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

Direct facility funding as a response to user fee reduction: implementation and perceived impact among Kenyan health centres and dispensaries

A. Opwora and others

Health Policy and Planning, vol.25, 2010, p. 406-418

An innovative system of direct facility funding of government health centres and dispensaries has been piloted in Coast Province, Kenya to address the negative effects of reducing user fees. It was perceived to have a highly positive impact through funding support staff, outreach activities, patient referrals, and renovations and through increasing health facility committee activity. The main challenges associated with the scheme were confusion over its operation, the continued overcharging of user fees, and very limited understanding among the broader community.

Health payment-induced poverty under China's New Cooperative Medical Scheme in rural Shandong

X. Sun and others

Health Policy and Planning, vol.25, 2010, p. 419-426

Since 2003, New Cooperative Medical Schemes have been developed as pilot projects in a number of Chinese counties with the objective of protecting country people from the risk of being pushed into poverty by medical expenses. This study in Ling County showed that the scheme provided only modest protection from health payment-induced poverty in households. Out-of-pocket payments for medical treatment remained a severe burden.

The impact of demographics on health and health care: race, ethnicity and other social factors

J. Jacobs Kronenfeld (editor)

Bingley: Emerald, 2010

The book focuses on differences in health and health care as linked to important social factors. The first section reviews basic material on the topic. The second section on racial and ethnic factors in differences in health and health care is the largest section of the book, and includes six articles looking at racial disparities in a variety of areas such as: knowledge of hepatitis C Virus; health services received and patients' experiences in seeking health care; and, the role of social capital in class and race disparities in health information seeking behaviour. Further sections include articles focused on geographic and community factors, gender and age, gender and language, and life course issues such as maternal depression and hospice care.

Improving the long-term sustainability of health aid: are Global Health Partnerships leading the way?

R. Dodd and C. Lane

Health Policy and Planning, vol. 25, 2010, p. 363-371

The provision of long-term predictable funding is a key aspect of scaling up health services to meet Millennium Development Goals, because the bulk of healthcare costs are recurrent and many interventions require sustained support if they are to be successful. Health donors are increasingly providing aid over the long term, and the Global Health Partnerships are at the forefront of this trend, pioneering many of the new approaches. However, all partners have scope to further improve the duration of aid within existing rules and legislation; the main constraints on so doing are political. Increased monitoring of aid duration and better incentives for donor agency staff to take on the risks and difficulties associated with making longer term commitments are needed.

Influencing EU health policy: supreme discipline or waste of time?

B. Baer

Journal of Management & Marketing in Healthcare, vol. 3, 2010, p. 192-195

The growing impact of the EU on national and local health policies calls for greater input from the health managers, researchers and policy makers from different parts of the health sector. There are many ways of influencing EU health policy. Firstly, there is an opportunity to inform the policy-making agenda. Secondly, policy may be shaped through networks, including EU working groups set up for that purpose. Thirdly, the insights of those working day-to-day in the health system can add substantial value and expertise to EU policy-making by linking what is happening in Brussels to concerns on the ground and thus support the implementation and sustainability of EU initiatives in the long-term.

International health and aid policies: the need for alternatives

J-P Unger and others

Cambridge: CUP, 2010

International health and aid policies of the past two decades have had a major impact on the delivery of care in low and middle-income countries. This book argues that these policies have often failed to achieve their main aims, and have in fact contributed to restricted access to family medicine and hospital care. Presenting detailed evidence, and illustrated by case studies, it describes how international health policies to date have largely resulted in expensive health care for the rich, and disjointed and ineffective services for the poor. As a result, large segments of the population world-wide continue to suffer from unnecessary casualties, pain and impoverishment.

The national free delivery and Caesarian policy in Senegal: evaluating process and outcomes

S. Witter and others

Health Policy and Planning, vol. 25, 2010, p. 384-392

This article presents an evaluation of the free delivery and Caesarian policy in Senegal. The policy was introduced in five poor regions in 2005 and extended to all regions apart from the capital in 2006. The evaluation found significant implementation difficulties, especially related to the allocation of funds and kits and the adequacy of their contents. In spite of the problems, significant increases in service utilisation for normal deliveries and in Caesarian rates were recorded. It is concluded that, in order to reach its full potential, the scheme requires improved systems for planning and allocating resources, and new channels to reimburse lower level facilities.

Political feasibility analysis of the new financing scheme for the National Health Insurance reform in Taiwan: an application of stakeholder analysis

C.-Y. Lin and others

Asian Social Work and Policy Review, vol. 4, 2010, p. 163-183

The National Health Insurance (NHI) Program, which was established in Taiwan in 1995, covers virtually all citizens. Between 2001 and 2004, the government engaged in a comprehensive reform project aimed at restructuring the NHI Program into the so-called Second Generation NHI Program. This study is part of the comprehensive review, focusing on the preferences and positions of key policy stakeholders with regard to the financial reform proposals, as well as their network relationships. Results show that the new financing scheme has some support from policy stakeholders participating in the study, and that the measures concerning equity and sustainability were most welcome. However, there is controversy with regard to the issue of equitable sharing of contributions. There is strong support for the new scheme among the administrative and legislative elites, but less among the social elite affiliated with employers' associations and welfare groups.

The state and healthcare: comparing OECD countries

H. Rothgang and others

Basingstoke: Palgrave Macmillan, 2010

Since the 1970s the state has witnessed significant challenges to its control over social policy institutions in the arena of health care. Examining these changes in comparative perspective, this volume provides a quantitative overview of financing, regulation and service provision for 21 OECD countries, with an in-depth qualitative analysis of three cases: the US, UK and Germany. The book argues that healthcare systems are converging towards mixed regimes and that this marks a new era in welfare state history.

Supplementary private health insurance in selected countries: lessons for EU governance?

S. Gechert

CESifo Economic Studies, vol. 56, 2010, p. 444-464

In order to contain costs, governments have cut back the coverage of statutory health insurance to the minimum and encouraged citizens to take out voluntary supplementary private insurance to obtain other benefits. This article tested this reasoning by analysing health insurance schemes in Canada, Australia and Switzerland that permit voluntary supplementary insurance in a regime with a mandatory basic insurance package. The evidence shows that markets do not function as desired. Insurers do not compete on quality or cost-effectiveness to contain costs or utilise managed care mechanisms. Instead, they indulge in expensive cream skimming.

Trends in out-of-pocket payments for health care in Kyrgyzstan, 2001-2007

J. Falkingham, B. Akkarzieva and A. Baschieri

Health Policy and Planning, vol.25, 2010, p. 427-436

Among the countries of the former Soviet Union, the Kyrgyz Republic has been a pioneer in reforming the system of healthcare finance. Since the introduction of a compulsory health insurance scheme in 1997, the country has gradually moved from subsidising the supply of services to subsidising the purchase of services through the single payer of the health insurance fund. In 2002 the government introduced a new co-payment for hospital inpatients along with a basic benefits package. A key objective of the reform was to replace the growing system of unofficial informal payments for healthcare with a transparent official co-payment, thereby reducing the burden of payments for the poor. This study investigated trends in out-of-pocket payments for healthcare using data from a series of national household surveys conducted over the period 2001-2007. The analysis showed that there had been a significant improvement in financial access to healthcare. Kyrgyzstan provides a model that could be replicated throughout the region.

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