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

ASSESSING ATTITUDE TOWARDS PRIORITISING HEALTHCARE IN ICELAND

K. Oddsson

Health Policy, Vol. 66, 2003, p.135-146

The article reports the results of a cross sectional survey of public attitudes to healthcare prioritisation in Iceland. Overall, people had strong reservations about prioritising between different patient groups. However, physicians appeared to be more prepared to prioritise and had a strong preference to opt for effective outcome rather than disease severity. Most respondents were reluctant to allocate limited resources to the most seriously ill patients who would benefit little from the treatment.

DIFFERENT SYSTEMS, SAME ISSUES

A. Wild, M. Iwami and G. Meads

Primary Care Report, vol.5, no.17, Oct 29th 2003, p.14, 16-19

Looks at how primary care organisations in 11 countries have tackled issues critical for reform including knowledge management, integration of health and social care, regulation and accountability, and relationships with central government.

DRUG REIMBURSEMENT IN FINLAND: A CASE OF EXPLICIT PRIORITISING IN SPECIAL CATEGORIES

L. Vuorenkoski, H. Toivianen and E. Hemminki

Health Policy, Vol. 66, 2003, p.169-177

Increased drug expenses have created challenges for drug reimbursement systems in many industrialised countries such as Finland. Prioritisation of drugs so that costs of medicines for serious illnesses are reimbursed at a higher rate than medicines for minor complaints could be one solution to this problem. The paper examines stakeholders' views of the prioritisation decisions made in the Finnish drug reimbursement system, particularly concerning drugs in the higher reimbursement categories.

IDEAS AND DISCOURSE: REFORM AND RESISTANCE IN THE CANADIAN AND GERMAN HEALTH SYSTEMS

V. Bhatia and W. D. Coleman

Canadian Journal of Political Science, vol.36, 2003, p.715-739

Presents case studies of health service reform in Canada and Germany in the late 1980s and early 1990s. Shows that key policy actors came together to agree upon a significant reform of health care policy in Germany, while only minor policy changes occurred in Canada. The key factor facilitating significant policy change in Germany was the presence of a challenging discourse that had three key characteristics:

  • a relatively broad consensus among core policy actors on the nature and severity of the problem;
  • an alternative policy frame consistent with broadly held normative values;
  • the marshalling of persuasive "social facts" in favour of the change which could not easily be countered by opponents.

LESSON FROM AMERICA

M. Gould

Society Guardian, November 5th 2003, p.6

This week, a team of US health experts who work for an organisation that excludes hundreds of thousands of low income and unemployed people from access to medical care will be touring England telling doctors, nurses and managers how to save the NHS. Their company is Kaiser Permanente, the California-based not-for-profit "health maintenance company" with a reputation for cutting hospital stays and keeping the ageing population out of hospital. Kaiser's approach to hip-replacement surgery means just three days in hospital compared to an NHS average of 12 days. But critics, including former Health Secretary Frank Dobson, have attacked Health Secretary John Reid for backing the Kaiser approach. Kaiser, along with the rest of the US health industry, does not provide care for 20 per cent of the population who cannot afford premiums.

OPINIONS ON CHANGES IN THE ROMANIAN HEALTHCARE SYSTEM FROM PEOPLE'S POINT OF VIEW: A DESCRIPTIVE STUDY

A. C. Bara and others

Health Policy, Vol. 66, 2003, p.123-133

The article studies the opinions of individuals and groups living in the Dolj region of Romania about the health system reforms introduced over the past 10 years. Overall, people judged the present situation to be better than the past. The elderly, the chronically ill, and people who believe that people were generally happier 10 years ago have a more critical view of the reforms. Educated people are generally more positive.

ORGANISATIONAL RESTRUCTURING IN EUROPEAN HEALTH SYSTEMS: THE ROLE OF PRIMARY CARE

A. Rico and others

Social Policy and Administration, Vol. 37, No. 6, December 2003, p.592-608

The article examines organisational change in European health care systems, with particular reference to strategies developed during the 1990's to improve co-ordination among health care providers. Special attention is also given to primary care. Evidence on organisational restructuring is used to address three questions:

  • is there convergence in pro-coordination policies through Europe?
  • how do the mechanisms adopted differ across European countries; and is there a model of best practice?
  • which are the drivers and barriers of recent pro-coordination reforms in healthcare?; and to what extent do they differ across European countries?

The article concludes that specific features of healthcare can impede the operation of market or hierarchical coordination mechanisms, although these can be successful if applied as levers to promote the role and impact of pro-co-operative co-ordination strategies.

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