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Welfare Reform on the Web (August 2005): Health care - overseas

Border-line case

L. Whitfield

Health Service Journal, vol.115, July 14th 2005, p.14-15

Discusses the development of a pan-European public health policy, which is being actively encouraged by the UK government. EU health ministers adopted a public health programme in 2002, which aims to improve public health information and knowledge, to enhance Europe's capacity to respond to health threats, and to address how other policies and activities affect people's health. The EU Commission in 2004 proposed a new health and consumer protection programme to run to 2008. Practically, this should relate to action plans for mental health, alcohol, diet and nutrition.

Continuity through change: the rhetoric and reality of health reform in New Zealand

T. Ashton, T. Mays and N. Devlin

Social Science and Medicine, vol.61, 2005, p.253-162

Before the 1990s hospitals and some other health services in New Zealand were planned and provided by regionally based, locally elected health boards. This system was replaced in 1993 by a quasi-market which separated service provision from purchasing/commissioning. In 2001 the quasi-market was abandoned in favour of a system of locally elected boards remarkably similar to that which existed in the 1980s. Article explores the depth of system change in practice, and the extent to which the stated goals of reformers have disguised the degree of continuity between reform eras.

'Consultation' or co-option? A case study from the Chilean health sector

J. Gideon

Progress in Development Studies, vol.5, 2005, p.169-181

A macro-meso-micro analysis of the institutionalisation of participatory mechanisms in the Chilean health sector indicates that, not unexpectedly, citizens are unable to bring about meaningful change through their participation in the current structures. The government is not as committed as it may appear to promoting citizen involvement in decision-taking in the health sector. At the same time the position of NGOs has been weakened through marketisation and they now lack the political and economic resources to have any real input into decision-making.

The cost-effectiveness of a competitive voucher scheme to reduce sexually transmitted infections in high-risk groups in Nicaragua

J. Borghi and others

Health Policy and Planning, vol.20, 2005, p.222-231

In order to encourage service uptake and effective treatment of sexually transmitted infections (STIs) in high risk groups in Managua, Nicaragua, a voucher scheme was set up under which recipients could claim free testing and treatment at participating clinics. Paper presents the average costs of treatment with and without the voucher scheme as well as an incremental cost-effectiveness analysis of the scheme compared with the status quo. While the voucher scheme cost more than service provision in the absence of vouchers, it was successful in reaching high-risk groups, providing them with an affordable and high-quality service and treating 92% of the four most common STIs. In the absence of vouchers, only 15% of STIs would have been cured.

Costs and revenue of health care in a rural Zimbabwean district

B. Vander Plaetse and others

Health Policy and Planning, vol.20, 2005, p.243-251

In the context of health service decentralisation, budgetary constraints and the growing importance of local cost-recovery mechanisms, the District Health Executive of Tsholotsho district conducted a health care cost study in 1997/98. Results provided an evidence-base for service reorganisation, particularly the downgrading of inefficient rural hospitals. Results also confirmed the soundness of the basic model of health care provision, which is based referral from health centres to the district hospital. Study showed that care rendered at the primary level is cheaper than that provided in hospital. It also indicated that good quality health care can be organised at relatively low cost.

Global health leadership and management

W. H. Foege and others (editors)

San Francisco, Calif.: Wiley, 2005

This book distils lessons about leadership from a wide variety of successful health programmes that have been implemented around the world. It outlines and describes core competencies such as: ~ identifying challenges and developing and managing policy ~ developing strategies, pathways, and solutions ~ creating networks and partnerships and planning for change ~ learning from experience to build a generation of leaders.

Health care resource allocation and individuals’ health care needs: examining the degree of fit

D. Litaker and T. E. Love

Health Policy, vol.73, 2005, p.183-193

Concern over the optimal allocation of health care resources has become acute in an era of rising medical costs and population ageing in the USA. This study of health care access in counties of a mid-Western state found that factors such as the supply of physicians, balance in the physician workforce and other health system characteristics do not appear to relate to difficulties individuals face in meeting health care needs. On the contrary, residents from the more deprived counties reported greater difficulties with access. The authors suggest that access to health care could be improved by economic and social regeneration of deprived areas, which would give residents the financial means to purchase care.

Health care-seeking behaviour and out-of-pocket payments in Tbilisi, Georgia

G. Gotsadze and others

Health Policy and Planning, vol.20, 2005, p.232-242

Results of a household survey conducted in Tbilisi, Georgia in 2000 show that accessing health care services is a financial burden and that private payments act as barriers to use. Members of the poorest households are less likely to seek care than the affluent and devote a higher share of their monthly income to health care. Households have adopted various strategies to overcome these barriers, such as self-treatment, not seeking care and inappropriate use of specialists as the first point of contact. Authors call on the government to prioritise public financing of services for the poor, improve primary care services, encourage rational drug use, and institute community-based health insurance schemes.

Health systems factors influencing maternal health services: a four country study

J.O. Parkhurst and others

Health Policy, vol.73, 2005, p.127-138

While each country is a unique case, the results of this comparative study of Bangladesh, Uganda, South Africa and Russia highlight three key areas in which health systems play significant roles in shaping how specific inputs can work to improve maternal outcomes. The first is the use and quality of human resources, in particular skilled birth attendants. The second is the importance of achieving an appropriate mix of public and private services. The third is the impact of health sector reforms, specifically user fees, on maternal services. The case studies illustrate how in each of these countries the set up and operation of the health system, in conjunction with these inputs, influence maternal health service provision and eventual outcomes.

Making Medicaid a block grant program: an analysis of the implications of past proposals

J.M. Lambrew

Milbank Quarterly, vol.83, 2005, p.41-63

Block grant programmes are those for which the US federal government gives states a fixed amount of funds to deliver services. Medicaid is currently an entitlement programme. Entitlement programmes create an obligation for government to finance services for a prescribed set of people regardless of cost. In 2003 President Bush proposed converting Medicaid from an entitlement to a block grant programmes. Similar proposals were made but not enacted in 1981 and 1995. Paper compares the block grant funding levels proposed in 1981 and 1995 with actual federal spending on Medicaid. Results show that the proposed 1981 and 1995 block grant funding levels were quite different to what actually occurred. This suggests that Medicaid probably could not maintain existing coverage under a block grant financing structure.

Mortality of white Americans, African Americans and Canadians: the causes and consequences for health of welfare state institutions and policies

S.J. Kunitz with I. Pesis-Katz

Milbank Quarterly, vol.83, 2005, p.5-39

Argues that the lower life expectancy of African Americans compared to White Americans is due to the impact of racism and the legacy of slavery. Since the 1970s, the life expectancy of White Americans has not improved as that of all Canadians. Author attributes the difference to the introduction of universal healthcare insurance in Canada, leading to better access to medical care.

One nation uninsured: why the U.S. has no national health insurance

J. Quagagno

Oxford: Oxford University Press, 2005

Every industrial nation in the world guarantees its citizens access to essential health care services - every country, that is, except the United States. Indeed, one in eight million - a majority of them in working families, do not have any health care insurance. This book shows how each attempt to introduce a national health insurance system was countered by fierce attacks by powerful stakeholders. In the first half of the twentieth century physicians led the anti-reform coalition, fearful of government control of the lucrative private health care market. Only with Medicare and Medicaid, which provide coverage for the old and the very poor - two groups that private insurers don't want to cover - has there been any success with government insured health care. After the success of Medicare, the insurance industry assumed a leading role against reform.

Payment mechanisms and prescriptions in four Thai hospitals

J. Bryant and A. Prohmmo

Health Policy, vol.73, 2005, p.160-171

Fee-for-service insurance schemes reimburse healthcare providers for the cost of each treatment; capitation schemes pay a fixed amount per person per year, regardless of treatment costs. This paper examines the effects of these different payment mechanisms on prescription patterns in four hospitals in provincial Thailand. Data drawn from treatment records, surveys and interviews showed that prescription costs for fee-for-service patients are significantly higher than those for capitated patients, controlling for age, sex, diagnosis and socio-economic status. The cost differences are attributable to the greater likelihood of fee-for-service patients receiving expensive drugs.

Pharmacy utilization and the Medicare Modernization Act

V. Maio and others

Milbank Quarterly, vol.83, 2005, p.101-130

The Medicare Modernization Act 2003 adds a prescription drug benefit to Medicare. Cost containment measures, including caps, co-payments and formularies, have been put in place to control expenditure and encourage the appropriate use of drugs. Article reviews the literature on the impact of such cost containment measures on a range of populations. The literature suggests that although caps on drug benefits lower pharmaceutical costs, they may also increase the use of other health care services and hurt outcomes.

The relationship between national income and health: a new measure applied to Bangkok

M. Clarke and S.M.N. Islam

Progress in Development Studies, vol.5, 2005,.p.182-198

Article presents a new framework for the analysis of the relationships between economic growth, health outcomes and social welfare and applies it to the situation in Bangkok from 1975 to 1999. This new approach to social welfare analysis is based on normative social choice theory, cost-benefit and systems analysis and is called (new) welfare economics.

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