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Welfare Reform on the Web (January 2011): Healthcare - overseas

Are elected health boards an effective mechanism for public participation in health service governance?

R. Gauld

Health Expectations, vol.13, 2010, p. 369-378

There is growing interest in the idea of elected members on health service governing boards as a means to promote public participation in planning and decision making, yet studies of elected boards are limited. Whether elected boards are an effective mechanism for public participation remains unclear. This article discusses the experiences of New Zealand, where, since 2001, there have been three sets of elections to district health boards. The New Zealand experience suggests that elected health boards may not be an effective mechanism for public participation. Voter turnout has declined since the inaugural elections in 2001, and non-voters form the majority. The elections have also failed to produce minority representation, while the capacity for elected members to represent their communities is subject to constraints.

The construction of evidence-based local health policy through partnerships: research infrastructure, process, and context in the Rotterdam 'Healthy in the City' programme

R. Wehrens, M. Bekker and R. Bal

Journal of Public Health Policy, vol. 31, 2010, p. 447-460

Academic Collaborative Centres (ACC) for Public Health were launched in the Netherlands in 2005 to foster long term collaboration between a regional public health service and a university research department. The programme aims to improve the use of scientific research in public health policymaking by facilitating interactions and mutual exchange of ideas between professionals, scientists and policymakers. This article explores the detailed workings of an ACC partnership between researchers, policymakers and practitioners in Rotterdam. It is pointed out that while a partnership structure may facilitate interactions, it does not automatically render these interactions meaningful.

A cross-national comparative study of orphan drug policies in the United States, the European Union, and Japan: towards a made-in-China orphan drug policy

B.-C. Liu and others

Journal of Public Health Policy, vol. 31, 2010, p.407-421

Drugs for rare diseases are commonly called orphan drugs because so few individuals are affected that pharmaceutical companies are reluctant to develop them given their small sales potential. In the United States, the EU and Japan specific legislation has been enacted to encourage pharmaceutical companies to invest in developing such orphan drugs. This article analyses the strengths and weaknesses of the incentives offered by these laws, to support the development of orphan drug policies in China.

Determinants of use of different types of health care provider in urban China: a tracer illness study of URTI

D. Qian and others

Health Policy, vol.98, 2010, p. 227-235

The implementation of market-oriented health reforms in China, which has coincided with increasingly high user fees, mean that patients are now free to use whatever level of provider they can afford. Patients in urban areas currently have a choice of three providers: private clinics, community health centres, and city hospitals. This study aims to analyse demand for different types of healthcare provision using data from the fourth China National Health Services Survey and examining the provider choices of patients with acute upper respiratory tract infections (URTI). Findings indicate that overall private clinics are important sources of medical care for low consumption households, that insured patients are more likely to use community health centres, and that children are more likely to see a high level provider. A number of other factors, including city size and severity of illness, were found to play a role in provider utilisation.

Do generic firms and the Spanish public purchaser respond to consumer price differences of generics under reference pricing?

J. Puig-Junoy and I. Moreno-Torres

Health Policy, vol.98, 2010, p. 186-194

Reference pricing is a system whereby a buying agent/insurer decides on a single maximum reimbursement price for a group of equivalent medicines, and the user/patient pays the difference if the medicine they choose is more expensive. The objective of this article is to assess the impact of competition under reference pricing in the Spanish generic drugs market on the consumer price and the average price paid by the National Health System. Results show that the Spanish reference pricing system produces very little consumer price competition between generics firms, price reduction thus being limited to regulatory methods. National Health System purchasing shows little sensitivity to price differences between equivalent drugs priced at or below the reference price.

Does the way physicians are paid influence the way they practice? The case of Canadian family physicians' work activity

S. Sarma and others

Health Policy, vol. 98, 2010, p. 203-217

Recent years have seen a move away from the traditional fee-for-service approach towards alternative methods of remunerating doctors in Canada. The introduction of new modes of remuneration has the potential to alter doctors' work patterns. This study investigated the impact of mode of remuneration on the work activities of Canadian family doctors in relation to: a) direct patient care in office/clinic; b) direct patient care in other settings; and c) indirect patient care. Results show that Canadian family doctors working in non-fee-for-service settings spend fewer hours on direct patient care in the office/clinic, but devote more hours to direct patient care in other settings and to indirect patient care.

Early initiation of antiretroviral therapy and universal HIV testing in sub-Saharan Africa: has WHO offered a milestone for HIV prevention?

S. Menon

Journal of Public Health Policy, vol. 31, 2010, p. 385-400

Most of the world's new HIV infections occur in sub-Saharan Africa, where financial resources, laboratory infrastructure, and healthcare workers are scarce compared to higher income settings. A 2009 World Health Organization (WHO) guideline recommends earlier initiation of antiretroviral therapy (ART) for adults and adolescents with HIV. Although universal testing and early initiation of ART for everyone diagnosed with HIV could reduce new infections by 20% within ten years, adherence to the WHO 2009 guideline is unlikely to be sustainable in low-income countries without guarantees of adequate national and donor support.

Events, public discourses and responsive government: quality assurance in health care in England, Sweden and Japan

N. Kodate

Journal of Public Policy, vol.30, 2010, p. 263-289

This paper examines three universal healthcare systems (England, Sweden and Japan) and explores the degree to which political institutions and public opinion affect the processes of quality assurance system building within them. It identifies three factors at play in determining when and how each government intervenes. Firstly, constantly high issue saliency as demonstrated by media coverage affects government actions. Secondly, prominent events such as medical malpractice scandals could push the issue of quality assurance up the political agenda. Thirdly, the balancing act of government between listening to the general public and prioritising the expertise and interests of the medical profession plays a crucial part in the development of quality assurance systems.

Health policy processes in Vietnam: a comparison of three maternal health case studies

Bui Thi Thu Ha and others

Health Policy, vol. 98, 2010, p. 178-185

This paper describes and analyses the processes involved in the development of three Vietnamese reproductive healthcare policies: skilled birth attendance, adolescent reproductive health and domestic violence response. The results show that the policy development process was different in each case, being influenced by the nature of the policy, the involvement of different actors, and the wider context both nationally and internationally.

Health systems and communicable diseases in Asia

R. Coker and R. Atun (guest editors)

Health Policy and Planning, vol.25, 2010, supplement 1, 162p

Programmes supported by the Global Fund to Fight Aids, Tuberculosis and Malaria, for example, are encouraged to use their disease-specific platform to strengthen health systems through investment in infrastructure, supply chain management to improve access to drugs, interventions to recruit and retain skilled staff, and by improving monitoring and evaluation capacity. This supplement presents six country case studies exploring interactions between Global Fund-supported targeted programmes and health systems in Indonesia, Nepal, Laos, Papua New Guinea, Thailand and Vietnam.

Patient perceptions of carrying their own health information: approaches towards responsibility and playing an active role in their own health: implications for a patient-held health file

R. Forsyth, C.A. Maddock and M. Lassere

Health Expectations, vol.13, 2010, p. 416-426

Increasing rates of chronic disease are leading to healthcare being delivered by multiple providers, often at distributed geographic locations. As a way of increasing the availability of patient information to care providers, this project will trial a patient-held health file (PHF). Patients would carry these files to doctors' appointments where clinicians would record information for other practitioners. Increasing the availability of patient information is expected to enhance the safety and quality of care delivery and improve health outcomes. This exploratory study investigated whether a small sample of 10 patients would be happy to carry their own health information to consultations with doctors and considered the implications for the development of a PHF.

The potential of legislation on organ donation to increase the supply of donor organs

R. Coppen and others

Health Policy, vol. 98, 2010, p. 164-170

The Dutch Organ Donation Act was originally designed to provide both legal certainty and trust in the procurement and distribution of organs for transplant. It was assumed that greater trust in the system would increase the supply of donor organs. Unfortunately implementation of the Act did not solve the shortage of donated organs. In order to boost the supply of donated organs, various proposals have been made to amend the Act, which are analysed in this paper. The most promising approach appears to be to change the consent system from explicit to presumed consent to donation. It is concluded that relying on legal measures alone to increase the supply of donated organs is unlikely to be successful.

Public-private partnerships in health services delivery: a network organizations perspective

A. Singh and G. Prakash

Public Management Review, vol.12, 2010, p. 829-856

From the early 1990s, health system reforms have been in progress in several States in India. This study focuses on one such reform, public-private partnerships, which are collaborative arrangements between government and private for-profit and not-for-profit providers. It conceptualises public-private partnerships from a network organisations perspective and applies the interorganisational relations framework to study the exchange of resources and information, and mechanisms of co-ordination in 15 public-private partnerships in a district health system in India. The research finds that the government plays a dominant role in the network because of the centrality of its position, authority and control of resources and information. Power is asymmetrically distributed in the network and there is great reliance on formal methods of co-ordination. For effective network governance, it is imperative to reduce the power asymmetry, develop horizontal co-ordination, trust and social capital, and enhance public managers' capacity for effectively conducting interorganisational relationships.

Unhealthy governance: security challenges and policy prospects

N. Thomas (guest editor)

Health Policy and Planning, vol. 25, 2010, p. 447-504

In the closing decade of the 20th century the challenges posed by infectious diseases in a globalised environment began to be redefined as threats to national and human security. The most widely applied model for identifying and responding to such threats is securitisation theory, as proposed by the Copenhagen School. However, its utility remains contested, especially in non-European and non-state settings. The papers in this special issue aim to: 1) analyse ways in which Asian states and international organisations have identified health challenges as security threats; 2) to draw upon the securitisation model as a way of understanding the full extent to which these states and international organisations have responded to the health threat; and 3) to identify areas where the theory might be strengthened.

WHO urges roll-out of new TB test despite worries over cost

S. Boseley

The Guardian, Dec. 9th 2010, p. 31

A test that can detect TB, including drug-resistant forms, in less than two hours could revolutionise treatment of the disease which killed 4,700 people every day last year, according to the World Health Organisation (WHO). The test is simple and safe to use and incorporates modern DNA technologies that can be used outside the laboratory, although the need for constant electricity supply may be a problem in rural settings. The main issue is cost with the market price for the equipment currently between $55,000 and $62,000 with an additional charge of between $55 and $82 for the cartridges it uses.

World Aids Day special issue

E. John (editor)

The Independent, Dec 1st 2010, p. 1-10

On the occasion of the World Aids Day, this edition of the Independent newspaper is edited by musician and Aids campaigner Sir Elton John, with reports on the impact of the Aids pandemic around the world and the progress being made in combating it. There are contributions dotted around various sections of the paper by Bill Clinton, Stephen Fry and Jamie Oliver among others.

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