Hasselhorn HM(1), Josephson M(2), Lindberg P(2), Tackenberg P(3), Mueller BH(3) and the NEXT-Study Group

(1) Department of Occupational Medicine, University of Wuppertal, Germany (2) Karolinska Institutet Stockholm, Sweden (3) Department of Occupational Safety and Ergonomics, University of Wuppertal, Germany

Intent to leave nursing among nurses in Europe – First results from the European NEXT-STUDY

Introduction: The provision of a sufficiently large pool of nurses will be a major challenge for health policy in the future. The problem of lack of nurses in Europe is well known. In several countries, decreasing interest in nursing education among young school leavers can be observed (e.g. Germany, Austria, Poland, Slovakia). Migration of nurses within Europe is prevalent but will not solve the problem. Most nurses in Europe leave their profession long before reaching retirement age.

The longitudinal NEXT-Study (Nurses – Early Exit Study, www.next-study.net) investigates the reasons for and the circumstances of premature departure from nursing in Europe. The study design bases on questionnaire assessments of nurses, special assessments of leaving nurses and check lists of the participating institutions. The NEXT-Study is being financed by the European Union and lasts from February 2002 until November 2004. So far, more than 28.500 self report questionnaires have been collected from nurses working in 378 institutions in 7 of the ten participating countries.

Results: Preliminary results show that between 4 and 13% of the European nursing profession considers leaving their profession weekly or more often. A gradient from north (less often) to south (more often) was observed. German preliminary data (n=3535) indicates that intent to leave was associated with high qualification level and with young age. In multivariate analysis “intent to leave” was strongly associated with “work-family conflict” (in all age groups), with “no challenging work” and to low degree with high physical work load (in older age groups). A differentiated analysis of the European data will be presented.

Conclusions: Our preliminary results from the German assessment indicate that especially highly qualified nurses have the highest �intent to leave nursing�. Taking a) the demographic change, and b) the decreasing interest in nursing education among young school leavers into account, our observations indicate a severe threat for future assurance of health care for all. However, to implement preventive action in institutions, a differentiated analysis is necessary which also includes organisational aspects. Furthermore, it must be assessed whether “intent to leave nursing” is associated with “actual departure” out of the profession. This will be the case in the European NEXT-Study.

Jane Lethbridge

Senior Research Fellow
Public Service International Research Unit
PSIRU- CMS, University of Greenwich
Park Row
London SE10 9LS
+44 8331 7781

Social and economic destabilisation in Europe: implications for health

Abstract

This paper will examine how public (health) sector unions are responding to changes caused by deregulation. Some of these changes – the impact of EU internal market legislation on national health systems, reform of national health systems, introduction of contracting, public-private partnerships – are introducing a form of commercialisation to the public health care system but are not yet leading to full privatisation. These present direct challenges to health workers in terms of pay, terms and conditions but also raise questions about accessibility of health care services for many disadvantaged groups. Some of the trade union responses are aimed at preserving terms and conditions but trade unions are increasingly forming alliances with other civil society groups to develop joint campaigns to preserve both user and workers rights.

These campaigns are also raising questions for trade unions about future health care policy and how to develop health care systems that address both the needs of the users and health workers. However the process of bringing trade unions and civil society organisations together is not an easy one. In some countries these alliances have not developed, in others the progress has been slow. There are underlying tensions between health workers and users of services, which are not easily resolved. The growing influence of users of health services (often with a focus on individual rather than collective needs) within health care systems requires new systems of participation and accountability to address these underlying conflicts. The challenges of deregulation and privatisation make the need to resolve these differences and develop long term strategic alliances which encompass a vision of a public health sector more urgent.

da Hellander, MD
PNHP Executive Director

Corporate Health Care Begets Fraud: Recent US Experience

ABSTRACT: Many countries are currently engaged in debates over the privatization of their health systems. Privatization is advocated by the IMF and World Bank way of decreasing government expenditures on health and improving efficiency, despite much evidence to the contrary. Previous research on the U.S. market-based health system, much of it by Harvard-based researchers Drs. David Himmelstein and Steffie Woolhandler, has shown that U.S. public spending on health care is the highest in the world despite a lack of access to care for over 40 million persons.

Also, for-profit hospitals, HMO�s, nursing homes, and dialysis facilities are of both higher cost and lower quality than their not-for-profit counterparts. Less well known is that the period after the failure of the Clinton health plan in the U.S. in 1994 was characterized by a frenzy of mergers among health care corporations – pharmaceutical firms, insurers/HMOs and hospitals. Since then, a wave of corporate fraud of “Enron-like” proportions has swept the health care industry. The two largest hospital chains � Tenet and Columbia/HCA have paid fines and penalties over $2 billion for defrauding Medicare. Drug companies have been convicted and fined for illegally preventing generic competition, defrauding the Medicaid program, and paying bribes and kickbacks to pharmacies and doctors to prescribe their products. A recent and massive case of fraud in the corporate health sector is HealthSouth, a chain of for-profit rehabilitation hospitals and laboratories. HealthSouth’s founder and CEO, Richard Scrushy, inflated the firm�s profits by over $2.5 billion to bilk investors and the government. Nine HealthSouth executives have already pleaded guilty to securities fraud. Countries considering privatization of any health services – even laboratories – have much to learn (and avoid) from the U.S. example that corporate health care begets fraud.

Motasem HAMDAN

1) Centre for Health Services and Nursing
Research, Katholieke Universiteit Leuven, Belgium

2) School of Public
Health, Al-Quds University, Jerusalem.
13th IAHPEurope Conference “Social and economic destabilisation in Europe: implications for health”

May 21st to24th 2003, Stockholm, Sweden

Health workforce in political and economic destabilisation: the interaction between health sector reform and human resources development in Palestine