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Welfare Reform on the Web (April 2001): Health Care - Overseas

COMPETITIVE HEALTH POLICIES AND COMMUNITY HEALTH

P. Stanton

Social Science and Medicine, vol. 52, 2001, p. 671-679

The introduction of market models of health care into Victoria, Australia, has had a number of effects on the management and organisation of community health centres. It has stifled innovation and creativity, bred a burdensome bureaucracy, and led to increased fragmentation of services.

DOES IT MATTER WHO OWNS HEALTH FACILITIES?

S. Duckett

Journal of Health Services Research and Policy, vol. 6, 2001, p. 59-62

Policy-makers should be wary about assuming that for-profit hospitals are more efficient than not-for-profit or public hospitals. The evidence is mixed, and comes mostly from the USA. Essay suggests that the ownership question is as secondary issue and that policy-makers should ensure that existing public hospitals are funded in a way that encourages efficiency.

IMPACT OF PAYMENT METHOD ON BEHAVIOUR OF PRIMARY CARE PHYSICIANS: A SYSTEMATIC REVIEW

T. Gosden et al

Journal of Health Services Research and Policy, vol. 6, 2001, p. 44-55

Review compared capitation, salary, fee-for-service and target payments. Fee-for-service resulted in a higher quantity of primary care services provided compared with capitation but the evidence of the impact on quantity of secondary services was mixed. Fee-for-service resulted in more patient visits, greater continuity of care, and higher compliance with a recommended number of visits, but lower patient satisfaction with access to a physician compared with salary payment. The evidence of the impact of target payment on immunisation rates was inconclusive. There is some evidence that how a primary care physician is paid does affect their behaviour but the generalisability of these studies is unknown. Most policy changes in the area of payment systems are inadequately informed by research.

INTEGRATION OF CARE IN THE NETHERLANDS: THE DEVELOPMENT OF TRANSMURAL CARE SINCE 1994

B. A. van der Linden, C. Spreeuwenberg and A. J. Schrijvers

Health Policy, vol. 55, 2001, p. 111-120

In 1994 a government advisory committee proposed measures to improve quality and efficiency in the Dutch health care system. While stating the need to stimulate the integration of primary and secondary care, most of the committee's recommendations were aimed at changing the organisation and reimbursement systems of GPs, medical specialists and hospitals within their own sectors. By these changes it was hoped that integration would be indirectly stimulated, resulting in the growth of transmural care. In 1999 the authors conducted a survey of 271 transmural care facilities to determine the extent of development of integrated services since 1994. This paper discusses the nature of seven different types of transmural care and comments on the results of the bottom up approach to integration in health care chosen by the Netherlands.

MANAGED CARE: CHALLENGES TO SURVIVAL AND OPPORTUNITIES FOR CHANGE

C. S. Berger

Smith College Studies in Social Work, vol. 71, 2000, p. 19-33

Paper explores the impact of managed health care on social work practice in the US. Concludes with a discussion of the potential scope for change in health care delivery systems due to:

  • possible introduction of universal health care;
  • greater reliance on capitation systems;
  • changing priorities to focus on issues of improving population health;
  • the growing role of advocacy.

MONITORING HEALTH REFORM: A REPORT CARD APPROACH

M. D. Brownell, N. P. Roos and L. L. Roos

Social Science and Medicine, vol. 52, 2001, p. 657-670

It is essential to monitor the impact of health reforms to determine their effect on such indicators as access to care and quality of care delivered. Paper proposes a framework for monitoring these and other indicators that may be affected by health care reform. Application of the framework is illustrated with data from Winnipeg, Manitoba. Despite the closure of almost 24% of hospital beds in Winnipeg between 1992 and 1996, access to care and quality of care remained generally unchanged. Improvements in efficiency occurred without harming the equitable delivery of health services.

TRAVELLERS' CHECKS

M. Wakeley

Health Service Journal, vol. 111, Jan. 25th 2001, p. 28-29

Interest in the costs of non-emergency operations in different countries is likely to grow as movement increases between European Union countries. There are huge variations in the cost to the state of the same operation in different countries. These may influence where services are purchased in the future.