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

Catastrophic health expenditure and impoverishment in Turkey

M.S. Yardim, N. Cilingiroglu and N. Yardim

Health Policy, vol. 94, 2010, p. 26-33

In 2006 there were five separate health insurance schemes in Turkey, each including some form of patient cost sharing or co-payment with the exception of the green card scheme for the very poor. This study used data from the 2006 Household Budget Survey of Turkey to identify levels of catastrophic health expenditure and impoverishment due to out-of-pocket payments for care. Results indicate that more people benefited from health insurance in Turkey in 2006 and were therefore protected from catastrophic medical expenses than in many other countries with comparable income levels at that time.

Consumer-oriented health care reform strategies: a review of the evidence on managed competition and consumer-directed health insurance

T.C. Buchmueller

Milbank Quarterly, vol. 87, 2009, p. 820-841

For many years, consumer-oriented strategies have been at the centre of health policy debates in the USA. In the 1990s, the concept of 'managed competition' was the basis of a number of reform proposals, while in the 2000s, 'consumer-directed' healthcare has gained prominence. Although price-conscious consumer demand plays a critical role in both the managed competition and the consumer-directed healthcare models, the two strategies are based on different visions of the healthcare marketplace and the best way to use market forces to achieve efficiencies. In the managed competition model, consumers choose on the basis of price and quality from a menu of managed care plans. If they are willing to switch from more costly to less costly plans, insurers will be incentivised to reduce costs so that they can compete on price. On the other hand, the consumer-directed model exposes users to greater cost-sharing at the time that care is received on the assumption that this will lead to economically efficient treatment decisions. This article reviews the research literature that tests the main hypotheses concerning the two strategies.

Creating the document 'Promoting health in schools: from evidence to action'

L. St Leger and I.M. Young

Global Health Promotion, vol. 16, no.4, 2009, p. 69-71

Evidence about effective school health promotion initiatives suggests that a whole school approach is most useful, where the subject links with other components of the curriculum. This article describes the development of the International Union for Health Promotion and Education's document Promoting health in schools: from evidence to action. This document sets out to explain to policymakers and practitioners in the education sector how and why the promotion of health in schools is important, how good management is the key, and how promoting health in schools is based on scientific evidence and quality practices from around the world.

Do guidelines create uniformity in medical practice?

J.D. de Jong and others

Social Science and Medicine, vol. 70, 2010, p. 209-216

The use of clinical guidelines that give recommendations about appropriate care is a way of reducing variation and improving quality. This article studies the impact of voluntary guidelines on drug prescription on variations among family physicians in the Netherlands. Results show that although there had been an overall increase in variations in prescribing practices, the increase was less for diseases for which guidelines had been introduced. It is concluded that the introduction of guidelines, although it probably tempered the increase in variation, did not reduce variation.

Evaluating community pharmacists' perceptions of future generic substitution policy implementation: a national survey from Malaysia

Chee Ping Chong and others

Health Policy, vol. 94, 2010, p. 68-75

Currently both private medical clinics and community pharmacies dispense drugs in Malaysia. The Malaysian government does not control the price of drugs, but more than half of consumers perceive medicines as being expensive and urge the government to step in. Under the National Medicines Policy, the government has attempted to establish community pharmacists as sole dispensers of drugs. Consequently, Malaysian community pharmacists will have a key role in reducing the cost of drugs through generic substitution, a change of which they are generally in favour.

Expensive cancer drugs: a comparison between the United States and the United Kingdom

R.R. Faden and others

Milbank Quarterly, vol. 87, 2009, p. 789-819

It is popularly believed that in the United States all patients have access to all cancer drugs as and when needed while in the UK top-down rationing presents insurmountable obstacles to access by British patients. In reality, in both Britain and America, not all patients who might benefit from or desire access to expensive new drugs can have them. In fact, key elements of the British system are fairer than the American one, and the British system is better structured to deal with difficult decisions about expensive end-of-life cancer drugs. Both systems face common ethical, financial, organisational and priority-setting challenges in making these decisions.

Exploring patient involvement in healthcare decision making across different education and functional health literacy groups

S.K. Smith and others

Social Science and Medicine, vol. 69, 2009, p. 1805-1812

Involving patients in healthcare decision making has become a priority for health practitioners and policy makers, driven by socio-political changes which have challenged medical paternalism. However, education and health literacy potentially limit a person's ability to be involved in decisions about their health. This paper reports on a qualitative interview study of 73 men and women in Sydney, Australia, with varying education and functional health literacy levels. Participants educated to degree level appeared to conceive their involvement in decision making as sharing responsibility with their doctor throughout the process. This entailed verifying the credibility of the information provided and exploring options other than those presented by the doctor. Participants with lower education appeared to conceive their involvement in terms of consenting to an option recommended by their doctor, and having the responsibility to either agree or disagree with the recommendation.

Healthy partnerships, healthy citizens? An international review of partnerships in health and social care and patient/user outcomes

K. Rummery

Social Science and Medicine, vol. 69, 2009, p. 1797-1804

A focus on partnership working between health and social care has assumed central importance in policy development in European Union, Nordic, Commonwealth and North American welfare regimes. Partnership working, both between public and other sectors, and between different areas of the public sector, is held up as being a way of achieving improved services for users where there is a commonality of interests between the partners, and a history of failing to co-ordinate services by other means. This article examines the international evidence base for improved patient/user outcomes as a result of partnerships (particularly health and social care partnerships, and those partnerships involving the private and/or voluntary sector and patients themselves).

The integration of bio-medicine and culturally based alternative medicine: implications for health care providers and patients

B. Lovell

Global Health Promotion, vol. 16, 2009, p. 65-68

Complementary and alternative therapies are used alongside or in place of bio-medicine worldwide. Many forms of complementary and alternative medicine (CAM) originate in culture. Large numbers of patients use CAM for mental health, pain and musculoskeletal problems. Mass immigration has led to an influx of groups accustomed to traditional medicine into societies using bio-medical healthcare systems. Physicians and other practitioners may lack educational opportunities to learn about CAM or health beliefs that are bounded in culture and lack of scientific studies has reduced their acceptance. There is need for education for both physicians and patients to promote the responsible use of CAM.

On health insurance and household decisions: a treatment effect analysis

S. Koch and O. Alaba

Social Science and Medicine, vol. 70, 2010, p. 175-182

There has been much debate about extending health insurance to cover more people in developing countries, primarily via compulsory insurance schemes. However, these debates rarely consider competing demands placed on the family budget, which will influence the acceptability of the programme to the population. This paper draws on data from the 2000 income and expenditure survey to examine treatment effects associated with household insurance status, providing a detailed examination of expenditure substitution patterns within South Africa. The expansion of health insurance coverage via compulsory schemes creates additional burdens for households, which they accommodate through expenditure substitution.

Patients, persons or partners? Involving those with chronic disease in their care

C.L. McWilliam

Chronic Illness, vol.5, 2009, p. 277-292

Self-care has become the preferred approach to the management of chronic illnesses in the community. However, practitioners often undermine the self-care efforts of people with chronic conditions, emphasizing their status as patients, failing to consider their larger life experience as people, and failing to consider them as potential partners in their own care. This article explores patient-centred care and the relational approach of empowering partnering as strategies for professional-patient interaction in chronic disease management, illuminating how each approach socially constructs the involvement of people with chronic disease in their care. The merits of the empowering partnering approach for optimising the involvement of people with chronic disease in the management of their conditions are identified.

Principles in health economics and policy.

J. A. Olsen

Oxford: OUP, 2009

Examining the different structures and techniques involved in making decisions about who benefits from those health care resources available in a publicly funded system, this book is a concise and compact introduction to health economics and policy. It introduces the subject of economics, explains the fundamental failures in the market for health care and discusses the concepts of equity and fairness when applied to health and health care. It provides a policy-oriented approach and emphasizes the application of economic analysis to health policy issues. Exploring key questions currently facing health policy makers across the globe, it asks: how should society intervene in the determinants that affect health?; how should health care be financed?; how should health care providers be paid?; and how should alternative health care programmes be evaluated when setting priorities?

Prioritization and patients' rights: analysing the effect of a reform in the Norwegian hospital sector

J.E. Askildsen, T.H. Holmas and O. Kaarboe

Social Science and Medicine, vol. 70, 2010, p. 199-208

In 2002, the Norwegian central government took over ownership of all public hospitals from the county councils. Hospitals were reorganised into five regional health authorities as local enterprises or trusts. The reform has provided central government with a channel to directly influence prioritisation of patients for treatment and so reduce geographical variations in waiting times across patient groups. Hence prioritisation practice was expected to be more geographically homogeneous after the reform. The analyses do not indicate that centralisation of hospital ownership has led to more equal prioritisation practices across the country. The results also indicate that an observed reduction in waiting times after the reform has favoured patients of lower prioritisation status, indicating a worsening of practices over time.

Societal entrepreneurs in the health sector: crossing the frontiers

M. Tillmar

Social Enterprise Journal, vol. 6, 2009, p. 282-298

This article explores the role of social entrepreneurship in the Swedish healthcare sector in 2008, during a period of radical change in the welfare state. The current reforms are on New Public Management lines, with outsourcing, competition and voucher systems as the main components. It presents case studies of two social entrepreneurs whose ambition is to promote better health by complementing local authority care.

Translating medical effectiveness research into policy: lessons from the California Health Benefits Review Program

J.M. Coffman and others

Milbank Quarterly, vol. 87, 2009, p. 863-902

Legislatures and executive agencies in the US are increasingly using reviews of the medical literature to inform health policy decisions. This article discusses the California Health Benefit Review Program which analyses the medical effectiveness of health insurance benefit mandate bills for the California legislature, as well as their impact on cost and public health. These bills mandate that health plans and health insurers cover specific tests, procedures, medications, diseases or conditions.

Welfare state regimes and population health: integrating the East Asian welfare states

S.A. Karim, T.A. Eikemo and C. Bambra

Health Policy, vol. 94, 2010, p. 45-53

Epidemiological studies have consistently shown that population health varies significantly by welfare state regime. However, these studies have focused exclusively on the welfare states of Europe, North America and Australasia. This focus ignores the existence of welfare states in East Asia. This study investigates whether the association between population health (Infant Mortality Rates and Life Expectancy at Birth) and welfare state regime is still valid when the welfare states of East Asia are added to the analysis. It also examines whether population health is worse in the East Asian welfare states. When GDP per capita was controlled, only Life Expectancy differed significantly by welfare state regime. Moreover, East Asian welfare states did not have the worst health outcomes.

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