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

Counterheroism, common knowledge and ergonomics: concepts from aviation that could improve patient safety

G.H. Lewis and others

Milbank Quarterly, vol. 89, 2011, p. 4-38

Many safety initiatives have been transferred successfully from commercial aviation to healthcare. This article develops a typology of aviation safety initiatives, applies this to healthcare, and proposes safety measures that might be adopted more widely. It then presents an economic framework for determining the likely costs and benefits of different patient safety initiatives. The initiatives considered fall into three categories: safety concepts that seek to downplay the role of heroic individuals and instead emphasise the importance of teams and whole organisations; concepts that seek to increase and apply group knowledge of safety information and values; and concepts that promote safety by design. The salient costs to be considered by organisations wishing to adopt these suggestions are compliance costs to clinicians, the administration costs to the organisation, and the costs of behavioural distortion.

Cost of diabetes and its complications in Thailand: a complete picture of economic burden

S. Chatterjee and others

Health and Social Care in the Community, vol. 19, 2011, p. 289-298

This study aimed to explore the cost of diabetes in Thailand from a societal perspective, covering all costs irrespective of who incurred them. Data were collected from 475 randomly selected diabetic patients who received treatment from Waritchaphum hospital in Sakhon Nakhon province of Thailand during 2007/08. A micro-costing approach was used in the calculations. The total cost of the illness for the 475 study participants was estimated to be $418,696 in 2008. The average cost per patient was $881.47. The existence of complications increased costs substantially. The cost of informal care made up 21% of the total. The disease affected not only the individual but also family, friends and neighbours. The economic and social burden of the disease emphasises the need for prevention and effective management of the condition to ward off complications.

Cultural competence and ethical incompetence: notes from a study of the new reproductive technologies in Israel

S. Gooldin

Diversity in Health and Care, vol.8, 2011, p. 45-54

Cultural competency advocates the recognition and meeting of the unique 'cultural needs' of subgroups of users of services. There is then an ethical imperative to respond positively to consumers' unique cultural needs. In Israel the healthcare system responds positively to consumer demands for biological parenthood in a pro-natal cultural context. The result is an unparalleled rate of utilisation of assisted reproductive technologies, which can potentially adversely affect the physical and emotional health of some infertile individuals, mainly women. Thus responding to consumers' perceived cultural needs for biological offspring can in practice increase social suffering. In this context, following the dictates of cultural competency creates urgent ethical dilemmas.

Equity in health: the Irish perspective

S. Smith and C. Normand

Health Economics, Policy and Law, vol.6, 2011, p. 205-217

Equity is espoused in many national health policy statements, although there is no universally agreed definition and different perspectives on equity can conflict with one another. The way in which equity is defined in policy has implications for how any healthcare system should be structured. This paper examines Irish health policy commitments to equity in the context of philosophical and international policy perspectives on equity and equity in healthcare. It highlights the conflicts that arise from pursuing different perspectives on equity in one system. The complexities experienced in the Irish system can serve as a warning for other countries that may be seeking to adjust healthcare structures out of concern for cost containment without full consideration of equity.

Expanding coverage under the Patient Protection and Affordable Care Act and primary care utilization

A.N. Hofer, J.M. Abraham and I. Moscovice

Milbank Quarterly, vol.89, 2011, p. 69-89

Provisions of the Patient Protection and Affordable Care Act 2010 (PPACA) expand Medicaid to all individuals in families earning less than 133% of the federal poverty level and make available subsidies to uninsured lower income Americans without access to employer-based coverage to purchase insurance in new exchanges. Since primary care physicians typically serve as the point of entry into the healthcare delivery system, an adequate supply of them is key to meeting the anticipated demand for medical care arising from this expansion of coverage. This article provides state-level estimates of the anticipated increases in primary care utilization under PPACA. Two strategies that policymakers may consider to meet increased demand for primary care are creating financial incentives to attract medical students into primary care and changing delivery systems in ways that lead to operational improvements, higher throughput and better care quality.

Health assets in a global context: theory, methods, action

A. Morgan, M. Davies and E. Ziglio (editors)

London: Springer, 2010

As global health inequities continue to widen, policymakers are redoubling their efforts to address them. Yet the effectiveness and quality of these programmes vary considerably, sometimes resulting in the reverse of expected outcomes. While local political issues or cultural conflicts may play a part in these situations, this book points to a universal factor: the prevailing deficit model of assessing health needs, which puts disadvantaged communities on the defensive while ignoring their potential strengths. The asset model proposed offers a necessary complement to the problem-focused framework by assessing multiple levels of health-promoting aspects of populations, and promoting joint solutions between communities and outside agencies. The book provides not only rationales and methodologies (e.g., measuring resilience and similar elusive qualities) but also concrete examples of asset-based initiatives in use across the world on the individual and community levels.

Health care providers' perspectives on the provision of prenatal care to immigrants

C. Ng and K.B. Newbold

Culture, Health and Sexuality, vol. 13, 2011, p. 561-574

Research shows that immigrant women experience poorer birth outcomes than the native populations, including low birth weights, premature births, intrauterine growth retardation and higher rates of infant mortality. However there is a limited focus within the existing literature on the complexity of delivering prenatal care to immigrants. This paper attempts to fill this gap by presenting the findings of an exploratory study of the experiences of healthcare providers working with immigrant women in Hamilton, Ont. Based on a series of qualitative interviews with healthcare professionals including nurses, midwives, gynaecologists and social workers, the paper aims to understand the difficulties they face when delivering care to this vulnerable population, especially when providers and patients have different expectations of each other and of the type of care received.

Patients' opinions of health care providers for supporting choice and quality improvement

L. Trigg

Journal of Health Services Research and Policy, vol.16, 2011, p. 102-107

Patient opinion websites are emerging in different forms around the world, following the trend for consumer review platforms such as Amazon and TripAdvisor. As well as independent platforms, providers are setting up dedicated websites. This essay identifies and explores three aspects of online reviews of healthcare: the role of patients as judges of healthcare quality; the motivation behind patients posting reviews; and patients' use of such information. It then discusses how useful patient opinion websites might be in supporting patient choice in healthcare markets and in expanding voice channels for quality improvement.

Pay scheme preferences and health policy objectives

B. Abelsen

Health Economics, Policy and Law, vol. 6, 2011, p. 157-173

This research studied the preferences among healthcare workers for pay schemes involving different levels of risk, based on a sample survey of public and private dentists in Norway. It identifies which pay scheme individuals would prefer for themselves, and which they think is the best for furthering health policy objectives. Results show a general preference amongst dentists for specific pay schemes, including those offering performance-related pay (PRP). Public dentists would like more exposure to PRP, while private practitioners are happy with their current high exposure to income risk. However, public dentists are generally more risk averse than private ones. Public dentists' preferred pay schemes coincided with the ones believed to further stabilise healthcare personnel, while the preferred pay schemes of private dentists coincided with those believed to further efficiency objectives.

Preferred providers and the credible commitment problem in health insurance: first experiences with the implementation of managed competition in the Dutch health care system

L.H.H.M. Boonen and F.T. Schut

Health Economics, Policy and Law, vol.6, 2011, p. 219-235

Since 2006, all persons who legally live or work in the Netherlands have been obliged to buy a basic benefits package from a private health insurer. Health insurers were expected to become prudent buyers of care for their enrolees and to channel them to selected providers. This article examines whether insurers have been able to take up their role as prudent buyers of care and explores consumers' attitudes towards insurers' new role. During the first four years of the reform, health insurers were very reluctant to engage in selective contracting and preferred to use soft positive incentives to encourage preferred provider choice rather than engaging in restrictive managed care activities. Consumers' attitudes towards channelling vary considerably by type of provider but became more negative in the first two years after the reform. Insurers' reluctance to use selective contracting can be at least partly explained by the presence of a credible-commitment problem. Consumers do not trust that insurers with restrictive networks are committed to provide good quality care.

Reaching universal coverage by means of social health insurance in Lesotho? Results and implications from a financial feasibility assessment

I. Mathauer and others

International Social Security Review, vol. 64, no.2, 2011, p. 45-63

A social health insurance financial feasibility assessment examines whether both household contributions and available government resources for healthcare are sufficient and sustainable. It also explores whether and how contribution payments may be expanded to achieve universal coverage. This article illuminates the process and methodology of the financial feasibility assessment of the proposed social health insurance scheme in Lesotho. The assessment reveals that, through a mix of tax financing and social health insurance contributions, all citizens of Lesotho could be covered by a defined benefit package of health services under the specified policy assumptions. Such a financing scheme would provide financial risk protection and enhance equity in access and health financing.

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