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

An analysis of China's national essential medicines policy

X. Guan and others

Journal of Public Health Policy, vol.32, 2011, p. 305-319

China has published seven essential medicines lists since 1982, but only the last, issued in 2009, has had a major impact on the healthcare system. It formed part of a plan for the comprehensive reform of health services to be implemented 2010-2012. To ensure effectiveness of the new essential medicines system, government agencies have issued new policies on selection, production and supply, use, pricing, payment, and other activities.

Assessing economies of scale in public hospitals

Y. Zhao, M. Foley and K. Eagar

Economic Papers, vol. 30, 2011, p. 341-347

In an attempt to increase efficiency and curb cost escalation, Australian public hospitals will be funded on the basis of activity. Activity Based Funding uses a casemix classification to quantify acute inpatient services and reimburse providers on the basis of average costs. The system rewards low cost providers and penalises high cost providers. This study investigates whether economies of scale exist in public hospital inpatient services in Australia in an effort to quantify and adjust them in future hospital funding formulae.

The challenge of achieving high training coverage for IMCI: case studies from Kenya and Tanzania

H.P. Mushi and others

Health Policy and Planning, vol. 26, 2011, p. 395-404

The Integrated Management of Childhood Illness (IMCI) is a strategy developed in the 1990s by the World Health Organisation and UNICEF to improve the health of children under five and reduce their mortality in low- and middle-income countries. To impact significantly on child health, it is recommended that at least 60% of primary level health workers managing children be IMCI trained. However, training coverage remains low in Kenya and Tanzania, as in other countries. This paper examines the factors facilitating and constraining the roll out of IMCI training in Kenya and Tanzania. Barriers to scaling up training coverage were found to be cost, the lack of funding to support training, and difficulties in measuring the impact of such integrated interventions and thus demonstrating their value. Alternative, lower cost methods of IMCI training need to be promoted, and greater advocacy for IMCI is needed both nationally and internationally.

The changing face and rapid pace of public health communication

E. Macario and others

Journal of Communication in Healthcare, vo.4, 2011, p. 145-150

Health consumers in the USA proactively seek information through the Internet, using interactive resources such as blogs, online social networks, online gaming and virtual worlds. Public health communicators need to use these technologies to deliver their messages. This article showcases some examples of the best practices public health communicators are using to disseminate their messages online through YouTube, Facebook, video gaming and virtual reality.

Community capacity building in practice: constructing its meaning and relevance to health promoters

S.A. Lovell, R.A. Kearns and M.W. Rosenberg

Health and Social Care in the Community, vol. 19, 2011, p. 531-540

Held up as an empowering form of health promotion, community capacity building (CCB) is the focus of a growing body of research under the banner of the New Public Health. Defined as the enhancement of a community group's abilities to identify and act on health concerns, it has gained traction because of its positive focus on the skills and abilities that enable a community to take action. This article draws on findings from interviews and focus groups to examine what CCB means to New Zealand health promoters, given concerns that the empowering discourse of landmark documents such as the Ottawa Charter may be that of the presiding bureaucratic elite rather than reflecting the realities of those who work directly with communities. It explores how health promoters undertake CCB and the meanings they assign to the term. In doing so, the paper questions the importance of CCB to health promoters, the relevance of health promotion theory to practice, and the challenges health promotion faces in moving to a broad-based socio-ecological model of health.

Dying patients given 'futile' cancer drugs

M. Beckford

Daily Telegraph, Sept. 27th 2011, p. 1 + 2

After a year long investigation, a panel of academics found that the cost to Western societies of treating cancer was spiralling out of control. Doctors were said to be recommending expensive new drugs with no thought to their cost or effectiveness, giving patients false hope. It was argued that it might be better for terminally ill patients to forgo these treatments in favour of better palliative care. More money should be spent of diagnosis, so that tumours could be detected early.

An evaluation of two health insurance schemes in India

B. Reshmi and others

British Journal of Healthcare Management, vol. 17, 2011, p. 353-360

Community-based health insurance schemes are programmes managed and operated by a community-based organisation that provide risk-pooling to cover the costs of healthcare services. Schemes can be initiated by hospitals, non-governmental organisations, trade unions, local communities or cooperatives and can be owned and run by any of these. In recent years these schemes have emerged as a possible means of improving access to healthcare among the poor. This study aimed to find out about the functioning of two community-based health insurance schemes through a survey of patients enrolled in them at a hospital in Karnataka, South India. Results suggest that many users are pleased with the health insurance they have chosen and utilisation of services is high. They are generally satisfied with the services and discounts provided by the scheme, which help them reduce medical expenses.

Human rights and universal access for men who have sex with men and people who inject drugs: a qualitative analysis of the 2010 UNGASS narrative country progress reports

A. Persson and others

Social Science and Medicine, vol. 73, 2011, p. 467-474

All UN member states have endorsed a commitment to protect human rights in the global fight against HIV and to ensure universal access to HIV prevention, treatment, care and support. This article explores the relationship between this UN Declaration of Commitment on HIV/AIDS and the different ways signatory countries address their progress in fulfilling this commitment in relation to men who have sex with men and people who inject drugs. To demonstrate progress in fulfilling this commitment, countries submit reports to UNAIDS biennially, known as UNGASS reports. Analyses of these reports show that many countries have made considerable efforts to achieve universal access, sometimes in very difficult circumstances. However, the analyses also reveal that critical blind spots persist in many parts of the world regarding human rights and universal access for most-at-risk populations, particularly men who have sex with men and people who inject drugs.

Innovation to improve health care provision and health systems in sub-Saharan Africa: promoting agency in mid-level workers and district managers

S. Fonn, S. Ray and D. Blaauw

Global Public Health, vol. 6, 2011, p. 657-668

A key component of the health crisis in Africa is the disempowerment of health workers, managers and policy makers at all levels so that no one feels able to effect changes that could improve services. Therefore assuming that introducing additional personnel will materially change health system performance is unrealistic. Currently mid-level workers are the backbone of many African health systems, but they are often demotivated and operate in circumstances where offering high quality care is challenging. A review of the literature suggests that mid-level workers are disempowered and demotivated due to low status, quality of care issues and working in poorly managed systems. In response the authors propose three interrelated interventions: a regional association of mid-level workers to enhance their status, a job enrichment and mentoring system to address quality and a district managers' association to improve health systems management. These interventions are currently being tested in Kenya, Nigeria, South Africa, and Uganda for acceptability and appropriateness.

Moving towards universal health insurance in China: performance, issues and lessons from Thailand

C. Li and others

Social Science and Medicine, vol. 73, 2011, p. 359-366

China is now implementing a new round of health system reforms and aims to achieve universal health insurance coverage. The current Chinese health insurance system is made up of three schemes, Urban Employee Basic Medical Insurance, the New Rural Cooperative Medical System, and the Urban Resident Basic Medical Insurance. This paper examines the performance of the system in terms of revenue collection, risk pooling, the benefit packages and provider payment mechanisms, based on a literature review and relevant data from official websites. The research then examines the health insurance reform experiences of Thailand as it moved towards universal coverage, and attempts to draw out some lessons for China. It is concluded that: 1) the gaps in the benefits packages across different schemes should be further reduced; 2) the current fee-for-service payment system needs to be reformed; 3) the primary healthcare delivery and referral system needs to be strengthened in coordination with the reform of the health insurance system; and 4) integrating fragmented insurance schemes should be a long-term objective of the reform.

Player or referee? Aid effectiveness and the governance of health policy development: lessons from Vietnam

R. Dodd and J.-M. Olivé

Global Public Health, vol. 6, 2011, p. 606-620

This article examines how aid effectiveness efforts are interacting with policy-making processes in the health sector in Vietnam. By aid effectiveness efforts the authors mean processes and activities inspired by the 2005 Paris Declaration on Aid Effectiveness. Vietnam has a reputation for strongly disciplining its donors and pushing for more efficient forma of aid delivery. It was one of the first countries to adopt and localise the Paris Declaration. This study presents a quantitative review of health aid flows in Vietnam and a qualitative analysis of the aid environment using event analysis, participant observation and key informant interviews. The analysis suggests that there is a range of forces influencing implementation of the aid effectiveness agenda in Vietnam. The various actors engaged in the giving and receipt of aid are influenced by different incentives and there are different rationales and logics underlying their actions. It is concluded that the health community needs a better understanding of the interests and incentives that affect the aid relationships.

Public health and prevention in Europe: is it cost effective?

S. Simoens

Journal of Pharmaceutical Health Services Research, vol. 2, 2011, p. 151-155

In the public debate surrounding public health and disease prevention, it is sometimes assumed that preventative interventions are by definition cost-effective. Although research has addressed the cost-effectiveness of individual preventative interventions such as cancer screening programmes and smoking cessation strategies, there is a need for a comprehensive analysis exploring whether prevention is more cost-effective than a curative approach to diseases. This study conducts an analysis of European economic evaluations included in the Tufts Medical Center Cost-Effectiveness Analysis Registry 2000-2007. Results were expressed in terms of costs per quality-adjusted life year. Results show that preventative interventions are not necessarily cost-effective. The data demonstrate that the cost-effectiveness of preventative interventions varies substantially and that a particular curative intervention may be more cost-effective than a specific preventative intervention. However, overall preventative interventions tended to be more cost-effective than curative interventions.

The responsibility principle: contradictions of priority-setting in Swedish healthcare

W. Schirmer and D. Michailakis

Acta Sociologica, vol. 54, 2011, p.267-282

By the 1990s, demands for publicly funded healthcare in Sweden had grown beyond the state's ability to finance them. The government responded by enshrining in law in 1997 an 'Ethical Platform', containing a hierarchy of three principles for priority setting in healthcare (the human dignity principle, the principle of need and solidarity, and the principle of cost-effectiveness). However, several subsequent evaluations showed that the 'Ethical Platform' failed in its goals of offering guidance to physicians and cutting costs. In response, the National Centre for Priority Setting proposed adding a principle of responsibility for one's own health to the hierarchy. Under this principle, patients can be given a lower priority for treatment on the grounds on an unhealthy lifestyle. The authors argue that the effectiveness of the principle of personal responsibility for health in priority setting is hampered by an underlying societal structural problem. The responsibility principle is revealed as a political attempt to use medical reasoning for its own ends, but this attempt has failed because politics cannot intervene in medical practice as such.

The role of community representatives on health service committees: staff expectations vs reality

S. Nathan, L. Johnston and J. Braithwaite

Health Expectations, vol. 14, 2011, p. 272-284

This paper examines staff views about legitimacy of different roles for community representatives sitting on health service committees as part of a formal community participation programme in an Area Health Service in Australia. A cross-sectional survey revealed generally positive staff attitudes to community participation, with positive impacts identified, including on service delivery and the conduct of health service meetings. Most saw community representatives as having legitimate roles in representing the community, improving communications between the health service and the community, and providing constructive feedback. However, staff expectations about the community's role on committees did not match the reality they said they observed and less than half the staff thought the community and health service agreed on the role of community representatives.

Solicited diaries as a means of involving patients in development of healthcare services

M. Elg and others

International Journal of Quality and Service Sciences, vol. 3, 2011, p. 128-145

Despite the fact that patients have detailed knowledge of their own care process, they are underused as a resource for the development of healthcare services. However, there is a knowledge gap around how patients can be most effectively involved in health service development. This research explores the use of patient diaries to solicit ideas for service improvement, based on a case study in Sweden. Analysis of the diaries contributed by patients led to the identification of 102 ideas for improvements in nine areas.

Taking the pulse of progress toward preconception health: preliminary assessment of a national OMH program for infant mortality prevention

R. Schiavo and others

Journal of Communication in Healthcare, vol.4, 2011, p. 106-117

Infant mortality rates in the United States continue to be twice as high among African Americans as Caucasians. Preconception care has long been identified as a key intervention to improve birth outcomes. In 2007 the Office of Minority Health launched a national programme - A Healthy Baby Begins with You - to reduce infant mortality by raising awareness of its disproportionate burden among African Americans and its root causes, as well as encouraging the adoption of certain preconception health-related behaviours. This article presents findings from an initial programme assessment, focusing mainly on the peer education component.

Understanding global health governance as a complex adaptive system

P.S. Hill

Global Public Health, vol.6, 2011, p. 593-605

The past decade and a half has seen a substantial increase in the numbers of stakeholders in health, and in the multiplicity of the relationships between them. Non-governmental organisations have proliferated and bilateral donors have moved from project-based engagement to offer leadership in programmatic and sectoral approaches. The role of philanthropy and the private sector has been redefined by the emergence of public-private partnerships. This paper argues that global health governance shares the characteristics of complex adaptive systems, with its multiple and diverse players, their constantly changing relationships and rich and dynamic interactions. It maps out the characteristics of complex adaptive systems as they apply to global health governance, linking them to developments in the past two decades and the multiple responses to those changes.

Where a cheap medicine is not the same as a generic medicine: the Belgian case

P. Dylst, A. Vulto and S. Simoens

Journal of Pharmaceutical Health Services Research, vol.2, 2011, p. 185-189

Since April 2006, physicians in Belgium have been obliged by law to prescribe a certain minimum quota of cheap medicines. This article aims to describe experience with this policy and to document its outcomes using publicly available data. The policy led to increased prescribing of both generic medicines and branded medicines whose cost had dropped to the reference price level. Given the fact that all groups of physicians easily met their targets for cheap medicines prescribing, and in the light of the availability of new generic medicines, the government raised the quotas in 2011.

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