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

Access to medicines and domestic compulsory licensing: learning from Canada and Thailand

V. Kuek, K. Phillips and J.C. Kohler

Global Public Health, vol. 6, 2011, p. 111-124

Within the array of measures for improving medicines access for the world's neediest populations, governments in many countries have turned to compulsory licensing, a statutory mechanism to enable third parties to manufacture a product still under patent. This paper focuses on a historic case example from Canada and the present example of Thailand's use of domestic compulsory licenses as a policy tool for ensuring public access to affordable medicines. It draws out legislative and policy insights that may be of value to countries with pharmaceutical manufacturing capability which are considering better access to patented medicines for their people under the current global intellectual property regime.

Brain flight: the exodus of health professionals from South Africa

J. Crush and W. Pendleton

International Journal of Migration, Health and Social Care, vol. 6, Nov. 2010, p. 3-18

This paper presents the results and discusses the implications of a national survey of South African health professionals which found extraordinarily high levels of dissatisfaction with working and living conditions in the country. Emigration potential is very high, and retention strategies have been largely unsuccessful. The survey findings suggest that remedial efforts within South Africa will not slow the brain drain. This has serious negative repercussions for the quality and level of healthcare available to patients in the country. The only workable retention strategy is for Western countries to stop issuing immigration and work permits to South African health professionals.

The effects of purchaser competition in the Dutch health system: is the glass half full or half empty?

F.T. Schut and W.P.M.M. van de Ven

Health Economics, Policy and Law, vol. 6, 2011, p. 109-123

In 2006 the Dutch government introduced a major reform of healthcare provision through the Health Insurance Act, which required every citizen to buy a basic package of benefits from a private insurer. Individuals can choose between insurers on an annual basis, and insurers can selectively contract or integrate with healthcare providers. Income-related subsidies aim to make health insurance affordable for everyone, while a risk equalisation scheme compensates insurers for enrolees with predicted high medical expenses in order to prevent risk selection. This article considers whether purchaser competition has improved the efficiency of the health system. There is evidence that competition has already significantly affected the provision of hospital care, pharmaceuticals and primary care, as well as efforts to gather and disseminate information about care quality. However, based on the crude performance indicators available, the reforms have not yet demonstrated significant effects on system performance.

( For comment see Health Economics, Policy and Law, vol.6, 2011, p. 125-145)

Entitlements to healthcare: why is there a preference for private facilities among poorer residents of Chennai, India?

C.R. Ergler and others

Social Science and Medicine, vol.72, 2011, p. 327-337

This research addresses the question of why poorer urban residents tend to use private healthcare for which they have to pay in preference to free public facilities. The study first mapped the distribution of health facilities around two slums in Chennai, India and found them sufficient to allow impoverished residents choice. Data were then gathered from a qualitative field study which included interviews with 14 slum residents and 58 stakeholders involved in caring for poor people. The results revealed how stakeholders and poor people felt about the healthcare system and highlighted barriers to access. Feelings can influence how care is both received and delivered, as well as which discourses on the part of both service providers and users are reinforced (e.g. the tarnished reputation of the public sector). Consequently, feelings about healthcare influence the health-seeking behaviour of poorer people.

European Union public opinion on policy measures to address childhood overweight and obesity

L.S. Suggs and C. McIntyre

Journal of Public Health Policy, vol. 32, 2011, p. 91-106

Increases in child obesity across the EU generate concern because of the many associated co-morbidities, psychosocial effects, and economic costs. Member states have introduced a wide variety of policies to tackle childhood obesity. This article describes public support for such measures using data from the Eurobarometer for all EU member states and four prospective countries. Results suggest consistent support across Europe for two policies: providing information to parents and more physical activity in schools. There was little support for imposing taxes on unhealthy food.

Evolution of Taiwan's health care system

J.-F. R. Lu and T.-L. Chiang

Health Economics, Policy and Law, vol. 6, 2011, p.85-107

An overview of the evolution of Taiwan's healthcare system over the past 50 years has shown that the country's reforms have been impressive. Firstly, along with economic growth and democracy, Taiwan has valued equal access to healthcare as a basic human right rather than an individual responsibility. Secondly, through careful planning, the supply of physicians and hospital facilities has expanded rapidly since the 1970s. Thirdly, the government has made a concerted effort to improve the geographic distribution of healthcare resources through the implementation of the GPCs and Medical Care Network programmes. Finally, in order to improve protection against catastrophic medical expenses and assure access to healthcare, the government implemented a universal single-payer social health insurance system characterised by a comprehensive benefits package and global budgeting system. This article identifies the impacts of knowledge, the socio-cultural context, economic resources and the political system on healthcare reform in Taiwan with illustrative policy examples.

Family bonds lie at the heart and soul of great healthcare

S. Boseley

The Guardian, March 31st 2011, p. 24

Sarah Boseley reports from Spain, one the world leaders in organ transplants and finds that its success in the theatre is matched by its holistic approach outside, where commitment of the younger generations to care for the elderly still persists, especially in rural areas.

For the sake of health! Reflections on the contemporary use of social capital and empowerment in Danish health promotion policies

P.T. Andersen, S.K. Jorgensen and E.L. Larsen

Social Theory and Health, vol. 9, 2011, p. 87-107

In 2007 the Danish healthcare system was reformed and responsibility for the improvement of population health was transferred to the municipalities. Consequently municipalities are now embarking on projects to improve the health of local communities. Community development projects grew out of the healthcare reform involving collaboration between municipalities and public housing neighbourhoods to promote healthy living. The concepts of social capital and empowerment are increasingly used as strategies to build healthy communities and as means of explaining inequities in health status.

Global health and global health ethics

S. Benatar and G. Brock (editors)

Cambridge: CUP, 2011

What can be done about the poor state of global health? How are global health challenges linked to the global political economy and to issues of social justice? What are our responsibilities and how can we improve global health? This book addresses these questions from the perspective of a range of disciplines, including medicine, philosophy and the social sciences. Topics covered range from infectious diseases, climate change and the environment to trade, foreign aid, food security and biotechnology. Each chapter identifies the ways in which we exacerbate poor global health and discusses what can be done to remedy the factors identified. Together, they contribute to a deeper understanding of the challenges faced, and propose new national and global policies.

A health warning for the UK: don't burden doctors with a costly paperchase

P. Toynbee

The Guardian, March 17th 2011, p. 28

Polly Toynbee reports from Germany where doctors spend a third of their week contesting patients' bills with insurance companies, amid a climate of permanent politically driven reforms.

'Knights' or 'Knaves'? Public policy, professional power, and reforming maternity services

K.M. Reiger

Health Care for Women International, vol. 32, 2011, p. 2-22

Evidence from public enquiries in Australia, Ireland and England makes it clear that systemic failures allow particular 'knaves' to flourish and institutionalised poor practices to occur in certain maternity care contexts. However, aspects of a powerful, self-interested obstetric professional culture act as a barrier to reform and to quality childbirth care. Policy initiatives to reform maternity care need to go beyond technical auditing measures to foster collaboration, social as well as institutional accountability, and critical self-reflection within the obstetric profession.

Managing radical change in health: quality, efficiency and equity

M. Nenonen (guest editor)

Journal of Management and Marketing in Healthcare, vol.4, Feb. 2011, p. 1-71

The articles in this special issue are drawn from the European Healthcare Management Association 2010 conference in Finland. It presents a set of new tools for promotion of equity in access to healthcare, recognising that patients are not equal in their capacity to benefit from healthcare services, to use healthcare services and to pay for healthcare services. Papers cover a wide range of issues, including development of doctor managers in the UK, the introduction of a culture of quality and safety into the Serbian healthcare system, the reform of primary care in Finland, improving medication adherence rates, and local community involvement in health service commissioning in England.

Markets, modernisation and national interest: three faces of patient choice policy in Turkey

H.H. Yildirim, D. Hughes and T. Yildirim

Health and Social Care in the Community, vol. 19, 2011, p. 168-177

This article discusses three aspects of the patient choice policy of a middle income country, Turkey. As part of its wider health transformation programme (HTP), Turkey has created a purchaser/provider split in which a single public purchaser channels funding to a range of public and private hospitals and patients have significant freedom to choose their hospital and physician. At the same time, marketisation has been softened by an emphasis on the creation of 'human centred' services, resulting in a variety of initiatives to enhance patients' rights and using a similar rhetoric to that employed in modernising 'Third Way' reforms in the UK. The Turkish choice policy is also driven by a strong political imperative arising from its ambition of joining the European Union. Europeanisation represents an approach to markets softened by social solidarity. However, in practice, medical staff shortages, the uneven distribution of resources across the nation and the lack of systematic information on provider outcomes limit the scope of choice for much of the population.

New Zealand's primary health care strategy: early effects of the new financing and payment system for general practice and future challenges

J. Cumming and N. Mays

Health Economics, Policy and Law, vol. 6, 2011, p. 1-21

The New Zealand Primary Health Care Strategy implemented in 2002 aimed to improve population health and involved three major changes: 1) a significant increase in government funding for primary care; 2) the development of primary health organisations as local non-governmental bodies providing services to their enrolled patients; and 3) payment of GPs on the basis of capitation instead of fee-for-service. However patient co-payments for most GP services remain set by individual GPs, not the government. This article explores the impact of these changes.

Newspaper reporting on legislative and policy interventions to address obesity: United States, Canada and the United Kingdom

N.M. Ries, C. Rachul and T. Caulfield

Journal of Public Health Policy, vol.32, 2011, p. 73-90

This paper analyses the content of articles in major newspapers in the United States, Canada and the UK that discuss legislative and policy measures to contain obesity. The aim was to identify and compare measures that attract media attention in the three jurisdictions, the tone of print media coverage, the characterisation of obesity, and attitudes towards government interventions to tackle it. News stories in the three countries consistently cited more advantages than disadvantages to government policy interventions to address obesity. Where mentioned, disadvantages did not dwell on curtailment of personal freedom or unwarranted intrusion by government. Although many media accounts pointed to individual lifestyle as a key cause of obesity, there is a growing recognition that environmental factors that constrain or promote healthier choices are critical and are appropriate targets for government policy interventions.

On the nature and strategies of organized interests in health care policy making

D. Contandriopoulos

Administration and Society, vol. 43, 2011, p. 45-65

Based on a literature review on interest group influence on healthcare policy making, the author proposes a basic definition and typology of the interest groups active in the field in the province of Quebec. He then uses Milbrath's communication framework to analyse interest groups' strategies for influencing policy making.

Passion for health services fires desire for excellence

S. Boseley

The Guardian, March 21st 2011, p. 26

Sarah Boseley reports from France, where even hospitals in the poorest areas like Bobigny on the outskirts of Paris are the envy of their British counterparts. The French healthcare system was rated first in the world by the World Health Organisation in 2000 - a ranking not updated since because of the political fallout. A decade on, with most developed countries struggling to contain health costs, France still accords health a very high priority, in line with its citizens' expectations.

Retreat from Alma Ata? The WHO's report on Task Shifting to community health workers for AIDS care in poor countries

C. Campbell and K. Scott

Global Public Health, vol.6, 2011, p. 124-138

This article examines the potential of community health worker programmes, as proposed by the 2008 World Health Organisation (WHO) document Task Shifting to Tackle Health Worker Shortages, to contribute to HIV/AIDS prevention and treatment and various Millennium Development Goals in low-income countries. It examines the WHO proposal through a literature review of factors that have facilitated the success of previous community health worker programmes. The WHO has taken account of five key lessons learnt from past programmes (the need for strong management, appropriate selection, suitable training, adequate retention structures and good relationships with other healthcare workers). It has, however, neglected to emphasise the importance of a sixth lesson, the 'community embeddedness' of these workers, found to be of critical importance to the success of past programmes.

Strengthening public health education in population and reproductive health through an innovative academic partnership in Africa: the Gates partners experience

G. Oni and others

Global Public Health, vol. 6, 2011, p. 193-209

Poor reproductive health constitutes one of the main public health problems in Sub-Saharan Africa. This article describes an academic partnership that commenced in 2003 between the Gates Institute at the Johns Hopkins Bloomberg School of Public Health and six Sub-Saharan African universities. The partnership addresses the human resources development challenge in Africa by strengthening public health education and research capacity to improve population and reproductive health outcomes in low-resource settings.

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