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

Comparative health policy. 2nd ed.

R. H. Blank and V. Burau

Basingstoke: Palgrave Macmillan, 2007

The book analyses key issues in health policy to assess the extent to which policy problems and responses in different countries have common causes or spring from specific national circumstances. It analyses what lessons can be learned about public/private mixes, provision and funding frameworks, and acute and preventive services in a wide range of health systems - systematically comparing Australia, Germany, Japan, New Zealand, the Netherlands, Sweden, Singapore, the UK and the US, but ranging more widely as appropriate. This edition updates the original text and includes new statistical tables, topical material and case studies to reflect the many changes that have taken place in the last few years in the area of health policy.

Comparison of services provided by urban commercial, community-governed and traditional primary care practices in New Zealand

P. Hider and others

Journal of Health Services Research and Policy, vol.14, 2007, p. 215-235

New Zealand experienced a period of major health service reforms in the 1980s and 1990s. In primary care, commercial clinics were introduced in the late 1980s and not-for-profit practices governed by community organisations became more common, especially in the 1990s. In this context the National Primary Medical Care Survey was undertaken in 2001-02 to compare practice types on the dimensions of performance, access, continuity and coordination, communication and patient centredness, population health and preventive interventions, and chronic disease management.

Empowering the chronically ill? Patient collectives in the new Dutch health insurance system

Y. Bartholomee and H. Maarse

Health Policy, vol. 84, 2007, p. 162-169

On January 1st 2006 a major reform of the Dutch health insurance scheme came into effect. Under the former system, roughly two-thirds of the population were covered by sickness funds, while the remaining one-third, whose incomes were above a certain level, were required to take out private health insurance. This dual system was replaced by a universal insurance scheme covering the entire population. Under the new system healthcare consumers can form collectives to negotiate group insurance contracts for their members. These collectives can negotiate reduced premiums and also work with insurers to develop plans tailored to the needs of their particular group. This article examines the formation of these patient collectives. The study shows that some patient groups were able to negotiate collective agreements with health insurers, whereas others were not. Success appeared to depend on the presence of a large membership with similar healthcare needs, and the eligibility of a group's disease for compensation through the risk equalisation fund.

Ethics policies on euthanasia in hospitals: a survey in Flanders (Belgium)

J. Lemiengre and others

Health Policy, vol. 84, 2007, p. 170-180

In 2002 Belgium introduced a law allowing euthanasia to be performed by physicians under strict conditions. Since the enactment of this law, debate on how to deal with euthanasia requests has intensified in Flemish hospitals. This survey of general directors of all hospitals in Flanders aimed to determine the prevalence, development, stance and communication of written institutional ethics policies on euthanasia in Flemish hospitals.

Hospital response to prospective financing of inpatient days: the Belgian case

J. Perelman and M.-C. Closon

Health Policy, vol. 84, 2007, p. 200-209

In Belgium all hospitals, public and private, are mainly financed by the public health insurance system, with low rates of co-payment by patients. Hospitals are paid on a fee-for-service basis for medical procedures. Since 1995 non-medical costs (mainly accommodation and nursing) have been reimbursed for a standard number of inpatient days based on the treatment and the patient's characteristics. Hospitals are penalised financially if they exceed the predicted number of inpatient days. This system was introduced to reduce length of stay in hospital and to encourage the development of day surgery. This study shows that the reform did not fully achieve these goals. Length of stay decreased and day surgery increased following the introduction of the new system, but these gains were balanced by an unexpected growth in expenditure on medical and surgical procedures. Hospital stays became shorter, but more treatment intensive.

International migration patterns of physicians to the United States: a cross-national panel analysis

P. S. Hussey

Health Policy, vol. 84, 2007, p. 298-307

Employers in developed countries rely on physician immigration to meet their staffing requirements. In the United States, one in four physicians was trained abroad. However, in the face of a worldwide shortage of physicians, the fairness of developed countries depending on immigration from the Third World to meet their workforce requirements has been seriously questioned. This study formulates a model of physician migration from all source countries to the United States. The model can be used to predict what level of physician migration countries can expect based on their economic development, proximity to destination countries, political freedoms and other factors. The analysis also suggests several potential policies for increasing physician retention in developing countries.

Managed care and a process of integration in health care sector: a case study from Poland

K. Kowalska

Health Policy, vol. 84, 2007, 308-320

For more than 40 years under the Communist regime, the Polish healthcare system was fully integrated. These large integrated state-owned structures came to be associated with poor service and poor management. In 1991 a split was introduced between healthcare purchasers, the 17 sickness funds, and providers. In 2002, two of the sickness funds implemented contractual arrangements with primary care providers which followed a managed care model of provision. The primary care providers taking part in the pilot projects took on responsibility for organising and coordinating the treatment of the enrolled patients and for managing the financial resources assigned to their healthcare packages. A capitation payment system was used to finance the providers taking part in the experiment. In this paper it is argued that reshaping ties between GPs and their patients, and devolving budgetary responsibilities to primary care generated stronger incentives for the establishment of new contractual arrangements between primary and secondary healthcare providers which may encourage spontaneous integration of services.

Patients' attitudes to co-payments for general practitioner services: do they reflect the prevailing system?

D. O'Reilly and others

Journal of Health Services Research and Policy, vol.14, 2007, p. 197-201

In the Republic of Ireland, 70% of patients pay a flat fee of euros 35-55 to see their GP. In Northern Ireland, as in the rest of the UK, healthcare is free at the point of use. Analysis of survey data from a random sample of 11,870 patients in Northern Ireland and the Irish Republic suggests general support for the status quo in both countries. There was little support for co-payments where there was currently no charging, but broad support where charging was established. However, support does exist in Northern Ireland for charging for missed appointments.

Priority setting for healthcare: who, how and is it fair?

D. Menon, T. Stafinski and D. Martin

Health Policy, vol. 84, 2007, p. 220-233

Growth in the availability of new medical technologies coupled with increased public demand have heightened expectations concerning which treatments ought to be provided by the state healthcare system in Canada. At the same time healthcare funders have tightened their purse strings, presenting challenges around deciding which expensive new treatments are affordable. As a result, the need for systematic, evidence-based and transparent approaches to setting healthcare priorities has become clear. This article assesses processes for setting healthcare priorities in the Province of Alberta. In general, priority-setting was found to involve four steps:

  1. identification of healthcare needs
  2. allocation of resources
  3. communication of decisions to stakeholders
  4. management of feedback from them.

Towards neo-Bismarckian health care states? Comparing health insurance reforms in Bismarckian welfare systems

P. Hassenteufel and B. Palier

Social Policy and Administration, vol. 41, 2007, p. 574-596

Up until now and despite institutional reforms, health insurance systems in France, Germany and the Netherlands have remained Bismarckian in that they are still mainly financed by social contributions, managed by health insurance funds and delivering public and private health care. This is due to the incremental strategy chosen for the introduction of structural change. Changes are embedded in the existing institutions and occur without revolution in the system. In the new world, health insurance systems combine universalisation through the state and marketisation based on regulated competition; they associate more state control (directly or through agencies) with more competition and market mechanisms.

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