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

Building effective public-private partnerships: experiences and lessons from the African Comprehensive HIV/AIDS Partnerships (ACHAP)

I. Ramiah and M.R. Reich

Social Science and Medicine, vol.63, 2006, p.397-408

This paper examines the dilemma between the growing desire for highly collaborative partnerships and the lagging capacity to manage the complex relationships that emerge in such partnerships. The dilemma is analysed as it evolved for the African Comprehensive HIV/AIDS Partnership between the Government of Botswana, Merck & Co and the Bill and Melinda Gates Foundation. This paper looks at the multiple challenges that ACHAP confronted in the first four years of its existence in building and managing relationships with other organisations and among ACHAP partners, especially the government.

Clinicians and the governance of hospitals: a cross-cultural perspective on relations between profession and management

P. Degeling and others

Social Science and Medicine, vol.63, 2006, p.757-775

Programmes of hospital reform pursued by policymakers in many industrialised countries are structured to encourage hospital staff to: 1) accept interconnections between the clinical and resource dimensions of care; 2) recognise the need to balance clinical autonomy with accountability; 3) support the systematisation of clinical work; and 4) subscribe to the power-sharing implications of team approaches to clinical work. Results of a survey of staff in hospitals in Australia, England and New Zealand indicate marked variations between doctors, nurses and managers in the acceptability of various aspects of the reform programme, particularly among doctors whose value profile suggested their opposition to most elements of the reform. In contrast, the value stances of doctors, nurses and managers within Chinese hospitals were more similar, and, on issues that touched the systematisation of clinical work, were consonant with the value orientations of the programmes of reform.

The Common Drug Review: a NICE start for Canada?

M. McMahon, S. Morgan and C. Mitton

Health Policy, vol.77, 2006, p.339-351

While drugs are licensed for sale based on evidence of safety and efficacy versus a placebo, many funders now require evidence of clinical and cost-effectiveness compared to existing drugs as part of their reimbursement criteria. In some countries, concerns about duplication of drug assessment across different jurisdictions have led to experimentation with various forms of centralised drug review processes. This paper describes the Common Drug Review, a Canadian version of a centralised drug review process. It describes the origins of the Common Drug Review and its relationship to provincial formulary decision-making processes, and presents evidence on the uptake of its early recommendations. It then compares the Common Drug Review to the National Institute for Health and Clinical Excellence in the UK.

Copayments and the demand for prescription drugs

D. Esposito

London: Routledge, 2006

Increasing prescription drug cost-sharing by patients - in the form of increasing copayments – is one of the most striking developments in the American health sector over recent years. Differential copayments for medically equivalent alternatives is one strategy insurers use to affect the choice of one drug over another when they face different prices for each drug. In particular, the book examines the market for statins, drugs that treat high cholesterol and coronary heart disease. This book’s results suggest that differences in copayments influence choice, shifting market share in these drug markets.

Health planning in the United States and the decline of public-interest policymaking

E.M. Melhado

Milbank Quarterly, vol.84, 2006, p.359-440

In the 1960s and 1970s health planning formed a major theme of American health policy. Planners aimed to improve health services and make them broadly available while using resources efficiently. This article provides a history of the origins of planning, its rise and its decline in favour of organizing and improving healthcare markets. It links the demise of health planning to the decline of an idealistic style of policymaking that emphasised non-market values.

Human resources for sexual and reproductive health care

Reproductive Health Matters, vol.14, May 2006, p.6-150

This special issue includes papers on the men and women who collectively form the human resource base of public sexual and reproductive health services in Bangladesh, Guatemala, Indonesia, Kenya, Lithuania, Mongolia, Morocco and Zambia and AIDS treatment programmes in Malawi and South Africa. The papers collectively demonstrate that, given the increasingly high expectations placed on health workers regarding reduction of maternal deaths, prevention of HIV infection, etc, more staff, better training and greater skills are needed and salaries and working conditions must be greatly improved.

The impact of Filipino micro health insurance units on income-related equality in access to healthcare

D.M. Dror, R. Koren and D.M. Steinberg
Health Policy, vol.77, 2006, p.304-317

This study aims to assess the impact of being insured by micro health insurance units (MIUs) on equality of access to healthcare among groups with inequitable income distribution using data from a household survey conducted in five regions in the Philippines in 2002. Results suggest that MIUs in the Philippines improve income-related equality of access to hospital treatment and medical consultation in cases of illness. This sudy strengthens the case for government support for MIUs as successful suppliers of health insurance.

Individual and area factors associated with general practitioner integration in Australia: a multilevel analysis

D. Dunt and others
Social Science and Medicine, vol.63, 2006, p.680-690

Integration of primary care within the wider health system has been identified as an imperative for reform in health care systems throughout the world. This reflects the increasing number of services that people with chronic illnesses must receive for care to be optimal. The GP Integration Index provides a measure of the level of GPs’ integration with the health care system based upon a description of their own behaviour. This paper aims to identify the factors associated with GP integration using this Index. If some of these factors are amenable to change through the policy-making process, greater GP integration with the health system could be achieved.

Pharmaceutical pricing in Europe: weighing up the options

E. Mossialos, D. Brogan and T. Walley

International Social Security Review, vol.59, July-Sept.2006, p.3-25

Rising expenditure on drugs has led governments to introduce a range of price control mechanisms. This paper offers a critical review of current price control policies for both on-patent and off-patent drugs. It concludes that free competition between manufacturers is the best way of keeping down the costs of off-patent (generic) drugs. For on-patent dugs, price and reimbursement decisions should be integrated. Cost-effectiveness analysis, combined with reimbursement decisions, requires a demonstrable improvement for an on-patent drug to be prescribed, dispensed and reimbursed. Integrating price and reimbursement decisions might encourage companies to target their research towards new and effective medicines, and less time, effort and money would be spent on drugs offering little therapeutic benefit.

Race, segregation and physicians’ participation in Medicaid

J. Greene, J. Blustein and B.C. Weitzman

Milbank Quarterly, vol.84, 2006, p.239-272

Using data from the 2000/01 Community Tracking Study, the authors show that physicians are less likely to accept Medicaid patients in areas where the poor are nonwhite and in areas that are racially segregated. This study contributes to a growing body of evidence that patient race influences physicians’ choices, which may contribute to racial disparities in access to healthcare in the USA.

Regulated competition in social health insurance: a three-country comparison

S. Gress

International Social Security Review, vol.59, July-Sept 2006, p.27-47

Healthcare reforms in Germany, Switzerland and the Netherlands which introduced competition between sickness funds in the 1990s were based on three assumptions. Firstly, consumers need to have free choice of insurer and exercise their right to choose. Formally, consumers indeed have free choice in all three countries, but are more sensitive to price differences in Germany than in Switzerland or the Netherlands. Secondly, sickness funds need to compete with each other in terms of price and quality of services. In Germany, price is the primary instrument of competition for sickness funds, while those in the Netherlands compete on what they can offer in the way of supplementary cover. The primary instrument of competition between funds in Switzerland is risk selection. The third assumption implies that sickness funds can exert pressure on inefficient healthcare providers to improve services. There is very little evidence that this assumption holds.

The role of law in public health: the case of family planning in the Philippines

M.M. Mello and others

Social Science and Medicine, vol.63, 2006, 384-396

Despite a 30 year effort, the Philippine Family Planning Program has failed to control the country’s population growth. Population surveys reveal persistent disparities between desired and actual family size, highlighting substantial unmet family planning needs among Filipino couples. The authors carried out a review of laws and policies related to family planning as part of a larger project to strengthen local government provision of health services. They aimed to examine how these laws constrain or facilitate contraceptive service provision and identify opportunities to use the law to improve it. This article presents a conceptual model for understanding the impact of law on public health and discusses findings in relation to the roles of healthcare provider regulation, drug regulation, tax law, trade policies and insurance law in determining access to modern contraceptives.

Routes to better health for children in four developing countries

T.W. Croghan, A. Beatty and A. Ron

Milbank Quarterly, vol.84, 2006, p.333-358

In this article, the authors describe the circumstances of four countries whose reductions in child mortality rates exceeded what might have been expected from their poor economic circumstances and ask whether they followed common routes to improve child health. Results suggest that targeted health interventions and foreign aid matter more than do contextual factors including the degree of economic development, good governance, and strong healthcare systems.

The social organisation of healthcare work

D. Allen and A. Pilnick (editors)

Oxford: Blackwell, 2006

The book brings together a series of papers describing major trends in health services in Australia, Canada, Finland, the Netherlands, South America, UK and the USA, including the introduction of new models of organisational governance, the emergence of new medical technologies, and the effects of the promotion of private health insurance. It draws on research from a range of disciplines, including organisational sociology and sociology of scientific knowledge, as well medical sociology, and fosters links between these different bodies of work.

Surviving decentralisation? Impacts of regional autonomy on health service provision in Indonesia

S. Kristiansen and P. Santoso

Health Policy, vol.77, 2006, p.247-259

Since 2001, health service administration in Indonesia has been devolved from central government to district level and health care is increasingly privatised. This research traced the impact of the 2001 decentralisation on access to, and quality of, health care in Indonesia. The authors conclude that:

  • There is a total lack of transparency and accountability in the handling of health service finance by local government
  • Public health institutions and hospitals now have to make a profit to cover their operational costs and are only interested in patients who can pay
  • The cost of good quality medicines and professional advice has risen sharply, leading poor people to return to traditional medicine.

The transition from excess capacity to strained capacity in US hospitals

G.J. Bazzoli and others

Milbank Quarterly, vol.84, 2006, p.273-304

In the late 1990s it was generally agreed that the US health system had several thousand unneeded hospital beds that, if closed, could reduce health expenditure. By the early 2000s, however, a perception was growing that hospital capacity was under strain in certain areas. This article looks at the reasons behind this changing perception, focusing on four sites monitored by the Community Tracking Study. Results show that perceptions of the adequacy of hospital capacity are influenced by population growth, health insurance market changes, and demand shifts linked to the closure of other local hospitals.

When social health insurance goes wrong: lessons from Argentina and Mexico

P. Lloyd-Sherlock

Social Policy and Administration, vo.40, 2006, p.353-368

This article assesses the potential of social health insurance to provide a sound model for healthcare financing, drawing on the experiences of Argentina and Mexico. It uses four criteria to assess the performance of social health insurance: coverage, equity, effectiveness and sustainability. In both countries large social insurance funds were established to cover workers in the formal economy. Initially it was hoped that coverage would expand with the growth of the formal workforce, but levels of informal employment remained high. In fact social health insurance led to the crowding out of publicly funded care through the formation of rival administrations and by reducing the stake of insured groups in supporting high-quality universal services.

Why do not all hip- and knee patients facing long waiting times accept re-referral to hospitals with short waiting time? Questionnaire study

H.O. Birk and L.O. Henriksen

Health Policy, vol.77, 2006, p.318-325

Due to long waits for hip and knee replacements at the local hospital, a Danish county offered patients the chance to have surgery at a hospital in another county with a shorter waiting list. However, fewer patients than expected accepted the offer. When asked the reason for their choice, patients who declined treatment at the more distant hospital said that they preferred to be treated locally because of the shorter travel time and previous positive experiences at the hospital nearby. This study calls into question the received wisdom that patients are willing to travel long distances to secure quicker treatment

Working in health and social care: an introduction for allied health professionals

T. C. Clouston and L. Westcott (editors)

Edinburgh: Elsevier, 2005

The health and social care organisations within the UK are amongst the biggest employers in the world. Because of their size and their relationship to central and local government these organisations have developed their own cultures, systems and philosophies, which impact on the day-to-day practice of the people who work in them. To best serve the public from within a large organisation practitioners need to have a clear understanding of their place within it, and this book aims to help the process of making sense of, and therefore practising most effectively within, the ever-changing health and social care organisations.

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