Neil Fraser

Age-based rationing in the allocation of health care.

Objectives:This article seeks to review debates about age-based rationing in health care. Methods:The article identifies four different levels (or types) of decisionmaking in health resource allocation—societal, strategic, programmatic, and clinical— and assesses how the issues of rationing vary in relation to each level. Results:The article concludes that rationing is least defensible at the clinical level, where it is also most covert. The role of rationing at other levels is more defensible when based on grounds of cost-effectiveness rather than equity. The article emphasizes the importance of fairness in health allocation and suggests that efficiency criteria need to be considered in that context. Discussion:The article suggests that rationing is most problematic where it is least overt. This raises further questions about how rationing can be made more explicit at different levels of decision making.

How strong is the case for targeting active labour market policies

The article assembles efficiency and equity arguments for and against targeting the long‐term unemployed in active labour market policies (ALMP), and refers to evidence from applications to date. The theory and practices of ALMP differ somewhat between low and high unemployment countries. The approach taken in Sweden in the 1960s to 1980s is used to discuss low unemployment countries, and OECD analysis in the 1990s to represent theory for the high unemployment countries. Targeting the long‐term unemployed is specifically a policy for high unemployment countries, and depends particularly on effects on wage pressure. The article concludes by urging that equity arguments be considered as well as efficiency and by drawing attention to the form which targeting takes. Comments are made about Britain’s New Deal in relation to the form of targeting.

Introduction: Britain's new deals

This paper introduces the active labour market policies or job search policies in the UK known as the New Deal, a major part of the Labour Governments package of welfare‐to‐work policies. Topics covered include estimates of their overall impact on employment; their limited effectiveness with disadvantaged job‐seekers, including increasing numbers of inactive, but not formally unemployed, people; and debates about these policies in relation to skill needs and areas of job decline.

Book Review: D. Gallie (ed.). Employment Regimes and the Quality of Work, Oxford, Oxford University Press, 2007, 304 pp., £55.00 (hbk), ISBN 9780199230105

This book results from work carried out in an EU-funded Network of Excellence, the Economic Change, Quality of Life and Social Cohesion (EQUALSOC). It addresses trends in work quality and the determinants of work quality. It is also an exploration of regime theories, primarily the production regimes of the ‘Varieties of Capitalism’ literature and employment regimes, a version of welfare regimes focusing on employment and industrial relations systems, dividing countries into ‘inclusive’ employment regimes, ‘dualist’ employment regimes and ‘market’ employment regimes. The employment regime analysis of the determinants of work quality in different countries is interesting but not altogether conclusive. The book begins with a chapter by Duncan Gallie that discusses dimensions of quality of work, and the rival regime theories. There are then five chapters testing changes in: (a) skill levels and pay dispersion (Michael Tåhlin); (b) job-related training (Martina Dieckhoff, JeanMarie Jungblut, and Philip J. O’Connell); (c) task discretion (Duncan Gallie); (d) work–family balance (Stefani Scherer and Nadia Steiber); and (e) job security (Serge Paugam and Ying Zhou). The countries compared (with some variation in individual chapters) are Denmark, Finland, Sweden, France, Germany, Spain, and the United Kingdom. There is finally a concluding chapter by Duncan Gallie that reviews the individual chapters and reaches a tentative preference for the employment regime perspective in illuminating differences in work quality – mainly because of differences within the coordinated market economies, such as between Germany and the Nordic countries. The whole work benefits from an impressively systematic approach, and there are very good discussions of how to measure the various quality of work concepts. Favoured are class measures of skill, time-spent measures of training, individual assessments of task discretion, different components of work–family conflict, and self-report measures of job insecurity. The variety of concepts leads to the use of a range of surveys, including the European Social Survey, the European Community Household Panel, the European Surveys on Working Conditions, particular Eurobarometer Surveys and the International Social Survey Programme module on Gender Roles. The statistical analyses, both cross-section and time-series analyses, seem to be carefully done. Some findings of specific chapters are particularly interesting and challenging. One such finding concerns the work–family stress felt by women. This was not found to be low in Sweden, for all their extensive welfare policies. Rather, Sweden had the second highest women’s work–family stress (after Spain) among the countries studied. This was explained through a selection model, in that women with difficult domestic situations still work in Sweden whereas in other countries they are more likely to be out of the labour market. There are also striking arguments about vocational training and skill differences, as measured by the training judged by workers as necessary to do their job. The differences in pre-labour force entry training may to some extent be compensated by differences in post-entry learning. For example, the UK had the lowest training requirements of five countries studied in respect of pre-entry training, but the second best in respect of post-entry learning. Overall the evidence in Tåhlin’s chapter is that skill requirements are increasing in all countries. The exploration of international differences in task discretion is very thorough, with national data sets being used to supplement the European Surveys on Working Conditions. Here (as in other chapters) there is an attempt to see if there is polarization in work quality between categories of employees. Britain and Spain were found to have an increasing gap between the discretion allowed to the low-skilled compared with professionals and managers, but in France, Germany and Sweden there was convergence. Gallie suggests this may be due to differences in the skills-formation system, stronger vocational training providing some protection for vulnerable employees. In terms of job security Denmark came out best (a plus for ‘flexicurity’). When job insecurity is related to lowquality job tasks, a strong association is found. However there were striking inter-country differences. For example, Britain has a lot of poor jobs which are nevertheless perceived as secure. Low quality-insecure jobs are a higher percentage of all jobs in France, Germany and Spain than in Britain and Sweden, and much higher than in Denmark. Low-quality insecure jobs are further analysed by skilllevel, gender, and whether classed as temporary jobs. In sum, this is an impressive study which generates many new ideas and angles for the analysis of policies in relation to the quality of work.