Welfare Reform on the Web (September 2008): Healthcare - overseas
Addressing legal and political barriers to global pharmaceutical access: options for remedying the impact of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and the imposition of TRIPS-plus standards
J.C. Cohen-Kohler, L. Forman and N. Lipkus
Health Economics, Policy and Law, vol.3, 2008, p. 229-256
The major conundrum in international drug policy is that despite international aid and a plethora of programmes devoted to improving global pharmaceutical access, drugs remain unavailable to those in the developing world who need them most. While poverty and insufficient infrastructure are significant causes of the drugs gap, so to a considerable extent are market and public sector failures. The authors suggest that international trade rules perpetuate and exacerbate drug inaccessibility, considerably restricting policy options for accessing affordable medicines. Specifically, this article explores the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and the TRIPS-Plus standards evident in bilateral and regional free trade agreements. It argues that several policy routes should be taken to mitigate the impact of TRIPS and TRIPS-Plus rules, including greater use of TRIPS flexibilities, advancement of human rights, an ethical framework for essential medicines distribution and a broader campaign that debates the legitimacy of TRIPS and the TRIPS-Plus standards themselves.
Choosing paths in European Union health services policy: a political analysis of a critical juncture
S.L. Greer
Journal of European Social Policy, vol. 18, 2008, p. 219-231
The organisation and financing of health services are the responsibility of the member states of the European Union. However, although the founding treaties of the EU explicitly confine the powers of EU institutions to certain public health issues, they are beginning in fact to shape health service policy through internal market law. The EU health policy arena is a rapidly changing system in which the borders defining policy, the institutions making policy and the structural balance of powers between states and interest groups are still to be determined. This article makes four points: 1) EU health policy is at a critical juncture, a moment at which decisions are highly contingent but, once taken, will shape policy for the future; 2) this critical juncture was created by reactions of the member states and the Commission to challenges created by European Court of Justice decisions; 3) decisions are difficult to predict but, once made, will be hard to change; and 4) several different models are being put forward for the EU.
A cluster analysis and time series approach to examine healthcare expenditure and convergence among Taiwan and the OECD countries
D. H.-M. Wang and T. H.-K. Yu
International Journal of Behavioural and Healthcare Research, vol. 1, 2008, p. 61-69
Healthcare expenditure in Taiwan and in the OECD countries has increased significantly in recent years. This study investigates whether healthcare expenditure in Taiwan is gradually converging with or exceeding levels in the OECD countries. Results show that the growth trend in Taiwan's healthcare expenditure is still in its appropriate domain.
Consumer-directed health care: promise or puffery?
D. Callahan
Health Economics, Policy and Law, vol. 3, 2008, p. 301-311
Consumer-directed health care is one of the ideas that has emerged in America as a way of increasing efficiency and controlling costs. Its principal aims are to give patients greater control over their care economically as well as medically, and to improve competition among providers to increase the range of patient control. It springs from American distrust of government, a worry about rising costs, and an appeal to the popularity of choice in almost all matters. It draws particularly on the business community as a source of ideas and inspiration. The author questions whether defining the patient as a discriminating consumer is sensible in the face of serious illnesses and complex decision-making situations. Scepticism is in order.
Electronic health records approaches and challenges: a comparison between Malaysia and four East Asian countries
M.K.A. Ghani and others
International Journal of Electronic Healthcare, vol. 4, 2008, p. 78-104
An integrated Lifetime Health Record (LHR) is fundamental for achieving seamless access to patient medical information and for ensuring continuity of care. This paper presents an overview of the approaches to the development of LHRs in the public health system taken by Japan, Singapore, Hong Kong, Taiwan and Malaysia. The review reveals a number of major challenges:
- Lack of existing system integration capability
- The need for process reengineering to facilitate integration
- Staff training and development
- Obtaining funding
- Putting in place appropriate laws, regulations and standards
The 'Papy-boom': a historical opportunity for French public hospitals
R. Holcman
International Social Security Review, vol. 61, no.3, 2008, p. 95-116
The cost of running the French public hospital system represents a major element of the country's overall social security expenditure. A very high proportion of total hospital expenditure is devoted to staff costs. In spite of financial pressures, it has proved impossible to reduce the size of the workforce because the vast majority of French public hospital employees are civil servants with career contracts. However, the retirement of the 'baby-boom' generation over the next decade presents a window of opportunity for effecting major change in the size and composition of the hospital workforce.
Pay for performance in Australia: Queensland's new clinical practice improvement payment
S. Duckett and others
Journal of Health Services Research and Policy, vol.13, 2008, p. 174-177
Following a high profile scandal about the quality of care in one of Queensland's regional centres, the health authority introduced a pay for performance element into its new hospital funding model. The Clinical Practice Improvement Payment system pays hospitals for the achievement of clinical process indicators. The first payments using pay for performance were made for work carried out up to June 2008. Although no data yet exist as to the impact of the new system, pay for performance appears to be gaining widespread acceptance.
Personal health records: key adoption issues and implications for management
M.S. Raisinghani and E. Young
International Journal of Electronic Healthcare, vol.4, 2008, p. 67-77
Electronic personal health records (PHRs) have been seen as a tool for empowering consumers to become active decision-makers as regards their healthcare. However there has been a lack of enthusiasm for PHRs. This paper examines the current healthcare climate and attempts to understand the major challenges associated with PHR adoption. There has been little empirical research conducted to demonstrate the value of PHRs, despite a widespread perception that these technologies are useful. Although survey data reveals a lack of awareness among the public, consumers are receptive to the concept, especially when recommended by a physician.