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Welfare Reform on the Web (November 2001): Healthcare - Overseas

35-HOUR WEEK RISKS FRENCH HEALTH CHAOS

J. Henley

Guardian, Sept. 6th 2001, p.13

French government plans to impose a 35-hour working week on the health service without recruiting sufficient extra staff to plug gaps could lead to its collapse.

ADOPTION OF SMART CARDS IN THE MEDICAL SECTOR: THE CANADIAN EXPERIENCE

B. A. Aubert and G. Hamel

Social Science and Medicine, vol.53, 2001, p.879-894

Reports the results of research evaluating the factors influencing the adoption of smart cards in the medical sector. A smart card has a microprocessor which contains information about the patient; identification, emergency data, vaccination, drugs used and the general medical record. Results show that tangible benefits must be available to motivate professionals and clients to adopt the technology. The fundamental dimension that needs to be assessed before massive diffusion is the relative advantage to the professional. The relative advantage of the system for the professional is linked to the obligation for the client to use the card. The system is beneficial for the professional only if the information on the card is complete.

ELICITING PATIENTS' VALUES BY USE OF "WILLINGNESS TO PAY": LETTING THE THEORY DRIVE THE METHOD

C. Donaldson

Health Expectations, vol.4, 2001, p.180-188

Reviews the potential and the state of the art of "willingness to pay" techniques for assessing how patients value different forms of healthcare. Author reviews three different approaches used to elicit people's willingness to pay for healthcare. Suggests that approaches which ask people what they would be willing to pay in order to secure their preferred rather than their less preferred option are most promising.

HEALTHCARE IN A LAND CALLED PEOPLE POWER: NOTHING ABOUT ME WITHOUT ME

T. Delbanco et al

Health Expectations, vol.4, 2001, p.144-150

Article presents a vision of healthcare that was developed during a 5-day seminar by a diverse group of people from 29 different countries. Guided by the principle of "nothing about me without me" their shared aspirations involve a shift from biomedicine to infomedicine. This consists of patients and health workers joining in informed, shared decision-making and governance. Patients and clinicians contribute actively to the patient record, transcripts of clinical encounters are shared, and patient education occurs primarily in the home, school and community based organisations. Patients and clinicians jointly develop individual "quality contracts", serving as building blocks for quality measurement systems that aggregate data. In the community, citizens work with health professionals to adopt responsible health behaviours from the earliest school days.

THE OREGON HEALTH PLAN: RHETORIC, RATIONING AND REALITY

J. Oberlander, T. Marmor and L. Jacobs

British Journal of Health Care Management, vol.7, 2001, p.358-362

The Oregon Health Plan (OHP) expanded Medicaid to cover all state residents below the federally-established poverty line. The price for this expansion was to be paid by rationing services. A list of medical services was created. The legislature decided each session how much money to allocate for the OHP, and a line was drawn on the list according to how many services the allocation covered. All services above the line were paid for by the state. In fact Oregon has not rationed services very much at all, nor has its policy of cutting public coverage for services produced substantial financial savings.

STRATEGIES FOR PROMOTING EQUITY: EXPERIENCE WITH COMMUNITY FINANCING IN THREE AFRICAN COUNTRIES

L. Gilson et al

Health Policy, vol.58, 2001, p.37-67

Article presents findings from a three country study, undertaken in Kenya, Benin and Zambia in 1994/95, which was initiated in order to better understand the nature of the equity impact of community financing initiatives as well as the factors underlying this impact. The relative affordability gains achieved in Benin emphasise the importance of ensuring that financing change is used as a policy lever for strengthening health service management in support of quality of care improvements. All countries, however, failed in protecting the most poorest from the burden of payment, benefiting this group preferentially and ensuring that their views were heard in decision-making.

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