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

Child public health. 2nd ed.

M. Blair and others

Oxford: OUP, 2010

Child public health is a rapidly developing field and is increasingly recognised throughout the world as a major area of focus for population health improvement. While some of the underpinning sciences, such as epidemiology and statistics, are well described in many texts, an overview of the political and cultural context in which public health is practised is more difficult to find. This book emphasizes the importance of child public health as a rapidly emerging field and puts the health of children centre stage as society's greatest asset. It maps out what needs to be done to promote and protect the health of children not only in the UK, but internationally and explores the current state of health of our children, the historical roots of the speciality and the relationship between early infant and child health and later adult health. A chapter on key concepts in the field will help to orientate the reader and a number of practical examples are given for those who are faced with the challenges of dealing with growing levels of mental ill health, obesity and health inequalities in their localities or practices.

Community health insurance in Gudalur, India, increases access to hospital care

N. Devadasan and others

Health Policy and Planning, vol. 25, 2010, p. 145-154

To reduce the burden of out-of-pocket payments on households in India, the government has introduced community health insurance (CHI) as part of its National Rural Health Mission. Indian CHI schemes have been shown to provide financial protection, and have the potential to improve the quality of care, but do not seem to improve access. This article explores this dimension of CHI performance and investigates conditions under which a CHI scheme can improve access to hospital care for the poor.

Continuing medical education in six European countries: a comparative analysis

L. Garattini and others

Health Policy, vol. 94, 2010, p. 246-254

In the context of rapid advances in the biomedical sciences, continuing medical education (CME) activities have been increasing in many developed countries. This study examines CME systems in a sample of six EU countries: Austria, Belgium, France, Italy, Norway and the UK. The aim of this comparative study was to assess the main country-specific institutional settings applied by governments. The analysis showed that CME is formally compulsory in Austria, France, Italy and the UK, although no sanctions are enforced against non-compliant physicians in practice. The only two countries that offer financial incentives to enhance CME participation are Belgium and Norway. Formal accreditation of CME providers is required in Austria, France and Italy, while in the other three countries accreditation is focused on activities. Private sponsorship is allowed, within limits, in all countries except Norway.

Contracting for health and curative care use in Afghanistan between 2004 and 2005

A. Arur and others

Health Policy and Planning, vol. 25, 2010, p.135-144

Afghanistan has used several approaches to contracting as part of its national strategy to increase access to basic health services. This article compares the impact of three different approaches to contracting on use of outpatient curative services in 2004 and 2005: 1) contracting out services to non-governmental organisations; 2) contracting in technical assistance at public facilities; and 3) non-use of contractors at public facilities. Results show that large scale contracting for health services in Afghanistan is associated with substantial increases in curative care use. Curative care at contracted facilities is reaching the poor and female patients.

The contribution of primary care to health and health systems in low- and middle-income countries: a critical review of major primary care initiatives

M.E. Kruk and others

Social Science and Medicine, vol. 70, 2010, p. 904-911

This paper aims to describe and assess the contribution of large primary care initiatives to a broad range of health system goals in low- and middle-income countries. These include improved health outcomes, service coverage, quality of care, and responsiveness to patients and communities as well as well as equity and efficacy. Given the shortcomings of the available evaluation research in this area, a formal meta-analysis was not possible. Instead, the authors present a critical review of a range of studies and suggest a research agenda for future work in this field.

Co-operation between patient organizations and the drug industry in Finland

E. Hemminki, H.K. Toiviainen, and L. Vuorenkoski

Social Science and Medicine, vol. 70, 2010, p. 1171-1175

This case study from Finland shows that co-operation between patient organisations and the drug industry is common, many-sided and not without problems. Drug firms financially support patient organisations, while many patient organisations consider industry support to be necessary for their income. The drug firms consider that co-operation with patient organisation helps their marketing efforts. Problems reported by patient organisations include threats to independence and the unpredictability of financial support. Unclear rules for co-operation were of concern to the drugs firms.

Development and dissemination of institutional practice guidelines on medical end-of-life decisions in Dutch health care institutions

B.A.M. Hesselink and others

Health Policy, vol. 94, 2010, p. 230-238

Practice guidelines on medical end-of-life decisions can improve the quality of care for the dying. No recent information is available about the development and dissemination of written policy statements on euthanasia and assisted suicide and institutional practice guidelines on medical end-of-life decisions in the Netherlands, even though there have been many changes in the field. The Euthanasia Act came into force in 2002 and increased attention is being paid to palliative sedation, which resulted in the production of a national guideline. This study describes the professionals and sources involved in the development of institutional guidelines on end-of-life decisions in the Netherlands, and the dissemination of written euthanasia and assisted suicide policy statements and of practice guidelines on end-of-life decisions.

The effects of the fraud and abuse enforcement program under the National Health Insurance program in Korea

H.C. Kang and others

Health Policy, vol. 95, 2010, p. 41-49

The public health insurance system in Korea allows the government to establish and implement a fraud and abuse enforcement programme. The government can investigate a healthcare provider for suspected wrongdoing and impose penalties such as monetary fines and suspension. If needed, criminal charges can be filed. This study examined the general deterrence effect of the programme on physicians. Results showed that clinics with greater fears of penalties arising from an onsite fraud investigation were less likely to present excessive reimbursement claims. It is concluded that designing effective fraud and abuse programmes can improve efficiency.

End of life care policies: do they make a difference in practice?

D. Goodridge

Social Science and Medicine, vol.70, 2010, p. 1166-1170

Many health care agencies have developed and adopted specific policies related to end of life care as a mechanism to improve quality. However, there has been little empirical examination of ways in which policies shape the focus and provision of care of the dying. Data drawn from health record reviews of 310 adults who had died in three hospitals in a large urban centre in Western Canada showed that relatively few providers actually followed policy directives for end of life care in practice. This study reveals a significant gap between institutional end of life care policies and actual practice in the health region..

An ethical justification of the chronic care model (CCM)

L. Oprea and others

Health Expectations, vol.13, 2010, p. 55-64

Chronic diseases are a major cause of morbidity and mortality in developed countries. Their effects can be mitigated by high quality evidence-based care, but this is not the norm in most systems. The Chronic Care Model (CCM) is an evidence-based policy response to this practice gap, which uses multiple strategies to promote the quality of chronic care. This article reviews the CCM through an ethical lens and concludes it has the potential to be more ethically robust than ordinary care as it aspires to promote mutual trust between the main stakeholders in healthcare services through multiple systemic changes at the practice level. Mutual trust is at the core of medicine and there is evidence that it can improve health outcomes for patients.

Evidence-based interventions for social work in health care

M. Egan

London: Routledge, 2010

Social work practice in health care requires that practitioners be prepared to meet the interdisciplinary and managed care demands for best practices in efficacious, time-limited, and culturally competent interventions with populations across the lifespan. This text is designed to meet that demand for evidence-based practice. The result of extensive systematic reviews, the book provides substantive in-depth knowledge of empirically based interventions for major and emerging diseases and health conditions particularly affecting diverse, at-risk and marginalized populations. It outlines best practices for the psychosocial problems associated with the emerging chronic and major health conditions of the twenty-first century, such as paediatric asthma, Type I and Type II diabetes, obesity, paediatric cancer, and adult hypertension. The interventions discussed are detailed in terms of for whom, by whom, when, under what circumstances, for what duration, and for what level client system the intervention has proved most effective.

Global politics of health

S. Davies

Cambridge: Polity, 2010

International responses to the outbreak of SARS, the spread of HIV/AIDS, and the promotion of health as a human right all demonstrate how global politics have a profound effect on the way we think about and respond to major health challenges. Despite a growing interest in the relationship between health and international relations there has yet to be a systematic study of the links between them. This book aims to fill this gap - ultimately showing how world politics can be good, or bad, for your health. It calls for a more nuanced understanding of the nature of the current global health crisis and the political dilemmas faced by those responsible for the development and implementation of responses to it. By charting these debates and showing how they shape the way actors think about key issues relating to health, such as people movement, infectious disease, the business of health, and the consequences of war, this volume provides an innovative and comprehensive introduction to health and international relations for students of global politics, health studies and related disciplines.

Health care systems in developing and transition countries: the role of research evidence

D. Masis and P. Smith (editors)

Cheltenham: Elgar, 2009

Health policy is a central preoccupation of many, if not all, developing countries. This book presents a selection of ten studies that illustrate the powerful tool that carefully conducted research can offer policy-makers seeking to address common health policy issues. The studies included in this book illustrate the major gains to patients and citizens that can accrue from research efforts, stimulating research capacity in developing countries. Although many of the challenges confronting health systems are universal, it is often the case that research results derived from developing countries can be misleading when applied to low or middle-income settings.

Healthcare policies over the last 20 years: reforms and counter-reforms

F. Toth

Health Policy, vol. 95, 2010, p. 82-89

It is argued in this article that the last two decades have been characterised by successive distinct waves of healthcare reform. In the early 1990s many countries introduced reforms which encouraged competition between the various components of their healthcare systems. In contrast, reforms in the late 1990s focused on greater integration and regulation. From 2000 onwards, policies promoting patients rights and freedom of choice have been in vogue. This study presents evidence drawn from six OECD countries: UK, France, Germany, the Netherlands, Sweden and New Zealand.

Informal caregivers

J. Piette (guest editor)

Chronic Illness, vol. 6, 2010, p. 3-80

For patients with chronic illnesses, informal caregivers play essential roles in filling the gaps in services provided by health care systems. They provide assistance with transport, emotional support, help with daily activities and perform a host of other vital tasks. At the same time, social network members can exacerbate self-care problems, and the act of caregiving carries risks for those offering support. The research presented in this special issue also highlights the dangers of relying too much on unstructured, poorly planned models of caregiver support.

Patient participation in collective healthcare decision making: the Dutch model

H.M. van de Bovenkamp, M. J. Trappenberg and K.J. Grit

Health Expectations, vol. 13, 2010, p. 73-85

Dutch patient organisations have become integrated into the formal decision making process about health services through what can be described as a neo-corporatist approach. However, there are too many opportunities for participation and organisations simply cannot cope with the demand. Some patient organisations, mainly those representing large patient groups, have responded through professionalization. Often patient organisations experience difficulty in getting their points across to professional partners whose knowledge is greater than their own, and they have little bargaining power to support their position.

Public accountability of newborn screening: collective knowing and deciding

B. Wieser

Social Science and Medicine, vol. 70, 2010, p. 926-933

Within Europe there are significant differences in the number of conditions for which infants are screened. Austria and the UK are at opposite ends of the European spectrum; Austria has an extensive newborn screening programme while the UK does not. Focusing on the decision-making processes behind the design and expansion of newborn screening, this study investigates how key institutions in Austria and the UK use scientific expertise to explain and justify newborn screening programmes. For this purpose the author compares the material that is made available to the public, including policy documents, scientific studies, medical guidelines, legal regulations, advisory committee reports and public engagement exercises. It was found that observed differences in accountability practices are rooted in nationally traditional forms of policymaking.

Public health: an action guide to improving health. 2nd ed.

J. Walley and J. Wright

Oxford: OUP, 2010

Many of the health problems in the developing world can be tackled or prevented through public health measures such as essential health care, improved living conditions, water, sanitation, nutrition, immunization, and the adoption of healthy lifestyles. This book explains public health approaches to developing effective health services and preventive programmes, with a particular focus on low-middle income countries. It covers essential clinical services and preventive programmes including those for TB, HIV/AIDS, malaria, diarrhoeal diseases and the integrated management of childhood and adult illnesses. Practical methods are given for assessing health needs, and working with communities to develop health services and the developing hospital, health centre, and community health services. Additionally gender, and social and economic influences on communities' health are explored.

The rise and fall of supervision in a project designed to strengthen supervision of Integrated Management of Childhood Illness in Benin

A.K. Rowe and others

Health Policy and Planning, vol. 25, 2010, p. 125-134

In developing countries supervision is a widely recognised strategy for improving health worker performance; and anecdotally, maintaining regular, high-quality supervision is difficult. In a project to strengthen supervision in Benin, after some initial success, the authors encountered obstacles at multiple levels in the health system that led to a breakdown in supervision. Key obstacles were: poor co-ordination; inadequate management skills; a lack of motivation; decentralisation; health worker resistance; less priority given to programme specific supervision; supervision workload; incomplete implementation of project interventions; and loss of leadership and effective supervisors.

Scaling up in international health: what are the key issues?

L.J. Mangham and K. Hanson

Health Policy and Planning, vol. 25, 2010, p. 85-96

'Scaling up' is used primarily to describe the process or ambition of expanding the coverage of health interventions, but can also refer to increasing the financial, human and capital resources required to expand coverage. Four major issues in scaling up the coverage of health interventions are: the costs of scaling up coverage; constraints to scaling up; equality and quality concerns; and key service delivery issues when scaling up. If the impressive health improvements that have been achieved over the past ten years are to be sustained, it is essential that efforts to increase the coverage of health interventions continue, despite the global recession.

Unmet health care needs of people with disabilities: population level evidence

M.A. McColl, A. Jarzynowska and S.E.D. Shortt

Disability and Society, vol. 25, 2010, p.205-218

This cross-sectional study examined the relationship between disability and unmet healthcare needs in Canada, using the National Population Health Survey. Results show that disabled adults reported more than three times as many unmet healthcare needs as their non-disabled counterparts. Even after controlling for the effects of age, gender and poor health, disability had a significant effect on the perception of unmet needs, particularly disabilities associated with pain, hearing impairment and emotional problems. The greatest barrier to receipt of needed services by people with disabilities was cost.

Values and moral experience in global health

K. Stewart, G. Keusch and A. Kleinman (guest editors)

Global Public Health, vol. 5, 2010, p. 115-196

Articles in this special issue cover: ethics and priority setting in global health research; measurement of the value of health; ethnography as a bridge between local narratives of health and the cosmopolitan global health values that shape macro-level health policies; and new directions in global health practice.

Western Europe: health departments in health policy

S.L. Greer (editor)

Social Policy and Administration, vol. 44, 2010, p. 113-224

The articles in this themed issue study central government health departments/ministries as bureaucracies. Health departments are understood as policy bureaucracies which produce policy just like the bureaucracy of a car maker produces cars. They can therefore be understood through a mix of political and bureaucratic analysis. Through studies of France, Germany, the UK and the United States, the authors clarify the nature and limits of health departments, usually in language that should generalise to the role of departments in other areas of policy.

Willingness to pay for community-based health insurance in Nigeria: do economic status and place of residence matter?

O. Onwujekwe and others

Health Policy and Planning, vol.25, 2010, p. 155-161

This study took place in Anambra and Enugu states in South-East Nigeria, and involved a rural, an urban and a semi-rural community in each. Generally, less than 40% of respondents were willing to pay for community-based health insurance (CBHI) scheme membership for themselves or other household members. The number of people willing to pay was much lower in rural communities, at less than 7%. The average monthly premiums that respondents were willing to pay ranged from US$1.7 in a rural community to US$2.9 in an urban community. It is concluded that: consumer awareness of the benefits of CBHI needs to be created to increase coverage; contributions would have to be augmented with other sources of finance; and that the poorest would need subsidies to enable them to join the scheme.