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Welfare reform on the Web (September 2006): Healthcare - Overseas

Adverse selection in a voluntary Rural Mutual Health Care health insurance scheme in China

H. Wang and others

Social Science and Medicine, vol.63, 2006, p.1236-1245

In the voluntary health insurance market, high-risk consumers are able to purchase insurance at a premium based on the average costs of looking after the whole target population. This situation is referred to as “adverse selection”. The objective of this study is to examine the incidence of adverse selection in a subsidised voluntary health insurance scheme in a poor area of rural China. The results show that although the scheme achieved the high enrolment rate of 71% of rural residents, adverse selection still existed. In general, individuals with worse health status were more likely to enroll than individuals with better health status. It is concluded that the scheme will not be financially sustainable if the incidence of adverse selection is not taken into account.

An awkward threesome: donors, governments and non-state providers of health in low-income countries

N. Palmer

Public Administration and Development, vol.26, 2006, p.231-240

This article draws on case studies from five countries to describe the type of engagement taking place in low-income countries between governments, donors and non-state providers of healthcare (NSPs). Four lessons are drawn from the analysis: 1) successful collaboration between governments and NSPs requires trust; 2) small-scale for-profit healthcare providers are widespread and need to be encouraged to interact with governments and donors; 3) it is difficult for governments to engage with and monitor the activities of scattered small-scale providers, legal and illegal; and 4) a myriad of pilot projects involving collaboration have done little to address any of these complex challenges. Approaches demonstrated in the cases examined were small-scale and without any clear agenda for evaluation or subsequent scaling up.

Choices in health care: the European experience

S. Thomson and A. Dixon

Journal of Health Services Research and Policy, vol.11, 2006, p.167-171

This paper examines choices in health care in western European health systems. It focuses on four aspects of choice: between public and private insurance; choice of public insurance fund; choice of first contact provider; and choice of hospital. It also outlines the context of reforms that increase or restrict choice and reviews the objectives, content and impact of selected policies.

Chronic disease self-management by people from lower socio-economic backgrounds: action planning and impact

D. Boldy and E. Silfo

Journal of Integrated Care, vol.14, Aug. 2006, p.19-25

The HealthPartners demonstration project in Western Australia was a collaborative venture aimed at people over 50 from lower socio-economic backgrounds with diabetes and/or cardiovascular disease plus one or more co-existing conditions. The project developed six new interventions for clients, including one-to-one facilitation. When the latter was used, a key aspect of client management adopted by HealthPartners was joint preparation of action plans by client and facilitator. This paper provides an overview of the action planning process and its outcomes, and the results of an impact study of the programme as a whole.

Does health-care spending crowd out other provincial government expenditures?

S. Landon and others

Canadian Public Policy, vol.32, 2006, p.121-141

The view that the growth in provincial government spending on healthcare has crowded out public expenditure on other types of goods and services is widespread. The present study takes an empirical approach in order to determine if this perception is true. Results indicate that there is no evidence that healthcare spending has crowded out other provincial expenditures during the sample period 1988/89-2003/04.

Holistic self-management education and support: a proposed public health model for improving women’s health in Zimbabwe

J.H.M. Kanchese

Health Care for Women International, vol.27, 2006, p.627-645

This article provides some insights into a comprehensive method of improving the health of Zimbabwean women, starting at grassroots level. It describes the development and use of holistic self-management education and support as a possible solution to the poor health and social status of women in Zimbabwe. Holistic self-management education and support is a combination of five public health improvement models, ie the chronic care, central human capabilities, ecological and transtheoretical models plus the SPECIES model of health and wellness, all operating within a primary healthcare framework.

Incoherent policies on universal coverage of health insurance and promotion of international trade in health services in Thailand

C.-A. Pachanee and S. Wibulpolprasert

Health Policy and Planning, vol.21, 2006, p.310-318

In 2001, the new government in Thailand embarked on a policy of universal health insurance coverage. Through this, an additional 18 million people have access to basic medical care without financial barriers. At the same time private health care providers, with the support of the government, have been marketing their services internationally in the hope of attracting large numbers of fee-paying foreign patients to Thailand. The success of this marketing campaign has increased the demand for health care professionals. These skilled health care professionals, especially doctors, are being enticed by promised financial rewards to leave rural public health care facilities and work for private providers in urban areas. The Thai government has responded to the additional demand for medical personnel by increasing the numbers of doctors in training, hiring retired doctors, and importing foreign doctors. It has also introduced financial incentives to encourage doctors to work in remote rural areas.

Multilevel community health promotion: how can we make it work?

N. Chappell and others

Community Development Journal, vol.41, 2006, p.352-366

Most health promotion programmes focus on changing individual behaviour, rather than addressing the determinants of ill health at the family, group, organizational, policy and societal levels. This paper addresses the practicalities of implementing a comprehensive, multi-level approach based on experience with a health promotion research project in Victoria, British Columbia which employs community activation. It discusses two strategies that assist with moving beyond a single focus or level. One is the use of multiple methods of community assessment prior to beginning interventions and for continual assessment thereafter. The second charts change activities by their level of focus, so the targets of a project’s time and energy become explicit, enabling a shift towards multi-level implementation.

President Bush and social policy: the strange case of the Medicare Prescription Drug Benefit

D. Jaenicke and A. Waddan

Political Science Quarterly, vol.121, 2006, p.217-240

The Medicare Prescription Drug Improvement and Modernization Act 2003 provides eligible older Americans with financial help with paying for prescription drugs. It was passed by a Republican government and opposed by a large majority of Democrats. This paper explores the paradox. Democrats opposed the Bill because it not only created a new Medicare entitlement but also contained provisions that begin to restructure the scheme along conservative lines. These include: the encouragement of incursion by private managed care plans into Medicare; making tax-privileged health savings accounts universally available; introduction of means testing into the voluntary part B of Medicare that covers outpatient physicians’ fees; and creation of an artificial trigger for determining a crisis in Medicare financing.

Strengthening health systems to meet MDGs

A. Singh

Health Policy and Planning, vol.21, 2006, p.326-328

Examining country situations in depth shows that it may not be possible to implement policies that will achieve the millennium development goals for improved health among the poor by 2015. Any policies aimed at improving the health of the poor must be accompanied by strategies to strengthen underpinning health systems and institutions.

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