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

Arguing for a centralized coordination solution to the public-private partnership explosion in global health

D.K. Ciccone

Global Health Promotion, vol.17, 2010, p.48-51

The public-private partnership (PPP) is defined by a hybrid structure of governance, such that both government and non-government entities provide finance and participate in decision-making. Harnessing their potential requires the establishment of harmony among the different incentive structures and internal cultures of profit-based companies, public institutions and humanitarian initiatives. The ability of PPPs to succeed as a mechanism for global health governance depends largely on whether they demonstrate accountability, effectiveness and sustainability. Without a layer of public oversight of the co-ordination of these entities, PPPs fail in many of these areas.

Barriers to and use of health care services among cross-border migrants in Botswana: implications for public health

T.M. Moroka and M. Tshimanga

International Journal of Migration, Health and Social Care, Vol.5, Dec. 2009, p. 33-42

There is a growing consensus that migrants often fail to access health services in host countries. Cross-border migrants are a sub-group whose health status and risks have not been widely researched, and who are systematically marginalised in the health care system in many countries. This study gathered data from 137 cross-border migrants from Zimbabwe, who were residing in Botswana but planned to visit their home country regularly. Their biggest barriers to accessing healthcare in Botswana were cost, negative attitudes of medical staff, fear of arrest and deportation, language and wanting a different doctor. This study has serious implications for public health policy, in terms of access to health care by non-citizens, help-seeking behaviours, cost of care and multicultural practice.

Beyond (financial) accessibility: inequalities within the medicalisation of infertility

A.V. Bell

Sociology of Health and Illness, vol.32, 2010, p. 631-646

There is a significant class disparity within the provision of medical treatments for infertility in the United States. In 2002, according to the Survey of Family Growth, only 10% of women with less than a high school education received fertility treatment, compared to nearly 18% of women with at least a bachelor's degree. The most common explanation for such disparity blames the inaccessibility of fertility treatment on its exorbitant cost and sparse insurance coverage. However, research has shown that even when accessibility is standardised, or equal across strata due to mandated insurance coverage, disparities still exist. Drawing on in-depth interviews with women of low socio-economic status, this paper explores the structural and political barriers to receiving infertility treatment that they face when confronted with a medical establishment which caters for white middle class women.

Community health promotion strategies to address non-communicable diseases in Africa

W.H. Giles (guest editor)

Global Health Promotion, vol.17, 2010, supplement 2, 97p

The papers in this supplement provide concrete examples of how public health practitioners are effectively implementing strategies to prevent and control non-communicable diseases (NCDs) in Africa. The articles and commentaries highlight: 1) the important role played by data and surveillance in describing the burden of these diseases, creating the political will to tackle them, and mobilising leadership in the area of NCDs; 2) the need to work across multiple government agencies; 3) the important role that policies play, particularly in the areas of tobacco, nutrition and physical activity, in creating healthy environments; and 4) the importance of engaging community members and non-governmental organisations in the planning, implementation and evaluation of NCD prevention and control efforts.

Competition and integration in Swedish health care

B. Ahgren

Health Policy, vol.96, 2010, p. 91-97

A new quasi-market model has been introduced in Swedish healthcare in recent years, which involves citizens acting as purchasers. They can choose their primary care provider, which generates a capitation payment to the selected facility. This new model is commonly referred to as 'choice of care', and policymakers believe that completion for patients will drive up standards and increase efficiency. On the other hand, this quasi-market model has led to fragmentation in the health system, which policymakers are seeking to counter by promoting various forms of integrated care arrangements. One example is 'local health care', which can be described as upgraded community-oriented primary care, supported by adaptable hospital services and tailored to the needs of the local population. This article explores whether these two approaches can be combined or whether they are incompatible.

Demand for EU cross-border care: an empirical analysis

C. Wagner and R. Linder

Journal of Management and Marketing in Healthcare, vol.3, 2010, p. 176-187

Under the Health Modernisation Act 2004, people resident in Germany who are members of a statutory health insurance fund can claim for inpatient and outpatient treatment in other EU countries. The legislation also allows statutory health insurance funds to enter into contracts with healthcare providers in other EU member states. The insurance fund Techniker Krankenkasse (TK) was quick to promote increased patient mobility in Europe and provided its members with the option of scheduled cross-border care before the legislation came into force. This paper analyses the responses to a TK survey which explored members' experiences of cross-border care.

Developing a national physical activity plan: the Kuwait example

J. Ramadan and others

Global Health Promotion, vol.17, 2010, p.52-57

In Kuwait, dramatic lifestyle changes and a concurrent increase in sedentary living have led to serious problems of obesity for both men and women. In response a National Physical Activity Committee has been formed to design and implement a National Physical Activity Plan, which could serve as a model for other countries. This article describes the background and principles behind the development of the National Plan, summarises a template based on the Kuwait experience, and shared lessons learned.

Do we have primary health care reform? The story of the Republic of Serbia

S. Simic and others

Health Policy, vol. 96, 2010, p. 160-169

Since the beginning of the transition to democracy in October 2000, Serbia has laid the foundations of wide-ranging reforms covering the scope, financing, organisation and management of the health system at primary, secondary and tertiary levels. The primary health sector has undergone many radical changes. This paper aims to provide insight into the effects of national activities and international assistance on technical and allocative efficiency and financial sustainability in primary health care. Results show that allocative efficiency improved, but technical efficiency was almost unchanged for all services, except for preschool healthcare. Financial sustainability also improved measured by indirect indicators of health expenditure.

The effects of pay-for-performance on tuberculosis treatment in Taiwan

Y.-H. Li and others

Health Policy and Planning, vol.25, 2010, p. 334-341

In order to make the treatment of Tuberculosis more effective and to lower the transmission rate of the disease, the Bureau of National Health Insurance in Taiwan implemented the Pay-for-Performance on Tuberculosis programme in 2004. This study investigated the effectiveness of the programme in terms of cure rate and length of treatment. Results showed that hospitals participating in the programme increased their rate of cure and reduced their length of treatment compared to non-participating hospitals.

Gender equity in treatment for cardiac heart disease in Portugal

J. Perelman, C. Mateus and A. Fernandes

Social Science and Medicine, vol.71, 2010, p. 25-29

Equity in healthcare delivery is one of the objectives of the Portuguese healthcare system. This study sheds light on the performance of the system in respect of gender equity, using a large database that includes all patients admitted to Portuguese NHS hospitals with cardiac disease between 2000 and 2006. Results indicate that Portugal experiences a persistent gender gap in favour of men in the use of high-technology treatments for heart disease and in-patient mortality from heart disease. In addition, women are more likely to be admitted to hospital for emergency treatment and less likely to have benefited from early diagnosis of the condition.

Global immunization policy making processes

M. Bryson, P. Duclos and A. Jolly

Health Policy, vol.96, 2010, p. 154-159

This paper reports the results of a global survey on the topic of immunisation policy development. Countries reported on actors involved, sources of evidence consulted, challenges faced and changes desired in the immunisation policy development process. Most countries had established or would like to establish an immunisation technical advisory group. Countries reported using many sources of information, the most valued being those from the World Health Organisation. Common challenges in immunisation policy development include funding, capturing the epidemiology of disease, and coordination of government and stakeholders.

Migration and the globalisation of health care: the health worker exodus?

J. Connell

Cheltenham: Elgar, 2010

This book examines the controversial recent history of international migration of health workers from under-privileged regions, and explores the economic and cultural rationale behind this rise of a complex global market in qualified migrants and its multifaceted outcomes. It pays particular attention to the increase in demand for migrants in more developed countries due to the complex ramifications of aging, and new opportunities and expectations. It illustrates how globalization has linked sub-Saharan Africa to Europe and North America, and created new demand in Japan for international migrants from China and isolated island states. The long-established skill-drain, with its impact on household relations and negative consequences for health care, is carefully balanced against new flows of remittances, the return of skills and complex regional changes. Wide-ranging policy interventions, and greater social justice, have been challenged by the rise of the 'competition state' and limitations to economic growth in the global south.

National implementation of Integrated Management of Childhood Illness (IMCI): policy constraints and strategies

H.M. Ahmed, M. Mitchell and B. Hedt

Health Policy, vol. 96, 2010, p.128-133

Approximately nine million children in developing countries die of preventable and treatable conditions every year. Integrated Management of Childhood Illness (IMCI) is a strategy that attempts to reduce deaths from these conditions by strengthening health worker skills and training, health systems and family and community practices. Multi-country evaluations of IMCI have shown benefits in improved health service quality as well as reductions in mortality and health costs. However, many countries have faced significant health system, political, and financial constraints to national implementation and as a result have not been able to observe sustained benefits from IMCI. This article reviews the empirical evidence regarding various IMCI benefits, commonly identified implementation constraints, and strategies for health system strengthening and successful implementation.

The (non) use of prioritisation protocols by surgeons

K. Dew and others

Sociology of Health and Illness, vol. 32, 2010, p. 545-562

Dominant discourses in contemporary health policy are those of priority setting and rationing. In New Zealand, clinical priority assessment criteria (CPAC) have been developed to make access to elective surgery more equitable and efficient. However analysis of audio and video recordings of 47 consultations with 15 different surgeons revealed no instances where CPAC tools were explicitly used. Using three case studies to illustrate the argument, it is suggested that the delivery of a diagnosis and a treatment plan is an interactionally complex matter which can be seen as a delicate process of breaking good or bad news. It does not lend itself to the rigid following of a protocol.

Nurses, Inc: expansion and commercialisation of nursing education in the Philippines

L. E. Masselink and S.-Y. D. Lee

Social Science and Medicine, vol. 71, 2010, p. 166-172

Training nurses to work abroad is part of a government-facilitated labour migration programme introduced in the Philippines in the 1970s. It continues despite the fact that the Philippines' domestic health system is weak and existing supplies of health workers are poorly distributed. This study explores the role of nursing schools in expanding and commercialising nursing education and perpetuating the link between nursing education and migration.

Patient costs for paediatric hospital admissions in Tanzania: a neglected burden?

P. Saksena and others

Health Policy and Planning, vol. 25, 2010, p. 328-333

Tanzania has a policy of free provision of inpatient care for young children in order to promote timely access and reduce current levels of mortality. However, interviews with 510 caretakers on the day of discharge of their child showed that child hospitalisation placed a considerable burden on poor families, due to out-of-pocket expenditure on food and medicine.

Policy and practice: non-governmental organisations and the health delivery system for displaced children in Khartoum, Sudan

A.O.A. Abdelmoneium

Child Abuse Review, vol.19, 2010, p. 203-217

The crises suffered by Sudan due to war and natural disasters have led to the displacement of more than one eighth of is population, chiefly women and children. Due to ongoing civil wars leading to high military expenditure and a low health budget, the Sudanese state is unable to meet the healthcare needs of its displaced people. This role has been assumed by non-governmental organisations (NGOs). This article focuses on the work of an international organisation delivering health services to displaced people in a refugee camp in Khartoum in order to argue the case for a rights based approach to healthcare, for separate provision of services to adolescent mothers, for sex education for children, and for sexual and reproductive health services and education for adolescent boys and men.

The response to flexibility: country intervention choices in the first four rounds of the GAVI Health Systems Strengthening applications

L. Goeman and others

Health Policy and Planning, vol. 25, 2010, p. 292-299

Since December 2005, the GAVI Alliance Health Systems Strengthening window has offered predictable funding to developing countries, based on a combined population and economic formula. This is intended to assist them to address system constraints to improved immunisation coverage and healthcare delivery, needed to meet the Millennium Development Goals. The application process invites countries to prioritise specific system constraints not addressed by other donors and allows them to allocate their eligible funding accordingly. This article presents an analysis of the first four rounds of countries' funding applications.

Success in a changing market: innovation, funding, communication

Journal of Management and Marketing in Healthcare, vol. 3, 2010, p.119-162

These special issue papers cover:

  • Introduction of a system of extrabudgetary payments to facilitate the inclusion of new technologies into the German inpatient reimbursement system
  • Improved co-ordination of the treatment of breast cancer in the South-West Finland hospital district
  • Health technology assessment in Europe
  • Tools for healthcare leaders to use in engaging their staff in an effective dialogue leading to innovation and reform.

Using wealth ranking to identify the poor for subsidies: a case study of community-based health insurance in Nouna, Burkina Faso

A. Souares

Health and Social Care in the Community, vol. 18, 2010, p. 363-368

Poor people in developing countries are less likely to seek healthcare than those who are better off. Community-based health insurance aims to improve healthcare utilisation by removing financial barriers, but has been less effective in securing equity than hoped. Poor people, who require greater protection from catastrophic health expenses, are less likely to enrol in such schemes. Therefore, it is important to implement targeted interventions so that the neediest are not left out. This article describes and evaluates the use of community wealth ranking to identify the poorest quintile of households in a district in Burkina Faso, who were then offered community-based health insurance at half the usual premium rate.

Vouchers as demand side financing instruments for health care: a review of the Bangladesh maternal voucher scheme

J.-O. Schmidt and others

Health Policy, vol.96, 2010, p. 98-107

Demand side financing (DSF) instruments, such as vouchers, attempt to transfer purchasing power for defined goods and services to specified groups instead of allocating all the resources to the supply side and assuming that all those with need are able to access services. This article presents the findings of a rapid evaluation of the Maternal Health Voucher scheme launched in 2007 in 33 sub-districts of Bangladesh, providing evidence of its impact on uptake and quality of maternal care. The scheme provides vouchers distributed by health workers to poor women that entitle them to receive skilled care at home or at a facility and also provide payments for transport and food.

Why do health systems matter? Exploring links between health systems and HIV response: a case study from Russia

E. Tkatchenko-Schmidt and others

Health Policy and Planning, vol. 25, 2010, p. 283-291

There are a number of pathways through which health system features may impact on HIV/AIDS programmes. The debates on health system-HIV/AIDS interplay in developing countries are equally relevant to middle-income countries where systems infrastructure and human capital are much more advanced. The Russian response to HIV/AIDS was influenced by features of the health system inherited from Soviet times and the changes introduced in the post-communist era of reforms. Strengthening HIV responses in post-Soviet societies will require improvements in their wider health systems, including advocacy of prevention for high-risk populations, reallocation of resources from curative to preventive services, building decision-making capacity at the local level, and developing better working environments for healthcare staff.

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