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Welfare Reform on the Web (May 2000): Health Care - Overseas

CHOICES IN DUTCH HEALTH CARE: MIXING STRATEGIES AND RESPONSIBILITIES

T.E.D. van der Grinten and J.P. Kasdorp

Health Policy, vol. 50, 1999, p. 105-122

The paper examines how Dutch policy-makers have dealt with the priority issue in health care over the past 10 years by means of a gradual incremental approach. In this approach, use is made of a mix of strategies and shared responsibilities, with an important role for the actors at the meso and the micro levels; while at the same time, the government has not abandoned the tried and trusted policy of national rationing. The degree to which the system can respond adequately to likely developments, such as recession, worsening waiting lists, application of market forces and the ongoing integration of 'Europe' is questioned.

CLARIFYING THE SCOPE OF ITALIAN NHS COVERAGE. IS IT FEASIBLE? IT IS DESIRABLE?

G. Fattore

Health Policy, vol. 50, 1999, p. 123-142

The reduction in National Health service expenditure as a share of total health care expenditure, the fragmentation of the NHS into 21 regional systems and the implementation of a 'quasi-market' on the provider side has pressed the government to define and specify the set of services that are to be guaranteed by the public sector. To understand whether rationing can be more rational and explicit in the Italian NHS, the following are analysed:

  • the new positive list of drugs;
  • the Di Bella case, as an example of the difficulties of rational policy-making on sensitive issues;
  • what Italian people think about health care rationing and priority setting;
  • the criteria defining the set of 'essential services' to be guaranteed to all Italian citizens, which are contained in the National Health Plan.

DRUG COST CONTAINMENT POLICIES IN ITALY: ARE THEY REALLY EFFECTIVE IN THE LONG-RUN? THE CASE OF MINIMUM REFERENCE PRICE

V. Atella

Health Policy, vol. 50, 2000, p. 197-218

Paper evaluates the long-run effects of the minimum reference price (MRP) policy adopted recently in Italy in order to contain drug expenditure. The evaluation is based on an econometric model of the demand for drugs, based on data covering the period from 1963 to 1994. Results from the simulation exercises have proved that the tendency of the pharmaceutical expenditure is to raise again after a few years of control. A cost containment policy that acts on prices alone can have serious implications in terms of welfare.

EQUITY IN THE FINANCING OF SOCIAL SECURITY FOR HEALTH IN CHILE

R. Bitran at al

Health Policy, vol. 50, p. 171-196

Real public health spending has more than doubled in Chile since 1990. This study examined the degree of equity in the financing of FONASA, the public insurer, which covered 62% of the population. Study results indicated that:

  • government health subsidies were well-targeted;
  • only 2.5% of subsidies leaked to higher-income, non-beneficiaries of FONASA;
  • FONASA's contributing beneficiaries self-financed their health benefits;
  • the indigent received the highest amount of annual net benefits per capita;
  • the evasion of payroll tax was pervasive.

Compulsory affiliation of workers to health social security would improve FONASA's finances.

HEALTH REFORM FOR CHILDREN: THE EGYPTIAN EXPERIENCE WITH SCHOOL HEALTH INSURANCE

A. K. Nandakumar et al.

Health Policy, vol. 50, 2000, p. 155-170

The paper reviews Egypt's experiences with the School Health Insurance Program. The paper first examines policy processes, then the implementation and consequences of the user policy in terms of coverage, financing, benefits, and delivery of services. The final section discusses the economic consequences of compromises necessary for achieving political feasibility.

MANAGED CARE IN THE UNITED STATES: A DILEMMA FOR EVIDENCE-BASED POLICY

R. Robinson

Health Economics, vol. 9, 2000, p. 1-7

Findings of literature reviews suggest that managed care contains costs without compromising quality of care or leading to less favourable outcomes than fee-for-service alternatives. In spite of this there is profound patient dissatisfaction with the performance of managed care, which creates a dilemma for health policymakers.

MANDATED HEALTH INSURANCE AND THE LOW-WAGE LABOR MARKET

D. R. Lee and R. S. Warren

Journal of Labor Research, vol. 20, 1999, p. 505-515

Argues that legislation compelling employers to provide health insurance cover for their staff is counter-productive in that it reduces labour-market flexibility and so adversely affects the efficiency of the economy as a whole.

PRICING LIFE: WHY IT'S TIME FOR HEALTH CARE RATIONING

P. A. Ubel

Cambridge, Mass. London, MIT, 2000

The author argues that physicians, health insurance companies, managed care organisations, and governments need to consider the cost-effectiveness of many new health care technologies. Ubel believes that standard medical training should provide physicians with the expertise to decide when to withhold health care from patients. He incorporates ethical arguments about the appropriate role of cost-effectiveness analysis in health care rationing, empirical research about how the general public wants to ration care, and clinical insights based on his practice of general medicine.

PRIORITIES IN HEALTHCARE: A PERSPECTIVE FROM SPAIN

I. Gaminde

Health Policy, vol. 50, 1999, p. 55-70

The paper aims to describe the process of transformation over the past two decades in the Spanish health care system. The main emphasis is on priority setting and rationing at different levels. On the supply side, the policies have focused on limiting the scope of pharmaceutical benefits in the system, and establishing a guaranteed healthcare package. On the consumer side, the main measures reviewed are copayments. Finally, a discussion of the research that has been done on public opinion about rationing is presented.

PRIORITY-SETTING AND RATIONING IN GERMAN HEALTH CARE

R. Busse

Health Policy, vol. 50, 1999, p. 71-90

While the framework for the German statutory health insurance system is determined at the national level and the states have a significant influence on the provision of hospital care and public health services, most decisions on the actual delivery of curative health care are made through joint negotiations between the associations of the physicians and the sickness funds at various levels. The public continues to favour the idea of health care system with unlimited funding for an unlimited range of benefits and doctors making decisions for individual patients. Currently, however, a shift towards evidence-based medicine, health technology assessment, etc as well as the will to cut benefits accordingly can be observed. Germany seems to be just at the beginning of a public debate on priority-setting and rationing in health care.

PRIORITY-SETTING IN AUSTRIA

A. Stepan and M. Sommersguter-Reichmann

Health Policy, vol. 50, 1999, p. 91-104

The description of the Austrian health care system is followed by a discussion of the theoretical framework and practical application of health policy goals and rationing techniques relevant for Austria. Subsequently, the results of a Eurobarometer survey on Austrian's view on rationing and priority setting are presented.

PRIORITY-SETTING IN FINNISH HEALTHCARE

P. Rissanen, U. Hakkinen

Health Policy, vol. 50, 1999, p. 143-153

The paper focuses on the Finnish healthcare system and its financing, and on the major characteristics of this system which influence the actual allocation of resources. It also discusses some prioritisation mechanisms incorporated into the economic incentives of the system, and the major principles which are applied in priority-setting for patient-level choices.

PRIORITY-SETTING IN HEALTH POLICY IN SWEDEN AND A COMPARISON WITH NORWAY

J. Calltorp

Health Policy, vol. 50, 1999, p. 1-22

The paper reviews priority setting policies during the last 10 years in Sweden and Norway. Both countries have health systems with pronounced public character. They also have National Priority Commissions that have developed general documents providing advice on how to set priorities. Resource constraints and the rapid restructuring of the health case system were important characteristics forming the background for the National Priority Commission in Sweden (1995). The Norwegian National Priority Commission was set up in 1987 to investigate the setting of limits for health care in a society with rapidly increasing wealth. The second Norwegian Commission (1997) initially reviewed the effects of the general principles for priority setting and demonstrated the importance of linking them to steering tools within health care services.

RATIONING HEALTH CARE IN FRANCE

P. J. Lancry and S. Sandier

Health Policy, vol. 50, 1999, p. 21-38

This paper discusses the main features of the financing and provision of health care services in France, and focuses on issues related to priority setting and rationing. Over the last 20 years, changes have been implemented which affected the demand and supply of health care services, as well as their prices. Attempts to control demand focused mainly on the increase of user charges. Control over supply consisted in limiting the number of health professionals and restricting hospital beds. The French public authorities had set a general system of administrative prices and implemented global budgets for public hospitals. Since 1996 the Parliament has been involved in setting national expenditure targets for sickness funds, the experimentation with a gatekeeping system, the development of practice guidelines and quality controls through the accreditation of hospitals.

THE REORIENTAITON OF MARKET-ORIENTED REFORMS IN SWEDISH HEALTH-CARE

M. Harrison, J. Calltorp

Health Policy, vol. 50, 2000, p. 219-240

Sweden was an important pioneer of market-oriented reform in publicly funded health-care systems. This study accounts for the rise and modification of Sweden's competitive reforms in terms of bargaining and interaction among the country's major policy actors. It concludes that Sweden's reforms were more than a passing policy fashion and that Sweden may be entering yet another phase of experimentation with market mechanisms.

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