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

Access as a policy-relevant concept in low- and middle-income countries

D. McIntyre, M. Thiede and S. Birch

Health Economics, Policy and Law, vol. 4, 2009, p. 179-193

Although access to healthcare is frequently identified as a policy goal, its precise meaning remains unclear. This article develops a conceptual framework that defines access as a multidimensional concept based on the interaction between healthcare systems and individuals. This framework is presented as a basis for understanding the opportunities and constraints that influence the healthcare seeking behaviour of individuals in different settings in a systemic and integrated way. Access is defined as the empowerment of an individual to use healthcare and as a multidimensional concept based on the degree of fit between the healthcare system and individuals, households and communities.

Creating a 21st century Medicaid health care coverage system

A. Rogers

Policy and Practice, Feb. 2009, p. 17-19

The US healthcare system is dysfunctional. The root causes of this include misaligned reimbursement policies and incentives, lack of integrated patient care, and poorly coordinated treatment. The author suggests that the system could be fixed by the introduction of electronic health information systems which would give providers access to complete patient records and patients access to self-care management tools.

Evaluation of Croatian model of polycentric planning and decision making

S. Sogoric and others

Health Policy, vol. 89, 2009, p. 271-278

In 1993 Croatia was divided into 21 administrative districts (counties) which became owners of healthcare institutions and thus legally responsible for health sector governance. In 1994, county authorities established their own administrative structure, including health, education and social welfare departments. However, neither these health departments nor newly established county public health institutes had any healthcare planning capacity. In order to improve the situation, a County Public Health Capacity Building Programme was launched in 2001. This research analysed the impact of the training programme on local public health policy and practice in 15 counties.

The exploration of political accountability in primary healthcare organisations

C.J. Cordery

International Journal of Public Policy, vol. 4, 2009, p. 296-311

Since 2002, the New Zealand government has increased its investment in primary healthcare. The increased funding has been paid to private, not-for-profit bodies called primary health organisations (PHOs), which are responsible for community health outcomes. These PHOs are required to be fully accountable to government and the public. This article reports on the manner in which the PHOs have discharged this duty of accountability. The research indicates that they have developed diverse practices as a consequence of organisational history and other community-specific factors.

Framework for assessing governance of the health system of developing countries: gateway to good governance

S. Siddiqi and others

Health Policy, vol. 90, 2009, p. 13-25

Governance is thought to be a key determinant of economic growth, social advancement and overall development, as well as essential for the attainment of millennium development goals in low- and middle-income countries. Governance is the least well understood aspect of health systems. This paper presents a framework for assessing health system governance at national and sub-national levels. In developing this framework key issues considered included: the role of the state vs the market; the role of ministries of health vs other state ministries; static vs dynamic health systems; and health reform vs the human rights based approach to health. Four existing frameworks were considered: the World Health Organization's domains of stewardship; the Pan American Health Organization's essential public health functions; the World Bank's six basic aspects of governance; and UN Development Programme principles of good governance. The proposed assessment framework includes ten principles: strategic vision, participation and consensus orientation, rule of law, transparency, responsiveness, equity and inclusiveness, effectiveness and efficiency, accountability, intelligence and information, and ethics.

It's health care, not welfare

M. Fogarty

Policy and Practice, Feb. 2009, p. 11-13

Record numbers of Americans are not covered by healthcare insurance. As healthcare reform has been slow to emerge at the federal level, Oklahoma has joined other states in undertaking initiatives to improve the system within the constraints of the Medicare Programme.

Medicine access and utilization in a population covered by primary health care in Brazil

A.D. Bertoldi and others

Health Policy, vol. 89, 2009, p. 295-302

The Brazilian Unified Health System is moving from focusing solely on treatment of illness to prioritising prevention. The Family Health Programme was created to bring health services closer to the general population, prioritising the poorest areas of the country. It replaces traditional clinics with outreach teams, each covering approximately 1000 families. The Programme also makes free medicines available, thus reducing the burden of family out-of-pocket spending on healthcare among the poorest people. Unfortunately prescribed medicines are not always available at Programme clinics when needed due to their either being out of stock or not being included on their list of approved drugs.. This cross-sectional survey of a random sample of 2988 individuals living in areas served by Programme clinics showed that respondents continued to pay out-of-pocket for a substantial proportion of the medicines they used, which were unavailable at the clinics when required.

Outcomes evaluation of the St Petersburg Russia Women's Wellness Center

L.C. Callister and others

Health Care for Women International, vol. 30, 2009, p. 235-248

Women's wellness centres were established in the former Soviet Union from 1992 under the aegis of the American International Health Alliance and USAID. They provide a comprehensive range of primary care services and health promotion, disease prevention, and educational programmes, including support groups, telephone helplines and public education campaigns. Because the St Petersburg Women's Wellness Center is considered one of the more advanced centres and represents a microcosm of opportunities and challenges in women's healthcare delivery in Russia, a descriptive qualitative outcomes evaluation of the clinic was conducted.

Partnerships for knowledge exchange in health services research, policy and practice

P. Mitchell and others

Journal of Health Services Research and Policy, vol. 14, 2009, p. 104-111

There is potential for governments and research funding bodies to improve support for partnerships for knowledge exchange between health services researchers, policymakers and practitioners. Governments and research funding bodies in Australia and internationally are favouring a particular model based on decision-maker involvement in research. This model is increasingly being promoted through mandating partnerships between decision-makers and health services researchers. The authors argue that it is premature for the health services community to privilege any particular model of partnership between decision-makers and researchers.

The political use of poll results about public support for a privatized healthcare system in Canada

D. Contandriopoulos and H. Bilodeau

Health Policy, vol. 90, 2009, p. 104-112

Within the context of the debate on privatization of the healthcare system in Canada, the authors examine the nature and the roll of opinion polls and of some of the data that can be drawn from them. The volatility of the responses recorded by the polls suggests that we cannot assume that poll results are faithful representations of the population's values and opinions. Public support for healthcare privatisation, as presented in the polls, is a construct whose logical underpinnings and methodological validity are extremely weak. The construct is undermined by potential biases in the poll. Moreover, equating poll results with the population's actual opinion fails to take into account the feedback effect which is characteristic of the political use of polls. In this context the poll is used instrumentally to create a public opinion that supports a given intervention.

Reimbursement systems, organisational forms and patient selection: evidence from day surgery in Norway

P.E. Martinussen and T.P. Hagen

Health Economics, Policy and Law, vol. 4, 2009, p. 139-158

Cream skimming can be defined as the selective treatment of patients that demand few resources while providing high economic returns. It is assumed to be more of a problem in market-oriented healthcare systems. Norway put an activity based financing scheme in place for hospitals in 1997. In a further reform in 2002, the central government took over responsibility for all public hospitals from the counties and turned them into trusts. This paper examines the kind of cream skimming that takes place when patients that demand few resources for a given payment are prioritised over patients that demand more resources for the same payment. Evidence is found of cream skimming after the introduction of activity based funding in 1997. It remains stable and does not further increase after 2002 organisational reform.

Values, institutions and shifting policy paradigms: expansion of the Israeli national health insurance basket of services

D. Chinitz, R. Meislin and I. Alster-Grau

Health Policy, vol. 90, 2009, p. 37-44

The Israeli case demonstrates that New Public Management (NPM) techniques, such as regulated competition, can be deployed successfully to manage healthcare delivery. However, as health policy moves beyond somatic healthcare into areas requiring more inter-sectoral partnership working, such as mental health, the appropriateness of NPM models is called into question. Unfortunately, the very success of models such as regulated competition causes policy makers to resort to them instead of developing new approaches.

Who benefits from demand driven distribution of HIV/AIDS services? An analysis of the emerging CBO sector in Malawi

A. Schou

Public Administration and Development, vol. 29, 2009, p. 155-166

Community-based organisations (CBOs) play a key role in Malawi's multi-sector programme for responding to the HIV/AIDS pandemic. In this programme they are funded in a demand-driven manner, which means that only those areas which form CBOs and apply for programme funds are blessed with programme benefits. This paper argues that this funding mechanism is not conducive to distributing CBO services to areas most in need or to enhancing downward accountability. Because areas most in need of services lacked the capacity to attract project funding, the programme did not reach them.

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