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

Do market fees differ from relative value scale fees? Examining surgeon payments in New Zealand

L. Panattoni, P. Brown and J. Windsor

Journal of Health Services Research and Policy, vol. 16, 2011, p. 203-210

Although New Zealand has a predominantly public health system, approximately 33% of surgical procedures are paid for privately on a fee-for-service basis. Other countries, notably Australia and the USA have responded to the fee-for-service environment by developing relative value scales (RVS) for surgical fees. In contrast, the private sector in New Zealand operates as a free market with no RVS or direct interference from the government. This study examines the extent to which the market-generated fees charged by private surgeons in New Zealand are consistent with those suggested by the Australian RVS and the extent to which procedure volume and speciality are associated with deviations. Analysis showed that surgical fees in New Zealand were generally consistent with those predicted by the RVS. However, fees for high volume procedures were relatively lower than predicted while fees for low volume procedures appeared more variable. The findings are consistent with the hypothesis that market forces lowered the prices for procedures with higher volumes.

Effect of state health insurance mandates on employer-provided health insurance

D.N. van der Goes, J.Wang and K.C. Wolchik

Eastern Economic Journal, vol. 37, 2011, p. 437-449

This paper shows the impact of a change in the number of US state health insurance mandates on the probability that an employee has employer-provided health insurance (EPHI). Mandates improve the quality of health insurance offered but also have costs; state health insurance mandates increase premium costs which are either paid by the employer or passed on to the employee. If premiums are high enough, then employees may opt out of coverage entirely or employers may stop offering coverage. Results of this empirical analysis suggest that increasing the number of mandates causes a decrease in the probability that a person has EPHI.

Health and well-being in radically changing societies

P. Bracke and G. Giarelli (guest editors)

Social Theory and Health, vol.9, 2011, p. 303-436

The topics of the papers included in this special issue can be grouped into three thematic blocks. The first one consists of a series of multi-disciplinary macro-perspectives on the evolving linkage between social structure and health. The second thematic block comprises two studies on health inequalities adopting different methodological perspectives. The third thematic block, including the last two papers, concerns the evolution of medicine in post-industrial societies.

Healthcare commercialisation in Jordan's private hospitals: ethics versus profit

S.S. Al-Oun and Z. Smadi

International Journal of Behavioural and Healthcare Research, vol.2, 2011, p. 362-374

Jordan's for-profit private hospitals expanded dramatically from the 1990s, as public hospitals focused on offering paid care for those without health insurance. This study investigates whether these private hospitals adhere to medical ethics, and maintain professional standards and whether Jordanian doctors in private hospitals experience conflicts between ethics and business requirements. Data were gathered from interviews with 30 doctors from private hospitals, 10 doctors from public hospitals, and five patients. Results show that while private sector doctors are likely to think more in terms of their obligations to individual patients, they compromise professional standards in favour of the requirements of the hospital owners. Doctors indicated that patients in private hospitals could therefore receive inappropriate medical treatment on cost grounds. Private hospitals also avoided taking care of poor or disadvantaged patients while admitting the wealthy. They were happy to treat short-term illnesses from which they could make handsome profits, while people with serious illnesses were referred to public hospitals.

Moving (realistically) from volume-based to value-based health care payment in the USA: starting with Medicare payment policy

R. Mayes

Journal of Health Services Research and Policy, vol. 16, 2011, p. 249-251

Employers and policymakers in the USA are desperate to slow the rate at which health expenditures grow. To do so, they will need to summon the political will to move away from the present fee-for-service payment system, which rewards providers for the quantity of care they supply, regardless of its quality or necessity. Due to its unsurpassed market power as the largest single purchaser of healthcare, Medicare provides a vehicle for achieving price reform.

New Public Management and health reform in Kazakhstan

F. Amagoh

International Journal of Public Administration, vol. 34, 2011, p. 567-578

Kazakhstan declared its independence from the former Soviet Union in 1991. Since then, the country has been making efforts to reform its healthcare system. This article provides a brief history of Kazakhstan's healthcare reforms since independence and analyses some provisions of its most recent strategy, the National Program of Health Care Reform and Development for 2005-2010 in the context of New Public Management. The article juxtaposes aspects of the Program with the following elements of New Public Management: decentralisation, competition, efficiency and quality, and civil society and partnerships.

One of history's great partnerships?

C. Ham

Health Service Journal, Nov. 24th 2011, p. 18-19

A seminal analysis by Prof. Christensen of Harvard Business School suggests that competition will drive beneficial innovation in healthcare as in other sectors. However, he argues that it is competition between different integrated systems that is needed. The case is based on the observed superior performance of integrated systems such as Kaiser Permanente in the USA. As an organisation responsible for providing the full range of healthcare to its members out of a fixed budget, Kaiser Permanente is well placed to give priority to prevention and use hospitals only when appropriate. Factors that lie behind its success include involvement of doctors in leadership roles, the extensive use of information to drive improvement, and a culture of continuous quality improvement. The article goes on the look at the implications of these findings for the NHS.

(For an interview with Prof. Christensen, see Health Service Journal, Nov. 3rd 2011, p. 16-17)

Patient affiliation with GPs in Australia: who is and who is not and does it matter?

I. McRae and others

Health Policy, vol. 103, 2011, p. 16-23

Patients formally enrol with GP practices under some health systems (e.g. UK), while having free choice in others (e.g. Australia). The Australian National Health and Hospital Reform Commission has proposed voluntary enrolment with general practitioners for certain groups to enhance continuity of care. This study draws on an existing dataset to provide evidence that there is a high level of de facto enrolment in Australia, but is not able to show how this would differ from formal enrolment. It does however give a clear view of who is and is not likely to be enrolled with a GP. In the Australian context of 2008, those with the poorest levels of self-assessed health, and so arguably most in need of continuity of care, are relatively less likely to be affiliated.

Public and private funding of general practice services for children and adolescents in New Zealand

S. Dovey and others

Health Policy, vol. 103, 2011, p. 24-30

The contribution of private finance to total New Zealand health system funding, mostly provided out-of-pocket at the time of service use, increased from 11.5% to 22.1% in the last twenty years of the twentieth century. New Zealand became caught in a cycle of higher private costs, less service use and poorer health. In 2001 a radical reform was implemented to tackle the problem. Primary Health Organizations were created as the main infrastructure for delivery of primary care and funding for general practice changed to a capitation base from fee for service subsidies to patients. This study provides evidence of the continuing complexity of general practice service provision for children and exposes the diverse public and private funding streams supporting these services. Capitation funding changed the balance substantially but did not remove ongoing reliance on private funding to support general practice care for children.

Trade liberalization in Indonesian health services: prospects and policies

D. Kelaher, B. Dollery and B. Grant

International Journal of Public Administration, vol. 34, 2011, p. 528-538

The growing worldwide demand for health services offers developing countries, like Indonesia, significant opportunities to expand trade in the area. However, there are tensions between the encouragement of trade in health services and the provision of healthcare for a nation's own citizens. This article seeks to provide an overview of the national and international frameworks under which Indonesian trade in health services functions, with special attention to the WTO General Agreement on Trade in Services (GATS); a discussion of Indonesia's health export and import interests; and identification of how Indonesia could improve its health service trade, and which domestic policy initiatives would support it.

World Aids Day Report 2011

Geneva: UN Aids, 2011

This new report by UNAIDS shows that 2011 was a game changing year for the AIDS response with unprecedented progress in science, political leadership and results. Nearly 50% of people who are eligible for antiretroviral therapy now have access to lifesaving treatment. Substantial scale up, even during the financial crisis, highlights country driven commitments and a new investment framework will help countries save more lives and money.


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