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Welfare Reform on the Web (April 2000): Health Care - Overseas

APPLYING DISEASE MANAGEMENT STRATEGIES TO MEDICARE

C.P. Tompkins, S. Bhalotra, and M. Trisolini

Milbank Quarterly, vol. 77, 1999, p.461-484

Article suggests that the US Medicare programme should adopt an expanded, population - based perspective. This approach would emphasize prevention of chronic illness, early identification, and aggressive monitoring of cost quality of care. This policy of intervention at earlier stages of diseases in order to lessen morbidity should reduce Medicare costs in the longer term. Discussion in the article is based on the example of chronic renal disease and the related entitlement to Medicare for patients with end-state renal disease (ESRD), a condition which requires renal replacement therapy for survival.

THE CHANGING LANDSCAPE OF HEALTH CARE FINANCING AND DELIVERY: HOW ARE RURAL COMMUNITIES AND PROVIDERS RESPONDING?

K.J. Mueller et al

Milbank Quarterly, vol. 77, 1999, p.455-510

Managed care and market changes have potentially important implications for access to health care services in rural areas. To build and sustain access, public policies are needed that help rural providers to participate in new systems of care and maintain their livelihood under new systems of finance. In the communities studied, three main ingredients for action that moulded change to meet the needs of the community were identified:

  • resources;
  • leadership;
  • community capacity.

CONCEPTUAL AND PRACTICAL DIFFICULTIES WITH THE ECONOMIC EVALUATION OF HEALTH SERVICES DEVELOPMENTS

J. Cost et al

Journal of Health Services Research & Policy, vol. 5. No. 1, 2000, p.42-48

The paper outlines the problems facing economic evaluations comparing hospital at home schemes with acute hospital care. Both conceptual and practical problems are discussed and strategies for overcoming these are suggested. Such strategies are important for those conducting economic evaluations and those funding appraisals of changes in the organisation of care.

EMPLOYER - SPONSORED HEALTH INSURANCE AND MANDATED BENEFIT LAWS

G.A. Jensen and M.A. Morrisey

Milbank Quarterly, vol. 77, 1999, p.425-459

Regulations for the content of private health plans, called mandated benefit laws, are widespread and growing in the US at both state and federal levels. A growing body of literature suggests that society is paying a high price for enhanced coverage via mandated benefits. These laws increase insurance premiums, cause wage reductions and lead some employers and their workers to forgo health insurance altogether.

US DOCTORS KEEP CLOSE WATCH ON THE PULSE OF NATIONAL HEALTHCARE DEBATE

D. McGregor

Financial Times, Jan. 18th 2000, p.7

Health policy is proving one of the leading issues in the present presidential election campaign. Concerns include the lack of health insurance for 44m Americans, the rising cost of prescription drugs for the elderly and the shaky state of Medicare. Republicans tend to favour market-based solutions, while Democrats support a large role for the federal government, particularly in extending health coverage to those who currently have none.

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