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

THE AMERICAN DREAM

R. Lewis

Public Finance, Apr. 23rd-29th 2004, p.20-23

Health Maintenance Organisations (HMOs) in the USA promote integration of hospital and primary care, community-based disease management and preventative medicine. The UK government is keen to learn from them and apply this preventative approach to the NHS.

THE EFFECT OF GENERIC COMPETITION ON THE PRICE OF BRAND-NAME DRUGS

J. Lexchin

Health Policy, Vol. 68, 2004, p.47-54

Research on drug prices in Canada found no reductions in the cost of brand-named products when generic equivalents come onto the market. It concludes that the lack of price competition may lead to increased costs in private healthcare since insurance companies generally do not require generic substitution and some provinces do not require generic substitution for cash paying customers.

EXPERIENCES OF FOREIGN EUROPEAN NURSES IN THE NETHERLANDS

A. de Veer, D.-J. den Ouden and A. Francke

Health Policy, Vol. 68, 2004, p.55-61

As a result of the shortage of "home-grown" nurses, the Dutch government has been encouraging the recruitment of nurses from other EU states. These nurses experienced difficulties in working in the Netherlands arising from the language barrier, problems with getting their qualifications recognised, and unfamiliarity with the Dutch legal, social security and healthcare systems. The government needs to take steps to make working in the Netherlands more attractive.

FROM CORPORATE GOVERNANCE TO HOSPITAL GOVERNANCE: AUTHORITY, TRANSPARENCY AND ACCOUNTABILITY OF BELGIAN NON-PROFIT HOSPITALS' BOARD AND MANAGEMENT

K. Eeckloo and others

Health Policy, Vol. 68, 2004, p.1-15

Based on a survey of 82 hospitals of the Flemish Community in Belgium, the article presents a detailed analysis of their governance arrangements, including board composition, size, independence, competencies and functioning, and the role of hospital physicians in management.

HEALTH SECTOR POLICY IN THE FIRST DECADE OF NEPAL'S MULTI-PARTY DEMOCRACY: DOES CLEAR ENUNCIATION OF HEALTH POLICIES MATTER?

S.R. Adhiteari and N. Maskay

Health Policy, Vol. 68, 2004, p.103-112

Throughout the 1990s Nepalese governments consistently enunciated policy goals aimed at improving the health of the rural population. The paper assesses whether the clear enunciation of these health priorities has transformed into positive health outcomes, such as increased life expectancy and reduced child and infant mortality. Data analysis suggests that, while there has been a clear enunciation of health policy priorities, there have not been positive effects on health outcomes.

THE IMPACT OF URBAN HEALTH INSURANCE REFORM ON HOSPITAL CHARGES: A CASE STUDY FROM TWO CITIES IN CHINA

Q. Meng and others

Health Policy, Vol. 68, 2004, p.197-209

China's transition from a centrally planned to a market economy has led to the reform of their urban health insurance system. The article assess the impact of this reform on hospital charges by comparing their evolution in two cities - one with and one without reform - and identifying the determinants for change. Data were collected from six hospitals in the two cities, with acute appendicitis and normal childbirth used as tracers for calculating charges. Results show that although charges increased in both cities, the rise was much greater in the city without reform. Health insurance arrangements and the average length of stay had the greatest influences on the charges. The article concludes that hospital expenses must be controlled if the reforms are to succeed.

MOVING FORWARD? COMPLEMENTARY AND ALTERNATIVE PRACTITIONERS SEEKING SELF-REGULATION

S. Welsh and others

Sociology of Health and Illness, Vol. 26, 2004, p.216-241

The article examines the attempts of three groups of complementary medicine practitioners (naturopaths, traditional Chinese medicine practitioners, acupuncturists and homeopaths) in the province of Ontario to achieve professional status through statutory regulation. These groups are using a variety of strategies, based on claims to knowledge of medical science, to demonstrate which practitioners should receive statutory regulation. The groups are attempting to create boundaries around who is considered a credible practitioner with a valid knowledge base versus those who are not.

NO "FORMULE MAGIQUE"

J. Hirst

Public Finance, Apr. 2nd-8th 2004, p.28-29

The French health insurance system has plunged into deficit as patient demand outstrips financial resources available to pay for it. French taxpayers are faced with the prospect of increased contributions and less choice of treatment.

PAYING FOR HEALTH SERVICES IN EAST AFRICA: A RESEARCH NOTE

R. K. Quaye

Social Theory and Health, Vol. 2, 2004, p.94-105

The paper explores the different reforms in healthcare financing introduced in Kenya, Tanzania and Uganda in the 1990s and assesses their effectiveness in improving access to and the efficiency of healthcare services. It finds that the Community Health Fund model introduced in Tanzania has been the most effective. This involves households paying a predetermined amount of money to cover health services for their members, with exemptions for poorer households agreed by village committees.

REGULATION OF JUNIOR DOCTORS' WORK HOURS: AN ANALYSIS OF BRITISH AND AMERICAN DOCTORS' EXPERIENCES AND ATTITUDES

R. Jagsi and R. Surender

Social Science & Medicine, Vol. 58, 2004, p.2181-2191

Regulation of junior doctors' work hours was first introduced in the United Kingdom and the United States over a decade ago in an attempt to improve patient care and doctors' wellbeing, whilst at the same time maintaining high quality medical training. The article examines effects of regulating doctors' hours through the experiences of physicians and surgeons from the UK and the US. It explores doctors' perceptions of the regulations, their attitude towards further reform and the degree to which the regulations have achieved their goal. Results indicate American doctors worked longer hours than their British counterparts, and consequently reducing working time was a high priority. In contrast British workers were more disenchanted with the reforms and more concerned about other aspects of their working conditions, such as pay and supervision. The study therefore shows that reducing hours only had limited benefits to junior doctors' wellbeing. the article concludes that unless reductions in hours are coupled with an injection of resources and a redesigned training system, improvements are unlikely to occur.

RELATIONSHIP BETWEEN HOSPITAL STRUCTURAL LEVEL AND LENGTH OF STAY OUTLIERS: IMPLICATIONS FOR HOSPITAL PAYMENT SYSTEMS

F. Cots and others

Health Policy, Vol. 68, 2004, p.159-168

The article examines the relationship between different hospital structures (defined by size, teaching activity and location) and the presence of length of stay outliers. Discharge records at 64 Catalan public hospitals were examined, with results indicating that patients treated in hospitals with greater structural complexity were more likely to be outliers that those treated in small community hospitals. This has implications for the financing and management of public hospitals, as the presence of outliers influences hospital costs and therefore financing needs.

TRENDS IN GEOGRAPHIC DISPARITIES IN ALLOCATION OF HEALTH CARE RESOURCES IN THE US

T. Horev, I. Pesis-Katz and D.B. Mukamel

Health Policy, Vol. 68, 2004, p.223-232

The article examines both the current level and historical trends of inequality in health resources in the US, focusing specifically on the allocation of hospital beds and physicians in each state. Results showed that physician distribution became less equitable between 1970 and 1998, whereas hospital bed equity increased.

UNIVERSAL HEALTH CARE FOR COLOMBIANS 10 YEARS AFTER LAW 100: CHALLENGES AND OPPORTUNITIES

R.-M. Rosa and I.C. Alberto

Health Policy, Vol. 68, 2004, p.129-142

The article examines the Columbian health care system ten years after its reform. It begins by examining the main features of the system before exploring the four central aspects of healthcare reform: the Unit of Payment by Capitation (UPC) as a provider payment mechanism, asymmetries of information among the different agents of the General System of Social Security in Health, the delegation of collection and control of funds from the Fund of Solidarity and Assurance to the Health Promotion entities and the attempt to achieve universal health insurance.

UNIVERSAL HEALTH COVERAGE IN THAILAND: IDEAS FOR REFORM AND POLICY STRUGGLING

S. Pannarunothai, D. Patmasiriwat and S. Srithamrongsawat

Health Policy, Vol. 68, 2004, p.17-30

The paper demonstrates the use of the Delphi survey technique and in-depth interviews in a debate about how to achieve universal access to health care in Thailand. Ideas on policy reforms were collected from a range of stakeholders, including policymakers, academics, health insurers, health care providers and patients. Most respondents agreed on the goal of universal health coverage, but there were different views on how to achieve it. Views were presented on sources of finance, fiscal implications for the Thai government, demand management and local government role. The paper also takes note of the actual reform implemented by the Thai government in 2001, which seeks to achieve universal coverage by introducing a modest co-payment of 30 baht for all inpatient and outpatient care.

USERS OF, AND ATTITUDES TO, CLINICAL PRIORITY ASSESSMENT CRITERIA IN ELECTIVE SURGERY IN NEW ZEALAND

D. McLeod and others

Journal of Health Services Research and Policy, Vol. 9, 2004, p.91-99

Clinical Priority Assessment Criteria (CPAC) were developed to determine in a clear and transparent way, which patients could have access to publicly funded surgery. The article presents the results of a qualitative study of the system which involved interviews with 65 GPs, surgeons and hospital administrators. It concludes that at the time of the study variability in the use of CPAC tools meant that they did not provide a transparent and equitable system for determining access to surgery.

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