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

Analysis of satisfaction about new cooperative medical scheme and its influencing factors in Weihai, China

J. Liu and others

Health Policy, vol. 86, 2008, p.239-244

The New Cooperative Medical Scheme (NCMS) offers health insurance against the costs of serious illness to people in rural China. Participation in the scheme is voluntary. It is organised and supported by the Chinese government, and funded jointly by individuals, the government and the collective. This survey of 4303 rural residents in Weihai found that 73.2% of subjects were satisfied with the scheme. Results also showed that:

  • Beneficiaries who had been admitted to hospital were more satisfied with the scheme than those who had not
  • Older people were more satisfied with the scheme than younger ones
  • Satisfaction rates could be improved by offering more free health check-ups
  • People with the worst self-rated health were least satisfied with the scheme

Collaboration between practice, policy and research in local public health in the Netherlands

M.W.J. Jansen and others

Health Policy, vol. 86, 2008, p. 295-307

This study investigated the barriers which prevent the collaborative development of public health policy, practice and research. Successful collaboration was defined as concerted action between local government, higher education and regional health services in the Netherlands which lasted beyond the initial funding period. Practical strategies to support collaboration in tackling six different public health problems were studied. The authors conclude that successful collaboration is more likely when administrative, institutional and individual changes among the partners are tuned to each other. Findings further suggest that organisational development strategies that address collaboration at the institutional level make a relatively strong contribution.

Competing norms: Canadian rural family physicians' perceptions of clinical practice guidelines and shared decision-making

A. Boivin, F. Légaré and M.-P. Gagnon

Journal of Health Services Research and Policy, vol. 13, 2008, p. 79-84

Clinical practice guidelines (CPGs) and patient participation in decisions about their care play an increasing role in primary care in all developed countries. Some authors have argued that CPGs, by providing a synthesis of the research literature, can inform decision-making and enhance patient autonomy. Others warn that CPGs standardise clinical practice and limit the patient's role in decision-making. Focus group interviews with 17 family doctors and residents in a rural Canadian town showed that physicians feel a tension between the need to consider patients' preferences and the pressure to adhere to guidelines.

Cross-border health activities in the Euregios: good practice for better health

H. Brand and others

Health Policy, vol. 86, 2008, p. 245-254

Cross-border cooperation in healthcare has a long tradition in the European Union, especially through transfrontier structures known as Euroregions. This article presents an overview and analysis of cross-border health-related activities in the Euroregions, based on surveys carried out by the EU evaluation project EUREGIO - Evaluation of Border Regions in the European Union. Results showed that 37 Euroregions had established health-relevant working groups, working circles, forums or projects. The cross-border health projects covered a wide range of issues including, education and training, patient care, prevention and disaster control. Target groups were in most cases medical personnel, patients or decision-making bodies. However, the survey showed a lack of publicly available information about the projects.

Cultural racism, language prejudice and discrimination in hospital contexts: an Australian study

M.-J. Johnstone and O. Kanitsaki

Diversity in Health and Social Care, vol. 5, 2008, p. 19-30

The failure to provide culturally and linguistically appropriate healthcare has been substantively implicated in racial and ethnic disparities in health. Recent research has also suggested that non-English speaking patients may be at disproportionate risk of being victims of medical errors leading to permanent disability or even death. This article describes the specific phenomenon of language prejudice and discrimination as a form of racism uncovered during a broader study of cultural safety and cultural competency in an Australian hospital. People who did not speak English proficiently or at all were at risk of being evaluated negatively and excluded from important healthcare relationships and resources. Patients were obstructed from access to qualified health interpreters and staff whose first language was not English were not respected or included as knowledgeable members of the healthcare team.

Decentralizing resource allocation: early experiences with district health boards in New Zealand

T. Ashton and others

Journal of Health Services Research and Policy, vol. 13, 2008, p. 109-115

In New Zealand in 2001, a system of purchasing health services by a centralised agency was replaced by 21 district health boards, which are responsible for both providing health services directly and for purchasing services from non-government providers. The government has set a number of objectives for the boards which are pertinent to the way in which funds are allocated and services purchased. This article describes the processes associated with the allocation of health resources in the decentralised system, and considers the extent to which four of the government's stated objectives are likely to be achieved.

Evaluation of chronic disease management on outcomes and cost of care for Medicaid beneficiaries

N.J. Zhang and others

Health Policy, vol. 86, 2008, p. 345-354

Medicaid expenditures are currently the fastest growing segment of overall state budgets. Increasingly state governments have responded by proposing programme cuts. Disease management programmes have also been recognised as effective in minimising use of emergency care, hospital admissions and prescriptions, and consequently cutting costs. This study evaluated the impact of a chronic disease management programme on patient outcomes and costs of care for Virginia Medicaid beneficiaries. Findings indicate that the disease state management programme significantly improved patents' drug compliance and quality of life, while reducing emergency department, hospital and physician office visits and adverse events.

Health economics: an international perspective. 2nd ed.

B. McPake and C. Normand

Abingdon: Routledge, 2008

The book provides comprehensive coverage of health economics principles and applications. Beginning with a look into simple models of supply and demand within health care, the book moves on to techniques of cost-benefit analysis, and then compares differing health care systems around the world. It provides an understanding of the performance of different health systems, from insurance-based approaches employed in the United States to the publicly-funded options more common in Europe and Canada, and the mixed arrangements characteristic of most developing countries.

Health human resource planning in Canada: a typology and its application

D. Wranik

Health Policy, vol. 86, 2008, p. 27-41

In spite of the strategic importance of human resources management in healthcare settings, the subject has been given little attention in the research literature. This article investigates human resources planning within the Canadian health care system through a series of group interviews with key stakeholders. The interviews revealed that innovative health human resources models arose primarily in response to perceived needs at the front line. At the same time top down strategic health human resources initiatives were implemented by government policymakers based on population level estimates of need. The research revealed a large disconnect between top down and bottom up approaches to health human resources planning. It makes two contributions to the debate: a classification of Canadian health human resources models and proposals for the creation of a new type of health professional role, the collaboration agent. The collaboration agent would provide leadership for innovative frontline health human resource planning initiatives, and also mediate between these and central government strategic policymakers.

Health system responses to 25 years of HIV in Europe: inequities persist and challenges remain

R.A. Atun and others

Health Policy, vol.86, 2008, p. 181-194

This paper draws on a rigorous review of the literature in English, combined with the authors' own research and experience, to explore the varied responses of European health systems to the HIV epidemic. In Western Europe multi sectoral, client-centred interventions integrated into mainstream health systems have evolved, but inequities in access remain for marginalised groups. In central Europe, health system responses have been strong, but there are gaps in coverage for intravenous drug users and commercial sex workers, particularly in Moldova. Eastern European countries still face a formidable challenge, as an effective response to the epidemic must contend with rapidly changing, hostile macro- and microenvironments, as well as the confluence of the HIV epidemic with drug abuse, venereal disease and TB epidemics. The health system responses in Eastern Europe have been hindered by weak leadership, inadequate multi sectoral coordination, verticalised services with poor horizontal linkages, ineffective coalition-building with civil society, and the varying interpretations of the law.

Horizontal inequities in Australia's mixed public/private health care system

E. van Doorslaer and others

Health Policy, vol. 86, 2008, p. 97-108

Australia provides universal access to healthcare through a publicly financed scheme known as Medicare. It also has a significant private sector, with private expenditure constituting around 32% of total health expenditure. Since 1996, government has encouraged the growth of private health insurance through tax incentives and subsidies. This article analyses data from the 2001 Australian National Health Survey to explore whether the mixed public/private healthcare system provides equitable access to medical care. It is concluded that Medicare does appear to be attaining an equitable distribution of health care access: all Australians in need of care do get to see a doctor and are admitted to hospital. However, the better-off are more likely to consult a specialist while those on lower incomes visit a general practitioner. Those on higher incomes are also more likely to be admitted to hospital as a private patient. The unequal distribution of private health insurance by income contributes to the phenomenon that the better-off and the less well off do not receive the same mix of services.

Improvements in the safety of patient care can help end the medical malpractice crisis in the United States

G.D. Dalton, X.F. Samaropoulos and A.C. Dalton

Health Policy, vol. 86, 2008, p. 153-162

The medical insurance system in the United States is currently embroiled in a major malpractice crisis, in which physicians are struggling to acquire insurance against liability for medical errors. Improvements in patient safety are needed to reduce the current high incidence of medical errors and must include the establishment of a culture of safety in every healthcare facility. Common features of a culture of safety include:

  1. creation of a blame free environment
  2. readiness to report errors
  3. an emphasis on teamwork and effective communication
  4. an organisational commitment to systems analysis and redesign to improve safety.

Just health: meeting health needs fairly

N. Daniels

Cambridge: Cambridge University Press, 2008

The book develops a comprehensive theory of justice for health that answers three key questions: What is the special moral importance of health? When are health inequalities unjust? How can we meet health needs fairly when we cannot meet them all? The theory has implications for national and global health policy: Can we meet health needs fairly in ageing societies? Or protect health in the workplace while respecting individual liberty? Or meet professional obligations and obligations of justice without conflict? When is an effort to reduce health disparities, or to set priorities in realising a human right to health, fair? What do richer, healthier societies owe poorer, sicker societies? The book explores the many ways that social justice is good for the health of populations in developed and developing countries.

Seed funding for health promotion: sowing sustainability or skepticism?

J.W. Higgins, P.-J. Naylor and M. Day

Community Development Journal, vol. 43, 2008, p. 210-221

Health promotion projects are enjoying renewed attention from governments under the banner of disease prevention, but funding allocated is often inadequate. Small grants to groups working in partnership are popular means for governments to distribute monies and groom communities to embed the funded activities into local ecology. The success of this seed funding in nurturing community capacity and engendering programme sustainability is controversial. This article discusses a recent seed-funding experience in the Canadian province of British Colombia.

'Southern-style' National Health Services? Recent reforms and trends in Spain and Greece

M. Petmesidou and A.M. Guillén

Social Policy and Administration, vol. 42, 2008, p. 106-124

Universal National Health Services were introduced in Greece in 1983 and Spain in 1986, replacing mature social insurance health care systems. Only a few years after health reform laws were enacted, an era of economic austerity began, which brought the need for efficiency and cost control in service provision. This article addresses the question of whether economic austerity has hindered full implementation of the reforms enacted in the early to mid-1980s, examining reform trajectories and financing and expenditure trends. It also considers the impact of austerity on access, the range of services provided, waiting lists and territorial inequalities. Finally it discusses the introduction of new managerial formulas and attempts at enhancing efficiency.

Who is willing to pay for long-term care insurance in Catalonia?

J. Costa-Font and J. Rovira-Forns

Health Policy, vol. 86, 2008, p. 72-84

The financing of long-term care for older people is a top policy concern in Europe in the light of population ageing. Spain introduced a tax funded scheme offering means-tested long term care services in 2007. However, as its coverage is limited there may still be a market for private insurance. This article reports an exploratory analysis of willingness to pay for long term care insurance in Catalonia. Results suggest that demand for long term care insurance may be limited at 'reasonable' insurance premiums, with only 16-21% of the population appearing willing to pay. Willingness to pay is influenced by the individual's perception of old age disability risk and housing tenure. Willingness to pay rises among middle-aged people and declines among house owners, given that such individuals might be able to self-insure.

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