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

ACTORS AND MOTIVES IN THE INTERNATIONALIZATION OF HEALTH BUSINESS

C. Holden

Business and Politics, Vol. 5, 2003, p.287-302

The article seeks to develop a systematic understanding of the relationships between the structure of welfare states, the social and economic policies of governments and international institutions, and the strategies and interests of private companies. It begins by exploring the role of international institutions such as the World Bank and the World Trade Organisation in the internationalisation process, but argues that although such institutions provide the framework within which liberalisation takes place, it is the relationship between governments and firms on which internationalisation depends. This is illustrated through a case study of the current process of reform in Britain, where the move from direct state provision towards public private partnerships is facilitating a process of internationalisation.

AIDS AND HEALTH-POLICY RESPONSES IN EUROPEAN WELFARE STATES

M. Steffen

Journal of European Social Policy, Vol. 14, May 2004, p.165-181

The article examines the complex policy issues brought about by the AIDS epidemic in Europe and analyses how European health systems reacted to the unexpected challenges of tackling the disease. It looks at the coping mechanisms in countries with well established medical-care sectors compared to those with weakly structured public health sectors and considers the policy changes that occurred as a result of the virus.

ANGER AS FRENCH HEALTH CUTS UNVEILED

J. Henley

The Guardian, May 19th 2004, p.13

Doctors, trade unions and opposition MPs are united in criticism of plans by the conservative French government to reform the country's widely praised but nearly bankrupt health service. A national day of action on June 5 has been called to defend the service. According to the Ministry, the French health system, ranked the fourth best in the world just four years ago, is now losing £15,554 a minute; it will end the year £8.7bn in the red, and could collapse altogether by 2020. The measures are due to be approved by Parliament by the end of July. They aim to boost revenue and cut expenditure.

DECENTRALIZATION AND PUBLIC SERVICES: THE CASE OF IMMUNIZATION

P. Khaleghian

Social Science and Medicine, Vol. 59, 2004, p.163-183

The study examines the impact of political decentralisation on childhood immunization rates. The relationship is examined empirically using a time series data set of 140 low and middle income countries from 1980-1997. It finds that decentralisation has different effects in low- and middle- income countries. In the low-income group, decentralised countries have higher coverage rates than centralised ones. In the middle-income group the reverse effect is observed. It concludes that decentralisation is not a panacea and can only flourish in the right environment, if properly designed.

DEVELOPMENT OF THE RURAL HEALTH INSURANCE SYSTEM IN CHINA

Y. Liu

Health Policy and Planning, Vol. 19, 2004, p.159-165

China's provision of health insurance to rural communities has been virtually non existent since the collapse of the Rural Cooperative Medical System (RCMS) in the early 1980s. The article explores why a new system hasn't been developed, especially in light of the county's rapid economic growth. Several hindrances to establishing a system are discovered, including the lack of ability to pay by low income families, adverse selection amongst those who are able to pay and organisational capacities for running RCMS schemes. However, lack of government involvement was found to be the most significant factor in China's failure to provide rural health insurance and the article concludes that without government support, China will never be able to establish a sustainable rural health insurance system.

ECONOMIES OF SCALE AND SCOPE IN VIETNAMESE HOSPITALS

M. Weaver and A. Deolalikar

Social Science and Medicine, Vol. 59, 2004, p.199-208

Historically, health care in Vietnam was provided exclusively by public facilities funded by government or by community health centres funded by work brigades. Hospitals were allocated by administrative units, with central level hospitals in major cities, provincial hospitals in provincial capitals and district hospitals in district capitals. Three health sector reforms in the late 1980s and early 1990s affected hospitals:

  • the introduction of user fees;
  • the introduction of social insurance in 1993;
  • legalisation of private medicine in 1993.

The study found that economies of scale did not depend on the number of beds and volume of output: large hospitals in one category had constant returns to scale, whereas smaller hospitals in another category had large diseconomies of scale. Among smaller hospitals, district hospitals had modest economies of scale and other Ministry hospitals had modest diseconomies of scale.

INTERACTIONS BETWEEN PATENT MEDICINE VENDORS AND CUSTOMERS IN RURAL NIGERIA

W.R. Brieger and others

Health Policy and Planning, Vol. 19, 2004, p.177-182

Patent medicine vendors (PMV) supply the majority of the drugs through which members of the public in African countries treat their illnesses. Minimal qualifications are required for the role and thus PMVs do not always have the adequate knowledge about medicines held in their stores or the illnesses experienced by customers. The study observed interactions between PMVs and their customers to determine whether they behave simply as business people or as health providers, and to see whether the quality of the interaction might be improved. Results showed that although most providers (69%) simply dispensed the requested medicine, some questioned the customer about their illness (19%) and provided instructions about how to take the medicine (21%). The study concludes that the role of the PMV could be enhanced through consumer education, PMV training and policy changes to standardise and legitimise PMV contributions to primary healthcare.

THE ROLE OF COMMUNITY-BASED HEALTH INSURANCE WITHIN THE HEALTHCARE FINANCING SYSTEM: A FRAMEWORK FOR ANALYSIS

S. Bennett

Health Policy and Planning, Vol. 19, 2004, p.147-158

The article provides a framework for analysing how community-based health insurance (CBHI) schemes interact with other components of health care financing in terms of financial flows, population coverage and benefit packages. Reference is made to four different CBHI schemes (two Asian, two African) and the paper sets out conceptual maps to explore how CBHI schemes contribute to national policy objectives. The article concludes that empirical research is needed in order for these issues to be fully explored.

UP THE GARDEN PATH AND OVER THE EDGE: WHERE MIGHT HEALTH SEEKING BEHAVIOUR TAKE US?

S. Mackian, N. Bedri and H. Lovel

Health Policy and Planning, Vol. 19, 2004, p.137-146

The article reviews the literature on health seeking behaviour (HSB). It finds that the literature does not adequately address either the nature of how people reach their decisions or the complexity of health care systems, and argues that a tool must be developed to help us understand how people engage with health systems, rather than using health seeking behaviour as a tool for describing how individuals engage with services. A social capital framework is suggested as one way of achieving this goal.

THE US MEDICARE PROGRAMME IN POLITICAL FLUX

T. Marmor

British Journal of Health Care Management, vol.10, 2004, p.143-147

Medicare offers hospital and physician health insurance to disabled and elderly Americans. Article analyses debate surrounding the so-called Prescription Drug Bill which was passed by Congress in December 2003. The Bill provides outpatient drug insurance to Medicare recipients, but also includes large new subsidies for private insurers and requirements that will ensure that Medicare never uses its massive buying power to force drug companies to reduce their prices.

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