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Welfare Reform on the Web (August 1999): Health Care - Overseas

THE CHANGING US HEALTH CARE SYSTEM: CHALLENGES FOR RESPONSIBLE PUBLIC POLICY

M. Gold
The Milbank Quarterly, vol. 77, 1999, p. 3-37

An analysis of five important themes that emerged from a review of the recent literature on health system change shows that an inherent tension exists between the interest in rapidly driving down health care costs through organisational change and the long time frames that are required to make fundamental changes in structure, process and orientation. In an environment in which purchasers are driven to seek cost savings and the political will supports a mixed public/private system, the health systems may take an alternative route, with purchasers relying increasingly on individual cost sharing and continuing to cut back on the amount of coverage they are willing to offer.

INTERNAL MARKETS AND HEALTH CARE EFFICIENCY : A MULTIPLE-OUTPUT STOCHASTIC FRONTIER ANALYSIS

U. G. Gerdtham and others

Health Economics, vol. 8, 1999, p.151-164

Tests for the existence and magnitude of the effect of purchaser/provider split combined with new reimbursement schemes on technical efficiency in the Swedish public hospital system. The analysis is carried out with a panel dataset covering the total population of 26 Swedish County Councils from 1989 to 1995. Results indicate that output-based reimbursement improves technical efficiency. The potential cost saving in a switch from budget-based allocation to output-based allocation is estimated to be almost 10%.

PAYMENT FOR HEALTH IN THAILAND

D. A. Reisman

International Journal of Social Economics, vol. 26, 1999 p. 609-641

Paper begins by discussing the age-structure and geographical distribution of the Thai population, together with mortality and morbidity rates. Then considers the delivery of both private and state health care. Finally evaluates seven ways in which health care is financed in Thailand and makes recommendations for the future of social insurance.

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