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

A DESCRIPTIVE FRAMEWORK FOR COUNTRY-LEVEL ANALYSIS OF HEALTH CARE FINANCING ARRANGEMENTS

J. Kutzin

Health Policy, vol. 56, 2001, p. 171-204

With respect to healthcare financing, there is frequently a confusion between policy tools and policy objectives. For example, many of the reforms involving health insurance have focused on establishing or refining, insurance schemes, without reference to the effects of these on the efficiency and equity of the broader system. Paper provides an alternative approach based on two principles: 1) reforms should be oriented to specific policy objectives; and 2) reform should take into account the organisation of the existing healthcare system. Begins by presenting a conceptual framework aimed at helping countries identify a co-ordinated set of policies to enhance the insurance function of their health care systems. Next incorporates lessons from country experience into a review of the various elements of the framework. Concludes with a review of selected key policy issues.

THE GERMAN STRATEGY FOR QUALITY IMPROVEMENT IN HEALTH CARE: STILL TO IMPROVE

D. Sauerland

Health Policy, vol. 56, 2001, p. 127-147

German health policy aims to ensure the efficient provision of good quality care through the introduction of more competition into the health sector. However, in the public mind, a conflict is perceived between the goals of efficiency and quality when competition is introduced. Article analyses the strategy chosen to ensure high quality care and demonstrates that implementing competition does not necessarily lead to a "victory" of efficiency over quality. Finally, proposes a strategy to assure high quality in healthcare which combines regulatory and competitive elements.

GOING NOWHERE

J. Sussex

Health Service Journal, vol. 111, May 10th 2001, p. 24-25

Expectations of significant numbers of patients crossing borders within the EU for treatment have not materialised, in spite of the establishment of projects in border regions designed to increase the number of patients going outside their own country for treatment. Doctors' reluctance to refer patients outside their own country may be a factor in this. However, there are still legal and administrative uncertainties about reimbursement for care in another country.

HEALTH CARE UNDER TRANSFORMATION IN POLAND

K. Tymowska

Health Policy, vol. 56, 2001, p. 85-98

In Poland the role of the central government as a provider of healthcare has been in decline since 1989. Compulsory general health insurance was introduced in 1999, and local governments became owners of many public hospitals and clinics. A parallel private healthcare system has also been developing over many years for those able to pay.

THE IMPACT OF PRIVATIZATION ON ACCESS IN TANZANIA

J. S. Benson

Social Science and Medicine, vol. 52, 2001, p. 1903-1915

In the late 1980s many developing countries were forced to adopt structural adjustment policies as a condition of securing loans from the International Monetary Fund (IMF) and the World Bank. One of the World Bank's recommended policies was to change the mix of private and public healthcare facilities. Study, based on fieldwork done in 1993, examined the impact of the policy on healthcare accessibility in two Northern Tanzanian districts, one urban and one rural. Accessibility was measured in terms of equality and equity of coverage. Found that the strategic placement of government clinics opened 1985-1993 did much more to improve coverage than the haphazard location of the new private clinics. Equity was not improved as very few clinics were placed in deprived areas.

IMPACT OF RURAL HOSPITAL CLOSURES IN SASKATCHEWAN, CANADA

L. Liu et al

Social Science and Medicine, vol. 52, 2001, p. 1793-1804

In Saskatchewan, 52 shall rural hospitals with less than eight beds stopped receiving funding for acute care services in 1993. Since then, concerns have been raised about the impact of the changes on rural residents' access to care, their health status, and the viability of rural communities. Study showed that hospital closures did not in fact adversely affect rural residents' health status or their access to impatient hospital services. Good rural health care does not depend on the presence of a very small hospital that cannot provide genuine acute care. It requires creative approaches to the provision of primary care, good emergency services and good communication with the public on the intent and outcomes of change.

JAPAN HEALTH SCHEME TO RUN INTO DEFICIT

G. Tett

Financial Times, May 1st 2001, p. 10

Reports that one of Japan's largest state-organised health insurance schemes is expected to post a Y400bn deficit next year and Y1, 300bn deficit in 2002. This is due to rising claims from an ageing population and the high cost of healthcare. It means that the government will have to either find several trillion yen to plug the hole or implement rapid reforms to the healthcare insurance system.

TARGETED HEALTH INSURANCE IN A LOW INCOME COUNTRY AND ITS IMPACT ON ACCESS AND EQUITY IN ACCESS: EGYPT'S SCHOOL HEALTH INSURANCE

W. Yip and P. Berman

Health Economics, vol. 10, 2001, p. 207-220

In Egypt, the School Health Insurance Programme (SHIP) is a government subsidised health insurance system that targets school children. Using the Egyptian Household Health Utilization and Expenditure Survey 1995, authors found that SHIP significantly improved access to healthcare by increasing visit rates and reducing financial burden of use (out-of-pocket expenditures). However, by targeting the children through school enrolment, the SHIP increased the differentials in the average level of access between school-going children and those not attending school (overall equity). Results also suggest that original calculations may underestimate SHIP financial outlays, thereby threatening the long term sustainability of the programme.

WHAT IS "BEST PRACTICE" IN HEALTH CARE? STATE OF THE ART AND PERSPECTIVES IN IMPROVING THE EFFECTIVENESS AND EFFICIENCY OF THE EUROPEAN HEALTH CARE SYSTEMS

M. Perleth, E. Jakubowski and R. Busse

Health Policy, vol. 56, 2001, p. 235-250

Authors reviewed the literature in order to

  • establish a definition for "best practice" in the health sector;
  • develop a framework to classify relevant information;
  • synthesise the literature on activities, disciplines and measures pertinent to the concept.
Currently, the concept of best practice can be broken down into three activities (Health Technology Assessment, Evidence Based Medicine and Clinical Practice Guidelines) by which evidence is synthesised either as an evidence base or in the form of recommendations. These activities gain input from the four disciplines of clinical research, clinical epidemiology, health economics and health services research. The different disciplines are related to each other in the three domains of input, dissemination/implementation and monitoring/outcome. These provide evidence on
  • the (potential) effects of healthcare interventions and policies;
  • the ways to implement them;
  • ways to monitor their actual outcome.