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

CHARACTERISTICS OF A MEDICAL CARE PROGRAM FOR SPECIFIC DISEASES IN JAPAN IN AN ERA OF CHANGING COST-SHARING

H. Nakatani and T. Kondo

Health Policy, Vol. 64, 2003, p.377-389

The Medical Care Program for Specific Diseases has two components: grants for research into the diseases and a medical costs subsidy, which covers all or part of the fees charged to patients. The article reports that recent reform of the program, which requires patients to contribute a small amount towards the cost of their treatment, influenced the number of patients and health service utilisation. Other health insurance reforms also have significant effects over numbers of patients registered with the program, reflecting the relative merit/demerit of the program in comparison with the general health insurance.

CONTRACTING FOR HEALTH SERVICES: AN EVALUATION OF RECENT REFORM IN NICARAGUA

W. Jack

Health Policy and Planning, Vol. 18, 2003, p.195-204

The main feature of health care reform in Nicaragua comprises a decentralisation of decision-making authority, phased in over time, coupled with an increase in local accountability. Local decision making has been increased by allowing managers more freedom to allocate resources. Accountability has been increased by the use of performance agreements negotiated between the Ministry of Health and individual hospitals. Incentives are provided by tying rewards (i.e. bonuses) to the satisfaction of these requirements.

EVALUATION OF PRIMARY HEALTHCARE REFORM IN ESTONIA

A. Koppel and others

Social Science and Medicine, Vol. 56, 2003, p.2461-2466

Ten years ago primary healthcare in the Western sense was unknown in Estonia. It was provided by different specialists in policlinics and the financial basis of the system was in crisis. The reform introduced family doctors and in 1998 a new funding system for primary care services was implemented. The paper presents a practical set of indicators to evaluate primary healthcare in terms of health economics criteria, and then to apply these indicators in evaluation of the Estonian reform.

FROM HOME TO HOSPITAL AND BACK AGAIN: ECONOMIC RESTRUCTURING, END OF LIFE AND THE GENDERED PROBLEMS OF PLACE-SWITCHING HEALTH SERVICES

C. Cartier

Social Science and Medicine, Vol. 56, 2003, p.2289-2301

The US federal health insurance scheme for the elderly has historically neglected to fund long term home care. There will be n increased demand for such care as the population ages because the large scale entry of women into the workforce means that unpaid family carers will not be available. Current policy trends forecast the decentralisation of care giving from hospitals to community and home settings.

THE IMPACT OF THE 1997-98 EAST ASIAN ECONOMIC CRISIS ON HEALTH AND HEALTH CARE IN INDONESIA

H. Waters, E. Saadah and M. Pradham

Health Policy and Planning, Vol. 18, 20003, p.172-181

The devaluation of the Indonesian currency, the Rupiah, during the 1997-98 economic crisis, led to inflation and reduced public expenditure on health. Households' expenditure on health also decreased, both in absolute terms and as a percentage of overall spending. Self-reported mortidity increased sharply from 1997 to 1998. The crisis led to a substantial reduction in health service utilisation, as the proportion of household survey respondents reporting an illness that sought care from a modern health care provider declined by 25%.

IS THE COLOMBIAN HEALTH SYSTEM REFORM IMPROVING THE PERFORMANCE OF PUBLIC HOSPITALS IN BOGOTÁ?

B. Mepake and others

Health Policy and Planning, Vol. 118, 2003, p.182-194

Health service reform in Columbia introduced a national health insurance system, created a purchaser-provider split and transformed public hospitals into "autonomous state entities". The paper reports the results of a study that tried to touch hospital performance in Bogotá after the reforms. The study found some evidence of increased activity and productivity and sustained quality despite declining staffing levels. Qualitative data suggest that staff noticed considerable changes, which include increased responsiveness to patients but also a heavier administrative burden.

MARKET COMPETITION: EVERYBODY IS TALKING, BUT WHAT DO THEY SAY? A SOCIOLOGICAL ANALYSIS OF MARKET COMPETITION IN POLICY NETWORKS

A. Paulus and others

Health Policy, Vol. 64, 2003, p.279-289

The Dutch healthcare system has several key players: consumers (individual or collective users, service user groups), providers (mainly private organisations that pursue social goals), the national government and insurers (public and private insurers who act as intermediaries between the government and care providers). The article analyses written statements by different actors about market competition, showing that the term is used with a range of different meanings by the various stakeholders.

PLACING PRIVATE HEALTHCARE: READING ASCOT HOSPITAL IN THE LANDSCAPE OF CONTEMPORARY AUCKLAND

R.A. Kearns, J.R. Barnett and D. Newman

Social Science and Medicine, Vol. 56, 2003, p.2303-2315

Ascot Integrated Hospital opened in 1999 in the affluent Auckland suburb of Remuer. It competes for patient patronage in a contracting market for surgical and medical providers. The article analyses how the hospital marketed itself and its achievements to potential customers. It glamorised medicine and linked healing with a contrived place.

PRO-POOR HEALTH POLICIES IN POVERTY REDUCTION STRATEGIES

L. Laterveer, L.W. Neissen and A.S. Yazbeek

Health Policy and Planning, Vol. 18, 2003, p.138-145

Since 1999 the International Monetary Fund and World Bank have required low income countries soliciting for debt relief and financial support to prepare a Poverty Reduction Strategy Paper (PRSP). The study investigates the extent to which the first batch of interim PRSPs actually address the health of the poor and vulnerable. It highlights concerns about the lack of country-specific data on the distribution of disease, the composition of the burden of disease, the prevailing health system constraints, and the impact of health services in the majority of interim PRSPs reviewed. More importantly, they make little effort to analyse these issues in relation to the poor. Furthermore, only a small group explicitly includes the interests of the poor in health policy design.

PROVIDING HEALTHCARE FOR OLDER PERSONS IN SINGAPORE

P. Teo, A. Chan and P. Straughan

Health Policy, Vol. 64, 2003, p.309-413

The paper analyses policy on health care provision for older people in Singapore and argues that state systems need to be better integrated with family care. In Singapore, family responsibility for the health care of older people is shared between the family, the state and the community. The bulk of the costs for long term care are borne by the community and the family. The role of the state is to provide excellent healthcare at prices which people can afford to pay through insurance schemes.

PUBLIC PARTICIPATION IN HEALTH PLANNING AND PRIORITY SETTING AT THE DISTRICT LEVEL IN UGANDA

L. Kapiriri, O.F. Norheim and K. Heggenhougen

Health Policy and Planning, Vol. 18, 2003, p.205-216

A qualitative exploratory approach was used to assess the public's and local council's experiences with participation in decentralised health planning. District level respondents reported that they had gained decision-making powers, but were concerned about the degree of financial independence they had. The national level respondents were concerned about the capacity of the districts to absorb their new roles. Public participation in the decision-making process in mainly through local elected leaders, due to reported cultural, economic, and social barriers that hinder the involvement of the rest of the public.

THE SHORTAGE OF REGISTERED NURSES AND SOME NEW ESTIMATES ON THE EFFECTS OF WAGES ON REGISTERED NURSES LABOR SUPPLY: A LOOK AT THE PAST AND A PREVIEW OF THE 21ST CENTURY

Y.A. Chiha and C.R. Link

Health Policy, Vol. 64, 2003, p.349-375

The USA and many other countries are facing a severe shortage of registered nurses. Labour supply models for currently registered nurses (RNs) are estimated by gender and marital status using data from the 1992, 1996 and 2000 National Sample Surveys of Registered Nurses. Results show that the trained RN's own wage had minor effects on both labour force participation and hours worked given participation. However, the RN wage has a significant and positive effect on the number of people entering nursing training in the USA.

SMALL NATION: FROM LITTLE ACORNS GROW BIG LESSONS

G. Meads

Primary Care Report, Vol. 5, May 29th 2003, 19-21

The article argues that primary care organisations can learn from innovative practices in smaller countries in Lithuania, Cuba, Costa Rica, Finland and Slovenia. Smaller states have experimented with a wide range of innovative models for the delivery of primary health care, including local financing, public-private partnerships and public consultation exercises.

TWO DECADES OF RESEARCH COMPARING FOR-PROFIT AND NON PROFIT HEALTH PROVIDER PERFORMANCE IN THE UNITED STATES

P.V. Rosenau and S.H. Linder

Social Science Quarterly, Vol. 84, 2003, p.219-241

The article reports on a systematic review of peer-reviewed scientific assessments of performance related differences between private for-profit and private non-profit US healthcare providers published since 1980. Overall, performance of non-profits was judged superior 59% of the time. For the rest (29%), no difference was found or results were mixed. The article concludes that caution should be exercised in encouraging for-profit organisations to replace private non-profit providers of health care services in the US.

USING BURDEN OF DISEASE INFORMATION IN HEALTH PLANNING IN DEVELOPING COUNTRIES: THE EXPERIENCE FROM UGANDA

L. Kapiriri, O.F. Norheim and K. Heggenhougen

Social Science and Medicine, Vol. 56, 2003, p.2433-2431

The article found that the burden of disease (BOD) study results have been used as the basis for national health policy in Uganda and in defining the contents of the essential health care package. The quantification and ranking of disease burden is appreciated by politicians and used for advocacy, resource mobilisation and re-allocation. Results have also provided information for priority setting and strategic planning. Limitations to its use include poor understanding of the methodology, poor quality data inputs, low involvement of stakeholders, inability of the methodology to capture key economic issues, and the costs of carrying out the study.

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