Impact of different health systems on the burden of type 2 diabetes in two populations

Objectives: Health policy directs the management of patients with chronic disease in a country, but evaluating nationwide policies is difficult, not least because of the absence of suitable comparators. This paper examines the management of patients with type 2 diabetes in two demographically comparable populations with different health care systems to see if this represents a viable approach to evaluation.

Methods: A secondary analysis of centralized prescribing databases for 2010 was undertaken to compare the levels and costs of care of patients with type 2 diabetes in Northern Ireland’s National Health Service (NHS) (NI, n = 1.8 million) which has structured care, financial incentives related to diabetes care and an emphasis on generic prescribing, with that of the Republic of Ireland (ROI, n = 4.3 million) where management of diabetes care is guided solely by clinical and other guidelines.

Results: The prevalence of treated type 2 diabetes was 3.59% in NI and 3.09% in ROI, but there were similar and high levels of prescribing of secondary cardiovascular medications. Medication costs per person for anti-diabetic, anti-obesity and cardiovascular medication were 46% higher in ROI than NI, due to differences in levels of generic prescribing.

Conclusions: These different health care systems appear to be producing similar levels of care for patients with type 2 diabetes, although at different levels of cost. The findings question the need for financial incentives in NI and highlight the large cost savings potentially accruing from a greater shift to generic prescribing in ROI. Cross-country comparison, though not without difficulties, may prove a useful adjunct to within-country analysis of policy impact.

Macro impacts on caseworker decision-making in child welfare: a cross-national comparison

This paper focuses on the factors impacting on decision-making in child and family social work through a cross-national comparison. In doing so, the larger arena of the political and social contexts of both the United States and Northern Ireland are examined. For each of the countries we describe the historical and political context of child welfare, particularly the tension between child safety and family support, and how children’s rights are attended to and interpreted in each country. This discussion also examines the extent to which decision-making in each jurisdiction is influenced by constitutional imperatives, with particular reference to the US Constitution and the European Convention on Human Rights. From this general comparison we conclude with observations about child welfare decision-making within the national context and offer suggestions for further theoretical development in this area whilst also examining where the practices in each jurisdiction may benefit from review.

THE IMPACT OF BURNING AND GRAZING OF HEATHLAND PLANTS AND INVERTEBRATES IN COUNTRY ANTRIM

The impact of burning and grazing on plant, ground beetle and spider species was investigated experimentally in stands of varying ages (burnt in 1982 and 1988 and unburnt plots) on an area of heather moorland in County Antrim, north-east Ireland. Burning initiated complex succession pathways which appear to have characteristic plant and invertebrate species associations. Removal of Calluna dominance initiated a period of high plant species diversity. Investigation of initial post-fire regeneration suggested that the frequency of occurrence of plant species changed over time and was affected by grazing. Grouping of species by the position of their renewal bud, i.e. their life-form, did not account for all observed interspecific variation. The dominant species after burning were Eriophorum vaginatum, E. angustifolium and Vaccinium myrtillus. Studies of vegetation canopy structure showed that, even with the exclusion of the main grazing herbivores, Calluna will not re-establish itself as the dominant species until several years after burning. The ground beetle Nebria salina was trapped more often on plots burnt in 1988 than on unburnt plots or those burnt in 1982. In comparison, Pterostichus niger and Carabus granulatus were trapped in greater numbers on plots burnt in 1982 than on unburnt plots and plots burnt in 1988. The large species Carabus problematicus and Carabus glabratus were trapped in greater numbers on unburnt plots. Similarly, more of the spiders Ceratinella brevipes and Centromerita concinna were trapped on the plots burnt in 1982. In comparison, Lepthyphantes zimmermanni and Robertus lividus were trapped more often on unburnt plots than on plots burnt in 1982 and 1988. Results are discussed with respect to the importance of the continuation of traditional heathland management practices.

Radical Change, Accounting and Public Sector Reforms: A Comparison of Italian and Canadian Municipalities

NPM has been generally regarded as an administrative reform for which resilience and consequences have been mainly investigated at a country level. Although accounting played a central role in NPM reforms over the last decades, how accounting change actually took place, and through what organizational dynamics, has been under-investigated. This paper adopts a new perspective, archetype theory, and looks into how intra-organizational dynamics (values, interests, power, capabilities) combine with reform processes to influence the outcome of accounting change. Evidence from Italian (disruptive process) and Canadian (sedimented process) municipalities shows that radical change is associated with specific configurations of intra-organizational dynamics.

The translation and sedimentation of accounting reforms. A comparison of the UK, Austrian and Italian experiences

Since the late 1980s, there has been a significant and progressive movement away from the traditional Public Administration (PA) systems, in favour of NPM-type accounting tools and ideas inspired by the private sector. More recently, a new focus on governance systems, under the banner Public Governance (PG), has emerged. In this paper it is argued that reforms are not isolated events, but are embedded in more global discourses of modernisation and influenced by the institutional pressures present in a certain field at certain points in time. Using extensive document analysis in three countries with different administrative regimes (the UK, Italy and Austria), we examine public sector accounting and budgeting reforms and the underlying discourses put forward in order to support the change. We investigate the extent to which the actual content of the reforms and the discourses they are embedded within are connected over time; that is, whether, and to what degree, the reform “talk” matches the “decisions”. The research shows that in both the UK and in Italy there is consistency between the debates and the decided changes, although the dominant discourse in each country differs, while in Austria changes are decided gradually, and only after they have been announced well in advance in the political debate. We find that in all three countries the new ideas and concepts layer and sediment above the existing ones, rather than replace them. Although all three countries underwent similar accounting and budgeting reforms and relied on similar institutional discourses, each made its own specific translation of the ideas and concepts and is characterised by a specific formation of sedimentations. In addition, the findings suggest that, at present in the three countries, the PG discourse is used to supplement, rather than supplant, other prevailing discourses.

A comparison of biodegradable municipal waste (BMW) management strategies in Ireland and the Czech Republic and the lessons learned

In order to meet the recycling and recovery targets set forth by the European Union's (EU) Waste and Landfill Directives, both the Irish and Czech governments’ policy on waste management is changing to meet these pressures, with major emphasis being placed upon the management of biodegradable municipal waste (BMW). In particular, the EU Landfill Directive requires reductions in the rate of BMW going to landfill to 35% of 1995 values by 2016 and 2020 for Ireland and the Czech Republic, respectively. In this paper, the strategies of how Ireland and the Czech Republic plan to meet this challenge are compared. Ireland either landfills or exports its waste for recovery, while the Czech Republic has a relatively new waste management infrastructure. While Ireland met the first target of 75% diversion of BMW from landfill by 2010 and preliminary 2012 data indicate that Ireland is on track to meet the 2013 target, the achievement of the 2016 target remains at risk. Indicators that were developed to monitor the Czech Republic's path to meeting the targets demonstrate that it did not meet the first target that was set for 2010 and will probably not meet its 2013 target either. The evaluation reports on the implementation of Waste Management Plan of Czech Republic suggest that the currently applied strategy to divert biodegradable waste from landfill is not effective enough. For both countries, the EU Waste Framework and Landfill Directives will be a significant influence and driver of change in waste management practices and governance over the coming decade. This means that both countries will not only have to invest in infrastructure to achieve the targets, but will also have to increase awareness among the public in diverting this waste at the household level. Improving environmental education is part of increased awareness as it is imperative for citizens to understand the consequences of their actions as affluence continues to grow producing increased levels of waste.

Graphical abstract
Despite the differences in the levels of waste generation in both the Czech Republic and Ireland, each country can learn from each other in order to meet the recycling and recovery targets set by the European Union's (EU) Waste and Landfill Directives. Both countries will not only have to invest in infrastructure to achieve the targets, but will also have to increase awareness among the public in diverting this waste at the household level. In addition, there needs to be minimum safe standards when land-spreading organic agricultural and organic municipal and industrial materials on agricultural land used for food production, as well as incentives to increase BMW diversion from landfill such as the increased landfill levy implemented in Ireland and the acceptance of MBT and/or incineration as a means of treating residual waste.