Health Expectations, vol.5, 2002, p.136-147
Study used data from semi-structured interviews to compare the extent to which women in England, the Netherlands and Germany were able to exert influence over the organisation and delivery of maternity services. Results showed marked differences between the aspirations and achievements of the groups in the three countries. Understanding the differences between countries in relation to user involvement entails taking account of differing social, political and cultural conditions.
S D Hartley and S L Wirz
Social Science and Medicine, vol. 54, 2002, p.1543-1557
Paper presents data collected from stakeholders in the field of communication disability and from its analysis develops a model which can inform policy makers in low-income countries. As the majority of people with communication difficulties in low-income countries live in rural areas, proposes offering a network of services through community based rehabilitation workers who would tackle the social aspects of the problems and assist with integration.
X Liu and A Mills
Social Science and Medicine, vol. 54, 2002, p.1691-1698
In 1980 public health institutions in China were fully state financed. By the 1990s, the state funding had fallen to 30-50% of revenue, while the share of revenue generated by user charges had grown to 50-70%. The economic incentives built into the reforms has led to the over-provision of non-essential services, the under-provision of socially desirable services, and reduced user take up of preventive services.
Financial Times, June 6th 2002, p.6
France's centre-right interim government has agreed to raise doctors' consultancy fees. The move has headed off a rolling strike by general practitioners. The deal aims to offset the cost to the national health insurance scheme through a cut in prescribing.
Health Policy and Planning, vol. 17, 2002, p.121-130
Family planning social franchise programmes adapt the commercial franchising model to create networks of private medical practitioners offering a standard set of services under a shared brand. Franchise members are offered training programmes, brand and commodity advertising, and a range of other benefits. In return, providers may be required to meet sales quotas, maintain specific levels of service quality and pay franchise fees. Paper provides an introduction to the franchising of family planning services in developing countries and explores which aspects of a franchiseis context, business design and market positioning are crucial for the franchise organisation is ability to achieve social goals.
S Gress and others
Health Policy, vol 60, 2002, p.235-254
Both Germany and the Netherlands introduced competition between health insurance funds in the 1990s. In Germany, contribution rates differ significantly between sickness funds, causing consumers to switch frequently. In the Netherlands differences between premiums is much lower, as is the number of people who change. The extent to which consumers change funds thus depends strongly on economic incentives.
F C J Stevens, F van der Horet and F Hendrickse
Health Policy, vol. 60, 2002, p.285-297
Vision care in the Netherlands lacks a well defined gatekeeper function, and therefore, a hierarchy of services. People with eye problems can go to an optician, optometrist, GP, ophthalmologist or eye clinic with the same complaint. This can lead to the time of ophthalmologists being wasted on routine cases. Article discusses various options for establishing a gatekeeping system for vision care services in the Netherlands.
A Colver and others
Health Policy, vol. 60, 2002, p.219-233
Study compared home social services (Denmark), day centres (Germany), expert centres (Belgium and Spain), group living (Sweden and France) and respite hospitalisation (France). Results showed that the group living programme appeared to be the most efficient way of reducing informal caregiver burden, independently from the country considered. In these centres, patients are lodged in specialised housing with private rooms grouped around a communal living area. Domestic activities are led by a registered nurse or housekeeper. There is no medical service attached to the structure.
S Kumpers and others
Public Administration, vol. 80, 2002, p.339-358
New Labour has promoted the integration of health and social care through the use of hierarchy to create prescribed network structures at the local level, with a statutory duty on respective actors to work in partnership. A limited scope for local decision making, determination of priorities and division of tasks is left to the networks. However the Dutch model is characterised by a mix of public and private providers, with the government having to encourage voluntary co-operation through financial incentives and indirect regulations.
S Mehrotra and S W Jarrett
Social Science and Medicine, vol. 54, 2002, p.1685-1690
Paper argues that, at the present stage of the development of health services in Africa and South Asia, the accountability of public providers can be improved by the use of "voice" by the customers. "Voice" is used to mean that beneficiaries have a say in how services are run. Grassroots organisations have an important role in providing this voice, often facilitated by non-governmental organisations (NGOs). Government needs to change its role by targeting its scarce resources on the poor and working in partnership with grassroots organisations.
Health Policy and Planning, vol. 17, 2002, p.161-166
Article discusses the reforms of the health care system in Hong Kong outlined in the consultation document "Lifelong Investment in Health". The health system in Hong Kong is characterised by the dominance of the medical model and a top down approach that focuses on individual responsibility with little commitment to community empowerment. Powerful interest groups such as the medical profession, private hospital heads and government define the "problem" and determine service delivery and resource allocation in ways that do not respond to community needs. There exists a tension between "top down" disease prevention and lifestyle change and "bottom-up" community empowerment. While the rhetoric of community empowerment is well spread, the traditional approach prevails in practice.
D P Béhague, H Gonçalves and J Dias da Costa
Health Policy and Planning, vol. 17, 2002, p.131-143
Paper explores the local political setting in which primary health care and community participation have been implemented in Pelotas, Brazil. Low income families have tended to reject public primary health care services in favour of private provision. This appears to be due at least in part to the poor quality of the public services, rather than any attachment to traditional (folk) health beliefs. The public primary health care services offered have focused on adequate preventive care and community empowerment. This has not met families' perceived needs for access to modern biomedical treatment.
T Bärnighausen and R Sauerborn
Social Science and Medicine, vol. 54, 2002, p.1559-1587
This study of the history of the German social health insurance system shows how:
Analysis is focused on the mode of development and the institutional arrangements. For each question analysed, authors consider whether experiences from the German case may be of use to low and middle-income countries.
P Rosén and J Karlberg
Health Expectations, vol. 5, 2002, p.148-155
Data were gathered through a postal survey based on a randomised sample of adults in Sweden and stratified samples of politicians, administrators and doctors. Results showed that the general public had high expectations of public health care which did not correlate with the professionals' and politicians' ideas of what could be offered. Physicians were in favour of increasing funding for healthcare through higher patient fees and use of private health insurance. They also wanted national politicians to take decisions about resource allocation within public healthcare, and to assume responsibility for excluding certain treatments. Politicians, however, preferred physicians to make the rationing decisions.
B Starfield and L Shi
Health Policy, vol. 60, 2002, p.201-218
A 1980s study indicated that the strength of the primary care infrastructure of a health service system might be related to overall costs of health services. The present study of thirteen industrialised countries aimed to determine the robustness of these findings in the light of the passage of 5-10 years. The countries were characterised by the relative strength of their primary care infrastructure, the degree of national income inequality and prevalence of smoking. Major indicators of health and health care costs were used as dependent variables. Results showed that the relationship between the strength of primary care and good performance with regard to lower costs and relevant measures of health was the same in the 1990s as the 1980s.
A Shiell and J Seymour
International Journal of Social Economics, vol. 29, 2002, p.356-369
A sample of 403 people from central Sydney, NSW participated in a telephone survey to elicit preferences for public or private health insurance. The results suggest a strong altruistic support for publicly funded health care even among those whose interests are better served by incentives to take out private health insurance. This result undermines the assumption in the public choice literature that people will only vote for a tax policy if it is in their self-interest.
Health Service Journal, vol. 112, June 7th 2002, p.11
US managed care has neither improved care nor contained costs. Health Maintenance Organisations combine glitzy marketing campaigns with inefficient services. Economic depression in the US is likely to lead to contraction in the health care industry, and companies are looking for new markets in the UK.
D McIntyre and L Gilson
Social Science and Medicine, vol. 54, 2002, p.1637-1656
Health Service reforms aimed at promoting equity are high on the social policy agenda, and certain programmes have been developed which are intended preferentially to benefit those who have been historically disadvantaged. However the reforms are being hampered by:
C G Ullrich
Journal of European Social Policy, vol. 12, 2002, p.123-136
Study investigates why attitudes supportive of social welfare are prevalent and even among taxpayers who rarely receive benefits. Qualitative data show that, in the case of the German statutory health insurance, the normative orientations and interest motives of scheme members correspond with the rates of financing and provision of health care benefits. The analysis focuses on two kinds of collective representations: "expectations of reciprocity" and "need-oriented beliefs about justice". Both types of collective representations serve to reconcile individual definitions of self-interest and basic value orientations with the institutional order of the scheme. Together they provide two pre-requisites for broad public support for the welfare state: the ability to refrain from pursuit of immediate self-interest and a "social consciousness".
R B Saltman
Social Science and Medicine, vol. 54, 2002, p.1677-1684
The desire of national policymakers to encourage entrepreneurial behaviour in the health sector has generated a new structure of market-oriented incentives and a new regulatory role for the state. To ensure that entrepreneurial behaviour will be directed towards achieving planned market objectives, the state must shift from bureaucratic models of command and control to more sensitive and sophisticated systems of oversight and supervision. Evidence suggests that this structural transformation is currently occurring in several North European countries.
M R Reich
Social Science and Medicine, vol. 54, 2002, p.1669-1675
From above, the modern state is constrained by agreements promoted by international agencies and by the power of multinational corporations. From within, the state is being reshaped by marketisation and by problems of corruption. From below, the state's role is being eroded through decentralisation and the rising influence of non-governmental organisations. Article suggests some implications of these processes for public health.
M Jegers and others
Health Policy, vol. 60, 2002, p.255-273
Article provides a framework to classify provider reimbursement systems according to the degree to which these might offer incentives for improved quality, efficiency and accessibility of care.