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Welfare reform on the Web (January 2007): Healthcare - Overseas

Americans’ views of health care costs, access and quality

R.J. Blendon and others

Milbank Quarterly, vol.84, 2006, p.623-657

For more than two decades, opinion polls have shown that Americans are dissatisfied with their current health care system. However, they are at the same time relatively satisfied with their own health care arrangements. As a result of the conflict between these views and the public’s distrust of government, there is often a wide gap between public support for a set of principles concerning what needs to be done about the overall problems facing the nation’s health care system and their support for specific policies designed to achieve these goals.

A behavioral model of clinician responses to incentives to improve quality

A. Frølich and others

Health Policy, vol.80, 2007, p.179-193

The use of performance related pay and public reporting of performance indicators in health care systems is rapidly increasing worldwide. The rationale for performance related pay and publication of performance indicators comes from experience in other industries and from theories about incentive use in psychology, economics and organisational behaviour. This article reviews the major themes from prior research and considers how they might be applied to health care. It then offers a comprehensive, health care specific model of how financial and reputational incentives might work, together and separately.

Child access to health services during the economic crisis: an Indonesian experience of the safety net program

E. Suci

Social Science and Medicine, vol.63, 2006, p.2912-2925

The Indonesian economic crisis of 1997 had an adverse impact on the health of poor children. The Indonesian government responded in 1998 by introducing a broad social safety net programme, including Jaring Pengaman Sosial Bidang Kesehatan for the health sector. This programme provided subsidies for medicines and imported medical equipment, and free health care, immunisations and food supplementation for poor children and lactating mothers. The funds were delegated to local health centres as a block grant. This evaluation of the programme found that in its first year of operation more sick children visited outpatient facilities and more children lived in households possessing health cards which entitled them to benefits.

Devolution and the interregional inequalities in health and healthcare in Spain

J. Costa-Font and A. Rico

Regional Studies, vol.40, 2006, p.875-887

The desirability of devolution of government responsibilities is often questioned on the grounds that it creates “postcode lotteries” and interregonal inequalities in service provision. This paper examines the impact of health system devolution on the emergence of interregional inequalities in healthcare outcomes (mortality) and outputs (expenditure) in Spain. Results show that:

  • Devolution has not led to increased inequalities in healthcare outcomes and outputs
  • There is no clear-cut evidence that devolution increased public health expenditure in the devolved regions, with the exception of fiscally accountable autonomous communities
  • Variations in healthcare expenditure are explained by differences in need, population size, and the local economic and demographic situation.

Disease management and health care reform in Germany: does more competition lead to less solidarity?

S.A.K. Stock, M. Redaelli and K.W. Lauterbach

Health Policy, vol.80, 2007, p.86-96

In order to curb spiralling costs and increasing deficits in the Statutory Health Insurance (SHI) system, free choice of sickness funds (open enrollment) was introduced in 1996 with the aim of promoting competition . However, in the interests of solidarity, sickness funds were forbidden to charge risk equivalent premiums. In order to prevent risk selection, a risk compensation scheme was introduced two years before the implementation of open enrollment and funds are obliged to contract with all applicants regardless of their health status. Despite these measures, risk selection became a major problem, with funds encouraging healthy people to apply. Avoiding applicants in poor health undermines solidarity and hampers efficiency and quality of care. To strengthen solidarity while promoting competition, enrollment in a disease management programme was brought in as a risk adjuster alongside the compensation scheme.

The economics of health and health care. 5th ed.

S. Folland, A. C. Goodman and M. Stano

Upper Saddle River, NJ: Pearson Prentice Hall, 2007

The book covers research information and empirical studies in the field of health and health care economics. It identifies the critical issues facing the health care system and illustrates the role of economics in addressing the issues. The chapters cover such topics as:

  • The production, cost and technology of health care
  • Demand and supply of health insurance
  • Consumer choice and demand
  • Key players in the health care sector
  • The pharmaceutical industry
  • Epidemiology and economics: HIV/AIDS in Africa

The enterprise formula, new public management and the Italian health care system: remedy or contagion?

P. Mattei

Public Administration, vol.84, 2006, p.1007-1027

The Italian government introduced sweeping changes to healthcare administration and policy in 1992. Two major themes run through the 1992 healthcare reform. The first is the introduction of private sector management practices, leading to the creation of the new post of general manager to head the administration of local health authorities and public hospitals. The second is the decentralisation of responsibility for health system administration to regional governments.

Health care funding reforms in Croatia: a case of mistaken priorities

L. Voncina, A. Dzakula and M. Mastilica

Health Policy, vol.80, 2007, p.144-157

Croatia’s health care system is based on a compulsory insurance scheme, through which citizens acquire their right to care. Since independence in 1991, the system has witnessed a constant mismatch between available public resources and spiralling costs. It has undergone a series of reforms which have aimed to address fiscal deficits by shifting responsibility for financing health care from the state to private sources by encouraging citizens to take out additional complementary insurance. This study argues that a better approach would have been to focus on curbing rising expenditure by health care providers.

A history of drug advertising: the evolving role of consumers and consumer protection

J. Donohue

Milbank Quarterly, vol.84, 2006, p.659-699

Spending on direct-to-consumer advertising of prescription drugs in the USA increased dramatically from $166m in 1993 to $4.2bn in 2005. This article discusses the expansion of direct-to-consumer advertising in the context of the history of federal drug regulation, the development of patients’ rights movements and the modern trend towards consumer-oriented medicine. It concludes by exploring the wider implications of direct-to-consumer advertising and consumer movements for contemporary policy debates about how to improve the health care system.

Managing competition in the countryside: non-profit and for-profit perceptions of long-term care in rural Ontario

M. W. Skinner and M.W. Rosenberg

Social Science and Medicine, vol.63, 2006, p.2864-2876

This paper contributes to the current debate about the private delivery of health care services by addressing the distinctive challenges, constraints and opportunities facing for-profit and non-profit suppliers in rural settings. It focuses on the case of Ontario, where extensive restructuring of long-term care was introduced in 1995 under the banner of managed competition. Results suggest that the introduction of managed competition has accentuated the problems of service provision in rural communities, and that historical issues surrounding care giving in rural areas transcend the differences between for-profit and non-profit provision.

The problem of health technology: policy implications for modern health care systems

P. Lehoux

Abingdon: Routledge, 2006

The book aims to illuminate the main layers of scientific and policy arguments about “the problem of health technology” that are currently deployed in various industrialised countries and to show why and how they are misleading. It revisits the clinical, commercial, and policy perspectives that dominate scientific and policy debates and seeks to develop an alternative conceptualization of health technology as it is assessed and used in industrialised health care systems. To achieve this objective, it compares and contrasts two main streams of literature: the work of Health Technology Assessment (HTA) scholars and Science and Technology studies (STS). While the HTA embodies a rational, science-based approach to dealing with the policy issues and the regulation of technology, STS focuses on the social practices that shape the processes underlying the design, adoption and use of technology. The book advocates that a dialogue should be established between these two fields in order to identify promising areas for future research and pragmatic ways to overcome the policy challenges facing health care systems.

Social inequalities in health: new evidence and policy implications

J. Siegrist and M. Marmot (editors)

Oxford: OUP, 2006

This book evolved mainly from research collaboration in the European Science Foundation Programme on ‘Social variations in health expectancy in Europe’. It explains social inequalities in health within three interrelated frameworks of scientific analysis:

  • A life course approach that models and tests pathways from pregnancy to adult health
  • A stress-theoretical approach that explores how an adverse psychosocial environment affects physical and mental health, with a special focus on work, coping and psychobiological stress responses
  • A macro-sociological approach that deals with health effects of aggregate deprivation and its wider socio-political and economic determinants, including different types of welfare regimes

Traditional risk-sharing arrangements and informal social insurance in Eritrea

G.K. Habtom and P. Ruys

Health Policy, vol.80, 2007, p.218-235

In Eritrea there are no formal health insurance schemes, public or private, covering people in the traditional (or informal) sector of the economy. In the absence of formal safety nets traditional Eritrean societies use their local social capital to cope with unexpected health care costs. Risk-sharing arrangements are made within extended families and mutual aid community associations. In a situation where the state no longer provides free health care and access to private insurance is denied, the transformation of voluntary mutual aid community associations into autonomous, locally organised social insurance schemes offers a possible solution.

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