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

The contested politics of sexual and reproductive health and rights

N. Worthington and others (guest editors)

Global Public Health, Vol.3, 2008, Supplement 2, 104p

Rapid changes have taken place in recent years in relation to the politics of sexual and reproductive health. Sexuality has emerged as a focal point of public discourse, and the field of sexual and reproductive health has generated some of the most hotly debated contemporary issues. At the global level debate has been triggered by the HIV/AIDS epidemic, a series of United Nations Conferences, and the rise of religious conservatism and extremism. At the country level, shifts in government from dictatorship to democracy, from secular to religious and from communist to capitalist have opened doors for the emergence of new political actors and movements. In this special supplement the contributing authors use case study analyses to capture the dynamics of such global and country-level changes and to explore the consequences for sexuality and sexual health and rights.

'Developing good taste in evidence': facilitators and hindrances to evidence-informed health policymaking in State government

C.J. Jewell and L.A. Bero

Milbank Quarterly, vol. 86, 2008, p. 177-208

This article expands on other studies of research utilisation by US State level policymakers. Based on interviews with 28 state legislators and politicians about their real life experiences of policymaking, it identifies common features of the policymaking process that affect how research evidence is incorporated into American state health policy decisions. Certain hindrances to incorporating research into policymaking, such as budget limitations, are not amenable to change. However, policymakers could benefit from evidence-based skills training to help them identify and evaluate information. Researchers and policymakers could thus collaborate to develop networks for generating and sharing relevant evidence for policy.

Documents considered by the Committee on July 22 2008, including the following recommendations for debate: carbon dioxide emissions from cars and light commercial vehicles, cross-border healthcare, future relations between the EU and the Overseas Countries and Territories

European Scrutiny Committee

London: TSO, 2008 (House of Commons papers, session 2007/08: HC 16)

This House of Commons paper includes the documents considered by the European Scrutiny Committee on the subject of cross-border healthcare. The first document introduces the Commission's proposals for EC legislation on cross-border healthcare while the second document is the draft of a Directive to give effect to them. The Commission's proposals begin by noting that the vast majority of EU patients receive healthcare in their own countries and prefer to do so. But sometimes they seek treatment in other Member State because, for example, they need highly specialised care not available in their home State or because they live in a frontier area and the nearest suitable treatment is on the other side of the border. Since 1998, the ECJ has consistently ruled that patients are entitled to reimbursement of the cost of healthcare received abroad that they would have been entitled to receive at home. The purpose of the draft Directive is to:

  • clarify the rights of reimbursement
  • ensure the quality, safety and efficiency of cross-border healthcare

Engaging in public priority setting for health technology assessment: findings from a citizens' jury

D. Menon and T. Stafinski

Health Expectations, vol. 11, 2008, p. 282-293

This research considers a citizen's jury that was used to formulate priority setting criteria for health technology assessments in Canada. Jury members developed a set of 13 criteria that they agreed on unanimously and which they subsequently ranked in order of importance. The top two criteria were 'potential to benefit a number of people' and 'extends life with quality'. Jury members evaluated the process positively and the authors suggest that it is feasible to use citizens' juries as a means of involving the public in setting local health technology assessment priorities.

Governing universal health insurance in Korea and Taiwan

H. Kwon and F. Chen

International Journal of Social Welfare, vol.17, 2008, p. 355-364

This article examines policy responses to rising healthcare costs in Korea and Taiwan from the viewpoint of governance, applying it as an alternative lens to the perspectives of the developmental state and democratisation. It shows that the state no longer has exclusive power of decision in healthcare policy. Multiple stakeholders, with the capacity to influence healthcare governance, have emerged. In Korea these new policy actors were unwilling to make compromises with the government, trust between the government and the medical profession was lost and deadlock has ensued. In contrast, Taiwan has had more success in controlling health expenditure through the introduction of a global budgeting system based on a measure of consensus.

Organizing and reorganizing: power and change in health care organizations

L. McKee, E. Ferlie and P. Hyde (editors)

Basingstoke: Palgrave Macmillan, 2008

Why are health care services in so many countries undergoing so much reorganization? What are the long term effects of such managerial restructuring? How might we start to make an assessment of such effects? This book brings together a group of international authors to examine these themes and offer a vital insight into organizing and reorganizing in health care. The handling of organizational politics, power and change is revealed as a core aspect of effective reorganizations which are not a simple or linear process. Crucially, the book explores how health care management research relates to health policy in this politically charged arena.

A plan for action: key perspectives from the Racial/Ethnic Disparities Strategy Forum

R.K. King and others

Milbank Quarterly, vol. 86, 2008, p. 241-272

Racial and ethnic disparities in healthcare in the United States have been well documented, with research largely focused on describing the problem rather than identifying strategies for addressing it. In 2006 the Disparities Solutions Center convened a Strategy Forum with the aim of identifying innovative approaches to tackling the problem. Participants decided that healthcare organisations needed a multifaceted plan of action to address racial and ethnic disparities in healthcare. Although the ideas offered are not new, the discussion of their practical development and implementation should make them more useful.

Rethinking medical professionalism: the role of information technology and practice innovations

D. Mechanic

Milbank Quarterly, vol.86, 2008, p. 327-358

Clinicians and the US public have become increasingly concerned about the erosion of medical professionalism. Changes in the organisation, economics and technology of medical care have made it difficult to maintain competence, meet patients' expectations, escape serious conflicts of interest and distribute finite resources fairly. Information technology, electronic health records, improved models of disease management, and new ways of relating to and sharing responsibility for patients' care can contribute to both professionalism and quality of care.

State responses to new flexibility in Medicaid

T.A. Coughlin and S. Zuckerman

Milbank Quarterly, vol.86, 2008, p. 209-240

US states have long lobbied to be given more flexibility in designing their Medicaid programmes. The Bush administration and the Deficit Reduction Act of 2005 have put in place policies to make it easier to grant states this flexibility. This study shows that since 2001 more than half of states have changed their Medicaid programmes, through either Medicaid waivers or provisions in the Act. These changes are in benefit flexibility, cost sharing, enrolment expansion and caps, privatisation and programme financing. So far, most changes have been fairly limited, but this may alter in the face of external pressures such as an economic downturn.

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