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Welfare Reform on the Web (July 2000): Healthcare - Overseas

BRUSSELS EASES COMPARING OF EU STATES' HEALTHCARE

M. Smith

Financial Times, May 17th 2000, p. 8

The European Commission's newly approved programme to improve health in member states includes:

  • production of comparative statistics on health and healthcare across the EU for citizens;
  • creation of a "rapid response capability" to deal with threats from infectious diseases;
  • putting in place effective health promotion and disease prevention measures.

CAN COST SHIFTING CONTINUE IN A PRICE COMPETITIVE ENVIRONMENT?

J. Zwanziger, G. A. Melnick and A. Bumezai

Health Economics, vol. 9, 2000, p. 211-225

Both Medicare and Medicaid are reducing payments to hospitals, and there is concern that these may respond by increasing prices to privately insured patients. Paper studies hospital behaviour in California during 1983 to 1991, a time of increasingly intense price competition. Results show that hospitals did cost shift in response to reductions in Medicare rates, but responses to changes in Medicaid rates were smaller and generally insignificant. Both for-profit and not-for-profit hospitals cost shifted, but cost shifting did not change over time, even though the health care market became more competitive.

THE EFFECT OF CAPITATION ON GPs' REFERRAL DECISIONS

T. Iversen and H. Luras

Health Economics, vol. 9, 2000, p. 199-210

In the Norwegian capitation trial, the payment system for GPs has been changed: a practice allowance component has been replaced by a capitation component and the fee-for-service component constitutes a smaller part of a GP's practice income than previously. The hypothesis that the replacement of the practice allowance by a capitation component would increase the rate of referral to specialists was supported by an exploratory empirical study of a sample of GPs participating in the experiment.

MAXIMUM WAITING TIME: A THREAT TO CLINICAL FREEDOM? IMPLEMENTATION OF A POLICY TO REDUCE WAITING TIMES

M. Hanning and U. W. Spangberg

Health Policy, vol. 52, 2000, p. 15-32

A maximum waiting time guarantee for 12 different treatments was introduced in 1992 in Sweden. Waiting times and waiting lists were initially reduced, but the effects were short lived. By 1996 they had reached the same levels as when the guarantee was introduced and the initiative was abandoned.

PRESIDENTIAL RIVALS THINK SMALL OVER HEALTHCARE REFORM PLANS

N. Timmins

Financial Times, May 8th 2000, p. 9

Both presidential candidates in the US are proposing small additions to federal and state health coverage programmes. Al Gore is proposing an extension to the Children's Health Insurance Programme (CHIP), a 25% tax credit for people who lack employer based health insurance and an extension of Medicare to Americans aged 55-65. George W. Bush would offer a $2000 tax credit towards health insurance for families earning less than $30,000 and not otherwise covered.

PROMOTING CIVIL RIGHTS THROUGH THE WELFARE STATE: HOW MEDICARE INTEGRATED SOUTHERN HOSPITALS

J. Quadagno

Social Problems, vol. 47, 2000, p. 68-89

Although the Civil Rights Act 1964 outlawed segregation and banned racial discrimination in employment and education, compliance was uneven across institutional spheres. Racial integration proceeded more rapidly and smoothly in the health care system than in other institutions because the Medicare programme, the largest expansion of welfare since the New Deal, provided leverage to force health care providers to comply with the law.

REFORMING HEALTH INSURANCE: A QUESTION OF PRINCIPLES?

D. M. Dror

International Social Security Review, vol. 53, Apr. - June 2000, p. 75-99

Two systems of health insurance prevail in industrialised countries: private, or public (social) health insurance. After reviewing the theoretical differences between them, author argues that most health systems are, in fact, hybrids and that health insurance reform in Europe and the US has accentuated this trend because the principles distinguishing the two systems have often been ignored. This is illustrated through the evolution of voluntary vs compulsory affiliation, coping with moral hazard, and provider regulation.

WEST SIDE STORY

H. Berliner

Health Service Journal, vol. 110, May 4th 2000, p. 27

Los Angeles county is home to 3 million people without health insurance out of a total population of 10 million. A financial crisis in 1995 led to a federal bail-out of the health care system through a cash injection of over $1 bn. Over the next month the federal government must decide whether to continue to help. The Los Angeles situation is an example of the difficulties that arise when the government recognises the need to provide care but refuses to take responsibility for ensuring a stable system.

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