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

COMMUNITY PHARMACY IN GHANA: ENHANCING THE CONTRIBUTION TO PRIMARY HEALTH CARE

F. Smith

Health Policy and Planning, vol.19, 2004, p.234-241

Pharmacists are viewed as being well-placed to advise on the management of common illnesses and long-term conditions, and to participate in health education and promotion. Paper considers possible directions for community pharmacy service development in Ghana.

COMPARISON OF PRIVATE FOR-PROFIT WITH PRIVATE COMMUNITY GOVERNED NOT-FOR-PROFIT COMMUNITY CARE PRACTICES IN NEW ZEALAND

P. Crampton and others

Journal of Health Services Research and Policy, vol.9, 2004, Suppl.2, p.17-22

Paper uses nationally representative survey data to compare the characteristics of patients, their diagnoses and the investigation and referral patterns at private community-governed not-for-profit and private for-profit primary care practices in New Zealand. Study confirms that, compared to their for-profit counterparts, community-governed not-for-profit practices serve a higher proportion of low-income families and minority ethnic groups and have patients with a higher number of presenting problems per visit.

DOES MORE EVIDENCE LEAD TO BETTER POLICY? THE IMPLICATIONS OF EXPLICIT PRIORITY-SETTING IN NEW ZEALAND'S HEALTH POLICY AND EVIDENCE-BASED POLICY

T. Tenbensel

Policy Studies, vol.25, 2004, p.189-208

In New Zealand in the 1990s three government agencies used different approaches to gather evidence on which to base decisions about priority-setting in healthcare. Unsurprisingly, the evidence each gathered had quite different policy implications. Article concludes that working out how to handle conflicting evidence is at least as important as gathering more evidence.

EFFECTIVENESS OF NGO PRIMARY HEALTH CARE PROGRAMME IN RURAL BANGLADESH: EVIDENCE FROM THE MANAGEMENT INFORMATION SYSTEM

A. Mercer and others

Health Policy and Planning, vol.19, 2004, p.187-198

Paper considers the effectiveness of a non-governmental organisation (NGO) primary health care programme in rural Bangladesh. It is based on data from the programme's management information system reported by 27 partner NGOs from 1996 to 2002. Data indicate that relatively high coverage has been achieved for reproductive and child health services, as well as lower infant and child mortality. Results show that NGOs can play an important role in health service delivery.

EQUITY OF ACCESS TO ELECTIVE SURGERY: REFLECTIONS FROM NZ CLINICIANS

D. McLeod and others

Journal of Health Services Research and Policy, vol.9, 2004, Suppl.2, p.41-47

Qualitative study explored factors influencing equitable access to elective surgery in New Zealand by describing clinicians' perceptions of equity and the factors they consider when prioritising patients for elective surgery. Results suggest that the structure of the health system contributes to inequities in access to elective care in New Zealand, particularly through differences in ability to access private medicine. Subjective decision-making by clinicians has the potential to advantage or disadvantage patients through the weighting clinicians place on socio-demographic factors when making rationing decisions.

EVIDENCE-BASED PRIORITY SETTING: WHAT DO THE DECISION-MAKERS THINK?

C. Mitton and S. Patten

Journal of Health Services Research and Policy, vol.9, 2004, p.146-152

Article reports on a participatory action research project conducted in a single health authority in Alberta. The research included in-depth interviews and focus groups with senior decision makers both before and after development and implementation of a macro-level priority setting framework (programme budgeting and marginal analysis, PBMA). Data were thematically coded and information on the use of evidence in priority-setting is reported. Barriers to the use of evidence in decision-making identified by decision makers included crisis-oriented management, time constraints and lack of skills. Decision-makers suggested using a mix of "hard" and "soft" forms of evidence in priority-setting. Following PBMA implementation, they wanted better evidence on capacity to benefit from treatment, but preferred to get this pragmatically from multiple sources of information rather than using a single metric.

FORMALIZING UNDER-THE-TABLE PAYMENTS TO CONTROL OUT-OF-POCKET HOSPITAL EXPENDITURES IN CAMBODIA

S. Barber, F. Bonnet and H. Bekedam

Health Policy and Planning, vol.19, 2004, p.199-208

Authors conclude that formalising under-the-table payments in Takeo Provincial Hospital - estimated at 45% of the hospital's total revenues - assured patients of fixed fees and promoted service use. A substantial and sustained increase in use of inpatient services was observed, with use fees contributing about one-third of the total hospital budget. By 2002 the hospital balanced its budget without donor support.

INDIGENOUS PARTICIPATION IN THE "NEW" NEW ZEALAND HEALTH STRUCTURE

A. Boulton and others

Journal of Health Services Research and Policy, vol.9, 2004, Suppl.2, p.35-40

Article reports on preliminary research on the implications of the 2001 health system reforms in New Zealand for the Maori community. Covers the development and implementation of the Maori Health Strategy, representation in decision-making at governance level in District Health Boards, the inclusion of the Treaty of Waitangi in legislation and workforce issues.

MODELS OF HEALTH CARE RATIONING

V.H. Schmidt

Current Sociology, vol.52, 2004, p.969-988

Article considers three different models of health care rationing. In Germany, rationing is implicit and decisions are made at the discretion of physicians. Here, rationing takes the form of choice of a cheaper treatment option, premature discharge from hospital, or premature termination of treatment. In Oregon, the publicly funded Medicaid Health Care Plan operates an explicit rationing system by specifying the package of treatments to which enrolees are entitled. Finally, Singapore's system of compulsory savings accounts and various government-backed insurance plans rations care explicitly by limiting the amount of funding to which individual subscribers are entitled over the course of their lifetime.

PRICING OF GENERAL PRACTICE IN AUSTRALIA: SOME RECENT PROPOSALS TO REFORM MEDICARE

G. Jones, E. Savage and J. Hall

Journal of Health Services Research and Policy, vol.9, 2004, Suppl.2, p.63-68

In the Australian Medicare system, GPs are paid on a fee-for-service basis. A GP can choose to bill the government directly (termed bulk billing) and receive 85% of a regulated fee as full payment. However, GPs are free to charge above the regulated fee. The patient can then claim a rebate from the government, but only the equivalent of 85% of the regulated Medicare fee. The rate of bulk billing has fallen to below 68%. In response, in April 2003 the Minister of Health introduced a reform package under the title A Fairer Medicare, which aimed, among other things, to increase the availability of bulk billing for some patients. A key feature of the proposal involved changes to the way that GPs are reimbursed. Following political opposition, a revised version, MedicarePlus, was released in Nov. 2003. Paper describes the factors influencing a GP's choice to bulk bill and examines the two proposals in this context.

PRIMARY HEALTH CARE IN PRACTICE: IS IT EFFECTIVE?

M. Lewis, G. Eskeland and X. Traa-Valerezo

Health Policy, vol.70, 2004, p.303-325

Healthcare in much of the developing world comprises an expensive hospital system in urban areas combined with a network of primary healthcare clinics offering preventative services to low-income families. A case study of El Salvador shows that households do not value the community health clinics and even the poorest families prefer high-cost private care because of lower waiting times and more effective treatment. Similarly, higher level public facilities such as hospitals are preferred because they offer a "one-stop-shop", do not require multiple visits and offer more successful treatments.

RESOURCE ALLOCATION EQUITY IN NORTHEASTERN MEXICO

G.M.N. Rocha and others

Health Policy, vol.70, 2004, p.271-279

Article proposes a new approach to healthcare resource allocation using equity as a tool for decision-making. Study looked at whether areas in Northeastern Mexico with greater health needs were in practice receiving their fair share of resources. Results showed little correspondence between health needs and actual expenditures.

USING BURDEN OF DISEASE/COST EFFECTIVENESS AS AN INSTRUMENT FOR DISTRICT HEALTH PLANNING: EXPERIENCES FROM UGANDA

A. Jeppsson and others

Health Policy, vol.70, 2004, p.261-270

The burden of disease/cost effectiveness (BoD/CE) analysis was introduced as a method for detailed planning and budgeting in 13 districts in Uganda. Study aimed to assess the outcome of this experiment, and, if actual practice differed from intended outcomes, as was hypothesised, to analyse some of the reasons using the theory of new institutionalism. An examination of actual budget allocations and expenditures revealed an increasing divergence from the pattern shown in the BoD/CE analysis. Final budgets and actual expenditures were the result of a negotiation process in which factors other than the BoD/CE analysis had to be taken into account.

THE LOST ART OF CARING: A CHALLENGE TO HEALTH PROFESSIONALS, FAMILIES, COMMUNITIES, AND SOCIETY

L.E. Cluff and R.H. Binstock (editors)

Baltimore: Johns Hopkins University Press, 2003

This book draws attention to the vital role of caring in health care and caring. Caring - the concern, compassion, and support of health professionals, family members, and communities - is of great importance to those coping with illness or disability. This book makes clear that effective caring involves meeting not only physical but also spiritual and psychological needs. The book brings together experts to examine the various aspects of caring, the reasons why it eroded, and the measures that can be taken to strengthen it.

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