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Welfare Reform on the Web (November 2007): Healthcare - overseas

Achieving millennium development goals for health: building understanding, trust and capacity to respond

T.J. Downs and H.J. Larson

Health Policy, vol. 83, 2007, p. 144-161

This paper focuses on how to achieve the millennium development goals for the improvement of population health in developing countries on the ground in partnership with multiple stakeholders. The authors argue for a transformative multi-stakeholder process that fosters social learning and strengthens social capital with three main features:

  • Participatory, systems-based assessment of the ecological, socio-cultural, economic and political contexts of health challenges and responses, identifying priorities using risk and vulnerability science, and modelling drivers.
  • Selection among intervention alternatives that makes ecological, socio-cultural, economic and political trade-offs transparent
  • A support system of capacity building to sustain selected interventions, and adapt to changing conditions and priorities over time

Catastrophic health payments and health insurance: some counterintuitive evidence from one low-income country

B. Ekman

Health Policy, vol.83, 2007, p. 304-313

Catastrophic health payments, defined as spending on healthcare that exceeds a certain level of the patient's income, have been found to be real and sizeable in both poor and rich countries. Health insurance is regarded as having a key role in reducing the risk of such payments. This article sets out to test this proposition using 1998 household level data from Zambia which contains detailed information on healthcare utilisation and spending and other key individual, household and community factors. The main results are counterintuitive in that health insurance is not found to provide financial protection against the risk of catastrophic payments, but in fact to increase it.

Health security for the rural poor? A case study of a health insurance scheme for rural farmers and peasants in India

S. Kuruvilla and M. Liu

International Social Security Review, vol. 60, no.4, 2007, p. 3-21

This article presents a case study of the highly successful Yeshasvini Health Insurance scheme introduced in the state of Karnataka in 2003. In its first year of operation the scheme covered 1.6 million rural farmers and peasants dispersed throughout Karnataka. For a low annual premium of approximately US$2.00 per year, participants are covered for all surgical interventions and outpatient services at a network of private hospitals.

The impact of generic reference pricing interventions in the statin market

J. Puig-Junoy

Health Policy, vol. 84, 2007, p.14-29

This study evaluated the intended and unintended impact on pharmaceutical use and volume of sales of three public financing reforms applied to the prescription of six commercially available statins from January 2001 to October 2004. These are:

  • A Spanish generic reference pricing system for lovastatin and impastation
  • A maximum consumer price for all statins introduced by the Andalusian Public Health Service
  • A quality prescribing incentive for general practitioners, also introduced in Andalusia.

Results show that reference pricing has been effective in reducing the volume of sales growth of the off-patent statins, yet its overall impact on sales of all statins has been relatively modest.

Implementing family health nursing in Tajikistan: from policy in practice to primary healthcare reform

B.A. Parfitt and F. Cornish

Social Science and Medicine, vol. 65, 2007, p. 1720-1729

Health service reform is underway throughout the countries of the former Soviet Union. Healthcare is moving away from the highly centralised, hospital-focused Soviet model to a system in which local-level comprehensive prevention and treatment are provided by generalist physicians and skilled generalist nurses. Family Health Nursing is a new model designed by WHO Europe in which skilled generalist community nurses deliver primary health care to local communities. This paper presents a qualitative evaluation of the implementation of Family Health Nursing in Tajikistan.

Maternal education, child immunisation and public policy: evidence from the US National Immunization Survey

A.D. Racine and T.J. Joyce

Social Science and Medicine, vol. 65, 2007, p. 1765-1772

This article measures the independent association of maternal education level and childhood immunisation rates in the USA and compares the association in states that provide free vaccines to all residents and those that do not using data from the 1995 to 2003 National Immunization Surveys. Adjusting for ethnicity, income and other covariates, children of mothers with less than high school education were found to be 7.8% less likely than children of mothers with college education to be up to date with the 4:3:1:3:3 vaccine series. For the newer pneumococcal conjugate vaccine, these children were 4.5% less likely to be up to date. Residence in a state with a free universal vaccination programme was found to attenuate these effects. Thus subsidising immunisation diminishes the disadvantage associated with lower maternal educational achievement.

Patient rights in EU member states after the ratification of the Convention on Human Rights and Biomedicine

H. Nys and others

Health Policy, vol.83, 2007, p. 223-235

The European Convention on Human Rights and Biomedicine was adopted by the Committee of Ministers of the Council of Europe on 19th November 1996 and opened for signature in Oviedo, Spain on 4th April 1997. So far 11 European Union member states have ratified the Convention. This article analyses whether these ratifying EU member states have fulfilled their obligation to implement the Convention's norms through national law. It explores, for each ratifying state, whether and how the Convention has influenced patients' rights legislation and policies.

The politics of global immunization initiatives: can we learn from research on global environmental issues?

K. I. Sandberg and G. Bjune

Health Policy, vol. 84, 2007, p. 89-100

Global health initiatives have gained momentum since the millennium, and new players are entering the scene. Newcomers include the Global Alliance on Vaccines and Immunization, public-private partnerships that focus on development of new drugs or vaccines, new private foundations and innovative funding mechanisms such as consumer campaigns and the sale of government bonds. These new initiatives add to an existing network of national and international stakeholders. The interests and priorities of the various initiatives may conflict. This article suggests that regime studies, originally applied to collaborations aimed at tackling environmental issues, can offer a new perspective on the politics of global cooperation on vaccines and immunisation.

Preventive service delivery: a new insight into French general practice

N. Pelletier-Fleury and others

Health Policy, vol. 83, 2007, p. 268-276

Disease prevention is increasingly recognised as a public health priority in most developed countries. General practitioners have a key role to play in preventive service delivery, but research in Europe and the US suggests a low level of activity in this area. This article seeks to investigate the place of prevention in French GP surgeries. It provides insights into the hidden preventive work that goes on every day in routine patient visits. A sample of 75 GPs in a Paris suburb were asked to rate on a five-item Likert scale the amount of primary or secondary prevention they normally offered during a patient visit regarding the 100 most common illnesses treated in primary care.

Pricing behaviour of pharmacies after market deregulation for OTC drugs: the case of Germany

T. Stargardt, J. Schreyogg and R. Busse

Health Policy, vol. 84, 2007, p. 30-38

Historically the German pharmacy market has been heavily regulated and protected from competition. On January 1st 2004 the German Federal government made a number of amendments to its drug regulation policies as part of the Statutory Health Insurance Modernisation Act. Over-the-counter drugs were no longer to be included in the Statutory Health Insurance benefits basket. The Act also deregulated the market for over-the-counter products, lifting the legally fixed dispensing fees for wholesalers and pharmacies which had previously guaranteed identical prices in all German pharmacies. Pharmacies in Germany are thus now allowed to compete in terms of over-the-counter drug prices. There is no evidence to date that pharmacies have reacted to the new legislation by choosing prices that differ substantially from the manufacturer's recommended price.

Priority setting for high-cost medications (HCMs) in public hospitals in Australia: a case study

G. Gallego, S.J. Taylor and J.E. Brien

Health Policy, vol. 84, 2007, p. 58-66

Allocating resources to the provision of innovative and expensive medications is challenging for health services and the decision-making processes used have not been widely researched. This case study describes the operations of the first reported High Cost Drug Subcommittee in a public hospital in Australia, and evaluates the decision-making process using Daniel and Sabin's ethical framework of 'accountability for reasonableness'.

Public policies and the problematic USA population health profile

D. Raphael

Health Policy, vol. 84, 2007, p. 101-111

As a result of systemic inequalities in income, wealth and power, the USA presents one of the worst population health profiles among wealthy developed nations. However, the US public health community is taking only cautious steps towards addressing the structural antecedents of health and disease, such as unemployment, working conditions, housing and income distribution. Instead, its gaze is firmly fixed on narrow issues of access to healthcare, racial disparities in healthcare, and individual behavioural risk factors.

The short-term effect on technical and scale efficiency of establishing regional health systems and general management in Greek NHS hospitals

V. Aletras and others

Health Policy, vol. 83, 2007, p. 236-245

In order to contain spiralling costs, the Greek National Health System went through a reform process in 2001. The reform established 17 Regional Health Systems (RHS) to monitor health organisations using performance indicators and appointed, for the first time, professional managers to run hospitals instead of relying on individuals selected on purely political grounds. Further reforms implemented in the same year required the appointment of external healthcare auditors for hospitals and the monitoring, evaluation and approval of individual hospital procurement policies by the RHS. This study aims at estimating the effects of these policy initiatives on the efficiency of general acute non-university hospitals. Results show that the expected benefits of the reforms have not been realised, at least in the short-term.

What influences government adoption of vaccines in developing countries? A policy process analysis

S.L. Munira and S.A. Fritzen

Social Science and Medicine, vol. 65, 2007, p. 1751-1764

The expanded programme for immunisation (EPI) package of vaccines is estimated to have saved 20 million lives in the developing world over the past two decades. However, the process of diffusion of these vaccines has been uneven, as countries with different priorities and access to resources adopt and sustain vaccines to different extents. This research investigated the determinants of the pace at which countries move to incorporate emerging vaccines with potentially great positive health impacts into their programmes through case studies of the adoption of the vaccine for Hepatitis B in Taiwan and Thailand.

Why invest in a national public health program for stroke? An example using Australian data to estimate the potential benefits and cost implications

D.A. Cadilhac and others

Health Policy, vol. 83, 2007, p. 287-294

Approximately 50,000 strokes occur annually in Australia with numbers predicted by rise by about one third over 10 years. This research assessed the economic implications of a public health programme for stroke prevention and management by predicting what potential health gains and cost-offsets could be achieved and by determining the net level of annual investment that would offer value-for-money. Results suggest that improved prevention and management could prevent about 27,000 strokes in 2015. In 2004 terms, about 85,000 Disability Adjusted Life Years (DALYs) and AUD$1.6bn in lifetime cost offsets could be recovered. The net level of annual warranted investment was AUD$3.63bn.

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