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

CHANGES IN DRUG UTILIZATION FOLLOWING THE OUTPATIENT PRESCRIPTION DRUG COST-SHARING PROGRAM - EVIDENCE FROM TAIWAN'S ELDERLY

S.-Z. Liu and J.C. Romeis

Health Policy, Vol. 68, 2004, p.277-287

The article examines changes in drug utilization following Taiwan's new National Health Insurance outpatient prescription drug cost-sharing programme for Taiwan's elderly. It looked at selected effects of the programme by comparing pre-cost sharing with cost-sharing periods for older Taiwanese affected and unaffected by the policy. Patients over 65, with and without chronic diseases, were drawn from 21 hospitals in the Taipei area. Results show that average prescription costs and prescription period increased for both groups, although the increase was significantly lower for the non cost-sharing group. Those with non-chronic diseases were found to be more sensitive to the cost-sharing programme. There was also a significant increase in the number of prescriptions. The article concludes that the cost-sharing programme did not reverse the trend of drug cost increases at hospital level, although it achieved moderate success from a cost-control perspective.

IMPACT OF NATIONAL HEALTH CARE SYSTEMS ON PATIENT EVALUATIONS OF GENERAL PRACTICE IN EUROPE

M. Wensing and others

Health Policy, Vol. 68, 2004, p. 353-357

The article examines the link between patient satisfaction with general practice and the characteristics of national health care systems. Patients evaluated general practice in 17 countries across Europe. Results show that there were no significant associations between patient satisfaction with general practice care and the characteristics of national health care systems, and the article concludes that patients can be highly satisfied with their general practice care in different national health care systems.

LESSONS FROM KOREA'S PHARMACEUTICAL POLICY REFORM: THE SEPARATION OF MEDICAL INSTITUTIONS AND PHARMACIES FOR OUTPATIENT CARE

H.J. Kim, W. Chung and S.G. Lee

Health Policy, Vol. 68, 2004, p.267-275

Traditionally, drugs in Korea have been prescribed and dispensed by both physicians and pharmacists, leading to over-prescribing and inappropriate selling of drugs and high pharmaceutical expenditures. In 2000, the Korean government launched a radical drug policy reform in an attempt to rectify this problem. However, this was not phased in slowly, but implemented all at once, nation-wide, leading to protests and strikes. The article examines the reform and considers the effectiveness of the new policy. It finds that it has led to greater inconvenience for patients, reduced access to medical care, increased drug spending, and a greater deficit in the budget of the Korean health insurance system. It concludes by considering how future health policy could be implemented more effectively.

LOGISTICS' CONTRIBUTIONS TO BETTER HEALTH IN DEVELOPING COUNTRIES: PROGRAMMES THAT DELIVER

P. Shawkey and C. Hart

Aldershot: Ashgate, 2004

Logistics are the set of activities that move products through the supply chain to the ultimate customer: these are of vital importance to the success of health programmes in the developing world. This volume comprises the best practices learned and promoted by the Family Planning Statistics Management Project, set up in 1986 and funded by the U.S Agency for International Development. The project covered approximately 40 countries in Africa, Asia, Latin America and the Caribbean interested in improving their supply chains. Using a range of international case studies, the book focuses on the approaches and tools that were the most effective for their settings.

A LARGE PROPORTION OF SWEDISH CITIZENS REFRAIN FROM SEEKING MEDICAL CARE - LACK OF CONFIDENCE IN THE MEDICAL SERVICES A PLAUSIBLE EXPLANATION?

M. Westin and others

Health Policy, Vol. 68, 2004, p.333-344

Although equal access has been a long-standing goal in Swedish healthcare, recent studies have shown that healthcare utilisation in Sweden is linked to certain socio-economic variables such as private economy and level of education. The study examines how different socio-demographic variables are associated with perceived unmet needs and looks at why people fail to see a doctor despite a perceived need, and what they do instead. 2648 people, chosen by random, took part in a nation-wide postal questionnaire. Questions concerned respondents' health and healthcare utilisation, and asked for information on socio-demographic variables. Results show that 24% of the population do not visit a physician despite perceiving a need. Women, those of non-Swedish origin and those with a low level of education refrained from seeing the doctor more than men, Swedish citizens and those with higher levels of education. Lack of confidence was the most popular reason for not visiting the doctor, but limited availability of physicians and lack of economic means were also cited as factors. The article concludes that the Swedish healthcare system does not provide for the unmet needs of a large proportion of the population and that this has equitable concerns.

MANAGING HEALTH: AN INTERNATIONAL PERSPECTIVE

N.M. Kane and N.C. Turnbull

San Francisco: Jossey-Bass, 2004

This book provides student and professionals in health care systems with an international perspective on tools and mechanisms that have been used to manage cost, care and the health of populations. Containing eleven teaching cases relating to health in North America, Western Europe, Eastern Europe, Asia and South America, this is a resource for helping students and professionals to develop solutions to real-world situations in health care reform to the challenges of health care reform.

THE PREDICTABILITY OF INDIVIDUAL PRIMARY CARE COSTS AND ITS IMPACT ON MANAGED CARE PLANS

M. Demers

Health Policy, Vol. 68, 2004, p.345-352

The article seeks to gain a greater understanding of the evolution of family practice costs in order to ensure that primary care is delivered in the most effective way. It examines the level of use, and the transition probabilities of remaining a low user of physician care, in family practices over a five year period. The study followed the entire population of a single administrative area in Quebec between 1996 and 2000. Results showed a strong stability of family practice costs over time due to low transition. Medical expenditures were also shown to be equally distributed between individuals over a period of time. Such results indicate the possibility of forecasting costs from a perspective of capitation plans.

RESERVED PROCEDURES IN DUTCH HOSPITALS: KNOWLEDGE, EXPERIENCES AND VIEWS OF PHYSICIANS AND NURSES

J. de Bie and others

Health Policy, Vol. 68, 2004, p.373-384

European countries have a number of different systems for regulating health care professionals and their competencies. These include monopolistic systems (involving a total ban on the unauthorised practice of medicine), tolerant systems, (leaving the practice of medicine open to all) and mixed systems (based on a tolerant approach with the exception of certain medical "reserved" procedures). In 1997 the Netherlands moved over from a monopolistic to a mixed system. The article examines the functioning of the reserved procedure regulations in Dutch hospitals in order to gain insight into physicians' and nurses' knowledge, experiences and views regarding them. Although results highlight areas for improvement, the article concludes that the functioning of reserved procedures regulations in hospitals is moderately positive.

SENIORS' PRESCRIPTION DRUG COST INFLATION AND COST CONTAINMENT: EVIDENCE FROM BRITISH COLOMBIA

S.G. Morgan, J.D. Agnew and M.L. Barer

Health Policy, Vol. 68, 2004, p.299-307

Prescription drug spending is increasing rapidly in Canada, putting pressure on individual consumers, government drug benefit plans and the sponsors of private insurance. The article develops an analytic framework to map out the nature and relative importance of different cost-driving trends in the prescription drug market. This framework is then used to calculate prescription drug cost-drivers for senior citizens in British Colombia.

SOCIOECONOMIC STATUS AND HEALTH: THE PROBLEM OF EXPLANATION AND A SOCIOLOGICAL SOLUTION

F.W. Young

Social Theory & Health, Vol. 2, 2004, p.123-141

The article examines the interrelationship between health and social indicators and attempts to explain the links between them. It considers issues such as the relationship between quality of health and years of schooling and the links between low and high socioeconomic status and shorter and longer lifespans. The article rejects the traditional biomedical explanation- that education and income operate through the "proximate determinants" of health - in favour of a sociological one. It argues that the components of socioeconomic status, especially schooling, predict behaviours because they reflect a superior problem-solving capacity that moderates behaviours and produces an optimum biological functioning. The article concludes that the new theory leaves the biological explanation intact for curative medicine and epidemics, but points to a social rationale for public health programmes orientated to enhancing positive health.

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