Welfare Reform on the Web (March 2003): Healthcare - Overseas

THE EFFECTS OF MANAGED CARE ON MEDICAL REFERRALS AND THE QUALITY OF SPECIALITY CARE

G.M. Fournier and M.M. McInnes

Journal of Industrial Economics, vol. 2, 2002, p. 457-474

Study looked at inpatient operations by surgeons in Florida and examined the relative number of patients treated by payer type (fee-for-service or Health Maintenance Organisation (HMO). Found that, after controlling for other risk factors such as speciality and experience, physicians who have additional malpractice claims over time tend to lose more fee-for-service patients than physicians with few claims. However, the same sort of shunning is not present among HMO patients. Evidence suggests that by providing a source of referrals when shunning occurs in the fee-for-service sector, managed care may protect a physician whose reputation has been damaged by medical malpractice.

EQUITY PRIVATIZATION AND COST RECOVERY IN URBAN HEALTH CARE: THE CASE OF LAO PDR

C. Paphassarang and others

Health Policy and Planning, vol. 17, suppl. 1, 2002, p. 72-84

The social goal of access to quality health care for all, as outlined in the Lao PDR reform policy, is not likely to be achieved with the current direction of development. Inequities between those who can afford comprehensive private services, such as through licensed private clinics, and those who have no access or have to settle for buying drugs on an ad hoc basis from private pharmacies are huge and likely to grow as the private sector becomes more entrenched. People are put off using public hospitals, regardless of their socio-economic status, by unwelcoming staff attitudes and procedural barriers.

EXEMPTIONS AND WAIVERS FROM COST SHARING: INEFFECTIVE SAFETY NETS IN DECENTRALISED DISTRICTS IN UGANDA

G. W. Kivumbi and F. Kintu

Health Policy and Planning, vol. 17, suppl. 1, 2002, p.64-71

The introduction of user payment systems for health services is frequently followed by concern about their impact on equity of access for poor people. Governments try to remedy the inequities they have created by introducing a system of exemptions and waivers. Study investigated constraints in implementation of exemption schemes in two administrative districts in Uganda. Little evidence was found of implementation of exemptions from payment by district governments, as their prime concern was to raise revenue to cover costs.

HEALTH EQUITY IN TRANSITION FROM PLANNED TO MARKET ECONOMY IN CHINA

J. Gao and others

Health Policy and Planning, vol. 17, suppl. 1, 2002 p. 20-29

Despite improvement in the health status of the Chinese population from 1993 to 1998, as expressed by the decline in overall and infant mortality rates and possible decline in health care needs, there is reason for concern about equity of access. There is a general trend to reduced equity in respect of receiving health care according to need within and between urban and rural population. Furthermore, there is evidence that the better off do not pay their fair share of increasing health care costs. Lower income groups are clearly stretched, using a much larger proportion of their incomes to pay for health care than those in the high-income brackets. They are also less likely to have insurance cover.

HOSPITAL CHARGE EXEMPTIONS FOR THE POOR IN SHANDONG, CHINA

Q. Meng, Q. Sun and N Hearst

Health Policy and Planning, vol. 17, Suppl. 1, 2002 p. 56-63

Public hospitals in China formerly funded by the state now rely mainly on user charges. Medical expenses have escalated but health insurance systems no longer operate as before, reducing the affordability of rapidly increasing medical costs. Article studied discount and exemption mechanisms for the poor operated by nine public hospitals in Shandong. Found that hospital managers saw discount mechanisms as marketing tools and designed them to limit their costs. Only a small fraction of hospital services were eligible for discount, and these were usually low cost or low utilisation items. Correct identification of poor people was difficult for the hospitals, and many who received discounts were not really poor. Government policies requiring discounts for the poor were not enforced.

HOSPITAL SELECTIVE CONTRACTING WITHOUT CONSUMER CHOICE: WHAT CAN WE LEARN FROM MEDI-CAL?

A. Bamezai and others

Journal of Policy Analysis and Management, vol. 22, 2003, p. 65-84

Hospital selective contracting in the USA had its origins in the recession of the 1980s, which caused tax revenues to fall. California chose to meet this fiscal challenge by allowing the state Medicaid programme (Medi-Cal) and private insurers to contract selectively with hospitals on the basis of price. Selective contracting allows insurers to channel their members to hospitals offering favourable terms, thereby forcing hospitals to compete on the basis of price. Article presents an analysis of Medi-Cal's contracting data which suggests that selective contracting has been successful in forcing traditionally high cost hospitals to cut costs, rationalise services and compete on the basis of price.

THE IMPACT OF PUBLIC VOLUNTARY HEALTH INSURANCE ON PRIVATE HEALTH EXPENDITURES IN VIETNAM

M. Jowett, P. Contoyannis and N. D. Vinh

Social Science and Medicine, vol. 56, 2003, p. 333-342.

Using data from a household survey in Vietnam, out-of-pocket expenditure on healthcare is compared between members and eligible non-members of the government-implemented voluntary health insurance scheme. Expenditure was analysed for people who had sought care during their most recent illness. Results showed that health insurance reduced average out-of-pocket expenditure by about 200%, and that the poor benefited significantly more than the rich.

MODERNIZING PUBLIC HEALTHCARE GOVERNANCE IN HONG KONG: A CASE STUDY OF PROFESSIONAL POWER IN THE NEW PUBLIC MANAGENENT

A.B.L. Cheung

Public Management Review, vol. 4, 2002, p. 343-365

The Hospital Authority took over management of government and subvented hospitals in Hong Kong in 1991. This reform represented a major attempt to implement a new management structure for public hospitals within a manageralist framework. Article examines the impact of this reform on professional power. The changes eventually led to the rise to eminence of a cadre of young doctors who embraced new public management concepts and practices and used the new structure to exert professional leadership of public healthcare policy and service delivery.

SETTING PRIORITIES ON WAITING LISTS: POINT-COUNT SYSTEMS AS LINEAR MODELS

D. Hadorn

Journal of Health Services Research and Policy, vol. 8, 2003, p.48-54

The Western Canada Waiting List project (WCWL) was a federal initiative designed to develop tools for managing waiting lists. The main tools developed by WCWL are point-count measures that assess the severity of patients' conditions and the extent of benefit expected from treatment. Points on each factor are added and the total score is considered indicative of relative clinical urgency.

THE USE OF "ARMS-LENGTH" ORGANIZATIONS FOR HEALTH SYSTEM CHANGE IN ONTARIO, CANADA: SOME OBSERVATIONS BY INSIDERS

G. H. Pink and P. Leatt

Health Policy, vol. 63, 2003, p. 1-15

Unlike the UK and the USA Canada has eschewed radical health service reform in favour of incremental change. Article explores how the government of Ontario has used three "arms-length" organisations to effect incremental change.

WHAT COULD BE ACHIEVED WITH GREATER PUBLIC HOSPITAL AUTONOMY? COMPARISON OF PUBLIC AND PNFP HOSPITALS IN UGANDA

F. Ssengooba and others

Public Administration and Development, vol. 22, 2002, p. 415-428

Study compares the performance of three private not-for-profit (PNFP) and three public hospitals in Uganda to see if there is evidence that greater autonomy improves performance. Finds that better management of drugs supply in PNFP hospitals is facilitated by their ability to buy drugs on the open market. Greater success with personnel management is plausibly related to their greater autonomy over staffing. Finally, higher levels of cost recovery are enabled by their freedom to set fees. However, use of PNFP finance strategies in public hospitals could limit access to care for those unable to pay.