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

Bridging divides: patient and public involvement on both sides of the Atlantic

J.Q. Tritter and K. Lutfey (editors)

Health Expectations, vol. 12, 2009, p. 221-287

This themed section seeks to capture some of the different conceptions of user involvement in health service planning found in the UK, the US and other countries such as Morocco and Brazil. The papers touch on diverse issues including the relationship between national law, policy and public and patient involvement (PPI); the importance of collective vs individualistic expectations in the support, maintenance and changing of PPI; and the differential development of PPI in different countries. The collection makes an important contribution towards explaining why PPI occurs differently across nations and how it feeds back into research, policy and practice.

The changing face of service quality in the New Zealand public health sector

M.A. Brunton

Journal of Management and Marketing in Healthcare, vol.2, 2009, p.260-277

In New Zealand, quality issues have been prominent since the Public Health and Disability Act 2000 introduced the statutory requirement to both focus on and report annually on progress being made to improve the quality of the public health service. This paper explores the issue of whether the political rhetoric is matched by improved patient experience on the ground through an analysis of a sample of mainstream media stories over a six-month period in 2007. The disjuncture revealed between political claims and institutional reality shows that quality objectives have not been achieved for all New Zealand citizens.

The cost-effectiveness of integrated home care and discharge practice for home care patients

T. Hammar, P. Rissanen and M.-L. Perala

Health Policy, vol. 92, 2009, p. 10-20

The most critical period after a hospital stay is the first two weeks at home. Some problems in home care and hospital discharge practices are common, such as shortcomings in the flow of information and the continuity of care, and a lack of integration of services based on the patient's needs. New practices such as case management and co-ordination, multidisciplinary team work, and integrated care and educational programmes have been developed to address these shortcomings and to control the costs of health and social care. This study evaluated the effects on use of services and the cost-effectiveness of integrated home care and discharge practice using a cluster randomised trial with 22 Finnish municipalities. Results suggest that integrated home care and discharge practice may be a cost-effective alternative to usual care.

Creating patient-centred healthcare practices: social marketing tools and strategies

G. Quinn and others

Journal of Management and Marketing in Healthcare, vol. 2, 2009, p. 221-237

Social marketing is a tool for the creation of behaviour change among groups of individuals to promote health improvement. This paper offers a brief overview of social marketing and explains how information collected through this approach can help healthcare providers develop patient-centred practices. It also suggests tools to facilitate data collection and analysis efforts by community representatives as opposed to university researchers. It describes the tools used to help pilot communities in Friendly Access, a national effort to improve access to, and use of, prenatal care and birth services in the USA, collect and analyse consumer data to aid in healthcare delivery decisions.

Deciding how to decide: the case of health care rationing

C. Landwehr

Public Administration, vol. 87, 2009, p. 586-603

One of the challenges facing health care systems around the world is the containment of expenditure in the face of exploding costs for new drugs and treatments. This article evaluates the different procedures used to ration health care in four countries:

  1. expert discussion, as exemplified by the National Institute of Clinical Excellence in the UK
  2. citizen deliberation, as exemplified by the Oregon Health Plan
  3. distributive bargaining, as exemplified by a Federal Committee at which doctors and health insurers negotiate services to be covered by health plans in Germany
  4. Parliamentary debate and decisions in Sweden

Formal and informal payments in health care facilities in two Russian cities, Tyumen and Lipetsk

P. Aarva and others

Health Policy and Planning, vol. 24, 2009, p. 395-405

While the Russian government proclaims its policy goal of improving access to and quality of free health services, it has approved regulations that give local authorities power to charge for services. Data from a survey of 2001 persons in two regional capitals of different economic status show the practice of informal payments for healthcare exists alongside the introduction of formal chargeable government services. Around 15% of respondents had made informal payments in the past three years. Being female, having a chronic disease, being a pensioner and being willing to pay for additional medical information increased the likelihood of making informal payments for healthcare services.

Funding and access to high cost medicines in public hospitals in Australia: decision-makers' perspectives

G. Gallego, S.J. Taylor and J.E. Brien

Health Policy, vol. 92, 2009, p. 27-34

One of the biggest challenges facing healthcare systems is providing patients with access to new treatments while at the same time ensuring the sustainability of funding. Australia has a two stage system which distinguishes access and subsidised access to approved pharmaceuticals. In the first stage drug companies apply for registration (licensing approval) to the Therapeutic Goods Administration (TGA). After marketing approval is granted by the TGA, companies can apply to the Pharmaceutical Benefits Advisory Committee for government subsidy through listing on the Pharmaceutical Benefits Scheme (PBS). However, medicines prescribed to public hospital inpatients are funded from within public hospital budgets and are not limited to those listed on the PBS. This study of the attitudes of decision-makers to access to high cost medicines in public hospitals revealed concerns about equity of access. Decision-makers wanted an explicit, systematic process to allocate resources to high cost medicines.

Health care errors and patient safety

B. Hurwitz and A. Sheikh (editors)

Chichester: Wiley Blackwell, 2009

The detection, reporting, measurement, and minimization of medical errors and harms are now a core requirement in clinical organizations throughout developed societies. This book focuses on this major new area in health care. It explores the nature of medical error, its incidence in different health care settings, and strategies for minimizing errors and their harmful consequences to patients.

Health promotion, user involvement and empowerment among migrants

M. Garcia-Ramirez and E. Hatzidimitriadou

International Journal of Migration, Health and Social Care, vol. 5, June 2009, p.2-57

The papers in this special issue discuss how socio-political development processes can contribute to dealing with challenges in health and social care promotion among disadvantaged users, and how community-based processes can be a very important methodological tool to complement evidence-based practices with migrant and ethnic minority groups. Articles present examples of health care promotion practices in Europe and the USA, providing an opportunity to reflect on the commonalities and the different challenges faced by users and carers in these varied geographic locations. The papers all point to the need to broaden our understanding of the role that migrant and ethnic minority service users can play in developing effective and appropriate health promotion programmes. Participatory methods and community engagement concepts are of importance in such developments.

Innovation in global health governance: critical cases

A. Cooper and J. Kirton (editors)

Farnham: Ashgate, 2009

Analysing twenty-first century innovations in global health governance, this volume addresses questions of pandemics, essential medicines and disease eradication through detailed case studies of critical and rapidly spreading infectious diseases such as HIV/AIDS and SARS and 'lifestyle' illnesses such as tobacco-related diseases, all of which are at the centre of the current global health challenge.

Is community-based health insurance an equitable strategy for paying for healthcare? Experiences from southeast Nigeria.

O. Onwujekwe and others

Health Policy, vol. 92, 2009, p. 96-102

Community-based health insurance (CBHI) is a form of voluntary health insurance that has become widespread in Africa in recent years. CBHI schemes are based on concepts of mutual aid and social solidarity and are designed for people in the informal sector who are unable to get adequate public, private or employer-sponsored health insurance. This study investigated how equitable enrolment and utilisation of CBHI are in two communities in Nigeria which had experienced varying degrees of success in implementing the scheme. Results showed that enrolment was generally low at 15.5% in the unsuccessful community and 48.4% in the successful community and premiums, though small, were retrogressive. However, there was equitable enrolment and utilisation of services. The authors call for efforts to be made to increase the number of enrolees, and for premiums to be supplemented by subsidies from donors and the government.

Managing change in healthcare: using action research

P. Parkin

London: Sage, 2009

The book looks at the leadership, interpersonal and management skills needed to develop and implement new services designed to bring patients into the centre of healthcare delivery. Key features of the text include:

  • unique use of Action Research as a model for planning and implementing change at the patient-service interface
  • chapters making use of evidence and case studies to demonstrate the stages of the change process
  • tips and useful strategies for achieving change
  • a demonstration that dynamic change can be achieved at the individual, team, departmental and organisational levels
  • chapters covering a range of topics including: organisational culture; leadership; conflict resolution; managerial roles and organisational analysis.

Obama tells America: I will not allow my reform to fail

T. Harnden

Daily Telegraph, Sept. 11th 2009, p. 16

Report of a speech by President Obama to both Houses of Congress in which he pledged to drive through ambitious healthcare reforms by Christmas 2009. He condemned the 'collective failure' of Americans to provide insurance schemes to make health insurance available for all, presenting reform as a moral imperative, while lambasting opponents for their 'scare tactics'. The proposed reforms would extend coverage to the 48 million Americans currently uninsured either through a state run insurance scheme or through schemes run by nonprofits. The reforms are estimated to be going to cost $900 billion over ten years.

Policy statements and practice guidelines for medical end-of-life decisions in Dutch health care institutions: developments in the past decade

H.R.W. Pasman and others

Health Policy, vol.92, 2009, p. 79-88

In the past decade there has been growing interest in the development of institutional policies and practice guidelines in healthcare organisations. The principal benefit of guidelines is to improve the quality and consistency of care received by patients. This study explored the prevalence of guidelines on euthanasia, do-not-resuscitate decisions, palliative sedation, alleviation of symptoms, and withholding or withdrawing treatment in Dutch healthcare institutions. The majority of institutions had a written policy statement on euthanasia (70%). Most also had practice guidelines on euthanasia and do-not-resuscitate decisions (62 and 63 per cent). A minority had guidelines on palliative sedation (27%), alleviation of symptoms (27%) and withdrawal of treatment (33%). The authors call on the many institutions which do not have practice guidelines for end-of-life decisions to produce them to improve quality of care.

The population-level impacts of a national health insurance program and franchise midwife clinics on achievement of prenatal and delivery care standards in the Philippines

K.B. Kozhimannil and others

Health Policy, vol. 92, 2009, p. 55-64

Starting in 1998, two programmes were widely expanded in the Philippines: a national health insurance programme (PhilHealth) and a donor-funded franchise of midwife clinics (Well Family Midwife Clinics). This paper examines population-level impacts of these interventions on achievement of minimum standards for prenatal and delivery care. Results suggest that the expansion of the national health insurance programme with accreditation standards was associated with significantly increased uptake of prenatal services and had a positive impact on the achievement of minimally adequate prenatal care standards among Filipina women.

Remote patient monitoring in home healthcare: lessons learned from advanced users

A. Darkins and J.H. Sanders

Journal of Management and Marketing in Healthcare, vol. 2, 2009, p. 238-252

Most healthcare organisations will face the challenge of having to re-engineer their legacy care delivery systems to accommodate health information technologies that will improve their efficiency and effectiveness. Current facility-based healthcare provision that was designed to deal with acute illnesses will have to adapt to cope with the needs of an ageing population with chronic conditions. Health information technologies can make the home into the location at which care is provided. This paper reviews the main drivers for the adoption of telehealth and the related clinical, technological and business challenges this presents.

Women's rights and women's health during HIV/AIDS epidemics: the experience of women in Sub-Saharan Africa

B. F. Dugassa

Health Care for Women International, vol. 30, 2009, p. 690-706

There is no cure or vaccination for HIV/AIDS and the disease spreads most rapidly where social life is chaotic, poverty is endemic, and human rights are violated. Therefore, the struggle for human rights and the empowerment of women should be seen as part of the effort to contain the epidemic.

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