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

The adoption of electronic medical record technology in order to prevent medical errors: a matter for American public policy

J.N. Crane and F.G. Crane

Policy Studies, vol. 29, 2008, p. 137-143

This article argues that the US federal government should mandate through legislation the use of electronic medical records as a way to ensure patient safety. It discusses the scope and nature of the medical error problem in the United States, the causes of medical errors, and use of electronic medical records as a solution to the problem.

Community-based health insurance and access to maternal health services: evidence from three West African countries

K.V. Smith and S. Sulzbach

Social Science and Medicine, vol. 66, 2008, p. 2460-2473

In Sub-Saharan Africa, where poverty is widespread, the decision to seek medical treatment is influenced by cost, including user fees, transport and lost working time. This article explores the impact of an intervention which aims to reduce out-of-pocket expenditure on health services: community-based health insurance. It uses household surveys in three West African countries, Senegal, Mali and Ghana, to examine the relationship between CBHI membership and access to formal sector maternal health care. Results show that membership of a CBHI scheme is positively associated with use of maternal health services, particularly in areas where utilisation rates are very low and for more expensive delivery-related care. However, membership of a scheme by itself is not sufficient to influence maternal health behaviours - it is the inclusion of a comprehensive package of maternal health care benefits in the scheme that makes the difference.

Community health workers and the response to HIV/AIDS in South Africa: tensions and prospects

H. Schneider, H. Hlophe and D. van Rensburg

Health Policy and Planning, vol. 23, 2008, p. 179-187

The response to HIV/AIDS has given rise to a large lay health worker presence in South Africa, comprising home-based carers, lay counsellors, DOT supporters, etc. In 2004 the term community health worker (CHW) was introduced as the umbrella concept for all the lay workers in the health sector and a national CHW policy framework was adopted. This article summarises the key features of the national CHW programme in South Africa, which include their integration into a national public works programme and the use of non-governmental organisations as intermediaries. It then reports on the experience of one Province, Free State. It concludes that CHWs are meeting important new service needs, but can only play meaningful roles in the context of strategies to improve the supply, management and deployment of human resources for health more generally. Strengthened systems are needed for the appropriate support and management of CHWs.

Future health systems

Social Science and Medicine, vol. 66, 2008, p. 2067-2075

This special issue aims to stimulate innovative thinking about health system development in low-income and transition countries. The papers seek to:

  • Rethink present understandings of health systems and the institutional arrangements that have been established
  • Identify trends relevant to the development of health systems, such as economic, social and institutional changes, the emergence of new technologies and changing patterns of health need
  • Identify emergent innovations.

The articles in the special issue are an initial exploration of the field, raising more questions than they answer. They provide glimpses of new realities that are emerging in a number of low and middle income countries. They reveal contexts more complex than many debates about health system reform suggest. They all indicate the extent to which health systems are increasingly co-constructed by multiple actors, local, national and global.

Pandemic influenza preparedness in Africa is a profound challenge for an already distressed region: analysis of national preparedness plans

G. Ortu, S. Mounier-Jack and R. Coker

Health Policy and Planning, vol. 23, 2008, p. 161-169

A new highly pathogenic strain of influenza virus, H5N1, has emerged causing severe outbreaks in poultry and high mortality rates when humans are infected. The threat of a new influenza pandemic has prompted countries to draft national strategic preparedness plans to prevent, contain and mitigate it. While many African countries have strategic pandemic influenza preparedness plans, most are developmental in nature and lack operational clarity, or focus principally on the containment of avian influenza rather than pandemic human influenza.

Preferences and choices for care and health insurance

B. van den Berg and others

Social Science and Medicine, vol. 66, 2008, p. 2448-2459

Legislation that came into effect in 2006 radically altered the health insurance system in the Netherlands. Under the new system, all citizens are required to be covered by private health insurance and all insurers are required to accept all applicants during an annual open enrollment period. Insurance products must offer a legally defined package of basic benefits, but the legislation gives insurers flexibility to design their schemes to better appeal to consumers and the ability to selectively contract with healthcare providers. Coverage is financed by a mixture of community-rated premiums set by insurers and income-related contributions set by the government and paid by employers. This study provides initial evidence on the preferences of Dutch consumers and how they view trade-offs between various aspects of health insurance product design.

'The problem of the worst-off is dealt with after all other issues': the equity and health policy implementation gap in Burkina Faso

V. Ridde

Social Science and Medicine, vol. 66, 2008, p. 1368-1378

The 1987 Bamako Initiative aimed to improve the quality and accessibility of healthcare services in Africa. A stock of essential generic drugs is given to a village dispensary. The drugs are sold to patients and the profits are used to purchase replacement stocks. The Bamako Initiative was launched in Burkina Faso in 1993. This paper presents a case study of the implementation of the Bamako Initiative in Burkina Faso which explored its focus on efficiency at the expense of equity. The research shows that:

  1. the equity aspect of the reform was omitted during training on the use of the proceeds of the drug sales
  2. donor and aid agencies were preoccupied with efficiency rather than equity
  3. reaching the worst off was not a priority with frontline workers
  4. decisions were made centrally without consultation and were not followed up.

Targeting the poor in times of crisis: the Indonesian health card

R. Sparrow

Health Policy and Planning, vol. 23, 2008, p. 188-199

In an attempt to protect access to healthcare for the poor during the Indonesian economic crisis, the health card programme was introduced in August 1998 as part of the larger social safety net. Households thought to be most vulnerable to economic shocks were allocated health cards, which entitled all family members to subsidised treatment at public healthcare facilities. By February 1999, 22 million people had received a health card. The programme followed a partly decentralised targeting process, involving both geographic and community-based targeting instruments. The health card programme was pro-poor in the sense that the poor had a higher probability of receiving a health card and using it to obtain free health services, but a considerable number of cards went to wealthier households. Moreover, some health card owners did not use it when obtaining care from public facilities.

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