Welfare Reform on the Web (January 2004): Healthcare - Overseas

A COMPARISON OF SINGLE- AND MULTI-PAYER HEALTH INSURANCE SYSTEMS AND OPTIONS FOR REFORM

P. Hussey and G.F. Anderson

Health Policy, Vol. 66, 2003, p. 215-228

A major choice confronting many countries is between single-payer and multi-payer health insurance systems. In single-payer systems one organisation, typically the government, collects and pools revenues and purchases health services for the entire population. In multi-payer systems several organisations carry out these roles for different population segments. The paper compares the two systems in areas of revenue collection, risk pooling, purchasing and social solidarity:

• single-payer systems are usually financed more progressively and rely on existing taxation systems; they effectively distribute risks through one large pool and offer governments a high degree of control over health spending;
• multi-payer systems sacrifice this control for a greater ability to meet the diverse needs of beneficiaries.

CONSUMER CHOICE OF SOCIAL HEALTH INSURANCE IN MANAGED COMPETITION

J.J. Kerssens and P.P. Groenewegen

Health Expectations, Vol. 6, Dec. 2003, p. 312-322

Reforms introduced to the Dutch social health insurance system in 1992 allowed people to change their insurance provider, but, very few have taken up the opportunity. The article examines why people choose one provider over another and the importance of a supplementary benefit package and a flat-rate premium. Respondents to the postal questionnaires can be categorised into three groups:

• those who have swapped insurers;
• those who have entered the market;
• those who have remained with their original insurer.

Results showed that those who had entered the market were the least satisfied with their insurer. A quarter of those choosing an insurer with a flat rate premium said that this influenced their choice, but consumers were also highly motivated by supplementary benefit packages.

CONSUMER INFORMATION MATERIALS FOR DIAGNOSTIC BREAST TESTS: WOMEN'S VIEWS ON INFORMATION AND THEIR UNDERSTANDING OF TEST RESULTS

H.M. Davey and others

Health Expectations, Vol. 6, Dec. 2003, p. 298-311

This Australian study investigates the information available regarding diagnostic tests for breast cancer, women's preferences concerning the content and presentation of such information and women's understanding of the test results. Women were interviewed over the telephone with some then participating in a face-to-face in depth interview. Results showed that women want as much information as possible regarding mammograms and that written information is better than verbal as they can read and digest it at home. They also revealed that many women have difficulty interpreting the test results.

IMPACT OF PATIENT INFORMATION BOOKLET ON TREATMENT DECISION - A RANDOMIZED TRIAL AMONG WOMEN WITH HEAVY MENSTRUATION

S. Vuorma and others

Health Expectations, Vol. 6, Dec. 2003, p. 290-297

The study examines whether providing an information booklet to menorrhagic women prior to their visiting a gynaecology clinic would increase the variety of treatments used. Women were given an information booklet about heavy menstruation and its treatment options, including the benefits and risks, at least seven days before attending their gynaecological appointment. Questionnaires were then sent to all those eligible for the study. The results showed that providing women with more information influenced their treatment choices, and better-informed women used newly introduced modalities less frequently than those who had not been given the information. However, additional information had no impact on the number of surgical treatments used. The report concludes that women found the extra information helpful in defining their own treatment preferences. It is thought that this may lead to more deviation from physician's preferences as new treatments emerge.

POLITICIANS' AND HOSPITAL MANAGERS' TRADE-OFFS IN THE CHOICE OF REIMBURSEMENT SCHEME: A DISCRETE CHOICE EXPERIMENT

M. Bech

Health Policy, vol.66, 2003, p.261-275

Study sought to elicit Danish county council politicians' and hospital managers' preferences for the anticipated incentives embedded in reimbursement schemes using the discrete choice method. Politicians and hospital managers agreed that increasing the number of patients treated was the most important objective for choice of reimbursement scheme. The second most important objective for politicians was providing budget safety, with improving quality of treatment third. However, hospital managers ranked improving treatment quality as the second most important objective, with budget safety third.

PRIORITY SETTING IN A HOSPITAL DRUG FORMULARY: A QUALITATIVE CASE STUDY AND EVALUATION

D.K. Martin and others

Health Policy, vol.66, 2003, p.295-303

Rising costs of new drugs are putting strain on hospital budgets. In response to these pressures hospitals must set priorities for which drugs they will list on their formularies. Paper describes priority setting for new drugs in a Canadian case study hospital, and evaluates this process using Daniels and Sabin's "accountability for reasonableness" framework.

PROVIDER-SPONSORED VIRTUAL COMMUNITIES FOR CHRONIC PATIENTS: IMPROVING HEALTH OUTCOMES THROUGH ORGANIZATIONAL PATIENT-CENTRED KNOWLEDGE MANAGEMENT

W.J. Winkelman and C.W. Choo

Health Expectations, Vol. 6, 2003, p. 352-358

The article explores the benefits to chronic patients of having access to support and information concerning their disease through virtual communities. The benefits such projects bring to healthcare organisations are also acknowledged, as patients provide a new source of knowledge that can be employed to inform advancements in service delivery and improve health outcomes.

PROVIDING EVIDENCE-BASED INFORMATION TO PATIENTS IN GENERAL PRACTICE AND PHARMACIES: WHAT IS THE ACCEPTABILITY, USEFULNESS AND IMPACT ON DRUG USE?

J.P. McCormack and others

Health Expectations, Vol. 6, 2003, p. 281-289

The study investigates the feasibility of producing evidenced-based guides for lay people and assess their acceptability, usability and impact. Guides were produced for three medical conditions - sore throat, heartburn and osteoporosis. GPs and community pharmacists in three locations in Canada were invited to participate in the study, and to recruit patients with the relevant condition. Patients were questioned about the guide through telephone interview within ten days of them receiving it. Eighty to ninety per cent of patients reported that the guide was easy to understand with 50-69% saying that it influenced their treatment process. However, results show that the guide did not have a measurable impact on how drugs were recommended, possibly because the majority of patients reviewed the guide at home rather than with their health practitioner.