Welfare Reform on the Web (February 2000): Health Care - Overseas

AGEING OF POPULATION AND HEALTH CARE EXPENDITURE: A RED HERRING?

P. Zweifel, S. Felder and M. Meiers

Health Economics, vol.8, 1999, p.485-496

Paper studies the relationship between health care expenditure and age, using longitudinal rather than cross-sectional data. The econometric analysis of health care expander in the last eight quarters of life of individuals who died from 1983 to 1992 indicates that HCE depends on closeness to death and not on calendar age. The limited impact of age on health care expenditure suggests that population ageing may contribute much less to the growth of the health care sector than claimed by most observers.

ARE MANAGED CARE FINANCIAL INCENTIVES REDUCING OPPORTUNITIES FOR PATIENT EDUCATION AND COUNSELLING?

J. L. Exline, L.A. Bastian, I. C. Siegler

National Academics of Practice Forum, vol.1, 1999, p.311-313

Article discusses the potential implications of financial incentives for increased productivity on the physician-patient relationship, within the context of a dilemma for primary care physicians - how to incorporate counselling about the benefits and risks of hormone replacement therapy within their practices. With pressures to reduce the duration of patient visits, physicians must seek other alternatives for patient education and counselling.

CANADIAN HEALTH CARE AND ITS VULNERABILITIES

D. A. Rochefort

Milbank Quarterly, vol.77, 1999, p.409-414

Identifies three main flows in the Canadian health care system:

• its dependence on public finance;
• its vulnerability to cuts by political ideologues;
• its inability to meet the needs of those requiring joined up care from health and social services.

CHANGING CLINICAL PRACTICE: EVIDENCE-BASED PRIMARY CARE IN AUSTRALIA

D. Weller and B. Veahe

Health and Social Care in the Community, vol.7, 1999, p.324-323

Paper focuses on the response of primary care practitioners and policy-makers to the challenges of EBHC in Australia. Government investment in EBC infrastructure is detailed, and the implementation of EBHC is described from the perspective of primary care providers, people with chronic illnesses and other consumers of primary care services. Current issues facing Australian primary care in implementing EBHC include the relative paucity of direction from a policy framework, the dearth of multi-disciplinary primary care teams, and the lack of experience in Australia of primary care health service reform.

CITIZENSHIP AND EMPOWERMENT: A REMEDY FOR CITIZEN PARTICIPATION IN HEALTH REFORM

J. W. Higgins

Community Development Journal, vol.34, 1999, p.287-307

This ethnographic case study followed four health planning groups' efforts to foster community participation in developing local community health plans in one region of British Columbia over an 11 month period. Data were also collected through interviews with participants and focus groups with non-participants. Findings suggest that the concepts of citizenship and empowerment are useful in explaining why some individuals engaged in the work of the health planning groups and others did not. The sense of full citizenship (enjoying the formal status and substantive effects of civil, political and social rights as an equal member of the community) distinguished participants from non-participants.

COMMUNITY CARE FOR PEOPLE WITH CHRONIC CONDITIONS: AN ANALYSIS OF NINE STUDIES OF HEALTH AND SOCIAL SERVICE UTILIZATION IN ONTARIO

S. Watt, G. Browne and A. Gafni

Milbank Quarterly, vol.77, 1999, p.363-392

Analysis of nine studies suggests that resources can be better used to help people with chronic conditions through a commitment to coordinated, proactive programmes of health and social services instead of conventional reactive, piecemeal community care. A health promotion approach to community-based care builds from the existing health status of the individual in an attempt to prevent further physical, social and emotional deterioration. Providers adopt a more holistic approach than is characteristic of traditional medical interventions, enabling them to anticipate patients' needs and figure out appropriate support services.

ECONOMICS, ETHICS AND THE PUBLIC IN HEALTH CARE POLICY

A. Williams

International Social Science Journal, no.161, 1999, p.297-312

Argues that, given that resources will always be scarce, rationing and prioritisation in health care are unavoidable. Demonstrates that the methods and concepts of economics can and should be employed to set priorities, and that using them does not imply the abandonment of the pursuit of equity or surrender to financial regimes concerned only with profitability.

GONE WEST

W. Moore

Health Service Journal, vol.109, Oct. 14th 1999, p.26-27

Russia abandoned its centralised state health service in favour of a mandatory insurance scheme launched in 1993. The new system is heavily flawed and the health of the nation has suffered, with TB and AIDS rife.

INSURING THE CHILDREN: OBSTACLES AND OPPORTUNITIES

J. D. Perloff

Families in Society, vol.80, 1999, p.516-525

The State Children's Health Insurance Program (CHIP) offers new opportunities to help children gain health insurance cover. Article identifies strategies human service professionals can use to help increase insurance among children, including :

• helping families to capitalise on opportunities for health care coverage through CHIP and Medicaid;
• influencing key state policy decisions in the design and implementation of CHIP;
• continuing to engage in research, policy analysis and advocacy, which will help improve health insurance coverage available to children and families.

MANAGED CARE AND ADVOCACY: BASIC CONTRADICTIONS IN A FAILING HEALTH CARE SYSTEM

L. Dumas

National Academies of Practice Forum, vol.1, 1999, p.279-283

In the US system of managed care, the need to contain costs is causing quality of care to be compromised.

PRIMARY CARE IN THE UNITED STATES AND ITS PRECARIOUS FUTURE

B. Starfield and T. Oliver

Health and Social Care in the Community, vol.7, 1999, p.315-323

For most of the twentieth century, the role of primary care in the US health services system has been precarious. Article discusses recent effort to enhance its status, including the Clinton healthcare reform proposals and subsequent state and federal actions. Also assesses the likely fate of primary care given the accelerated growth of managed care and market competition, the dissatisfaction of large sections of the population with managed care and the mistaken identification of managed care with primary care. Finally highlights how managed care fails to achieve the cardinal functions of primary care, and summarises initiatives that would be required to secure a stronger position for primary care in future.

PROFITS OF DOOM

H. Berliner

Health Service Journal, vol.109, Nov. 4th 1999, p.30

A spectacular slump in the profits of health maintenance organisations is jeopardising the future of health insurance in the US. Yet no alternative to HMOs has emerged, and if they do not succeed there is nothing to take their place.

THE ROLE OF THE WORLD BANK IN INTERNATIONAL HEALTH : RENEWED COMMITMENT AND PARTNERSHIP

J. A. de Beyer, A. S. Preker and R. G. A. Feachem

Social Science and Medicine, vol.50, 2000, p.169-176

Over the past ten years, the World Bank has become the single largest external financier of health activities in low and middle income countries and an important voice in national and international debates on health policy. Article highlights the Bank's new strategic direction in the health sector aimed at: improving the health, nutrition and population outcomes of the poor; enhancing the performance of health care systems; and securing sustainable health care financing.

UNDERSTANDING CONTINUITY OF CURE AND HOW TO BRIDGE INTERSECTORAL GAPS: A PLANNING AND EVALUATION FRAMEWORK

M. B. Harrison et al

National Academics of Practice Forum, vol.1, 1999, p.315-326

Health service providers are increasingly challenged to strive for continuity of care with an ageing population, less institutionally based care and rigorous cost containment. Article offers a framework for planning and evaluation of health services changes for improved continuity of care and illustrates its application with a complex health population.

WHAT IS RIGHT ABOUT THE CANADIAN HEALTH CARE SYSTEM?

R. Evans and N. P. Roos

Milbank Quarterly, vol.77, 1999, p.393-399

Argues that the Canadian comprehensive tax-financed public insurance system with negotiated fee schedules is administratively lean and very efficient in directing care where it is most needed.

WHAT IS WRONG WITH THE US HEALTH CARE SYSTEM? IT DOES NOT EFFECTIVELY EXIST FOR ONE OF EVERY FIVE AMERICANS

K. M. Gorey

Milbank Quarterly, vol.77, 1999, p.401-407

Points out that while one of every seven Americans is uninsured, one of every five may be defined as inadequately insured, that is, uninsured or underinsured, and therefore barred from being a full beneficiary of the American health care system. Goes on to illustrate the inequity of the US health care system using the example of cancer survival rates. Well-insured people who have their cancer diagnosed early and access to the best treatments are two to ten times more likely to survive that their less fortunate counterparts.