Welfare Reform on the Web (September 2003): Healthcare - Overseas
THE AVAILABILITY OF DRUGS: WHAT DOES IT MEAN IN UGANDAN PRIMARY CARE?
J. Jitta and others
Health Policy, vol.65, 2003, p.167-179
Article examines drug availability in six primary care units in Uganda, emphasising the differing perspectives of health planners, health workers, and users of health services. Health care reforms, including co-payment, are meant to reduce drug inadequacies by making care demand driven and by introducing flexibility in the supply and use of drugs. There are inherent contradictions between the government's policy of encouraging the rational use of drugs by supplying essential drug kits and regulating what health units may provide, and requiring service users to pay fees. When government health units are unable to supply popular drugs, users can simply buy them on the private market. There is a need for local autonomy for health units to procure drugs actually being used. Greater flexibility is also needed to meet variable local use patterns.
BUDGETARY IMPLICATIONS OF A PUBLICLY FUNDED MEDICAL SAVINGS ACCOUNT PLAN
J.Schaafsma and W. Land
Canadian Public Policy, vol.29, 2003, p.181-196
In a Medical Savings Account (MSA) programme the government deposits into individual accounts a sum equal to the deductible of a publicly funded catastrophic health insurance programme. Account holders are expected to use these funds to pay for their initial health care costs. When the MSA balance is depleted, public health insurance coverage commences. Account holders can draw out surplus funds after a certain length of time, but with restrictions on their use. Authors develop an analytical framework to demonstrate the savings and cost implications of such a programme. The model is then applied to 1999 health care expenditure on the 45-64 year-old Manitoba population. Results show that, under realistic assumptions, MSA allowances are consistently more costly than medicare.
HAVE DRG-BASED PROSPECTIVE PAYMENT SYSTEMS INFLUENCED THE NUMBER OF SECONDARY DIAGNOSES IN HEALTH CARE ADMINISTRATIVE DATA?
L. Serden, R. Lindqvist and M. Rosen
Health Policy, vol.65, 2003, p.101-107
In Sweden, the number of secondary diagnoses per case increased in the 1990s, at the same time as some county councils introduced DRG (diagnosis related group) payment systems. Study investigated whether the introduction of such systems had in fact influenced the number of secondary diagnoses. Concludes that DRG-based systems focus on recording diagnoses and therefore increase their number. Other factors may also have contributed to the trend, such as changes in the speciality mix during the study period.
THE PRICE OF CARROTS
H. Berliner
Health Service Journal, vol. 113, Aug.21st 2003, p.18-19
Attempts to improve care in US hospitals by offering financial incentives are hampered by a reluctance to penalise poor performers.
THE RISING NUMBER OF UNINSURED AMERICANS: HOW ADEQUATE IS OUR HEALTH SYSTEM?
S. H. Glover and others
International Journal of Social Economics, vol.30, 2003, p.867-882
As of 1997, 43.4 million Americans of working age were covered neither by private health insurance nor by publicly funded health assistance schemes. This represents an increase of ca. 9 million uninsured people since 1993. This increase is due to rising costs of health insurance causing a decline in employment-based coverage for people working for small firms. Paper presents various proposals for extending Medicaid coverage for children and their families, including an examination of their costs and implications for providers.
STANDARD OF CARE AND LIABILITY IN MEDICAL MALPRACTICE LITIGATION IN JAPAN
H. Hagihara, M. Nishi and K. Nobutomo
Health Policy, vol.65, 2003, p.119-127
Study analysed decisions made in medical malpractice cases in Japan between 1986 and 1998 in ten district courts. Found that medical malpractice litigation gave doctors an economic incentive to avoid delivering substandard care, but could corrupt the compensation process by creating an adversarial atmosphere.
WHAT DOES CANADA PROFIT FROM THE FOR-PROFIT DEBATE ON HEALTH CARE?
G. Currie, C. Donaldson and M. Lu
Canadian Public Policy, vol.29, 2003, p.227-251
Finds that research literature on for-profit versus not-for-profit hospital care based on the US experience is not applicable to Canada. In other words, the empirical results from comparisons of for-profits and not-for-profits are particular to the regulatory and competitive environment within which hospitals are operating.