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Welfare Reform on the Web - January 2001: Healthcare - overseas

BUSINESS AND HEALTH CARE POLICY REFORM IN THE 1980s: THE 50 STATES

B. Mintz and D. Palmer

Social Problems, vol. 47, 2000, p. 327-359

Presents results of empirical cross-sectional analyses of business involvement in health care reform across the 50 US states. Study focuses on three types of state-level initiatives: hospital financial disclosure legislation, hospital rate setting and review laws, and legislation that promoted the development of health maintenance organisations (HMOs). Business involvement was most vibrant in states where large corporations were headquartered. The presence of large health care companies inhibited overall business reform activity while stimulating formal coalition development In turn, coalition development influenced health care reform legislation in case of financial disclosure legislation. For the other two types of legislation, business interests, state interests and state capacities all contributed to progress towards passage.

THE CHILDREN'S HEALTH INSURANCE PROGRAM: EXPANDING THE FRAMEWORK TO EVALUATE STATE GOALS AND PERFORMANCE

L. Shi, T. R. Oliver and V. Huang

Milbank Quarterly, vol. 78, 2000, p. 403-446

Describes a comprehensive framework devised to evaluate the State Children's Health Insurance program (SCHIP), established in 1997 in the US. Analysis reveals that states propose a wide range of objectives and measures and that there is considerable variation among them. Overall, states SCHIP plans tend to stress programme enrollment and access to services but fail to emphasize the type and quality of service children receive once they are enrolled in the programme.

CROSS-BORDER ISSUES IN THE PROVISION OF HEALTH SERVICES: ARE WE MOVING TOWARDS A EUROPEAN HEALTH CARE POLICY

P. Kanavos and M. McKee

Journal of Health Services Research and Policy, vol. 5, 2000, p. 231-236

Paper analyses the likely implications of two recent European Court rulings on the provision of health care across borders within the European Union. The rulings render health goods and services as tradeable across borders, making them subject to two of the fundamental principles on which the EU was founded, freedom in the movement of goods and services. They suggest that, within a single market, health care will be available to patients regardless of national frontiers and reimbursable subject to rules prevailing in the patient's country of origin.

DOLLARS, DEBTS AND DUTIES: LESSONS FROM FUNDING AUSTRALIAN GENERAL PRACTICE

W. A. Rogers and B. Veale

Health and Social Care in the Community, vol. 8, 2000, p.291-297

Paper reports on the changes in resource allocation and activities associated with a devolutionary model of funding to Australian divisions of general practice which linked monies to nominated outcomes. Results showed that changes in funding procedures which use nominated outcomes as a major accountability mechanism may produce unexpected and unintended results, including significantly decreased expenditure in areas with outcomes which are hard to define and measure, but which are important to public health improvement.

THE EXTENT AND LIMITS OF SOLIDARITY IN DUTCH HEALTH CARE

R. ter Meulen and J. van der Made

International Journal of Social Welfare, vol. 9, 2000, p. 250-260

Solidarity and equal access are the twin principles in the Dutch health care system. Solidarity between rich and poor and among people with high and low risks formally guarantees equal access to healthcare services. Equal access is however under threat from two directions. Firstly, through government policies, patterns of inequality have emerged that favour people with private medical insurance over those who are insured through the state sickness fund. Secondly, scarcity of resources may have negative effects on the readiness of friends and family to provide informal care. Voluntary activity of this kind needs to be supported by help from nurses, paramedics, home helps and day centres if it is to continue.

THE FORMER NHS DOCTOR TRYING TO HEAL BANGLADESH'S SICK HEATH SYSTEM

P. Popham

Independent, Oct. 25th 2000, p.16

Describes how two doctors are trying to set up a system of primary healthcare in Bangladesh. Monthly contributions from families in village communities are used to fund a doctor and four to seven health workers.

HAS THE PORTUGUESE NHS ACHIEVED ITS OBJECTIVES OF EQUITY AND EFFICIENCY?

Dixon and E. Mossialos

International Social Security Review, vol. 53, no. 4, 2000, p. 49-78

The Portuguese healthcare system has been in a state of continuous change since 1974, when legislation was enacted to establish a universal and comprehensive national health service "approximately free" at the point of use. This article demonstrates that these objectives have not been achieved. Groups of the population enjoy different levels of cover, patients face significant direct costs or have to purchase services in the private sector; allocation of resources favours urban and coastal areas; and providers have few incentives to be efficient.

MANAGED CARE IN THE SUBSTANCE ABUSE ARENA: CHALLENGES AND CHOICES

O. M. Church and R. Anderson

Journal of Substance Use, vol. 5, 2000, p. 103-105

Describes the daily operations of an assessment centre for behavioural health contract management. Then describes a specific case to which screening criteria are applied.

PUBLIC HEALTH CARE IN THE BALANCE: EXPLORING POPULAR SUPPORT FOR HEALTH CARE SYSTEMS IN THE EUROPEAN UNION

J. Gevers et al

International Journal of Social Welfare, vol.9, 2000, p. 301-321

Analysis of data from the Eurobarometer survey series showed that support for public health care appears to be particularly positively related to social-democratic attributes of welfare states, whereas support drops with increasing degrees of liberalism and conservatism. Further, support for public health care proved to be associated with wider coverage and public funding of national care services. There were also higher levels of support in countries with scarce social services for children and the elderly, and larger proportions of female (part-time) employment.

UNKINDEST CUT?

H. Berliner

Health Service Journal, vol. 110, Nov. 2nd 2000, p. 33

The US Balanced Budget Act 1997 introduced massive cuts in federal government spending on Medicare. With the economy now booming, these cuts are now being eroded under pressure from the industry and public opinion.

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