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

Advancing the business creed? The framing of decisions about public sector managed care

H. Waitzkin, J. Yager and R. Santos

Sociology of Health and Illness, vol.34, 2012, p. 31-48

Managed care evolved in the United States in the 1990s and for-profit corporations using this model have been contracted to deliver public programmes such as Medicaid. This study investigated how executives in such for-profit healthcare corporations frame their own motivations and behaviour, and how government officials frame their interactions with executives. Data were gathered through in-depth structured interviews with chief executives of managed care organisations and high-ranking state government officials. Results showed that the rate of profit, which proved relatively low in the Medicaid managed care programme, occupied a limited place in executives' self-described motivations, and in state officials' descriptions of corporation-government interactions. Non-economic motivations included a strong orientation towards corporate social responsibility and a creed in which market processes advanced human wellbeing.

Assessing the effects of removing user fees in Zambia and Niger

M. Lagarde, H. Barroy and N. Palmer

Journal of Health Services Research and Policy, vol. 17, 2012, p. 30-36

In the face of evidence that user fees constitute a barrier to health care use in low income countries, some donors and non-government organisations have lobbied for their removal. However evidence on whether national reforms have actually improved access to health care for vulnerable groups remains scarce. This article examines the effects of the abolition of user charges in Zambia and Niger on health care use by different age groups and over time using routine district health services data from before and after the abolition of charges. Results showed that removing user fees for primary health care services in rural districts in Zambia and for children over five in Niger increased use of services by the target groups. The impact of the policy change differed widely across districts and eighteen months after the reform some of its effects had eroded.

Can a sector-wide approach underpin and advance universal health coverage?

A. Ulikpan and others

Asian Social Work and Policy Review, vol. 6, 2012, p. 56-65

The barriers to achieving universal health coverage in Mongolia include finance, staff competence and attitudes, management skills and styles and the silo-like operations of the various departments of the Ministry of Health. Donor agencies complicate the situation by implementing standalone projects in areas that interest them but may overlap with other schemes or not fit with national priorities. Universal health coverage requires a systems/holistic approach. A sector wide approach could offer such an alternative system for managing the health service to achieve it.

Climate for evidence-informed health systems: a profile of systematic review production in 41 low- and middle-income countries, 1996-2008

T. Law and others

Journal of Health Services Research and Policy, vol. 17, 2012, p. 4-10

A profile of systematic reviews being conducted by authors based in a given country can provide helpful insights to policymakers about the climate for evidence-informed health systems. This paper aims to describe systematic review production in 41 countries in Africa, the Americas, Asia and the Eastern Mediterranean. While there had been a significant increase in systematic review production in the most recent six-year period compared to the preceding seven-year period, the overall number of reviews being produced remained relatively low and only a small fraction of these reviews addressed health system topics. Moreover, while countries such as China and Brazil had a significant pool of corresponding authors on which to draw, and these same countries appeared to be targeted by many systematic reviews, no systematic reviews had been produced by a corresponding author based in nine countries and no systematic reviews appeared to target five countries. Thus in many countries those seeking to support evidence-informed health systems cannot turn to experienced local systematic reviewers to help them. These findings suggest a need for local capacity building initiatives.

Confronting corruption in the health sector in Vietnam: patterns and prospects

T. Vian and others

Public Administration and Development, vol.32, 2012, p. 49-63

Corruption in Vietnam is a national concern that could derail health sector goals for equity, access and quality. This article builds on the findings and discussion at the Donors Roundtable held as part of the 6th Anti-Corruption Dialogue between the Vietnamese government and the international donor community in 2009. At that meeting, development partners, government agencies, Vietnamese and international non-government organisations, media representatives and other stakeholders explored what was known about problems such as envelope payments to medical staff, corruption in the pharmaceutical supply system and health insurance fraud. The participants proposed interventions in the areas of enhanced administrative oversight, transparency and structural health reforms. This analysis assesses the prospects for success of these interventions given the Vietnamese institutional context.

Dutch launch mobile euthanasia scheme

K. Connolly

The Guardian, Mar. 2nd 2012, p. 21

A controversial system of mobile euthanasia units that will travel around the country to respond to the requests of sick people who wish to end their lives has been launched in the Netherlands. The scheme will send teams of specially trained doctors and nurses to the homes of people whose own doctors have refused to carry out patients' requests to end their lives. The launch of the so-called Levenseinde, or "Life End", house-call units - whose services are being offered to Dutch citizens free of charge - coincides with the opening of a clinic of the same name in The Hague, which will take patients with incurable illnesses as well as others who do not want to die at home. The scheme is an initiative by the Dutch Association for a Voluntary End to Life (NVVE), a 130,000-member euthanasia organisation that is the biggest of its kind in the world.

Framing, ideology and evidence: Uganda's HIV success and the development of PEPFAR's 'ABC' policy for HIV prevention

J.O. Parkhurst

Evidence and Policy, vol.8, 2012, p. 17-36

The President's Emergency Plan for AIDS Relief (PEPFAR) had a large component focused on AIDS prevention based on the 'ABC' approach of 'Abstain, Be faithful or use Condoms'. The ABC approach proved controversial and how it could be used for AIDS prevention was interpreted differently by right and left wing activists. Yet both sides of this debate have claimed their contrasting interpretations of ABC to be evidence-based and have drawn on the HIV prevention experience of Uganda to justify their conclusions. They have interpreted and constructed the same set of historical and epidemiological evidence differently, based on their underlying moral beliefs. They have selected different elements of the history of AIDS prevention in Uganda, and drawn differing lessons from it. This paper explores how policy constructions of HIV prevention derive from competing underlying moral belief systems, and the interpretive framing process based on those beliefs. The findings illustrate the importance of making these interpretive processes explicit in order to strengthen the use of evidence in policy and to improve understanding of the policy-making process.

Health care, the market and consumer choice

A. Enthoven

Cheltenham: Elgar, 2012

This book develops the ideas of consumer choice and managed competition in alternative health care financing and delivery systems, as well as describing ways to improve quality and reduce the cost of health care. It demonstrates how these ideas could be applied in the American employment-based health insurance model; how similar ideas have been introduced in the British National Health Service; how these ideas have been applied in the Netherlands; and the need for integrated comprehensive care systems. The book traces the development of two important and related themes. Firstly, the 'output' of the health services industry has been produced by disaggregated physicians, nurses and other health professionals, hospitals, drugs and device companies that somehow combine to serve the patient. Progress in quality and the economy requires these components to be integrated into coherent systems in which the incentives of all providers are aligned with the needs and wants of patients for quality affordable care. Secondly, the book argues that the framework that can provide such incentives is an appropriately designed form of market competition among systems of care seeking to serve value-conscious patients.

Innovation and participation for healthy public policy: the first National Health Assembly in Thailand

K. Rasanathan and others

Health Expectations, vol.15, 2012, p. 87-96

This paper describes the process and initial outcomes of the first National Health Assembly in Thailand, as an innovative example of health policy making. The first National Health Assembly was held in December 2008 in Bangkok and brought together over 1500 people from government agencies, academia, civil society, the health professions and the private sector to discuss key issues and produce resolutions to guide policy making. It adapted an approach used at the World Health Assembly of the World Health Organization. Fourteen agenda items were discussed and resolutions passed. Early impacts on policy have included an increase in the 2010 budget for Thailand's universal health coverage scheme; cabinet endorsement of proposed strategies for universal access to medicines for Thai people; and establishment of national commissions on health impact assessment and trade and health.

Integration and coordination in healthcare: an operations management view

P. Lillrank

Journal of Integrated Care, vol. 20, 2012, p. 6-12

Integration in healthcare is assumed to lead to synergies and effectiveness, but there is little measurable evidence of success. One reason for this is that there is no unanimous definition of integration, and what cannot be defined cannot be measured. This paper examines the concept of integration and its corollary coordination from the perspective of operations management with a view to defining them in the context of healthcare. It is argued that integration and coordination need to be conceptually separated, as the former means the merger of different contributions to produce a common understanding of a patient's situation, while the latter means the arrangement of service elements into processes.

Maternal leave policies and vaccination coverage: a global analysis

M. Daku, A. Raub and J. Heymann

Social Science and Medicine, vol.74, 2012, p. 120-124

Childhood vaccination is a proven and cost-effective way to reduce child mortality, but participation in vaccination programmes is not universal even when they are free or low cost. Studies in various countries have reported work conflicts as limiting parents' ability to vaccinate their children. Using policy data for 185 UN member states, this research explored the hypothesis that an increased opportunity for parents to bring children to vaccination sites would translate into higher vaccination rates. Results showed that a higher number of full-time equivalent weeks of paid maternity leave was associated with higher childhood vaccination rates, even after controlling for GDP per capita, health care expenditures and social factors.

Medicaid, the states and health care reform

L. K. Olson

New Political Science, vol.34, 2012, p.37-54

The Patient Protection and Affordable Care Act 2010 seeks to medically insure thirty-two million more Americans at an estimated cost of $940bn over ten years. Nearly half (sixteen to eighteen million) of the newly enrolled population will be covered by Medicaid which will in 2014 be expanded to include all households with an income at or below 133% of the Federal Poverty Level. This article argues that these newly insured low-income households will be joining a means-tested programme with second-rate services. Benefits packages, enrolment procedures and provider payment rates will vary between states. Thus, participants' ability to access services will still depend on where they live. Medicaid is jointly funded by the federal government and the states. When state budgets are strained, local officials will downsize benefits packages, raise co-payments, mandate more managed care and reduce provider payments, negatively affecting the availability, scope and quality of services.

Migration and health in the European Union

B. Rechel and others (editors)

Maidenhead: Open University Press/ McGraw Hill Education, 2011

While migrants are often comparatively healthy, a phenomenon known as the "healthy migrant effect", they often face particular health challenges and are vulnerable to a number of threats to their physical and mental health. However, all too often the specific health needs of migrants are poorly understood and health systems are not prepared to adequately respond. The situation is compounded by problems in realizing their human rights, accessing health and other basic services and relegation to low paid and often dangerous jobs, with the most acute challenges for undocumented migrants, trafficked persons and asylum-seekers. This book explores key features of health and migration in the European Union (EU). Health systems have to be responsive to their respective populations and as populations in Europe are becoming increasingly diverse, health systems need to find ways of responding adequately to this diversity.

Network structures and their relevance to the policy cycle: a case study of The National Male Health Policy of Australia

C.A. Holden and V. Lin

Social Science and Medicine, vol. 74, 2012, p. 228-235

A growing body of research emphasises the role networks in policy formulation. To illustrate the application of a network approach to policy analysis, the authors introduce the Australian National Male Health Policy as a case study of a web of competing interests within the health policy domain. An analysis of a sample of actors with an interest in the development of a men's health policy is presented to describe the network structures that exist for different relational purposes. Reflecting on the history of the men's health network policy process in Australia, the authors propose that the different relational structures reflect different stages of the policy process. The opportunities that may arise when decision-makers apply a network framework to different stages of the policy cycle (stakeholder engagement, consensus and implementation) are discussed.

Obama's healthcare reforms fight move to the US supreme court

C. McGreal

The Guardian, Mar. 26th 2012, p. 15

The US Supreme Court heard the opening salvos in the politically charged legal challenge to Barack Obama's healthcare reforms in March 2012 as the nine justices considered whether they had the authority to take on the case. The first of three days of hearings - the longest of any case in nearly half a century - focused on whether the punishment for not buying mandatory health insurance under the new law is a tax or a penalty. If it is a tax, then under a 19th century law, the Anti-Injunction Act, the legislation could not be challenged until the tax had been collected beginning in 2015, and the court would not be able to hear the case immediately. If it is a penalty, the lawsuit could go ahead. Both the government and the 26 US states challenging the health reform law were keen for Supreme Court to consider the constitutionality of the legislation and so they joined in supporting the notion that the consequence of not buying insurance is a penalty.

Patients' and pharmacists' perceptions of a pilot Medicines Use Review service in Auckland, New Zealand

J. Sheridan and others

Journal of Pharmaceutical Health Services Research, vol. 3, 2012, p. 35-40

Medicines Use Review (MUR) is a new and emerging community pharmacy-based service designed to help improve medicines use. MUR uses a structured process to identify and resolve problems related to access, adherence and day-to-day medicines management. There is an expectation of reduction in medicines wastage and improved outcomes for patients. This paper presents findings from an evaluation of a pilot MUR service undertaken in Auckland, New Zealand. The findings point to the complexity of MUR delivery, and mixed outcomes for both patients and pharmacists. Key benefits reported by patients were increased knowledge and understanding of their medications, greater confidence regarding medicine and health issues, and a closer relationship with their pharmacist. However, no specific health benefits were reported by patients as a result of the intervention. Pharmacists reported improved relationships with patients, increased professional skills, and improved relationships with other health professionals. However they also reported a lack of available staff and time to deliver the service.

A unique drug-injury relief system in Taiwan: comparing drug injury compensation in different countries

A.W.F. On and others

Journal of Pharmaceutical Health Services Research, vol. 3, 2012, p. 3-9

Over the past decades there have been significant severe drug injuries caused by medicines that have given rise to social problems around the world. Taiwan operates a unique no-fault compensation scheme for injuries caused by medication use. This article describes the operation of the Taiwan Drug Relief Foundation established in 2001 under the Taiwan Drug Hazard Relief Act to run the scheme. It also briefly reviews similar no-fault compensation schemes in Germany, Japan, New Zealand and the Nordic countries.

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