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Welfare Reform on the Web (September 2002): Healthcare - Overseas

ATTRACTION OF OPPOSITES

J Buchan

Health Service Journal, vol. 112, July 4th 2002, p.22-24

Magnet hospitals in the US are institutions which have been identified as being successful in recruiting, retaining and motivating nursing staff. Research on magnet hospitals has highlighted positive links between good human resources management, staffing characteristics and outcomes of care. Key to magnet organisations are participative management style, strong professional development and flexible working practices. The magnet concept appears to be an effective way of tackling nurse shortages in the UK.

DENTISTRY AND DISTRIBUTIVE JUSTICE

S Dharamsi and M J MacEntee

Social Science and Medicine, vol. 55, 2002, p.323-329

The potential demand globally for dental services is enormous, but those that are offered are predominantly curative with only a small emphasis on disease prevention. Moreover, there is no obvious agreement on what constitutes a reasonable range of oral healthcare services, a just allocation of resources, or fair compensation to providers. Delivery of care can be viewed from several theoretical perspectives, but the greatest rewards for society can be derived from an egalitarian (universal access) perspective on prevention supplemented by a social contract for curative care that will render maximum benefit to the least advantaged.

E-HEALTH: IMPACTS OF INTERNET TECHNOLOGIES ON VARIOUS HEALTHCARE AND SERVICES SECTORS

S Martin, D C Yen and J K Tan

International Journal of Healthcare Technology and Management, vol. 4, 2002, p.71-86

Various sectors of the healthcare and services industry in North America are embracing the internet to provide more efficient workflows, reduce time lags, and so lower costs. This article highlights the traditional characteristics, tasks and functions of various health services sectors including hospitals, nursing homes, physicians' offices, health insurers and pharmaceutical companies. It then explores the benefits and risks of modern healthcare internet applications to these sectors.

E-HEALTHCARE STRATEGIES AND IMPLEMENTATION

K Siau, P B Southard and S Hong

International Journal of Healthcare Technology and Management, vol.4, 2002, p.118-131

Intense competition between healthcare providers in the US has encouraged them to increase efficiency by cutting costs, improving decision-making processes and raising the quality of patient care through information technology. Paper describes various decision-support systems, internet applications and e-business opportunities for healthcare organisations.

EVALUATION OF EXPLICIT PRIORITISATION FOR ELECTIVE SURGERY: A PROSPECTIVE STUDY

S Derrett and others

Journal of Health Services Research and Policy, vol. 7, 2002, Suppl. 1, p.14-22

New Zealand has been at the forefront of attempts to improve the management of waiting lists as a means of determining fair access to elective surgery. The Priority Criteria project developed criteria to rank patients for surgery. In 1996 criteria were introduced nationally in conjunction with a system of booking specific times for surgery for patients who were above the criteria thresholds. Research investigated:

  • whether Clinical Priority Assessment Criteria (CPAC) scores determine access to surgery in practice;
  • whether CPAC scores prioritise according to need at the time of hospital assessment;
  • whether CPAC scores prioritise according to ability to benefit from surgery.

GOOD VIBRATIONS

T Shifrin

Health Service Journal, vol. 112, June 27th 2002, p.15

US health maintenance groups such as Kaiser Permanente are likely to be used as consultants to improve primary care trust performance. Kaiser can offer access to very sophisticated IT systems that combine an electronic patient record with decision support software that would provide doctors with the latest recommended interventions for a particular condition.

HEALTH INFORMATION PRIVACY AND E-HEALTHCARE

E P Kelly and F Unsal

International Journal of Healthcare Technology and Management, vol. 4, 2002, p.41-52

Information privacy in e-healthcare is at present inadequately addressed by state and federal law in the US. Article examines issues of health information privacy, covering:

  • personal health data collection;
  • legal perspectives;
  • ethical challenges.

HOW COMPREHENSIVE ARE THE BASIC PACKAGES OF HEALTH SERVICES? AN INTERNATIONAL COMPARISON OF SIX HEALTH INSURANCE SYSTEMS

M Polikowski and B Santos-Eggimann

Journal of Health Services Research and Policy, vol. 7, 2002, p.133-142

By explaining the basic package of services covered by social health insurance in France, Germany, Israel, Luxembourg, The Netherlands and Switzerland this paper identifies the major differences between the countries. It looks at the possible factors that explain these differences.

THE IMPACT OF MANAGED CARE AND PRACTICE SIZE ON PRIMARY CARE FOR PHYSICIANS' PERCEIVED ABILITY TO REFER

T Xu, J Rohrer and T Borders

Journal of Health Services Research and Policy, vol.7, 2002, p.143-150

This paper compares the perceived ability of primary care physicians to refer patients when medically necessary and determines how this influences the quality of care patients receive in the US. It compares the approaches of solo/two physician practices and group practices.

IMPEDIMENTS TO CHANGE IN AN AUSTRALIAN TRIAL OF COORDINATED CARE

K Gardner and B Sibthorpe

Journal of Health Services Research and Policy, vol. 7, 2002, Suppl. 1, p.2-7

The Australian Capital Territory (ACT) Coordinated Care trial pooled funds from five sources through a new purchasing organisation, Care Plus. Eligible clients were those who, in the opinion of their GP, had complex needs and could benefit from improved care coordination. GPs were care co-ordinators and ordered services for which Care Plus was billed. 1271 clients were recruited and assigned to intervention and control groups at a ratio of 3:2. Results showed that the trial had no discernible impact on client health and well-being although it probably operated within existing resources. Paper examines reasons for the trial's relative lack of success in achieving its objectives.

IMPLEMENTING HOSPITAL REFORM IN CENTRAL AND EASTERN EUROPE

J Healy and M Mckee

Health Policy, vol. 61, 2002, p.1-19

Paper explores the experiences of attempts to restructure hospital systems in countries of central and Eastern Europe and the former Soviet Union. It identifies a series of challenges that have often been addressed inadequately. These include a failure to take account of the specific context within which reform is taking place, an over reliance on market mechanisms to bring about change, insufficient recognition of the wide range of stakeholders involved, a failure to ensure that policies and incentives are aligned, and a lack of appropriate human resources to implement change.

IMPROVING THE QUALITY OF HEALTH CARE IN THE UNITED STATES OF AMERICA: THE NEED FOR A MULTI-LEVEL APPROACH

D Mechanic

Journal of Health Services Research and Policy, vol.7, 2002, Suppl. 1, p.35-39

Article considers both factors internal to the health care system and those from the outside that affect the quality of medical care in the USA. Good care begins with quality of medical education, professional culture and leadership, and availability of reliable information for consumers about services. The functioning of the system is also influenced and constrained by three external factors: private and government regulation, the legal system and opportunities for litigation, and the activism of advocacy groups representing consumers, professionals and other interest groups.

A LOSS OF FAITH: SOURCES OF REDUCED POLITICAL LEGITIMACY FOR THE AMERICAN MEDICAL PROFESSION

M Schlesinger

Milbank Quarterly, vol.80, 2002, p.185-235

Article explores the reasons for the loss of authority by the American medical profession since the mid twentieth century. Found that:

  • policy elites are less supportive of physicians' influence than the general public;
  • the erosion of medical authority in American politics can be attributed largely to concerns about medical efficacy, the failure of physicians to maintain their altruistic image of treating the poor, and a lack of trust in the political involvement of the medical profession;
  • the public is more concerned than elites about physicians' failure to act as agents for patients, but many of these concerns are not associated with reduced support for medical authority.

MEETING THE HEALTH CARE NEEDS OF PERSONS WITH DISABILITIES

C M Clancy and E M Andresen

Milbank Quarterly, vol.80, 2002 p.381-391

The US Agency for Healthcare Research and Quality has established the Office of Priority Population Research and is currently developing a research agenda to improve healthcare for persons with disabilities.

THE ORGANISATION AND FINANCING OF HEALTH SERVICES FOR PERSONS WITH DISABILITIES

G DeJong and others

Milbank Quarterly, vol.80, 2002, p.261-301

The article outlines the principal challenges in health care organisation, delivery and financing for disabled people in the US, and how the health services research community might help to meet these challenges. It first specifies the size and scope of the population, the changing epidemiology and demography of disability, the variety of healthcare needs of people with disabilities, and their actual utilisation of healthcare.

POLICY AND PROFESSION: ELITE PERSPECTIVES ON REDEFINING GENERAL PRACTICE IN AUSTRALIA AND ENGLAND

J Lewis

Journal of Health Services Research and Policy, vol.7, 2002, suppl. 1, p.8-13

There is a significant literature on the apparently growing propensity of states to redefine their relationships with the medical profession, and a widely accepted argument that an erosion of clinical freedom or academic autonomy is occurring. Paper aims to understand how policy elites perceive the medical profession is being redefined and is redefining itself, and to build a framework that can be used for analysing this redefinition. General practice was chosen as the focus since there has been a large amount of policy attention directed at it in both Australia and England in the last decade. Found that policy elites perceive that the authority and autonomy of general practitioners has changed but the reforms have not led to generalised losses for the profession.

POLITICAL CULTURES, HEALTH SYSTEMS AND HEALTH POLICY

S Atkinson

Social Science & Medicine, vol.55, 2002, p.113-124

This paper examines the critical role played by informal aspects of health system management and the political cultures of the country in the implementation of policy and the performance of local health systems. It looks specifically at research carried out in Northeast Brazil.

PRIMARY HEALTH CONCEPT REVISITED: WHERE DO PEOPLE SEEK HEALTH CARE IN A RURAL AREA OF VIETNAM

N K Khe and others

Health Policy, vol. 61, 2002, p.95-109

Results of a survey indicate that self-treatment is common practice and private providers are an important source of health services for both rich and poor households. The costs of health care are substantial for households, and lower income groups were found to spend a greater proportion of their income on health care than the rich. Recommends that the burden on the poor be reduced through:

  • funding rural health care services primarily out of taxation;
  • developing risk sharing schemes such as co-payment or community based health insurance;
  • supporting and regulating the private sector;
  • contracting out state services to private providers.

PUBLIC-PRIVATE PARTNERSHIPS FOR PUBLIC HEALTH

M R Reich (ed)

Cambridge, Mass: Harvard Center for Population and Development Studies, 2002

Focusing on the use of public-private partnerships and of specific products to improve health conditions in poorer countries, this book brings together case studies of specific diseases, international organisations and multinational pharmaceutical companies to guide efforts to reduce global health disparities.

REDUCING INEQUALITIES IN HEALTH: A EUROPEAN PERSPECTIVE

J Mackenbach and M Bakker

London: Routledge, 2002

This book examines successful policies and interventions for reducing inequalities in health care. It compares the approaches taken by 14 European countries; it discusses conceptual issues for research; it provides examples of good and bad practice and points out the policy and research implications for the future.

REFORM AND COUNTER REFORM: HOW SUSTAINABLE IS NEW ZEALAND'S LATEST HEALTH SYSTEM RESTRUCTURING?

J Cumming and N Mays

Journal of Health Services Research and Policy, vol.7, 2002, suppl.1, p.46-55

Paper focuses on recent health care reform experiences in New Zealand, particularly the rapid implementation of a quasi-market model and its subsequent dismantling in the 1990s, and the establishment in 2000/01 of 21 territorial District Health Boards (DHBs) to manage the planning and delivery of services for their populations. They will be responsible for promoting health, purchasing services for their populations from primary and community health care providers, and delivering publicly owned health services, including public hospitals and related facilities.

TOWARDS IMPROVING HOSPITAL PERFORMANCE IN UGANDA AND ZAMBIA: REFLECTIONS AND OPPORTUNITIES FOR AUTONOMY

K Hanson and others

Health Policy, vol.61, 2002, p.73-94

In Zambia and Uganda decentralisation has been applied to district level hospitals while some measure of autonomy (known as self-accounting in Uganda) has been given to higher level referral hospitals. Both policies involve a change in the locus of control over key management decisions. Decentralisation devolves these to a regional authority, while autonomy delegates key decisions to a hospital board. Both approaches raise issues of institutional capacity below the central level, the appropriate balance of power between the centre and the regions, and the best strategy to promote a public health agenda and defend against narrow local interests. In addition autonomy usually implies a degree of market exposure, leading to incentives to pursue revenue generation, and introduction of, or increases in, user charges.

UNITED STRAITS

H Berliner

Health Service Journal, vol.112, June 27th 2002, p.32

The US is facing difficulties in the recruitment and retention of hospital nurses which it is solving in the short term by importing them from abroad. The long term solution of the problem requires more recruitment from among black and minority ethnic groups in its own population and better working conditions in hospitals.

WHAT DOES 'ACCESS TO HEALTH CARE' MEAN?

M Gulliford et al

Journal of Health Services Research and Policy, vol.7, 2002, p.186-188

'Access' can be considered a complex concept. This article evaluates four aspects of access: services availability; utilisation of services and barriers to access; relevance, effectiveness and access; and equity and access.

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