Click here to skip to content

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

DETERMINANTS OF MEDICAL EMPLOYMENT IN URBAN MEXICO: ASCRIPTION, ACHIEVEMENT AND CONTEXT

J. Frenk et al

Current Sociology, vol. 49, no. 3, May 2001, Monograph 1, p. 79-95

Over the past 25 years Mexico has been in a situation in which large numbers of unemployed doctors co-existed with populations without access to medical care. The health system was unable to absorb substantial increases in the supply of physicians. Measures were therefore taken in the 1980s to reduce the number of admissions to medical school. A survey in 1993 showed that this had led to reduced rates of un- and underemployment of doctors.

EVERYDAY EXPERIENCES OF IMPLICIT RATIONING: COMPARING THE VOICES OF NURSES IN CALIFORNIA AND BRITISH COLUMBIA

I. L. Bourgeault et al

Sociology of Health and Illness, vol. 23, 2001, p. 633-653

Based on group interviews with nurses in California and British Columbia, research shows that the price to be paid for the promise of cheaper and more efficient healthcare through managerial strategies in borne largely by nurses. Nurses in California and British Columbia share similar experiences of how the amount of care is rationed at the bedside through care pathways, early discharge policies and reduced staffing. The rationing of access to care, however, differs because of the differing socio-political contexts of the two health care systems.

FINANCING TO FOSTER COMMUNITY HEALTH CARE: A COMPARATIVE ANALYSIS OF SINGAPORE, EUROPE, NORTH AMERICA AND AUSTRALIA

J. Duff

Current Sociology, vol. 49, no. 3, May 2001, Monograph 1, p. 135-154

As populations of industrial countries age, there appears to be a convergence towards health and welfare policies that rely more on community care. There are hopes that community care will allow older people to remain in their own homes and be as autonomous as possible. However there are fears that this will usher in greater inequality in care in two ways. First, people who can afford to pay for care in the market will have a better quality of life in old age than those depending on residual state services. Second, women will be required to take on additional work, either in the low-paid secondary labour market or as unpaid carers, as fewer services are provided in the formal health and welfare sectors.

GOING DUTCH ON HEALTH

T. Reilly

Public Finance, Sept. 21st-27th 2001, p. 22-23

Describes the Dutch system of financing health services through a layered system of private and social insurance. Citizens who earn more than £18,700 per year are obliged by law to have private cover, although they remain free to choose their insurer. The state insurance system, the "Ziekenfonds" insure those who earn less than the wage cut-off and includes the over-65s with an annual pension of less than NLG 41,800, and the self-employed earning less than NLG 42,000.

IF CHANGING THE SKILL MIX IS THE ANSWER, WHAT IS THE QUESTION?

J. Buchan, J. Ball and F. O'May

Journal of Health Services Research and Policy, vol. 5, 2001, p. 233-238

Changing skill mix is often identified as a potential solution to health services staffing or resourcing problems, or is related to health service reform. Essay draws on research supported by the World Health Organization; it discusses what is meant by skill mix, provides a typology of the different approaches to assessing skill mix, and examines, by means of case studies, the contextual, political, social and economic factors that play a part in determining skill mix. These factors are examined in relation to three dynamics: the reasons (or drivers) for examining skill mix; the impact of contextual constraints; and the effect of varying spans of managerial control in different public and private health care systems.

THE IMPACT OF LEGISLATIVE VS NON-LEGISLATIVE QUALITY POLICY IN HEALTH CARE: A COMPARISON BETWEEN TWO COUNTRIES

E. M. Sluijs et al

Health Policy, vol. 58, 2001, p. 99-119

Article compares two countries with different quality management (QM) policies in health care organisations. In the Netherlands QM is required by law and health care is organised at a national level. In Finland, QM is not required by law and responsibility for organising health care rests with the municipalities. Data from a cross-sectional survey show that slightly more QM activities and more patient participation were found in Dutch health care organisations than in Finnish ones. However, the Finnish organizations reported more positive effects of their QM activities. Further analysis showed that some QM activities are more effective than others.

PUBLIC ROLES FOR THE MEDICAL PROFESSION IN THE UNITED STATES: BEYOND THEORIES OF DECLINE AND FALL

R. A. Stevens

Milbank Quarterly, vol. 79, 2001, p. 327-353

Articles assess the potential for medical professional organizations to assume a positive role in the health care system in the US. Reflects on why these organisations have lost credibility, how sociologists and historians have analyzed the changed role of the medical profession, and how the public service mission of the profession might be reinvented.

RATIONING HEALTH CARE TO DISABLED PEOPLE

G. L. Albrecht

Sociology of Health and Illness, vol. 23, 2001, p. 654-677

Paper analyses how medical care in a managed care environment is experienced by disabled users in the US. It identifies the major stakeholders and the politico-economic forces that influence individual, family and organisational decision-making. The disparity between the concept of managed care and the experienced reality is examined, and the consequences of rationing care for disabled people are explored. For disabled people in the US care is rationed at the service level and also in terms of restricted access to the care sought. This often results in inadequate care and inflated costs. These problems are due to the competitive nature of the major stakeholders, emphasis on profit maximisation, devaluing of the lives of disabled people and the weak bargaining position disabled people hold as consumers.

SENSE OF PLACE, ORGANIZATIONAL CONTEXT AND THE STRATEGIC MANAGEMENT OF PUBLICLY FUNDED HOSPITALS

N. T. Hanlon

Health Policy, vol. 58, 2001, p. 151-173

Paper looks at the influence of organisational setting and context on the strategic direction of public hospitals in a time of persistent fiscal and regulatory pressures. The example of public hospitals in Ontario is set out as a study of strategic management and organisational adaptation. While publicly funded organisations are generally more sheltered from the risks and uncertainties of the private sector, several years of fiscal and regulatory constraints have produced a qualitative change in the Canadian health care delivery environment, with growing pressure being exerted on managers by government to maintain access and quality while simultaneously controlling costs.

TO DIAGNOSE PRESCRIBE AND DISPENSE: WHOSE RIGHT IS IT? THE ONGOING STRUGGLE BETWEEN PHARMACY AND MEDICINE IN SOUTH AFRICA

L. Gilbert

Current Sociology, vol. 49, no. 3, May 2001, Monograph 1, p. 97-118

Article explores the conflict in South Africa between pharmacists' pursuit of their discretionary powers to prescribe and doctors' quest to engage in the dispensing of medicines. Adopting a global perspective, the article analyses issues such as occupational task boundaries, dominance, jurisdiction and autonomy of the professions. It also contemplates the role of the state in these issues in the current South African transitory context.

WHAT IS THE POTENTIAL FOR FORMAL PATIENT REGISTRATION IN CANADIAN PRIMARY CARE? THE SCALE OF INFORMAL REGISTRATION IN MANITOBA

V. Menec et al

Journal of Health Services Research and Policy, vol. 6, 2001, p. 202-206

Formal registration of patients with physicians is increasingly being considered in Canada as a means to improve the primary care system. The purpose of this study was to examine the extent to which patients were "informally" registered with a single provider group in Manitoba; that is the extent to which individuals received the majority of their care from the same clinic. Results showed that "informal" registration was higher among rural practices (60%) than among urban practices. This suggests that moving towards a formal registration system would involve considerable disruption to both patients and physicians.

WELFARE, CHOICE, AND SOLIDARITY IN TRANSITION: REFORMING THE HEALTH SECTOR IN EASTERN EUROPE

J. Kornai and K. Eggleston

Cambridge: Cambridge University Press, 2001

This book looks at the general principles of reform and characteristics of the health sector giving examples of international experiences. It goes on to focus on the health sector in Eastern Europe and offers health sector reform recommendations for 10 countries in Eastern Europe. Reform ideas are based on organized public financing for basic care, private financing for supplementary care, pluralistic delivery of services and managed competition.

Search Welfare Reform on the Web