Concerns at rising health care costs led to institutional reforms in both Britain and France in the early 1990s. A major objective in both countries was to improve labour utilization by decentralizing authority to local management. One of the main ways of achieving this at establishment level was through the reorganization of working time. This article draws on case study research to examine the two reform approaches, and suggests that the reform programmes facilitated local management efforts to increase shift-working and part-time and temporary employment, although the extent and form of working-time flexibility continue to reflect differences in the social and regulatory context of the two health systems.
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