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

An approach to health system strengthening in the Union of Myanmar

N. Tin and others

Health Policy, vol.95, 2010, p. 95-102

In 2007 and 2008, the Union of Myanmar, through its Department of Health, and with the support of the Global Alliance for Vaccines and Immunisation (GAVI), developed a health system strengthening (HSS) strategy and proposal. In July 2008 the proposal was recommended for approval by GAVI, and identified as an example of best practice in HSS proposal development. This article describes and analyses the development process and content of the HSS strategy.

Attitudes of stakeholders and policymakers in the healthcare system towards the provision of spiritual care in Israel

N. Bentur, S. Resnitzky and A. Sterne

Health Policy, vol.96, 2010, p. 13-19

Spiritual care services and chaplaincy in the healthcare system are provided for people with serious illnesses, with the aim of helping them to achieve moments of peace and acceptance when contending with sickness or facing death. Chaplaincy has been available in Europe and the USA for many years, but such programmes started to develop in Israel only recently. This paper examines the attitudes of stakeholders, directors and policymakers in the healthcare system towards the provision of spiritual care.

Disclosing clinical adverse events to patients: can practice inform policy?

R. Sorensen and others

Health Expectations, vol.13, 2010, p.148-159

Following the loss of two major malpractice cases in the mid-1980s, the Veterans Affairs Medical Centre in Kentucky implemented an organisation-wide full disclosure policy around adverse events. Many governments and health organisations worldwide are following their lead, but empirical evidence on which to base models of patient-clinician communication and policy development is scant. Open disclosure makes health service managers and clinicians explicitly accountable to patients for the outcomes of care. To achieve this level of accountability, the patient's perspective must be better understood and harnessed as a practice and policy resource. This means connecting directly with the experiences of patients harmed in care to inquire about their needs, values and preferences.

The female community health volunteer programme in Nepal: decision makers' perceptions of volunteerism, payment and other incentives

C. Glenton and others

Social Science and Medicine, vol. 70, 2010, p. 1920-1927

The Female Community Health Volunteer (FCHV) Programme in Nepal has existed since the late 1980s and includes almost 50,000 volunteers. Although volunteer programmes are widely thought to be affected by high attrition levels, the FCHV Programme loses less than 5% of its volunteers annually. This study explored the views of stakeholders who had participated in the design and implementation of the Programme about volunteer motivation and appropriate incentives, and compared these views with those of the volunteers themselves. Stakeholders saw volunteers as motivated primarily by social respect and religious and moral duty. Regular wages in this social context were seen as not only financially unfeasible, but also as a potential threat to volunteers' social respect, and thereby to their motivation. These views were reflected in interviews with, and previous studies of, female community health volunteers. It is concluded that, in order to improve the sustainability of community health worker programmes, incentives should be aligned with the context-specific expectations of the volunteers.

Financial incentives in the German statutory health insurance: new findings, new questions

S. Stock and others

Health Policy, vol.96, 2010, p. 51-56

This paper presents the results of a mandatory three-year evaluation of an incentive scheme offered by German Statutory Health Insurance Funds. The scheme offered rewards to Fund members who took part in health promotion and illness prevention programmes. Fund members were rewarded for take up of immunisation against influenza, for participating in check-up and screening interventions, and for joining licensed exercises classes, sports clubs or gyms. Results showed that these financial incentives led to significant savings in costs of treating illnesses in the short term.

Global health diplomacy for obesity prevention: lessons from tobacco control

C. Blouin and L. Dube

Journal of Public Health Policy, vol. 31, 2010, p. 244-255

Global health diplomacy involves collective action and negotiation of rules and norms to address health challenges by nation states and a diverse group of non-state actors. To date the global health diplomacy agenda has focused on infectious diseases. However this article focuses on an example of its use to tackle chronic diseases in the shape of the Framework Convention on Tobacco Control and explores what lessons can be learned from this experience for obesity prevention.

Health and globalization

G. Cockerham and W. Cockerham

Cambridge: Polity, 2010

This book examines the multidimensional influence of globalization on human health and disease. The acceleration of globalization since the end of the Cold War has had numerous far-reaching impacts on health-related issues, both social and political, and as this book shows, globalization continues to present both positive and negative implications for the state of human health. The book focuses on the relationships between globalization and a variety of health-related topics including the spread of Western medicine, the rise of medical tourism, and adverse effects on the environment. Particular attention is paid to issues of contemporary urgency such as the spread of pandemics and the role of global health governance. in addition the book includes reviews changes in health care delivery systems in the United States, United Kingdom, Japan, China, Russia, and selected developing countries. The book provides an account of the many actors involved in global health, analyzing the interactions of national governments, governmental and nongovernmental organizations, and multinational corporations in addressing global health issues.

Health systems governance in Europe: the role of European Union law and policy

E. Mossialos and others (editors)

Cambridge: CUP, 2010

There is a fundamental contradiction at the core of health policy in the EU that makes it difficult to draw a line between EU and Member State responsibilities. This raises a number of difficult questions for policy makers and practitioners as they struggle to interpret both 'hard' and 'soft' laws at EU and Member State level and to reconcile tensions between economic and social imperatives in health care. The book addresses these complex questions by combining analysis of the underlying issues with case studies that illustrate how broader principles are played out in practice. Each chapter addresses a topical area in which there is considerable debate and potential uncertainty. The book thus offers a comprehensive discussion of a number of current and emerging governance issues in EU health policy, including regulatory, legal, 'new governance' and policy-making dynamics, and the application of the legal framework in these areas.

Impact of regulation of community pharmacies on efficiency, access and equity: evidence from the UK and Spain

M. Lluch and P. Kanavos

Health Policy, vol.95, 2010, p. 245-254

This paper assesses the impact of pharmacy regulation on access, equity and efficiency in Spain and the UK from a healthcare and from a market perspective. In Spain, community pharmacies are strictly regulated, while the regime in the UK is liberal by EU standards. The findings indicate that improved pharmacy operational efficiency is achieved through an appropriate incentive structure, ownership liberalisation, and freedom to set the prices of medicines sold over-the-counter (OTC) as is the case in the UK. Equity and access seem to be better achieved through the establishment of geographic, demographic, or needs-based criteria for opening new pharmacies, as is the case in Spain.

International involvement and national health governance: the basic benefits package in Tajikistan

B. Rechel and G. Khodjamurodov

Social Science and Medicine, vol. 70, 2010, p. 1928-1932

Tajikistan is the poorest of the former Soviet republics and one of the 20 poorest countries in the world. Tajikistan's health sector is supported by a large number of international organisations. Coordination of external assistance is through an in country consultative group, the Donor Coordination Council, but formal government-led donor coordination has been weak. This research investigates how international involvement has impacted on national health governance in Tajikistan. This question is addressed using the example of the introduction of the basic benefit package and patient co-payments in the years after 2004, as this illustrates key challenges of health governance.

Involvement of ministries of health in health service coverage decisions: is England an aberrant case?

S. Ettelt and others

Social Policy and Administration, vol. 44, 2010, p. 225-243

This article examines the role of ministries of health in making decisions about the range of collectively funded health services in four European countries: Denmark, England, France and Germany. Ministries assume four roles in relation to determining what is collectively funded: developing legislation on behalf of government, setting the framework for healthcare delivery, controlling the budget, and supervising organisations which are responsible for decision making or provide advice to inform decisions taken by the ministry. The level of involvement of ministries of health in such decisions differs between countries, reflecting differences in institutional arrangements. However the study shows that, contrary to received wisdom, the Department of Health plays a similar role in decisions about coverage to ministries in the other three countries. England is not an extreme case of bureaucratic centralisation and ministerial intervention compared to its neighbours.

Legislating for health: locating the evidence

R. Pawson, L. Owen and G. Wong

Journal of Public Health Policy, vol. 31, 2010, p. 164-177

Legislation, in the form of direct curbs on people's behaviour, is potentially a powerful tool for improving public health and cutting healthcare costs. However, the issue is whether there is evidence to show that legal interventions work and data to show whether or not they should be extended. This article considers how one might go about collecting and synthesising evidence to help judge the efficacy of a public health law to regulate behaviour.

Organizing health services

G. Currie and M. Kitchener (editors)

London: Sage, 2010

Convergence between models of public and private sector management in recent years has turned the research of public service organizations into a fertile and expanding field. This four-volume set brings together a collection of keynote papers spanning research and practice across health services worldwide, bridging the gap between organization studies and literature more specific to the sociology of health and illness, social policy and health services research.

Policy analysis of oral health promotion in South Africa

S. Singh, N.G. Myburgh and R. Lalloo

Global Health Promotion, vol.17, 2010, p. 16-23

This research aimed to determine the form and coherence of oral health promotion elements within health policies of post-apartheid South Africa. The study set out to test the hypothesis that oral health promotion elements are fully integrated into health policy and programmatic efforts. A conceptual framework was developed to systematically analyse oral health promotion policy and decision-making at national and provincial levels. The information was drawn from policy documents, protocols and programme plans complemented by interviews. The results indicate that South African health policy rhetoric was not translated into action. The development and implementation of oral health promotion was dominated by dentists who perpetuated a curative focus in service delivery.

Poverty, vulnerability and provision of healthcare in Afghanistan

J.-F. Trani and others

Social Science and Medicine, vol.70, 2010, p. 1745-1755

In 2002, the government of Afghanistan established a Basic Package of Health Services, contracting out primary healthcare delivery to non-state providers. The priority was to give access to the most vulnerable groups: women, children, disabled people and the poorest households. This paper uses data from a nationwide survey conducted in 2005 to examine provider choice and the perceptions of these vulnerable groups regarding healthcare delivery and the value of the Basic Package of Health Services. It contributes to the ongoing debate on equitable access to healthcare in complex environments and fragile states.

The public's perspectives on advance directives: implications for state legislative and regulatory policy

K.M. Pollack, D. Morhaim and M.A. Williams

Health Policy, vol.96, 2010, p. 57-63

Advance directives were created to ensure the autonomy of patients who lack capacity to make decisions for themselves. They include the living will and health care power of attorney. Advance directives were introduced in Maryland in 1991 through the Health Care Decisions Act, but anecdotal evidence suggests that take up remains low. This paper describes the prevalence of advance directives in a diverse population-based sample of Maryland adults, examines perceived barriers and enablers to their adoption, and identifies policy solutions to address these barriers.

Purchasing health services abroad: practices of cross-border contracting and patient mobility in six European countries

I.A. Glinos, R. Baeten and H. Maarse

Health Policy, vol.95, 2010, p. 103-112

Cross-border care in the form of patients obtaining treatment outside their country of residence can take various forms in the EU. The focus of this paper is on a specific type of patient mobility, namely when care is planned, purchased by statutory purchasers and delivered outside the country which funds it. Findings suggest that statutory healthcare purchasers enter into contractual agreements with foreign and private providers in order to diversify suppliers and improve performance. Under pressure to deliver value for money and striving for cost efficiency, they experiment with new ways of organising health services for their population.

Reforming medical education: a review and synthesis of five critiques of medical practice

C.S. Sales and A.L. Schlaff

Social Science and Medicine, vol.70, 2010, p.1665-1668

This essay discusses the scope of educational reform needed to train US physicians to practice effectively in an increasingly complex healthcare arena. A review and synthesis of five critiques of medical practice in the US was carried out. These critiques were of quality, evidence-based medicine, population medicine, health policy and heuristics. Findings suggest that physicians are inadequately trained to function in the complex organisational and social systems that characterise modern practice. Successful healthcare reform in the US will require physicians who are trained not only in bio-medicine, but also in the social sciences. (For commentary see Social Science and Medicine, vol.70, 2010, p. 1669-1681)

Reliable in their failure: an analysis of healthcare reform policies in public systems

D. Contandriopoulos and A. Brousselle

Health Policy, vol.95, 2010, p. 144-152

Reforming healthcare delivery and financing to adapt them to evolving population needs, technological transformation and financial constraints has proved to be a major challenge worldwide. This paper uses Quebec's situation as a case to discuss the processes and forces that structure health system reform within a neo-institutional framework. The analysis shows that the obstacles to tackling the health system's main problems may have less to do with programmatic (what to do) than with political and governance (how to do it) questions.

'Rights-based approaches' to health policies and programs: articulations, ambiguities and assessment

S. Gruskin, D. Bogecho and L. Ferguson

Journal of Public Health Policy, vol. 31, 2010, p. 129-145

Over the past 20 years the public health community has reached a consensus that viewing health policy through a human rights lens helps in determining who is disadvantaged and who is not; who is included and who is ignored; and whether a given disparity is merely a difference or an actual injustice. However, academics, the United Nations, government agencies and non-governmental organisations still struggle with how to operationalise a rights-based approach to health. This article identifies principles underlying rights-based approaches and key definitional challenges. It reviews how scholars describe rights-based approaches and analyses statements of key institutions as the basis for discussing the implications of diverse understandings of them for policy, programmes and outcomes. The authors suggest a framework to guide implementation and assessment of their contribution to health.

The role of health technology assessment on [sic] pharmaceutical reimbursement in selected middle-income countries

W. Oortwijn, J. Mathijssen and D. Banta

Health Policy, vol. 95, 2010, p.172-184

The rapid diffusion of health technologies around the world presents challenges for government's seeking to deliver high quality healthcare within budget while safeguarding equity of access. Health technology assessment is increasingly used to identify treatments that provide the best value for money. This article aims to provide an overview of how health technology assessment is used and organised in selected middle-income countries and its role in the process of extending pharmaceutical coverage.

Security and global health: toward the medicalization of insecurity

S. Elbe

Cambridge: Polity, 2010

This book shows that in the new millennium international politics is no longer characterized by its preoccupation with a single disease, but precisely by its need to urgently confront what is now an epidemic of epidemics. Over the past decade a whole host of diverse global health issues have raised the highest levels of political concern, provoking governments and international institutions to tackle such health threats through the prism of security - be it national security, biosecurity, or human security. This convergence between health issues and security concerns has also produced the new notion of health security, which has already begun to shape the way international health policy is formulated. The intersection of the worlds of health and security is beginning to change our very ideas of what security means and how it is achieved. At the outset of the twenty-first century, practising security increasingly demands that citizens become patients, that states resemble huge hospitals, and that security itself becomes a technology of medical control.

Stakeholder perceptions of aid coordination implementation in the Zambian health sector

J. Sundewall and others

Health Policy, vol.95, 2010, p. 122-128

Coordination of health aid refers to actions taken by external donors and the national government to ensure that foreign contributions to the health sector enable it to work more effectively and in line with local priorities. Zambia is often proposed as a country where coordination in the health sector works particularly well. To explore if this is really so, this study investigated donor and government stakeholders' perceptions of the process of health sector aid coordination in Zambia.

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