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

Attitudes towards mandatory national premarital screening for hereditary haemolytic disorders

J.Y. Al-Aama

Health Policy, vol. 97, 2010, p. 32-37

Sickle cell disease and thalassemia are the most common genetic disorders in Saudi Arabia. In order to reduce incidence of the diseases, a compulsory national premarital screening programme was introduced in 2004. However, many couples decide to go ahead with the marriage regardless of the result. This may be due to lack of understanding or ineffective genetic counselling. Coercive interference with the marriage of 'genetically incompatible' couples is now being advocated in the media. This article uses data from a survey of 800 university students to explore the attitude of educated young people to the pre-marital screening programme.

China gets $1bn health cash meant for poorest countries

M. Moore and P. Hutchison

Daily Telegraph, Aug. 6th 2010, p. 16

A former official of the Global Fund to Fight AIDS, Tuberculosis and Malaria has disclosed that China made contributions of $16m to the fund but received $1bn in payouts, despite becoming the world's second largest economy. He said that China had exploited the set up to win more aid grants than 29 African countries. Other states were said to be afraid of incurring China's diplomatic displeasure if they opposed the grants.

Cross-country issues in health care: choice, equity, efficiency and cost

G. Bevan, J.-K. Helderman and D. Wilsford (guest editors)

Health Economics, Policy and Law, vol.5, 2010, p. 251-387

Health economists and policy analysts have wrestled for many years with the issue of how ensuring equity (access by need and not by ability to pay) can be reconciled with efficiency (generating incentives to reduce costs and improve quality) and control of total costs. The papers in this special issue examine choice policies in European healthcare, which aim to help resolve these tensions. Three papers consider the nature of differences between and within countries following the Beveridge and Bismarck models of financing and organising the delivery of care, and how choices are changing within different systems. Within countries following the Beveridge model, current policies in England, Denmark and Sweden emphasise increasing patient choice of provider. Within countries following the Bismarck model, current policies in France and Germany seek to restrict choice of specialist by introducing 'soft' gatekeeping, while in the Netherlands there is a system of managed competition with choice of insurer that in principle allows insurers to contract selectively with providers. A fourth paper considers how government policies which seek to restrict choice within systems of universal coverage have been challenged in the courts.

Decentralized health care priority-setting in Tanzania: evaluating against the accountability for reasonableness framework

S. Maluka and others

Social Science and Medicine, vol.71, 2010, p.751-759

Fair priority-setting has become one of the biggest challenges faced by healthcare decision-makers worldwide. The ethical framework Accountability for Reasonableness has emerged as a guide to achieving a fair and legitimate priority-setting process. This article evaluates the processes of setting healthcare priorities in Mbarali district, Tanzania, against Accountability for Reasonableness. Results showed that the district-level priority setting process was not nearly as participatory as official guidelines suggest it should have been. Priority-setting usually took place in the context of budget cycles, and the process was driven by historical allocation. Stakeholders' involvement in the process was minimal. Decisions (but not the reasoning behind them) were publicised through circulars and notice boards, but there were no formal mechanisms in place to ensure that this information reached the public. There were neither formal mechanisms for challenging decisions nor an adequate enforcement mechanism to ensure that decisions were made in a fair and equitable manner. Therefore, priority-setting in Mbarali district did not satisfy the four conditions of Accountability for Reasonableness, namely relevance, publicity, appeals and revision, and enforcement.

Design-based regulation and patient safety: a regulatory studies perspective

K. Yeung and M. Dixon-Woods

Social Science and Medicine, vol. 71, 2010, p. 502-509

This review article seeks to show how ideas and insights from the new field of regulatory studies can help to draw into focus and provide a conceptual apparatus for thinking about important problems in the regulation of medicine and healthcare. To illustrate the analysis, technology is identifies as a regulatory modality, and a critique is offered, from a regulatory perspective, of the use of action-forcing technology as a means of securing patient safety.

The evolution of health care advance planning law and policy

C.P. Sabatino

Milbank Quarterly, vol. 88, 2010, p. 211-239

Since the mid-1970s, healthcare advance directives have been promoted in the USA as the primary legal tool to communicate wishes regarding end-of-life care and decision making. These documents spell out the patient's healthcare goals and instructions, and appoint a proxy decision maker in the event of incapacity. This article provides an overview of the evolving legal landscape of end-of-life decision taking generally, and advance directives specifically, and highlights a fundamental shift in that landscape. There has been a paradigm shift in state law away from standardised, formal legal documents to a communication-oriented approach to advance care planning. The article then introduces Physician Orders for Life Sustaining Treatment, the next step in the evolution of advance care planning.

Exploratory study of the impacts of Mutual Health Organizations on social dynamics in Benin

V. Ridde and others

Social Science and Medicine, vol. 71, 2010, p. 467-474

Mutual Health Organizations (MHOs) are non-profit community organisations whose aim is to improve their members' access to healthcare. Membership is voluntary. MHOs are also social organisations that interact with and act upon their environments. Because they are community-based and their voluntary activities support solidarity, MHOs may positively influence social dynamics in settings where they are implemented. In this exploratory study of four MHOs in Benin, the authors examined social dynamics related to mutual aid, relationships of trust and empowerment.

From targeted exemptions to user fee abolition in health care: experience from rural Zambia

F. Masiye, B.M. Chitah and D. McIntyre

Social Science and Medicine, vol. 71, 2010, p. 743-750

Poor access to healthcare is one of the greatest impediments to improved health in Africa. In Zambia, user fees, introduced in 1993, are blamed for a decline in healthcare utilisation. A national fee exemption policy was introduced in 1995 to protect the poorest and most vulnerable, but was ineffective in reaching the target population. In 2006 the President of Zambia announced the abolition of user fees at primary healthcare facilities in designated rural areas. The authors have demonstrated statistically significant increases in the utilisation of primary healthcare in rural areas where user fees were removed, using a comprehensive longitudinal dataset on utilisation at all health centres in Zambia. Increases in use were greatest in districts with the highest levels of material deprivation.

Global health

D.A. Andelman (editor)

World Policy Journal, vol. 27, Summer 2010, p. 1-53

How medical treatment and the personnel needed to deliver it are distributed is one of the greatest challenges facing the world today. This themed section begins with a panel of experts exploring the question of what is the most pressing global health crisis and how it can be solved. Other articles cover the rise of Islamic extremism in medicine, lethal counterfeit drugs, the impact of influenza pandemics, sanitation in Ghana, how Dhaka copes with its sick and ailing population, and healthcare in India, Brazil and France from a consumer's point of view.

The impact of pharmaceutical policy measures: an endogenous structural-break approach

P. Pita Barros and L.C. Nunes

Social Science and Medicine, vol.71, 2010, p. 440-450

Pharmaceutical spending has risen steeply in many countries in recent years. European countries have adopted an array of measures to control spending, including increased co-payments, administratively imposed price cuts, and promotion of use of generic drugs. This article uses a novel time series approach to determine which policy measures have a significant impact, with Portugal as the case study. Findings suggest that none of the policy tools so far tried have controlled pharmaceutical spending.

Medical dominance and neoliberalisation in maternal care provision: the evidence from Canada and Australia

C. Benoit and others

Social Science and Medicine, vol. 71, 2010, p. 475-481

Since the 1970s, governments in many high-income countries have implemented a series of reforms aimed at improving the efficiency and effectiveness of their healthcare systems. Many of these reforms have been market-oriented, involving deregulation of key services, the creation of competitive markets, and the privatisation of health and social care. This article explores how such neoliberal reforms have impacted on traditional medical dominance of maternity care in Canada and Australia. The findings indicate that neoliberal reforms have not substantially changed the historically hegemonic role medicine has played in maternity care provision.

Patient-centred care: a Nordic perspective

I-L. Johansson, L. Noren and E. Wikstrom (guest editors)

International Journal of Public Sector Management, vol. 23, 2010, p. 325-412

Governments in the Nordic countries have sought to improve health services by empowering patients and turning them into demanding consumers with ability to choose among competing providers. Strengthening the patient's position is assumed to put pressure on providers to improve the care delivered. The articles in this special issue explore the different ways in which consumerism has evolved in the Nordic countries and problematise its relationship to patient centred care. The challenges to patient centred care posed by consumerism are common to most European countries, although solutions may differ.

Pharmaceutical supply chain in China: current issues and implications for health system reform

Xuan Yu and others

Health Policy, vol. 97, 2010, p. 8-15

In China, the pharmaceutical industry has expanded rapidly over the past two decades, ensuring that medicines are available to use, but at a cost that poorer people cannot afford. This has led to mounting complaints from the public. This paper analyses the current pharmaceutical supply chain in China, in order to pinpoint the reasons for the very high cost of drugs. The root causes are found to be ineffective supervision of the industry, pressure on hospitals to maximise their profits by using more expensive drugs for which they can charge patients, and lack of an authoritative drug formulary.

Policy implications of a financial incentive programme to retain a physician workforce in underserved Japanese rural areas

M. Matsumoto, K. Inoue and E. Kajii

Social Science and Medicine, vol. 71, 2010, p. 667-671

Existing evidence supports the effectiveness of financial incentives offered to medical students and young physicians in exchange for obligatory rural service for reducing the shortage of doctors in country areas. However, whether the experience of obligatory rural service affects the physician's choice of practice location once the service is completed remains unknown. This study analysed the practice location of Jichi Medical University (JMU) graduates. JMU is a Japanese medical education programme with a contract system under which all graduates have an obligation to serve in under-doctored areas for about six years in exchange for a 6-year undergraduate tuition waiver. 484 JMU graduates who were in rural service in 2000 and had completed the service by 2006 were included in the study. Results suggested that experience of rural service early in the physician's career had a positive impact on later choice of a rural practice. The study supports the use of a policy that attracts early-career physicians to practice in rural areas.

A report card on the physician work force: Israeli health care market - past experience and future prospects

A. Toker and others

Health Policy, vol. 97, 2010, p. 38-43

In the coming years, a worldwide shortage of doctors is expected due to complex social, political and economic forces that vary from country to country. In Israel a physician shortage is expected in the very near future due to changes in the immigration pattern (i.e. fewer immigrant doctors entering the country under the Jewish law of return), gender effects, population growth, and transparency of data on demand for physicians.

Translating knowledge into policy and action to promote health equity: the Health Equity Fund policy process in Cambodia 2000-2008

P. Ir and others

Health Policy, vol. 96, 2010, p. 200-209

In Cambodia, access to essential health services remains problematic, especially for the poor. To tackle this problem, multiple health financing innovations have been tested in recent years, including the Health Equity Fund (HEF). Under this scheme, eligible poor patients receive full or partial financial support for payment of user fees, transport costs and other costs during hospitalisation. HEF pilots proved relatively successful and showed potential for improving equity and reducing poverty. Supported by knowledge gained from the pilots, HEFs went on to become part of national health policy. This article analyses the HEF policy process to illustrate how knowledge gained from the pilots was used to inform national health policy and draws lessons for translating knowledge into policies that promote equity.

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