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Welfare Reform on the Web (March 2002): Health Care - Overseas

THE CHALLENGE OF HOSPITALS IN HEALTH SECTOR REFORM: THE CASE OF ZAMBIA

E. Blas and M. Limbambala

Health Policy and Planning, vol. 16, suppl. 2, 2001, p.29-43

Results of the study show that Zambia is faced with a large and very run down hospital sector which it cannot afford to maintain. The geographic distribution of hospital capacity is highly inequitable, with most beds and doctors concentrated in the Copperbelt and Lusaka. The referral system is not working: higher level hospitals provide a better standard of care to their immediate catchment areas than is available in the rest of the country. Zambian doctors have either left the country or are concentrated at the highest referral levels in two provinces, leaving most of the country in the hands of expatriate doctors.

COST RECOVERY BEDS IN PUBLIC HOSPITALS IN INDONESIA

A. Suwanduno et al

Health Policy and Planning, vol. 16, suppl. 2, 2001, p.10-18

A policy of allowing public hospitals to invest in the development of more attractive in-patient facilities, as a way of selling services to those able and willing to pay for "hotel services", was introduced in Indonesia in the mid-1990s. Study shows that none of the three hospitals it investigated managed to recoup even their 1998 recurrent costs for running the commercial beds, although two recovered net costs. One reason for the low cost recovery ratios was that between 55% and 60% of the revenue was used for staff incentives, mostly for doctors. This was more than the maximum of 40% stipulated in the policy. The high proportions of total revenue going to staff were a result of hospital management having set bed fees too low.

FINANCIAL INCENTIVES IN HEALTH CARE: THE IMPACT OF PERFORMANCE - BASED REIMBURSEMENT

E. Forsberg, R. Axelsson and B. Arnetz

Health Policy, vol.58 2001, p.243-262

Paper examines the results of a study which looked at whether performance - based reimbursement (PBR) is a useful way to create the right incentives for efficiency improvements in healthcare. Study found that PBR may result in a greater cost awareness and shorter average length of stay, but it may also lead to negative effects on quality of care.

FRENCH PUBLIC HEALTH WORKERS NURSE WHOLESALE GRIEVANCES

R. Graham

Financial Times, Jan. 22nd 2002, p.18

Article notes that all is not well in the French public health system, acknowledged to be one of the best in Europe. Discontent from doctors, interns, hospital staff, midwives and nurses has culminated in a series of protest stoppages over pay and conditions.

HEALTH CARE IN FRANCE AND GERMANY: LESSONS FOR THE UK

D.G. Green and B. Irvine

London: Civitas, 2001

Argues that France and Germany enjoy a much better standard of health care than the UK because their systems are funded by social insurance.

IT HEALED ME - AND IT COULD CURE THE ILLS OF THE NHS

P. Preston

The Guardian, Jan 21st 2002, p.14

Author relates personal experience of Spain's system of public and low-cost private healthcare.

MANAGED COMPETITION FOR THE POOR OR POORLY MANAGED COMPETITION? LESSONS FROM THE COLOMBIAN HEALTH REFORM EXPERIENCE

B. Plaza, A. B. Barona and N. Hearst

Health Policy and Planning, vol.16, Suppl. 2, 2001, p.44-51

In 1993 Colombia enacted and subsequently implemented a radical reform of its healthcare system, moving from traditional provision via public hospitals to a managed competition model in which the government buys health insurance for the poor. The new system made important gains in the first few years, including the enrolment of 7 million Colombians in health insurance plans and improved access to cure. Problems arose from lack of a managerial infrastructure and lack of clear information about their rights for plan holders. This meant that insurance coverage did not always result in true access to health care.

ORGANISATION DEVELOPMENT IN HEALTH CARE: STRATEGIC ISSUES IN HEALTH CARE MANAGEMENT

R. K. Rushmer (ed) et al

Aldershot: Ashgate 2002

This book examines the impact of organisational development on improving quality and efficiency in healthcare. Focusing on organisational and managerial development is healthcare, it provides accounts of organisational reconfiguration in the UK and draws on experts from Europe and America. Structural and procedural changes are examined and it suggests that these changes must be matched by the development of human resource services if increases in efficiency and effectiveness are to be achieved.

PHARMACEUTICAL COST-CONTAINMENT POLICY: EXPERIENCES IN SHANGHAI, CHINA

S. Hu et al

Health Policy and Planning, vol. 16, Suppl. 2, 2001, p.4-9

In the decade after 1983, the annual growth rate of drug expenditure was about four times as high as that of per capita gross domestic product in Shanghai. In 1993 and 1994 a drug list policy and hospital revenue capping policy were introduced. These appear to have attained their objectives of containing the escalation of drug expenditure and improving the rational use of drugs without loss of equity.

THE POLICY ON PUBLIC - PRIVATE MIX IN THE UGANDAN HEALTH SECTOR: CATCHING UP WITH REALITY

H. Birungi et al

Health Policy and Planning, vol. 16, Suppl. 2, 2001, p.80-87

Article analyses Uganda's efforts to improve health service delivery through integrating the private sector with the national health system. Uganda has tried to evolve a policy based on consensus, but a framework for intervention is still missing. The policy inadequately addresses the institutional and legal issues that are critical for deriving a sustainable public - private mix strategy that reflects the dynamics of the Ugandan health care system.

A STAKEHOLDER APPROACH TOWARDS HOSPITAL ACCREDITATION IN INDIA

S. Nandraj et al

Health Policy and Planning, vol. 16. Suppl. 2, 2001, p.70-790

Accreditation has been recommended as a mechanism for assuring the quality of private sector health services in low income countries, especially where regulatory systems are weak. A survey was conducted in Mumbai, India, in 1997-98 to elicit the views of the principal stakeholders on the introduction of accreditation and what form it should take. There was a high level of support for the classical features of voluntary participation: a standards - based approach to assessing hospital performance; periodic external assessment by professionals; and the introduction of quality assurance measures to assist hospitals in meeting these standards. However, the biggest obstacle to introducing accreditation in poorly resourced settings such as India is how to finance it. This will need government support and funding.

STRENGTHENING USER PARTICIPATION THROUGH HEALTH SECTOR REFORM IN COLOMBIA: A STUDY OF INSTITUTIONAL CHANGE AND SOCIAL REPRESENTATION

M. Mosquera et al

Health Policy and Planning, vol. 16, Suppl. 2 p.52-60

The study took place in Cali, Colombia and focused on two institutional mechanisms created by the state to encourage citizen involvement in the health care system: user associations and customer service offices. This is a case study with multiple sources of evidence using a combination of qualitative and quantitative methods. Analysis revealed a range of practical concerns and a considerable degree of scepticism among public and private institutions, consumer groups and individual citizens about user participation. Although participation in Colombia has been introduced on political, managerial and ethical grounds, the study shows that users do not yet have a meaningful input into decision - making.

USER-PAYMENT, DECENTRALIZATION AND HEALTH SERVICE UTILIZATION IN ZAMBIA

E. Blas and M. Limbambala

Health Policy and Planning, vol. 16, Suppl. 2, 2001, p.19-28

Study was undertaken to assess the impact of health sector reform from 1993 to 1997 in Zambia in respect of health care service utilisation and the shift of caseload from hospitals to health centres. There was a dramatic fall in general attendance at both hospitals and health centres following the introduction of general user fees. The results of the study, however, also suggest that access to some priority services has markedly improved and that utilisation has shifted from the hospital to the health centre.

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