Click here to skip to content

Welfare Reform on the Web (June 1999): Health Care - Overseas

DEVELOPING HEALTH INSURANCE IN TRANSITIONAL ASIA

T. Ensor
Social Science and Medicine, vol. 48, 1999, p. 871-879.

A strength of most former centrally planned health systems was that almost universal access to health facilities was ensured. The central weakness was that the funding system tended to encourage inefficient patterns of hospital provision. It is still unclear how the new systems of insurance will develop in Asian transition economies. The main fear is that progressing too far along some type of contribution based system will jeopardise universal access and substitute one inefficient funding system for another.

DRUG POLICY IN CHINA: PHARMACEUTICAL DISTRIBUTION IN RURAL AREAS

H. Dong and others
Social Science and Medicine, vol. 48, 1999, p. 777-789.

The changed drug distribution network has given health care providers more sources from which to purchase drugs at competitive prices. The reform has also afforded patients easier access to drugs as more drugs are available on the market. However the reform has also had some negative effects. The old drug administrative system is not suitable for the new drug distribution network. It is easy for people to over-use and misuse drugs and there is a risk of fake or low quality drugs being distributed.

THE ECONOMIC CONSEQUENCES OF REORGANISING HOSPITAL SERVICES IN BISHKEK, KYRGYZSTAN

A. Street and J. Haycock
Health Economics, vol. 8, 1999, p. 53-64.

Paper describes the development of plan for the rationalisation of hospital services in Bishkek, Kyrgyzstan, with particular emphasis on the economic aspects of the process. This involved calculating future hospital requirements by modelling a variety of policy options, ranging from changes in clinical practice to hospital closures. The model generated estimates of resource requirements for each hospital, from which the costs falling on the health budget and on patients were derived.

MICRO-INSURANCE: EXTENDING HEALTH INSURANCE TO THE EXCLUDED

D. M. Dror and C. Jacquier
International Social Security Review, vol. 52, 1999, p. 71-97.

Proposes the improvement of health provision for populations that are usually excluded from access to health services through a system of group-based health insurance or "micro-insurance".

PRIORITY CARE FOR EMPLOYEES: A BLESSING IN DISGUISE?

W. B. F. Brouwer and F. T. Schut
Health Economics, vol. 8, 1999, p. 65-73.

As a result of strict regulation of the supply of health care in the Netherlands, waiting lists increased while at the same time employers became fully responsible for sick pay. To reduce sick pay and production losses employers are prepared to pay for priority care. By treating employees outside of normal working hours of hospitals, waiting lists are avoided and a quick return to work is assured.

THE REFORM OF THE RURAL COOPERATIVE MEDICAL SYSTEM IN THE PEOPLE'S REPUBLIC OF CHINA: INTERIM EXPERIENCE IN 14 PILOT COUNTIES

G. Carrin and others
Social Science and Medicine, vol. 48, 1999, p. 961-972.

During the 1960s and the 1970s the Chinese government encouraged the 'rural co-operative medical systems' (RCMS) in order to ensure access to basic health care among the rural population. There was a break in the development of the RCMS in the early 1980s as a result of market economic reforms. In 1994 the Chinese government initiated a project to re-establish the RCMS. The project was implemented on a pilot basis in 14 counties of seven provinces.

RUNNING ON EMPTY

H. Berliner
Health Service Journal, vol 109, Feb. 18th 1999, p. 29.

Explains how serious financial problems beset managed care companies in the US, to the point where the continued ability of firms to provide services to their subscribers is being questioned.

RURAL HEALTH PREPAYMENT SCHEMES IN CHINA: TOWARDS A MORE ACTIVE ROLE FOR GOVERNMENT

G. Bloom and S. Tang
Social Science and Medicine, vol. 48, 1999, p. 951-960.

A large majority of China's rural population were members of health prepayment schemes in the 1970s. Most of these schemes collapsed during the transition to a market economy. In early 1997 a new government policy identified health prepayment as a major potential source of rural health finance. Paper draws on experience of existing schemes to explore how government can support implementation of this policy.

USING SOCIAL HEALTH INSURANCE TO MEET POLICY GOALS

C. Normand
Social Science and Medicine, vol. 48., 1999, p. 865-869.

The main risks of health insurance are incomplete coverage of the population and rising costs due to volume and price increases. Although the purpose of insurance is to extend coverage and increase available resources, it is important to look at the collection of funds, contracting for services and provision for cost increases. To achieve better access, it is necessary to limit entitlements to services. Incentives are needed to ensure the efficient provision of services. There is also a need to avoid rising prices of professional services.

HOUSEHOLD HEALTH EXPENDITURES IN NEPAL: IMPLICATIONS FOR HEALTH CARE FINANCING REFORM

D. R. Hotchkiss and others
Health Policy and Planning, vol. 13, 1998, p. 371-383.

Paper uses the Nepal Living Standards Survey to investigate the level and distribution of household out-of-pocket health expenditure. Results show that about 5.5% of total household expenditures go on health care and that households account for 74% of the funds used to finance the health economy. Rural households spend relatively more on health care than urban households. Both the wealthy and the poor rely heavily on public sector provision. Results of this analysis are used to discuss the feasibility of implementing alternative healthcare financing policies.

THE PUBLIC SECTOR AND MENTAL HEALTH PARITY: TIME FOR INCLUSION

M. F. Hogan
Journal of Mental Health Policy and Economics, vol. 1, 1998, p. 189-198.

Concludes that there are substantial structural, economic and social problems associated with the "two-tiered"! system of commercial/employer-paid insurance and public mental health care in the USA. Examining data from one state's system, the paper further concludes that it might be feasible to finance a single system of mental health benefits, if public resources were redeployed and private contributions continued.

REGIONAL DECENTRALISATION OF HEALTH POLICY IN SPAIN: SOCIAL CAPITAL DOES NOT TELL THE WHOLE STORY

A. Rico, M. Fraile and P. Gonzalez
West European Politics, vol. 21, 1998, p. 180-199.

Study examines the impact of decentralisation on the inter-regional equity and efficiency of welfare services provision. The interactions between territorial decentralisation and welfare policies are examined through the analysis of the dynamics of regional health care policy in Spain from 1981 to 1996.

Search Welfare Reform on the Web