Welfare reform on the Web (February 2007): Healthcare - overseas

Equity in out-of-pocket payments for hospital care: evidence from India

K. Roy and D.H. Howard

Health Policy, vol.80, 2007, p.297-307

Out-of-pocket payments are the principal means of financing health care throughout much of Asia, including India. This study draws on data from the 52nd round of the National Sample Survey to estimate the relationship between household consumption (proxy for ability to pay) and out-of-pocket payments for hospitalisation. Findings indicate that out-of-pocket payments, both absolute and as a share of consumption, increase with ability to pay. This suggests that: 1) the better-off have to pay from out-of-pocket to secure quality health care; and 2) the poor are limited in their ability to divert resources from basic needs to pay for care. The poorest of the poor may simply forgo the care they need.

The extension of healthcare coverage and protection in relation to the labour market: problems and policies in Latin America

C. Mesa-Lago

International Social Security Review, vol.60, Jan.-March 2007, p.3-31

In the past 25 years almost all 20 countries in Latin America have reformed their healthcare systems, but coverage by social insurance averages 53% of the total population, ranges from 7 to 26% in ten countries and has stagnated or decreased in at least eight. The root of the problem is that since the 1980s number of people employed in the urban formal labour sector has diminished while the informal economy has grown. Most informal workers are either excluded from social insurance schemes or have very poor cover. Other challenges to social insurance schemes include incorporation of the rural population, indigenous peoples and the poor. This article analyses the problem of low coverage and summarises recommendations from international organisations on improving coverage and access. It suggests specific policies to expand protection and identifies areas where more research is required.

Maternal health policy and the politics of scale in Mexico

L. Mills

Social Politics, vol.13, 2006, p.487-521

During the 1980s and the 1990s there were two contradictory trends affecting welfare regimes and women’s rights in the developing world. On the one hand global forums codified women’s rights internationally and reconceptualised reproductive health as a human right. On the other hand, international financial institutions have promoted neoliberal structural adjustment programmes that have undermined the health of women and children in developing countries. The concept of reproductive and maternal health as a human right has been transmitted from the international scale to the local and national scales by internationally funded non-governmental organisations and via the commitments of national governments. However national state power in the health sector has been scaled back due to decentralisation. This article explores the impact of decentralisation on maternal health services in two Mexican states. The impact of decentralisation on health services has differed according to: 1) its timing and nature; 2) the number and expertise of NGOs working on maternal health issues, and their connections with international networks; and 3) the responsiveness of state governments to maternal health issues.

Patient performance standards: the next bold policy initiative in health care?

S. Buetow and G. Elwyn

Journal of Health Services Research and Policy, vol.12, 2007, p.48-52

There are performance standards for healthcare providers in many countries and some are paid bonuses for delivering high quality care. The authors suggest that performance-related rewards could be introduced for patients who improve their condition or lessen their risk of illness by choosing a healthier lifestyle, complying with treatment, etc.

The politics of health care

M.J. Elders

Social Research, vol.73, 2006, p.805-818

The USA spends 14% of its gross domestic product on health care, but the system is not comprehensive, equitable or cost-effective. Moves towards establishing a system offering universal access to high quality affordable health care are obstructed by the uncompromising stances of groups favouring their own self-interest, including politicians, big business, organised religion, and the educational establishment.

Resource allocation in public hospitals: is it effective?

N. Withanachchi and others

Health Policy, vol.80, 2007, p.308-313

Public hospitals in Sri Lanka are administered according to rigid rules and regulations. Staff are allocated by central or provincial ministries of health and not recruited by hospital managers. Managers are allocated an annual operating budget by the ministry. Between 1993 and 2002 the number of physicians in tertiary-care hospitals under study increased by 91%, while expenditure on equipment was reduced and the availability of drugs and other consumables declined. This study suggests that human resource utilisation in these hospitals is sub-optimal due to inadequate expenditure on drugs and equipment. The reorientation of resource allocation towards capital investment may save more lives.

Seven habits of highly effective global public-private health partnerships: practice and potential

K. Buse and A.M. Harmer

Social Science and Medicine, vol.64, 2007, p.259-271

This article highlights seven contributions made by global public-private health partnerships to tackling diseases of poverty. It then presents seven common unhealthy practices: 1) skewing national priorities by imposing external ones; 2) depriving certain stakeholders of a voice in decision-making; 3) inadequate governance mechanisms; 4) misguided assumptions about the efficiency of the public and private sectors; 5) committing insufficient resources to implement partnership activities and pay for alliance costs; 6) wasting resources through inadequate use of recipient country systems and poor harmonisation; and 7) inappropriate staff incentives. It concludes by presenting seven actions that would assist global health partnerships to adopt better habits.

Unequalizing citizenship: the politics of Poland’s health care change

P. Watson

Sociology, vol.40, 2006, p.1079-1096

Health care reform in post-communist Poland has been integral to the transformation of the social order and the creation of new power asymmetries based on poverty and wealth. The marketisation of health care has contributed to the creation of a new social class structure. One’s position in that structure is determined by the extent to which one is able to afford specialist care, basic medicine or even nutritious food in times of illness, even though constitutionally the right to healthcare for all is guaranteed in Poland. These issues are explored through qualitative research carried out in Nova Huta.

Waiting for cataract surgery: effects of a maximum waiting-time guarantee

M. Hanning and M. Lundstrøm

Journal of Health Services Research and Policy, vol.12, 2007, p.5-10

In 1991 the Swedish government and the Swedish Federation of County Councils agreed to offer a maximum waiting-time guarantee covering twelve different elective procedures, including cataract surgery. Under the policy, if patients had to wait more than three months for treatment, they could choose another provider at the expense of their home county council. The guarantee was in force from 1992 to 1996. Findings of this study suggest that the guarantee was effective in securing shorter waits for cataract patients in most need. The termination of the guarantee removed the prioritisation of patients with the worst sight and the indications for cataract surgery widened. The widening indications and the increase in the volume of referrals led to longer waiting times for all categories, including patients with the most severe needs.