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

FOCUSING ON CHANGING CLINICAL PRACTICE TO ENHANCE RATIONAL PRESCRIBING: COLLABORATION AND NETWORKING ENABLE COMPREHENSIVE APPROACHES

A. Helin-Salmivara and others

Health Policy, Vol.66, 2003, p.1-10

Government bodies and the medical profession took joint responsibility for the education programme for rational prescribing launched in Finland at the end of the 1990s. The goals were to enhance critical thinking and, when appropriate, change prescribing behaviour. Various approaches including evidence-based continuing medical education, implementation of clinical guidelines, delivering information and providing prescribing feedback were used simultaneously. The commitment of stakeholders and participants has been strong and the approaches have succeeded even though there is no clear outcome measure.

HEALTHCARE FINANCING IN THE AFRICAN COUNTRIES OF THE EASTERN MEDITERRANEAN

B. Sabri

International Social Security Review, Vol. 56, No.3/4, 2003, p.73-85

Improving financing is high on the agenda of most healthcare system reforms in the region. The main objectives of the planned policy changes in healthcare financing are to mobilise resources for health development, secure better equality in access, and improve overall system efficiency. Resource mobilisation needs to focus on promotion of investment in healthcare using national resources freed up through debt relief. Efforts are being made to reduce financial barriers to access through extension of insurance coverage and pro-poor policies. Health system efficiency is promoted through application of modern management techniques, leading to cost savings.

HEALTH SERVICES RESEARCH AND DEVELOPMENT IN PRACTICE: AN AUSTRALIAN EXPERIENCE

K. Eagar and others

Journal of Health Services Research & Policy, Vol. 8, 2003, p.7-13

Although the importance of health services research, and how it can inform health policy decisions, is beginning to be recognised, the situation is still far from perfect. This article focuses on the experiences of the Centre for Health Service Development (CHSD) at the University of Wollongong, with particular regard to their work on the development of case-mix classifications and information systems to inform policy and funding in the sub-acute and non-acute hospital and community care centres.

HONESTY AS GOOD POLICY: EVALUATING MARYLAND'S MEDICAID MANAGED CARE PROGRAM

D.I. Chang and others

Milbank Quarterly, vol.81, 2003, p.389-414

Article describes Maryland's assessment of its Medicaid managed care programme. The experience gained in Maryland's HealthChoice evaluation reveals how a strong commitment to an open and participatory process combined with a rigorous focus on the need for quantitative and qualitative data contributed to both a better understanding of the programme's effects and greater support for its future development.

HOW CAN WE IMPROVE THE QUALITY OF HEALTHCARE IN JAPAN? LEARNING FROM JCQHC HOSPITAL ACCREDITATION

H. Hirose and others

Health Policy, Vol. 66, 2003, p.29-49

In 1995 the Japan Council for Quality in Health Care was founded to implement third party accreditation of hospitals. Concurrent with the foundation of JCQHC, the sharply rising cost of medical malpractice litigation motivated the authorities and medical facilities to work towards protecting patient safety at all levels. JCQHC accreditation is an important tool for furthering these efforts.

LINKING COMMUNITY INITIATIVES TO NATIONAL INSTITUTIONS: GHANA

M. Cichon and others

International Social Security Review, vol.56, no.3/4, 2003, p.59-71

Argues for a fusion of the social health insurance and mutual health organisation concepts in Ghana, thus linking community initiatives to national institutions, enhancing coverage and the quality of services for all. Envisages an established public agency acting as partner, coach and sponsor of smaller, community-based social security schemes. Describes a pilot project launched to test this concept with a view to extending health care cover.

PRIORITY-SETTING AND HOSPITAL STRATEGIC PLANNING: A QUALITATIVE CASE STUDY

D. Martin and others

Journal of Health Services Research & Policy, Vol. 8, No. 4, October 2003, p.197-201

A case study of a strategic planning process at Sunnybrook & Women's College Health Science Centre, Toronto. The process is also compared to an internationally recognised ethical framework for evaluating priority-setting in hospital strategic planning, "Accountability for Reasonableness".

SERVICE PRODUCTION AND CONTRACT CHOICE IN PRIMARY PHYSICIAN SERVICES

R.J. Sprensen and J. Grythen

Health Policy, Vol. 66, 2003, p.73-93

The paper addresses the impact of alternative contracts and payment systems on primary care physicians' supply of services. Until June 1st 2001, there were two types of primary care physicians in Norway:

  • local government employees paid a fixed salary
  • contract physicians paid on a fee-for-service basis.

The study found that fee-for-service contract physicians produced a higher number of consultations and other patient contacts than salaried physicians, due mainly to longer working hours. It concludes that a change from a salaried position to a fee-for-service contract will increase productivity by 20-40%.

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