Welfare Reform on the Web (January 2010): Healthcare - overseas

An analysis of the costs and treatment success of collaborative arrangements among public and private providers for tuberculosis control in Indonesia

B. Johns and others

Health Policy, vol. 93, 2009, p. 214-224

This study assessed the cost-effectiveness of 'public-private mix' programmes for TB control in twelve districts across four provinces of Indonesia. Three strategies were assessed: hospital outpatient diagnosis with referral to public health centres (PHCs) for treatment, hospital outpatient diagnosis and treatment, and private practitioner referral of suspects to PHCs. All three strategies had a positive impact on case-finding and the number of cases successfully treated. Neither collaboration among private practitioners nor among hospitals is clearly preferred based on cost effectiveness. However, the study suggests that having hospitals refer patients to health centres is preferable to hospitals administering treatment.

Cost-sharing in the German healthcare system: effects of health reforms on efficiency and equity

C.A. Gericke and others

Journal of Management and Marketing in Healthcare, vol. 2, 2009, p. 410-426

This paper analyses the historical development of cost-sharing measures in German social health insurance and reviews the evidence on the impact of these measures on efficiency and equity. First introduced in 1923, cost sharing has become increasingly important in the past thirty years due to increasing pressure to contain rapidly escalating expenditure. Some form of cost sharing is now used in every part of the German health system. It is concluded that cost sharing measures have a negative impact on equity despite the sophisticated exemption mechanisms in place. They have increased the cost burden experienced by patients, households and employees, while reducing employers' contributions to social health insurance.

Culture and climate in health organizations

P. Hyde, J. Braithwaite and A. Fitzgerald (guest editors)

Journal of Health Organization and Management, vol. 23, 2009, p.577-671

Papers in this special issue cover the role of organisational culture and climate in patient safety, the role of networks in producing positive change, conflicts and tensions inherent in the role of the clinician-manager, models for translating knowledge into action, and how NHS managers sought to apply 'critical thinking' skills acquired through studying for a masters degree in their work.

Determinants of accessibility and affordability of health care in post-socialist Tajikistan: evidence and policy options

L. Fan and N.N. Habibov

Global Public Health, vol. 4, 2009, p. 561-574

There is increasing evidence of rising inequalities in access to healthcare in the transition states in Central Asia and the Caucasus. Against this background, the paper assesses the affordability and accessibility of healthcare in Tajikistan. Results show that poverty and the level of out-of-pocket payments have become major deterrents to healthcare utilisation. The authors call for the introduction of a state subsidised package of basic free healthcare entitlements targeted on the poor, the chronically sick and the disabled.

Exploring the pathways of inequalities in health: health care access and financing in decentralized Spain

J. Costa-Font and J. Gil

Journal of European Social Policy, vol. 19, 2009, p. 446-458

This article attempts to explore the association between health outcome inequalities and inequalities in healthcare access and financing. Specifically, it explores the extent to which politically accountable regional health systems in Spain exhibit higher inequalities in health outcomes, healthcare access and health financing than those which are managed by central government. The results suggest that decentralisation does not lead to a rise in inequalities in health outcomes of healthcare access. Inequalities in access were found to be minimal and overall financing was progressive and equitable.

Globalisation, markets and healthcare policy: redrawing the patient as consumer

J. Tritter and others

London: Routledge, 2010

Although the last two decades have seen the healthcare systems of most developed countries face pressure for major reform, the impact of this reform on the relationship between empowerment, consumerism and citizen's rights has received limited research attention. The book sets out to redress this imbalance by exploring the extent to which globalisation and commercialisation relate to current and emerging health policies. It also looks at the implications for citizens, patients and social rights, as well as how health policy making interacts with the interests of global and European trade and economic policies. Topics discussed include:

• How the impact of globalisation on health systems is apparent in the influence of international actors and European policies
• How the impact of globalisation is mediated by national priorities and policies
• How commercialisation of health is presented as benefiting citizens and patients but has the potential to undermine the aims and values inherent in health systems
• How citizens' interests, social rights, patient's rights and priorities of patient and public involvement need to be separated from commercialisation, choice and consumerism in health care

P. Gottret, G. Schieber and H. Waters (editors)

Washington, DC: World Bank, 2008

For humanitarian reasons and due to concern for households' economic and health security, the health sector is at the centre of global development policy. Developing countries and the international community are scaling up health systems to meet the Millennium Development Goals (MDGs) and are improving financial protection by securing long-term support for these gains. Yet money alone cannot buy health gains or prevent impoverishment due to catastrophic medical bills; well structured, results-based financing reforms are needed. Unfortunately, global evidence of 'successful' health financing policies that can guide the reform effort is very limited and therefore the policy debate is often driven by ideological, one-size-fits-all solutions. This book attempts to fill the void by systematically assessing health financing reforms in nine low- and middle-income countries that have managed to expand their health financing systems to both improve health status and protect against catastrophic medical expenses. The participating countries are: Chile, Colombia, Costa Rica, Estonia, the Kyrgyz Republic, Sri Lanka, Thailand, Tunisia, and Vietnam. The study seeks to identify common enabling factors of their good performance. While the findings for each country are important, collectively they send a clear message to the global community that more effort is needed to define 'good practice' and then to evaluate and disseminate the global evidence base.

Impact of the patient-centred medical home on stakeholders in the care management industry

H. Wang

Journal of Management and Marketing in Healthcare, vol. 2, 2009, p. 343-354

The patient-centred medical home (PCMH) is a new care approach that has gained substantial media and market attention in the USA. Efforts from both the private and the public sectors have resulted in more than two dozen pilot projects. These pilot programmes could have a profound impact on the future direction and priorities of US healthcare reform. The PCMH will transform primary care into a more integrated and coordinated service addressing patients' comprehensive care needs, but its success hinges on engaging the interest of small to medium-sized physician practices and alleviating their concerns over required changes to processes and personnel, the costs of technology adoption, and the adequacy of financial payouts.

Implementing new modes of governance in the New Zealand health system: an empirical study

P. Barnett and others

Health Policy, vol. 93, 2009, p. 118-127

New Zealand has experienced four restructurings of its health system since 1980. Following international trends, modes of health governance in the late 1980s reflected some local control incorporated into a hierarchical managerialist framework, with 14 population-based area health boards responsible for hospital and public health services. The election of a more radical neoliberal government in 1990 led to market modes of governance in health that encouraged privatisation, competition and contracting out of services. Locally elected boards were replaced by boards of directors appointed by central government. By 1997 these arrangements had been modified by a more moderate coalition government that limited privatisation, introduced a more collaborative approach and appointed some local representatives to boards of directors. The most recent changes introduced in 2001 by a centre-left coalition government reflect a move towards multiple modes of governance, with the establishment of 21 District Health Boards (DHBs). DHBs are integrated delivery systems that fund or provide comprehensive health services, integrated with networks of local providers, for geographically defined populations.

Mapping European healthcare systems: a comparative analysis of financing, service provision and access to healthcare

C. Wendt

Journal of European Social Policy, vol. 19, 2009, p.432-445

Healthcare systems have been set up to provide medical care for those in need. Comparative studies should therefore focus on differences in healthcare provision and on how access to services is regulated. This article presents a typology of healthcare systems which takes into account data on expenditures, financing, provision and access to healthcare in 15 European countries. Three types of healthcare system are constructed:

1. a health service provision-oriented type that is characterised by a high number of service providers and free access to doctors
2. a universal coverage-controlled access type where healthcare provision has the status of a social citizenship right and equal access to healthcare is of higher importance than free access and choice
3. a low budget-restricted access type where financial resources are limited and access is restricted by high out-of-pocket payments.

P. Bywaters, E. McLeod and L. Napier (editors)

Bristol: Policy Press, 2009

Tackling inequalities in health is an essential social work task. Every day, social workers grapple with the impacts on people's lives of the social inequalities that shape their health chances and experiences. This book examines the relationship between social work and health inequalities in the context of globalisation. Based on the practice expertise and research of social workers from developing and developed countries worldwide and using specific examples, this book:

• demonstrates the relevance of health inequalities to social work practice and policy across the life course
• analyses the barriers to good health that result from global social, economic, environmental and political trends
• develops core ideas on how social workers can act to combat the negative effects of globalisation by applying a health inequalities lens.

Structural barriers and human rights related to HIV prevention and treatment in Zimbabwe

J.J. Amon and T. Kasambala

Global Public Health, vol. 4, 2009, p. 528-545

There has long been recognition that individual risk factors can only partially explain vulnerability to HIV infection, and that a broader range of socio-economic, cultural and political factors must be taken into account. This article demonstrates how explicitly recognising human rights provides a mechanism for addressing structural level barriers to HIV prevention and care and encourages government and donor agency accountability. The discussion is based on an example from Zimbabwe, with a particular focus on the structural barriers and human rights abuses currently faced by people living with HIV/AIDS. The paper proposes illustrative 'structural rights' interventions aimed at reducing vulnerability to HIV infection and extending access to treatment.