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

Challenges for performance assessment and improvement in primary health care: the case of the Portuguese health centres

C.A. da E.F. Amado and S.P. dos Santos

Health Policy, vol. 91, 2009, p. 43-56

This paper aims to contribute to the discussion regarding appropriate ways to compare the performance of primary healthcare providers. Following a review of the literature, a conceptual framework for performance assessment of health centres is developed and tested using the Portuguese system as an example. The empirical analysis uses data from 2004 and 2005 for all Portuguese health centres and compares equity of access to services, technical efficiency and quality of services across district health authorities. Large variations across districts were found on all measures.

Community-based programs and policies: contributions to social policy development in health care and health care-related services

H. Palley (editor)

London: Routledge, 2009

This collection is focused on the provision of community-based programmes and activities in health and related long-term care services that have contributed, or may in the future contribute, to social policy development in the US. It deals with community-based health and long-term care programme and policy initiatives that have been facilitated through federal programmes such as Medicare, Medicaid and the Older Americans Act. The implementation of some of these community-based programmes has significantly influenced social policy thinking regarding the beneficial effects of integrating medical and social aspects of health and long-term care services, as well as the health care team approach to the delivery of health and long-term care services. Another dimension addressed is the impact of interest groups, such as family caregivers, in advancing social policy that supports the efforts of community-based family care givers in providing services to patients in need.

Comparative effectiveness research and evidence-based health policy: experience from four countries

K. Chalkidou and others

Milbank Quarterly, vol. 87, 2009, p. 339-367

The discussion about improving the efficiency, quality and long-term sustainability of the US healthcare system is increasingly focusing on the need to provide better evidence for decision-making through comparative effectiveness research. In recent years several other countries have established agencies to evaluate health technologies and broader management strategies to inform healthcare policy decisions. This article reviews experiences from Britain, France, Germany and Australia. It concludes that while the entities evolved separately and have different responsibilities, they have adopted a set of core structural, technical and procedural principles, including mechanisms for engaging with stakeholders, governance and oversight arrangements, and explicit methodologies for analysing evidence, to ensure a high quality product that is relevant to their system.

Contracting-in management to strengthen publicly financed primary health services: the experience of Punjab, Pakistan

B. Loevinsohn and others

Health Policy, vol. 91, 2009, p. 17-23

Pakistan has an extensive network of publicly operated primary health care facilities which are under-used. This article describes the government of Punjab's experience of contracting with a non-governmental organisation to manage the primary health care facilities in one district. An evaluation showed that contracting out the management of the health facilities led to an increase in out-patient visits and greater satisfaction in the community with health services. Contracting out management worked well in this context and has now been expanded.

Health policy reform in China: lessons from Asia

M. Ramesh and X. Wu

Social Science and Medicine, vol. 68, 2009, p. 2256-2262

In China since the 1970s, health expenditures have increased rapidly while the proportion of the population with access to healthcare has decreased. Government has responded by increasing expenditure on publicly owned health facilities so that they can provide basic care for free or at substantially discounted prices. It is also expanding subsidised health insurance to cover the 80% of the population that currently has no protection. This paper examines the potentials and pitfalls of the two reforms by analysing the experiences of Korea, Singapore and Thailand, which have gone through similar changes in recent years. It is argued that increasing expenditure without reforming the system for paying providers will not cure the core problems afflicting Chinese healthcare services.

Involvement of family nurses in home visits during an 8-year period encompassing primary healthcare reforms in Poland

L. Marcinowicz and others

Health and Social Care in the Community, vol. 17, 2009, p. 327-334

This study explores the involvement of family nurses in home visits in the context of organisational and legal changes to service provision in Poland. A series of surveys was undertaken in a small town in North Eastern Poland in 1998, 2002 and 2006 (surveys I, II, and III). In 1998 family nurses were employed by family doctors, but by 2002 nurses had established their own practices and held direct contracts with the National Health Fund. A significant increase in the percentage of patients receiving home visits from a family nurse was observed between surveys I and II, but this had declined by survey III. Patients over 75 years on age were the main demographic group receiving family nursing at home.

The new cooperative medical scheme in China

X. You and Y. Kobayashi

Health Policy, vol. 91, 2009, p. 1-9

The New Cooperative Medical Scheme is a heavily subsidised voluntary insurance programme established in 2003 to reduce the risk of catastrophic health spending for rural residents in China. This review presents knowledge currently available about the performance of the scheme in relation to revenue collection, risk pooling, reimbursement rules and provider payment. The available evidence suggests that the NCMS has substantially improved health care access and utilisation among participants. However, it appears to have had no significant effect on average household out-of-pocket spending and catastrophic expenditure risk.

The process of decision-making in home care case management: implications for the introduction of universal assessment and information technology

M. Egan and others

Health and Social Care in the Community, vol. 17, 2009, p. 371-378

Increasingly jurisdictions are adopting universal assessment procedures and information technology to aid in healthcare data collection and care planning. Before their potential can be realised, a better understanding is needed of how these systems can best be used to support clinical practice. This study investigated the decision-making process and information needs of home care case managers in Ontario prior to the widespread use of universal assessment, with a view to determining how universal assessment and information technology could best support this work.

Shifting boundaries of public health: Europe in the twentieth century

S. Solomon, L. Murard and P. Zylberman (editors)

Rochester, N.Y.: University of Rochester Press, 2008

European public health was a playing field for deeply contradictory impulses throughout the twentieth century. In the 1920s, international agencies were established with post-war optimism to serve as the watch tower of health the world over. Within less than a decade, local level institutions began to emerge as seats of innovation, initiative, and expertise. But there was continual counter pressure from nation states that jealously guarded their policy-making prerogatives in the face of the push for cross-national standardization and the emergence of original initiatives from below. In contrast to histories of twentieth century public health that focus exclusively on the local, national, or international levels, this book explores the connections or 'zones of contact' between the three levels. The interpretive essays focus on four topics: the oscillation between governmental and non-governmental (public) agencies as sites of responsibility for addressing public health problems; the harmonization of nation states' agendas with those of international agencies; the development by public health experts of knowledge that is both placeless and respectful of place; and the transportability of model solutions across borders. The volume breaks new ground in its treatment of public health as a political endeavour by highlighting strategies to prevent or alleviate disease as a matter not simply of medical techniques, but of political values and commitments.

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