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

CLINICAL DIRECTORATES: STAKEHOLDERS' KNOWLEDGE AND EXPECTATIONS

M. Dunnion and E.A. Dunne

British Journal of Healthcare Management, vol.10, 2004, p.12-17

Achieving the goal of clinicians-in-management operationalised in the clinical directorate structure requires a more systematic approach to change than is usual in health care management. Paper describes the pre-intervention knowledge and expectations of clinical directorates of key stakeholders in an Irish acute hospital, and considers the implications of findings for later stages of their implementation.

DO POLITICAL FACTORS MATTER FOR HEALTH CARE EXPENDITURE? A COMPARATIVE STUDY OF SWISS CANTONS

A. Vatter and C. Ruelfi

Journal of Public Policy, vol. 23, 2003, p.301-323

Study presents an empirical investigation into differences in public healthcare expenditure and private health insurance costs between the 26 Swiss cantons in the 1990s. Expenditure is influenced by demand for healthcare, which is determined by socio-economic factors, by the number of practitioners and the overall level of provision on the supply side, and by state proclivities towards interventionism.

THE EFFECT OF HOSPITAL OWNERSHIP CONVERSIONS ON NON-ACUTE CARE PROVIDERS

D. Gurewich, J. Prottas and W. Leutz

The Milbank Quarterly, Vol. 81, 2003, p.543-565

The article explores the impact of the conversion of US community hospitals from not-for-profit to for-profit status. Using inter-organizational theory, it examines how a change in ownership status affects a hospital's collaborative and competitive behaviour toward non-acute care providers serving vulnerable populations.

THE IMPACT OF BLUE CROSS CONVERSIONS ON ACCESSIBILITY, AFFORDABILITY AND THE PUBLIC INTEREST

M.A. Hall and C.J. Conover

Milbank Quarterly, Vol. 81, 2003, p.509-542

The article explores the complex issues raised by proposals to convert Blue Cross health insurance plans from not-for -profit to for-profit sales. It draws on interviews with key informants, original data analyses, the available literature and the evidence developed during legislative, regulatory and judicial proceedings in various US states in which Blue Cross conversions were undertaken. It finds that conversion creates pressures to increase profitability and this leads to changes that may be both negative and positive. There is little evidence of price increases that differ from overall trends or dramatic changes in medical underwriting practices. The parties affected most adversely by conversions have been health care providers, who have been forced to offer deeper discounts.

INFORMAL PAYMENTS FOR HEALTH CARE IN TRANSITION ECONOMIES

T. Ensor

Social Science & Medicine, Vol. 58, 2004, p.237-246

The article examines the prevalence of unofficial payments in the healthcare markets of transition countries. Such payments not only adversely effect the efficiency of healthcare organisations but also have an impact on the equity of the system. Several strategies for dealing with the problem are suggested, including:

• formalising payments;
• self-regulation by a professional association;
• incentives and market enhancing controls.

The article concludes that the problem must be tackled at national and even international levels if it is to be solved.

THE NEW ZEALAND HEALTH REFORMS: DIVIDING THE LABOUR OF CARE

R. Fitzgerald

Social Science & Medicine, Vol. 58, 2004, p.331-341

Health care in New Zealand has undergone many reforms in recent years. This article examines the unintended effects of these reforms on the concept of care for workers in a New Zealand hospital group between 1997 and 1998, especially the polarisation they have caused between management and care workers.

POVERTY, OUT-OF-POCKET PAYMENTS AND ACCESS TO HEALTH CARE: EVIDENCE FROM TAJIKISTAN

J. Falkingham

Social Science & Medicine, Vol. 58, 2004, p.237-246

Informal payments constitute a significant component of overall healthcare spending of countries in the former Soviet Union. Legitimising these payments and incorporating them into the formal healthcare financing stream seems to be a solution to the problem. However the extent to which these increased charges may affect access to health services, especially amongst the poor, must be considered before such reforms can take place. The article uses the Tajikistan Living Standards Survey to examine the level and distribution of informal payments for healthcare and whether they create inequalities in health access. The report concludes that there are both advantages and difficulties in legitimising unofficial payments and that policy makers need to consider the situation very carefully.

PROVISION OF AMBULATORY HEALTH SERVICES IN POLAND: A CASE STUDY FROM KRAKOW

M. Chawla and others

Social Science & Medicine, Vol. 58, 2004, p.227-235

The article examines the organisation and supply of health care services in Poland through a case study of the city of Krakow. It begins by describing Polish health care reforms, in particular the introduction of the social health insurance system in 1999, before describing how the provider market is organised. It goes on to analyse sources of finance. It discovers that the health financing reforms have led to an even playing field between public and non-public health providers and that the introduction of a market environment has changed the way providers are compensated. It concludes that further research on a country-wide basis is needed in order for a fuller picture to emerge.

THE RISE AND FALL OF A KAISER PERMANENTE EXPANSION REGION

D. Gitterman and others

Milbank Quarterly, Vol. 81, 2003, p.567-601

Prepaid Group Practices (PGPs) vertically integrate the organisation, financing and delivery of healthcare to a specific population. The article reflects on the potential, performance and prospects of prepaid group practice as a healthcare delivery model. To do this, it examines the rise and fall of the Kaiser Permanente (KP) expansion effort in North Carolina in order to gain insight into making prepaid group practice work. It concludes that KP's failed North Carolina expansion resulted not from an inherent flaw in the PGP model but from a complex interaction of political, economic and organizational factors.

RISK SEGMENTATION AND EQUITY IN THE CHILEAN MANDATORY HEALTH INSURANCE SYSTEM

C. Sapelli

Social Science & Medicine, Vol. 58, 2004, p.259-265

The article examines the inequalities of the Chilean health insurance system. It discusses the issues of risk segmentation and equity, giving particular attention to the considerations affecting individuals when choosing between the public and private system.

USER FEES AT A PUBLIC HOSPITAL IN CAMBODIA: EFFECTS ON HOSPITAL PERFORMANCE AND PROVIDER ATTITUDES

H. Akashi and others

Social Science & Medicine, Vol. 58, 2004, p. 553-564

The article explores the introduction of user fees in health care facilities in developing countries through a case study of a Cambodian public hospital. As the fees were invested into the hospital the quality of service improved, the number of outpatients doubled, and patient satisfaction increased dramatically. This in turn increased hospital revenue, allowing even more rapid improvements. Staff satisfaction remained low due to low salary compensation, although their work attitude shifted from salary-orientated to patient-orientated.

WAGE INEQUALITY, THE HEALTH SYSTEM, AND INFANT MORTALITY IN WEALTHY INDUSTRIALIZED COUNTRIES, 1970-1996

J. A. Macinko, L. Shi and B. Starfield

Social Science & Medicine, Vol. 58, 2004, p.279-292

The article examines whether social inequality has a direct relationship with population health. It uses data from 19 wealthy Organization for Economic Co-operation and Development (OECD) countries to assess the links between wage inequality and infant mortality and the effect this has on health system variables. It concludes that low wages do effect infant mortality and that improving the healthcare system may be the only defence against the negative effects of social inequalities on population health.