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

Advocacy for free maternal and child health care in Nigeria: results and outcomes

F. Okonofua and others

Health Policy, vol. 99, 2011, p. 131-138

At present Nigeria has one of the highest maternal mortality rates in Africa and is one of the fifteen countries worldwide with the worst rates of mortality for children under five. At a presidential retreat on health in July 2006, the elimination of user fees was identified as an essential short-term strategy to reduce maternal and child mortality. A presidential advisory team was subsequently constituted, whose mandate included advocacy at the national and sub-national level for the elimination of user fees for children and pregnant women and the implementation of free services. Advocacy consisted of presentations to high-level policymakers, dissemination of situational analysis reports, and media publicity. Three years later, the number of States offering free maternal and child health services had increased from four to nine; the number offering partially free services had increased from 11 to 14; and the number offering no free treatment had decreased from 22 to 14.

An analysis of hospital capital planning and financing in three European countries: using the principal-agent approach to identify the potential for economic problems

C.R. Thompson and M. McKee

Health Policy, vol. 99, 2011, p. 158-166

This research seeks to understand the relationships among actors involved in hospital capital planning and financing in three different European countries with health systems financed primarily by social insurance (France) and general taxation, with decision-making concentrated centrally (United Kingdom) and regionally (Sweden). Case studies of major new hospital developments were undertaken in each of the three countries, based on a review of the documents and the national framework within which they took place, as well as interviews with key informants. There was evidence of, and opportunity for, economic problems in all three systems, but these seemed to be greater in France and England where the hospital led the process, where there was limited involvement by regional bodies, and informational differences appeared greater. The Swedish model appeared to have fewest problems, probably because the county council was able the neutralise opportunism on the part of the hospital.

Disempowered doctors? A relational view of public health policy in urban India

K. Sheikh and J.D.H. Porter

Health Policy and Planning, vol. 26, 2011, p. 83-92

Indian doctors are widely successful in resisting attempts by authorities to enforce public health guidelines. At the same time, practitioners are unable to contribute effectively to the development of public health policy. The study findings suggest that stronger regulation and greater accountability need to be balanced by measures to include the voices of frontline medical practitioners in public health policy discourse.

Engaging consumers in healthcare system design and reform: moving beyond the rhetoric

C.A. Bain and C. Fountain

International Journal of Behavioural and Healthcare Research, vol. 2, 2010, p. 192-204

The need to involve consumers in healthcare systems design and reform is well recognised. While consumers have been involved in discussions about the specifics of care delivery in a range of settings, engagement needs to penetrate into the sphere of systems design and improvement if we are to deliver on the goal of building healthcare systems around people and their needs. A key distinction to this end is around consumers influencing decision-making as a marker of true engagement, versus just being involved. This paper examines the issue in depth through a case study, supplemented by a limited literature review.

Enhancing community system in China's recent health reform: an effort to improve equity in essential health care

Hua Li and Wei Yu

Health Policy, vol. 99, 2011, p. 167-173

As part of its programme for creating a harmonious society, the Chinese government has allocated 850bn Yuan over three years to establish a community-based health system to provide essential care for every resident. The successful establishment of a community-based healthcare system faces three main challenges: 1) joint action by seven government agencies; 2) substantial variation in funding capacity among local governments; and 3) adjustment by community health centres to a new financial settlement, which requires them to provide free or low-cost services instead of generating maximum income from fees and sale of medicines. This paper analyses these three challenges in depth using survey data from two cities with different financing capabilities and management strategies.

An evaluation of financial incentive policies for organ donations in the United States

A.J. Wellington and E.A. Sayre

Contemporary Economic Policy, vol. 29, 2011, p. 1-13

Demand for organs for transplant in the USA far exceeds supply. Although the National Organ Transplant Act of 1984 prohibits payments for organs for transplant, financial incentives have been introduced which could directly or indirectly affect the supply. This paper considers whether more stringent state-level funeral regulations reduce the supply of transplantable organs from deceased donors and whether recent laws that provide some financial rewards to live organ donors increase the supply of transplantable organs. There is no evidence that these indirect financial incentives impact organ donations.

An evaluation of the policy on community health organizations in China: will the priority of new healthcare reform in China be a success?

H. Wang, M.K. Gusmano and Q. Cao

Health Policy, vol. 99, 2011, p. 37-43

China has been engaged in health system reform for several years. A new healthcare reform plan, enacted by the State Council of China, was published in April 2009. A central feature of this plan was a call for the development of community health organisations and establishment of a stronger public health and primary care system. Despite regular efforts to expand them, the development of community health organisations has been erratic. Since the late 1970s, huge changes in the healthcare system, coupled with socio-political and economic reforms, have inhibited their development. This paper reviews the history of health policy change in China, with a particular focus on the evolving role of community-based care. It evaluates the feasibility of current plans to enhance the role of primary care in the Chinese system and suggests changes that may facilitate these efforts.

Fighting for life: health care and democracy in capitalist Poland

P. Watson

Critical Social Policy, vol.31, 2011, p. 53-76

The privatisation of economic enterprises after the fall of communism met with little outward social protest in Poland. In contrast, the struggle over the privatisation of hospitals has continued since the introduction of major health reforms in 1999. Opposition to the reforms has been reflected in industrial action, in parliamentary debates, in social dialogue and survey responses, and in extensive press reporting. The reforms have been a stumbling block for successive governments. This paper aims to gain insight into the social and political processes healthcare reform in Poland has involved in practice. It examines what lies behind the friction between government and people, why the issues remain invisible to transnational health policy discourse, and how this relates to a global health discourse which emphasises empowerment, the preservation of equity and the importance of trust. In particular, the paper focuses on the Polish nurses' protests and draws on interviews, health protest bulletins, and official and media reports collected before, during and after healthcare reform.

The future of pharmaceutical policy in the European Union until 2025: results of a Delphi survey

E. van Ginneken and R. Busse

Journal of Pharmaceutical Health Services Research, vol.1, 2010, p. 53-60

This research examined expectations of, and opinions on, the development of EU and national competencies in pharmaceutical policy to 2025. Experts expect that authorisation, pharmacovigilance, classification, distribution, advertising and post-licensing will show a steady and gradual trend towards European regulation. Pricing, dispensing, prescribing and reimbursement will remain national competencies. Convergence due to the Europeanisation of the pharmaceutical market reinforces opportunities for (and in some cases necessitates) more European collaboration or regulation. National governments would be well advised to support such collaboration and to actively participate in the direction of future EU policy instead of resisting it.

Health financing in Brazil, Russia and India: what role does the international community play?

D. Sridhar and E.J. Gomez

Health Policy and Planning, vol. 26, 2011, p. 12-24

Brazil, Russia and India are middle-income countries in which health funding has become independent of external aid. This article tests the assumption that in these circumstances there will be no bias towards any particular kind of disease and that budgetary allocations will reflect the epidemiological burden of disease. Results show that resource allocation for public health in Brazil and India converges with global priorities, while Russia's financing pattern diverges. The combination of pressures from donors through financing for particular diseases, from the pharmaceutical industry, and from transnational advocacy movements at the global, national and local level seems to be key to understanding convergence in Brazil and India and divergence in Russia.

Health reform and caesarean sections in the private sector: the experience of Peru

A. Arrieta

Health Policy, vol. 99, 2011, p. 124-130

Caesarean sections in the Peruvian private healthcare sector have doubled in the last 15 years, while growing more slowly in public facilities. The gap between c-section rates in public and private facilities is mainly attributable to differences in how doctors are paid. While doctors in public hospitals receive fixed salaries, physicians in private facilities work under a fee-for-service scheme. Because c-section pays more and requires less time per birth than vaginal delivery, fee-for-service creates incentives to over-utilise them.

Health sector decentralization and local decision-making: decision space, institutional capacities and accountability in Pakistan

T. J. Bossert and A.D. Mitchell

Social Science and Medicine, vol. 72, 2011, p. 39-48

In recent years it has been argued that decentralisation will only improve health service delivery when an appropriate degree of discretion (decision space) is combined with adequate institutional capacities to make choices consistent with good performance and accountability for those choices to local representatives. This article reports on research on the decision space, institutional capacities and accountability of officials in four provinces in Pakistan in the period prior to the re-establishment of democracy in 2009. It assesses the degree of variation in actual decision-making exercised by local officials within the legally defined range of choices granted to them, and relates those choices to concomitant institutional capacities and mechanisms of accountability. The study demonstrates that decentralisation is a varied experience, with some district officials making greater use of decision space than others. Those who do so also tend to have more capacity to make decisions and are held more accountable to local officials for such choices.

Hot news for the partnership way

D. Carlisle

Health Service Journal, Feb. 17th 2011, p. 24-25

Sanitas, the Spanish subsidiary of Bupa, manages acute, primary and intermediate health services on behalf of the public for 197,000 people in Manises, Valencia. Sanitas receives a per capita allowance of 516 for each of the people under its care. For this, the company provides primary care at 20 GP surgeries, acute care at a new 220 bed hospital and two specialist units and intermediate care for people with mental health problems and chronic illnesses in 137 dedicated beds. Each year, Sanitas agrees targets with the regional government, which can track the care provided. Sanitas can provide services more cheaply than public sector organisations because it employs fewer staff and pays them less and through the use of state-of-the-art IT systems. This public-private partnership model is creating widespread interest in the UK.

The impact of patient drug advocacy: the case of innovative breast cancer drug reimbursement

R. Nahuis and W.P.C. Boon

Sociology of Health and Illness, vol. 33, 2011, p. 1-15

In spite of some success in influencing the biomedical research agenda, patient advocacy groups are generally only marginally involved in policymaking. This article looks at the limited success of patient groups in the Netherlands in a campaign to influence the prescription and reimbursement of Herceptin, an expensive breast cancer drug prescribed in hospitals. Organisations of patients allied with organisations of medical specialists to combat the problem of unequal access to the drug. Their final impact on reimbursement procedures was limited due to counterstrategies based on the existing policy monopoly enjoyed by insurance companies and hospitals sustaining the prevailing system of cost control in healthcare.

Improving children's healthcare through state health insurance programs: an emerging need

C.-C. Chen and others

Health Policy, vol. 99, 2011, p. 72-82

A pressing concern in the USA is the number of children without adequate health insurance coverage. To mitigate this problem, State Children's Health Insurance Programs (SCHIP) were designed to enable federal and state governments to work in partnership to expand coverage for children whose families cannot afford to purchase private insurance but do not qualify for Medicaid. SCHIP offers states three options for programme design: 1) Medicaid eligibility expansion; 2) design of a separate SCHIP programme; and 3) a combination of Medicaid expansion and SCHIP single programmes. This study contributes to the research literature by analysing the behaviour of children with unmet healthcare needs under variant forms of SCHIP programme.

Informal payments and the quality of health care: mechanisms revealed by Tanzanian health workers

O. Maestad and A. Mwisongo

Health Policy, vol. 99, 2011, p. 107-115

Informal payments to providers of health services are common in Tanzania. This paper explores how a system of informal payments can affect the quality of care through interactions among workers in health facilities. It provides examples of the various types of informal payment that occur in the Tanzanian health service, explores the ways in which these payments are allocated among workers, and their effect on health worker behaviours and the quality of health services.

A maternal health voucher scheme: what have we learned from the demand-side financing scheme in Bangladesh?

S. Ahmed and M.M. Khan

Health Policy and Planning, vol. 26, 2011, p. 25-32

The Bangladesh Ministry of Health and Family Welfare is implementing a Maternal Health Voucher scheme in 33 sub-districts of the country, with the aim of empowering women in disadvantaged areas to purchase care from the provider of their choice. Information to analyse the early impact of the scheme was gathered through semi-structured interviews with stakeholders at the sub-district level. Results showed that the resources available through the scheme failed to attract new providers to enter the market and public facilities remained the only eligible provider after scheme implementation. However, incentives provided by the voucher system did motivate public providers to improve services. It is concluded that, for a demand-side strategy to work in poor countries, there must be significant expansion of the service delivery capacity of health facilities.

A nationwide study on generic medicines substitution practices of Australian community pharmacies and patient acceptance

C.P. Chong and others

Health Policy, vol. 99, 2011, p. 139-148

Government policy has successfully driven the increasing frequency of generic medicines substitution in Australia. Australian community pharmacists initially embraced the policy because of the opportunity to increase their profits due to the discounted price offered them by generics manufacturers. A high generic substitution rate continued following the abolition of the discount system and its replacement by a direct cash incentive for generic dispensing. Patient acceptance of generic medicines does not appear to have been maximised , especially in urban areas and among those with chronic diseases. Education and information about the quality and effectiveness of generic medicines by pharmacists, government and other health practitioners is needed to improve patient acceptance.

Regulating private health insurance: the reality behind the rhetoric in Uganda

E.M. Taylor

Global Public Health, vol.6, 2011, p. 72-82

In recent years, the acknowledged failure of the public sector in low-income countries to meet health targets has stimulated debate on the role that private insurance could play in providing extra financing for healthcare. However, the market failures inherent to insurance constitute a major concern and there are calls for state regulations, subsidies and incentives designed to offset the risks. This article examines in depth the development of health policy in Uganda, where the government has generally embraced the private sector, made plans to regulate it, and seriously considered the role of health insurance as a financing mechanism. It concludes with the acknowledgement that Uganda has so far been unable to implement the policies it has developed to regulate the private health insurance market.

The relevance of personal characteristics in health care rationing: what the Australian public thinks and why

M. Anderson and others

American Journal of Economics and Sociology, vol. 70, 2011, p. 131-151

This study examined the public's views on priority setting in healthcare based on the personal characteristics of patients, using data from the Monash Health and Social Values Survey. It differs from other studies in its emphasis on explaining the public's preferences. While there was strong support for giving patients 'equal priority' regardless of their personal characteristics, respondents did reveal a preference for married patients over single, for children over adults, for carers of children and the elderly, sole breadwinners and good community contributors. Further, they would give a lower priority to those perceived as 'self-harmers' - smokers, individuals with unhealthy diets, and those who rarely exercise.

A scoping review of the literature on the abolition of user fees in health care services in Africa

V. Ridde and F. Morestin

Health Policy and Planning, vol. 26, 2011, p. 1-11

In Africa, user fees constitute a barrier to healthcare access and increasingly international agencies are supporting countries that abolish them. However, African decision-makers need to know if eliminating user fees is effective and how it can be implemented. This literature review shows that abolition of user fees generally has a positive effect on health service utilisation, but also highlights the importance of implementation processes about which there is little research evidence.

Transcalar networks for policy transfer and implementation: the case of global health policies for malaria and HIV/AIDS in Cameroon

M.Z. Ngoasong

Health Policy and Planning, vol. 26, 2011, p. 63-72

This paper explores the nature and type of policy transfer promoted by global health partnerships to facilitate access to medication in Cameroon. The research analyses policy documents, technical and media reports, and journal articles related to two global health partnerships in Cameroon: Roll Back Malaria and the Accelerating Access Initiative. These partnerships helped to create the national malaria and HIV/AIDS programmes in Cameroon. Global health policies were transferred to Cameroon through a consensual dialogue process involving the global, national and local partners who constitute the national HIV/AIDS and malaria committees. Analysis of policy interventions reveals that global health partnerships offer a 'technical fix' based on specific medical interventions with a limited focus on disease prevention. The approach generates new governance challenges due to policy resistance strategies from international agencies working directly with hard-to-reach communities to deliver programmes which overlap with those agreed by the national committees.

Universal health care in Thailand: concerns among the health workforce

S.H. Thoresen and A. Fielding

Health Policy, vol. 99, 2011, p. 17-22

The Thai government implemented universal healthcare coverage on a populist platform in 2001. Initially, the policy gave universal access to public health service providers with a flat co-payment of 30 Thai baht, although this was later abolished. This paper reports some of the subjective perceptions of, and attitudes to, universal coverage among the health workforce. Anecdotal evidence suggests that current healthcare policy is adding to the workloads of professionals in the public sector. This has the potential to push more health professionals into private practice. While universal coverage has improved access to care, it has not guaranteed equal treatment after access and has exacerbated rural-urban and public-private tensions.

Willingness to pay in China's New Co-operative Medical System

P.H. Brown and T. Huff

Contemporary Economic Policy, vol. 29, 2011, p. 88-100

The New Cooperative Medical System (NCMS) launched in 2002 is a voluntary insurance programme that targets rural residents who might otherwise fall into poverty as a result of catastrophic illness. The programme is administered at county level and local officials have tremendous flexibility in its design and management. This paper analyses the factors that influence a household's willingness to pay for health insurance through the NCMS programme in order to allow each county to set participation fees so as to maximise the total funds available for risk pooling.

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