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

R. Panelli, L. Gallagher and R. Kearns

Social Science and Medicine, vol.62, 2006, p.1103-1114

This paper shows how community action can highlight the gaps between policy rhetoric and healthcare access experiences. It documents how a community organisation in New Zealand (Rural Women New Zealand) completed a national survey of as a form of community action. The study recorded rural households’ experiences and challenges when accessing both primary and secondary health services. A range of access problems was identified. The study also illustrates how community-based action concerning healthcare need not be local or single service focused, but can involve a critique of policy at the national level.

M.W. Kroneman, H. Maarse and J. van der Zee

Health Policy, vol.76, 2006, p.72-79

In Europe there are two models which determine access to health care. The first is the gate-keeping system under which patients have to be referred for specialist care by a general practitioner. The second model is the direct access system, which leaves patients free to visit either a general practitioner or a specialist first. This study addresses the question of to what extent gate-keeping or direct access to specialist care influence patient satisfaction with GP services in 18 European countries. Results show that, in countries where specialist health care providers were directly accessible, patients were more satisfied with general practice than in countries where referrals were required. However this satisfaction related to the organisational aspects of GP services such as waiting times; direct access systems do not influence patients’ judgements about the actual care provided by their GP.

M.L. Rurup and others

Social Science and Medicine, vol.62, 2006, p.1552-1563

When a patient becomes incompetent it may be difficult for relatives and doctors to make end-of-life decisions when they are not sure what the patient would have wanted. However, decision-making can be made easier if the patient has an advance directive in place. Article describes previous research on advance directives in the USA, and presents a study of the current situation in the Netherlands. The article concludes by discussing how the formulation of advance directives could be encouraged in the Netherlands, since the study found that relatively few people had recorded their end-of-life wishes.

S. Smith and others

Maidenhead: Open University Press, 2005

No nation can afford to provide all the health care that its population wants. Countries can, however, ensure they obtain the greatest benefit from the resources available for health care. Evaluation of health care can help determine which services should be provided and how they should best be organized and delivered. The book analyses health care interventions, from specific treatments to whole delivery systems, in terms of four key dimensions: effectiveness, efficiency, humanity, and equity.

J. Heymann and others (editors)

Oxford: OUP, 2006

The book examines social determinants of health. It asks: to what extent is health determined by biological or social factors? And how do biological and social factors interact? Among the social factors looked at are: nutrition, working conditions, social inequalities, and geographic disparities. The final chapter seeks to answer the question, Where do we go from here? The authors provide a conceptual framework for translating research into action and conclude with recommendations for researchers and policy makers on the best ways of increasing their effectiveness in creating healthier societies.

T. Vian and others

Social Science and Medicine, vol. 62, 2006, p.877-887

Albania is beginning reforms to increase resources for health services, expand access and improve quality of care. This qualitative study was designed to help increase policy makers’ understanding of informal payments so that they can begin to address the problem. Researchers used in-depth interviews and focus groups with 131 general public and provider informants in three districts. The results suggest that informal payments are encouraged by perceived low salaries of health staff, the desire to get better service, the fear of being denied treatment, and the tradition of giving a gift to express gratitude. Members of the public also believe that informal payments create anxiety and uncertainty during the care seeking process, while providers think that informal payments harm their professional reputation, induce unnecessary medical interventions, and create discontinuity of care.

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

Basingstoke: Palgrave Macmillan, 2005

This book examines the industrial relations aspects of health care reform in five jurisdictions: Great Britain, New Zealand, the Australian state of New South Wales, 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 chapters discuss governments’ labour policies and the methods that governments and management use to address the industrial relations issues generated by health reform. They also examine health unions’ roles in and responses to the reform process.

D.L. Williamson and others

Health Policy, vol.76, 2006, p.106-121

Low-income Canadians have free access to publicly funded physician and hospital services co-ordinated by provincial/territorial health care plans. Some vulnerable groups are eligible for free services beyond those provided by the provincial health care plans, such as access to dentistry and prescription drugs. Interview data collected from low-income people, service providers, advocacy group representatives and public servants suggested that, in addition to health care programmes, access to a broad range of services related to income security, recreation and housing influence the ability of low-income Canadians to attain, maintain and enhance their health.

M. Higgins and Associates

Edinburgh: Mosby Elsevier, 2006

The focus of this new edition remains on providing comprehensive coverage of management topics and issues faced by health service managers. New concepts and strategies for multidisciplinary health service management and leadership have been added. The text is arranged according to six major themes – health service managers and the changing organisational context; health service management practice- working with people; health service management practice- working with information; health service organisations; improving organisational performance; and case studies in health service management.

J. Nemec and N. Kolisnichenko

International Review of Administrative Sciences, vol.72, 2006, p.11-26

After the fall of Communism all Central and East European countries implemented large scale health care system reforms. These included the introduction of health insurance financing systems to replace the socialist model based on funding from general taxation, privatisation of services and the introduction of co-payments. Recent research has shown that these market-based reforms failed to deliver the expected improvements. This paper attributes the failure to deliver to: 1) the introduction of the reforms at a time when GDP was falling and the banking system was unstable; 2) inadequate preparation for their implementation; and 3) the refusal of states paying lip service to marketisation to relinquish central control of health systems.

National catastrophic drug insurance revisited: who would benefit from Senator Kirby’s recommendations?

P.V. Grootendorst and M.R. Veall

Canadian Public Policy, vol.31, 2005, p.341-358

The Canada Health Act 1984 does not mandate the public subsidy of prescription drugs and this has resulted in a relatively small public share of total drug spending. Provincial government drug plans account for the lion’s share of public spending on prescription drugs outside hospitals, but there is substantial variation in the comprehensiveness of their coverage. Because of the apparent lack of coverage against potentially ruinous drug costs, Senator Kirby’s report recommended that federal funds should be pumped into private and provincial public drug plans that met certain eligibility criteria. He proposed that, to be eligible for federal assistance, public drug plans would need to cap household prescription drug expenses at 3% of total household income. Private drug plans would need to cap household prescription drug expenses at 3% of total household income or $1500 per household member, whichever is lower. Paper assesses the effects of implementing a Kirby-style catastrophic drug insurance scheme on the distribution of programme benefits and costs, initially assuming that all households not already in a qualifying insurance plan would be enrolled in one.

P. Roffe, G. Tansey and D. Vivas-Eugui (editors)

London: Earthscan, 2006

Since 2005 the supply of cheap generic drugs to combat diseases such as malaria and AIDS in developing countries has been threatened by the new World Trade Organization rules on intellectual property. This book discusses how action may be taken to ensure that intellectual property regimes are interpreted and implemented in a manner supportive of the right to protect public health and, in particular, to promote access to medicines for all.

K. Walshe and R. Boaden (editors)

Maidenhead: Open University Press, 2006

Healthcare organisations are often dangerous places to be. This book presents a research-based perspective on patient safety, drawing together the most recent ideas and thinking how to research and understand patient safety issues, and how research findings are used to shape policy and practice. The key issues are: analysis and measurement of patient safety, approaches to improving it, future policy and practice and the legal dimensions.

R. Normann and N. Arvidsson (editors)

Chichester: Wiley, 2006

Health care is one of the fastest growing areas of activity in the world. It is regarded as a central part of welfare systems. In Europe, this has resulted in a high degree of tax financing, a high degree of public ownership and a political responsibility for welfare. The European systems tend to be essentially monolithic while the US system is fragmented, in spite of efforts to introduce ‘managed care’. The authors analyse existing health care systems and provide an alternative model which aims to alter the decision-making process in a way that the interests of more stakeholders than politicians and physicians receive such influential status.

J. Walburg and others (editors)

London: Routledge, 2006

Performance management in the health care sector aims to constantly improve the results of the best possible health care processes by making optimal use of tools. The book addresses the organisational preconditions and provides a step-by-step approach for the realisation of performance management in a health care organisation. It then proceeds to discuss the relevance of performance management to disease management and the professional development, and concludes with a topical debate on the publication of results and a set of case histories.

R. Gross and M. I. Harrison

Health Policy, vol.76, 2006, p.213-232

The National Health Insurance Law enacted in 1995 regulated the previously unregulated competition in the Israeli health maintenance organisation market, radically changing the environment in which Israel’s four not-for-profit HMOs operate. This study addresses the organisational behaviour of the HMOs as they adjusted to new regulations and incentives in the health care system.

M. de Allegri and others

Health Policy, vol.76, 2006, p.58-71

Demand for health insurance is low in poor countries and community-based health insurance (CBI) is failing to reach satisfactory levels of participation among target populations. However a clear understanding of why enrolment rates remain low is missing. This paper presents a qualitative investigation of consumers’ preferences for elements of a CBI scheme recently implemented in the District of Nouna, Burkina Faso. Data was gathered from interviews with 32 heads of household and 10 focus groups. Respondents’ decisions to enrol were influenced by their satisfaction/dissatisfaction with premium level and payment mechanisms, the benefits package, the health service provider network, and the CBI management structure.

(See also Social Science and Medicine, vol.62, 2006, p.1520-1527)

Ke Xu and others

Social Science and Medicine, vol.62, 2006, p.866-876

All fees at first level government health facilities in Uganda were abolished in March 2001. This study explores the impact on health service utilisation and catastrophic health expenditures using data from the National Household Surveys undertaken in 1997, 2000 and 2003. Utilisation increased for the non-poor, but at a lower rate than it had in the period just before fees were abolished. Utilisation among the poor increased much more rapidly after the abolition of fees than beforehand. Unexpectedly, the incidence of catastrophic health expenditure among the poor did not fall. The most likely explanation is that frequent unavailability of drugs at government facilities after 2001 forced patients to purchase from private pharmacies. Informal payments to health workers may also have increased to replace the lost revenue from fees.

What are “third way” governments learning? Health care consumers and quality in England and Germany

P. Allen and P. R. Hommel

Health Policy, vol.76, 2006, p.202-212

This paper examines how information made available to healthcare consumers can be used to improve the quality of care in non-market systems, using England and Germany as case studies. Both countries elected social democratic governments in the late 1990s. The paper examines how both governments have responded to concerns about quality of care and traces policy changes between their first and second terms in office. In England information made available to consumers is being used to support a gradually widening choice of healthcare provider. On the other hand in Germany the government has sought to reduce choice of provider in order to control expenditure.

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