Ethics and Social Welfare, vol. 3, 2009, p. 32-53
Advance directives are legally protected instructions on health care. An advance directive, executed when an adult is mentally competent, becomes active in the event of his or her mental capacity to make decisions about healthcare being lost. Advance directives are underpinned by complex philosophical theories and concepts such as self-determination, the idea of a good death, and the ethics of care. Using the situation in the United States as a case study, this article discusses bioethics as it relates to advance directives.
J. Adams, K. Witten and K. Conway
Community Development Journal, vol. 44, 2009, p. 140-157
Since the early 1990s health policy in New Zealand has recognised that reducing health inequalities will require action on the social, economic and cultural determinants of health. The Ranui Action Project used a community development approach to address the social determinants of health inequalities in a high-need, ethnically diverse urban locality. The rationale of the project was emerging evidence in the public health literature of the significance of working intersectorally to build social capital and social cohesion to improve population health at the neighbourhood level.
V. Hoss, M. Thoni and R. Staudinger
International Journal of Behavioural and Healthcare Research, vol. 1, 2009, p. 143-159
Performance-oriented hospital financing was introduced in Austria in the late 1990s to control costs and is a prospective payment system based on Diagnosis-Related Groups (DRGs). A system of integrated healthcare is also being introduced and is intended to comprise a kind of patient 'throughput system' which will ensure that prophylaxis, diagnosis, therapy, rehabilitation and nursing are provided in the right order, by the right unit, in a reasonable timescale and with maximum benefit to the patient. In order to achieve this goal, particular emphasis is placed on organising the healthcare system as a network in order to promote co-operation between hospital and community services. This article focuses on the synergies that arise from the combination of the two policy instruments.
M.L. Bruni, L. Nobilio and C. Ugolini
Health Policy, vol. 90, 2009, p. 140-148
The design of incentive schemes for improving quality of care is a central issue for health services. This article investigates the impact on quality of care of the introduction of two financial incentive schemes for primary care physicians in Emilia Romagna, Italy: pay-for-participation programmes, and pay-for-compliance with best practice programmes. It focuses on a scheme which rewards general practitioners for assumption of responsibility for patients with Type 2 Diabetes (pay-for-participation) and for adherence to regional clinical guidelines (pay-for-compliance). Results suggest that higher shares of GPs' income received through these programmes significantly reduce the probability of hyperglycaemic emergencies in their patients.
D.P. Gnawali and others
Health Policy, vol. 90, 2009, p. 214-222
This paper reports results from an evaluation of the impact of community-based health insurance on health service utilisation in rural Burkina Faso, where out-of-pocket expenditure is more than 50% of total healthcare expenditure, and the household average healthcare financial burden is about6.5% of total household cash income. Between 6% and 15% of households face catastrophic health expenditure. Results showed the overall effect of CBI on healthcare utilisation to be significant and positive, but the benefit of CBI was not enjoyed equally by all socioeconomic groups. There is a need to subsidise the premium to encourage the enrolment of the very poor, and various measures need to be put in place to maximise the population's capacity to enjoy the benefits of insurance once insured, such as help with travel costs for visiting healthcare facilities.
J. Polonsky and others
Health Policy and Planning, vol. 24, 2009, p. 209-216
Research shows that the poorest members of society often fail to benefit from healthcare and social welfare programmes. As a result there is increasing recognition of the need to evaluate equity. This applies to community health insurance schemes which are becoming an increasingly important healthcare financing mechanism in low-income countries. This paper describes the findings of an evaluation of Oxfam's community health insurance schemes in rural Armenia. Results show that the schemes are achieving their primary goal of equitable coverage of healthcare for the target population. Women, the elderly and the poorest benefit most from joining the schemes. Importantly, membership is improving overall utilisation, indicating an improved quality of care.
S.M. Cox, M. Kazubowski-Houston and J. Nisker
Social Science and Medicine, vol. 68, 2009, p. 1472-1480
Arts-based approaches to public engagement offer unique advantages over traditional methods of consultation. This article describes and assesses the use of theatre as a method of public engagement in the development of health policy on pre-implantation genetic diagnosis, a controversial method for selecting the genetic characteristics of embryos created through in vitro fertilisation. The exercise involved 16 performances of the play Orchids in three Canadian cities in 2005 and used various methods the engage the audience in policy-related dialogue.
Abingdon: Routledge, 2009
For more than a quarter of a century there has been significant international migration of skilled health workers, but in the last decades, with critical changes in both sending and receiving countries, few parts of the world are now unaffected by the consequences of the migration of health workers, either as sources, destinations or sometimes both. The book takes the understanding of health worker migration substantially beyond the more scattered and fragmented papers and anecdotes that largely existed before, into the first consolidated analysis. In doing so it reveals its exceptional significance for both sending and receiving countries (in economic, social and political terms), provides the only analysis of remittances of health workers, casts new light on gender, globalisation, transnational linkages, the trade in services (linked to GATS) and the overall relationship between migration and development, and reviews practical responses and solutions.
F. Tediosi, S. Gabriele and F. Longo
Health Policy, vol.90, 2009, p. 303-312
This article reviews the recent experience of the Italian National Health Service (Servizio Sanitario Nazionale, SSN) where responsibilities have been devolved to the regions. Decentralisation has raised two questions which are examined in this article: 1) what sort of regulatory framework and institutional balances are required to govern a decentralised health system in heterogeneous country under tough budget constraints? ; and 2) how can policymakers ensure that the more advanced regions remain committed to solidarity and support the weaker ones? The main lessons emerging from the research are:
J.F. Travaglia, M.T. Westbrook and J. Braithwaite
Health, vol.13, 2009, p. 277-296
Incident reporting systems have become a central mechanism in most health service patient safety strategies. In this article the authors compare health professionals' anonymous, free-text responses in an evaluation of a newly implemented electronic incident management system in New South Wales, Australia. The research revealed inter-professional differences in reaction to the new system which may constrain inter-disciplinary co-operation and communication.
N. Henke, S. Kadonaga and L. Kanzler
McKinsey Quarterly, 2009, p. 54-63
Japan's healthcare system has come under severe stress and its sustainability is in question. The country needs to control rising and unsustainable demand for health care, find a way to allocate medical resources to the places where they are actually needed, and rein in spiralling costs, without damaging the quality of care.
T. Smets and others
Health Policy, vol. 90, 2009, p.181-187
A particular concern when any country legalises euthanasia or physician-assisted suicide is how to ensure that the practice is monitored and controlled to prevent abuse. Currently only the Netherlands and Belgium have officially legalised euthanasia and physician-assisted suicide. Both countries have devised monitoring systems to control the practice and have established both substantive and procedural safeguards against abuse in their euthanasia law. This article systematically studies and compares Belgian and Dutch official documents relating to the procedures for the notification, control and evaluation of euthanasia.
Critical Social Policy, vol. 29, 2009, p. 171-190
In Western industrialised nations the obesity epidemic impacts the population along traditional lines of economic disadvantage, its incidence being inversely related to income and education. In this study evidence is presented of a long tradition of associating illness and poverty with moral shortcomings in their victims. The presence of a moralised understanding of obesity in Australia is then demonstrated through an analysis of its representation in local media since 2005, with particular reference to the reporting of politicians. It is further suggested that this trajectory magnifies the likelihood that policy will address the moral failures of the obese, instead of tackling the structures which create ill health and poverty.
B.H. Gray (editor)
Milbank Quarterly, vol. 87, 2009, p. 1-316
This special issue is devoted to obesity as a public policy problem. Obesity has reached crisis levels in the USA due to its spread across the population, its contribution to morbidity and mortality rates, and its impact on healthcare costs. The articles focus on both public and private policy options for addressing high rates of obesity. They present new empirical studies, policy history, overviews of developments in particular areas such as schools, workplaces and the built environment, and analyses of different legal strategies and policy approaches.
M. Ruiz-Rodriguez, V.J. Wirtz and G. Nigenda
Health Policy, vol. 90, 2009, p. 149-155
Both Colombia and Chile implemented structural reforms of their health services in the second half of the twentieth century. These changes included the creation of a National Health System in Colombia in 1968-75 and a National Health Service in Chile in 1952-72. Both systems adopted a systematic, centralised approach complemented by satellite assistance systems, redefined the roles of the public and private sectors and used market-oriented service delivery policies. Despite these similarities the two systems performed quite differently in relation to reducing maternal mortality rates, with Colombia lagging behind Chile.
S.H. Ebrahim and others
Health Policy, vol. 90, 2009, p. 196-205
The overall health of Americans compares unfavourably to that of people living in other countries with established market economies. Improvement in some health indicators appears to have stalled over the past five years, especially in the areas of women's health, maternal mortality and infant morbidity and mortality. Improving maternal and child health in the US will require action to tackle the social determinants of ill health such as poverty and inequality, promotion of healthy lifestyles, and reduction of the barriers to healthcare access.
H. Hakonsen, A.M. Horn and E.-L. Toverud
Health Policy, vol. 90, 2009, p. 277-285
Despite having a tradition of strict regulation of medicines, the Norwegian authorities have, during the last two decades, intensified their fight against increasing pharmaceutical costs with an emphasis on pricing systems. Direct price control is applied to all prescription drugs with marketing authorisation while indirect pricing methods are being tested for the off-patent market. The direct pricing strategy, ie international reference pricing, introduced in 2000 was regarded as the most successful policy because it led to considerable and predictable price reductions. In contrast, because of unpredictable market mechanisms such as delivery failure, asymmetric information, and counteractive behaviour, the effects of the indirect pricing strategies, eg reference pricing (1993-2000), generic substitution (2001 onwards), and index pricing (2003-2004) have been more limited.
T. Albreht and N. Klazinga
Health Policy, vol. 90, 2009, p. 262-269
Following the fall of Communism, privatisation was seen as a magic cure for the ills of the state healthcare system in Slovenia. This paper explores the privatisation process, covering its background, nature, extent and facilitating and inhibiting factors. Privatisation of healthcare in Slovenia has been a gradual process. In 2008, 30% of primary care, 60% of dentistry, and about 20% of specialist outpatient services were delivered by private practitioners. Privatisation of hospitals has been limited and there has not been significant private investment in the health infrastructure. Private health insurance (including insurance to cover co-payments) has expanded and now accounts for 15% of total health expenditure, while out-of-pocket payments have also increased. They now make up 12% of total health spending.
Community Practitioner, vol. 82, May 2009, p. 24-27
Health services in Ireland are being reoriented towards community-based care and the promotion of population health. Public health nurses have an important contribution to make to reducing health inequalities among one vulnerable population group, mothers and infants. They have early access to this entire population and deliver a service of preventative healthcare that begins in the post natal period.
G. Sinha, D.H. Peters and R.C. Bollinger
Health Policy and Planning, vol. 24, 2009, p. 197-208
With over 2.5 million estimated cases, India has one of the highest numbers of HIV-infected individuals in the world. Approximately 60% of India's HIV cases occur in rural residents, with 40% of cases occurring in women. In rural India, there are currently substantial gender differences in access to HIV testing and care services and associated clinical and socio-economic outcomes. As HIV- and gender-related health policies emerge for rural India, strategies including gender-specific rural HIV services for patients, gender-sensitivity and HIV skills training for healthcare providers and institutional partnerships and oversight methods should be implemented and assessed for gender equity.
P.D. Mango and V.E. Riefberg
McKinsey Quarterly, 2009, p. 40-53
Making healthcare more affordable is the key to making the US system sustainable. This article explains how three of the largest sources of cost growth can be brought under control. The public and private sectors should collaborate to tackle three underlying problems: 1) the rising incidence of lifestyle- and behaviour-induced diseases, such as obesity; 2) the economic distortions that now tend to prevent consumers and providers from making value-conscious decisions; and 3) the system's wasteful and unnecessary administrative complexity.
C. Eldridge and N. Palmer
Health Policy and Planning, vol. 24, 2009, p. 160-166
Performance-based payment is increasingly advocated as a way to improve the performance of health systems in low-income countries. This systematic review of the literature on the subject found that there is little consensus on its meaning or use. The literature would be strengthened by multi-disciplinary case studies that present both the advantages and disadvantages of performance-based payment, factors that influence success, and more detail about the projects from which the evidence is drawn. The paper suggests that more research is required on the appropriateness of transferring performance-based payment schemes to less developed countries, and on problems associated with how performance is defined and measured.
J. Xu and Y. Yang
Health Policy, vol. 90, 2009, p. 133-139
This study examines the role of traditional Chinese medicine in the current healthcare system in China. It shows that traditional Chinese medicine is well integrated into the healthcare system alongside Western medicine. However, it faces a number of challenges:
In response to these challenges the Chinese government is putting a lot of effort into supporting and expanding the role of traditional medicine in the healthcare system.
T. Ensor, S. Clapham and D.P. Prasai
Health Policy, vol. 90, 2009, p. 247-253
It is generally thought that high financial cost is a major barrier to utilisation of delivery care, particularly in remote areas of Nepal. To measure the importance of this barrier, and to inform the national skilled attendance strategy that was being developed by the Ministry of Health and Population, the Nepal Safer Motherhood Project commissioned a study on the financial implications of skilled attendance at delivery. Following the publication of the study, policy interest in the area moved swiftly. Skilled birth attendance became a major issue in 2001, the research on financing was commissioned in 2003, and a policy was implemented across the country in 2005. This paper analyses why the results of research in this case influenced policy so quickly. Credible research, supported by clear dissemination by respected project staff already close to government helped to prepare the ground. The policy was also seized on by a flagging government as a way of improving its fortunes and increasing its popularity.
D. Farrell, B. Kocher and E.S. Jensen
McKinsey Quarterly, 2009, p. 28-38
Research indicates that the USA spends $650bn more on healthcare than might be expected given the country's wealth and the experience of comparable members of the OECD. Analysis shows that the higher than expected spending is due to rising costs of outpatient care, sky high drug prices, and inefficient healthcare administration due to the country's fragmented health insurance system.
X. Wei and others
Health Policy, vol. 90, 2009, p. 206-213
The Fidelis project implemented in Shanxi Province aimed to promote TB case detection and maintain high cure rates by offering financial incentives to both patients and providers. A quantitative study of the impact of the project showed that it had largely failed to produce the intended improvements in the diagnosis and treatment of TB. This qualitative study investigated the reasons for project failure. It found that the project failed because: