Click here to skip to content

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

Advanced Asia’s health systems in comparison

R. Gauld and others

Health Policy, vol.79, 2006, p.325-336

This article extends the literature on comparative analysis of advanced Asian health systems, considering the cases of Japan, Taiwan, Hong Kong, South Korea and Singapore. It begins by providing background information and health indicators for the five jurisdictions. It then describes each of them in terms of regulation, funding and provision, pointing out commonalities and differences. It concludes that problems exist in “classifying” the five diverse regimes; that the systems face common pressures; and that there are considerable opportunities to enhance primary care, service quality and system integration.

Better the devil you know than the doctor you don’t: is advertising drugs to doctors more harmful than advertising to patients?

R. Vaithianathan

Journal of Health Services Research and Policy, vol.11, 2006, p.235-239

Most countries ban advertising of prescription drugs directly to patients, yet allow drug companies to promote medicines directly to doctors intensively. This difference in regulatory approach appears to be founded on a belief that doctors are fully rational and informed in their response to drug promotion by pharmaceutical companies, while consumers are easily manipulated by misleading advertising. However, evidence suggests that consumers are not in fact naïve and doctors are not totally rational. This article calls for the relationship between doctors and pharmaceutical companies to be made more transparent and for direct advertising of drugs to consumers to be deregulated.

Choice of public or private health insurance: learning from the experience of Germany and the Netherlands

S. Thomson and E. Mossialos

Journal of European Social Policy, vol.16, 2006, p.315-327

Several European countries have considered introducing choice of public or private health insurance, usually by allowing people to opt out of the statutory scheme, on the assumption that enhancing consumer choice and stimulating competition will be beneficial. This article tests that assumption by examining the impact of opting out on the equity and efficiency of health systems in Germany and the Netherlands. The analysis suggests that current policy debates may overstate the benefits of opting out. Due to market failures in health insurance and differences in the regulatory frameworks governing public and private insurers, choice of public or private coverage creates strong incentives for private insurers to select risks. Choice heightens the degree of financial risk borne by the public scheme and lowers incentives for prvate insurers to operate efficiently.

The determinants of policy for population health

D.M. Fox

Health Economics, Policy and Law, vol.1, 2006, p.395-407

This article reports on the differences between what researchers recommend and what policy makers do about improving the health of populations. What policy makers can do is constrained by a wide range of factors that include: the priorities of voters, the diffusion of responsibility for improving health, the absence of evidence about matters of consequence to policy makers, the arraying of some evidence in ways that frustrate policy making, resistance among clinicians and industries that manufacture drugs and medical equipment, and the political influence of people with long term conditions and their families.

Does federal health care policy influence switching between the public and private sectors in individuals?

R.E. Moorin and C.D.J. Holman

Health Policy, vol.79, 2006, p.284-295

Since the introduction of Medicare (the universal health insurance scheme) in Australia in 1984, use of private health insurance has been in decline. In order to reduce waiting times for treatment, the Commonwealth government introduced incentives in the late 1990s to increase levels of private health insurance coverage. This study sought to determine if these changes in Commonwealth health policy have influenced individual behaviour regarding use of private health insurance in Western Australia. Results suggest that recent policies supporting private health insurance have reduced the drift away from its use. However, the reported increases in utilisation of private health insurance were only partially explained by patients who had previously been hospitalised under Medicare switching to the private sector. This suggests that recent reforms have increased, rather than merely shifted, demand for healthcare.

Healthcare as a commodity: a financing mechanism to control costs and ensure access

A. Liberman and T. Rotarius

International Journal of Public Policy, vol.1, 2006, p.407-420

In the USA demand for, and costs of, healthcare are outstripping available funding. The authors propose an innovative solution to this problem, involving the creation of an annuity at birth for each citizen. The annuity would mature at age 65, and the proceeds would be used to purchase healthcare for the rest of an individual’s life. Investment for this annuity programme would come from the federal government at the rate of $1,000 per year for the first three years of life.

The impact of Medicare reimbursement changes on staffing and the quality of care in nursing homes

L. Unruh, N.J. Zhang and T.T.H. Wan

International Journal of Public Policy, vol.1, 2006, p.421-434

This study assesses the impact of recent Medicare reimbursement changes on qualified nurse staffing levels and quality of care in nursing homes in the USA. Results showed that the 1997 Balanced Budget Act had a negative effect on staffing and quality of care while the 1999 Balanced Budget Reconciliation Act and the 2000 Benefits Improvement and Protection Act had positive effects. The percentage of Medicaid patients was a strong contributor to lower staffing and quality, and moderated the effects of all three policies.

Learning to cross boundaries: the integration of a health network to deliver seamless care

J.D.H. van Wijngaarden, A.A. de Bont and R. Huijsman

Health Policy, vol.79, 2006, p.203-213

Integration of care can be seen as an organisational process that seeks to achieve seamless, co-ordinated care tailored to the patient’s needs. This paper presents an analysis of the development of such an integrated care network for stroke patients in the Netherlands in which professionals from different organisations were able to improve coordination and deliver more seamless and coordinated care. It shows how, through a process of collective learning, social contacts between health professionals increased and improved. These professionals learned to speak each other’s language, learned how other organisations work, and learned to look at the care process from a network instead of a purely organisational perspective. They also experienced the value of direct contact for sharing information and the limitations of protocols and rules.

A pan-Canadian perspective on institutional long-term care

W. Berta and others

Health Policy, vol.79, 2006, p.175-194

In Canada healthcare is managed provincially. In the case of institutional long-term care, this has led to regional variation with respect to the mix of public and private funding, facility ownership, costs to residents, residency requirements and the availability of alternative domiciliary and community services. However, residential long-term care is not a publicly insured service under the Canada Health Act and is not fully insured in any province. In order to initiate a discussion of the feasibility of developing a national policy for long-term care, the authors present a descriptive nationwide analysis of the long-term care industry based on data collected through the Residential Care Facilities Survey 1996-2001.

Patient empowerment and the introduction of hospital choice in Denmark and Norway

K. Vrangbaek and K. Østergren

Health Economics, Policy and Law, vol.1, 2006, p.371-394

Choice, competition and rights became powerful ideas in both countries in the 1990s. They were linked to national discussions about waiting times and lack of flexibility and this created pressure for policy change. National politicians in both countries seized the idea of choice and presented it as a potential solution to the ills of the health sector, including long waiting times for treatment and poor use of resources. The authors use a framework of structural, historical and situational factors to identify similarities and differences in the introduction and design of patient choice in the two countries.

Primary care in the twenty-first century: an international perspective

G. Meads

Oxford: Radcliffe, 2006

The book provides a comprehensive overview of primary care theory and reviews the future of general practice from an international perspective. Particular emphasis is placed on innovations in developing countries and lessons for modernising primary care organisations in the West. It also includes healthcare systems summaries of twenty-four countries and describes how family medicine is now practised around the world.

Using project evaluation to build capacity for integrated health care at local levels

S. Elmer and S. Kilpatrick

Journal of Integrated Care, vol.14, Oct. 2006, p.6-13

This paper reports the experience of using a project evaluation to build the capacity of Australian health professionals to better integrate service delivery for patients transferring between hospital and community-based general practitioner care. The evaluation provided an opportunity to involve the health professionals who participated in the project in a reflective, action-learning cycle that extended its impact and better embedded joint working in the region.

Search Welfare Reform on the Web