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

ACUTE HOSPITALS AND OLDER PEOPLE IN AUSTRALIA

J. McCormack

Ageing and Society, vol. 22, 2002, p. 637-646

The current and projected future levels of health expenditure on older people in Australia are receiving intense scrutiny. Older patients in acute hospitals are portrayed as being a major contributor to health system stress. Short-term policy responses are being developed which specifically target older people for early discharge and alternative levels of care. Although claiming positive intentions, these may both introduce new forms of age discrimination into the health system and reinforce the marginalisation of old and frail patients.

THE CHANGING NATURE OF CONTRACTS IN GERMAN HALTH CARE

P. Reimer - Hommel

Social Science and Medicine, vol. 55, 2002, p. 1447-1455

Article begins by describing the evolution of contracts in German health care and the rigidities inherent in the current system. Then surveys recent reform proposals, which all demand grater flexibility in the contracting arrangements between sickness funds and providers. This demands the introduction of selective arrangements. Article then analyses reforms already implemented, ie structural contracts and experimental settings, with regard to their impact on parties involved in financing and providing health care. Finally considers the impact that the reintroduction of selective contracts would have on the German health care market.

THE DISTRIBUTION OF HEALTH PLANNING AND MANAGEMENT RESPONSIBILITIES BETWEEN CENTRE AND PERIPHERY: HISTORICAL PATTERNS AND REFORM TRENDS IN FOUR CARIBBEAN TERRITORIES

A. Mills, and others

Health Policy, vol. 62, 2002. p. 65-84

The paper examines the historical distribution of responsibilities within the health sector in four territories: Trinidad and Tobago, the Bahamas, Martinique and Surinam. Identifies roles different levels, changes and reforms.

DO COMPETITION AND MANAGED CARE IMPROVE QUALITY?

N. Sari

Health Economics, vol. 11, 2002, p. 571-584

In recent years, the US health care industry has experienced a rapid growth of managed care, formation of networks, and an integration of hospitals. Paper provides new insights into the quality consequences of this dynamic in US hospital markets. Finds that higher managed care penetration increases quality, when inappropriate utilisation, wound infections and complications are used as indicators. On the other hand, hospital mergers have undesirable quality consequences.

EXPANDING THE SCOPE OF HEALTH REFORM: APPLICATION IN THE UNITED STATES

C. E. Begley and others

Social Science and Medicine, vol. 55, 2002, p. 1213-1229

Health reform debates worldwide tend to focus on pro-market versus non-market alternatives for improving the performance of health care systems. Paper proposes a broader definition under which all government initiatives whose primary purpose is to improve health should be considered part of health policy. Performance indicators traditionally used to evaluate market minimizing/maximizing strategies for reforming healthcare are redefined for evaluating strategies to improve health.

FAIRNESS, ACCOUNTABILITY FOR REASONABLENESS AND THE VIEWS OF PRIORITY SETTING DECISION-MAKERS

D. K. Martin, M. Giacomini and P. A. Singer

Health Policy, vol. 61, 2002, p. 279-290

Fairness is a key goal of priority setting and "accountability for reasonableness" has emerged as the leading framework for fair priority setting. However, as it was developed in the context of a primarily privately funded health system, its applicability to publicly funded systems is uncertain. Paper explores the applicability of accountability for reasonableness in actual priority setting in the Canadian health system, which is publicly funded. Results show that the framework is acceptable and applicable.

FINANCING OF HEALTH CARE IN FOUR CARIBBEAN TERRITORIES: A COMPARISON WITH REFORMS IN EUROPE

F. Rutten and others

Health Policy, vol. 62, 2002, p. 103-113

This paper considers health care finance in four Caribbean territories and plans for reform in comparison with developments in European countries.

HEALTH POLICY-MAKERS' PERCEPTIONS OF THEIR USE OF EVIDENCE: A SYSTEMATIC REVIEW

S. Innvaer and others

Journal of Health Services Research and Policy, vol. 7, 2002, p. 239-244

Summarises evidence from interview studies of facilitators of, and barriers to, the use of research evidence by health policy-makers. Two theoretical perspectives were dominant in the literature. The first argues that there are large and complex communication problems separating researchers from policy makers. This was often referred to as the "two communities thesis" or the "two cultures". The second perspective focuses on the concept of the "use of research". It argues that the word "use" is ambiguous and may have fundamentally different meanings.

HEALTH SYSTEMS DEVELOPMENT IN FOUR CARIBBEAN TERRITORIES: INTRODUCTION

E. Haqq and A. Mills

Health Policy, vol. 62, 2002, p. 55-63

Editorial, by guest editors, of the special section on health systems in the Caribbeans. Argues that, because the region has diversity of health care arrangements, the Caribbean offers an opportunity to explore the performance of different types of health systems.

THE HISTORICAL DEVELOPMENT OF HUMAN RESOURCES POLICIES IN THE HEALTH SECTOR OF FOUR CARIBBEAN TERRITORIES: IMITATED OR CREATED?

G. Walt, and others

Health Policy, vol. 62, 2002, p. 85-101

Paper explores the historical development of human resources, focusing on doctors and nurses, in four Caribbean territories - the Bahamas, Martinique, Surinam and Trinidad and Tobago.

AN INTERNATIONAL STUDY OF HOSPITAL READMISSIONS AND RELATED UTILIZATION IN EUROPE AND THE USA

G. P. Westert and others

Health Policy, vol. 61, 2002, p. 269-278

Study concerns a comparative analysis of hospital readmission rates in Finland, Scotland, the Netherlands and three states in the USA. Data showed that initial hospital stays were generally longer for patients who were readmitted than for those who were not. Short stays were not associated with a higher risk of readmission, meaning that hospital readmissions were not produced by premature discharges in the population. However, it was found that countries or states with relatively shorter stays showed higher readmission rates and vice versa. Since patients with readmissions in all of the areas had on average longer initial stays, this finding at country level indicates a country specific trade off between length of stay and rate of readmission.

NICHE WORK, IF YOU CAN GET IT

H. Berliner

Health Service Journal, vol. 112, Oct. 3rd 2002, p. 27

Single-speciality hospitals known as "focused factories" being developed in the USA are threatening the financial stability of general hospitals. They do not have to participate in Medicare or Medicaid, provide charity care or maintain accident and emergency departments. They can therefore be less expensive than general hospitals.

PARTICIPATION IN HEALTHCARE PRIORITY-SETTING THROUGH THE EYES OF PARTICIPANTS

D. Martin, J. Abelson and P. Singer

Journal of Health Services Research and Policy, vol. 7, 2002, p. 222-229

Paper begins with a review of the literature on public and professional participation in health care priority setting and describes three key gaps in it. Then describes the views of members of two priority setting committees in Ontario, Canada on participation. These suggest that members of the public can contribute directly to important aspects of priority setting. Interviews also suggested that consistency of committee membership over an extended period contributes to consistency in decision-making and that inclusion of a critical mass of individuals in certain roles can facilitate their contribution.

REFORMING THE REFORM: THE GREEK NATIONAL HEALTH SYSTEM IN TRANSITION

Y. Tountas, P. Karnaki and E. Pavi

Health Policy, vol. 62, 2002, p. 15-29

The state of continuous crisis in the Greek National Health System has led to the introduction of radical reforms. The changes are presented and discussed in this paper.

WHAT CAN THE NHS LEARN FROM US HEALTH CARE SYSTEMS?

M. Land and D. Sanderson

Primary Care Report, vol. 4, no. 16, Sept. 25th 2002, p. 36-37

In the first of three articles on the economics of health care the authors weigh up the pros and cons of managed care organisations like California's Kaiser Permanente.

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