Click here to skip to content

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

Access and choice: competition under the roof of solidarity in German health care: an analysis of health policy reforms since 2004

M. Lisac and others

Health Economics, Policy and Law, vol. 5, 2010, p. 31-52

Germans enjoy a high level of free access to healthcare and of choice of providers and health insurance schemes. However the system is characterised by over- and misuse of health services. Policy makers have recently introduced measures to encourage more rational use of services and to limit free choice of providers. The 2004 reform introduced a quarterly co-payment for first visits to an outpatient provider and for visits to any other physician during the same quarter without referral. These measures promote care co-ordination by introducing voluntary restrictions on patients' choice of provider and elements of managed care. At the same time reforms in 2004 and 2007 aimed to increase competition among healthcare providers and insurers by giving patients more choice of insurer and benefits package. These measures aim to improve efficiency, quality and patient responsiveness.

Achievement of equity and universal access in China's health service: a commentary on the historical reform perspective from the UK National Health Service

Y.C. Wan and Y.I. Wan

Global Public Health, vol. 5, 2010, p. 15-27

The UK NHS has always been and remains primarily funded out of general taxation, strongly regulated by central government, and free at the point of use, thus ensuring universal access. In contrast, China has moved from a centrally planned health system based on the Rural Co-operative Medical Schemes and social insurance, to a fee-for-service model, leading to serious problems of inequity in access.

Advancing newborn health: the Saving Newborn Lives initiative

A. Tinker and others

Global Public Health, vol. 5, 2010, p.28-47

Until the twenty-first century, newborn health was virtually absent from policies, programmes and research in developing countries. Now, assistance agencies, national governments and non-governmental organisations are increasingly addressing this issue. The experience of the Saving Newborn Lives initiative, launched in 2000 by Save the Children USA, documents some of the progress that has been made and the challenges and opportunities that lie ahead. Targeted research has demonstrated low-cost, community-based interventions and strategies that can significantly reduce newborn mortality.

Agency problems in hospitals participating in self-management project under global budget system in Taiwan

Y.-H. Yan and others

Health Policy, vol. 94, 2010, p. 135-143

The Self-Management Project for Taiwanese hospitals involves annual allocation of a fixed budget to each hospital by the Bureau of National Health Insurance (BNHI) on the basis of performance. However, hospitals face the risk that the budget allocated will be insufficient to cover operational costs, or they may treat more patients than expected. There is then a conflict of interests between the BNHI and the hospitals. The BNHI controls the budget and requires the hospitals to provide good quality care within limited resources. The hospitals on the other hand strive to extract more resources from the BNHI.

The challenges of budgeting in a newly introduced district health system: a case study

G.A. Nnaji and others

Global Public Health, vol.5, 2010, p. 87-101

In 2005 the Enugu State of Nigeria passed a Health Sector Reform Law which introduced seven District Health Boards accountable to the State Health Board and supervising 56 Local Health Authorities. The health reform aimed to decentralise the decision-making process, authority and power. This case study documents attempts to prepare a budget at the district level in 2006. These attempts were hampered by lack of capacity for planning and budgeting among district health officials, an inadequate health management information system, a non-functional financial management system, and an unreliable human resources management system.

Crossborder trade in health services: lessons from the European laboratory

H. Jarman and S. Greer

Health Policy, vol. 94, 2010, p. 158-163

EU member states have developed a health policy which does not respect national boundaries or the idiosyncrasies of national health systems. The EU is the best current example of the application of the principles of market liberalisation to real health services by supranational bodies. The General Agreement on Trade in Services (GATS) is an international agreement that came into force in 1995 which aims to eliminate barriers to trade in the services sector. This article argues that GATS and the EU have comparable effects on health policy, reviews the EU experience, and draws lessons for understanding GATS and its effects.

Framing and the politics of public health: an examination of competing health narratives in Honduras

C. Johnson

Global Public Health, vol.5, 2010, p.1-14

Health policy in Honduras has been largely shaped by the priorities of donor agencies such as the World Bank, USAID, the World Health Organisation (WHO) and the Pan American Health Organisation (PAHO). These have different ideologies and policy goals. For the World Bank and USAID, Honduras is a success story, having experienced economic growth, expanded public health infrastructure and improved key health indicators over the past few decades. For the WHO and PAHO the markers of health policy success are different and include distributional fairness, reduction of inequality and improved health access and outcomes for vulnerable groups. Against these criteria, Honduras is a basket case due to extreme levels of poverty, inequality, indebtedness and poor health.

Labor markets and employer-sponsored health insurance coverage

Journal of Labor Research, vol. 30, 2009, p. 293-397

This symposium consists of five papers related to trends in employer sponsored health insurance coverage in the United States. The papers examine: 1) changes in who is covered and the costs of coverage between 2002 and 2005; 2) the impact of job displacement on the probability that employers will offer health insurance; 3) how local labour market conditions affect the probability that employer sponsored insurance will be offered and accepted; 4) the extent to which private health insurance can compensate for lack of access to employer sponsored insurance as coverage decreases; and 5) trends in provision of employer sponsored health insurance to retirees.

Medicine prices in urban Mozambique: a public health and economic study of pharmaceutical markets and price determinants in low-income settings

G. Russo and B. McPake

Health Policy and Planning, vol. 25, 2010, p. 70-84

It has been suggested that medicines are unaffordable in low-income countries and that world manufacturing and trade policies are responsible for high prices. This research investigated medicine prices in urban Mozambique with the objective of understanding how prices are formed and with what public health implications. Results showed that a) local mark-ups are responsible for up to two-thirds of drugs' final prices in private pharmacies; b) statutory profit and cost ceilings are applied unevenly, due to lack of government control and collusion among suppliers; and c) the local market appears to respond effectively to the urban population's diverse needs through its low-cost and high-cost segments, although uncertainty about the quality of generics may be inducing consumers to purchase less affordable drugs.

Personalized medicine: factors influencing reimbursement

L.M. Meckley and P. J. Neumann

Health Policy, vol. 94, 2010, p.91-100

Over the past decade, the concept of using new technology to 'personalise' medicine based on genetic or other characteristics has advanced. While researchers have actively investigated personalised medicine (PM) technology, there are relatively few applications in use in clinical practice. This paper examines a series of case studies to explore factors influencing adoption, coverage and reimbursement of personalised medicine. It is concluded that, to date, the promise and hype of PM has outpaced its evidentiary support. In order to achieve favourable coverage and reimbursement and to support premium prices for PM, manufacturers will need to bring better clinical evidence to the marketplace and better establish the value of their products.

The preferred doctor scheme: a political reading of a French experiment of gate-keeping

P. Dourgnon and M. Naiditch

Health Policy, vol.94, 2010, p. 129-134

Gate-keeping has been promoted as a powerful tool that regulates both demand for and supply of medical care so as to avoid unnecessary use of health services. In January 2006 France launched its own version of gate-keeping, the preferred doctor scheme. Each patient over the age of 16 is invited to select a GP or specialist who becomes his or her preferred doctor. The preferred doctor acts as first point of contact with the health system and provides the care needed or makes a referral to a specialist. The patient pays a fee to the physician and is then reimbursed by the National Sickness Fund plus through complementary insurance if he or she is covered. However, the scheme seems to have done little to transform the provision and delivery of services or to reduce costs.

The ten characteristics of the high-performing chronic care system

C. Ham

Health Economics, Policy and Law, vol. 5, 2010, p. 71-90

This paper traces the history of attempts in the last decade to give higher priority to chronic care, starting with a description of the Chronic Care Model developed by Wagner and colleagues and summarising evidence of its impact. This is followed by a review of international evidence on gaps in the quality of chronic care. These gaps suggest that, useful as the Chronic Care Model is, more is needed to help decision makers reorient health systems to meet the needs of populations in which chronic diseases predominate. The second half of the paper sets out the ten characteristics and four implementation strategies needed in a high-performing chronic healthcare system. In doing so, it provides practical guidance to policy makers on the most promising strategies for improving the provision of chronic care, drawing on experience in England, New Zealand and the USA.

'This body does not want free medicines': South African consumer perceptions of drug quality

A. Patel and others

Health Policy and Planning, vol. 25, 2010, p. 61-69

Like many other developing countries, South Africa provides free medicines through its public healthcare facilities. Policies encourage generic substitution in both the private and public sectors. This study explored South African consumer perceptions of drug quality and whether these perceptions influenced how people procured and used medicines. Results show that South African consumers perceive free and generic medicines as poor quality. If this view is widespread in other developing countries, it could severely limit the effectiveness of national medicines policies.

Search Welfare Reform on the Web