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Welfare Reform on the Web (February 2009): Healthcare - overseas

Ethics frameworks in Canadian health policies: foundation, scaffolding or window dressing?

M. Giacomini, N. Kenny and D. DeJean

Health Policy, vol. 89, 2009, p. 58-71

Health policy documents increasingly feature ethics frameworks that outline guiding principles. This article reports findings from a large interdisciplinary project involving ethicists, policy analysts and policy makers which investigated the nature, quality and uses of ethics frameworks in Canadian health policy. It reviews a large set of policy documents to reveal conventions in the style and content of ethics frameworks. It examines in detail three illustrative examples of ethics frameworks and the treatment of two commonly cited ethics principles, equity and accountability. It also seeks to identify some features of a robust, coherent and meaningful ethics framework.

Extending health care coverage: potential linkages between statutory social security and community-based social protection

J. Schremmer and others

International Social Security Review, vol. 62, Jan.-Mar. 2009, p. 25-43

Extending social healthcare protection in developing countries is a widely recognised priority. This article focuses on extending healthcare cover through a mix of statutory social security schemes and community-based social protection mechanisms, with the aim of developing a typology of linkages between such schemes and mechanisms. Individually statutory social security schemes and community-based social protection mechanisms have their own specific advantages and disadvantages in terms of their ability to provide healthcare cover to different population groups in developing countries. Linking the two, in order to compensate for their respective weaknesses and to exploit their respective strengths, appears to offer a promising way forward.

Going separate ways? The reform of health insurance funds in Germany, Japan and South Korea

G.-J. Hwang

Policy Studies, vol. 29, 2008, p. 421-435

Many aspects of the Japanese and Korean national health insurance systems were modelled on the German system where non-competitive sickness funds were administered by corporatist actors on the state's behalf. However, in the era of globalisation each country has followed a separate reform trajectory. Germany has chosen to grant freedom of choice between different sickness funds and so to introduce competition. Korea has merged all health insurance societies into one, while Japan has continued with a multiplicity of societies as reform proposals failed. This paper looks at the reform process in each country.

Health policy in the Baltic countries since the beginning of the 1990s

V. Bankauskaite and J.S. O'Connor

Health Policy, vol. 88, 2008, p. 155-165

This article compares the development of health policies in Estonia, Latvia and Lithuania from 1992 to 2004 and reflects on whether those policies are developing in parallel, converging or diverging in some aspects. The review indicates considerable movement towards a Western European social insurance funding model, the development of a primary care system anchored on a general practitioner service and a lessening of the hospital orientation of the pre-1990s system. There is considerable evidence of progress in key health policy and outcome characteristics towards EU15 levels, combined with convergence across the three countries in expenditure measures and divergence in key hospital provision and usage statistics..

Is universal access to antiretroviral drugs an emerging international norm?

J. Youde

Journal of International Relations and Development, vol. 11, 2008, p. 415-440

Antiretroviral drugs are the main treatment used to fight HIV/AIDS. The treatment regimen can be complicated and difficult, as patients must be continuously monitored to ensure the drugs' effectiveness, and the drugs themselves can be incredibly expensive. Despite the expense and difficulty of administering ARV treatment, the international community appears to have embraced universal access to ARV drugs as a new norm. This new norm, made most visible by the 3x5 and All by 2010 Campaigns promotes providing access to these drugs regardless of ability to pay or country of residence. This article explores how this new norm emerged and why it has emerged at this point in time. To understand the success of the norm of universal antiretroviral access, it examines the failure of an earlier health-related norm, that of universal access to primary health care.

The legal framework for health care quality assurance in Germany

D. Sauerland

Health Economics, Policy and Law, vol.4, 2009, p. 79-98

The German healthcare system is facing two major challenges: sustainable financing and improvement of the quality of care. This article develops a theoretical quality assurance framework which it uses to analyse the current situation in Germany, paying special attention to the improvements expected from the implementation of the Statutory Health Insurance Modernization Act of 2004, which explicitly addressed quality issues. The Federal Ministry of Health remains responsible for establishing the legal framework for quality assurance. The regulatory details are assigned to a new corporatist body, the Federal Joint Committee, which represents the interests of medical providers, third-party payers and, to a limited extent, patients. The Committee delegates certain tasks in quality measurement, data collection, and information provision to two different organisations which are supposed to be independent but are financially dependent on the FJC. Patients' rights to receive information have been improved, but they are still waiting for more reliable information on which to base their choice of healthcare provider.

NHS looking across the pond to Obama's cures

M. Macdonnell and D. Noble

Health Service Journal, Jan. 29th 2009, p. 12-13

This article outlines President Obama's plans for increasing health insurance coverage in the USA and controlling spiralling costs. The US health system and the NHS face common problems of maintaining system affordability, which will involve reducing costs of caring for people with chronic conditions and more emphasis on preventative measures, and improving the quality of care.

Outsourcing primary health care services: how politicians explain the grounds for their decisions

R. Laamanen and others

Health Policy, vol. 88, 2008, p. 294-307

This article explores the outsourcing of primary healthcare services in four municipalities in Finland. One municipality in Southern Finland had contracted all its primary healthcare services out to a not-for-profit voluntary organisation, while the other three had opted to outsource only a few services. A survey showed that politicians in all four municipalities had experienced many problems relating to outsourcing. There was little appetite for totally outsourcing all services, especially among left wing parties. The most popular candidates for total outsourcing were ambulance services, speech therapy, and occupational health and those most selected for partial outsourcing included diagnostic services, substance abuse care, mental health services, home and day care, dental care and rehabilitation. Services considered inappropriate for contracting out were non-urgent medical care, inpatient care, preventive services and social work.

Pakistan's health policy: appropriateness and relevance to women's health needs

N. Rizvi and S. Nishtar

Health Policy, vol.88, 2008, p. 269-281

This paper aims to assess if Pakistan's national health policy formulated in 2001 is relevant and appropriate to women's health needs. Through a review of existing data on women, a profile of women's health needs was developed which was used as a framework for analysis of the policy. This analysis shows that although the policy focuses on women's health through the prioritisation of gender equity, it is addressed as an isolated theme without acknowledging the vital role played by gender inequalities in defining women's health needs. Gender equity translates in the policy into the provision of reproductive health services for married mothers, ignoring issues such as sexual abuse, violence, induced abortion, etc. Strategies for strengthening health systems are suggested but these fail to recognise the main obstacles to women's use of healthcare such as non-availability of female health professionals, illiteracy, lack of power to make their own decisions about health, etc.

Patient choice and access to primary physician services in Norway

J. Grytten and R. J. Sorensen

Health Economics, Policy and Law, vol. 4, 2009, p. 11-27

Health services in Norway have been reformed to operate as quasi-markets characterised by competition and free consumer choice, combined with public financing of services. A regular general practitioner scheme was also introduced in 2001. This article investigates the effects that quasi-markets have on access to primary physician services. Analysis of data from two comprehensive national surveys shows that patients take advantage of their right to choose to move from general practitioners who have too little capacity to those who have spare capacity. Patient choice means that consumers are not stuck with doctors who have too little capacity to provide an adequate service.

Pediatric epidemic crisis: lessons for policy and practice development

D.B. Nicholas and others

Health Policy, vol. 88, 2008, p. 200-208

Healthcare services in Toronto, Canada were confronted by an outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003. Infection control leaders and researchers have warned the global health community to be prepared for future outbreaks of SARS or other infectious diseases. While several studies have identified biomedical data and psychosocial impacts, lessons learned from SARS for health policy and patient care have received little attention. This paper addresses the gap in the literature and outlines policy and practice implications of SARS, specifically from a pediatric perspective based on descriptive qualitative interviews with pediatric SARS patients, their parents and healthcare providers. Effective strategies in pediatrics include practices that provide family centred care while minimising disease transmission.

Policy choice or economic fundamentals: what drives the public-private health expenditure balance in Canada?

L. Di Matteo

Health Economics, Policy and Law, vol. 4, 2009, p. 29-53

The public share of Canada's total health expenditure declined between 1975 and 2005 from 76.2% to 69.6%. This article explores whether the decline in Canada's public share of health expenditure is due to economic forces or ideology. It is concluded that the public-private balance in healthcare spending is as much a social policy choice as the result of economic forces. This reinforces the view that public provision of healthcare is ultimately a political choice.

Prioritising pain in policy making: the need for a whole systems perspective

C. Phillips and others

Health Policy, vol. 88, 2008, p. 166-175

In this review, estimates of the burden and cost of chronic pain from a variety of perspectives are provided, and their implications for the prioritising of pain management in government policies are discussed. It is concluded that pain management should be addressed in several areas of government policy, but it is not given the priority it requires on the basis of its cost to individuals and society, and it needs to become far more prominent in all countries. It is essential for a joined-up cross agency approach to be adopted, involving all those who have an interest in preventing ill-health at work, treating ill-health and rehabilitating those who have suffered from pain.

Private health expenditure in the Greek health care system: where truth ends and the myth begins

O. Siskou and others

Health Policy, vol. 88, 2008, p. 282-293

In 1983 Greece introduced a national health service free at the point of use. The country also has universal mandatory coverage by a social insurance system and a low level of co-payments. However, Greece also has the highest level of private expenditure on healthcare of all EU countries. In 2004, 47.2% of total healthcare expenditure was funded privately. The rise in private health expenditure and the development of the private sector since 1983 took place at a time of under funding of the public system. The gap was filled by private investment. At the same time, rising disposable incomes and the mobilisation of private health insurance led more households to use private medical services in order to meet unsatisfied demand.

The provision of oral care by local government authorities in Israel: policy issues and empirical evidence

Y. Machnes and A. Carmeli

Health Policy, vol. 89, 2009, p. 107-114

Despite the high ratio of dentists to residents, oral health as assessed for children and young people in Israel is relatively poor, although dental care is available on the open market to those who can afford to pay. Local authorities in Israel have been empowered and authorised by central government to supply public dental care to children and the needy, but only 28% do so. This article examines the characteristics of localities that provide dental care to their school children and those that do not, in an attempt to contribute to a better understanding of the policy choices of local government.

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