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

Balancing adoption and affordability of medical devices in Europe

J. Schreyogg, M. Baumler and R. Busse

Health Policy, vol. 92, 2009, p. 218-224

This article explores the policies pursued by four European countries to achieve a balance between improving access to new medical devices and containing costs. It outlines the policies of the four European countries with the largest expenditures on medical devices: the UK, Germany, France and Italy. It concludes that reference prices, if defined as maximum reimbursement levels and based on groups of products with comparable effectiveness and quality, can help to achieve balance because they contain costs effectively but do not necessarily act as a barrier to the adoption of innovations.

Budget allocation in EU-15 countries operating under tax-financed healthcare systems: the stalemate of the Greek NHS

V. Vaskantiras and others

International Journal of Behavioural and Healthcare Research, vol. 1, 2009, p. 247-257

The Greek National Health Service does not apply a capitation scheme for allocating resources but continues to distribute these on a historical basis. A weighted capitation model intended to reduce geographical inequalities in the funding of health services has been proposed but never implemented. Introduction of such a model would cause a major confrontation between the Ministry of Health and powerful interest groups. However, the inefficiency of the present system means that it cannot continue.

Care for chronic conditions for indigenous Australians: key informants' perspectives on policy

J. Baeza, R. Bailie and J.M. Lewis

Health Policy, vol. 92, 2009, p. 211-217

The World Health Organization's 2002 global report, Innovative Care for Chronic Conditions, proposes a comprehensive framework for health services to meet the challenges posed by the dramatic increase in chronic conditions worldwide. This paper uses the policy environment component of the framework as a lens through which to examine key informants' perspectives on the management and prevention of chronic conditions in rural and remote Aboriginal communities in Australia. The research found considerable success in developing strategies for chronic illness care since the change of government in 2007, but concludes that more needs to be done to strengthen partnership working and to retrain the workforce. The study has the potential to contribute to new national policy directions in indigenous health.

Choice and competition in publicly funded health care

J. Le Grand

Health Economics, Policy and Law, vol. 4, 2009, p. 479-488

There are four models for the delivery of publicly funded healthcare: 1) trust, where managers and clinicians are trusted to know and deliver what is best for their users without government interference; 2) command and control, where central government sets targets for providers, rewarding success and penalising failure; 3) Voice, where users express dissatisfaction directly to providers; and 4) consumer choice and competition among providers. All of these models have their merits and demerits, but there are good theoretical and empirical arguments for preferring systems with a strong element of choice and competition in most situations. (For responses see Health Economics, Policy and Law, vol.4, 2009, p. 489-490)

Decision makers' experiences of prioritisation and views about how to finance healthcare costs

E. Werntoft and A.-K. Edberg

Health Policy, vol. 92, 2009, p. 259-276

The Swedish healthcare system is financed through taxation and is governed by political decisions made in democratically elected bodies at both national and local levels. Decisions about prioritisation are steered by three ethical principles developed by the Swedish Parliamentary Priorities Commission. In this context, the study reported here aimed to describe decision makers' experience of prioritisation, and their views concerning willingness to pay and healthcare finance. An additional aim was to compare the views of politicians and physicians. Data were gathered through a questionnaire administered to 700 politicians and physicians. A majority of decision makers (55%) thought that rising costs should be financed through higher taxation, but more physicians than politicians thought that higher patient fees, private health insurance and a reduction in social expenditure were better alternatives. Prioritisation aroused anxiety: politicians were afraid of displeasing voters while physicians were afraid of making medically incorrect decisions.

Drop-out analysis of community-based health insurance membership at Nouna, Burkina Faso

H. Dong and others

Health Policy, vol. 92, 2009, p. 174-179

In the past decades, community-based health insurance (CBI) has been seen as a promising new tool for improving access to healthcare for rural populations in Sub-Saharan Africa. However schemes have suffered from low enrolment and retention rates. This study of a CBI scheme in Nouna in rural Burkina Faso aims to identify why previously enrolled people decide not to renew their scheme membership. The results may help decision makers to design measures that can enhance CBI retention rates and improve the sustainability of schemes.

Funding health technologies in decentralised systems: a comparison between Italy and Spain

G. Cappellaro, G. Fattore and A. Torbica

Health Policy, vol. 92, 2009, p. 313-321

In both Italy and Spain responsibility for healthcare delivery is devolved to the regions, but citizens are granted the same access rights across jurisdictions. Although the Spanish and Italian healthcare services are managed at the regional level, they are subject to national rules concerning coverage, and to a large extent, financing. This paper reports the first comparative study of whether and how medical devices are included in the national health benefit baskets, how these devices are funded through public resources, and what purchasing mechanisms are in place. The main differences between Italy and Spain were found in funding mechanisms. Negotiated global hospital budgets in Spain and DRG-based prospective payments in Italy create different incentives for organisations with respect to technology use.

Health system strengthening in Cambodia: a case study of health policy response to social transition

J. Grundy and others

Health Policy, vol. 92, 2009, p. 107-115

Cambodia, following decades of civil conflict, and social and economic transition, has in the last ten years developed health policy innovations in the areas of health contracting, health financing and health planning. This paper aims to outline recent social, epidemiological and demographic health trends in Cambodia, and on the basis of this analysis, to analyse and discuss these policy responses to social transition.

Hospital response to a global budget program under universal health insurance in Taiwan

S.-H. Cheng, C.-C. Chen and W.-L. Chang

Health Policy, vol. 92, 2009, p. 158-164

Within a few years of its implementation in 1995, Taiwan's universal health insurance programme was faced with a financial crisis. As a result, Taiwan's Bureau of National Health Insurance began implementing global budget programmes, beginning with dental services in 1998 and ending with hospital services in 2002. Following the implementation of the global budget programmes, the overall growth rate of national healthcare expenditures has decreased. This study examines the response of hospitals in Taiwan to the global budget programme in its first two years of operation.

Hospital supplements in Belgium: price variation and regulation

A. Lecluyse and others

Health Policy, vol. 92, 2009, p. 276-287

The financial accessibility of a healthcare system is directly related to the amount and distribution of out-of-pocket payments. In Belgium, the latter consist of official co-payments, charges for treatments not covered by the health insurance system, and extra payments to providers on top of the fee agreed upon with health insurance. The two latter payments are called 'supplements'. Although official reimbursements and co-payments are strongly regulated, providers have considerable freedom in the levying of supplementary charges. However, the government and insurers have imposed various restrictions on supplementary charges to protect vulnerable groups and ensure that healthcare remains accessible. This article investigates how prices are set and whether the restrictions have been effective.

Informal payments: a side-effect of transition or a mechanism for sustaining the illusion of 'free' health care? The experience of four regions in the Russian Federation

M. Fotaki

Journal of Social Policy, vol. 38, 2009, p. 649-670

Informal payments for health services are widespread in the former Soviet Union. Their existence significantly contributes to the financing of the health system. This article discusses the findings of a study investigating the nature and extent of informal payments in four regions of the Russian Federation. It argues that, despite the level of declared support for moderate cost-sharing by different population groups, it is unlikely that any legalised form of co-payment or private health insurance will replace informal payments. These are used by the government to maintain the illusion of 'free' healthcare, a policy to which it is publicly committed. This policy cannot easily be jettisoned because it taps into a long tradition of communitarian egalitarianism in Russia.

Purchasing health care in China: competing or non-competing third party purchasers?

W. Xu and W.P.M.M. van de Ven

Health Policy, vol. 92, 2009, p. 305-312

The Chinese government has promised to increase state funding for healthcare by 1-1.5% of Gross Domestic Product during the coming years. However, it is unclear how the new money should be spent to tackle current problems of inefficiency and inequity in the healthcare system. To help answer this question, the authors analyse three models of healthcare organisation that may be relevant to China. These are government provision, a regulated market with non-competing third-party purchasers, as exemplified by market reforms in the NHS, and a regulated market with competing third-party purchasers, as exemplified by the current Dutch system. It is concluded that the creation of prudent third-party purchasers, who are able to act on behalf of individual customers, is a critical success factor for healthcare reform in China.

Some pain, no gain: experiences with the no-claim rebate in the Dutch health care system

J. Holland and others

Health Economics, Policy and Law, vol. 4, 2009, p. 405-424

In order to contain expenditure and reduce demand, a no-claim rebate was introduced into the Dutch health insurance system in 2005. It was launched as a consumer friendly bonus system to reward prudent use of health services. Consumers were entitles to an annual rebate of 255 euros if no claims were made. During the year, all health care expenses except for GP visits and maternity care were deducted from the rebate until it reached zero. This article discusses the rationale for the no-claim rebate, the available evidence of its effect and why it was replaced in 2008 by a mandatory deductible.