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

THE AMERICAN WAY

R. Lewis and R. Rosen

Health Service Journal, Vol. 113, September 25th 2003, p.30-31

The article demonstrates how increased integration throughout the care process has improved chronic disease management in the USA. Chronic disease management based on risk management, proactive case managers and patient education is effective. Managed care organisations increase efficiency through use of high quality clinical information, financial incentives and performance management.

CAPITOL HILL BRACED FOR TUSSLE OVER HEALTH

J. Harding

The Financial Times, September 3rd 2003, p.12

The proposal to modernise Medicare by adding financial aid for the elderly to pay for prescription drugs is likely to dominate Washington's news throughout September. Neither Republicans nor Democrats are happy with the plans, the former accusing them of being too generous and the latter not generous enough.

CHOICE BITES IN BOCA RATON

D. Light

Health Service Journal, Vol. 113, September 25th 2003, p.18-19

Due to spiralling costs, employers in the USA are cutting back on health insurance cover for their staff, reducing the number of medical services covered and making their employees pay more of their medical bills. Numbers of people with no insurance are rising by 3,000 a day. At the same time medical practitioners are cashing in by raising their fees and increasing the numbers and procedures done. They are establishing specialised clinics to siphon off the most profitable procedures from general hospitals and investing heavily in the latest equipment. Healthcare providers are also maximising their profits by finding new ways to defraud government programmes systematically.

DEVELOPMENT OF INTEGRATED CARE IN ENGLAND AND THE NETHERLANDS: MANAGING ACROSS PUBLIC-PRIVATE BOUNDARIES

I. Mur-Veeman and others

Health Policy, Vol. 65, 2003, p.227-241

The paper addresses the impact of the public-private mix in the Dutch and English health and social care systems on the development and delivery of integrated care. It demonstrates that the presence of fault-lines, such as the financial split between short-term and long-term care in the Netherlands and the divisions between health and social care as well as between the public, private and voluntary sectors in England have hindered integrated care development in both countries. Contradictory interests, differences in professional and organisational cultures, power relations and mistrust between and within these sectors have had a clear impact on integrated care delivery.

DOWNSIZING WITHIN A HOSPITAL: CUTTING CARE OR JUST COSTS?

I. Brown, B. Arnetz and O. Pelcusson

Social Science and Medicine, Vol. 57, 2003, p.1539-1546

It is important to evaluate whether the downsizing that is occurring in hospitals around the world in response to shrinking budgets is compromising the quality of patient care. The paper reports the results of a study in Sweden that investigated doctor, nurse and patient perceptions of quality of care during a period of downsizing. Although there were no significant changes in perceptions of quality of care, perceptions of workload substantially increased whilst perceptions of mental energy substantially decreased.

HEALTH INSURANCE AND THE GROWTH IN PHARMACEUTICAL EXPENDITURES

P.M. Danzon and M.V. Pauly

Journal of Law and Economics, Vol. 45, 2002, p.587-613

Between 1987 and 1996 most people under 65 in the USA with health insurance added drug coverage to their policies, while coverage also increased for senior citizens through various public and private plans. The reduction in the cost of drugs to consumers' pockets led to increased demand. Costs also increased because people moved from older drugs to newer, more expensive ones. The authors estimate that growth in insurance cover accounts for between one quarter and one half of total growth in drug spending over this period.

IMPACT OF SEPARATING DRUG PRESCRIBING AND DISPENSING ON PROVIDER BEHAVIOUR: TAIWAN'S EXPERIENCE

Y. J. Chou and others

Health Policy and Planning, Vol.18, 2003, p.316-329

In many Asian countries physicians both prescribe and dispense drugs. This practice is thought to have caused high drug expenditure and widespread prescription antibiotics in Asia. Recently Taiwan implemented an experimental separation policy. The paper evaluates the impact of Taiwan's separation of drug prescribing and dispensing on drug expenditure and total healthcare expenditure. It found that the probability of prescription and drug expenditure per visit were respectively 17-34% and 12-36% less among visits to clinics without on-site pharmacies, compared with control sites. However, no difference in total health expenditure was found between the two types of visits.

LUMPING AND SPLITTING: THE HEALTH POLICY AGENDA IN INDIA

D. H. Peters, K. S. Rao and R. Fryatt

Health Policy and Planning, Vol. 18, 2003, p.249-260

The paper shows that conditions are so varied across states in India that health policies and programmes specific to local needs are required. The central government also needs to assume new roles, focusing on overcoming inequalities in health outcomes, on tackling challenges to health such as the AIDS epidemic and on providing leadership on systemic issues such as regulation of the private sector and development of quality assurance systems.

PRIORITY SETTING IN HEALTH AUTHORITIES: A NOVEL APPROACH TO A HISTORICAL ACTIVITY

J. Mitton

Social Science and Medicine, Vol. 57, 2003, p.1653-1663

Describes a participatory action research project which instituted a novel priority setting framework christened macro-marginal analysis (MMA) in a fully integrated health region in Alberta, Canada. The focus of MMA is on identifying areas for service growth and areas for resource release, then determining, based on pre-defined locally generated criteria, if actual shifts or re-allocation of resources should occur.

STATES OF CHANGE

P. Dempsey

Health Service Journal, Vol. 113, September 25th 2003, p.32-36

The article presents an overview of changes in the US healthcare system, covering leadership, chronic disease management, investment in IT, staff working hours and user engagement.

UP THE CREEK: MIXED FUNDING, MIXED BLESSINGS

G. Meads

Primary Care Report, Vol. 5, No. 14, September 10th 2003, p.20-25

No primary care trust has enough funding from general taxation to achieve its aims. They must now look for additional funding streams. The article looks at how primary care organisations worldwide have accessed multiple funding streams, including co-payments and financial support from local authorities.