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

A CONSUMER INVOLVEMENT MODEL FOR HEALTH TECHNOLOGY ASSESSMENT IN CANADA

J. Pivik, E. Rode and C. Ward

Health Policy, vol.69, 2004, p.253-268

The paper aimed to empirically asses the interest in, and potential mechanisms for, consumer involvement in Health Technology Assessment i.e. the rigorous assessment of interventions such as drugs, vaccines, surgical procedures, etc. It investigated what health consumer organisations consider to be meaningful involvement, examined current practices internationally, developed a model for their involvement in Health Technology Assessment and provided feedback on mechanisms for facilitating this involvement.

CHINA'S EVOLVING HEALTHCARE MARKET: HOW DOCTORS FEEL AND WHAT THEY THINK

M.-K. Lim and others

Health Policy, vol.69, 2004, p.329-337

As China makes the transition from a planned to a market economy, health policy makers are grappling with issues of cost containment, structural reorganisation and market regulation. The article reports the results of a study of doctors' levels of satisfaction and their views on healthcare in China. It found low satisfaction with income (8%), job (27%), skill (30%) and other aspects of professional life. There was concern about quality of care and patient safety, especially in the growing but poorly regulated private sector. The public sector was criticised for high fees and poor service quality.

CONTRACTING FOR HEALTH SERVICES IN A PUBLIC HEALTH SYSTEM: THE NEW ZEALAND EXPERIENCE

T. Ashton, J. Cuming and J. McLean

Health Policy, vol.69, 2004, p.21-31

Paper reports on the processes and outcomes of contracting for health services in New Zealand between 1993 and 2000, when a purchaser-provider split was in place. Overall, the introduction of contracting improved the focus of providers on costs and volumes; led to greater clarity through detailed specification of services; encouraged providers to focus on quality improvement; and enabled new styles of service provision from providers that had not traditionally received public funds for health services. Good relationships between purchasers and providers were seen as key to successful contracting.

ESTIMATING RESOURCE NEEDS FOR HIV/AIDS HEALTH CARE SERVICES IN LOW-INCOME AND MIDDLE INCOME COUNTRIES

S. Bertozzi and others

Health Policy, vol.69, 2004, p.189-200

Bodies such as the Global Fund for HIV/AIDS, Tuberculosis and Malaria make funding decisions on the basis of burden of disease estimates and financial need calculations. The paper presents a model for estimating HIV/AIDS health care resource needs in low- and middle- income countries.

THE FEASIBILITY OF COMMUNITY-BASED HEALTH INSURANCE IN BURKINO FASO

H. Dong and others

Health Policy, vol.69, 2004, p.45-53

Health services in rural Burkino Faso are characterised by inequitable utilisation and poor quality. The government is seeking to improve access through the introduction of community-based health insurance. Under this system, community members would own the scheme, collect the premiums, pay providers and negotiate the benefits package. Premiums would be paid by households, not individuals. Paper investigates the acceptability of community-based insurance to the populace, examining local people's preferences for the benefits package and estimating the premium on the basis of household heads' willingness to pay.

HEALTH AND HEALTH CARE AS SOCIAL PROBLEMS

P. Conrad and V. Leiter

Oxford: Rowman & Littlefield, 2004

This volume examines various sets of social problems in current American health and health care including:

• the medicalization of human problems and the social construction of health problems;
• how social movements can affect the understanding and treatment of medical problems;
• an exploration of the role of gender in health and illness;
• the roles that race and class play in the provision of health care;
• the issue of medical accountability in society

HEALTH CARE RATIONING POLICY IN NEW ZEALAND: DEVELOPMENT AND LESSONS

R. Gauld

Social Policy and Society, vol.3, 2004, p.235-242

The article charts the course of healthcare rationing policy development in New Zealand. It opens by discussing the context through which rationing policy emerged. It then looks at key rationing initiatives since 1991, including attempts to develop a "core service" listing, clinical guidelines and prioritisation processes, new technology assessment and pharmaceutical budget management.

HEALTH COVERAGE INSTABILITY FOR MOTHERS IN WORKING FAMILIES

S.G. Anderson and M.K. Eamen

Social Work, vol.49, 2004, p.395-405

Using data from the U.S. National Longitudinal Survey of Youth, the authors examined the health insurance stability of 1,667 women in working families over a three-year period. Findings suggest that consistent health insurance coverage is likely to be unavailable to most mothers leaving welfare and to about half of all low-income working mothers. It is therefore highly likely that mothers leaving welfare for low paid jobs will be worse off in terms of health care coverage than those who remain on benefits, where Medicaid coverage is generally available to all.

HEALTH SYSTEM REFORM IN MONTREAL: IMPACT ON THE USE OF DAY SURGERY AND ON SURGICAL PATIENTS AND THEIR CAREGIVERS

P. Tousignant and others

Canadian Public Policy, vol.30, 2004, p.207-230

Major cutbacks in resources for acute hospital care in Montreal resulted in the closure of 7 hospitals, 29% of hospital acute care beds, 9 surgical theatres and 7 emergency rooms. To facilitate the cutbacks, hospitals were encouraged to make greater use of day surgery and shorten patient stays. The article evaluates the effects of these changes on the wellbeing of surgical patients and their caregivers. It compares the experiences of two cohorts of patients, one seen at the beginning of the changes and the other seen when adaptation to the changes was largely complete. Results show that although the reforms reduced the services used by patients, their wellbeing, and that of their caregivers, was not affected.

IMPACT OF EUROPEAN UNION ENLARGEMENT ON HEALTH PROFESSIONALS AND HEALTH CARE SYSTEMS

E.D. Avgerinos, S.A. Koupiidis and D.K. Filippou

Health Policy, vol.69, 2004, p.403-408

EU enlargement will facilitate the free movement of doctors and break down national quality controls which ensured that migrant doctors were suitably trained and skilled. There is an over-supply of doctors in some EU countries and unemployment in the medical profession is rising. This will fuel mass migration.

IMPLEMENTING CHANGE IN HEALTH SYSTEMS: MARKET REFORMS IN THE UNITED KINGDOM, SWEDEN & THE NETHERLANDS

M.I. Harrison

London: Sage Publications, 2004

This book examines the development and implementation of national cost-containment programmes and health systems reorganisations in the UK, Sweden and The Netherlands - countries that have been leaders in health system reform. It explores the processes of implementing market reforms in each country and considers the outcomes, both expected and unintended. In all three countries competitive reforms encountered serious technical, organizational and political obstacles. Yet they paved the way for significant new health policies including:

• changes in the quality, efficiency and costs of care;
• growing managerial and political control over health care professionals;
• increased influence and centrality of community-based care;
• diffusion of ideas and practices from business management into healthcare.

INFLUENCE OF SOCIAL CONTEXT ON PARTNERSHIPS IN CANADIAN HEALTH SYSTEMS

C.M. Scott and W.E. Thurston

Gender, Work and Organisation, Vol.11, 2004, p.481-505

The article presents a comparative case study of two partnerships in the Canadian health system. The successful partnership was explicitly based on feminist principles of collective responsibility and social equity that acknowledge power imbalances. In the ineffective partnership, the organisations operated within strongly patriarchal and bureaucratic structures. These practices undermine the collaborative work required to build sustainable partnerships.

INTRODUCING CO-ORDINATED CARE (1): A RANDOMISED TRIAL ASSESSING CLIENT AND COST OUTCOMES

L. Segal and others

Health Policy, vol.69. 2004, p.201-213

The Australian Co-ordinated Care Trial aimed to improve services for patients with multiple chronic illnesses through the implementation of a written care plan by a care co-ordinator that would ensure access to all appropriate services. The trial involving 2,742 participants in Melbourne demonstrated no significant differences between the intervention and usual care groups on two quality of life measures and no difference in mortality rates. Total resource usage in the intervention group was higher, due to the extra costs involved in care planning, case management and the administration of the scheme.

(See also Health Policy, vol.69, 2004, p.215-228 for a companion paper discussing why programme goals were not achieved.)

IS CLIENT CENTRED CARE PLANNING FOR CHRONIC DISEASE SUSTAINABLE? EXPERIENCE FROM RURAL SOUTH AUSTRALIA

J. Fuller, P. Harvey and G. Misan

Health and Social Care in the Community, vol.12, 2004, p.318-326

Three chronic disease management tasks have been identified as medical management, role management (i.e. behaviour changes necessitated by the chronic disease), and emotional management (i.e. dealing with the emotional sequelae of living with a chronic disease). Dealing with these tasks would ideally involve a partnership between the client and a range of health professionals that develops from the client's perspective of their problems, which the authors term client-centred care planning. Article reports results of a qualitative evaluation of a chronic disease self-management project in rural South Australia and considers the sustainability of client-centred care planning under present organisational and funding arrangements. Three issues emerged which are important for the sustainability of this approach:

the time, and hence the resources required to explore client determined problems and goals;

the support required by care planners to deal with a wide range of client issues;

the funding processes that impede teamwork between the State-salaried allied health workers and the Commonwealth-funded fee-for-service GPs.

JUSTICE IMPLICATIONS OF A PROPOSED MEDICARE PRESCRIPTION DRUG POLICY

H. Larkin

Social Work, vol.49, 2004, p.406-414

Medicare provides health insurance for elderly and disabled US citizens. However it does not cover the cost of prescription drugs. In spite of various legislative proposals in recent years an extension of Medicare coverage to include prescription drugs has yet to be implemented. The article argues that a focus on the needs of the elderly has failed to achieve prescription drug legislation. It therefore suggests a claim based on rights rather than needs. Needs, however, can be used to highlight the plight of disadvantaged individuals, whose rights must be addressed.

NETWORKS FOR INTEGRATED CARE PROVISION: AN ECONOMIC APPROACH BASED ON OPPORTUNISM AND TRUST

B. Meijboom, J. de Haan and P. Verheyen

Health Policy, vol.69, 2004, p.33-43

In the Netherlands there is a commitment to developing voluntary, long-term agreements between diverse parties for the delivery of integrated care. Paper analyses integrated care delivered by institutions working in partnership from an economic organisation theory perspective.

PAKISTAN'S MATERNAL AND CHILD HEALTH POLICY: ANALYSIS, LESSONS AND THE WAY FORWARD

S. Siddiqi and others

Health Policy, vol.69, 2004, p.117-130

An estimated 400,000 infant and 16,500 maternal deaths occur annually in Pakistan, often from easily treatable or preventable causes. In order to establish why there has been no improvement, authors analyse Pakistan's maternal and child health and family planning policies over the past decade, identify strengths and weaknesses and factors underlying these, and suggest strategic directions for policymakers.

THE PERFORMANCE OF DIFFERENT MODELS OF PRIMARY CARE PROVISION IN SOUTHERN AFRICA

A. Mills and others

Social Science and Medicine, vol.59, 2004, p.931-943

In developing countries primary care coverage remains incomplete and of poor quality. Users frequently patronise private providers, ranging from informal drug sellers to trained professionals. Recent research reviews suggest establishing relationships between the public sector and private providers, in particular through contracting out services. Study explored whether the South African government should continue with its present public hierarchical model of primary care provision, or should consider contracting out services. Performance of a cross-section of public clinics was compared with a range of privately owned primary care services, in order to identify the models' strengths and weaknesses. The study also considered influences on the performance of the different models (including contract design) and differences between models that should be taken into account when writing contracts.

POST-FORDISM'S CONTRADICTORY TRENDS: THE CASE OF THE ISRAELI HEALTH CARE SYSTEM

D. File

Journal of Social Policy, vol.33, 2004, p.417-436

The article studies the transformations which have taken place in the Israeli health care system since 1980 in order to reveal the interplay of contradictory trends and forces in the transition to Post-Fordism. It emphasises the contradiction between the partial commodification of financing and the privatisation of certain health care facilities, and the National Health Insurance Law, which guaranteed rights of access to public health care services.

THE RELATIVE IMPORTANCE OF LEADERSHIP AND PAYMENT SYSTEM: EFFECTS ON QUALITY OF CARE AND WORK ENVIRONMENT

E. Forsberg, R. Axelsson and B. Arnetz

Health Policy, vol.69, 2004, p.73-82

Article explores the relationship between leadership and financial incentives in a health care system. Physicians in a Swedish County Council with performance-related reimbursement and in 10 councils without such a system were surveyed using a self-report questionnaire. Results suggested that strong leadership can shield a health care organisation from the unwanted side-effects of financial pressure. Good leadership fosters a better quality of care, professional autonomy and job satisfaction.

RIVAL PRESCRIPTIONS FOR HEALTH COSTS

E. Kelleher

Financial Times, August 26th 2004, p.8

George Bush and John Kerry have very different approaches to funding ever more expensive medical healthcare. Mr. Bush favours using free-market tactics, while Mr. Kerry would ask the government to shoulder more of the medical care burden.

SHIFTING THE BURDEN OF HEALTH CARE FINANCE: A CASE STUDY OF PUBLIC-PRIVATE PARTNERSHIP IN SINGAPORE

M.-K. Lin

Health Policy, vol.69, 2004, p.83-92

Since independence in 1965, the Singapore government has persuaded its citizens to pay more towards the costs of their own health care. Private spending now accounts for three-quarters of health expenditure nationally. Singaporeans appear content to pay part of their medical expenses plus additional fees for better services. Mechanisms are in place to pay the medical bills of the poor and needy and to protect citizens from financial impoverishment due to catastrophic illness.

TECHNICAL EFFICIENCY IN THE USE OF HEALTH CARE RESOURCES: A COMPARISON OF OECD COUNTRIES

D. Retzlaff-Roberts, C.F. Chang and R.M. Rubin

Health Policy, vol.69, 2004, p.55-72

The paper examines technical efficiency in health care resource use by comparing health outputs achieved, given the level of health care resources consumed and the health challenges facing each country. Results show that technically inefficient countries could reduce infant mortality by 14.5% and increase life expectancy by 2.1% without using more resources. On the other hand, they could reduce inputs by 14% without raising the level of infant mortality and by 21% without reducing life expectancy. It concludes that the USA can learn from countries more economical in their use of health care resources that more is not necessarily better.

TRADING PRACTICES: LESSONS FROM SCANDINAVIA

G. Bottom, S. Grepperud and S.M. Neiland

Health Policy, vol.69, 2004, p.317-327

In order to boost treatment capacity, Norway launched the Patient Bridge in 2000/01. This project organised the treatment of Norwegian patients in private hospitals in neighbouring countries. All expenses involved (treatment, accommodation and transport) were paid for by the project. The Patient Bridge turned out to be a relatively expensive project partly due to travel costs and partly because of high treatment costs abroad.

UNCONTROLLED IMMIGRATION AND THE US HEALTH CARE SYSTEM

A. Green and J. Martin

Journal of Social, Political and Economic Studies, vol.29, 2004, p.225-241

Authors argue that high rates of legal and illegal immigration are causing a drain on health care resources. Under current US law, hospitals must treat anyone who seeks emergency care. However, many hospitals are not reimbursed for treating immigrants, spelling financial disaster for them.

UNDERSTANDING THE IMPACT OF INTERGOVERNMENTAL RELATIONS ON PUBLIC HEALTH: LESSONS FROM REFORM INITIATIVES IN THE BLOOD SYSTEM AND HEALTH SURVEILLANCE

K. Wilson, J. McCrea-Logie and H. Lazar

Canadian Public Policy, vol.30, 2004, p.177-194

The article examines the role of effective intergovernmental relations in the development of a successful public health policy in Canada. It creates a framework for characterising the different forms of intergovernmental relations that exist in public health before going on to apply it to relations in the blood system following its reform in response to the Krever Inquiry. The effectiveness of these relations is then compared to the set of governmental relationships in the field of health surveillance. From here, recommendations are made on the benefits of different government structures for public health reform.

WOMEN, MEN AND PUBLIC HEALTH: HOW THE CHOICE OF NORMATIVE THEORY AFFECTS RESOURCE ALLOCATION

A. Mansdotter, L. Lindholm and A. Öhman

Health Policy, vol.69, 2004, p.351-364

Women live longer than men in almost all countries, but men have less morbidity than women as well as more power, influence and resources. A variety of sometimes contradictory interventions have been proposed to tackle these inequalities. Interventions are varied because they are based on different philosophical underpinnings. The article looks at four theories (welfare economics, extra-welfarism, egalitarianism and feminist justice) and how they might be applied to public health and gender equality.