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Welfare Reform on the Web (May 2003): Health Care - Overseas

THE EFFECT OF FUNDING POLICY ON DAY OF WEEK ADMISSIONS AND DISCHARGES IN HOSPITALS: THE CASES OF AUSTRIA AND CANADA

K. Leonard and others

Health Policy, vol. 63, 2003, p. 239-257

This paper compares two different funding policies for inpatients: the case-based approach in Austria versus the global budgeting approach in Canada. It examines the impact of those funding policies on length of stay of inpatients as one key measure of health outcome.The analysis proves that funding policies have a significant impact on the expected length of stay. Austrian inpatients stayed longer compared to Canadian. Moreover inpatients were not admitted and discharged equally throughout the week. Inpatients could be discharged on certain days such as Mondays or Fridays depending on the funding policy. The study concludes that, with the right incentives in place, the length of stay can be decreased and discharge anomalies eliminated, leading to a decrease in healthcare expenditure and an increase in healthcare effectiveness.

HEALTH SECTOR REFORM IN OCCUPIED PALESTINIAN TERRITORIES (OPT) : TARGETING THE FOREST OR THE TREES?

R. Giacaman, H.F. Abdul-Rahim and L. Wick

Health Policy and Planning, vol. 18, 2003, p. 59-67

Article begins by outlining the development of the Palestinian healthcare system since 1948. Goes on to discuss major obstacles to successful health system reform at the present time, which include ongoing conflict, frail Palestinian quasi-state institutions, and inappropriate aid agency policies. Donor institutions tend to impose their own inappropriate solutions without consulting the Palestinian people.

IMPROVING GOVERNMENT HEALTH SERVICES THROUGH CONTRACT MANAGEMENT: A CASE FROM CAMBODIA

R. Soeters and F. Griffiths

Health Policy and Planning, vol. 18, 2003, p. 74-83

Public healthcare services in Cambodia perform poorly due to the informal activities of the poorly paid staff. These supplement their incomes by informally operating "extra-legal" private clinics, pharmacies and laboratories. In 1998 the Cambodian government started an experiment with contractual management of health services in eight districts. In five districts healthcare management was contracted to private sector operators, and their results were compared to three control operators. Article describes in detail the experience of the contractor managing services in the Pereang district.

INVOLVING THE GENERAL PUBLIC IN PRIORITY SETTING: EXPERIENCES FROM AUSTRALIA

V. Wiseman and others

Social Science and Medicine, vol. 56, 2003, p. 1001-1012

In this study a convenience sample of 373 citizens attending two clinics in central Sydney were surveyed about the role of the public in priority setting in healthcare. Found that 80% of respondents thought that the views of the public should inform priority setting. Their preferences were seen as particularly important in informing decisions about how to prioritise across broad health care programmes and about criteria to be used in allocating funds across population groups. In contrast, the preferences of doctors and health service managers were rated most highly in relation to prioritisation of particular treatments. However in all cases respondents felt that prioritisation decisions should be informed by the preferences of a range of groups including medical professionals, health care mangers, voluntary organisations and advocacy groups.

ISRAELIS EVALUATE THEIR HEALTH CARE SYSTEM BEFORE AND AFTER THE INTRODUCTION OF THE NATIONAL HEALTH INSURANCE LAW

A. Shmueli

Health Policy, Vol. 63, 2003, p. 279-287

This article reports on the evaluation of the Israeli health care system made by samples of Israeli Jewish urban citizens aged 45-74 at two points in time: 1993 and 2000. The findings are analysed with respect to changes - in particular, the introduction of the National Health Insurance Law. It is argued that while the NHIL has been an important social achievement, it has failed to keep up with public expectations.

JAPAN'S RADICAL REFORM OF LONG-TERM CARE

J. C. Campbell and N. Ikegami

Social Policy and Administration, vol. 37, 2003, p. 21-34

Paper describes the mandatory long-term care insurance system launched in Japan in 2000. The benefits are in the form of institutional or community-based services, not cash, and are aimed at covering all caregiving costs (less a 10% co-payment) at six levels of need as measured by objective tests. Revenues are from insurance contributions and taxes. The scheme costs $40bn, annually, which is expected to rise to about $70bn annually by 2010.

MEDICAL CARE USE AND SELECTION IN A SOCIAL HEALTH INSURANCE WITH AN EQUALIZATION FUND: EVIDENCE FROM COLOMBIA

A. J. Trujillo

Health Economics, vol. 12, 2003, p.231-246

Paper studies the relationship between health status and insurance participation, and between insurance status and medical care use in the context of a social health insurance with an equalisation fund (SHIEF). Under this system revenues from a mandatory payroll tax are collected in a single pool (equalisation fund) which reimburses for-profit sickness funds according to a capitated formula. Shows that participation in SHIEF increases medical care use. Less healthy individuals are less likely to participate in the SHIEF, which implies that the sickness funds may be overpaid. On the other hand, individuals with a chronic health condition are more likely to be enrolled in the SHIEF, which indicates that sickness funds may be underpaid.

PAYMENT SYSTEM REFORM FOR HEALTH CARE PROVIDERS IN KOREA

S. Kwon

Health Policy and Planning, vol. 18, 2003, p. 84-92

The national health insurance scheme in Korea pays healthcare providers on a fee-for-service basis. This has led to over-provision and distortion in the mix of medical care because physicians have an incentive to offer more expensive services which maximise their profits. In order to reduce costs, the government introduced two supply-side reforms : Diagnosis Related Group (DRG) and Resource Based Relative Value (RBRV). A pilot programme using a DRG-based prospective payment system has proved successful in controlling costs, where as RBRV - based payment led to an almost uniform increase in fees for physician services without a mechanism to control volume or expenditure.

PLANNING FOR HEALTH SECTOR REFORM IN POST-CONFLICT SITUATIONS: KOSOVO 1999-2000

D. Shuey and others

Health Policy, vol 63, 2003, p. 299-310

The restoration and development of health care systems in post conflict situations are attracting attention. In Kosovo, the World Health Organization (WHO) led a process of developing a health policy framework for the emergency period that included elements of health sector reform. There was tension between the need to have a policy in place rapidly and the desire to be participatory. Although there was some tension between relief and development agendas, the policy did direct significant resources that contributed to longer-term reform. A rapidly developed health policy framework at the onset of an emergency is desirable. Policy developers should be experienced, seen as being neutral and be relatively independent. WHO is well suited to play this role.

RESTRUCTURING A MINISTRY OF HEALTH : AN ISSUE OF STRUCTURE AND PROCESS : A CASE STUDY FROM UGANDA

A. Jeppsson, P.- O. Östergren and B. Hagström

Health Policy and Planning, vol. 18, 2003, p. 68-73

Analyses the processes involved in the restructuring of the Ugandan Ministry of Health between 1997 and 1999. The restructuring followed the decentralisation of health services and was intended to enable the Ministry to assume a new role concerned with the formulation of policy and guidelines. However fruitful collaboration between the centre and the periphery is proving difficult due to communication problems.

THE SAZA STUDY : IMPLEMENTING HEALTH FINANCING REFORM IN SOUTH AFRICA AND ZAMBIA

L. Gibson and others

Health Policy and Planning, vol. 18, 2003, p. 31-46

Paper explores the policy-making process in the 1990s in South Africa and Zambia in relation to health care financing reforms. Looks at the political and bureaucratic realities shaping the process of policy change and its impacts. Through a case study approach, it provides a picture of the policy environment and processes in the two countries, specifically considering the extent to which technical analysts and technical knowledge were able to influence the reform.

SHOULD I STAY OR SHOULD I GO? WAITING LISTS AND CROSS-BORDER CARE IN THE NETHERLANDS

W. Brouwer and others

Health Policy. vol. 63, 2003, p. 289-298

The recent ruling of the European Court of Justice in the case Smits-Peerbooms mentions undue delay as a justification for cross-border care within the EU. In the Netherlands, waiting times are well above the norm, which might indicate Dutch patients are often entitled to care in other member states.However, experiments demonstrate that few Dutch patients are willing to travel abroad, seeming to prefer longer waiting in the Netherlands to shorter waiting through going abroad. Given this inertia, cross-border treatment will probably remain an insignificant phenomenon in terms of quantities of patients travelling abroad and therefore the impact of the Smits-Peerbooms ruling is limited.

SPECIALISED MEDICAL TRAINING IN THE SPANISH HEALTH SYSTEM: A CRITICAL ANALYSIS

M. I. Alonso Magdaleno

International Journal of Healthcare Technology and Management, vol. 4, 2002, p.456-466

Presently, and for some years past, an excessive number of specialist training posts have been available for Spanish doctors. This is leading to the creation of a surplus of medical specialists for whom there are no jobs. This situation is the result of lack of foresight and "short-termism" in planning decisions.

(See also International Journal of Healthcare Technology and Management, vol. 4, 2002, p. 498-504)

A TALE OF TWO VISIONS: THE CHANGING FORTUNES OF SOCIAL HEALTH INSURANCE IN SOUTH AFRICA

D. McIntyre, J. Doherty and L. Gilson

Health Policy and Planning, vol. 18, 2003, p. 47-58

South Africa has debated whether or not to introduce social health insurance (SHI) for the past 15 years, and the design of the proposals has changed dramatically over that period. Paper illustrates how SHI design may be affected by the trade-offs made to accommodate key players' views, an accommodation that may undermine the achievement of key objectives. Emphasizes that in order to achieve equity and sustainability, a common contribution and risk pool across private medical insurance and the SHI is essential. Given that SHI is usually introduced as part of a package of reforms, attention must be given to appropriate sequencing of implementation.

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