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

Achieving the good life: why some people want latrines in rural Benin

M.W. Jenkins and V. Curtis

Social Science and Medicine, vol.61, 2005, p.2446-2459

Public health programmes to improve sanitation in developing countries have framed their promotional messages in terms of disease prevention and largely fail to produce changes in behaviour. This paper presents a study of consumer motivation for installing a household latrine in Benin. Exploratory in-depth interviews were carried out with 40 heads of household. Eleven distinct motivating factors for latrine adoption emerged from the interviews: prestige-related drivers, promotion of family well-being, and avoidance of environmental hazards involved in using open defecation sites. Health considerations played only a minor role. Motivating factors varied with gender, occupation, age, travel experience, education and wealth and reflected perceptions of the physical and social geography of the village, linked to availability of open defecation sites, social structure, road access and urban proximity.

A certain ratio? The policy implications of minimum staffing ratios in nursing

J. Buchan

Journal of Health Services Research and Policy, vol.10, 2005, p.239-244

Identifying what constitutes a "safe", a "minimum" or an "effective" staffing level in nursing remains a contentious issue. The conventional wisdom is that staffing levels are best determined by local management. This "bottom up" philosophy has now been challenged by a fundamentally different approach: the use of mandatory, standardized nurse : patient or nurse : bed ratios. This paper examines the early results of the use of mandatory staffing ratios in Victoria, Australia and California.

Community-based health insurance in poor rural China: the distribution of net benefits

H. Wang and others

Health Policy and Planning, vol.20, 2005, p.366-374

Prior to 1978, the rural Co-operative Medical System (CMS), a form of community-based health insurance, covered 92% of the farming population. With the transition from the collective to the individual household land leasing and farming system in 1978, the CMS collapsed. There have since been a number of efforts to re-establish some form of community-based insurance (CBI). Most of these newly established CBIs share certain common features: they offer one single benefit package covering both basic and catastrophic expenses, they require a low premium, and enrolment is voluntary. However, in order for CBIs to be financially sustainable, a low premium has to be balanced by high co-payments for services. Study empirically assesses the impact of China's newly established CBIs on the equity of CBI enrolment, health service utilisation, and the net benefit distribution among enrolees and the overall population in the community that established CBI.

Concerns grow over rising cost of healthcare

N. Timmins

Financial Times, November 9th 2005, p.10

Healthcare costs are again rising fast and look set to accelerate further, causing growing concern in almost all developed countries. Since 1997 health spending has risen faster than economic growth in all OECD countries. Given that most health expenditure is publicly financed through taxation or social insurance, costs are now putting pressure on public budgets.

Converging patterns in hospital organisation: beyond the professional bureaucracy

F. Lega and C. DePietro

Health Policy, vol.74, 2005, p.261-281

This study builds a framework to investigate the current trends emerging in hospital organisational design and its implications for human resource management. It found that large multi-speciality hospitals located in different countries are moving towards a common design scheme, which the researchers labelled "the care-focused hospital". Such hospitals are characterised by:

• Clinical integration through multi-disciplinary teams
• Resource pooling
• Patient focus, i.e. a design centred around care needs and processes
• Engagement of clinicians in hospital management

European prices of newly launched pharmaceuticals: a pilot study

J. Martikainen, I. Kivi and I. Linnosmaa

Health Policy, vol.74, 2005, p.235-246

The introduction of new, high priced medicines replacing older and cheaper ones is causing an upward spiral in pharmaceutical costs in many European countries. In order to contain costs, most EU member states control the prices of reimbursable medicines. There is however, little internationally comparable information on prices. This study aimed to examine the prices of new, reimbursable pharmaceuticals in EU member states. Price data were collected on eight products authorised by the EU in 2000. The prices of these products varied considerably. Wholesale prices of pharmaceuticals seem to be highest in countries where manufacturers can price their products freely. Wholesale prices do not, however, predict the final price. Pharmacy margins and taxes vary between countries and change the ranking of the most expensive or the cheapest countries.

For profit ownership of facilities would lead to a more efficient health care system

Canadian Health Services

Research Foundation Journal of Health Services Research and Policy, vol.10, 2005,p.255-256

Research in the USA demonstrates that neither costs nor waiting times are reduced when health care is delivered by for-profit providers. The American literature also suggests that patients who receive care in for-profit facilities are more likely to die than those in non-profit ones.

Health governance in Europe: issues, challenges and theories

M. Steffen (editor)

Abingdon: Routledge, 2005

The book explores the dynamic and multi-faceted process of denationalizing health policies and illustrates how European policies develop in a sector that still appears to be under exclusively national control. It describes the multiple forms and paths the Europeanization process takes, driven by market integration, public health crises and politics of consumer protection. The detailed analysis includes topics such as:

• The pharmaceutical sector
• The blood provision and plasma industry
• European politics on bioethics
• Risk reduction in the field of drug abuse

Managerialism in the Australian public health sector: towards the hyper-rationalisation of professional bureaucracies

J. Germov

Sociology of Health and Illness, vol.27, 2005, p.738-758

Paper draws on qualitative case-study research to discuss the impact of managerialism on the work organisation of public sector health professionals in Australia. The findings show that while health professionals were able to exert their agency to influence managerial processes, the incorporation of managerial strategies into professional practice placed constraints upon professional autonomy.

Priority setting in hospitals: fairness, inclusiveness and the problem of institutional power differences

J.L. Gibson, D.K. Martin and P.A. Singer

Social Science and Medicine, vol.61, 2005, p.2355-2362

Paper reviews a case study in hospital operational planning in Toronto, which had been designed by the executive management of the hospital to be broadly inclusive of senior and middle-level clinical and administrative leaders. It reports three power differences which arose as limiting factors to the inclusiveness of the priority setting process. These were: lack of information on which to base decisions, pressure from senior management, and being placed in a position of responsibility without power. These factors suggest the importance of minimising the effects of power differences in the decision-making setting to ensure fair priority setting.

The promotion of private health insurance and its implications for the social organisation of healthcare: a case study of private sector obstetric practice in Chile

S.F. Murray and M.A. Elston

Sociology of Health and Illness, vol.27, 2005, p.701-721

Paper examines the implications of the process of privatisation of a national healthcare system for the delivery, organisation, and ultimately , the outcomes of services. It outlines the national healthcare system reforms set in train by the military dictatorship in Chile from 1973, and the associated development of private companies in charge of financing and delivering medical services to their subscribers. Then, drawing on obstetricians' accounts, it analyses the work patterns that have been created by changes in healthcare financing. Finally, it considers some consequences of the changes for service delivery and for users of private maternity services.

Reforming acute care hospitals in Newfoundland

Journal of Health Services Research and Policy, vol.10, 2005, supplement 2, 73p

In order to contain costs, provincial governments in Canada have devolved responsibility for health care to a series of regional boards. In the St Johns region of Newfoundland, three boards governing acute care institutions, long term care institutions and community care were established in the mid-1990s. This supplement contains a series of papers reporting results of an evaluation of the impact of the changes on the acute care sector. Papers evaluating costs, utilisation and efficiency, human resources indicators and provider attitudes, and quality of care during and shortly after restructuring are presented.

Reproductive agency, medicine and the state: cultural transformations in childbearing

M. Unnithan-Kumar (editor)

Oxford: Berghahn, 2004

Recent years have seen many changes in human reproduction resulting from state and medical interventions in childbearing processes. The book considers the relationship between human reproductive processes (including attitudes to fertility, pregnancy, childbirth and the postpartum period), medical technologies and state health policies in diverse cultural contexts, especially outside Northern Europe and North America.

Rises in healthcare costs risk being unsustainable, study warns

N. Timmins

Financial Times, November 7th 2005, p.2

An international PwC [Price Waterhouse Cooper] study of health leaders in government, academia and service delivery warns that projected spending increases are unsustainable, and that current thinking will not meet future needs. Co-payment is seen as inevitable even by traditionally free service providing states, and demand control, improved chronic disease management, disease prevention, healthy lifestyle investment and outcome and productivity incentives from service commissioners are argued for.

What makes things happen? An analysis of the development of nine health-promoting measures aimed at children and adolescents in three Swedish municipalities

K. Guldbrandsson, S. Bremberg and H. Back

Social Science and Medicine, vol.61, 2005, p.2331-2344

Study aimed to explore, through nine case studies, how the Swedish national government could encourage the municipalities to initiate public health promotion measures. The study identified five motivating factors contributing to the development of health promotion measures aimed at children and young people. These are financial problems, perceived local needs, access to external funding, statements in national and international policy documents and the presence of a local public health sector. Politicians, public officials, and non-governmental organisations were the most frequently mentioned actors, with heavy commitment, professional skills and positions of power as prevalent characteristics. Public health core concepts such as epidemiological statistics and evidence-based measures were rarely mentioned. The health care sector does not appear to have had any direct influence on municipal health promotion activities.