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

COMPARING THE CAMPAIGNING PROFILE OF MATERNITY USER GROUPS IN EUROPE: CAN WE LEARN ANYTHING USEFUL?

S Tyler

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.

DEVELOPMENT OF A "COMMUNICATION DISABILITY MODEL" AND ITS IMPLICATION ON SERVICE DELIVERY IN LOW-INCOME COUNTRIES

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.

FINANCING REFORMS OF PUBLIC HEALTH SERVICES IN CHINA: LESSONS FOR OTHER NATIONS

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.

FRANCE GIVES IN TO DOCTORS' FEE DEMANDS

R Graham

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.

FRANCHISING HEALTH SERVICES IN LOW-INCOME COUNTRIES

D Montagu

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.

FREE CHOICE OF SICKNESS FUNDS IN REGULATED COMPETITION: EVIDENCE FROM GERMANY AND THE NETHERLANDS

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.

THE GATEKEEPER IN VISION CARE: AN ANALYSIS OF THE COORDINATION OF PROFESSIONAL SERVICES IN THE NETHERLANDS

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.

HEALTH STATUS AND WORK BURDEN OF ALZHEIMER PATIENTS' CAREGIVERS: COMPARISONS OF FIVE DIFFERENT CARE PROGRAMS IN THE EUROPEAN UNION

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.

THE INFLUENCE OF INSTITUTIONS AND CULTURE ON HEALTH POLICIES: DIFFERENT APPROACHES TO INTEGRATED CARE IN ENGLAND AND THE NETHERLANDS

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.

IMPROVING BASIC HEALTH SERVICE DELIVERY IN LOW-INCOME COUNTRIES: VOICE TO THE POOR

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.

"LIFELONG INVESTMENT IN HEALTH" THE DISCURSIVE CONSTRUCTION OF "PROBLEMS" IN HONG KONG HEALTH POLICY

E Herdman

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.

MAKING MEDICINE FOR THE POOR: PRIMARY HEALTH CARE INTERPRETATIONS IN PELOTAS, BRAZIL

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.

ONE HUNDRED AND EIGHTEEN YEARS OF THE GERMAN HEALTH INSURANCE SYSTEM: ARE THERE LESSONS FOR MIDDLE AND LOW INCOME COUNTRIES?

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:

  • universal coverage was achieved;
  • equal access to a comprehensive benefit package was established;
  • equity in financing was improved;
  • consumer choice and competition were introduced into the system;
  • sustainability was ensured;
  • costs were contained.

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.

OPINIONS OF SWEDISH CITIZENS, HEALTH-CARE POLITICIANS, ADMINISTRATORS AND DOCTORS ON RATIONING AND HEALTH-CARE FINANCING

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.

POLICY RELEVANT DETERMINANTS OF HEALTH: AN INTERNATIONAL PERSPECTIVE

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.

PREFERENCES FOR PUBLIC HEALTH INSURANCE: EGOTISM OR ALTRUISM

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.

PROPHETS OR PROFITS?

H Berliner

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.

PUTTING EQUITY IN HEALTH BACK ONTO THE SOCIAL POLICY AGENDA: EXPERIENCE FROM SOUTH AFRICA

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:

  • failure to promote cross-subsidisation between private and public health sectors;
  • implementation of macroeconomic policies, particularly budget deficit reduction targets, which are likely to undermine social policy initiatives;
  • failure to involve communities in service development;
  • failure to sustain initial efforts through the Reconstruction and Development Programme to promote coherence in social policies.

RECIPROCITY, JUSTICE AND STATUTORY HEALTH INSURANCE IN GERMANY

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".

REGULATING INCENTIVES: THE PAST AND PRESENT ROLE OF THE STATE IN HEALTH CARE SYSTEMS

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.

RESHAPING THE STATE FROM ABOVE, FROM WITHIN, FROM BELOW: IMPLICATIONS FOR PUBLIC HEALTH

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.

A TYPOLOGY FOR PRIVATE PAYMENT SYSTEMS IN HEALTH CARE

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.

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