This article is an analysis and description of public sector management changes in developed economies over the past 10 years as seen from the perspective of two practitioners who regard themselves as general supporters of the new "managerialism" and are strong believers in the need for, and possibility of, well-performing public institutions and organizations. We aim to describe what we think the changes are, or should have been about, and to suggest where the successes and failures have occurred. In doing so, we draw on the analysis and description of these changes by a number of prominent academics. Not surprisingly, we differ from them in a number of respects. In some of the detail, we have more to say about Australia than other countries. This reflects our involvement in the reform program of that county as well as our view that Australian reform efforts, despite their flaws, are of particular interest because of the attention they paid to the linkages between policymaking at the center, the systems, processes and structures that support strategic policymaking and the translation of strategic policy into efficient and effective implementation, including effective provision of goods and services to the community.

The majority of health problems encountered in association with travel stem from pre-existing, perhaps latent, illness in the individual which may be exacerbated by the rigours and hazards of travel. It is essential that the advising physician understands the hazards that are likely to be encountered during travel in order that they may develop informed decisions regarding fitness for travel and give appropriate advice. In an occupational health setting, the employer has a responsibility to safeguard the health of their employees whilst travelling on behalf of the organisation and will also have to fund any treatment abroad or the cost of repatriation. The dictating factor in determining fitness to travel will often be fitness to travel by air, consequent to the reduced partial pressure of oxygen and pressure changes in-flight. The majority of significant health problems encountered during travel are attributable to coronary heart disease and detailed guidance exists to determine fitness for travel. For many health problems little if any evidence based guidance exists and decisions will therefore have to be based on an understanding of the hazards likely to be encountered during travel. Access to appropriate standards of medical care abroad and the difficulties and expense of repatriation, should this be necessary, are also important factors to consider in addition to the basic determination of fitness for travel itself. This paper outlines the main factors to be considered when assessing fitness to travel and also examines available guidance for some of the more commonly encountered conditions.

This article surveys budgetary reforms in the Organization for Economic Cooperation and Development (OECD) countries, which have aimed both at reducing budget deficits and improving public sector performance. (1) It discusses the pressures giving rise to these reforms, recent trends in reducing deficits and the changes to budgetary processes adopted by various countries. Brief reference is also made to changes in expenditure programs. In some OECD Member countries, changes to budgetary processes have been part of an overall program of reform in public sector management. While there are differences of emphasis between countries, there is considerable convergence toward establishing new budgetary processes which have multi-year approach, provide for greater budgetary devolution to ministries and agencies and focus more on managing the performance of government organizations and programs.

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