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Welfare Reform on the Web (March 2007): Healthcare - overseas

Advocacy coalitions and the internationalization of public health policies

S. Princen

Journal of Public Policy, vol. 27, 2007, p. 13-33

The growing power of the European Union and other international organisations has led to a situation where policies are developed in a multitude of domestic and international institutions that are closely intertwined. These multilevel systems offer a range of new strategic options for political actors because, in addition to their domestic institutions, they can now also appeal to the European or global level to promote their preferred policies. As a result, political actors may strategically try to shift issues to another level of government. This article investigates the extent to which the existence of international governance structures has led to a change in the relationship between state actors and interest groups, using anti-smoking policy and alcoholism policy as case studies.

The chance of Sweden’s public health targets making a difference

A. Lager, K. Guldbrandsson and B. Fossum

Health Policy, vol. 80, 2007, p. 413-421

The Swedish public health targets have been in existence since 2003. They focus on health determinants rather than on mortality or morbidity rates. Their purpose is to create social conditions that will ensure good health on equal terms for the entire population. Most of them deal with health determinants at the societal level. The health care sector is considered to be only one of many sectors with a role in improving public health. This article considers whether the Swedish health targets are capable of functioning as a primary tool for use by politicians to influence the behaviour of the public administration. It concludes that the targets cannot function in this way because they are not explicit enough.

Diffusion of complex health innovations: implementation of primary health care reforms in Bosnia and Herzegovina

R.A. Atun and others

Health Policy and Planning, vol. 22, 2007, p. 28-39

Using an innovation lens, this study examines the introduction and diffusion of family medicine centred primary healthcare reforms in Bosnia and Herzegovina. The introduction of family medicine centred primary health care is complex and involves organisational, financial, clinical and relational changes. Such innovations are not simply disseminated but rather assimilated into the health system, a process which is influenced by stakeholder perceptions of the benefits of the innovation, the level of consensus among adopters, and the bidirectional interaction between the innovation and the context. In Bosnia and Herzegovina, a holistic approach, comprising multifaceted and simultaneous interventions at multiple levels of the health system, reduced policy resistance and enhanced the adoption and diffusion of the reforms.

The distribution of net benefits under the National Health Insurance programme in Taiwan

N. Huang and others

Health Policy and Planning, vol.22, 2007, p.49-59

The redistributive effects of a social health insurance programme are determined by how the programme is paid for (who pays and how much they pay) and how the benefits are distributed. Assessing equity by source of social insurance financing while ignoring the benefit side, or looking at equity in benefits while ignoring the funding side both risk misleading findings. When both factors are taken into consideration, the distribution of net benefits of the Taiwan National Health Insurance programme is clearly pro-poor and indicates that it has successfully served its purpose.

Do HMO plans reduce health care expenditure in the private sector?

J. Shin and S. Moon

Economic Inquiry, vol.45, 2007, p.82-99

US Health Maintenance Organisations (HMOs) are designed to implement a tight utilisation review and authorisation process, along with limited choice of providers, in order to control use and quality. By comparing health care expenditure patterns of HMO members with those of non-HMO members among the privately insured, non-elderly population, this study seeks to understand the impact of HMOs on health care expenditure in the private sector. The study found little evidence that HMO members are significantly healthier than non-members. Secondly results show that HMO membership reduces out-of-pocket expenditure on healthcare, while not reducing total spending on health or total payments by private insurers. Finally, HMO enrollees demonstrate lower satisfaction with the non-pecuniary elements of their plan such as the overall quality of care.

Does therapeutic reference pricing always result in cost-containment? The Hungarian evidence

Z. Kaló and others

Health Policy, vol.80, 2007, p. 402-412

Therapeutic reference pricing is increasingly used to contain the costs of drugs. The reimbusement of any drugs included in the system cannot exceed the reimbursement of the reference product(s), thus increasing co-payment for the non-reference drugs. Therefore patients have an incentive to move from higher priced medicines to lower priced reference products in order to avoid the increased co-payment. This article describes the Hungarian experience with introducing therapeutic reference pricing for statins in 2003.

Exploring the international arena of global public health surveillance

P. Calain

Health Policy and Planning, vol.22, 2007, p. 2-12

In order to tackle the threat of cross-border epidemics of infectious diseases, the concept of global public health surveillance has been developed and formalised by the World Health Organization and its technical partners. However, the health surveillance agenda is now being influenced by real or perceived threats of bio-terrorism and fears about disruption of the global economy. The impartiality and independence of the WHO are at risk in this process, and these elements challenge the sovereignty of WHO member states and their commitment to abide by the revised (2005) International Health Regulations.

From the field side of the binoculars: a different view on global public health surveillance

P. Calain

Health Policy and Planning, vol.22, 2007, p. 13-20

The implementation of a global health surveillance agenda is imposing new constraints and programmatic priorities upon the fragile health systems of developing countries. The multiplication of supra-national public health surveillance initiatives reflects a focus on the interests and priorities of donor countries or institutions. In low income countries, strengthening the health system and empowering frontline health workers would be a more efficient way of achieving proper detection of, and response to, outbreaks of disease.

Inconsistent objectives: reflections on some selective health care policy developments in Europe

A. Oliver

Health Economics, Policy and Law, vol.2, 2007, p. 93-106

Since 1990, EU member states have focused on: 1) increasing health service activity in order to reduce waiting lists; 2) extending patient choice; and 3) maximizing health gains from available health care resources, ie establishing which treatments offer “good value for money“. This article describes and assesses these developments, while pointing out that they may undermine some fundamental principles of these systems, for example that health care should be universal and affordable at the point of use.

Legal thoughts on the implications of cost-reducing guidelines for the quality of health care

S. Callens, I. Volbragt and H. Nys

Health Policy, vol. 80, 2007, p. 422-431

Clinical practice guidelines were originally developed by doctors to enhance the quality of care. In developing recent patients’ rights laws, many legislators refer to practice guidelines when specifying the right to quality in health care. Recently policy-makers have discovered that clinical guidelines can also be used to reduce or contain costs. Increasingly cost-controlling guidelines are being incorporated into legislation with sanctions for non-compliance. The authors consider whether a doctor, in case of a conflict with a patient who claims that his right to quality care has been violated, can defend himself in court by stating that he was acting in compliance with cost-controlling guidelines.

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