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Welfare Reform On the Web (March 2006) : Health care - overseas

L.G. Chestnut and others

Contemporary Economic Policy, vol.24, 2006, p.127-143

The article provides estimates of the economic benefits of reducing respiratory and cardiovascular hospitalisations based on cost of illness and willingness to pay. The willingness-to-pay estimates suggest that individuals value the prevention of a five-day stay in hospital at an average of approximately $2,400. Average total costs of illness per hospitalisation are $22,000-39,000.

J. Barden-O’Fallon, G. Angeles and A. Tsui

Health Policy and Planning, vol.21, 2006, p.80-90

This study uses health facility survey data to examine characteristics of the primary health care labour force in Nicaragua, Tanzania and Bangladesh. Results show that in Nicaragua rural areas are likely to be served by the lowest tier of health facilities staffed by young, inexperienced personnel. More than one third of health posts, which are almost entirely located in rural areas, are without a physician or nurse. Such a distribution of the workforce cannot meet the health needs associated with its chronic rural poverty. In Tanzania, as in Nicaragua, the majority of doctors and nurses are located in urban areas. Providers in rural areas also tend to be younger and are less likely to be female than their counterparts in urban areas. In Bangladesh, the facilities located in rural areas have more staff per facility than do the equivalent facilities in urban areas. However, many facilities lack highly skilled staff, as almost half of the 463 health centres without inpatient beds surveyed were without a doctor or nurse.

A. Garcia-Prado and M. Chawla

Health Policy and Planning, vol.21, 2006, p.91-100

Unjustifiable or unexplained absenteeism is common practice among doctors and nurses in Costa Rica. This paper analyses the evolution of absenteeism in Costa Rican hospitals between 1995 and 2001, when reforms were introduced in the organisation and financing of the health sector. A decentralisation process brought health facility managers autonomy in areas such as budgetary procurement and administrative and human resource management. A sick-leave policy was also implemented based on not providing temporary cover for absent workers. It was expected that peer pressure would reduce sick absence rates. However, absenteeism in fact increased throughout the period under discussion. In the context of a highly permissive organisational culture and in the absence of effective incentive and disciplinary systems for workers, staff responded to workloads which increased due to absent colleagues by going sick themselves.

N. Homedes and A. Ugalde

Health Policy and Planning, vol.21, 2006, p.123-131

The population of many Latin American countries is having increasing difficulty in accessing needed medicines due to price rises and increased poverty in the region. This article reports on two country-wide programmes aimed at increasing access to medicines: the AIDS control programme in Brazil, which has been judged highly successful, and the Remediar programmes in Argentina. Both programmes have significantly increased access to needed drugs. It is suggested that pharmaceutical interventions are successful when there is a firm political commitment, when they are comprehensive, when they include the participation of civil society, and when they use a combination of methods to control price rises, including centralised international competitive bidding processes for drug procurement and reliance on multi-source drugs.

M.K. Ranson and others

Social Science and Medicine, vol. 62, 2006, p.707-720

Paper measures the distributional impact of a large community-based health insurance scheme in Gujerat, India which reimburses hospitalisation costs and identifies barriers to optimal distributional impact. The study found the scheme to be inclusive of the poorest. Submission of claims for care is equitable in Ahmedabad City, but inequitable in rural areas. The better off in rural areas are significantly more likely to submit claims than the poorest, and men are significantly more likely to submit claims than women. Members living in areas with better access to health care submit more claims than those living in remote areas. The study concludes that even a well-intentioned scheme may have an undesirable distributional impact if it does not address the major barriers to accessing hospital care and if the process of seeking reimbursement is burdensome to the poor.

(See also Health Policy and Planning, vol.21, 2006, p.132-142)

J. J. Fins

London: Jones and Bartlett, 2006

The book focuses on the challenges and barriers facing the growing field of palliative care. It serves as a comprehensive primer on the ethics of end-of-life care starting with the ethical and legal principles essential to end-of life decision making and ending with a practical methodological approach and a pathway to clinical care.

K. Landzelius and J. Dumit (editors)

Social Science and Medicine, vol.62, 2006, p.529-682

This special issue examines health activism as part of the flurry of activity around health matters that includes advances in technoscientific medicine, healthcare restructurings, and a rethinking of science-society contracts. Three sets of patient movements are identified: 1) movements that empower and advocate for patients, such as AIDS organisation; 2) movements that resist medical hubris and the hegemony of biomedicine such as vaccination resistors; and 3) movements that herald “mutations in the category of the patient” such as the anti-ageing movement in the US that seeks to redefine old age as a treatable disease.

P. McNamara

Health Policy and Planning, vol.21, 2006, p.101-109

In most healthcare systems in most countries, providers are not held accountable for the quality of care by governments, purchasers, professional associations or civil society. One approach to improving provider accountability that is being debated and implemented, particularly in the US, is provider-specific comparative performance monitoring. This review discusses design options for report cards, presents developing country examples, explores challenges and outlines implementation steps.

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