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Welfare Reform on the Web (March 2000): Health Care - Overseas

BEYOND NEW ZEALAND'S DUAL HEALTH REFORMS

R. Gould

Social Policy and Administration, vol. 33, 1999, p.567-585

Paper discusses the New Zealand health reforms of the 1990s. A number of directions are emerging from the ongoing process of reform, including:

  • a continued push for devolution of service delivery and control of resources to the primary care sector;
  • an intensification of the powers and jurisdiction of the purchasing Health Funding Authority;
  • a reduction in the size and influence of the Ministry of Health;
  • a proliferation of the number of private and non-government operators in the health sector;
  • an ongoing pursuit of the 'bottom line' in health delivery;
  • the persistence of a competitive, uncertain and tension-infused environment.

THE EFFECT OF MANAGED CARE ON HOSPITAL STAFFING AND TECHNOLOGICAL DIFFUSION

N. Zhang et al

Health Policy, vol.48, 1999, p.189-245

Paper examines the impact of managed care in the US on the efforts of hospital managers to control labour costs and technological diffusion. Hospitals were sorted into four categories based on the level of HMO penetration in their metropolitan statistical area, and data on differences in staffing levels and the availability of technology from 1982 to 1999 was compared across the four categories. Results do not validate the hypothesis that hospital managers are responding to local competitive pressures of managed care by changing their number of personnel, mix of personnel, diffusion of technologically advanced services. These findings cast doubt on the widely spread belief that hospitals are making major structural changes in response to managed care.

HEALTH FOR SOME? THE EFFECTS OF USER FEES IN THE VOLTA REGION OF GHANA

F. Nyonator and J. Kutzin

Health Policy and Planning, vol.14, 1999, p.329-341

Study found that health facility managers have been very active in setting and collecting fees and using the revenues to purchase essential supplies. The revenues mobilised account for between two-thirds and four-fifths on non-salary expenditure in government health facilities, and virtually all the resources for non-salary operating expenses in mission hospitals. Official exemptions from fees are largely non-functional. Less than one in 1000 patients were granted exemption in 1995. With 15-30% of the population living in poverty, the failure of exemption to function means that fees are preventing access by the poor. Health facilities in the Volta Region have achieved a kind of 'sustainable in equity' with fees enabling service provision to continue, while at the same time preventing part of the population from accessing them.

MEDICAL CARE AND PUBLIC POLICY: THE BENEFITS AND BURDENS OF ASKING FUNDAMENTAL QUESTIONS

T. R. Marmor and D. Boyum

Health Policy, vol. 49, 1999, p.27-43

Article reviews the grounds for the collective financing of medical care, the plausible limits to that commitment, and the implications of both the commitment and the limits to resource allocation. Address the question of what health services should be a collective responsibility and thus accessible to all. Argues that unresolved questions about the range of publicly financed medical services are not the principal obstacles to medical care reform, and that trying to delineate and justify are particular benefits package is liable to be counter productive. Further concludes that none of the revolutionary approaches to health care delivery currently being proposed are likely, in practice, to transform how governments approach the challenges of contemporary health care policy.

NEWLY IMPLEMENTED HEALTH SYSTEM REFORM IN ISRAEL: PHYSICIANS' ATTITUTDES

R. Wilf - Miron et al

Health Policy, vol. 49, 1999, p.137-147

The attitudes of Israeli physicians towards a newly implemented health care reform was explored through a nationwide mail survey. Results suggested that Israeli physicians favoured a change in the health care system, despite a perceived adverse effect of the reform on medical practice. Respondents did not believe that the new law would improve the system, but thought that the scope of services would diminish, while payments by the private sector and national expenditure on health would continue to increase. They predicted that the reform would improve the quality of primary care, without concomitant improvement in in-patient care.

PARTY POOPERS

H. Berliner

Health Service Journal, vol. 109, Dec. 9th 1999, p.28

Outlines the health care reform proposals of the three US presidential candidates. Al Gore has proposed an expansion of the children's health insurance programme and some reform of Medicare. Bill Bradley has proposed an ambitious federally supported programme to give healthcare access to almost 95% of the population. C.W.Bush has made no comment on the issue.

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