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

ACCREDITATION AND THE QUALITY MOVEMENT IN FRANCE

A. Giraud

Quality in Health Care, vol.10, 2001, p.111-116

The ordnance of 24 April 1996 required all public and private health care organisations in France to submit to an external evaluation procedure called accreditation. Accreditation is a government sponsored initiative which is compulsory, patient centred and orientated to continuous quality improvement.

A CRITICAL REVIEW OF PRIMARY HEALTH CARE REFORM IN BULGARIA

S. Tz. Popova and A.G. Kerekovska

International Journal of Consumer Studies, vol.25, 2001, p.123-131

Paper seeks to evaluate the ongoing reform of primary health care in Bulgaria from the perspective of the consumer. Shows that contradictions exist between the legislative reforms and existing realities. Some of the reforms have had a negative impact on consumers and have infringed their rights. A major reason for the problems could be the simultaneous introduction of financial and structural reform. The legislation clearly defined the final goals of the reform but the actual route of the reform process was not properly developed. Owing to the breadth of the reform, the legislation of itself was unable to immediately transform existing societal relations. Paper proposes development of an assessment system to monitor the reform process and evaluate the effectiveness of the changes.

DETERMINANTS OF CUSTOMER SATISFACTION WITH THE HEALTH CARE SYSTEM, WITH THE POSSIBILITY TO CHOOSE A PERSONAL PHYSICIAN AND WITH A FAMILY DOCTOR IN A TRANSITION COUNTRY

J. Kersnik

Health Policy, vol.57, 2001, p.155-164

Results of a postal survey of patients showed that health care reform in Slovenia had had a positive impact on consumers' perceptions of health care quality, measured in terms of customer satisfaction with the health care system, the possibility of choosing a family doctor and overall satisfaction with that family doctor. Health care in Slovenia is financed through a compulsory insurance scheme run by the National Health Insurance Institute (NHII). An annual agreement for service provision is made between the NHII and health care providers (public and private), with the Ministry of Health in a co-ordinating role.

DOCTORS AS MANAGERS: NEW PUBLIC MANAGEMENT IN A NEW ZEALAND HOSPITAL

B. Doolin

Public Management Review, vol.3, 2001, p.231-254

In order to contain escalating costs, senior management in a New Zealand hospital introduced the concept of clinical leadership to make clinicians accountable for the resources consumed as a result of their treatment decisions. An organisational restructuring created semi-autonomous business units based around clinical specialities and headed by clinician managers. These played a boundary role between their professional colleagues and management. In the short term, a number of senior clinicians adapted to this role and there was some evidence of their acculturation into management identifications. However the majority acted to absorb change rather than actively champion it.

FUNDING HEALTH CARE IN EUROPE: RECENT EXPERIENCES

A.Dixon and E. Mossialos

Health Care UK, Spring 2001, p.66-77

This article provides a review of changes seen in health care funding in Europe. It examines recent trends and draws some tentative conclusions about the significance of those for debate in the UK. Article looks specifically at:

  • the shift from social health insurance to tax funding in France;
  • Insurer Competition in social health insurance systems;
  • private health insurance and shifting costs to patients.

HOUSEHOLD OUT-OF-POCKET HEALTH CARE EXPENDITURE TRENDS, 1980-95

D.L. Sharpe, J.X. Fan and G.S. Hong

International Journal of Consumer Studies, vol.25, 2001, p.114-32

Study uses 15 years of US Consumer Expenditure Survey data to chart trends in constant dollar out-of-pocket expenditures and household budget shares for health insurance, medical services, prescription drugs and medical supplies, taking into account eligibility for government health care programmes. Results showed that constant dollar out-of-pocket expenditures for health insurance rose sharply over time while constant dollar out-of-pocket expenditure for medical services declined. Older consumers spent more in constant dollars and had higher budget shares for all aspects of health care than younger consumers. Although Medicare and Medicaid provide access to basic health care, results indicate that, for older consumers who are poor, health care expenditure may still crowd out spending on other necessities.

IMPROVING THE QUALITY OF HEALTH CARE IN THE UNITED KINGDOM AND THE UNITED STATES: A FRAMEWORK FOR CHANGE

E.B. Ferlie and S.M. Shortell

Milbank. Quarterly, vol.79, 2001, p.281-315

Concern over the quality and outcomes of care has increased in both the UK and the US. Both countries have launched a number of initiatives to deal with these issues. These initiatives are unlikely to achieve their objectives without explicit consideration of the multilevel approach to change that includes the individual, group/team, organisation and larger environment/system levels. Attention must be given to issues of leadership, team development and information technology at all levels. A number of contingent factors influence reform efforts in both countries, such as historical context, organisation of the medical profession and the emergence of evidence based medicine. Each country has to balance a number of trade offs between centralisation and decentralisation in efforts to sustain the impetus for quality improvement.

MASS PRODUCTION

H. Berliner

Health Service Journal, vol.111, June 28th 2001, p.28

Health benefit schemes offered by US employers to their workers are unpopular with both parties. Employers, faced with greater regulation and higher prices, are finding it difficult to shift more costs onto workers. Employees, unhappy with the costs passed on to them, are dissatisfied with the restrictions employers have imposed on plans in an effort to contain costs.

MÜLLER HEALTH PLAN ADDS TO TENSIONS

H. Williamson

Financial Times, Jul. 18th 2001, p.8

Werner Müller, Germany's economics minister has put forward a radical proposal to reform the country's costly healthcare system. Published in the ministry's annual report, the proposals go against the current health ministers position. Article goes on to discuss how the proposals would alter health insurance contributions and discusses how he is proposing to spend the money. Mr Müller has said his proposals were meant to "promote discussion" and were not meant to represent policy.

NEOLIBERALISON AND HEALTH CARE

S. McGregor

International Journal of Consumer Studies, vol.25, 2001, p.82-89

Paper explores the neoliberal mindset shaping health care reform in the UK, Canada, the US, Australia and New Zealand. Neoliberalism is comprised of three elements: individualism, free market via deregulation, privatisation and decentralisation. After describing the nature of a health care system that is shaped by those embracing this mind set, an alternative approach is introduced that could bring dignity and a human face to health care.

PUBLIC RELEASE OF PERFORMANCE DATA AND QUALITY IMPROVEMENT: INTERNAL RESPONSES TO EXTERNAL DATA BY US HEALTH CARE PROVIDERS

H.T.O. Davies

Quality in Health Care, vol.10, 2001, p.104-110

Interviews with key stakeholders in six US hospitals showed that they were often (but not always) antipathetic towards publicly released comparative data. Such data were seen as lacking in legitimacy and their meanings were disputed. Nonetheless, the public nature of these data did lead to some actions in response, more so when the data showed that local performance was poor. There was little integration between internal and external data systems. Findings show that the public release of comparative data may help to ensure that greater attention is paid to the quality agenda within health care providers, but greater efforts are needed both to develop internal systems of quality improvement and to integrate these more effectively with external data systems.

PUBLICLY DISCLOSED INFORMATION ABOUT THE QUALITY OF HEALTH CARE: RESPONSE OF THE US PUBLIC

E.C. Schneider and T. Lieberman

Quality in Health Care, vol.10, 2001, p.96-103

The US experience of the past decade suggests that sophisticated quality measures and reporting systems that disclose information on quality have improved the process and outcomes of care in limited ways in some settings but have not led to the "consumer choice" market envisaged. Reasons for this failure include limited salience of objective measures to consumers, the complexity of the task of interpretation, and insufficient use of quality results by organised purchasers and insurers to inform contracting and pricing decisions. Nevertheless public disclosure may motivate quality managers and providers to undertake changes that improve the quality of care.

RECENT HEALTH POLICY INNOVATIONS IN SOCIAL SECURITY

A. Ron and X. Scheil-Adlung (eds)

London: Transaction Publishers, 2001 (International Social Security Series; vol.5)

This book focuses on health insurance policy innovations in selected countries in Africa, the Americas, Asia and Europe. It looks specifically at "new approaches in extending coverage in a health insurance system, confronting resource scarcity, innovative strategies, refining benefits to meet current needs, new institutional and administrative frameworks and transformations through information technology systems".

REFORMS AND PERFORMANCE OF THE MEDICAL SYSTEMS IN THE TRANSITION STATES OF THE FORMER SOVIET UNION AND EASTERN EUROPE

C. Davis

International Social Security Review, vol.54, no.2/3, 2001, p.7-56

In the initial years of transition most countries in the former Soviet Union and Eastern Europe experienced increases in morbidity and mortality that were due to deteriorating social, economic and environmental conditions and deficiencies in medical systems. These were the result of economic collapse, continued low priority status of health, and ineffective health reforms. Although health trends in the East have become more positive in recent years, they are unlikely to converge rapidly with those in Western Europe unless health services in transition countries to get more resources and improve their efficiency.

AN "UPSIDE-DOWN" VIEW OF RURAL HEALTH CARE

M. Mahoney et al

International Journal of Consumer Studies, vol.25, 2001, p.102-113

In Australia, the difficulties experienced by rural communities in attracting doctors has long been recognised as a contributing factor to the relatively high levels of morbidity and mortality in rural areas. Paper, based on the study of two small rural communities in Australia, suggests that improving the health of people in country areas will require more than increasing the accessibility of health services. Well-being in such communities relies as much on the sense of community cohesion as it does on access to medical services. This cohesion has in recent years diminished due in part to government policies that have encouraged an exodus to the cities. Governments need to focus on building healthy communities rather than simply on provision of medical services.

THE WIDER PICTURE

J. Lyall

Health Service Journal, vol.111, July 5th 2001, p.20

Delegates from a number of countries at the European Health Management Association conference have all reported problems of running health systems for increasingly demanding patients in the face of growing staff shortages.