Search

Objective This paper examines how negative experiences with the health-care system create a lack of confidence in receiving medical care in seven countries: Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States. Methods The empirical analysis is based on data from the Commonwealth Fund International Health Policy Survey 2007, with nationally representative samples of adults aged 18 and over. For the analysis of the experience of cost barriers and confidence in receiving medical care, we conducted pairwise comparisons of group percentages as well as country-wise multivariate logistic regression models. Results Individuals who have experienced cost barriers show a significantly lower level of confidence in receiving safe and quality medical care than those who have not. This effect is most pronounced in the United States, where people who have foregone necessary treatment because of costs are four times as likely to lack confidence as individuals without the experience of cost barriers (adjusted odds ratio 4.00). In New Zealand, Germany, and Canada, individuals with the experience of cost barriers are twice as likely to report low confidence compared with those without this experience (adjusted odds ratios of 1.95, 2.19 and 2.24, respectively). In the Netherlands and UK, cost barriers are only a marginal phenomenon. Conclusions The fact that the experience of financial barriers considerably lowers confidence indicates that financial incentives, such as private co-payments, have a negative effect on overall public support and therefore on the legitimacy of health-care systems. [ABSTRACT FROM AUTHOR]

In this paper we argue that far from being surpassed by globalization, the nation-state remains a key space for organized labour. However, labour geographers’ focus on patterns of union organization and strategies of ‘internationalism’ underplays the enduring role of national institutions. Moreover, while labour geographers have recognized the significance of new forms of work organization, such as just in time and lean production, with some exceptions they have not examined how unions both formally and informally determine the trajectory of workplace change. Based on case studies of unions in the Canadian and German auto industries, we stress that the linkage between national and workplace scales remains critical to understanding how unions are responding to the challenges being presented by lean and just in time production. Finally, while there is a re-scaling of bargaining in the automobile industry to the firm or enterprise scale, the outcomes of decentralization depend largely on the national regulatory context. [ABSTRACT FROM AUTHOR]