Welfare Reform on the Web (February 2006): Health care - overseas

Chronic disease and the healthcare crisis

H.R. Holman

Chronic Illness, vol.1, 2005, p.265-274

Over recent decades chronic disease has emerged as the dominant healthcare problem in the USA. In comparison with the care of acute illness:

• The goal of care is function and comfort for the patient, not cure
• The patient takes prime responsibility for the efficient management of the disease
• The physician must ensure that the patient is taught how to manage the disease and must share decision-making with he patient
• A wide range of health professionals have a role in the care of the patient as his/her needs change over time
• Care is delivered in the community rather than in hospital
• The physician works in partnership with the patient

The Difficulties presented by cost comparison for health care trusts: an empirical analysis

A. Barretta

Public Management Review, vol.7, 2005, p.589-613

Article presents a case study of a cost comparison project covering 16 public health care trusts in Tuscany and identifies the difficulties encountered. Chief among these were the variable quality and lack of comparability of the data available from the trusts. Author concludes by defining strategies which could be used to create conditions under which intertrust cost comparisons could be used for voluntary benchmarking purposes.

Efficiency of a care coordination model: a randomized study with stroke patients

N. Claiborne

Research on Social Work Practice, vol.16, 2006, p.57-66

Care coordination addresses patient care and treatment resources across the health care system to reduce risk, improve clinical outcomes and maximise efficiency. A randomly assigned pre-post experimental design measured medical services utilisation by 28 patients after inpatient rehabilitation. The intervention group received individual assessment, advocacy, crisis counselling, educational reinforcement to patients and caregivers, brief psychological counselling and referral. Hospitalisation, accident and emergency, and physician utilisation measures were collected three months prior to rehabilitation and compared to utilisation during the study. Results showed a change in the behaviour of the intervention group towards appropriate use of outpatient physicians rather than accident and emergency. This led to significant cost savings.

Health financing in Singapore: a case for systemic reforms

M.K. Asher and A. Nandy

International Social Security Review, vol.59, 2006, p.75-92

Since the 1980s Singapore has attempted to meet the pension, housing and healthcare needs of its population through a mandatory savings system called the Central Provident Fund. It has eschewed the use of risk-pooling social insurance as a method for financing healthcare and direct funding by government out of the public purse remains low. Article argues that this system will not be sustainable as the population rapidly ages. It concludes that public expenditure on health care will have to rise and that some form of risk pooling will have to be introduced.

The health workforce: managing the crisis: ethical international recruitment of health professionals: will codes of practice protect developing country health systems?

T. Martineau and A. Willetts

Health Policy, vol.75, 2006, p.358-367

Many developed countries are recruiting health professionals from the Third World to make up shortfalls at home. This study explores the potential for using voluntary codes of practice on ethical international recruitment to protect developing country health systems from the loss of skilled professionals. While effective dissemination of such instruments is generally in place, support systems, incentives and sanctions and monitoring systems necessary for effective implementation and sustainability are currently weak or have not been planned.

The impact of a caregiver health education program on health care costs

R.W. Toseland and T.L. Smith

Research on Social Work Practice, vol.16, 2006, p.9-19

This study examined health care cost outcomes resulting from a health education programme for spouse caregivers of frail older adults. One hundred and five spouses were recruited and assigned to the health education programme or usual care. Caregivers and care recipients who participated in the programme had significantly lower overall health care costs and significantly lower outpatient costs than those who participated in usual care.; By two years, the total cost savings for caregivers and care recipients who participated in the programme were $309,461.

Impact of administrative restrictions on antibiotic use and expenditure in Ontario: time series analysis

D. Marshall and others

Journal of Health Services Research and Policy, vol.11, 2006, p.13-20

In an attempt to guide antibiotic prescribing based on clinical evidence and to mitigate the spread of antibiotic resistance, in 2001 the Ontario Drug Benefit programme restricted reimbursement of two fluoroquinolone antibiotics to its beneficiaries. This study sought to estimate the effects of this policy change on the volume and cost of antibiotic prescribing. Results suggest that the change in reimbursement policy to restrict prescribing of fluoroquinolones decreased their use. However, these decreases were offset by increases in the use of other antibiotics.

The impact of population ageing on future Danish drug expenditure

H.W. Kildemoes and others

Health Policy, vol.75, 2006, p.298-311

Study aimed to estimate the impact of population ageing in Denmark on future expenditure on prescription drugs, accounting for proximity to death and holding mean drug expenditure by age, gender and survival constant. Authors conclude that the ageing of the population is likely to increase future Danish expenditure on prescription drugs. The predicted increase, however, is small compared to recently observed rising trends in overall drug expenditure. Moreover, the drug expenditure increased only slightly during the last year of life. Results indicate that Danish policies aimed at limiting the increase in public drug expenditure should focus on rational pharmacotherapy and on the promotion of prescription of cost-effective pharmaceuticals, rather than targeting the drug use of the elderly.

The inequity of informal payments for health care: the case of Hungary

A. Szende and A.J. Culyer

Health Policy, vol.75, 2006, p.262-271

Informal “under-the-counter” payments for health care are still common in Central Europe and this is especially the case for hospital care in Hungary. Results of a survey of a representative sample of the Hungarian population show that such payments are especially burdensome for the poor, who pay proportionally more for public health care services through the informal system than the relatively rich.

Labour relations and health reform: a comparative study of five jurisdictions

K. Wetzel with contributions from S. Bach, M. Bray and N. White

Basingstoke: Palgrave Macmillan, 2005

The book examines the industrial relations of health care reform in Great Britain, New South Wales, New Zealand, and the provinces of Alberta and Saskatchewan in Canada. Each chapter deals with the period of health reform during which labour relations restructuring was particularly intense, as established industrial relations structures and practices changed to what was intended to become the new order.

The long-term effects of outpatient geriatric evaluation and management on health care utilization, costs and survival

J.B. Engelhardt and others

Research on Social Work Practice, vol.16, 2006, p.20-27

The long term effectiveness and efficiency of an outpatient geriatric evaluation and management (GEM) programme was compared to usual primary care. In a randomised controlled trial involving a sample of 160 male veterans aged 55 and above over a four year period, patients assigned to the intervention group incurred significantly lower overall health costs than those receiving usual primary care. Cost savings were mainly due to fewer hospital days of care. No significant differences were found in survival.

Quality indicators for cardiac care: national standards in a community context

W. Putnam and others

Journal of Health Services Research and Policy, vol.11, 2006, p.5-12

Comparative performance data on individual physicians and hospitals are readily available in the US and the UK. In Canada, a Cardiovascular Health and Services in Ontario Atlas containing hospital-specific data for all hospitals in the province was published in 1999. Study explored the attitudes of a group of Canadian physicians to the publication of performance data on quality of cardiac care for patient use. Findings from a series of focus groups showed general support for this particular group of quality indicators, with the caveat that data should be carefully interpreted in the context of each community.

Representation strategies in public participation in health policy: the Aboriginal Community Health Council

D. Quantz and W.E. Thurston

Health Policy, vol.75, 2006, p.243-250

A key strategy for improving the health of Canada’s aboriginal population has been to increase the involvement of community representatives in health care delivery and health policy development. The Calgary Health Region’s Aboriginal Community Health Council has provided a setting for involving the local Aboriginal population in health policy development for over ten years. Article presents the results of a case study which identified the Council’s strategies for this work. Strategies utilised to involve the public included building links with community organisations, networking, consultation exercises and identification of special needs groups.