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

CLOSING THE GAP BETWEEN RESEARCH AND PRACTISE IN HEALTH: LESSONS FROM A CLINICAL EFFECTIVENESS INITIATIVE

R Surender, and others
Public Management Review, vol.4, 2002, p.45-61.

Article looks at the current popularity of evidence based public services. Authors suggest a number of key factors that need to managed if this is to be effective, particularly the role of macro-systems and of human agency.

EXAMINING THE ROLE OF HEALTH SERVICES RESEARCH IN PUBLIC POLICY

J. N. Lavis et al
Milbank Quarterly, vol.80, 2002, p.125-154

Used organising frameworks and analytic insights from three research fields to study the role of health services research in public policy making, with Canada as an example. Results suggest that:

• some policies seem to be particularly amenable to being informed by research;
• accepting as research use only explicit statements from policy-makers as to how they used citable research appears to be an over simplification of a complex process;
• sustained interactions between researchers and policy makers appear to make a difference.

There is a need to look at research use in the context of other, competing influences.

HEALTH SECTOR REFORM IN SOUTH ASIA: NEW CHALLENGES AND CONSTRAINTS

A. Islam and M. Z. Tahir
Health Policy, vol.60, 2002, p.151-169

Paper critically examines the impact of four interconnected forces on the health sector in South Asia:

• economic globalisation and the information/communication revolution;
• continuing population growth;
• the HIV/AIDS pandemic;
• urbanization.

MANAGED CARE MEMBERS TALK ABOUT TRUST

S. D. Goold and G. Klipp
Social Science and Medicine, vol.54, 2002, p.879-888

Members of managed health care schemes in Michigan discuss their trust, or lack of it, in individual physicians, the medical profession generally, hospitals, and insurers.

MARKET REFORMS AND PUBLIC INCENTIVES: FINDING A BALANCE IN THE REPUBLIC OF MACEDONIA

R. J. Nordyke and J. W. Peabody
Social Science and Medicine, vol.54, 2002, p.939-953

Health sector reforms in Macedonia seek to improve the quality and efficiency of primary care by strengthening the role of the market in health care provision. The implementation of a capitation payment system to incentivise primary health care physicians is proposed. In addition, the sale of primary health care clinics to private groups is being considered.

MEDICAID MATTERS: CHILDREN'S HEALTH AND MEDICAID ELIGIBILITY EXPANSIONS

K. A. Lykens and P. A. Jargowsky
Journal of Policy Analysis and Management, vol. 21, 2002, p.219-238

In the late 1980s the US federal government enacted a series of laws which extended Medicaid eligibility to more children. States had considerable discretion as to how fast and how far these expansions were implemented. As a result, there was great variation amongst the states in defining who was eligible for the programme. Using data from the National Health Interview Survey, authors investigated whether the Medicaid expansions improved child health. Results showed that white children experienced significant reductions in acute health conditions and functional limitations. Black and Hispanic children showed some evidence of improvement, but this was inconclusive in the study sample.

NOT AFRAID TO BLAME: THE NEGLECTED ROLE OF BLAME ATTRIBUTION IN MEDICAL CONSUMERISM AND SOME IMPLICATIONS FOR HEALTH POLICY

M. Rosenthal and M. Schlesinger
Milbank Quarterly, vol.80, 2002, p41-95

In a US managed care context, article investigates whom patients blame when they suffer a bad outcome, what determines whether they attribute responsibility to their physician or their health insurance plan, and what determines whether or not they will act if dissatisfied by, for example, complaining. Authors develop a new conceptual framework and set of hypotheses, building on ideas ranging from attribution theory in psychology to theories of exit, voice and loyalty. They then test these hypotheses using data from a survey of people with serious mental health problems and discuss the implications of their findings for medical consumerism in health policy.

PATHOLOGY SERVICES AS A PILOT FOR THE MARKET-LED CONTROL OF HEALTH RESOURCES IN NEW ZEALAND

N. France, J. F. Smith and S. Lawrence
Public Management Review, vol.4, 2002, p.23-43

An analysis of the impact of imposed market reforms upon Health Services in New Zealand. The conclusions are not optimistic regarding the impact of such reforms upon public services. Authors conclude that many of the market models are too simplistic to deal with the complex rationing and decision making aspects of public health services.

PERFORMANCE - BASED CONTRACTING IN WISCONSIN PUBLIC HEALTH: TRANSFORMING STATE - LOCAL RELATIONS

J. Chapin and B. Fetter
Milbank Quarterly, vol.8 2002, p.97-124

Article documents a first attempt by a state to develop and implement a performance - based system that holds local health departments accountable. Article describes how the system works and the political strategies that were used to put it into place.

PLURALISM, PUBLIC CHOICE, AND THE STATE IN THE EMERGING PARADIGM IN HEALTH SYSTEMS

Argues that consumers of health care can be empowered when the state financed system includes competing fund-holding institutions that organize and manage the consumption of care (OMCC), such as Health Maintenance Organisations and sickness funds. OMCC institutions can play an essential role in shaping individual's entitlement to care and expressing their members' preferences. To do this, the OMCCs need to be financed through capitation and endowed with appropriate constitutional rights on how to use the funds.

PRIVATE MEDICAL PRACTITIONERS AND MANAGED CARE IN MALAYSIA: A SURVEY OF KNOWLEDGE AND ATTITUDES HELD BY FEDERAL TERRITORY BASED DOCTORS

G. Marnoch and P. C. S. Lian
Social Science and Medicine, vol.54, 2002, p.869-877

Results show that the majority of private doctors have concerns about the implementation of managed care in Malaysia. They fear loss of clinical autonomy, and that financial considerations may prevail over patient need. However most respondents believed that managed care would become increasingly prevalent, and expressed a willingness to be trained in its principles.

REFORMING CHINA'S URBAN HEALTH INSURANCE SYSTEM

Y. Liu
Health Policy, vol.60, 2002, p.133-150

Since the 1980s China has implemented a series of health insurance system reforms, culminating in the decision in 1998 to introduce a social insurance scheme for urban workers. This replaced a network of labour insurance schemes based on work-units and the government employee insurance scheme. The new scheme expands coverage to include private sector employees and is administered by the municipalities. It is financed by premium contributions from employers and employees.