Increments toward what?

Incremental proposals to expand health insurance coverage, such as expansions of the State Children's Health Insurance Program (SCHIP) or creation of new tax credits, should be examined for the values that underlie them and for how they structure future options for additional incremental coverage expansions. This paper examines five design issues in incremental reform: who determines coverage options for the newly insured; what risk pool do they enter; what is the government's contribution toward their coverage; what barriers are created by efforts to encourage efficiency; and how are issues of federalism handled? Tax credits are a departure from past approaches, while an SCHIP expansion is a continuation of current policy directions.     

Interventions: what works, what doesn't?

This review examines the evidence for the effectiveness of occupational stress interventions. Three types of interventions are considered: psychotherapy and counselling services, stress management training, and organizational level interventions. The review concludes that there is good evidence that, for specific mental health problems, formal psychotherapy is effective in terms of reducing individual symptoms. Other forms of intervention have been less well evaluated. The evidence that exists indicates that counselling services and stress management training have modest but short-term effects on individual well-being. Organizational interventions have insignificant effects on individual well-being and on organizational outcomes.     

Accreditation at what cost?

Analyses the implications of the management of labour for an organization undertaking an accreditation exercise. Considers the King's Fund Organizational Audit (KFOA) accreditation scheme, which is concerned with process and facilities, and assesses the quality of the hospital environment in which the health care product is supplied. Concludes that, given the current enthusiasm for finding best practice in health care and the ever-increasing number of cost-effectiveness analyses of therapeutic interventions, it seems somewhat contradictory that interventions which cover the whole environment in which health care interventions are performed are not treated in the same way.