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

Afghanistan women’s health crisis, health service delivery and ethical issues for international aid

H. Turner

Health Care for Women International, vol.27, 2006, p.748-759

A review of the literature shows that the health of women in Afghanistan is very poor. This is reflected in poverty levels, human rights violations and the level of maternal deaths. Health services face a difficult task providing adequate input in the face of continuing violent conflict and prevalent fundamentalist Islamic ideas. Humanitarian assistance is being provided by international aid agencies, and the literature demonstrates that these are not being used as political tools or a further means of controlling people. The literature provides no quick solutions to the problems faced by health services in Afghanistan, but does offer guidance on how health professionals should interact with Afghan women.

The balance of care: trends in the wages and employment of immigrant nurses in the US between 1990 and 2000

M. Arends-Kuenning

Globalizations, vol.3, 2006, p.333-348

Shortages of “home grown” nurses and doctors are increasingly leading hospitals and care homes in developed countries to recruit health professionals from the Third World. In this article, the 1990 and 2000 Census Public Use Micro Survey data files are used to address the issue of nurse migration. It examines changes in the number, location, wages, countries of origin and other economic and demographic variables for foreign-born nurses and nurses’ aides and US born nurses and nurses’ aides. Results show that foreign-born nurses and nurses aides increasingly come from developing countries, especially Africa. This raises ethical issues as Africa faces a severe shortage of nurses in the context of the AIDS pandemic.

The case for risk-based premiums in public health insurance

P. Zweifel and M. Breuer

Health Economics, Policy and Law, vol.1, 2006, p.171-188

In the course of the past decade, several countries have turned to competition between public health insurers in the hope of controlling rising healthcare expenditure. The concept is that of managed competition, implying that health insurers continue to be subject to many regulations. Among these regulations, uniform, risk-independent premiums are accepted as a given, meaning that expected loss is not reflected in contributions. This paper shows that uniformity of health insurance premiums entails a considerable loss of efficiency. It proposes risk-based premiums complemented by means-tested, tax-financed transfers as an alternative.

The changing context of Western European healthcare systems: convergence vs. divergence in nursing problematics

A. Spitzer and others

Social Science and Medicine, vol.63, 2006, p.1796-1810

Western Europe has been swept in the last two decades by extensive reforms of hospital care. Parallel to these widespread reforms, increasing difficulties have emerged in the nursing profession, including staff shortages, burnout, low pay, absence of career structures, and limited autonomy. The same kinds of problems have come to light in widely divergent organisational contexts in countries with very different healthcare systems and cultures. Solutions to problems in the nursing workforce are more likely to be local than uniform across Europe.

Conceptualizing decentralization in European health systems: a functional perspective

R.B. Saltman and V. Bankauskaite

Health Economics, Policy and Law, vol.1, 2006, p.127-147

Decentralisation has emerged as a cornerstone of health policy in numerous West European countries. This article defines decentralisation in terms of three key functional dimensions: political, administrative and fiscal. It uses these three categories to identify key theoretical issues concerning decentralisation, emphasising its advantages and disadvantages. It then examines the usefulness of the theoretical framework in explaining recent policy decisions within a number of tax-based health systems in Western Europe.

Developing a marketing function in public healthcare systems: a framework for action

F. Lega

Health Policy, vol.78, 2006, p.340-352

Marketing has traditionally been disdained in national health services funded by taxation and delivered under central government control. Politicians feared that it would lead to escalation of demand for treatment and therefore costs. More recently, there has been debate about the use of marketing as a tool for improving the performance of publicly funded healthcare systems. Healthcare organisations operating in such systems increasingly face pressures to contain costs and improve service quality and clinical appropriateness. Systems are being redesigned along managed competition and per capita funding lines. Organisations see marketing as a management tool to help cope with these changes.

Does decentralisation improve human resource management in the health sector? A case study from China

X. Liu and others

Social Science and Medicine, vol.63, 2006, p.1836-1845

This paper presents a case study which examined whether decentralisation resulted in improved management of human resources in the health sector in one province of China. The case study examined HR outcomes for selected indicators of workforce effectiveness before and after decentralisation. It demonstrates that decentralisation can give health service managers more control over their staff. In some cases this may lead to improved HR outcomes, such as enough staff with appropriate skills delivered within budget. In other cases, decentralisation may lead to worse provision through inappropriate human resource management.

Equity in resource allocation for health: a comparative study of the Ashanti and Northern Regions of Ghana

A.D. Asante, A.B. Zwi and M.T. Ho

Health Policy, vol.78, 2006, p.135-148

This study demonstrates that, although deprivation is widespread in Ghana, there are variations among districts that need to be taken into account in the allocation of public sector health resources. In both the Ashanti and Northern regions, findings suggest varying levels of deprivation among districts, with rural districts being more deprived than their urban counterparts. Results show that the intra-regional allocation of donor-pooled funds has been more equitable in the Northern than in the Ashanti region.

Financial incentives for disease management programmes and integrated care in German social insurance

S. Gress and others

Health Policy, vol.78, 2006, p.295-305

As a result of recent reforms, sickness funds and healthcare providers in Germany have new financial incentives to implement disease management and integrated care programmes. Sickness funds receive higher payments from the risk adjustment system if they set up certified disease management programmes and induce patients to enrol. If health care providers establish integrated care projects they are able to receive extra-budgetary funding. In consequence, the number of certified disease management programmes and integrated care contracts is increasing rapidly.

Global processes, local consequences: gender equity and health sector reform in Peru

C. Ewig

Social Politics, vol.13, 2006, p.427-455

The author focuses on the effects of globally inspired neoliberal health sector reforms on gender equity in poor communities in Peru. Four reforms to the public health care system were initiated in the 1990s: introduction of fees for services; means testing; a targeted basic package of health services; and administrative decentralisation. This paper evaluates their impact on gender equity. Fees and means testing worked against gender equity, as they presented a barrier to access to health care to women and girls who are over-represented among the poor. Within families, spending on male healthcare was prioritised. The basic health package, while it recognised some men’s and women’s specific health needs, ignored others, reified existing unequal gendered patterns in the distribution of care work, and distributed only the most basic forms of health care. However, administrative decentralisation had a number of unintended positive consequences for gender equity, including opening up spaces for new patterns of community leadership, responding to culturally specific health needs, and increasing efficiency.

Health care costs in the last year of life: the Dutch experience

J.J. Polder, J.J. Barendregt and H. van Oers

Social Science and Medicine, vol.63, 2006, p.1720-1731

It is generally agreed that health care costs rise significantly in the last year of life. It is also argued that traditional projection methods overestimate the influence of population ageing on health expenditure because improvements in life expectancy will postpone rather than raise costs. This paper aims to: 1) estimate health care costs in the last year of life in the Netherlands; 2) describe age patterns and differences between causes of death for men and women; 3) compare cost profiles for decedents and survivors; and 4) use these figures in more advanced projections of future health expenditure. Results show that cause of death needs to be taken into account when estimating costs; people who die of cancer consume more resources in the last year of life than those who die of heart failure. Age is also important; people who die in their sixties and seventies cost more in their last year of life than those who die in their nineties. Taking these issues into account, the authors’ projection demonstrated a 10% decline in the growth rate of future health expenditure compared to conventional projection methods.

The influence of health insurance on hospital admission and length of stay: the case of Vietnam

A. Sepehri, W. Simpson and S. Sarma

Social Science and Medicine, vol.63, 2006, p.1757-1770

The compulsory health insurance (CHI) scheme in Vietnam covers civil servants, and employees of state enterprises and large private firms. The complementary voluntary health insurance scheme is open to all those not covered by CHI, including the self-employed and employees of small firms and local government. Finally, there is a free health insurance card for the poor. This paper provides an empirical assessment of the influence of the different schemes on hospital admission and length of stay, using data from the Vietnam National Health Survey 2001-2002.

Innovations in health care: a reality check

A. L. Casebeer, A. Harrison and A. L. Mark (editors)

Basingstoke: Palgrave Macmillan, 2006

The book describes how innovations occur within health care settings. It analyses how and where research and theory make a difference; identifies when practice experience leads the way; defines evidence based management; and explores managing across boundaries. It compiles descriptions of innovations within complex health care settings that are working and provides examples of what can be and has been accomplished through organizational change. It also explores a range of examples where innovations were hindered, blocked, or not sustained across time, and examines where current theories and practices are falling short and why there are problems that remain unsolved.

Integrating spirituality in health and social care: perspectives and practical approaches

W. Greenstreet (editor)

Oxford: Radcliffe, 2006

The book considers the concept of spiritual care as an explicit component of holistic health and social care. It is a practical guide which focuses on integrating spirituality in healthcare as a whole, rather than limiting it to any particular care environment. It takes into account not only religious, cultural and philosophical views, but also the value and use of music, art and other creative therapies.

The landscape of community health insurance in India: an overview based on 10 case studies

N. Devadasan and others

Health Policy, vol.78, 2006, p.224-234

The Indian health system is mainly funded by out-of-pocket payments. Health insurance covers only3% of the population, either civil servants or employees in the formal sector. Some non-governmental organisations have initiated community health insurance schemes to ease the burden of health expenditure on the poor. This article describes and analyses a selection of 10 Indian community health insurance schemes.

Measuring efficiency in health care: analytic techniques and health policy

R. Jacobs, P. C. Smith and A. Street

Cambridge: Cambridge University Press, 2006

With the health sector accounting for a sizeable proportion of national expenditures, the pursuit of efficiency has become a central objective of policy makers within most health systems. The book examines some of the most important techniques available to measure the efficiency of systems and organisations in health care. It points out the advantages and pitfalls of implementing these techniques and includes practical examples.

Non-compliance on the part of the professional community with a national guideline: an argumentative policy analysis

M. Moret-Hartman and others

Health Policy, vol.78, 2006, p.353-359

In 1997 the National Health Insurance Board of the Netherlands introduced a guideline for the use of a new anti-epileptic drug, Lamotrigine. The goal was to limit the use of this relatively expensive drug to patients with hard-to-treat epilepsy. A survey of neurologists has shown that the policy measure has been largely ineffective: only a minority (22%) knew of the protocol and even fewer put it into practice. Research reported in this article investigated why the policy failed.

Nursebots to the rescue? Immigration, automation and care

N. Folbre
Globalizations, vol.3, 2006, p.349-360

The intense pressure to cut costs in US hospitals is reducing the quality of nursing care and leading to staff shortages due to deteriorating working conditions. The shortage of nurses is driving two trends that could lead to further deterioration in the quality of care: increased international immigration and new forms of automation such as “nursebots” under development in artificial intelligence laboratories. Unfortunately, many healthcare consumers lack the power to effectively monitor or respond to reductions in the quality of care.

Policy context of the poor progress of the pro-poor policy: a case study of the Medical-Aid policy during Kim Dae-jung’s government (1998-2002) in the Republic of Korea

Y.-J. Shin

Health Policy, vol.78, 2006, p.209-223

Medical-Aid, launched in 1977, is Korea’s public medical assistance programme for the poor. The scheme has been criticised for its low coverage, insufficient level and range of benefits, unstable finances and discrimination against its beneficiaries by health services. In 1998 Kim Dae-jung was elected president, having promised in his campaign to expand welfare provision. This article investigates why he failed to deliver his election promises to expand Medical-Aid. Three barriers to the expansion of Medical-Aid are identified: prevalence of ideologies hostile to pro-poor policy interventions, social conflict, and the immaturity of civil society.

Priority setting of public spending in developing countries: do not try to do everything for everybody

R. Baltussen

Health Policy, vol.78, 2006, p.149-156

This paper presents a rational approach to targeting and prioritisation of public spending on healthcare, with special reference to Ghana. Interventions were first tested against the economic justification for public funding, to define on whom spending should be targeted. Resulting interventions were then prioritised on the basis of medical and non-medical criteria. Disease control priorities emerged as prevention of mother-to-child HIV/AIDS transmission and oral rehydration therapy to treat childhood diarrhoea and public funding of these interventions was found to be justified for the whole population. Case management of pneumonia in childhood was also identified as a priority, but with public funding targeted on the poor only.

Public involvement policies in health: exploring their conceptual base

S. Wait and E. Nolte

Health Economics, Policy and Law, vol.1, 2006, p.149-162

Public involvement is a central pillar of the health policy process in the UK, Canada and Australia. Different countries have experimented with initiatives such as public consultation to guide priority setting, regional or community health councils, and lay involvement in health boards. The incorporation of public views into policy making is perceived as a means to restore trust, improve accountability and secure cost-effective decision-making within health systems. This analysis aims to explore some of the key questions, issues and conceptual frameworks underpinning public involvement policies in healthcare, based on a review of the published literature.

Social problems: a focus for a new branch of public health?

F.W. Young

Social Theory and Health, vol.4, 2006, p.264-274

The biomedical theory that guides the work of public health departments in the USA does not explain the health impacts of social problems such as teenage pregnancies, unemployment or homelessness, but these are increasingly concerned with such situations. The author presents a “structural ecology” theory of health that explains how social problems cause ill health and how strong social structure improves population health. This alternative theory suggests the possibility of designing a new branch of public health that focuses on social problems rather than pathogens.

The sociology of health and illness. 2nd edition

S. Nettleton

Cambridge: Polity, 2006

The book introduces some of the key contemporary debates within the sociology of health and illness. It includes discussions of food and eating, e-health, the MMR debate, embryo stem cell research, recent approaches to health inequalities, and the health implications of the information age. A central theme running throughout the book is that we are moving towards a new paradigm of health and health care, one in which people are no longer passive recipients of treatment when they are ill, but are active participants in the maintenance of their own health. This is reflected in contemporary health policy which emphasizes health promotion, community health care and consumerism.

Solidarity in competitive health insurance: analysing the relevant EC legal framework

F. Paolucci, A. Den Exter and W.P.M.M. Van De Ven

Health Economics, Policy and Law, vol.1, 2006, p.107-126

The markets for social health insurance in many EU countries have been made more competitive over the past two decades. Although competition may stimulate insurers to become more efficient and responsive to consumer preferences, they have a major problem in the apparent incompatibility between solidarity and equivalence principles. Solidarity means that low-risk individuals cross-subsidise high-risk ones. The equivalence principle refers to the fact that, without external interventions, competitive health insurance markets tend to use risk-adjusted premiums. This paper presents four strategies that governments can use to achieve solidarity in competitive health insurance markets: 1) legal restriction on competition; 2) risk compensation schemes; 3) premium compensation schemes; and 4) excess-loss compensation schemes. The analysis shows that, from both an economic and a legal perspective, risk compensation schemes represent the best intervention for achieving an acceptable level of risk solidarity.

Theatre as a public engagement tool for health policy development

J. Nisker and others

Health Policy, vol.78, 2006, p.258-271

A play, Sarahs Daughters, was written for this study on the sensitive theme of predictive genetic testing. The play was performed before and range of Canadian audiences, including clinicians, the Jewish community, and the general public. Each performance was followed by a debate about the health policy issues raised by predictive genetic testing. Analysis of the audience member comments showed that people were engaged emotionally and cognitively by the predicament of the characters and the health policy issues. Audience members offered informed opinion on policy issues, including resource allocation, patenting of genetic tests, research funding, genetic test based health insurance discrimination, and imperatives for public education.

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