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Welfare Reform on the Web (June 2000): Health Care - Overseas

COMMUNITY-LEVEL CHANGES IN BEHAVIORAL HEALTH CARE FOLLOWING CAPITATED CONTRACTING

C. A. Heflinger and D. A. Northrup

Children and Youth Services Review, vol. 22, 2000, p. 175-193

A survey of all community agencies in one area that provided or interacted with behavioural health services was administered during the implementation of a clinically-managed demonstration project and again four years later after the transition to a captivated managed care system had a significant negative impact on the behavioural health service system for children and youth in that community.

COST CONTAINMENT OF PHARMACEUTICAL USE IN ICELAND: THE IMPACE OF LIBERALISATION AND USER CHARGES

A. B. Almarsdottir, J. M. Morgall and A. Grimsson

Journal of Health Services Research and Policy, vol. 5, 2000, p. 104-113

The liberalisation of community pharmacy ownership in 1996 and the subsequent increase in patients' share of drug costs in 1997 failed to have the desired effect of lowering the drug bill footed by the Icelandic State Social Security Institute.

COST RECOVERY IN MAURITANIA: INITIAL LESSONS

M. Audibert and J. Mathonnat

Health Policy and Planning, vol. 15, 2000, p. 66-75

Cost recovery was introduced in Mauritania in 1993. Initial results appear to be largely positive regarding the improvement of the quality of health care and the overall level of utilisation of basic health establishments. They suggest that users are willing to pay when the quality of care improves. The article proposes extending user fees to the second and third levels of the health system.

FUTURE PROPOSPECTS OF VOLUNTARY HEALTH INSURANCE IN THAILAND

S. Supakankunti

Health Policy and Planning, vol. 15, 2000, p. 85-94

This study looks at voluntary health insurance in Thailand, in particular the Health Card Program introduced in 1983. It examines health card purchase and utilisation patterns, using data from Khon Kaen Province, and finds that employment, education levels and the presence of illness are significant factors influencing card purchase. The last factor is related to the problem of adverse selection of the program; families with symptoms of sickness are more likely to buy cards, resulting in greater use of health services. The results also show an improvement in accessibility to health care and a high level of satisfaction among card holders.

HEALTH INSURANCE MARKETS AND INCOME INEQUALITY: FINDINGS FROM AN INTERNATIONAL HEALTH POLICY SURVEY

C. Schoen and others

Health Policy, vol. 51, 2000, p. 67-85

Data were collected through a survey of 5059 adults in Australia, the UK, Canada, New Zealand and the US. Results showed care experience to be more unequal in the US, Australia and New Zealand, where systems rely most heavily on private health insurance and markets. Reliance on private health insurance and user fees also appeared to lead to more divided views of the overall health system as well as inequity in access to care.

HISTORICAL ANALYSIS OF THE DEVELOPMENT OF HEALTH CARE FACILITIES IN KERALA STATE, INDIA

V. R. Kutty

Health Policy and Planning, vol. 15, 2000, p. 103-109

The article describes the growth of health care facilities in Kerala, with respect to: the increase in the number of public institutions and beds, and the trends in government expenditure on health; the current pattern of distribution of health care facilities in the public and private sectors; and the implications arising from these for the state's future health development.

THE IMPACT OF FINANCING AND QUALITY CHANGES ON HEALTH CARE DEMAND IN NIGER

M. Chawla and R. Ellis

Health Policy and Planning, vol. 15, 2000, p. 76-84

This paper assesses the demand effects of a cost recovery and quality improvement pilot study conducted in Niger in 1993. Direct user charges and indirect insurance payments were implemented in government health care facilities. Decision-making by patients is modelled as a three-stage process of reporting an illness, seeking treatment and choice of provider; and multinomial nested logit techniques are used to estimate the parameters of the decision-tree. Overall, the results give a favourable impression of the policy changes. Despite an increase in formal user charges, the observed decline in rates of visits is statistically insignificant, suggesting the success of measures to improve the quality of health care.

LEGITIMATE DECISION MAKING: THE ACHILLES' HEEL OF SOLIDARISTIC HEALTH CARE SYSTEMS

N. Mays

Journal of Health Services Research and Policy, vol. 5, 2000, p. 122-126

Argues that the main threat to the sustainability of universal publicly financed health care systems lies in the inability of so-called "advanced" societies to develop institutions that are capable of acceptably reconciling scarce resources with individual and collective desires to have all the health care we want. Many "advanced" societies lack, or fail to incorporate into their health systems, the range of intermediate institutions that could potentially help in more effectively reconciling individual wants with collectively determined levels of resources.

THE MANY MEANINGS OF DEINSURING A HEALTH SERVICE: THE CASE OF IN VITRO FERTILIZATION IN ONTARIO

M. Giacomini, J. Hurley and G. Stoddart

Social Science and Medicine, vol. 50, 2000, p. 1485-1500

Deinsuring IVF in Ontario was intended to support several policy goals including: controlling public expenditure, restricting public coverage of 'medically necessary' services, applying evidence of effectiveness as a criterion for medical necessity, and controlling new reproductive technologies. This case study shows that:

  • individual services interact with the rest of the system and cannot be removed without systemic effects;
  • inconsistent use of coverage principles can undermine legitimacy of both priority-setting principles and processes;
  • evidence-based decisions can founder on differing stakeholder ideas about appropriate evidence.

NOT JUST FOR BUREAUCRATS ANY MORE: BUREAUCRAT BASHING, OVERHEAD DEMOCRACY AND MANAGED CARE

R. McEldowney and W. L. Murray

Administration and Society, vol. 32, 2000, p. 93-110

Argues that managed care is undergoing the kind of bureaucrat bashing familiar to government employees, because managed care plans are being asked to perform the same type of allocation of social resources (in this case access to health care) typically conducted by government employees. In doing so, managed care has run afoul of two deeply ingrained American traditions: bureaucrat bashing and overhead democracy. Article uses a case study of managed care bashing to argue that private interests who perform a role in allocating social resources will be subject to the same type of criticism as government officials face in performing the same function, as well as political leaders impulses towards control (overhead democracy).

PUBLIC AND PRIVATE HOSPITALS IN BANGLADESH: SERVICE QUALITY AND PREDICTORS OF HOSPITAL CHOICE

S. S. Andaleeb

Health Policy and Planning, vol. 15, 2000, p. 95-102

The article compares the quality of services provided by public and private hospitals in Bangladesh. Since private hospitals are not subsidised and depend on income from clients, they are more motivated than public hospitals to provide quality services to patients to meet their needs more effectively and efficiently. Patient perceptions of service quality and key demographic characteristics were also used to predict choice of public or private hospitals. The model, based on discriminate analysis, demonstrated satisfactory predictive power.

THE RESPONSE OF PROVIDERS TO CAPITATION PAYMENT: A CASE-STUDY FROM THAILAND

A. Mills et al

Health Policy, vol. 51, 2000, p. 163-180

Those designing payment systems for health care in low and middle income countries are increasingly looking to capitation payment in order to avoid the cost inflation experience with fee-for-service payment. Paper draws on several research studies to explore the response of health care providers at both market and facility level to the introduction of a capitation system of payment in the context of a new compulsory insurance scheme for workers in Thailand.

RESTRUCTURING HEALTH POLICY NETWORKS: A FRENCH POLICY STYLE?

S. Griggs

West European Politics, vol. 22, 1999, p. 185-204

Essay examines the process of health policy change in France, analysing the dynamics of hospital management policy and the persistent attempts of the French State to restructure hospital management policy networks and renegotiate the state-medical profession compromise. Concludes that, as in other West European states, policy making is erratic, driven by the 'demands' of politicians and proceeds more by trial-and-error than any rational response. Different values and objectives are imported into the management of health policy networks by successive sets of ministers and senior officials driving the process of change.

AN UPDATE ON SPAIN'S HEALTH CARE SYSTEM: IS IT TIME FOR MANAGED COMPETITION?

M. Rodriguez, R. M. Scheffler, and J. D. Agnew

Health Policy, vol. 51, 2000, p. 109-131

The Spanish health care system confronts continued pressure to provide high quality universal care in the face of ever increasing costs and competing uses for financial resources. These pressures have led to reforms which introduce an element of competition, and to measures intended to improve performance through the use of management techniques imported from the private sector. Further reforms may include implementation of managed care and managed competition as developed in the US.

USER FEES AND DRUGS: WHAT DID THE HEALTH REFORMS IN ZAMBIA ACHIEVE?

S. Van Der Geest et al

Health Policy and Planning, vol. 15, 2000, p. 59-65

The article reports on exploratory research into the effects and prospects of health reforms in Zambia. The research, which was qualitative, was carried out in two rural and two urban health centres and their surroundings catchment areas. The authors focus on four principles of health reform: community involvement, prevention, equity and quality of care. One of the main conclusions is that the introduction of cost sharing does not improve the availability of drugs.

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