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

1.2 million: the hidden toll of malaria deaths

S. Boseley

The Guardian, Feb. 3rd 2012, p. 1

Malaria kills twice as many people every year as formerly believed, taking 1.2 million lives and causing the deaths not only of babies but also older children and adults, according to research that overturns decades of assumptions about one of the world's most lethal diseases. The findings from the research, which reanalysed 30 years of data on the disease using new techniques, will force a rethink of the huge global effort that has been under way to eliminate malaria. That ambition now looks highly unlikely by the UN target date of 2015.

Differences in external price referencing in Europe: a descriptive overview

C. Leopold and others

Health Policy, vol. 104, 2012, p. 50-60

In the early 1990s, most governments in Europe decided to implement a mix of different pharmaceutical policies that aimed to contain public expenditure while stimulating research and industrial development. These policies focused on either controlling medicine prices and/or containing the prescribed volume of medicines or both. One particularly widely used pricing policy is External Price Referencing (EPR), also known as international price comparison. This study aims to examine the differences and commonalities in the implementation of EPR in all 27 European Union member states plus Norway.

The effects of new pricing and copayment schemes for pharmaceuticals in South Korea

I.-H. Lee and others

Health Policy, vol. 104, 2012, p. 40-49

After a policy of separation of prescribing and dispensing that prevented doctors from dispensing and pharmacists from prescribing was introduced in 2000, pharmaceutical expenditure surged. To contain costs, the Korean government introduced a new pricing system in 2006. This consisted of price, volume and quality control and market restructuring. There were two fundamental changes: introduction of a positive list and a formal request for economic evidence in reimbursement decisions; and a price agreement for new drugs. This reform was followed up by an extension of coinsurance, i.e. a selective increase in patient charges. This study investigated the effects of the new pricing and copayment schemes: 1) on per patient drug expenditure, utilisation and unit prices of pharmaceuticals; 2) on the utilisation of essential medicines; and 3) on the utilisation of less costly alternatives. Results suggested that the reforms contained costs not by the intended mechanisms, such as substituting generics for branded products, but by reducing patients' access to costly therapies regardless of clinical need.

Equity and equality in the use of GP services for elderly people: the Spanish case

E. Crespo-Cebada and R.M. Urbanos-Garrido

Health Policy, vol. 104, 2012, p. 193-199

In 2060, half of the Spanish population will be aged 50 or over. Thus, the analysis of inequalities in the use of primary care by elderly people and the identification of horizontal inequity in the delivery of primary care to this group are of interest to policymakers. This investigation shows the presence of pro-poor inequalities in both access to and frequency of use of GP services, which are mainly explained by unequal distribution of need. Ill-health indicators mostly show a pro-poor distribution, and some of them, such as co-morbidity and chronicity, contribute significantly to pro-poor inequality in healthcare demand. The relevance of the social determinants of health is thus confirmed, as is the need for policy initiatives to reduce health inequalities.

Evaluation of the equity of age-sex adjusted primary care capitation payments in Ontario, Canada

L.M. Sibley and R.H. Glazier

Health Policy, vol. 104, 2012, p. 186-192

Primary care in Canada has been affected by a shortage of doctors which has led to patients having difficulty in gaining timely access to treatment. In response Ontario has introduced a variety of new models for primary care provision and physician remuneration. Two of these models, Family Health Networks and Family Health Organisations, are funded predominantly through age-sex adjusted capitation. There is concern that adjusting capitation rates for age and sex alone does not take into account the increased morbidity burden and health care needs that are associated with lower socio-economic status. This study assesses the extent to which the current age-sex capitation rates in Ontario reflect health care needs of patients across socio-economic status by comparing Ontario's age-sex adjusted capitation remuneration rate index with relative expected healthcare resources use by socioeconomic status. Results suggest that physicians are under-compensated for the healthcare needs of low-income patients and over-compensated for the needs of high income patients. Adjusting capitation rates for morbidity burden in addition to age and sex may reduce incentives to preferentially enrol patients with higher socioeconomic status.

Evaluation of the first two years of the positive list system in Korea

S.E. Park and others

Health Policy, vol. 104, 2012, p. 32-39

In order to control spiralling spending on pharmaceutical reimbursement under the Korean National Health Insurance system, the government announced a drug expenditure rationalisation plan in May 2006. One of the major components of this plan was the introduction of the Positive List System (PLS). The appropriateness of a new drug for reimbursement is assessed by the Health Insurance Review and Assessment service (HIRA), and if the drug is approved for reimbursement, the price and expected usage volumes are decided through a negotiation between the National Health Insurance Corporation and the manufacturer. All drugs reimbursed before the introduction of the PLS are subject to sequential HIRA re-evaluation and their reimbursement status could change.

Health care systems in Europe and Asia

C. Aspalter, Y. Uchida and R. Gauld (editors)

Abingdon: Routledge, 2012

This book addresses the global need for more comparative studies on health policy and health care systems, given the rise in recent decades of societal ageing, modern mass diseases, economic globalization, and resulting permanent fiscal austerity of governments, which have fundamentally altered the status quo of health care systems. The book examines the healthcare experiences of the most developed countries in Asia (Japan, South Korea, Taiwan and Singapore) and compares these with four of the most important health care systems in Europe (UK, France, Germany and Italy). Focusing on the public health care systems, the contributors discuss the rising need for reforms in health care and health insurance administration, delivery systems, financing and overall health care policy strategies, particularly in fast-ageing societies in Asia, and highly aged societies in Europe.

Health policy and ethics

J. Fincham

London: Pharmaceutical Press, 2011

This text provides comprehensive coverage of international health policy and ethics. It promotes understanding of health policy and its influencers, and explains how policy directly affects health and health care. An in-depth review of pertinent background concepts, current issues, future needs and assessments is provided. Coverage includes:

  • health care systems, policies, impacts and influencers
  • health care quality concerns
  • justice and access to care
  • social and cultural issues
  • regulatory actions
  • global public health problems.

Laboratory equipment maintenance: a critical bottleneck for strengthening health systems in sub-Saharan Africa

P.N. Fonjungo and others

Journal of Public Health Policy, vol. 33, 2012, p. 34-45

Laboratory systems, services and networks constitute an integral part of a functioning health system. They play a pivotal role in the routine diagnosis, care and treatment of patients, plus in early detection and disease surveillance. Functioning equipment is essential for the smooth running of a laboratory. This article reviews the benefits and challenges of sustaining laboratory equipment maintenance. It proposes equipment management policies as well as a comprehensive equipment maintenance strategy that would involve equipment manufacturers and strengthen local capacity through the pre-service training of biomedical engineers. Strong country commitment and leadership are needed to assure development and implementation of policies and strategies for standardisation of equipment, and regulation of its procurement, donation, disposal and replacement.

Regulatory agencies, pharmaceutical information and the Internet: a European perspective

R. Bauschke

Health Policy, vol. 104, 2012, p. 12-18

In the field of drug therapy, information provided to patients via the Internet can increase compliance with instructions and improve general understanding of pharmaceutical risks and benefits. However, information offered electronically by drug companies may be biased, with information about adverse reactions subordinated to highlighting the benefits of a treatment. It is argued in this article that regulatory bodies in the pharmaceutical sector may represent an alternative source of objective information. This exploratory analysis reviews the websites of European pharmaceutical regulatory agencies regarding the usability of the information they offer by lay people. While most regulatory agencies do provide product-related information on their websites, it is often inaccessible to the lay person.

The regulatory gap in chronic disease prevention: a historical perspective

H.L. Walls, K.L. Walls and B. Loff

Journal of Public Health Policy, vol. 33, 2012, p. 89-104

Public health experience shows that legislative reform measures can be potent, equitable and cost-effective, leading to substantial improvement in population health. The history of regulatory intervention in public health suggests that 'tipping points' necessary to catalyse regulatory change may be identified. This article examines three areas in which governments have legislated to protect public health: sanitation, building standards and vehicle emissions. The lessons are then applied to regulatory reform addressing obesity.

Stitching the gaps in the Canadian public drug coverage patchwork? A review of provincial pharmacare policy changes from 2000 to 2010

J. R. Daw and S.G. Morgan

Health Policy, vol. 104, 2012, p. 19-26

Though they comprise the second largest component of health care costs in Canada, prescription drugs used outside of hospital are not included in the basket of services offered by the national health insurance system. As a result, provinces have independently developed public drug insurance programmes for some vulnerable groups, under various eligibility and patient cost sharing arrangements. By tracking the characteristics of public drug benefit programmes in Canada's ten provinces from 2000 to 2010, this research sought to determine if any plan designs were emerging as a national standard, and where gaps in public coverage remained. Results showed that, while changes in public drug benefits had been modest, universal income-based catastrophic insurance appeared to be emerging as an implicit national standard. However, due to the nature and variation in patient cost-sharing, policy convergence on this model did not equate to substantial progress towards expanding coverage and reducing inter-provincial disparities.

Why we need to rethink the strategy and time frame for achieving health-related Millennium Development Goals

E. Özaltin and S.V. Subramanian

International Health, vol.3, 2011, p. 246-250

Targets and interventions for the Millennium Development Goals related to reducing hunger (MDG1) and child mortality (MDG4) have ignored the role of intergenerational influences on health. The social conditions during the mother's childhood impact on her height through net nutrition (the balance between her nutritional intake and demands on it). This study shows that socioeconomic conditions, lagged by one generation, are very powerfully associated with child mortality and growth failure. Hypothetical scenarios manipulating contemporaneous factors at various increases of mean population height show that achieving MDG targets is likely to be realised sooner for populations with greater accumulated health stock.

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