision-making is poised as being significantly different from decision processes use by managers in a multinational context.     

Reclaiming Life: Six Consumers of Mental Health Services Talk About What Helped and What Did Not Help Them Get Their Lives Back

This article summarizes a roundtable discussion held at Thresholds in Chicago, Illinois in September 2012, where six people diagnosed with serious mental illness talked about what helped and did not help them recover and successfully reclaim their lives. Their comments, taken as part of their personal narratives, can help enhance understanding of the recovery process. The discussion is organized by the themes that emerged: considering life as distinct from diagnosis, meeting basic needs, empowerment, education, community, faith and hope, healthy thinking, peers, and focus on wellness. Panel members also offer advice for mental health service providers.     

The Man in the Red Coat—Management in the Circus

Authored by a circus performer/manager and an academic, this paper uses concepts from the work of Alasdair MacIntyre to interpret ethnographic material from the traditional circus. The paper outlines MacIntyre’s conceptual architecture of goods, practices and institutions in which exercise of the virtues by those who manage the institution is required to maintain the integrity of practices. Such exercise is one defining feature of what MacIntyre calls ‘practice‐based communities’. Following a discussion of method it uses ethnographic material to describe the organisation of work in the circus and the self‐understanding of the managerial role of ringmaster. A series of incidents illustrate the use of the virtue of phronêsis, practical judgement in this role to maintain the integrity of the practice. The paper concludes by considering the extent to which travelling circus may be considered an example of the practice‐based community.     

Daughters as Caregivers of Aging Parents: The Shattering Myth

A review of the history of de-institutionalization is given. The problem today for the older chronic former mental hospital patient is described. A protective services model is then proposed for these ex-mental hospital patients. The proposed model follows those that were developed to help older persons who become impaired to remain in the community. This model recommends that a careful assessment be made of the patient's ability to manage his/her life prior to discharge and that a service plan be developed from the assessment. Then the community agency, preferably the community mental health center which is already mandated this duty, assumes responsibility for planning and service to the patient. This service assures that patients are receiving the basic necessities and superviser their general welfare.     

Organized manufacturing for superior market performance

This article describes a series of case studies which show the global marketing benefits that can result from a strategic deployment of advanced manufacturing technology. The paper points out that a desirable collaboration between manufacturing and marketing is often not achieved. The authors then identify a number of factors that inhibit the rapid adoption of manufacturing technology for competitive advantage. This leads to a final section where recommendations are made for achieving a better linkage between technology and competitive strategy, and for facilitating the introduction of technology in the plant itself.     

When His Ship Comes Home: The Stress of The Australian Seafarer's Partner

This article explores the stress that the wives of Australian Merchant Navy men experience as a result of the seafarer's lifestyle. The article first describes the difficulties that the wife and family experience due to the long absence of the seafarer. An exploratory survey was conducted in which 52 partners of seafarers answered questions regarding the stress they and their family experience. In addition, data were collected on their work patterns, the effect of the lifestyle on their marriage and sexual relations. While the sample obtained in this study was small, it did reveal several interesting problems associated with the seafaring family life. Eighty-three per cent (83%) of seafarer's wives found it stressful before and after their husband was due to return home. In their roles as mothers, they also felt their children experienced considerable stress because of the seafarer's absence. Many women felt that the seafaring life caused difficulties in their marriage and 25 % of the wives believed that their husbands had or were having sexual relations outside their marriage. The results of this study offer a preliminary profile into some of the difficulties families experience as a result of the seafaring life.