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

Concentration in the Greek private hospital sector: a descriptive analysis

Z. Boutsioli

Health Policy, vol. 82, 2007, p.212-225

Over the past 20 years governments have attempted to increase competition between healthcare providers in order to control costs and increase efficiency. In response, providers are merging and acquiring other firms. If this trend continues, healthcare markets will be dominated by a few large firms. This paper measures the industrial concentration of Greek private hospitals, and shows that a very few large firms now dominate the market.

Counting backward to health care’s future: using time-to-death modelling to identify changes in end-of-life morbidity and the impact of aging on health care expenditures

G. Payne and others

Milbank Quarterly, vol. 85, 2007, p. 213-257

In most developed countries, as the largest population cohorts approach the age of 65, the impact of population aging on health care expenditures has become a topic of growing interest. This literature review creates a reasonably detailed picture of the role of age, morbidity and death in health care expenditures. The evidence suggests that reduced morbidity and mortality and low growth in costs associated with dying could reduce forecasted expenditures on medical treatments, but high growth in spending on social care could create new pressures on health systems.

Development of Regional Health Information Organizations (RHIOs): knowledge networks and collaboration

T. Ghosh and J. Marquard

International Journal of Public Policy, vol. 2, 2007, p. 298-315

Regional Health Information Organizations in the USA are being developed to improve the coordination of care through the secure exchange of patient information among hospitals, physician offices, etc. The authors argue that RHIOs need move beyond electronic health information exchange and be seen as a catalyst for knowledge sharing and the dissemination of evidence-based practices. Sharing evidence-based practices allows for shared system improvement. RHIOs can serve as convener organisations that can act as catalysts for bringing diverse stakeholders to work together towards a common purpose and set of goals.

The effect of Taiwan's National Health Insurance programme on hospital physicians' perceptions of their careers: a survey

B. Y.-J. Lin, S.-P. Luh and C.-H. Lee

International Journal of Public Policy, vol. 2, 2007, p. 264-280

Structured questionnaires were used to elicit physicians’ views of five health policy and payment reforms, including case payment, separation of drug prescription and dispensing, reasonable outpatient volumes, hospital global budgeting and self-governing hospital budgeting. The research explored how respondents felt that the reforms had affected their lives in respect of conflicts in values, increased pressures, quality of personal lives, and career satisfaction among other issues. The results showed that the five reforms had had a negative effect on hospital physicians’ satisfaction with their careers.

Extending the risk pool for health in developing countries: the challenges of moving to general tax funding

C.C. Baeza and T.G. Packard

International Social Security Review, vol. 60, Apr.-Sept. 2007, p.83-97

The authors realise that national governments in low-income countries do not have the fiscal space to finance general free access to health care out of taxation, even taking into account extensive international public subsidies. Instead they propose means-tested access to tax-financed healthcare for the poor and vulnerable. Non-poor informal and self-employed workers could be encouraged to contribute to health insurance schemes through the introduction of risk-rated premiums. This should reduce the perceived gap between contributions and health benefits received and make the schemes offer better value for money.

'Go and tell people what it’s like here'

E. Dent

Health Service Journal, vol. 117, June 7th 2007, p. 24-28

Malawi’s health care system struggles with too few nurses, inadequate resources, and high disease rates. Almost a million people are living with HIV and AIDS. UK funding should see nurses’ salaries increase by 52% by 2010/11, but many seek overseas work as soon as they are qualified.

Health information technology: will it make higher quality and more efficient healthcare delivery possible?

J.J. Shen

International Journal of Public Policy, vol.2, 2007, p. 281-297

Health information technology (HIT) implementation has become the latest national priority for improving the healthcare system in the USA. The author concludes that, although enormous challenges lie ahead, implementation of the Electronic Health Record information system has the potential to fundamentally transform healthcare delivery and improve it out of recognition, to the ultimate benefit of patients.

The impact of contracting out on health system performance: a conceptual framework

X. Liu, D.R. Hotchkiss and S. Bose

Health Policy, vol. 82, 2007, p. 200-211

In response to perceived inefficiencies and/or insufficient capacity of government healthcare delivery systems, many developing countries have contracted out health services to private providers. Advocates for contracting out claim that the practice will improve services by stimulating competition among providers and through payment by results schemes. However the research evidence for the effectiveness of contracting out is inconsistent. This paper presents a conceptual framework aimed at facilitating comprehensive, rigorous and standardised evaluation of contracted out services.

The impact of quality and efficiency on federal healthcare

J.P. Harrison and M.N. Coppola

International Journal of Public Policy, vol. 2, 2007, p. 356-371

Data for 157 federal hospitals in 1997 and 175 in 2000 were analysed using the Data Envelopment Analysis methodology to measure their efficiency. Results indicate that overall efficiency in federal hospitals improved from 65% in 1997 to 68% in 2000. These results indicate that value associated with expenditures in the US federal hospital industry is increasing. The study also has policy implications because many federal hospitals are facing budget cuts due to limited healthcare resources. This article provides an innovative approach to measuring cost and quality as the US federal government attempts to make best use of scarce healthcare resources.

Implementing an electronic medical record system: successes, failures, lessons

T. Scott and others

Oxford: Radcliffe, 2007

The NHS is currently implementing its first electronic medical records (EMRs) system – the National Programme for Information Technology. The risk of failure is high due to the undeveloped state of the technology and the organisational challenges involved in implementation. The book is a detailed account of the actual implementation of an electronic medical records system in a large US health maintenance organization. Focusing on the importance of organisational culture and leadership, it uses qualitative methods to report the experiences of clinicians, managers and implementation team members. This book provides useful insights to help the NHS achieve higher levels of adoption, acceptance and use of its EMRs.

Is there a business case for quality in the Netherlands? A critical analysis of recent reforms of the health care system

T. Custers, O.A. Arah and N.S. Klazinga

Health Policy, vol. 82, 2007, p. 226-239

In 2006, the compulsory health insurance for acute care for people with incomes below a certain level was merged with the voluntary private insurance for people with incomes above that level to form a new mandatory and privately administered basic health insurance for curative care. This analysis of the new system demonstrates that it offers providers and insurers no incentives to compete on quality of care, but encourages competition on the basis of price and efficiency.

Managing for health

D. J. Hunter (editor)

London: Routledge, 2007

The book concentrates on the management of the public health function and how it is different from the management of clinical work. The book takes a comparative perspective on the issues of health improvement and the struggle between the needs of acute care providers, such as hospitals and those that provide preventative measures to promote health. It posits the theory that unless the attempt is made to control the rising demand for health care services and redirect resources to preventative measures all health care systems funded through public means will become unsustainable. The key issues addressed by this book include:

  • the concept of managing for health, or public health management
  • the importance of public health management
  • the skills required of managers and practitioners working in health systems
  • the implications for training and development.

Repression or repair? Managing complaints

A. Kent

British Journal of Healthcare Management, vol. 13, 2007, p. 210-212

This article explores the failings of the Swedish National Medical Responsibility Board in handling complaints from patients. Some 96% of complaints by patients lead to no disciplinary action, and Swedish culture leads healthcare professionals and managers to cover up mistakes and failings. It is very rare for the Board to revoke a practitioner’s license to practice. Patients who complain also risk being refused healthcare.

Research driven Medicaid reform: the case of managed care

R.E. Hurley

International Journal of Public Policy, vol.2, 2007, p. 249-263

Reforming Medicaid to contain costs is a longstanding goal of policymakers that has received intense interest in recent years. Much of this reform has not been guided by rigorous policy research. A notable exception to this pattern is the expansion of Medicaid managed care which has taken place over the past 20 years while being subject to continuing research evaluation. Though the research has not always been timely or uniform or definitive, it provides a number of lessons on how policymakers and researchers can engage in constructive, long-term partnerships.

Using population segmentation to provide better health care for all: the 'Bridges to Health' model

J. Lynn and others

Milbank Quarterly, vol. 85, 2007, p. 185-208

This model divides the population into eight groups: people in good health, in maternal/infant situations, with acute illness, with stable, chronic conditions, with a serious but stable disability, with failing health near death, with advanced organ system failure, and with long-term frailty. Each group has its own definitions of optimal health and its own priorities among services. Interpreting these population-focused priorities in the context of the US Institute of Medicine’s six goals for quality yields a framework that could shape planning for resources, care arrangements and service delivery, thus ensuring that each person’s health needs can be met effectively and efficiently.

(For comment see Milbank Quarterly, vol. 85, 2007, p. 209-212)

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