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

Centralized or decentralized? A case study of Norwegian hospital reform

J. Magnussen, T.P. Hagen and O.M. Kaarboe

Social Science and Medicine, vol. 64, 2007, p. 2129-2137

In many European countries, decentralisation is the favoured strategy for managing healthcare systems. Norway, however, has moved against the trend towards decentralisation. Since the 1970s, the organisation of the Norwegian healthcare system has been based on the belief that decentralisation of both policy and financial control to the county level would ensure efficiency. In 2002, Norway abandoned this model and switched to one based on the belief that centralising these powers at national level would produce better results. This paper examines the processes leading to the change of direction, and reviews available evidence of its economic effects.

Commoditization of the international teleradiology market

T. McLean

Journal of Health Services Research and Policy, vol. 12, 2007, p. 120-122

Use of teleradiology services enables American hospitals to provide out-of-hours cover and to access an increased supply of radiologists, many of whom will work for a fraction of the cost of their US counterparts. On the other hand, American hospitals that do business with overseas radiologists may be more exposed to medical malpractice liability for negligently hiring less qualified foreign physicians. In addition, American radiologists are lobbying for trade barriers in order to protect their jobs. In short, international teleradiology will substantially increase volatility in the healthcare marketplace. Using teleradiology as a model, this article examines how healthcare could be commoditized to reduce fluctuation in physician supply and price. The commoditization of teleradiology would not only stimulate market growth but would also provide a means to globally improve the quality of healthcare.

Corruption in health services

S. Cave

Journal of Health Services Research and Policy, vol. 12, 2007, p. 67-68

Corruption is rife in health services worldwide. Doctors, faced with inducements from pharmaceutical companies, over-prescribe drugs or prefer expensive branded products to generics. Other health professionals inflate their claims for services to insurers and funders. Insurance companies, managers and politicians inflate prices, offer or accept bribes, and siphon off funds.

Evaluation of the chronic disease self-management program (CDSMP) among chronically ill older people in the Netherlands

H. Elzen and others

Social Science and Medicine, vol. 64, 2007, p. 1832-1841

Many older patients in the Netherlands have a combination of more than one chronic disease. There is therefore a need for self-management programmes that focus less on the problems related to one specific disease, and more on general problems that are the same for different long-term conditions, such as pain, fatigue, anxiety, etc. The Chronic Disease Self-Management Program (CDSMP) developed at Stanford University in the USA targets people with more than one chronic disease. In evaluations of the programme carried out in the USA and China, positive effects on self-management behaviour and health status have been found. However, this Netherlands evaluation found no evidence for the effectiveness of the CDSMP in improving self-efficacy, self-management behaviour or health status of older patients.

Health care resource prioritization and rationing: why is it so difficult?

D.W. Brock

Social Research, vol. 74, Spring 2007, p.125-148

Ever growing costs of healthcare in the US will increasingly force the issue of rationing limited resources into the open for public, professional and political attention. The author argues that there are two broad ethical considerations that should guide healthcare rationing. First, resources should be allocated efficiently so as to maximise the health benefits they produce. Secondly, the health benefits derived from limited resources should be distributed fairly or equitably. The article goes on to illustrate conflicts between those goals, when equity requires that resources should be concentrated on the poorest and the sickest, but greater health gains could be produced overall by treating the more affluent.

Inequality in the face of death? Public expenditure on health care for different socioeconomic groups in the last year of life

B. Hanratty and others

Journal of Health Services Research and Policy, vol. 12, 2007, p. 90-94

Low socioeconomic status is associated with higher levels of morbidity, premature death, and reduced access to health care. It follows that poorer people may need more treatment and thus incur higher public expenditure at the end of their disadvantaged lives. This study investigated whether healthcare expenditure in Stockholm county in the last year of life varied by the socioeconomic status of the patient. Results showed that county council expenditure on healthcare in the last year of life rose with increasing income of the deceased person. Median per capita expenditure increased from 55,417 Swedish Kronor in the lowest income group to SEK 94,678 in the highest.

An introduction to health planning for developing health systems. 3rd ed.

A. Green

Oxford: Oxford University Press, 2007

Health planning is a critical component when responding to the health needs of low and middle income countries, characterised by particularly stringent resource constraints. The major communicable diseases such as AIDS, TB and malaria often appear in parallel with growing non-communicable diseases including heart disease and diabetes, and yet resources are often less than the levels recommended by the World Health Organisation for basic health care. The new edition of this text explains the importance of health planning in both developing regions such as Africa, and those in transition, such as Central and Eastern Europe. It stresses the importance of understanding the national and international context in which planning occurs, and provides an up to date analysis of the major current policy issues, including health reforms. Separate chapters are dedicated to the distinct issues of finance for health care and human resource planning. The various techniques used at each stage of the planning process are explained, starting with the situational analysis and then looking in turn at priority-setting, option appraisal, programming, implementation, monitoring, and evaluation. The book ends by examining the challenges facing planners in the 21st century, particularly in the light of growing globalisation.

Kidney transplants and the shortage of donors: is a market the answer?

A.J. Wellington and J.B. Whitmire

Contemporary Economic Policy, vol.25, 2007, p. 131-145

In the United States, demand for kidneys for transplant far outstrips supply. This study examines the viability of allowing a market for cadaveric kidneys and investigates the implied equilibrium price based on survey responses. It concludes that a market equilibrium price for cadaveric kidneys may be prohibitively high. Consequently, the authors support other levers for increasing supply, particularly presumed consent and mandated choice.

Pharmaceutical regulation in Greece at the crossroad of change: economic, political and constitutional considerations for a new regulatory paradigm

X. Contiades, C. Golna and K. Souliotis

Health Policy, vol. 82, 2007, p. 116-129

In Greece, national policies aimed at keeping pharmaceutical expenditure in check focus of strict pricing controls. They do not employ demand control mechanisms with a view to rationalising consumption. As a result pharmaceutical expenditure has increased rapidly due to unchecked demand. This article evaluates the current regulatory regime at the political, economic and constitutional levels and proposes an alternative model that addresses both the supply and demand sides of the market.

The politics of reproductive health in Peru: gender and social policy in the global south

S. Rousseau

Social Politics, vol.14, 2007, p.93-125

This article analyses the politics of reproductive health policy-making in Peru in the context of healthcare reform initiatives undertaken since the early 1990s. Through limited national public health insurance schemes, a new social policy model, based on a targeted poverty-reduction paradigm, is now partially addressing the reproductive health needs of the majority of Peruvian women. Policy implementation, however, is highly contested, fragile and subject to setbacks. This article shows that, in developing countries such as Peru, the role of international actors and the impact of unconsolidated democratic institutions are two key variables in the comparative analysis of social policy formation.

Price differences between Japan and the US for medical materials and how to reduce them

H. Ide and others

Health Policy, vol. 82, 2007, p. 71-77

Previous investigations revealed that market prices of medical materials in Japan were two to four times higher than in the US. In response, the Japanese government introduced the foreign price adjustment (FPA) rule in 2002 to reduce reimbursement prices. Under the FPA, market prices in Japan are compared with those in the US, UK, Germany and France, and reimbursement prices are reduced biennially by a maximum of 25% if the market price in Japan is higher than twice the mean price abroad. This study found that, in spite of the FPA, differences between US and Japanese prices had widened. The investigation revealed several problems with the FPA:

  • the determination process for reimbursement prices is inappropriate, and has made the Japanese market less competitive
  • the FPA takes too long to resolve price differences
  • price data collected is inaccurate.

Prioritization and resource allocation in health care: the views of older people receiving continuous public care and service

E. Werntoft, I.R. Hallberg and A.-K. Edberg

Health Expectations, vol. 10, 2007, p. 117-128

A total of 146 Swedish older people aged 65-100 were interviewed face-to-face about their views on resource allocation in healthcare. About 80% agreed that healthcare prioritisation should not be affected by age per se, but that family situation, patientsí well-being and lifestyle should be taken into account. The respondents wanted doctors to decide on prioritisation at an individual level and wanted higher taxes to fund increasing healthcare costs. Although respondents wanted publicly funded healthcare, a relatively high number were willing to pay for treatment rather than wait.

Priority setting at the micro-, meso- and macro-levels in Canada, Norway and Uganda

L. Kapiriri, O.F. Norheim, and D.K. Martin

Health Policy, vol.82, 2007, p. 78-94

Priority setting, the allocation of scarce resources between competing demands, occurs in every health system at the macro-level (national and provincial), meso-level (regional and institutional) and micro-level (clinical programmes). Priority setting determines the sustainability of any health system, whether primarily privately or publicly financed. This study aims to describe the process of healthcare priority setting in Ontario, Norway and Uganda at the macro-, meso- and micro-levels, to evaluate the descriptions using a common conceptual framework, accountability for reasonableness, and to identify lessons for good practice.

Sub-Saharan Africa: beyond the health worker migration crisis?

J. Connell and others

Social Science and Medicine, vol. 64, 2007, p. 1876-1891

Migration of skilled health workers from Sub-Saharan African countries has increased this century, with most countries becoming sources of migrants. In the context of widespread existing health staff shortages in Africa, migration has further weakened fragile health systems. This global overview indicates that key destinations of migrants remain the UK and the USA and major sources of supply are South Africa and Nigeria. Migrants move primarily for economic reasons, and increasingly choose health careers because they offer migration prospects. Migration has depleted workforces, diminished the effectiveness of healthcare delivery and reduced the morale of remaining staff. Countries have sought to implement national policies to manage migration, mitigate its harmful impacts and strengthen African healthcare systems. Recipient countries have been reluctant to establish ethical codes of recruitment practice to stem the flow, or to offer other forms of compensation.

Telling stories: news media, health literacy and public policy in Canada

M. Hayes and others

Social Science and Medicine, vol. 64, 2007, p. 1842-1852

A total of 4372 stories were analysed from 13 Canadian daily newspapers using a constructed week per quarter method. Stories were sampled from each newspaper for the years 1993, 1995, 1997 and 2001. Topics related to healthcare (dealing with issues of service provision and delivery or management and regulation) dominated the newspapers, accounting for 65% of all stories. Physical environment stories accounted for about 13% of all stories, the socio-economic environment about 6% of stories, personal health practices about 5% of stories and scientific advances in health research about 4% of stories. Canadian newspapers rarely report on socio-economic influences frequently cited in the research literature as being most influential in shaping population health outcomes.

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