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

Achieving large ends with limited means: grand strategy in global health

L.A. Curry and others

International Health, vol. 2, 2010, p. 82-86

Unprecedented attention is focused on global health, with a four-fold increase in development assistance in the last 15 years. Additionally, with globalisation and the accelerating risks of pandemic disease, the scope of global health has expanded beyond infectious disease to include chronic disease, health systems strengthening, and overall development. As the impact of global health is more widely understood, it is also increasingly recognised as a crucial element of economic development and foreign affairs. Given the increasing prominence of global health, the understanding and application of grand strategy is of critical importance. Grand strategy, i.e. the development and implementation of comprehensive plans of action to achieve large ends with limited means, has been refined through centuries of international relations but has been inadequately applied to global health policy and implementation. This article reviews key principles of grand strategy and demonstrates their applicability to a central global health issue: maternal mortality.

Assessment of the impact of market regulation in Mali on the price of essential medicines provided through the private sector

D. Maiga and B. Williams-Jones

Health Policy, vol. 97, 2010, p. 130-135

In 1998, the government of Mali adopted a national pharmaceutical policy aimed at promoting a supply system for generic medicines that would guarantee equal access for all citizens. Distribution and delivery is a shared responsibility of both public and private sectors (wholesalers and pharmacies). To influence private sector behaviour, the national policy uses a combination of government regulation and market forces. In 2006, the government issued a decree fixing maximum prices in the private sector for 107 drugs from the national list of 207 essential medicines. This paper presents the results of a study of prices of 49 generic essential medicines sold by private wholesalers and pharmacies in Bamako, Mali, and evaluates the effect of the 2006 government decree on the evolution of market prices and subsequent availability and public access to essential medicines. The results show that the prices of essential medicines have evolved favourably towards the prices recommended by the government decree and that the government regulation did not negatively affect drug availability.

Attitudes of health care professionals, relatives of advanced cancer patients and public towards euthanasia and physician-assisted suicide

E. Parpa and others

Health Policy, vol.97, 2010, p. 160-165

In Greece, active euthanasia is punishable by imprisonment. This study is a comparative survey of how physicians, nurses, relatives of terminally ill cancer patients, and lay people perceive issues around active euthanasia and physician assisted suicide in Greece.

A comparative study of European rare disease and orphan drug markets

A. Denis and others

Health Policy, vol.97, 2010, p. 173-179

Drugs to treat rare diseases (orphan drugs) are less likely to be developed by industry because the market is small, and research and development costs are too high to make the products profitable. This comparative study has revealed that Belgium, France, Italy, the Netherlands, Sweden and the UK have adopted varying approaches towards the institutional context, domestic marketing authorisation procedures, pricing, reimbursement, distribution channels, and prescribing processes governing orphan drug markets. The authors recommend defining priorities for research on rare diseases and orphan drugs at the European level, setting up disease and patient registries with a view to investigating long-term effectiveness and cost-effectiveness of orphan drugs at national level, assessing the profitability of orphan drugs over the life cycle, and taking account of societal considerations in addition to cost-effectiveness and budget impact when evaluating orphan drugs at national level.

Evidence and policymaking: the introduction of MMR vaccine in the Netherlands

S. Blume and J. Tump

Social Science and Medicine, vol.71, 2010, p. 1049-1055

This paper focuses on the introduction of measles, mumps and rubella (MMR) vaccine in the Netherlands two decades ago. It has been suggested, in relation to evidence-based medicine, that what counts as evidence is contested. This paper argues that the same is true for evidence-based health policy. It demonstrates that the decision to introduce MMR in the Netherlands was the outcome of a protracted process in the course of which the significance of different kinds of evidence changed. This change shows a growing reliance on international data at the expense of national data. This development had, and continues to have, major consequences for national scientific competences.

Healthcare reform: maternity service provision in Ireland

P. Kennedy

Health Policy, vol.97, 2010, p.145-151

The objective of this article is to explore recent and proposed future developments in maternity services in Ireland in the context of health policy reform. Ireland is experiencing an unprecedented demand for maternity services with in excess of 75,000 births in 2009, the highest since the 1970s. A further 10% rise is projected for 2010. This demographic change has placed increased demands on an already over-stretched maternity service. Despite more than a decade of economic success, the health service has remained in constant crisis. Reform of maternity services has begun and this article presents two case studies to demonstrate regional variations in provision in a country which has a national health services and a national Maternity and Infant Care Scheme. It shows what developments have occurred and the likely direction of travel of maternity services in the next ten years.

IVF policies with emphasis on Israeli practices

F. Simonstein

Health Policy, vol. 97, 2010, p. 202-208

The Israeli National Health Insurance covers unlimited cycles of IVF for all Israeli women citizens up to two children in a given relationship (even if the woman already has living children). This paper reviews IVF policies in several countries before focusing on the use of assisted reproduction technologies in Israel. It reviews evidence on the effectiveness of IVF cycles over time as reflected in the literature; examines women's health and welfare after long term IVF use; and asks if women would necessarily be better off if offered unlimited free access to IVF.

Judgment of unbearable suffering and willingness to grant a euthanasia request by Dutch general practitioners

D. van Tol, J. Rietjens and A. van der Heide

Health Policy, vol. 97, 2010, p. 166-172

'Unbearable suffering' is a pivotal criterion for lawful euthanasia in the Netherlands. However it is not defined in law and could refer to physical pain or psychological distress. This vignette study conducted among Dutch general practitioners investigated what doctors consider unbearable suffering to mean. There was general agreement that untreatable physical pain constituted unbearable suffering, and that euthanasia requests should be granted in this case, but opinions varied in cases where patients suffered a combination of irreversible functional loss and psychological distress.

The motivations for participation in public-private partnerships for the provision of tuberculosis treatment in South Africa

E. Sinanovic and L. Kumaranayake

Global Public Health, vol.5, 2010, p. 479-492

South Africa is experiencing a rapidly emerging tuberculosis and AIDS epidemic that is straining state health system resources. One response to the need to find effective ways of managing rising TB caseloads is the promotion of public-private partnerships (PPPs). Using a new institutional economics approach, this study examines the motivations of private and government organisations for participating in public-private partnerships for delivery of TB treatment and the incentive mechanisms attributable to different models of PPP. Findings suggest that private providers have both financial (profit maximisation) and non-financial (controlling TB, training, maintaining good relations with government) motives for participating in PPPs. The main motivation for government actors appears to be cost-saving and improving TB programmes through better compliance and increased access to treatment.

Patient safety. 2nd ed.

C. Vincent

Chichester: Wiley-Blackwell, 2010

The book reviews the evidence of risks and harms to patients, and provides practical guidance on implementing safer practices in health care. It discusses each and every aspect of patient safety clearly and compellingly. Examples of team based initiatives show how patient safety can be improved by changing practices, both cultural and technological, throughout whole organisations. Not only does this benefit patients; it also impacts positively on health care delivery, with consequent savings in the economy.

Politics and health in eight European countries: a comparative study of mortality decline under social democracies and right-wing governments

J.A. Tapia Granados

Social Science and Medicine, vol.71, 2010, p. 841-850

Recent publications have argued that the welfare state is an important determinant of population health, and that social democratic governments and higher levels of health expenditure promote health progress. In the period 1950-2000, Greece, Portugal and Spain were the poorest market economies in Europe, with a fragmented system of welfare provision and many years of authoritarian right-wing regimes. In contrast, the five Nordic countries were the richest market economies in Europe, governed mostly by centre or centre-left coalitions and having a generous and universal welfare state. In spite of these socioeconomic and political differences, and a large gap between the five Nordic and the three Southern nations in levels of health in 1950, population health indicators converged among these eight countries. Mean decadal gains in longevity of Spain and Portugal between 1950 and 2000 were almost three times greater than the gains in Denmark, and almost twice as great as those in Iceland, Norway and Sweden during the same period. All this raises serious doubts regarding the hypothesis that the political regime, the political party in office, the level of healthcare spending, or the type of welfare state exert major influences on population health.

The role of Product Development Partnerships in research and development for neglected diseases

M. Moran and others

International Health, vol.2, 2010, p. 114-122

Product Development Partnerships (PDPs) are playing an increasingly important role in the development of new medicines for the neglected diseases of the Third World. However, little information has been published about the funding and expenditure patterns of this important group of R&D actors. This paper aims to fill the gap by analysing PDP's 2007 funding and expenditure flows, based on data collected as part of the 2008 Global Funding of Innovation for Neglected Diseases survey.

Rural vs urban hospital performance in a 'competitive' public health service

J. Garcia-Lacalle and E. Martin

Social Science and Medicine, vol.71, 2010, p. 1131-1140

This paper seeks to explore whether market reforms affect rural and urban hospitals differently in a European health service. Rural and urban hospital performance is compared on measures of efficiency and perceived quality. The study focuses on the Andalusian Health Service in Spain, which has implemented a freedom of hospital choice policy and a reimbursement system based on hospital performance. The results show that the rural and urban hospitals perform similarly in the efficiency dimension, whereas rural hospitals perform significantly better in the patient satisfaction dimension.

Theft and corruption take malaria drugs away from Africa's poorest

O. Steeds

The Independent, Oct. 1st 2010, p. 30

An investigation by Channel 4 has revealed that widespread government corruption and theft of anti malaria drugs is preventing the poorest people in Uganda from receiving treatment for a preventable disease that kills 300 people in the country every day.

The tradeoff between centralized and decentralized health services: evidence from rural areas in Mexico

A. Vargas Bustamante

Social Science and Medicine, vol.71, 2010, p. 925-934

Decentralisation is portrayed as a policy which promotes efficiency in the financing and delivery of healthcare. This paper tests this hypothesis by comparing the performance of centralised and decentralised healthcare providers in rural Mexico that co-existed in seven states in the 1990s. It also compares clinics decentralised in the early 1980s with others decentralised in the mid-1990s. Results show that overall centralised providers performed better. The analyses show that families from rural Mexico who received benefits from centralised clinics paid less out-of-pocket for healthcare and used preventive care more often than those who accessed decentralised clinics.

Turning the world upside down: the search for global health in the 21st century

N. Crisp

London: Royal Society of Medicine, 2010

The book explores what richer countries can learn from poorer ones and suggests that, instead of talking of international development - where the richer help the poorer - we should think in terms of co-development, each learning from the other. By bringing together insights from all parts of the world, the book sets out a new vision for global health, based on our interdependence, our desire for independence and on our rights and accountabilities as citizens of the world.

Unravelling the concept of consumer preference: implications for health policy and optimal planning in primary care

M.M. Foster and others

Health Policy, vol. 97, 2010, p. 105-112

The authors question whether mainstream thinking about preferences, namely that consumers are capable of deliberating between rival strategies and are willing to make trade-offs, is a reliable way of thinking about preferences given the complexities of the health-decision making environment and the personal psyche. The example of primary care in Australia is used as a means of developing this discussion. The paper concludes by outlining some of the contributions to health policy if the conceptualisation and elicitation of consumer preferences allows for diverse perspectives.

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