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

A baseline survey of the primary healthcare system in South Eastern Nigeria

C.M. Chukwuani and others

Health Policy, vol.77, 2006, p.182-201

Primary health care services in Nigeria have struggled in the face of economic crises, structural adjustments and neoliberal ideology. The Federal government has recently launched a comprehensive reform programme aimed at laying a solid foundation for economic growth, job creation and poverty reduction. This reform process is encapsulated in the National Economic Empowerment and Development Strategy which is also being adopted and implemented by state level governments. Within this framework the Enugu state government has embarked on a comprehensive health sector reform. This paper reports on a baseline survey to audit community perceptions and expectations of the primary health care system in Enugu. Results show that the majority of health facilities do not offer the full range of services required of them, are poorly maintained, have insufficient skilled health workers and operate without a budget. There appears to be no formal financial management system in place and no policy on financial resource generation. This poor service provision leads to low use of primary health care services by the community.

Entrepreneurship at the state level: a case of Massachusetts’ prescription drug program

K.L. Guo and Y. Sanchez

International Journal of Public Administration, vol.29, 2006, p.489-499

Article describes how the Massachusetts prescription drug programme for older people has successfully combined the entrepreneurial strategies of competition, community involvement and outreach with results-oriented and customer driven government to improve access and reduce costs. Masschusetts is an example of one state’s investment in entrepreneurship strategies which has resulted in the development of a successful and lasting drug coverage programme for older people.

Health care in China: the role of non-government providers

Y. Liu and others

Health Policy, vol.77, 2006, p.212-220

While health care in China is primarily financed by out-of-pocket expenditure, health care providers, especially hospitals, are still largely state owned and government controlled. Even though the private sector is playing an increasing role in ambulatory care provision, private services are not covered by the social insurance benefits package, and thus serve primarily self-payers. The government’s reservations about private provision stem from concerns that it may drive up costs and offer services of questionable quality. This paper has sought to gather evidence on the relative performance of the private and public sectors. It found no indications that the private sector providers charge higher prices or primarily serve the better off. On the contrary, available data suggest that the private sector serves low-middle income groups and that consumer satisfaction with cost and quality of care is higher in the private than the public sector. This may be due to competition among private providers.

Integrating gender interests into health policy

J. Gideon

Development and Change, vol.37, 2006, p.329-352

This article shows that the gender mainstreaming initiative within the Chilean health sector has made important inroads towards advocating for gender-sensitive reforms. The project has succeeded in bringing together gender and health activists and has developed a coherent set of proposals by a range of actors. They have ensured that the need for gender-sensitive health reform has become a subject of public concern, with on-going media attention now given to the issues of gender bias in the private health insurance system and the implications for women of the proposed changes in the public system. However, in order to ensure an effective state response, women’s organisations need to form new strategic alliances both with government officials and with a broader range of civil society organisations.

Older people’s views on how to finance increasing health-care costs

E. Werntoft and others

Ageing and Society, vol.26, 2006, p.497-514

This paper investigated the views of older people in Sweden about how healthcare should be financed and their willingness to pay for treatment, while also looking for variations in these views by age and gender. Survey participants were divided into “young-old” (60-72 years), “old-old” (78-84 years) and “oldest-old” (87-93 years). Participants recommended increasing taxes to fund healthcare, but said that they were willing to pay for certain treatments themselves, eg cosmetic surgery. Many were willing to pay for cataract surgery to shorten the wait if they could afford it. Results also showed that views on how to pay for healthcare differed amongst the age groups and between men and women.

Perspectives from the field: will recent public policies reduce entrepreneurship in the healthcare industry?

N. Borkowski and R. Kulzick

International Journal of Public Administration, vol.29, 2006, p.479-488

The US Balanced Budget Act 1997 and Sarbanes-Oxley Act 2002 imposed significant added regulatory burdens and increased uncertainty on entrepreneurs. The number of Medicare managed care plans withdrawing and/or reducing their service areas suggests that entrepreneurs may be viewing the healthcare industry as hostile. As such, entrepreneurs will turn to other areas of the economy, leaving healthcare starved of innovation.

Self-medication with antibiotics: does it really happen in Europe?

M. H. Vaananen, K. Pietila and M. Airaksinen

Health Policy, vol.77, 2006, p.166-171

Data were collected by survey from a convenience sample of 1000 Finns living in Southern Spain. Antibiotics had been used by 28% of the respondents in the six months before the survey. Of the antibiotics users, 41% had bought them without a prescription. Forty-five per cent of antibiotics users had taken a course for the common cold and 17% for a sore throat. The authors conclude that unnecessary use of antibiotics seems to be common in Southern Spain among Finnish immigrants. This may indicate that the Spanish healthcare system, including community pharmacies, is failing in its task of enhancing rational use of medicines.

Views of physicians, disciplinary board members and practicing lawyers on the new statutory disciplinary system for health care in the Netherlands

J.M. Cuperus-Bosma and others

Health Policy, vol.77, 2006, p.202-211

Disciplinary proceedings against healthcare professionals are dealt with by five regional disciplinary boards and appeals are made to the central disciplinary board. The system has been in existence for about 75 years, and was originally regulated by the Medical Disciplinary Act. However this was superseded in 1997 by the Individual Health Care Professions Act, which introduced important changes including: 1) increasing the number of legally qualified members of disciplinary boards; 2) opening the proceedings to the public; and 3) extending the system to cover four more professional groups. This evaluation of the effectiveness of the reformed system found that it could be improved by: 1) increasing the number of health professional board members; 2) adapting the composition of the disciplinary boards to suit the specialism of the accused professional; and 3) introducing the option of upholding a complaint without imposing a sanction.

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