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Welfare Reform on the Web (March 1999): Healthcare Overseas

BACKLASH AGAINST MANAGED CARE

G. Baker
Financial Times, 16th July 1998, p. 30

Reports widespread discontent with the managed care system of health care in the U.S. Under schemes run by managed care providers, patients do not have an unrestricted choice of doctor, surgeon or treatment, but must choose from the range offered by the scheme. This has pleased employers by keeping the cost of health insurance premiums down, but has led to scandalous cases of patients being denied necessary treatment on grounds of costs. President Clinton has responded by urging Congress to pass a Patients Bill of Rights, and Senator Edward Kennnedy has published a bill that would guarantee wider access to treatments and doctors, provide a right of appeal if patients were denied care and give them the right to sue if denied legitimate treatment. Insurers say such measures would cause health insurance premium inflation to take off again, but the current popular outcry looks set to force reform.

COST RECOVERY IN GHANA : ARE THERE ANY CHANGES IN HEALTH CARE SEEKING BEHAVOUR?

W. K. Asenso - Okyere and others
Health Policy and Planning, vol. 13, no. 2, June 1998, p. 181-188

Higher user charges and the cost of drugs have led people to resort to self-medication. Where knowledge of the appropriate medication is limited, advice is sought from drug store operators, leading to longer delays in reporting illnesses to hospitals and clinics. Though it was generally believed that the prices of drugs at government facilities were lower than at private stores and clinics, people were willing to use the latter because drugs were always available.

FRANCE SEEKS TO CURB COST OF HEALTHCARE

R. Graham
Financial Times, 7th July 1998, p. 2

Reports that in an effort to curb a growing defecit in the national health insurance scheme, France is to launch a campaign to cut drug prescriptions. Pharmaceutical companies are expected to be asked to reduce the price of their products, or be obliged to make a special one-off contribution to the health insurance scheme.

HEALTH, THE MEDICAL PROFESSION AND REGULATION

P. Zweifel (eidtor)
Boston, Mass: Kluwer, 1998 (Developments in health economics and public policy, vol. 6)

Papers include: investigation of priority setting by Norwegian clinicians in response to a change in relative fees; a study suggesting that Australian GPs change their style of practice in response to economic incentives; analysis of cream skimming of good risks by Swiss sick funds regardless of their status as social insurers; an exploration of cross-border care in the EU; and a study of the effect of financial incentives on primary care provision in the UK.

LISTLESS FEELING

R. Kipping
Health Service Journal, vol. 108, no. 5613, 16 July 1998, p. 26-27

New Zealand is attempting to replace waiting lists with a booking system for elective surgery such as hip replacements, cataract removal and heart bypass operations. The proposed system would only accept for treatment patients assessed as likely to gain the greatest benefit. It is intended to reflect the total volume of elective services the purchaser can buy with available resources during the funding year. This would be achieved, using the assessment criteria, by raising or lowering the thresholds for entry. The proposals are being opposed by clinicians on the grounds that in some cases, they would rule out 30% of patients from treatment.

MANDATORY POOLING AS A SUPPLEMNT TO RISK-ADJUSTED CAPITATION PAYMENTS IN A COMPETITIVE HEALTH INSURANCE MARKET

E. M. van Barneveld and others
Social Science and Medicine, vol. 47, no. 2, July 1998, p. 223-232

Risk adjusted capitation payments (RACPs) to competing health insurers are essential elements of the market-oriented health care reforms in many countries. However RACPs based on demographic variables only are insufficient and encourage cream skimming. A solution would be to supplement RACPs with some form of mandatory pooling which reduces incentives for cream skimming. Paper analyses which of three pooling variants (high-risk pooling, excess-of-loss and proportional pooling) yields the greatest reduction in incentives for cream skimming. Results show that high-risk pooling is the most effective of the three. However, all variants include ex post compensations to insurers for some members which depend on actually incurrred costs. Therefore these variants all reduce incentives for efficiency and cost containment.

MORAL HAZARD AND THE DEMAND FOR PHYSICIAN SERVICES : FIRST LESSONS FROM A FRENCH NATURAL EXPERIMENT

P. A. Chiappori, F. Durand and P. Y. Geoffard
European Economic Review, vol. 42, no. 3/5, May 1998, p. 499-511

Results of a longitudinal study of 4578 individuals followed for two years shows that a change in relative price had no influence on GP surgery visits or specialist visits. However, change in relative price did have a moderating effect on the demand for GP home visits.

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