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

Competition in primary healthcare in Ireland: more and better services for less money

C. Boate

Economic and Social Review, vol.42, 2011, p. 313-342

Understanding precisely the nature of competition in primary healthcare has an important role to play in identifying ways to improve service delivery. This is particularly the case in Ireland where the private sector plays a large role in primary care. If the nature of competition is not understood, regulations and policies are less likely to be effective and may even be harmful. If competition is unnecessarily restricted, consumers and the state face higher costs and less availability of primary healthcare services. This paper shows how well designed regulations and systems of state funding of primary healthcare can ensure that competition works well and contributes to better availability and quality of services at the lowest possible cost. It begins by describing the relationship between competition and regulation in Ireland, and then outlines obstacles to competition identified by the Competition Authority as harmful to consumers and the state. Conclusions are then drawn on the implications of this analysis for regulatory structures and rules, and value for money for consumers and the state.

Defining health diplomacy: changing demands in the era of globalization

R. Katz and others

Milbank Quarterly, vol. 89, 2011, p. 503-523

More leaders in academia and policy are thinking about how to structure and use diplomacy in pursuit of global health goals. This article describes the context, practice and components of health diplomacy, as applied operationally. It examines the foundations of various approaches to global health diplomacy, along with their implications for policies shaping the international public health and foreign relations environments. Based on these observations, a taxonomy for the subdiscipline is proposed. It is concluded that global health diplomacy requires a delicate combination of technical expertise, legal knowledge and diplomatic skills which has not been systematically cultivated by either foreign service or global health professionals. The deepening links between health and foreign policy require both communities to re-examine the skills, comprehension and resources necessary to achieve their mutual objectives.

An empirical review of major legislation affecting drug development: past experiences, effects and unintended consequences

A.S. Kesselheim

Milbank Quarterly, vol. 89, 2011, p. 450-502

This report provides an historical perspective on proposals for encouraging drug research. Four US legislative programmes have been primarily designed to offer market exclusivity to promote pharmaceutical development: the Bayh-Dole Act of 1980; the Orphan Drug Act of 1983; the Hatch-Waxman Act of 1984; and the paediatric exclusivity provisions of the FDA Modernization Act of 1997. This review shows that all four programmes were successful in promoting medical advances. They have also, however, been characterised by misuse and may contribute to harmful secondary consequences in related markets. Certain practices, such as mechanisms for reevaluation and closer ties of incentive programmes to public health outcomes, can help address these problems.

Healthcare experiences of families affected by Huntingdon disease: need for improved care

H. Etchegary

Chronic Illness, vol. 7, 2011, p. 225-238

While an extensive literature documents psychosocial effects of genetic diseases from a largely clinical or individual patient perspective, their wider social and familial impacts have not been so fully considered in policy deliberations and healthcare provision. Understanding how families manage inherited illness, as well as identifying health and social service needs, is critical for the planning and provision of genetic health services. This paper presents the health and social service experiences of families living with Huntington disease, a fatal genetic disorder, in Eastern Canada. Complex needs for healthcare services and emotional supports were found. Participants expressed frustration at the lack of knowledge about the condition displayed by their family physicians. They described numerous difficulties accessing appropriate healthcare and other supports, and anticipated access difficulties in the future. Participants offered several suggestions for improving the quality of care, including better training of healthcare professionals about Huntington disease and the provision of regular follow up support.

How three countries in the Americas are fortifying dietary salt reduction: a north and south perspective

B. Legowski and B. Legetic

Health Policy, vol.102, 2011, p. 26-33

Most people in the Americas over consume salt, leading to raised blood pressure and associated cardiovascular diseases. This article looks at the measures put in place in Canada, Argentina and Chile to reduce salt consumption using a framework developed by Brownson and colleagues. This framework identifies and defines three policy domains: communications (information supply to the public to encourage healthy behaviour), physical context ( limiting access to unhealthy choices), and economic levers (cost incentives). Results show that in all three countries policy has concentrated on public information provision, for example through media and education campaigns or through standardised information on the salt content of packaged foods. In the physical environment, moves are underway in all three countries towards the voluntary reformulation of processed foods to reduce salt content. No government in the three countries has yet considered using economic incentives or disincentives.

Increasing access to palliative care and hospice services: opportunities to improve value in health care

D.E. Meier

Milbank Quarterly, vol. 89, 2011, p. 343-380 A small proportion of patients with serious illness or multiple chronic conditions account for the majority of healthcare spending in the US. Despite the high cost, evidence demonstrates that these patients receive healthcare of inadequate quality, characterised by fragmentation, overuse, medical errors and poor quality of life. Palliative care and hospice services improve patient-centred outcomes such as pain, depression and other symptoms; increase patient and family satisfaction; and offer care in the place the patient chooses. By helping patients to get the care they need to avoid unnecessary emergency hospital admissions and shifting the locus of care to home or community, palliative care and hospice services reduce healthcare spending for America's sickest and most costly patient populations.

Normalizing policies of inaction: the case of healthcare in Australia for women affected by domestic violence

M. Tower, J. Rowe and M. Wallis

Health Care for Women International, vol. 32, 2011, p. 855-868

The impact of domestic violence on women's health is devastating. It results in poor general, reproductive and psychological health. Women who are victims of domestic violence seek help from a wide range of professionals within health and social care, but research shows that their experiences tend to be negative. This article highlights the complexity and layers of politics involved in designing policies that address the healthcare needs of domestic violence victims in Australia. Then, using Queensland as an example, it illustrates how, without reciprocal communication concerning women's needs between government and victims, policy filters down ad hoc to the grassroots level. In a nutshell, policy declares that it will deliver for women affected by domestic violence, but fails to follow through.

Quo vadis SANEPID? A cross-country analysis of public health reforms in 10 post-Soviet states

C.B. Maier and J.M. Martin-Moreno

Health Policy, vol.102, 2011, 18-25

Following the dissolution of the Soviet Union in 1991, it became evident that the public health services of the newly independent states were severely underfunded and unresponsive to their populations' needs. Since then, these states have had to reconcile the Soviet sanitary-epidemiological system with new and more complex public health challenges. This article presents a review of trends in public health reforms in ten post-Soviet states, looking at both the processes and the contents of the reforms. Public health reforms have varied greatly: some countries have preserved the san-epid structure, some have built structures in addition to the san-epid system, and others have set up a new public health infrastructure. Traditional functions of the former san-epid system, such as vaccination, are still more advanced, while health promotion and intersectoral collaboration are less developed.

Systematic reviews and health policy: the influence of a project on perinatal care since 1988

D.M. Fox

Milbank Quarterly, vol. 89, 2011, p. 425-449

Four interrelated publications between 1988 and 1992 contributed to the developing methodology of systematic reviews and, because they applied this methodology across an entire field of healthcare, attracted the attention of many clinicians and policymakers. These publications are: the Oxford Database of Perinatal Trials (ODPT), Effective Care in Pregnancy and Childbirth (ECPC), A Guide to Effective Care in Pregnancy and Childbirth (GECPC), and Effective Care of the Newborn Infant (ECNI). This article applies historical methods to the analysis of primary sources that help explain the influence of systematic reviews, mainly on health policy. The influence of the four publications was mainly a result of: 1) their powerful blending of the rhetoric of scientific and polemical discourse, especially in ECPC; 2) a growing audience for systematic reviews as a source of evidence-based healthcare among clinicians, journalists and consumers in many countries; and 3) recognition by policymakers that systematic reviews could contribute to making healthcare more effective and to containing the growth of costs.

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