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Welfare Reform on the Web (February 2012): Healthcare - overseas

Beijing fifteen years on: the persistence of barriers to gender mainstreaming in health policy

S. Payne

Social Politics, vol. 18, 2011, p. 515-542

Fifteen years after the Beijing declaration on women's rights, inequalities between men and women persist around the world, despite the unprecedented global spread of the concept of gender mainstreaming as a means of eradicating them. This paper focuses on gender mainstreaming in the context of health policy as an example of the persistence of barriers to gender equality. It suggests the need for a model of the underlying factors limiting progress. Barriers to gender mainstreaming and gender equality in health policy can be viewed as pragmatic, reflecting practical difficulties; conceptual, reflecting problems associated with the meaning attached to gender mainstreaming; or political, reflecting constraints that stem from gender relations of power. This approach which attempts to consider barriers in terms of their origins allows a clearer articulation of the ways different barriers operate at various levels and the different strategies required to challenge these obstacles.

Circus monkeys or change agents? Civil society advocacy for HIV/AIDS in adverse policy environments

N. Spicer and others

Social Science and Medicine, vol.73, 2011, p. 1748-1755

The criminalisation of injecting drug use is a major structural driver of the HIV/AIDS epidemic in Eastern Europe and Central Asia. It stimulates risky practices and can lead to human rights abuses and poor access to HIV/AIDS services. This paper explores the factors enabling and undermining civil society efforts to advocate for policy reforms relating to illicit drug use and HIV/AIDS in three countries affected by these issues: Georgia, Kyrgyzstan and Ukraine. It examines how political contexts and civil society actors' strengths and weaknesses inhibit or enable advocacy for policy change. Few examples of civil society/state synergy were found. Some civil society organisation advocacy was tolerated by government, but their participation in the policy process was at best tokenistic and at worst acrimonious. Moreover, civil society organisations were in competition with each other for external donor funding, which undermined collective action.

The contributions of physician assistants in primary care systems

R.S. Hooker and C.M. Everett

Health and Social Care in the Community, vol. 20, 2012, p. 20-31

Physician assistants are recognised as health professionals who practice medicine in collaboration with doctors through delegated clinical tasks and patient management. As of 2011, the United States had about 75,000 clinically active physician assistants and there were almost 1,000 in other countries. This review aimed to synthesise the available evidence regarding the contribution of physician assistants to primary care. Contemporary studies suggest that physician assistants can enhance certain aspects of the delivery of primary care. Their addition to primary care teams tends to improve care coordination and comprehensiveness and helps to maintain care continuity. Available evidence suggests that care provided by physician assistants is safe, effective and satisfying to patients.

Doubts cast on breast cancer screening

S. Boseley

The Guardian, Jan. 23rd 2012, p. 2

Breast cancer screening can no longer be justified, because the harm to many women from needless diagnosis and damaging treatment outweighs the small number of lives saved, according to a book that accuses many in the scientific establishment of misconduct in their efforts to bury the evidence of critics and keep mammography alive. Peter Gøtzsche, director of the independent Nordic Cochrane Collaboration, has spent more than 10 years investigating and analysing data from the trials of breast screening that were run, mostly in Sweden, before countries such as the UK introduced their national programmes. The data, Gøtzsche has maintained for more than a decade, does not support mass screening as a preventive measure. Screening does not cut breast cancer deaths by 30%; it saves probably one life for every 2,000 women who go for a mammogram. But it harms 10 others. Cancerous cells that will go away again or never progress to disease in the woman's lifetime are excised with surgery and sometimes (six times in 10) she will lose a breast. Treatment with radiotherapy and drugs, as well as the surgery itself, all have a heavy mental and physical cost

Galvanizers, guides, champions and shields: the many ways that policymakers use public health researchers

A.S. Haynes and others

Milbank Quarterly, vol. 89, 2011, p. 564-598

This article describes how policymakers use researchers in policymaking and examines how these activities relate to models of research utilisation. It also explores the extent to which policymakers' accounts of using researchers concur with the experiences of 'policy-engaged' public health researchers. Data collected through semi-structured interviews with 32 Australian civil servants, ministers and ministerial advisers showed that policymakers use researchers in many ways: as contributors to advisory groups, task forces and independent committees; as presenters at conferences; as government-commissioned researchers and authors of tailored reports; and as intervention experts who help civil servants design and evaluate programmes. These uses are complemented by researchers working with community groups, professional associations, and advocacy coalitions, and also contributing to public debate by engaging with the media as educators and/or advocates, both in collaboration with, and in opposition to, government.

Health-care cost containment through evidence-based competition: on the rebirth of an old idea and the chances of implementing it today

R. Boscheck

World Competition, vol. 34, 2011, p. 661-674

In 2010, the OECD warned that governments can no longer boost spending to improve health outcomes but must raise the efficiency of the entire healthcare system. In the process, market-driven healthcare reforms would need to align incentives for multiple product and service suppliers to guarantee treatment outcomes. The healthcare reform of the Obama Administration reflects this approach. However, as with previous reform initiatives, it will be unable to ensure an efficient supply of necessary care unless performance is clearly defined in terms of treatment outcome. Current US regulatory initiatives, complementing the healthcare bill, could put an end to the recent history of ill-defined market-driven healthcare reform. The challenge is to navigate rather different views on the accessibility and marketability of different levels of outcome data and to coordinate seemingly conflicting regulatory agendas into an integrated approach in support of properly constituted healthcare markets.

Improving access to government health care in rural Bangladesh: the voice of older adult women

A. Hossen and A. Westhues

Health Care for Women International, vol. 32, 2011, p. 1088-1110

In spite of the widespread acknowledgement that service user input is essential to develop health policy and services that meet their needs, the voice of older women from rural areas continues to be absent in health planning in Bangladesh. The health care needs of women are defined almost exclusively in relation to their reproductive role by male providers and administrators. As a result, government health services continue to be under-used by older women in these rural areas. This study sought to explore system related barriers to use of health services experienced by a group of 17 older women from a village in Bangladesh and the changes they would like to see. Three main barriers were identified: perceived discrimination based on age, class and gender; structural aspects of the healthcare delivery system; and quality of care.

The New Public Management Theory and reform of European health care systems: an international comparative perspective

D. Simonet

International Journal of Public Administration, vol. 34, 2011, p. 815-826

New Public Management Theory is a rhetorical construction with diverse intellectual roots. This diversity means that it is open to reinterpretation and is implemented differently in different countries. This overview critically examines New Public Management implementation in various EU health systems. New Public Management led to a greater focus on market forces and competition and improved information sharing and cooperation among health networks, and changed the way that care is delivered. NPM has taken root much more extensively in the UK than in France and Germany. The variety of capitalism and institutional systems provides an explanation for divergences in NPM implementation.

A service model for improving healthcare delivery in rural developing communities

R.J. Leach and others

International Journal of Services, Economics and Management, vol. 4, 2012, p. 75-92

The infrastructure needed to deliver standard telemedicine is extremely expensive, making its implementation in rural areas of developing countries highly unlikely. However, it is possible to develop an inexpensive telemedicine system, albeit with reduced capabilities, at relatively low cost, and within the constraints of the available infrastructure. The application of current thinking in systems service engineering, when coupled with economic models of costs (in both monetary and resource areas), can deliver a useful environment.

Why national eHealth programs need dead philosophers: Wittgensteinian reflections on policymakers' reluctance to learn from history

T. Greenhalgh and others

Milbank Quarterly, vol. 89, 2011, p. 533-563

National eHealth programmes, such as the National Programme for IT in the NHS, rarely roll out as predicted, especially when carefully planned in advance. However, policymakers often persist in thinking that things will go better next time or will sort themselves out. This article argues that lessons are rarely learned from national eHealth programmes because insufficient value is placed on in-depth case studies, and makes the case on philosophical rather than methodological grounds. It is proposed that national eHealth programmes, and other complex technology projects with multiple stakeholders and interdependencies, could usefully be reconceptualised as Wittgenteinian mind games.

Why Ugandan rural households are opting to pay community health insurance rather than use the free healthcare services

J.M. Twikirize and C. O'Brien

International Journal of Social Welfare, vol. 21, 2012, p. 66-78

In 2001, Uganda adopted a policy where health services are provided free of charge at all government facilities, financed from general taxation and by support from foreign donors. At the same time Community Health Insurance (CHI) was introduced as a complementary financing mechanism. Nine years after the reform, less than 30% of the population were using the free services. This research investigated the barriers to the use of the free health services through a case study of Rubabo County in South-Western Uganda. The study found that 21% of households always used the government's free health services, while 79% used private health services. The reasons given were poor quality services, including frequent drug stock-outs, unmotivated and poorly trained health personnel, and overcrowding. Factors influencing enrolment in community health insurance included easier access to healthcare, financial protection against the cost of care, better quality care, and benefits related to mutual assistance.

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