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

Adoption of hospital case management: economic and institutional influences

S. D. Roggenkamp, K.R. White and G.J. Bazzoli

Social Science and Medicine, vol.60, 2005, p.2489-2500

Case management was adopted in US hospitals in the 1990s as a means of controlling costs, improving quality of care and reducing variations, and enhancing staff and patient satisfaction. Article studies the diffusion of case management practices across American hospitals between 1994 and 2000. It explores the economic and institutional influences that promoted or inhibited the adoption of case management.

Are African Americans really less willing to use health care?

J. Schnittker, B.A. Pescosolido and T.W. Croghan

Social Problems, vol.52, 2005, p.255-271

It is assumed that African-Americans are more averse to using healthcare than whites and more sceptical about its effectiveness. Using data from the 2000 General Social Survey, authors find no evidence that African-Americans are less likely to seek treatment or expect less from treatment. These results are discussed in the context of other research that shows that African-Americans in practice seek care less often, are less satisfied with physician visits and refuse higher cost treatments. This disparity points to something in the doctor-patient interaction that disappoints African-Americans.

Cancer treatment at home or in the hospital: what are the costs for French public health insurance?

R. Raphaël and others

Health Policy, vol.72, 2005, p.141-148

Hospital at home services aim at improving patient satisfaction and quality of life and at increasing healthcare efficiency. Study reported in this article was carried out at the Centre Léon Bérard at Lyons, where a Hospitalisation Alternatives Department has been set up to manage hospital at home care following inpatient treatment. Research compared the cost of this type of patient management with the estimated cost of treating the same patients in a standard hospital setting. Results showed that the average cost of hospital at home was much less than the estimated cost of hospitalisation.

Contracts in the real world: case studies from Southern Africa

N. Palmer and A. Mills

Social Science and Medicine, vol.60, 2005, p.2505-2514

The desirability of using the private sector to deliver public services is widely debated. Understanding the nature of the contracts that initiate and govern such public-private partnerships, and the extent to which they can define the performance of private providers, is key to addressing the problems that underlie this debate. Such understanding has to be gained in part by better knowledge of the determinants of contractual relationships. Paper presents case studies of three contracts for primary care services in Southern Africa. It reports on aspects of the institutional and environmental context in which they operate and reflects on the nature of publicly financed primary care as a service to be contracted out. Findings illustrate some of the practical challenges for low- and middle-income countries of writing and managing contracts with private providers of primary care services.

Defining the role of the hospital social worker in Australia. Part 2. A qualitative approach

C. Davis and others

International Social Work, vol.48, 2005, p.289-299

Research seeks to explore in-depth the meaning and importance of the social work role in hospitals and what distinguishes it from other professional roles. Finds that hospital social workers continue to be concerned about the lack of understanding of the social work role among medical professionals and patients and are themselves ambiguous about what their role should and should not entail.

Determinants of patient and surgeon perspectives on maximum acceptable waiting times for hip and knee arthroplasty

B. Conner-Spady and others

Journal of Health Services Research and Policy, vol.10, 2005, p.84-90

Lengthy waiting times for hip and knee replacement surgery in Canada have raised concerns about equitable and timely access to care. The Western Canada Waiting List project has developed priority scores linked to maximum acceptable waiting times (MAWT) for different levels of priority. Study assessed the determinants of patient- and surgeon-rated MAWT and tested whether anticipated waiting times (i.e. what can be expected in local conditions) has an independent influence after adjusting for age, sex and patient urgency.

Health care in rural China: lessons from HeBei province

O. Anson and S. Sun

Aldershot: Ashgate, 2005

This work examines health in rural China today. It explores the current social distribution of health status, health behaviour and health care and the processes by which these came about. The authors are interested in the social processes which shape the social distribution of health and health care, and draw policy implications for both post-industrial and developing societies.

Inequality in willingness-to-pay for community-based health insurance

H. Dong and others

Health Policy, vol.72, 2005, p.149-156

In Community Based Health Insurance (CBI), community members pool their resources to share the financial risks of health care, own the scheme, and control its management, including the collection of premiums, the payment of healthcare providers and the negotiation of the benefits package. Interviews with 2414 individuals in Burkina Faso used a bidding game method to elicit information about willingness to pay premiums for CBI. Results suggested that if the premium is not adjusted for income, or if there are no exemptions or subsidies, poor people will be less likely to enrol in CBI and will consequently have poorer access to health services than the rich.

The integration of medical specialists in hospitals: Dutch hospitals and medical specialists on the road to joint regulation

G.R.M. Scholten and T.E.D. van der Grinten

Health Policy, vol.72, 2005, p.165-173

In Dutch hospitals, following the Integration Act 2000, the Executive Board has final responsibility for running the organisation and medical specialists are defined as employees under its control. In practice, the Medical Staff Executive forms an alternative centre of power which protects the interests of the clinicians. It aims to obtain a grip on the strategic decision-making for which the Executive Board has final responsibility. The dominant goal of the Staff Executive is to protect the medical domain against unwelcome policy plans by the Board.

Primary care teams: New Zealand’s experience with community-governed non-profit primary care

P. Crampton, P. Davis and R. Yay-Lee

Health Policy, vol.72, 2005, p.233-243

Study carried out a detailed examination of the composition and characteristics of primary care teams in community-governed, non-profit practices in New Zealand and compared them with more traditional primary care organisations, with the aim of drawing conclusions about the capacity of the different structures to carry out population-based primary care. Data from a national cross-sectional survey of primary care practitioners was used. Primary care teams were largest and most heterogeneous in community-governed non-profit practices, employing doctors, nurses, receptionists, managers, community workers and midwives. Most traditional practices employed only doctors, nurses and receptionists. Authors conclude that community-governed, non-profit practices have staffing arrangements that are better suited to the diverse demands of population-based primary care.

The public-private mix for health

A. Maynard (editor)

Oxford: Radcliffe, 2005

This book brings together practitioners in health economics and health services who are recognised experts on the funding and provision of healthcare. They describe the public-private mix in healthcare in the US, Canada, France, Scandinavia, Germany New Zealand and Australia. They show both the universality of the problems facing healthcare provision in the UK and abroad and some of the different routes to the best and most equitable service.

The public uses health system report cards to make decisions about their health care

Canadian Health Services Research Foundation

Journal of Health Services Research and Policy, vol.10, 2005, p.126-127

There is no evidence that patients in Canada consult published performance data when choosing a healthcare provider. This may be because they are unaware that the data is available, because they think it unreliable, or because they have no realistic options as care is regionalised.

State health insurance market reform: towards inclusive and sustainable health insurance markets

A.C. Monheit and J. C. Cantor (editors)

London: Routledge, 2004

Since the late 1980s many US states have sought to incrementally reform their health insurance markets. The intent of such reform has been quite straightforward: to ensure access to affordable health insurance by addressing insurer practices perceived to be exclusionary. In the light of this, a compelling public policy issue is whether these efforts to address disparity in the population's access to health insurance have been successful or have yielded unintended consequences. This volume provides a critical assessment of the current state of knowledge on insurance market reform and the economics of healthcare.

Tackling excessive waiting times for elective surgery: a comparative analysis of policies in 12 OECD countries

L. Siciliani and J. Hurst

Health Policy, vol.72, 2005, p.201-215

Paper compares policies for tackling excessive waiting times for elective surgery in 12 OECD countries. Waiting times may be reduced by acting on either the demand for, or the supply of, surgery. Supply can be increased through financial incentives to raise productivity or by generating more capacity. Demand may be reduced by raising clinical thresholds for publicly funded treatment. Preliminary evidence also suggests that an increase in private health insurance coverage may reduce waiting times.

US physicians' perceptions of the effect of practice guidelines and ability to provide high-quality care

J. Bartelli and others

Journal of Health Service Research and Policy, vol.10, 2005, p.69-76

In the USA, managed care organisations (MCOs) often develop guidelines for their physicians in order to influence medical practice. However these guidelines are often ignored when disseminated. Nontheless, US physicians perceive that the guidelines have a substantial effect on their practice. Paper examines the relationship between the perceived effect of the guidelines on practice and perceived quality of care for US primary care physicians and specialists. Findings support the idea that the degree of financial involvement of a physician with an MCO may affect the physician's perception of, and response to, practice guidelines, at least at the primary care level.

Your money of your life: strong medicine for America’s healthcare system

D. M. Cutler

Oxford: Oxford University Press, 2004

"Medical care is in crisis," Americans are repeatedly told, and so it is. Barely one in five thinks the medical system works well. However, the author argues that health care has improved exponentially over the last fifty years, and the successes of the system suggest ways in which care might be improved, the system made easier to deal with and coverage extended to all Americans.

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