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Welfare Reform on the Web (April 2008): Healthcare - overseas

Achieving successful EPR implementation with the penta-stage model

R.K. Bali and N. Wickramasinghe

International Journal of Healthcare Technology and Management, vol. 9, 2008, p. 97-105

Electronic patient record (EPR) systems are currently being implemented in a plethora of healthcare organisations in the UK and the USA. These systems, through their ability to integrate several functions and provide seamless access to information, are expected to enable the delivery of patient-centred and value-driven healthcare. However, EPR implementation has major organisational and cultural implications that have not been addressed and thus play a major role in the less than optimal results of its introduction to date. The authors argue that more successful EPR implementation could be achieved through the use of the penta-stage model which has been developed through the analysis of various projects in the UK and USA.

Cost-effectiveness analysis in health: a practical approach. 2nd ed.

P. Muennig

San Francisco: Jossey-Bass, 2008

The book reviews issues and methods of assessing health care technologies and related programmes. It emphasizes methods for performing economic evaluations, such as cost-effectiveness and cost-benefit analysis; methods to assess efficacy, effectiveness, and safety of health care technologies; effectiveness research; and applications to clinical and public policy. The book provides in-depth discussion of the uses and conduct of cost-effectiveness analyses as decision-making aids in public health, health services, and medicine. It explores cost-effectiveness in the context of societal decision making for resource allocation purposes. Chapter topics include: Defining and explaining cost-effectiveness, principles of cost-effectiveness analysis, how to develop a research project, working with costs, probabilities and models, calculating life expectancy, working with health-related quality of life measures, calculating quality-adjusted life years and conducting a sensitivity analysis.

Costs and determinants of privately financed home-based health care in Ontario, Canada

D.N. Guerriere and others

Health and Social Care in the Community, vol. 16, 2008, p. 126-136

The Canadian context in which home-based healthcare services such as nursing and personal support are delivered is characterised by limited resources and escalating costs. As a result, home care recipients now receive a mixture of publicly and privately financed services. This study sought to:

  1. determine how costs are split between families and the healthcare system
  2. assess the determinants of privately financed home care
  3. identify whether public and private expenditures are complements or substitutes.

The regression model indicated that age, gender, extent of activities of daily living (ADL) impairment, number of chronic conditions, and the interaction between both public expenditure and ADL level and age and number of chronic conditions increased private expenditure. Analysis of the relationship between private and public expenditure indicated that increased public expenditures were associated with increased private expenditures, suggesting that the two types of expenditure complemented each other.

The crisis in human resources for health care and the potential for a 'retired' workforce: case study of the independent midwifery sector in Tanzania

B. Rolfe and others

Health Policy and Planning, vol. 23, 2008, p. 137-149

The human resource crisis in health care means that many countries are far from reaching the health-related Millennium Development Goals (MDGs). Factors contributing to this crisis include mal-distribution and low workforce productivity combined with a shortage of skilled workers in the government health sector. One strategy to alleviate strain upon government services has been to encourage various forms of private provision, but there are concerns that this may contribute to the drain of scarce expertise from government services. This article presents findings on the drivers and inhibitors acting upon the development of one new element of non-government provision in Tanzania - the small-scale independent midwifery practice run by retired nursing officers - and considers what contribution this sector may be expected to make to the MDG target of increasing skilled attendance at delivery. It is concluded that sustainability and utilisation of independent clinics in poor communities requires supportive measures such as reform of the costly registration procedures for practices and consideration of on-going financing arrangements such as micro-credit for users, contracting or vouchers.

Global health and global aging

M. Robinson and others (editors)

San Francisco: Jossey-Bass, 2007

The book covers the fundamentals of global aging and health and provides real-world models from countries and regions that offer best practices. It presents information about leadership and governance challenges as well as insights about aging in different cultures and countries in all regions of the world. The book explores the factors that contribute to high rates of longevity and shows how countries including Denmark, France, Finland, Germany, Japan, the Netherlands, Spain, Sweden, the United Kingdom, and the United States contribute to the overall health of their populations. The book also outlines the challenges facing specific countries such as Russia, India, and China that have rapidly aging populations. It delves into recent research findings that identify factors conducive to successful aging and outlines the key ways that a global society can influence how we age. Research scholars in global aging and health, finance and pensions, housing, education, employment, transportation and disability, and public policy identify findings that offer hope and expand optionsavailable to young and old for healthy aging.

Global health governance: conflicts on global social rights

W. Hein and L. Kohlmorgen

Global Social Policy, vol. 8, 2008, p. 80-108

This article analyses the impact of new institutional structures in global health governance on the realisation of social rights in poor countries, focusing on the example of global HIV/AIDS politics. Due to the hegemony of neoliberal concepts in economic globalisation in the 1980s and 1990s, progress on the realisation of social rights was slow in most developing countries as priority was given to economic growth. Since the mid-1990s it has been realised that poverty reduction and health improvement do not automatically result from economic growth. Today poverty reduction and health improvement are among the top issues on the global political agenda, especially where they are seen as threatening economic and political stability. The fight against diseases like HIV/AIDS is now being taken forward by partnerships between national governments seeking to ensure political stability, transnational corporations in pursuit of profits, and civil society organisations advocating for social rights. The new structure tends to bypass international organisations such as the World Health Organisations.

Health, human rights and the United Nations: inconsistent aims and inherent contradictions?

T. MacDonald

Oxford: Radcliffe, 2008

The book analyses the origin, development and structure of the United Nations (UN) and its key agencies, and considers its capacity to mediate the Universal Declaration of Human Rights. It takes a detailed look at human rights abuses in Sudan's Darfur province, Burma, Liberia, the Occupied Palestinian Territories and the United Kingdom. By investigating the development of the World Health Organization (WHO) and the pressures being brought to bear upon it, the book exposes contradictions in the aims of both the WHO and the UN. Does the current global political scene and its neoliberal policies nullify the work of both? Is the UN fit for purpose? Can drastic reforms result in equitable solutions? Can a new trans-national body be developed, to arbitrate global trade, health, human rights and fiscal issues? The book seeks to answer these questions and proposes that at the very least the UN needs to be reformed, both organizationally and philosophically.

Has donor prioritization of HIV/AIDS displaced aid for other health issues?

J. Shiffman

Health Policy and Planning, vol. 23, 2008, p. 95-100

As donor attention to the prevention, control and treatment of HIV/AIDS increases, there is concern that funding for tackling other diseases that afflict the poor may have been adversely affected. In order to investigate this issue, the author considers funding from major donors for health improvement from the early 1990s, focusing on HIV/AIDS, population, health sector development and infectious diseases control. Several trends indicate possible displacement effects, including HIV/AIDS' rapidly growing share of total health aid, a concurrent global stagnation in population aid, the priority HIV/AIDS receives in US funding, and HIV/AIDS aid levels in several Sub-Saharan African states that approximate or exceed their entire national health budgets. On the other hand, aggregate global funding for health and population quadrupled between 1992 and 2005, allowing for funding growth for some other health issues even as HIV/AIDS acquired an increasingly prominent place in donor health agendas.

Identifying sources of resistance to change in healthcare

R. E. Landaeta and others

International Journal of Healthcare Technology and Management, vol. 9, 2008, p. 74-96

The pace of change in healthcare is accelerating and will remain rapid due to market shifts and the introduction of new technologies and treatments. The authors postulate that there may be sources of resistance to change among healthcare personnel that differ from those found in in other sectors, such as manufacturing. This hypothesis was tested using a phenomenology approach to identifying sources of resistance to change in the formulation and implementation stages of an initiative at Sentara Leigh Hospital, in Norfolk, Va. The research confirms that there may sources of resistance to change that are unique to healthcare personnel.

Key topics in healthcare management: understanding the big picture

R. Jones and F. Jenkins (editors)

Oxford: Radcliffe, 2007

This volume considers key topics in management, leadership and development in the Allied Health Professions (AHPs). It sets out various approaches and provides a range of information to enhance the evidence base, knowledge, understanding and skills to support managers, leaders and clinicians. It assists in managing and leading services pro-actively, effectively and efficiently. With contributions from internationally renowned professionals, the book covers topics including care pathways, quality, user involvement, managing staff and communication.

Maternal health

House of Commons International Development Committee

London: TSO, 2008 (House of Commons Papers session 2007-08; HC 66)

This report by the House of Commons International Development Committee examines how the UK Department for International Development (DFID) and other donors can support progress towards Millennium Development Goal five, to reduce the level of maternal mortality worldwide and attain universal access to reproductive health by 2015. The report looks at why maternal health is so central to development and how addressing socio-cultural inequalities such as gender and poverty can help reduce maternal deaths. It also highlights what can be done at a global level, particularly by DFID, and identifies strategies for success, focusing on approaches that have been proven to work in preventing maternal deaths and whether these can be replicated at scale. Strategies include: boosting the numbers of midwives worldwide; increasing the availability and quality of training opportunities for them; increasing the availability of equipment and supplies; and supporting improved health information systems. The report recommends that DFID needs to prioritise carefully and support other actors, especially the UN, in playing their part to ensure that maternal health receives the urgent political commitment that it deserves. In particular it recommends that DFID should:

  • find new ways to help governments encourage health professionals to provide quality services in remote and rural areas
  • work with the World Health Organization to advocate with national governments for national essential drugs lists to contain drugs that are crucial to maternal survival
  • seek to build political commitment within countries to ensure that crucial medical supplies are appropriately funded within national health plans and budgets
  • advocate within the UN system for maternal, sexual and reproductive health to be prioritised in humanitarian emergencies

Organizing for quality: the improvement journeys of leading hospitals in Europe and the United States

P. Bate, P. Mendel and G. Robert

Oxford: Radcliffe, 2008

The book draws on the findings from an international study designed to help practitioners and researchers understand the factors and processes that enable healthcare organisations in the United States and Europe to achieve - and sustain - high quality services for their users. The in-depth case-studies from seven leading hospitals give an international, evidence-based outlook that focuses on both the organisational and cultural processes of quality improvement. Implication for research and practice are considered, and a checklist of possible challenges has been drawn up to help identify any 'gaps' in initiatives.

Peruvian leaders cry foul as Chavez exports healthcare

R. Carroll and A. Schipani

The Guardian, March 24th 2008, p. 23

A healthcare initiative in Peru led by Venezuelan president Hugo Chavez has led to claims that Chavez is simply using the scheme as a front for promoting political agitation and supporting Peruvian militants. The Mision Milagro Mission Miracle scheme flies poor Peruvians with eyesight damage to Venezuela for free surgery.

Public social policy development and implementation: a case study of the Ghana National Health Insurance scheme

I.A. Agyepong and S. Adjei

Health Policy and Planning, vol. 23, 2008, p. 150-160

Though social policy reform has technical as well as political challenges, inadequate attention is paid to recognizing, analysing and dealing effectively with the political challenges. In 2001, Ghana, a low-income developing country in Sub-Saharan Africa, embarked on a process of developing a National Health Insurance scheme to replace out-of-pocket fees for medical treatment at the point of use. Despite high-level political commitment, popularity of the proposed reform and availability of information on technical challenges, limited understanding and management of the political challenges resulted in potentially avoidable difficulties. There is a need to promote better dissemination, understanding and use of analytical frameworks on the political economy of reform in developing countries to assist reformers to manoeuvre within the challenges of the environmental context, agenda-setting circumstances, and policy characteristics of reform.

Review of corruption in the health sector: theory, methods and interventions

T. Vian

Health Policy and Planning, vol. 23, 2008, p. 83-94

Corruption, defined as misuse of entrusted power for private gain, is a pervasive problem in the health sector, with negative effects on health status and social welfare. Several tools exist to help define the problem and measure corruption, including expenditure surveys, corruption perception surveys, qualitative data collection and control systems reviews. A theoretical framework is presented in this article to guide policymakers in examining corruption in the health sector and identifying possible ways to intervene to increase accountability, transparency, citizen voice, detection and enforcement, and to control discretion and reduce monopoly power.

Sociology, systems and (patient) safety: knowledge translations in healthcare policy

C.B. Jensen

Sociology of Health and Illness, vol. 30, 2008, p.309-324

In 2000 the American Institute of Medicine published the report To Err is Human: Building a Safer Health System, which focused on the functioning of healthcare as a system. By reconceptualising healthcare as a system, the authors argued that it would be possible to move from the existing culture of blame, which caused individuals to avoid being assigned responsibility for error by covering up mistakes, to a culture of safety. The report draws upon the work of several prominent social scientists to help make its case. However, the analyses of these researchers are not immediately relevant to health policy. It requires knowledge translation to make them so. This paper analyses the process of translation.

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