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

Affiliation with a primary care provider in New Zealand: who is, who isn't?

S. Jatrana and P. Crampton

Health Policy, vol. 91, 2009, p. 286-296

Primary healthcare in New Zealand is only 60% funded by the government. Because of patient co-payments, the paucity of Maori and Pacific Islanders in the workforce, and the uneven distribution of GPs, significant financial, cultural and geographical barriers to access exist in some parts of the country. New Zealand's current primary healthcare strategy launched in 2001 aims to tackle some of these barriers by grouping primary care providers into primary health organisations (PHOs), which are funded on a capitation basis to provide a specific set of treatments to their enrolled populations. Healthcare providers are encouraged to join a PHO by more generous subsidies which are regularly increased in line with the Consumer Price Index. As a result of these subsidies, levels of co-payments for primary care have reduced significantly. Affiliation to a primary care provider is a widely accepted measure of potential access to primary care. Survey data reported in this article suggest that people with high health needs in New Zealand, such as the elderly, Maori and women, have high rates of affiliation to a primary care provider. The results also suggest that current health policies are ensuring that people with greater healthcare needs are affiliated to a primary care provider.

Economic reforms and health insurance in China

J. Du

Social Science and Medicine, vol. 69, 2009, p. 387-395

During the 1990s, Chinese state-owned enterprises and collective enterprises decreased the health insurance cover they offered employees. This paper investigates the changing pattern of health insurance cover using panel data from the China Nutrition and Health Survey 1991-2000. Specifically, it aims to disentangle the effects of the Open Door policy, deregulation of collective enterprises, and state-owned enterprise reform on health insurance coverage. Results showed that unemployment as a side effect of the Open Door policy and the deregulation of state-owned and collective enterprises were the main causes of the decrease in coverage. For example, urban areas that were highly affected by the Open Door policy saw a 17% decrease in health insurance coverage.

Embracing a family centred response to the HIV/AIDS epidemic for the elimination of pediatric AIDS

V. DeGennaro and P. Zeitz

Global Public Health, vol. 4, 2009, 386-401

There are 2.1 million children under the age of 15 living with HIV/AIDS, and 290,000 children died of AIDS in 2007. The number of children receiving antiretroviral therapy remains inappropriately small, and prevention of mother-to-child transmission efforts have been grossly inadequate. Countries with comprehensive, integrated family-centred care programmes are better equipped to prevent and treat pediatric HIV/AIDS. True family-centred care offers prompt maternal and pediatric HIV diagnosis, antiretroviral prophylaxis, cotrimoxazole prophylaxis, and long-term ART for the entire family, as appropriate. To eliminate paediatric HIV/AIDS, national governments must embrace family-centred care, implement pediatric-friendly infrastructure, and train healthcare workers to treat children.

Health care as the central civic and political problem of the United States: a comparative perspective

G. Freddi

European Political Science, vol. 8, 2009, p. 330-344

Using the cultural theory of American exceptionalism, this article discusses why there is no compulsory universal health insurance in the USA. It reconstructs the structural development of the healthcare system in the 20th century, and documents the anti-social medicine ideological positions of the providers. The idea of a combination of rugged individualism and reformist liberalism producing a satisfactory collective outcome has not worked in this case. There is an imbalance between the interests of the providers and a fragmented public thus far incapable of acting cooperatively in pursuit of better collective outcomes.

Health care reforms in developing Asia: propositions and realities

X. Wu and M. Ramesh

Development and Change, vol.40, 2009, p. 531-549

The notion that healthcare is a key state responsibility has increasingly been challenged. Confronted with rising expenditure, inequitable access and perceptions of public sector inefficiencies, many developing countries have turned to the market to improve the delivery of healthcare. However, the realities have fallen far short of expectations, and the reforms have often aggravated the problems they were meant to solve. This article critically examines eight key arguments used to justify market reforms that continue to appeal to policymakers and analysts.

Lessons for the UK in Obama's universal plan

M. MacDonnell and D. Noble

Health Service Journal, Aug. 13th 2009, p. 10-11

The financial crisis has put restraining healthcare costs at the centre of the policy debate in both the UK and the US. Demand for healthcare is rising in both countries due to population ageing and costs are exploding as new treatments and technologies are adopted. A focus on improving quality alone will not prevent costs of care from rising; both countries will have to improve quality and control costs at the same time. Promising strategies for both countries are to introduce stronger incentives to reduce the over-provision of care, and to mobilise local citizens to supplement central resources.

Overwhelming health expenditures among the poor in a transition economy: a case study from Turkey

F. Yilmaz and others

International Journal of Health Promotion and Education, vol.47, 2009, p. 72-78

No previous studies have measured catastrophic health expenditures among poor people in Turkey. This research involved face-to-face interviews with 92 households in Ankara which were in the priority group for assistance identified by the Social Risk Mitigation Project of the Social Solidarity Fund. Results showed that 125 household members (34.3%) had at least one chronic illness and/or disability, and 14 households (15.2%) were facing catastrophic health expenditures that constituted an average of 62.3% of their non-food spending. In poor households, people could be protected from catastrophic health expenditure by reducing the health system's reliance on out-of-pocket payments and by extending financial protection (health insurance).

Public participation in health care priority setting: a scoping review

C. Mitton and others

Health Policy, vol. 91, 2009, p. 219-228

Governments appear to recognise the benefits of consulting multiple publics using a range of methods, though more traditional approaches to engagement continue to predominate. There appears to be a growing interest in deliberative approaches to public engagement, which are more commonly on-going rather than one-off, and more apt to involve face-to-face contact. However, formal evaluation of public engagement efforts is rare. Also absent is any real effort to demonstrate how public views might be integrated with other decision inputs when allocating social resources.

World society, family planning programs and the health of children

W. Roberts

International Journal of Sociology and Social Policy, vol. 29, 2009, p. 414-425

This study sought to shed light on the relationship between countries' world society embeddedness, family planning programme capacity and child health outcomes. Results show that countries' adoption and commitment of resources to family planning programmes is influenced by their relative immersion in the network of world society organisations. This global influence serves as a more powerful predictor than countries' level of economic resources, political responsiveness or ecological necessity. Moreover, analyses show that these world-society informed programmes have a significant impact on child health, improving child survival by decreasing fertility and improving immunisation coverage.

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