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Welfare Reform on the Web (May 2005): Healthcare - Overseas

ABOLITION OF COST-SHARING IS PRO-POOR: EVIDENCE FROM UGANDA

J. Nabyonga and others

Health Policy and Planning, vol.20, 2005, p.100-108

In February 2001 the government of Uganda decided to abolish user fees in all public healthcare facilities at the community level, while retaining a two-tier fee system in public hospitals. Abolition of user fees led to a marked increase in the use of outpatient facilities by all sectors of the population. This has been especially beneficial to the poor. Findings suggest that cost-sharing decreases access to health services, especially among the poor.

CHANGES TO ACCESS TO HEALTH CARE IN CHINA 1989-1997

J.S. Akin and others

Health Policy and Planning, vol.20, 2005, p.80-89

Since 1979 much of the Maoist era social welfare system in China has been dismantled. There were drastic reductions in central government funding of health services, greater reliance on local government support and user fees as the main cost-recovery mechanism, and a loosening of restrictions on health care workers' location and remuneration. Article considers the impact of these reforms on access to health care.

E-HEALTHCARE: A MODEL ON THE OFFSHORE HEALTHCARE DELIVERY FOR COST SAVING

S.K. Sharma, N. Ahmed and R.S. Rathinasamy

International Journal of Healthcare Technology and Management, vol.6, 2005, p.331-351

In order to reduce costs, healthcare providers in the USA are exploring the new option of offshore delivery. For example, the process of offshore treatment involving elective surgery might include:

  • initial consultation over the Internet;
  • diagnostic tests done locally but interpreted offshore;
  • surgery carried out offshore;
  • further check-ups and advice delivered via the Internet.

GOVERNANCE IN GRIDLOCK IN THE RUSSIAN HEALTH SYSTEM; THE CASE OF SVERDLOVSK OBLAST

R. Sheaff

Social Science & Medicine, vol. 60, 2005, p. 2359 - 2369

In Sverdlovsk oblast, a funding conflict between a medical insurance incentive to cut costs by reducing bed days and local funding formulas caused a gridlock, which immobilised hospital management systems. The source of gridlock, which is attributed to the interaction of Soviet residues and the new insurance system rather than either one individually, is seen as a potential problem for all health system reforms. This case study is contextualised by Russian hospitals' resource allocation problems following federal reforms to the health sector, which introduced health insurance while decentralising administration, and by the crises to which the reforms responded.

THE HEALTH BUSINESS UNDER NEO-LIBERALISM: THE ISRAELI CASE

D. Filc

Critical Social Policy, vol.25, 2005, p.180-197

Over the past 20 years the world economy has undergone changes that may be characterised as the transition from one hegemonic model, the Keynesian/Fordist model, to another, the neo-liberal/post-Fordist one. This article discusses the place of health care in the process of capital accumulation that characterises the neo-liberal/post-Fordist hegemonic model, claiming that the combination of technological advances and the centrality of the body and of health within neo-liberal governmentality render health care central to the accumulation process. Author analyses the health business in Israel to provide empirical support for these claims.

IMPLEMENTING AN ELECTRONIC HEALTH RECORD SYSTEM

J.M. Walker, E.J. Bieber and F. Richards (editors)

London: Springer, 2005

This book addresses the range of issues and opportunities that implementing an electronic health record system poses for any size of medical organization - from the small one person operation to a large healthcare system. The book is divided into sections on support, preparation, implementation, and a summary and prospects section, enabling the clinician to define the framework necessary to implement and evaluate a clinically effective EHR system. With the increasing involvement of clinicians in the day-to-day running of the practice, interest is now focused on HER as a key area for improving clinical efficiency.

PENALIZING PATIENTS AND REWARDING PROVIDERS: USER CHARGES AND HEALTH CARE UTILIZATION IN VIETNAM

A. Sepehri and others

Health Policy and Planning, vol.20, 2005, p.90-99

After years of declining resources and deteriorating facilities, the introduction of user charges in 1995 provided public health facilities, especially hospitals, with a growing source of revenue. The cost recovery programme helped cash-starved hospitals improve the quality of services and staff morale, but left patients open to abuse by providers. Study found that between 1996 and 1998 the rapid growth in fee revenues at public health facilities was associated with increases in the utilisation rate and treatment intensity. Growth in treatment intensity was more pronounced for inpatient contacts. Both the admission rate and the length of hospital stay were far higher for the better off than the poor and for the insured than the uninsured.

PERFORMANCE-BASED PARTNERSHIP AGREEMENTS FOR THE RECONSTRUCTION OF THE HEALTH SYSTEM IN AFGHANISTAN

V. Riddle

Development in Practice, vol.15, 2005, p.4-15

The reconstruction of health services in Afghanistan is in its early stages, and donors have suggested using Performance-based Partnership Agreements which would contract out delivery of healthcare to private organisations. In the short term, certain aid agencies may be able to provide better services than a dysfunctional government. However, this approach will not help build up a government bureaucracy that is capable of taking over responsibility for healthcare provision nationwide in the longer term.

PRIVATE AND PUBLIC CROSS-SUBSIDIZATION: FINANCING BEIJING'S HEALTH INSURANCE REFORM

M. Wu and others

Health Policy, vol.72, 2005, p.41- 52

Reports on an evaluation of a proposed health insurance reform by Beijing municipal government. The reform aims to consolidate existing insurance programmes into a single system, and to extend coverage to all current and retired urban workers. The scheme is to be financed through a fixed-rate payroll tax. This means that firms paying higher wages such as international enterprises must contribute more to the scheme than firms paying lower salaries. Article concludes that the proposed scheme would place an unacceptable cost burden on high-paying private sector firms.

QUALITY MEDICINES FOR THE POOR: EXPERIENCE OF THE DELHI PROGRAMME ON THE RATIONAL USE OF DRUGS

R.R. Chaudhury and others

Health Policy and Planning, vol.20, 2005, p.124-136

Prior to 1994, Delhi State was spending 30-35% of its health budget on drugs but availability of good quality products was poor and irrational prescribing of unnecessary medicines was leading to huge amounts of waste. The Delhi Drug Policy of 1994 successfully tackled these problems through the establishment of:

  • an essential drugs list comprising safe, efficacious and cost-effective medicines;
  • a pooled procurement system, including rigorous selection of suppliers;
  • training programmes in rational prescribing for clinicians.

REDUCING HEALTH DISPARITIES THROUGH PRIMARY CARE REFORM: THE NEW ZEALAND EXPERIMENT

M. Hefford, P. Crampton and J. Foley

Health Policy, vol.72, 2005, p.9-23

In July 2002 the New Zealand government introduced a set of primary healthcare reforms aimed at reducing average co-payments, moving from fee-for-service to capitation funding, promoting population health management, and developing a network of not-for-profit primary health organisations to deliver primary care. The reforms aim to reduce health inequalities between Maori and Pakeha New Zealanders by improving access to primary care. Paper reviews policy documents and enrolment and payment data for the first 15 months to assess the likely impact on health inequalities.

VIRTUAL HEALTH/ELECTRONIC MEDICAL RECORD: CURRENT STATUS AND PERSPECTIVE

C.B.H. Hough, J.C.H. Chen and B. Lin

International Journal of Healthcare Technology and Management, vol.6, 2005, p.257-275

Computerised medical records have the potential to improve patient care and reduce waste, but the US healthcare industry has been slow to adopt them. Article presents a case study of how a specific company (Rockwood Clinic) moved towards the creation and implementation of an electronic record.

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