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

Are MSAs effective for cost containment?

A.M. Ali

British Journal of Healthcare Management, vol. 15, 2009, p. 476-483

Medical savings accounts (MSAs) have attracted increasing interest within both academic and political spheres as a demand-side approach to curbing escalating healthcare costs in the developed world. By having patients pay for their care out of a personal savings account, they aim to reduce the unnecessary use of health services and encourage the selection of high quality providers. However, a system of compulsory MSAs in Singapore has failed to reduce healthcare costs owing to the changes it evoked in provider behaviour. MSA schemes also tend to disadvantage financially vulnerable groups.

Comparative effectiveness research in Ontario, Canada: producing relevant and timely information for health care decision makers

D.M. Whicher and others

Milbank Quarterly, vol.87, 2009, p. 585-606

Hospital officials throughout Ontario have expressed frustration at public pressure to adopt new medical technologies without objective evidence of their effectiveness. In response, the Ontario Health Ministry created a system under which decision makers can request a medical technology review by the Ontario Health Technology Advisory Committee (OHTAC). Following the review, if OHTAC considers evidence of the technology's clinical effectiveness, safety or cost-effectiveness to be inadequate, it can request a prospective clinical study, usually a pragmatic clinical trial, to be conducted. This article describes the main programmes involved in Ontario's comparative effectiveness research network for non-drug technologies. It then looks at workforce and funding requirements and discusses possible lessons from the Ontario experience for policymakers in the USA.

Coordinated care: what does that really mean?

C. Ehrlich and others

Health and Social Care in the Community, vol.17, 2009, p. 619-627

Fragmentation is the Achilles heel of the current health system in Australia and elsewhere and contributes to poor outcomes that can be experienced by people with chronic and complex conditions. Underlying the success of any initiatives to address fragmentation is the need to coordinate several diverse components of the system, including management, healthcare delivery, science and finance. Through a review of the research literature, this paper identifies several key issues that need to be addressed when adopting a coordinated approach to chronic disease management in primary care. Delivery of coordinated care in the primary healthcare setting relies on complicated concepts such as partnerships, networking, collaboration, knowledge transfer, person-centred practice and self-management support.

Enabling volunteer health planning capacity: a rural Canadian case study

M. Coady

Journal of Enterprising Communities, vol.3, 2009, p. 393-404

The development of partnerships between health systems and communities is advocated as a means of enhancing overall community capacity to address priority concerns and to reduce escalating costs. The process of building health partnerships is complex, requiring extensive assessment of both health system and community readiness. This study finds that dialogue is a key mechanism for assessing community and system readiness, and for building trust and mutual understanding. There is also a need to nurture and support the capacity of volunteers to work with health systems in planning service delivery and to minimise barriers to their participation.

Evaluation of the impact of program budgeting and marginal analysis in Vancouver Island Health Authority

F. Dionne and others

Journal of Health Services Research and Policy, vol. 14, 2009, p. 234-242

Program budgeting and marginal analysis (PBMA) is a formal process for setting priorities and allocating scarce resources. Faced with demands that typically outstrip available resources, healthcare decision-makers need a process to guide allocation decisions. PBMA was introduced at Vancouver Island Health Authority in 2005 and has demonstrated its ability to handle some of the key issues associated with this challenge.

Germany goes ahead with health vouchers

W.F. Richter

CESifo DICE Report, 3/2009, p. 53-61

The Social Insurance Pro Competition Act came into force in Germany in 2007. This Act changed the way in which sickness funds compete for members. In the past sickness funds competed on the basis of contribution rates. In the new system, the rate of contribution is uniform and no longer fund specific. Workers are issued with vouchers which they use to join the health plan of their choice. If the fund pays out less in reimbursements than the total value of the vouchers it receives, it may distribute the surplus among members. If fund expenditure exceeds income, it must ask members to pay an extra premium. The new system encourages people to seek out health plans that provide care economically.

Global health funding: how much, where it comes from and where it goes

D. McCoy, S. Chand and D. Sridhar

Health Policy and Planning, vol. 24, 2009, p. 407-417

It is frequently stated that global health funding has increased dramatically over the past decade. However, there are inadequate data to describe the precise volume of global health expenditure, the source of this funding, its management and how it is spent. A detailed description of global health funding is needed to improve the efficiency, accountability, performance and equity impact of the many actors that populate the global health landscape. In particular, it is necessary to track and monitor the activities of non-OECD donors as well as funding that is sourced by and channelled through private actors.

Globalization and health: pathways, evidence and policy

R. Labonte and others (editors)

London: Routledge, 2009

Contemporary globalization has had a tremendous impact on health equity worldwide. This book systematically analyzes the relationship between globalization and global trends in health outcomes. It consolidates and updates the findings of a global research project undertaken by the Globalisation Knowledge Network (GKN) of the World Health Organization's Commission on Social Determinants of Health. Chapters examine such questions as:

  • How has trade liberalisation affected the social determinants of health?
  • How has globalization affected food security, nutrition and equitable access to water and sanitation?
  • How well do present global governance structures take account of the health equity effects associated with the social determinants of health?

Health policy and healthy populations

Social Science Quarterly, vol.90, 2009, p. 1039

This special issue offers new research and findings that inform the current debate on health policy in the United States. It presents papers on population health, including disparities between and among subgroups of the population. It demonstrates that introduction of universal health insurance would improve population health in the US and shows how non-medical policy interventions addressing the social determinants of poor health could help. Finally it looks the challenges involved in translating research evidence on 'what works' into practice.

Hospital investment policy in France: pathways to efficiency and the efficiency of the pathway

I. Guerrero, P.R. Mosse and V. Rogers

Health Policy, vol. 93, 2009, p. 35-40

In recent years the French hospital system has introduced numerous principles and practices inspired by New Public Management. However, New Public Management is an ideology, of which many different versions exist. Consequently, specific applications may engender trends which lead in different directions. This article analyses New Public Management in action in Hôpital 2012, the latest French hospital investment plan. It explores the implementation of the plan in two regions in order to identify and explain the discrepancies between the objectives of the national plan and its implementation at regional level.

Informal sector providers in Bangladesh: how equipped are they to provide rational health care?

S.M. Ahmed, M.A. Hossain and M.R. Chowdhury

Health Policy and Planning, vol. 24, 2009, p. 467-478

Informal sector practitioners are the main providers of healthcare to the poor in Bangladesh, especially in rural areas, but the majority lack requisite training to provide basic curative services rationally. Irrational use of drugs, including antibiotics, is common among these informal providers. Given their importance, the public sector should recognise and develop the capacity of selected informal providers so as to integrate them into the mainstream health system with appropriate regulatory controls.

The new health policy

R. Gauld

Maidenhead: McGraw-Hill with Open University, 2009

This book analyzes the issues that form the nucleus of the emerging 'new health policy' agenda. It brings together in one volume a comprehensive picture of the health policy challenges facing contemporary developed world health systems, as well as the strategies for tackling these. Focusing on policy responses in Britain, New Zealand and the United States, the individual chapters cover:

  • Challenges in health care funding and organization
  • Quality and patient safety
  • The application of information technology
  • Clinical governance
  • The changing nature of professionalism and public involvement in health care planning
  • Public health
  • The role of the private sector

Policymaking without policy choice: the rise of private health insurance in Denmark

J.D. Olesen

Journal of Public Policy, vol. 29, 2009, p. 263-285

Policymaking and policy outcomes are not necessarily the result of a carefully designed process but can result from intertwined political and institutional dynamics that are unforeseen at the outset. Relatively small reforms in public policy can trigger a process of institutional change with unintended consequences. This article examines one such process, the dramatic rise in the uptake of private health insurance in Denmark, which is puzzling in a comprehensive welfare state.

The politics of healthcare reform in Postcommunist Europe: the importance of access

A. Roberts

Journal of Public Policy, vol. 29, 2009, p. 305-325

Under communism, countries in Eastern Europe shared a common healthcare model based on state ownership and control. Since the fall of communism some countries have moved away from this system, which provided reasonable levels of care at a relatively low cost, and have introduced a national insurance authority or a system of private insurers. This article seeks to explain why the Czech Republic introduced a system of competing private insurers, Hungary moved to a single national insurer, and Poland retained its national health service.

Primary health care in New Zealand: who has access?

S. Jatrana and P. Crampton

Health Policy, vol. 93, 2009, p. 1-10

Despite the general recognition that comprehensive health care systems need a strong primary care component, achieving equitable access to primary care has proved difficult. There are many financial, structural and personal barriers that may impede an individual from gaining needed medical care. This research examined the demographic, socioeconomic, health behaviour and health determinants of financial barriers to access to general practitioner services, prescription drugs and dental care in New Zealand. Results clearly demonstrated that financial barriers exist for a substantial subgroup of the population. Special efforts are needed to lower financial barriers to access by reducing co-payments.

Responsive consumerism: empowerment in markets for health plans

B. Elbel and M. Schlesinger

Milbank Quarterly, vol. 87, 2009, p. 633-682

The US is increasingly relying on consumerism to improve the performance of its healthcare system. This article investigates the extent to which consumers respond to problems with their health insurance plans by voicing formal grievances or leaving. A telephone survey of 5000 consumers conducted in 2002 shows that the vast majority do not formally voice complaints or exit their plans, even in response to problems with serious consequences. Moreover, given the greater prevalence of trivial problems, consumers are far more likely to complain or leave their plans because of minor difficulties. It is concluded that relying on individual consumers' responses to influence the market for health plans is doomed to fail in its current form.

Spaces of care in the third sector: understanding the effects of professionalization

G. Carey, A. Braunack-Mayer and J. Barraket

Health, vol. 13, 2009, p. 629-646

Many authors have commented on the professionalization processes which have occurred in a range of third sector organisations as a result of receipt of government funding. Often these processes are thought to draw organisations away from their community groups as they become more aligned with the state. This article explores workers' experiences of changing organisational space through the processes of professionalization in an Australian third sector organisation offering services to people affected by hepatitis C. It shows that professionalized third sector spaces can still be community spaces where individuals may give and receive care and services.

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