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Welfare Reform on the Web (August 2000): Health Care - Overseas

COMPREHENSIVE INTEGRATED PRIMARY MENTAL HEALTH CARE FOR SOUTH AFRICA. PIPE-DREAM OR POSSIBILITY?

I. Petersen

Social Science and Medicine, vol. 51, 2000, p. 321-334

Study suggests that while free health care in South Africa has increased access, it has compromised the capacity of the health care system to provide comprehensive primary health care. Expectations that primary health care personnel should provide comprehensive primary healthcare in the face of increased patient numbers, budget cuts and lack of support has led to a demoralised workforce. Adding mental healthcare to the existing overburdened primary health care service is likely not only to be met with negative attitudes by service providers but also to result in a bio-medically oriented approach to primary mental health care.

A CONVERSATION WITH GAIL R. WILENSKY

G. R. Wilensky

Policy and Practice of Public Human Services, vol. 58, June 2000, p. 28-31

Ms Wilsensky gives her views on reform of Medicare, the US federal government health care scheme for older people. Medicare is on old-fashioned indemnity insurance type programme which offers only limited coverage for hospital stays and lacks features such as routine check-ups, eye tests and dental services which are currently included in most health insurance plans.

DECENTRALISING THE HEALTH SECTOR: ISSUES IN BRAZIL

C. Colins, J. Araujo and J. Barbosa

Health Policy, vol. 52, 2000, p. 113-127

The health care system in Brazil has undergone important changes, particularly with the development of the Unified Health System (SUS). Decentralisation is an important principle of SUS and advances have been made in transferring responsibilities and resources to local government units knows as municipios. Article describes changes introduced, focusing on the system of municipio classification and the funding mechanisms introduced through the Basic Operating Rule of 1996.

THE DETERMINANTS OF THE PUBLIC-PRIVATE MIX IN CANADIAN HEALTH CARE EXPENDITURES: 1975-1996

L. Di Matteo

Health Policy, vol. 52, 2000, p. 87-112

The key determinants of the public-private mix in Canadian health care are real per capita income, the income share of the top quintile and the value of federal health transfers. Increases in per capita income have tended to be associated with more private health care spending relative to public spending. Real per capita federal transfers are positively related to the public share and their rapid decline since 1989 combined with the onset of the Canada Health and Social Transfer in 1996 has resulted in much of the reduction of the public share of health care expenditure since 1990. Finally, the rise of the top quintile share of income is also associated with a decline in the public share of health care expenditure.

THE GLOBAL CHALLENGE OF HEALTH CARE RATIONING

A. Coulter and C. Ham (editors)

Buckingham; Open University Press, 2000

Views rationing as synonymous with priority-setting and assumes these are inevitable parts of healthcare. Looks at the experience of governments in the Nordic countries, the US, Israel, and the Third World. Examines the ethical dimensions of some real situations and includes guidance on how decision-makers should test the process they are using. Attention is focused on techniques for making decisions, involving the public and the practical experience of rationing. Concludes that the institutions, information, techniques and intellectual framework in place to underpin rationing are still inadequate.

HOLES IN THE SAFETY NET? ASSESSING THE EFFECTS OF TARGETED BENEFITS UPON THE HEALTH CARE UTILIZATION OF POOR NEW ZEALANDERS

J. R. Barnett, P. Coyle and R. A. Kearns

Health and Social Care in the Community, vol. 8, 2000, p. 159-171

Recent research on GP utilization in New Zealand suggests that low rates of utilization are increasingly typical of the 'new underclass' made up of the poor who include many Maori and Pacific Island people. Paper provides recent evidence from a survey conducted in Christchurch of economic influences on GP utilization and attempts to assess the extent to which financial barriers remain significant barriers to the use of care by poor New Zealanders. Results showed that a large proportion of respondents delayed seeking care because of the costs.

IMPORTING BUDGET SYSTEMS FROM OTHER COUNTRIES: WHAT CAN WE LEARN FROM THE GERMAN DRUG BUDGET AND GP FUNDHOLDING?

D. Delnoij and G. Brenner

Health Policy, vol. 52, 2000, p. 157-169

In Britain GP Fundholders were responsible for prescribing costs from 1991 to 1999 and in Germany an overall expenditure cap for pharmaceutical prescribing has been used since 1993. Article analyses these two systems in order to identify the conditions needed for successfully implementing budget systems for controlling prescribing costs in other countries. A good information infrastructure is a necessary condition for implementing any budget system. In order to implement fundholding, a number of additional conditions need to be met, such as having gatekeeping GPs with personal lists and having a single-payer system.

MEDICAID AND THE COSTS OF FEDERALISM, 1984-1942

J. D. Gilman

New York, London: Garland, 1998

The enlargements to Medicaid which occurred in the late 1980s and early 1990s were unprecedented and unexpected. This book examines the nature and scope of the government expansions at the state and national levels, as well as the environmental, political, and institutional factors that promoted them. It also answers the questions of why and how did state and federal officials manage to enlarge the program to such an unprecendented extent?

THE PREVALENCE OF HEALTH PROMOTION AND DISEASE PREVENTION SERVICES: GOOD NEWS, BAD NEWS, AND POLICY IMPLICATIONS

P. C. Olden and D. G. Clement

Milbank Quarterly, vol. 78, 2000, p. 115-146

Recently American health care has shifted towards an emphasis on population health in communities. National data from the American Hospital Association Annual Survey of Hospitals are used to describe the prevalence of 26 services provided by general hospitals that could contribute to health promotion and disease prevention. Results showed that many specific services are offered by thousands of hospitals, but prevalence, distribution and availability of services are variable across the size and ownership of hospitals and their communities. Policy initiatives could increase the prevalence of these services.

REGULATED COMPETITION AND CITIZEN PARTICIPATION: LESSONS FROM ISRAEL

D. Chinitz

Health Expectations, vol. 3, 2000, p. 90-96

The Israeli reform of healthcare is based on a regulated competition model, in which citizens have free choice among highly regulated competing sick funds. At the same time, the reform process has been accompanied by legal, institutional and political frameworks, as well as significant interest group activity, all aimed at increasing public input into processes of health policy making and implementation. The Israeli case, it is argued, lends support to the proposition that citizen participation (voice) and individual choice (exit) and complementary modes of ensuring citizen influence over health services. Paper expresses cautious optimism that citizen participation is a projection of a healthy social learning process, and suggests ways in which public policy might encourage this outcome.

THE ROLE OF INDEPENDENT AGENTS IN THE SUCCESS OF HEALTH INSURANCE MARKET REFORMS

M. A. Hall

Milbank Quarterly, vol. 78, 2000, p. 23-46

Drawing on an extensive qualitative study in seven American states, article explores the role agents play in the functioning of small-group and individual-market health insurance reforms. Study shows agents to be almost uniformly enthusiastic about guaranteed-issue requirements and other components of market reforms. Although insurers devise strategies for manipulating agents in order to avoid undesirable business, these opportunities are limited and do not appear to be seriously undermining the effectiveness of market reforms. Despite the layer of costs that agents add to the system, they play an important role in making market reforms work, and they fill essential information and service functions for which many purchasers have no ready substitute.

THE ROLE OF THE PRIMARY CARE PHYSICIAN IN THE ISRAELI HEALTH CARE SYSTEM AS A 'GATEKEEPER': THE VIEWPOINT OF HEALTH CARE POLICY MAKERS

H. Tubenkin and R. Gross

Health Policy, vol. 52, 2000, p. 73-85

The health care system in Israel has a deficit of two billion shekels. Although many attempts have been made to improve efficiency and produce savings, the Ministry of Health has never tried a policy of strengthening the role of primary care. Study aimed to assess the attitudes of policymakers to a change in the role of primary care physicians and to ascertain the conditions under which they would be prepared to adopt the model of primary care physicians as gatekeeper. Interviews with 20 policymakers showed that, while they wished primary care physicians to play a central role in the health care system, only half supported a full gatekeeper model, and most thought that the gatekeeper concept had a negative connotation.

WHEN PROVIDERS AND COMMUNITY LEADERS DEFINE HEALTH PRIORITIES: THE RESULTS OF A DELPHI SURVEY IN THE CANTON OF GENEVA

D. Schopper et al

Social Science and Medicine, vol. 51, 2000, p. 335-345

The Delphi method was used to determine health priorities in a Swiss canton. The opinion of various groups concerned, either as health professionals or as representatives of the general population, was gathered to identify the health determinants and health problems perceived as most important, to clarify the reasons for these choices, and to recommend interventions to be undertaken to improve the situation in the identified priority areas. Though the identified priorities and proposed activities, a new vision of health emerged which emphasised:

  • psychosocial problems as priorities;
  • health promotion;
  • disease prevention;
  • the importance of the social environment in determining health status;
  • the importance of social, economic legal and educational policies as part of a health strategy.
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