Click here to skip to content

Welfare Reform on the Web (June 2006): Healthcare - overseas

Can limiting choice increase social welfare? The elderly and health insurance

Y. Hanoch and T. Rice

Milbank Quarterly, vol.84, 2006, p.37-73

Elderly people as a group experience a marked decline in higher cognitive functions. The introduction of prescription drug benefits into Medicare in 2006 will face them with a bewildering array of choices and options. This article surveys the options for accessing prescription drug benefits through Medicare, noting how the availability of too many choices could hamper sound decision-making by elderly patients.

Children’s access to four medical services: impact of welfare policies, social structural factors and family resources

T. Cheng

Children and Youth Services Review, vol.28, 2006, p.595-609

Medicaid generally helps uninsured poor children gain access to healthcare services. However, the dissolution of the ties between Medicaid and cash assistance initiated by the welfare reforms of 1996 led to a sharp decline in children’s enrollment in Medicaid. To reduce the ranks of uninsured children, State Children’s Health Insurance Programs have been developed. This research examines the factors that affect children’s access to health care in the USA. Results show that children’s access to medical services is influenced by their race/ethnicity, family income, health insurance status, and welfare policies.

Evidence into policy and practice? Measuring the progress of US and UK policies to tackle disparities and inequalities in US and UK health and health care

M. Exworthy and others

Milbank Quarterly, vol.84, 2006, p.75-109

Policy in both the US and the UK is increasingly focusing on the remediation of inequalities in health and health care. This article begins by looking at the nature and cause of disparities in health and health care. It then explains the difficulties in measuring these, examining mechanisms used in the US and the UK as illustrations. Finally it considers the implications of such mechanisms for future policy and practice.

An examination of the financial feasibility of electronic medical records (EMRs): a case study of tangible and intangible benefits

Steven J. Simon and Stuart J. Simon

International Journal of Electronic Healthcare, vol.2, 2006, p.185-200

Electronic medical records (EMR) systems have been in existence for abut ten years, but adoption rates have been low in US hospitals and physician practices. The main barrier appears to be cost. Article presents the business case developed by a medical practice in Atlanta, Ga., when considering implementing an EMR system which showed a return on investment of 309% as well as intangible benefits in the shape of improved quality of care.

Factors contributing to patient dumping in Taiwan

H.-C. Lin and others

Health Policy, vol.77, 2006, p.103-112

Patient dumping occurs when patients are transferred between hospitals on economic grounds rather than their need for medical care. A nationwide survey of hospital superintendents in Taiwan showed the practice to be widespread under the National Health Insurance system. Higher levels of patient dumping were associated with extent of competition between hospitals, introduction of the case payment system under when hospitals are paid a fixed fee for each patient treated, and government imposition of global budgets (expenditure caps)

The fragmentary federation: experiences with the decentralized health system in Russia

K. Danishevski and others

Health Policy and Planning, vol.21, 2006, p.183-194

This paper provides new information on the scale and nature of decentralisation of health care since the breakdown of the former USSR, reporting the results of case studies undertaken in six regions of Russia (Samara, Tver, Tula, Chelyabinsk, Sverdlovsk and Moscow oblasts). The study draws attention to four particular issues: 1) the very variable nature of relations between national, regional and municipal governments; 2) the relatively small variations in how health systems actually operate, reflecting legislative constraints and system rigidities; 3) the innovative model tried in Samara; and 4) the so far overlooked importance of municipal government in health care delivery in Russia.

Globalization, women, and health in the twenty-first century

I. Kickbusch, K. A. Hartwig and J. M. List (editors)

Basingstoke: Palgrave Macmillan, 2005

The book examines both the positive and negative influences of globalization on women and men’s health. It portrays diverse perspectives, including ethical, economic, political, and social to illuminate the complex interrelationship at the intersection of gender, globalization and health. Some of the questions the book seeks to answer are:

  1. Does health or its absence impact global society in new ways?
  2. How does a global health challenge such as HIV/AIDS impact gender relationships?
  3. In what way does health become an intermediary factor for a better life or a potential beacon for emancipation?
  4. Is health itself a major driving force for change?

Health plans respond to parity: managing behavioral health care in the Federal Employees Health Benefit program

M. S. Ridgley and others

Milbank Quarterly, vol.84, 2006, p.201-218

For many years, health insurance plans in the USA have offered coverage for mental disorders at significantly lower levels than for other medical conditions. Many insurers, including those in the flagship Federal Employees Health Benefit Program (FEHB), limited insurance coverage by creating a restrictive benefits design that discouraged the enrolment of high cost individuals and limited use of mental health services. In 2001 the Office of Personnel Management (OPM) required FEHB carriers to offer mental health and substance abuse benefits equal to general medical benefits. This article reports on how 156 carriers nationwide responded to the change. The research shows that the OPM parity policy directive was associated with an increased use of managed care, as opposed to fee-for-service, by insurers in an attempt to control costs.

The impact of decentralised drug-budgets in Sweden: a survey of physicians’ attitudes towards costs and cost-effectiveness.

S. Jansson and A. Anell

Health Policy, vol.76, 2006, p.299-311

In 1998 the prescription drugs budget in Sweden was devolved from central government to the 21 county councils. By 2002 nine out of the 21 county councils had decentralised the drug-budget to district or healthcare facility level with a view to increasing cost awareness among prescribing physicians. The principal model for decentralisation involved allocating budgets for “general drugs” to primary care centres on the basis of demographic variables pertaining to listed patients. Budgets for specialist drugs tend to be allocated to hospital departments on the basis of historic expenditure levels. Results of a postal survey of 738 physicians showed that GPs have a higher degree of cost awareness than other physicians. However, the rating of the top four decision-making criteria (therapeutic effects, side effects, compliance and cost-effectiveness) were not significantly different when GPs were compared with specialists and physicians practising in county councils with decentralised drug- budgets were compared with other physicians. The main barriers to greater consideration of costs when prescribing were perceived difficulties in switching drugs and a fear of losing credibility with patients.

Informal payment for health care: evidence from Hungary

P. Gaal, T. Evetovits and M. McKee

Health Policy, vol.77, 2006, p.86-102

Paper begins by attempting to clarify the order of magnitude of informal payments in Hungary using official statistics and surveys and critically assessing their findings in relation to the methods used to collect the data. It then explores the distribution of payments among health care workers on the basis of survey findings. Analysis suggests that in 2001 informal payments amounted to between 64.8 and 203.6 million euros which represented 1.5-4.6% of total health expenditures in Hungary. Informal payments are unequally distributed among health workers, with the bulk of the money going to physicians.

Is decentralisation the real solution? A three country study

I. Mosca

Health Policy, vol.77, 2006, p.113-120

Decentralisation has been perceived as a means of improving the performance of health services and making them more responsive to local needs. Funding and/or management responsibilities have been transferred to local or regional government or to specially created agencies such as strategic health authorities in Britain. However, control of the health service has recently returned to central from local government in the Nordic countries, which historically have had highly decentralised systems. This study presents case studies of three countries, Italy, Spain and Norway. It sheds light on some difficulties that Italy and Spain may experience given the current decentralisation of their health services and explains the drivers for the recentralisation of health care in Norway.

Measuring shrinkage in the welfare state: forms of privatization in a Canadian health-care sector

A. Gildiner

Canadian Journal of Political Science, vol.39, 2006, p.53-76

Article traces the series of changes in car insurance legislation, industrial injury compensation and health care that transformed Ontario’s rehabilitation services from being almost entirely public in 1990 to being almost entirely private a decade later. Threshold no-fault automobile casualty insurance, introduced by the Ministry of Finance in 1990, established a new balance between tort and no-fault benefits that led to the creation of a demand-driven market for privately delivered rehabilitation services. This new market was entrenched by further changes to car insurance introduced by the New Democratic Party in 1994. The market’s existence made it easier, in 1998, for changes to be made to workers’ compensation legislation, increasing both reliance on private providers and the capacity of employers to be involved in rehabilitation decision-making regarding injured employees. The increased cost exposures for casualty insurers and payers, under both car accident and workplace injury policies in the early 1990s, created new incentives for payers to advocate for policy changes that would give them greater control over actual allocations under the policy. With the car insurance policy changes in 1996 and 2001, and the workers’ compensation changes in 1998, they achieved this control.

The Norwegian hospital reform of 2002: central government takes ownership of public hospitals

T. P. Hagen and O.M. Kaarbøe

Health Policy, vol.76, 2006, p.320-333

Starting in January 2002 the Norwegian central government took over all public hospitals from the county councils. This reform is the latest attempt by central government to resolve problems of long waiting lists for elective treatment, lack of equity in the supply of hospital services, and a lack of financial responsibility and transparency that led to a blame-game between the counties and the central government.

Rehabilitating the health system after conflict in East Timor: a shift from NGO to government leadership

A. Alonso and R. Brugha

Health Policy and Planning, vol.21, 2006, p.206-216

Efforts to re-develop health systems following prolonged conflict have been characterised by poor co-ordination among a plethora of helping agencies, including non-governmental organisations (NGOs), donors, military forces, multilateral agencies and the media. This paper analyses the roles of a range of actors in the establishment of a government-led district health system in East Timor after decades of conflict and Indonesian occupation. During the emergency phase from September 1999 to March 2000 non-governmental organisations played a major part in delivering relief to the population co-ordinated by UN agencies. An Interim Health Authority was established in March 2000 and major donors began to shift funding from NGOs to the newly established Ministry of Health. A rapid phasing out of NGOs, accompanied by steps to build the capacity of the Timorese to manage the new district health system was implemented.

Responsibility, fairness and rationing in health care

A.W. Cappelen and O. F. Norheim

Health Policy, vol.76, 2006, p.312-319

So-called life-style diseases such as obesity and heart disease constitute an increasing percentage of health problems. The probability of acquiring these diseases is affected by the choices people make about how to live their lives. Paper tries to show that it is possible to assign a limited but significant role to individual responsibility in rationing healthcare resources. This approach can help policy-makers in situations where the cost-effectiveness of different alternatives and the severity of the illnesses are approximately the same, or if the society wants to assign some weight to responsibility for choice. It can also be easily linked to a system of graduated co-payments.

Stories from the sharp end: case studies in safety improvement

D. McCarthy and D. Blumenthal

Milbank Quarterly, vol.84, 2006, p.165-2006

Motivated by governmental and nongovernmental regulators, pressure from staff and patients, and their own desire to do the right thing, leaders of health care organisations throughout the US are introducing innovative schemes to improve patient safety. This article presents six case studies of promising patient safety improvement programmes. All of these programmes identified organisational culture change as critical to making patients safer. Their goal is the creation of a safety culture which promotes continuing innovation and improvement.

Taking the call-bell home: a qualitative evaluation of tele-homecare for children

N. L. Young and others

Health and Social Care in the Community, vol.14, 2006, p.231-241

The Hospital for Sick Children in Toronto implemented a tele-homecare service on an experimental basis in 2000 to smooth the transition of children with complex health needs from hospital to home. The service used vital signs monitors and two way video-conferencing equipment to connect the home to the hospital. Hospital-based monitoring centre nurses provided scheduled and on-demand support twenty-four hours a day for a maximum of six weeks. Families also received regular home visits from community-based nurses. This paper reports on the experiences of 16 families who used the service.

Telemedicine services in the Republic of Ireland: an evolving policy context

A. MacFarlane, A.W. Murphy and P. Clerkin

Health Policy, vol.76, 2006, p.245-258

Following an overview of the Irish healthcare system and policy context, paper presents empirical data from a review of telemedicine in two regional health authority areas in the North-West and West of the Republic of Ireland. It assesses the resonance of these data with the international literature on telemedicine, with particular reference to May et al’s model for assessing the potential for successful normalisation of telemedicine services. Analysis shows that none of the services reviewed has reached the point of normalisation. There are no examples of the transfer of tele-services from the realm of enthusiasts to routine clinical settings.

Understanding the global dimensions of health

S. W. A. Gunn and others (editors)

New York: Springer, 2005

The book examines the bioethical, socio-political and scientific aspects of health, epidemics, aging populations, food safety, and other major health concerns at the international level. It seeks to answer multiple questions involved in keeping the developing world in optimal health:

  1. Are health technologies wisely used?
  2. Does the West rely too much on health technologies?
  3. Can today’s medicine coexist with traditional views and cultural practices?
  4. Will the configuration of health resources change as people live longer?
  5. Why are pandemics not controlled better?
  6. What happens when health systems clash with socio-political systems?
  7. Does globalization necessarily mean homogenization of care?

Search Welfare Reform on the Web