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

ALTERNATIVE MODELS OF HOSPITAL-PHYSICIAN AFFILIATION AS THE UNITED STATES MOVES AWAY FROM TIGHT MANAGED CARE

J. Casalino and J.C. Robinson

Milbank Quarterly, vol.81, 2003, p.331-351

The rise of managed care has led to major changes in the formal relationships between hospitals and the doctors who admit patients. A variety of alternatives replaced the traditional model in which the only linkage between hospitals and their medical staffs was the physicians' admission privileges. Article describes three basic forms of physician-hospital affiliation:

  • the traditional medical staff model;
  • the hospital owned practice;
  • hybrid arrangements.

Uses concepts from organisational theory to analyse the strengths and weaknesses of the various models and to explore why changes in changes in purchasers' strategies have led to changes in physician-hospital affiliation arrangements.

CONVERGENCE OR DIVERGENCE? REFORMING PRIMARY CARE IN NORWAY AND BRITAIN

O.S. Lian

Milbank Quarterly, vol.81, 2003, p.305-330

Many countries are currently reorganising their health services in response to global cultural, economic and technological changes. Because the changes are global, different countries are drawn towards similar reform programmes. But countries' cultural, economic and political differences also may lead to divergent responses. Looking at policy goals, changes in organisational structures and remuneration systems, and the policy process, author compares the trajectory of primary care reform in the UK and Norway. More evidence of divergence than convergence was found, which is explained in terms of historical, institutional and political factors, including the position of the medical profession.

DECENTRALISATION AND ITS IMPLICATIONS FOR REPRODUCTIVE HEALTH: THE PHILIPPINES EXPERIENCE

R. Lakshminarayanan

Reproductive Health Matters, vol.11, May 2003, p.96-107

The early phase of the Philippines experience shows that decentralisation in and of itself does not always improve the efficiency, equity and effectiveness of the health sector. Instead, it can exacerbate inequities, weaken local commitment to priority health issues and decrease the effectiveness of service delivery by disrupting the referral chain. Such effects pose a particular threat to reproductive health services, some of which (e.g. family planning) are controversial and susceptible to local pressures and others of which (e.g. emergency obstetric care) require a functioning health system.

A FRAMEWORK FOR DEVELOPING REPRODUCTIVE HEALTH POLICIES AND PROGRAMMES IN NEPAL

B. C. Campbell and others

Reproductive Health Matters, vol.11, May 2003, p.171-182

Based on experience in Nepal in 1996-2001, paper presents a six element framework to support governments in poor countries in developing and implementing reproductive health programmes. The six elements in the framework are:

  • collaborative planning and programming;
  • strategic assessment;
  • policy and strategy development;
  • guideline and material development;
  • reproductive health programme management;
  • policy review.

HEALTH POLICY IN THE ASIAN NIES

M. Ramesh

Social Policy and Administration, vol. 37, 2003, p.361-365

Paper systematically compares the health policies of Hong Kong, Taiwan, South Korea and Singapore. With respect to provision of healthcare, Hong Kong and Singapore rely largely on public hospitals for delivering inpatient care, while Korea and Taiwan rely on private providers. Health care financing arrangements also display two distinct patterns: Korea and Taiwan rely on universal health insurance supplemented by substantial co-payment, while Hong Kong and Singapore rely on direct government subsidy of public hospitals combined with out-of-pocket payment for outpatient care.

IMPACT OF DECENTRALISATION ON SEXUAL AND REPRODUCTIVE HEALTH SERVICES IN GHANA

S. H. Mayhew

Reproductive Health Matters, vol. 11, May 2003, p.74-87

Within a national reproductive health policy framework, previously disparate family planning, maternal and child health, STD and HIV/AIDS programmes have become more integrated, and donors have pooled or co-ordinated their funding. Some decision-making about resource allocation is meant to happen at district and regional level, but remains in practice centrally controlled. This may be a necessary safeguard for sexual and reproductive health services. Earmarked donor funds ensure a regular supply of contraceptive and STD drugs, but paying for these at local level is problematic. Sexual and reproductive health staff in rural areas experience poor working conditions, resulting in a high turnover and many vacancies.

THE IMPACT ON OFFICIALS OF PUBLIC SECTOR RESTRUCTURING: THE CASE OF THE NEW ZEALAND HEALTH FUNDING AUTHORITY

R. Gauld

International Journal of Public Sector Management, vol. 16, 2003, p.303-319

The New Zealand Health Funding Authority (HFA) was abolished as part of a sector restructuring announced in 1999. Article discusses the impact of the restructuring on senior HFA officials through the lens of a survey conducted in August 2000.

INTEGRATING REPRODUCTIVE HEALTH SERVICES IN A REFORMING SECTOR: THE CASE OF TANZANIA

M. Oliff and others

Reproductive Health Matters, vol. 11, May 2003, p.37-48

In-depth interviews were conducted with central level stakeholders, and focus group discussions held with health management staff in three regional and nine district offices to assess progress in the integration of reproductive health services in Tanzania. Respondents at all levels reported stalled integration and lack of synchronisation in the planning and management of key services. This was attributed to fear of loss of power and resources among national level managers, uncertainty as to continuation of donor support, and lack of linkages to the Health Sector Reform Secretariat. The uncoordinated and conflicting agenda of the donors on whom Tanzania is heavily dependent is a major obstacle to integration.

MARKETISATION AND RESIDUALISATION: RECENT REFORMS IN THE MEDICAL FINANCING SYSTEM IN HONG KONG

R.C.M. Chau and S.W.K. Yu

Social Policy and Society, vol.2, 2003, p.199-207

Article sets the scene by describing the historical development of medical services in Hong Kong and the poor performance of the economy since 1997. In this context the Hong Kong government has introduced proposals for reforming medical finance by expanding the principle of selectivity at the expense of universal provision, raising charges and introducing compulsory savings schemes.

PHARMACEUTICAL REFORM AND PHYSICIAN STRIKES IN KOREA: SEPARATION OF DRUG PRESCRIBING AND DISPENSING

S. Kwon

Social Science and Medicine, vol.57, 2003, p.529-538

Up to July 2000, pharmacists and physicians in Korea both prescribed and dispensed drugs, resulting in their overuse and misuse. On July 1st 2000, the Korean government implemented a reform that mandated the separation of drug prescribing from dispensing. The reform was strongly opposed by physicians faced with losing the profits they made from charging for the drugs they provided. Following a wave of strikes, the government was forced to modify the reform package and to raise medical fees substantially to compensate for the physicians' income loss.

REFORMING MEDICARE PAYMENT: EARLY EFFECTS OF THE 1997 BALANCED BUDGET ACT ON POSTACUTE CARE

N. McCall and others

Milbank Quarterly, vol.81,2003, p.277-304

The 1997 Balanced Budget Act (BBA) reformed payment for Medicare postacute services. Article examines postacute care use just before and immediately after implementation of the BBA for hospital discharges for five diagnosis-related groups that commonly use postacute care. Changes in treatment patterns were more beneficiaries receiving no postacute care, much less use of home health services and slightly more use of rehabilitation and long-term care hospitals. However, no consistent increases in adverse outcomes were observed using logistic regression models.

REGULATING HEALTHCARE: A PRESCRIPTION FOR IMPROVEMENT?

K. Walshe

Maidenhead: Open University Press, 2003

Healthcare organizations in the UK and the US face a growing tide of regulation, accreditation, inspection, and external review, all aimed at improving their performance. But does such regulation work? This book asks this question by:

  • Exploring the development and the use of healthcare regulation in both countries
  • Offering a structured approach to analysing what regulators do and how they work
  • Developing principles for effective regulation

REPRODUCTIVE HEALTH CARE IN THE NETHERLANDS: WOULD INTEGRATION IMPROVE IT?

A. Hardon

Reproductive Health Matters, vol.11, May 2003, p.59-73

Article describes reproductive health services in the Netherlands, their historical roots and current configuration, including services for family planning, abortion, STDs, infertility, sex education, counselling on sexuality and antenatal and delivery care, in the context of cost containment and other recent reforms. It shows that, although these core components are well covered and the system of reimbursement of costs has improved accessibility, they are not well integrated into the primary health care system.

RESTRUCTURING THE HEALTH SYSTEM: EXPERIENCES OF ADVOCATES FOR GENDER EQUITY IN BANGLADESH

R. Jahan

Reproductive Health Matters, vol.11, May 2003, p.183-191

Paper illustrates how advocates of gender equity succeeded in influencing the restructuring of the health system in Bangladesh in the 1990s, but failed to influence the implementation of the reforms. Argues that because civil society was involved in the design of the reforms, the voices of women, particularly poor women, were heard. During the implementation phase, the reform became a government-donor driven programme disconnected from civil society, and the space for women's voices was limited. When a new government assumed power in 2001, opponents of reform succeeded in halting the restructuring of the health system, in part because civil society was no longer engaged with the reform process and registered little protest.

RISK ADJUSTMENT IN EUROPE

W.P.M.M. van de Ven (editor)

Health Policy, vol.65, 2003, p.1-98

Focuses on five European countries with a Bismarckian sickness fund system: Belgium, Germany, the Netherlands, Israel and Switzerland. The healthcare systems of the five countries have many common elements, including mandatory health insurance, risk-bearing sickness funds, a risk adjustment mechanism, guaranteed periodic consumer choice among sickness funds and supplementary health insurance. Articles in this special issue describe recent developments in the financing and organisation of healthcare relevant for understanding each country's risk adjustment scheme.

SCHRÖDER VICTORY ON HEALTHCARE REFORMS

H. Williamson

Financial Times, July 22nd 2003, p.1

Gerhard Schröder,,German Chancellor, yesterday received a significant boost to his reform plans when the government and the opposition agreed to slash healthcare costs.

UNIVERSALISM WITHIN TARGETING: NURSING HOME CARE, THE MIDDLE CLASS AND THE POLITICS OF THE MEDICAID PROGRAM

C.M. Grogan and E.M. Patashnik

Social Service Review, vol.77, 2003, p.51-71

The Medicaid programme was originally targeted on certain defined groups of low-income Americans. However, it is now being used to pay the nursing home fees of large numbers of middle class senior citizens.

USING ACCOUNTABILITY TO IMPROVE REPRODUCTIVE HEALTH CARE

A. George

Reproductive Health Matters, vol.11, May 2003, p.161-170

Using case studies of participatory processes for improving sexual and reproductive health service delivery, paper focuses on how accountability mediates relationships between service providers and communities and between different kinds of health personnel at the primary health care level.

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