Welfare Reform on the Web (October 1999): Healthcare - Overseas

DO YOU SINCERELY WANT TO BE RICH?

U. Reinhardt

Health Economics, vol. 8, 1999, p. 355-362

Describes the rise and fall in the US of for-profit Physician Practice Management (PPM) companies. These PPMs purchase physicians' practices and sign on the doctors as salaried employees. The PPMs then bundle into one giant cash flow the individual cash flows yielded by the patients. This can then be re-sold on Wall Street at handsome arbitrage profits.

DOWN THE DOC AND DUCK

A. Maynard

Health Service Journal, vol. 109, 15th July 1999, p. 18-19

Reports on the German government's attempts to reform the healthcare system by:

• reducing numbers of doctors;
• transferring control of hospitals from local authorities to sickness funds;
• extending a diagnosis-related group system of payment, which currently covers about 20% of hospital activity, to the rest of the system.

THE EFFECTS OF ECONOMIC REFORM ON HEALTH INSURANCE AND THE FINANCIAL BURDEN FOR URBAN WORKERS IN CHINA

T. W. Hu and others

Health Economics, vol. 8, 1999, p. 309-321

Study based on a 1992 survey of 5920 workers in 406 enterprises in 22 cities shows wide variations in coverage for health care benefits among Chinese urban workers. It was also found that workers with partial coverage were as likely to incur out-of-pocket medical expenses as workers without coverage. These out-of-pocket medical expenses could be as much as 25% of a worker's annual income.

ENROLLMENT IN THE STATE CHILD HEALTH

INSURANCE PROGRAM: A CONCEPTUAL FRAMEWORK FOR EVALUATION AND CONTINUOUS QUALITY IMPROVEMENT

N. Halfon, M. Inkelas and P. W. Newacheck

Milbank Quarterly, vol. 77, 1999, p. 181-204

The State Child Health Insurance Program (SCHIP) provides an opportunity to extend health insurance to a population of children that has not been well covered through Medicaid or through private health insurance. However the legacy of Medicaid's low participation rate by eligible families raises concerns about the potential of SCHIP to improve children's access to care. Article describes how access measures and 'enrollment critical management procedures' can be utilised to establish mechanisms at the state and federal levels that will support continuous improvement of enrollment policies and procedures.

GRANDMOTHER'S FOOTSTEPS

S. Seton-Browne

Health Service Journal, vol. 109, July 1st 1999, p. 30-31

The Maori population of New Zealand has poorer health than the general population and finds access to traditional health services difficult. A programme using non-professionals for health promotion has produced significant results, including a dramatic improvement in take-up of immunisation.

HEALTH INSURANCE COVERAGE OF THE UNEMPLOYED: COBRA AND THE POTENTIAL EFFECTS OF KASSEBAUM-KENNEDY

M. C. Berger and others

Journal of Policy Analysis and Management, vol. 18, 1999, p. 430-448

When confronted with a medical catastrophe, lower or middle income households in the US that lack health insurance face financial rain. A drawback of the US system of employer-provided health insurance is that labour force transitions may have the side effect of eliminating the worker's health insurance coverage. COBRA, and, more recently, the Health Insurance Portability and Accountability Act were enacted to provide workers with a safety net in the event of a job interruption. Health insurance coverage can be maintained under this legislation during changes in employment status.

NOTHING SUCCEEDS LIKE SUCCESS: MANAGED CARE COMES TO MEDICAID IN NEW YORK CITY

M. S. Sparer and L. D. Brown

Milbank Quarterly, vol. 77, 1999, p. 205-223

Article reviews the politics of Medicaid managed care in New York City, concentrating on the transition from the policy of incremental growth that pertained during the early 1990s to its 1995 replacement that was geared to more rapid implementation. Examines the many problems that flowed from the decision to accelerate the transition, which, taken together, persuaded state officials to return to the earlier approach.

ON THE CRITICAL LIST

D. McGregor

Financial Times, July 28th 1999, p. 19

Despite efforts at reform, the US health system continues to suffer from some of the highest medical costs in the world and inadequate provision of medical care. The system faces two main challenges: how to fund Medicare (the Federal health insurance programme for elderly and disabled Americans) and how to provide an equitable system of managed care. There is a public perception that health insurers are more concerned about saving money than providing the best treatment.

WHITE HOUSE MAY AGREE TAX CUTS DEAL

R. Wolffe

Financial Times, July 29th 1999, p. 6

Reports that Bill Clinton is expected to lift his threat of a veto against all tax cuts higher than $250bn in exchange for agreement on extending the Medicare health programme to cover prescription drug benefits.