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

Consumer use of publicly released hospital performance information: assessment of the national hospital evaluation program in Korea

H.-Y. Kang and others

Health Policy, vol. 89, 2009, p. 174-183

Public release of physician and hospital performance data is becoming increasingly common. In Korea since 2004 all general hospitals and all hospitals with 300 or more beds have to be evaluated every three years, and evaluation results are made public. The Korean National Health Insurance system places few restrictions on consumer choice of healthcare providers, and so patient use of hospital performance data is expected to be widespread. This study asked a sample of 385 outpatients visiting four general hospitals in Seoul about their intention to use hospital performance information when choosing a healthcare provider. Overall more than half of the respondents expressed an intention of using the performance data generated by the new system.

Empowering women to obtain high quality care: evidence from an evaluation of Mexico's conditional cash transfer programme

S.L. Barber and P.J. Gertler

Health Policy and Planning, vol. 24, 2009, p. 18-25

Improving healthcare quality has become an important policy priority in low- and middle-income nations. Most quality improvement initiatives focus on in-service training and supply side improvements. Few interventions consider the role of households, consumers or patients in improving the quality of care. However this study shows that being a beneficiary of Mexico's Oportunidades conditional cash transfer programme is associated with receipt of more prenatal care among low-income, rural women. This result is probably a manifestation of the programme's empowerment goal, which encouraged beneficiaries to be informed and active health consumers.

Health care financing and health outcomes in Pacific Island countries

A. Gani

Health Policy and Planning, vol. 24, 2009, p. 72-81

This paper provides empirical evidence of the relationship between per capita public health expenditure and three measures of health outcomes (infant and under-five mortality rates and crude death rates) using cross-country data for seven Pacific Island countries for selected years between 1990 and 2002. The study provides strong evidence that per capita health expenditure is important in determining health outcomes, with per capita incomes and expenditure also featuring strongly. The results suggest that a 10% increase in per capita health expenditure would lead to an approximate 6.6% reduction in the infant mortality rate, equating to an average reduction of 2.0 infant deaths per 1000 live births for the Pacific Island countries.

The impact of globalisation on hospital management: corporate governance rules in both public and private nonprofit hospitals

P. Mordelet

Journal of Management and Marketing in Healthcare, vol. 2, 2009, p. 7-14

Hospital reforms in most countries aim to provide fiscal and management autonomy to public hospitals in order to improve healthcare quality and safety, as well as efficiency and cost effectiveness. In their current organisational form, hospitals are unable to effect improvements as they are prevented by bureaucratic government regulations from implementing the necessary management and financial interventions. The combination of 'new public management' and the application of corporate governance rules offers a possible route for addressing management weaknesses.

Level and determinants of incentives for village midwives in Indonesia

T. Ensor and others

Health Policy and Planning, vol. 24, 2009, p. 26-35

Since the early 1990s Indonesia has attempted to reduce persistently high levels of maternal mortality by placing rural midwives in every village. Rural midwives are given a one year diploma training and operate as multi-purpose providers of health services with a particular focus on pregnancy, delivery and post-partum care. However, these midwives earn substantial income from private practice. This needs to be replaced by the public sector if they are to properly serve those who cannot afford to pay for services.

Planning in the Irish healthcare system: legislative strategy or administrative control?

V. Byers

Journal of Management and Marketing in Healthcare, vol. 2, 2009, p. 7-14

Although strategic planning in healthcare has been in evidence in many OECD countries since the early 1970s, it did not emerge in Ireland until the advent of legislatively mandated service planning in the 1990s. This occurred in the context of significant managerial, organisational and environmental change, including the devolution of accountability and responsibility from the centre to the periphery and the publication of a national strategy for healthcare. Service planning in the health sector in Ireland is seen as part of a strategic planning ethos and functions as a strategic management tool. This paper reports on part of a wider study that examined the intent and consequences of legislatively mandated service planning and looked at the process of its implementation in Irish healthcare.

Privatization and the working conditions of health care support staff

R. Zullo and I. Ness

International Journal of Public Administration, vol. 32, 2009, p. 152-165

Within the literature on the social and economic effects of privatisation lies the question of how contracting out public services to private organisations changes employment conditions for staff. Using an assisted survey approach, this study compares health care service workers' perceptions of work in public and privatised settings in the USA. Results indicate that laundry, maintenance, food service, and housekeeping staff employed by privately managed medical institutions have more negative perceptions of job rewards than their public sector counterparts, with no difference in perceptions of supervisor support, work stress, autonomy and opportunity. Enhanced cost-efficiency in privatised services appears to be due to lower wages, with no evidence of superior personnel management.

Public health policy decisions on medical innovations: what role can early economic evaluation play?

S. Hartz and J. John

Health Policy, vol. 89, 2009, p. 184-192

In many countries today, new medical technologies have to prove cost-effectiveness, affordability and benefits to the healthcare system before national health services or insurance schemes will pay for them. Economic evaluation is the most widely recognised method of determining cost-effectiveness. This literature review aims to explore the different ways in which early economic evaluation can inform public health policy decisions on new medical technologies.

Reproductive cancers

Reproductive Health Matters, vol.16, Nov. 2008, p. 4-198

Reproductive cancers are major killers globally. Breast cancer has reached epidemic proportions in the developed world and increasingly in middle income countries. Cervical cancer is the first or second most common killer of women in developing countries, particularly the poorest women, even though the means to detect and treat precursors of cervical cancer have been available for decades. New technology, including a simpler form of cervical screening, and a test and vaccine for human papillomavirus, will greatly affect how prevention of cervical cancer is handled. This journal issue focuses on policy and programmes for breast and cervical cancer, gross inequity in access to screening and treatment in resource poor countries due to low priority given to these cancers, and personal experiences of patients.

Thirty years of national health insurance in South Korea: lessons for achieving universal healthcare coverage

S. Kwon

Health Policy and Planning, vol. 24, 2009, p. 63-71

South Korea introduced mandatory social health insurance for workers in large corporations in 1977 and extended it incrementally to the self-employed until it covered the entire population in 1989. The Korean experience of the rapid development of social health insurance can provide valuable lessons for low- and middle-income countries which aim to provide healthcare coverage for their entire population. It shows that: 1) a mix of social insurance and tax can work well for healthcare financing; 2) political commitment and family-based membership contribute to rapid population coverage; and 3) effective purchasing and the regulation of providers are key factors in the sustainability of healthcare financing.

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