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

Approaches to reducing the most important patient errors in primary health-care: patient and professional perspectives

S. Buetow and others

Health and Social Care in the Community, vol. 18, 2010, p. 296-303

Approaches to managing patients' contribution to error have received little attention in the research literature. This article aims to assess how patients and primary care professionals perceive the relative importance of different patient errors as a threat to patient safety based on focus groups held in Auckland, New Zealand during 2007. In response to the errors ranked as most important by their own group, participants suggested approaches to managing patient error. What is needed was described by four inter-related actions: Grow relationships; Enable patients and professionals to recognise and manage patients' contributions to error; be Responsive to the capacity of these stakeholders to manage the errors; and Motivate action for patient safety. Evidence for this approach is illustrated through two key patient errors: the action error of non-adherence and the mental error of forgetfulness.

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

This article reviews the research literature that tests the main hypotheses concerning managed competition and consumer-directed health care. 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 have an incentive to reduce costs in order to compete on price. In the consumer-directed model, price-sensitive demand for medical services, rather than insurance, is the key driver. The fundamental idea is that exposing consumers to greater cost sharing for treatments will reduce demand for care. This article reviews and synthesises research on consumer price sensitivity.

Country-level governance of global health initiatives: an evaluation of immunisation co-ordination mechanisms in five countries of Asia

J. Grundy

Health Policy and Planning, vol. 25, 2010, p. 186-196

Recent significant changes in the strategic environment for immunisation in Asia include new vaccines and technologies and trends towards health system integration and decentralisation. Immunisation Coordination Committees, the principal coordination mechanism for Global Alliance for Vaccines and Immunisation (GAVI) investments, are functioning well in relation to information sharing and proposal application processes, but less well in areas of evaluation, strategic gap analysis and coordination of technical co-operation. In an era of more pluralistic and complex health systems, it will be increasingly important for immunisation planners to link to a wider coordination system that is inclusive of the health sector, regulatory authorities, civil society and private sector interests. Governance of global health initiatives at country level needs to extend beyond the concept of 'management by committee' to more systematic engagement with health system, civil society and private sector interests.

Developing civic virtue in Kenyan health governance

C.O. Miruka

International Journal of Behavioural and Healthcare Research, vol.1, 2009, p. 371-387

The Kenyan health service enjoys very little trust from the people it is supposed to serve arising from a general suspicion of government. This general mistrust of government is shared by administrators within the health service itself. It is argued that health service administrators need an internal moral compass to guide their individual behaviour while carrying out professional duties. The concept or ideal of civic virtue provides such a guide, and instilling it into health administrators could enable improved operation of services and eventually restore trust in government.

Diffusion of potential health-related e-services: an analysis of Swiss health customer perspectives

L. Muhdi and R. Boutellier

Journal of Management and Marketing in Healthcare, vol.3, Apr. 2010, p. 60-72

Health-related e-services can be customised to meet the needs of different consumer groups, and have the potential to improve service delivery and increase customer satisfaction and loyalty. Based on the diffusion of innovations theory proposed by E.M. Rogers, this research investigated the attitudes of Swiss university students to health-related e-services. Results show that health wikis, online health accounts, and rating tools for care providers were popular with this client group. Online forums and online patient communities appeared to be growing in popularity, whereas e-services providing only company or product information were poorly rated. Understanding the perceptions of different customer groups can support the development of more consumer-oriented e-services that have a higher potential of being accepted and utilised by clients.

Expenditure on obstetric care and the protective effect of insurance on the poor: lessons from two Indonesian districts

Z. Quayyum and others

Health Policy and Planning, vol.25, 2010, p. 237-247

The Indonesian government has recently introduced a health insurance scheme to improve access to care for the poor. This research investigated the payments made by households for various types of obstetric care, the economic consequences of payments and the effects of the new insurance on that expenditure. Results showed that insurance for the poor was relatively effective in protecting households from the impact of catastrophic payments for obstetric care. However, coverage needs to extend to the non-poor who can also be impoverished by payments for medical care and who are only protected because hospital rules on who qualifies have been relaxed.

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

R.R. Faden and others

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

This article describes British and American coverage, access, and cost-sharing policies with regard to expensive cancer drugs and then compares the costs of eleven such drugs to British patients, American Medicare beneficiaries and American patients purchasing drugs on the retail market. In both the British and American healthcare systems, not all patients who might benefit from, or desire access to, expensive cancer drugs can get them. The popular characterisation of the United States, where all cancer drugs are available for all to access as and when needed, and that of the NHS, where top-down rationing poses insurmountable obstacles to British patients, are far from the reality in both countries.

From public to private and back again: sustaining a high service-delivery level during transition of management authority

B. Jacobs and others

Health Policy and Planning, vol. 25, 2010, p. 197-208

Contracting out of health service delivery to non-governmental organisations has been shown to improve outputs considerably over relatively short time frames in low-income countries, especially when applying performance-related pay as a stimulus. A key concern is how to manage the transition back to a government-operated system while maintaining health service delivery output levels. This paper presents a longitudinal case study from Cambodia in which the authors describe and analyse the transition from NGO-managed to government-managed health services.

Health and social assistance during economic and financial crisis

A.H. Fidler and V. Moran

Journal of Management and Marketing in Healthcare, vol. 3, Apr. 2010, p. 4-7

Health services are expected to suffer funding cuts due to the current global financial and economic crisis. In this opinion piece the authors argue that: 1) achievements in public health improvement and equity should not be put at risk by across-the-board budget cuts; 2) governments must find innovative ways to protect the poor and vulnerable and must enact better market regulation; and 3) they should take advantage of the present turmoil to enact long-lasting reforms.

Health care reform in Massachusetts: implementation of coverage expansions and a health insurance mandate

M.T. Doonan and K.R. Tull

Milbank Quarterly, vol. 88, 2010, p.54-80

Massachusetts launched its health reform programme in 2006 based on shared responsibility among individuals, government and business. Building on the existing system, the state expanded its Medicaid Programme, created a new subsidised programme through a health insurance exchange, instituted insurance market reforms to make insurance more affordable and available, and required employers not offering insurance to contribute a modest amount of money to help finance government subsidies. The state was also the first to require individuals who could afford it to purchase health insurance. Lessons for expansion of national coverage in the US can be learned from the process of decision making, the need to keep stakeholders engaged, the relationship of decisions to existing programmes and regulations, and the interactions among programme components.

How do Europeans perceive their healthcare system? Patterns of satisfaction and preference for state involvement in the field of healthcare

C. Wendt and others

European Sociological Review, vol. 26, 2010, p. 177-192

This article sought to examine public attitudes towards healthcare systems by looking at different social groups as well as institutional structures in Europe. The focus was on the preferred level of state involvement in healthcare provision and on measures of consumer satisfaction. There is high public support for state involvement in healthcare provision almost everywhere in Europe. Satisfaction with the healthcare system, in contrast, is more strongly linked to local institutional arrangements and social class. For example, in healthcare systems with lower levels of expenditure, fewer general practitioners, and higher co-payments, the overall level of satisfaction is lower.

Innovation of healthcare services in pharmacies

H. Gebauer

International Journal of Behavioural and Healthcare Research, vol.1, 2009, p.427-444

Confronted with competitive challenges, pharmacies in Switzerland are rethinking the services they offer. They are seeking to regain their market share by offering additional services such as measuring blood pressure and monitoring cholesterol levels. This paper seeks to identify the factors associated with the success of these innovations through 12 in-depth case studies.

The National Strategic Plan of South Africa: what are the prospects of success after the repeated failure of previous AIDS policy?

E. Wouters, H.C.J. van Rensburg and H. Meulemans

Health Policy and Planning, vol. 25, 2010, p.171-185

South Africa has one of the worst AIDS epidemics in the world, but successive strategies over three decades have failed to tackle it. This review begins by systematically identifying the reasons for past failures through a literature review. The analysis demonstrates that a complex interplay among the content, context, actors and process of AIDS policy created a gap between policymaking and policy implementation, which rendered near ideal AIDS policies ineffective. The article next evaluates the chances of success of the most recent policy, HIV & AIDS and STI Strategic Plan for South Africa, 2007-2011. The analysis shows that the National Strategic Plan contains dynamic and comprehensive policy content, sensitive to the socio-economic and cultural dimensions of HIV/AIDS. However, many of the political actors who hampered treatment implementation in the past are still in office. Monetary and human resource shortages also create a policy context that is unfriendly to the implementation of a comprehensive HIV/AIDS strategy.

Patient flows as a key driver of university hospital modernisation: lessons for other transitional countries from the Serbian case

A. Katrava and others

Journal of Management and Marketing in Healthcare, vol.3, Apr.2010, p. 40-59

Today many healthcare providers are looking at how patients, staff and materials flow through their facilities. Improving these flows can reduce costs and enhance quality of care and the patient experience. This article describes an EU-funded project for improving process and patient flows at four university hospitals in Serbia through infrastructure reconstruction, building redesign and sustainable redevelopment of tertiary care policy and services.

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 branch agencies in the USA and other nations are increasingly using reviews of the medical literature to inform health policy decisions. To clarify these efforts to give policymakers evidence of medical effectiveness, this article discusses the California Health Benefit Review Program. This programme, based at the University of California, analyses the medical effectiveness of health insurance benefit mandate bills for the California legislature, as well as their impact on cost and public health.

Traveller health and primary care in Ireland: a consultative forum

M.C. Van Hout

Community Practitioner, vol.83, May 2010, p. 27-30

Travellers in Ireland have a less favourable health status than the sedentary population. The Department of Health and Children has recognised that Travellers 'have a right to have their culture recognised in the planning and provision of services'. Primary healthcare programmes for Travellers have been identified as a cornerstone of this approach, with such programmes being developed across Ireland to provide advocacy and address health needs. This paper presents an exploratory account of stakeholder perspectives on Traveller needs relating to primary care provision.

Understanding the organization of public health delivery systems: an empirical typology

G.P. Mays and others

Milbank Quarterly, vol.88, 2010, p. 81-111

Policy discussions about improving the US healthcare system increasingly recognise the need to strengthen its capacities for delivering public health services. A better understanding of how public health delivery systems are organized across the United States is critical to improvement. To facilitate the development of such evidence, this article presents an empirical method of classifying and comparing public health delivery systems based on key elements of their organisational structure. Public health delivery systems were found to vary widely in organisational structure, but the observed patterns of variation suggested that they adhere to one of seven distinct configurations. Systems frequently migrated from one configuration to another over time, with an overall trend towards offering a broader range of services and engaging a wider spectrum of organisations.

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