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

Access to healthcare: lessons from Turkey

A. Kisa and M.Z. Younis

International Journal of Health Promotion and Education, vol.45, no.2, 2007, p. 53-60

National governments and international organisations such as the World Bank have focused on the risk that high health expenditures pose to the financial security of the poor and vulnerable. This paper describes the means-tested healthcare financing scheme for the poor in Turkey, known as the Green Card System. This gives poor people who are not covered by existing social security programmes access to free healthcare.

Customers' and physicians' opinions of and experiences with generic substitution during the first year in Finland

R. Heikkila and others

Health Policy, vol. 82, 2007, p. 366-374

Expenditure on drugs has consistently increased in Finland over the past 25 years. In order to control costs a reform was introduced in 2003 by which pharmacists are obliged to substitute the cheapest generic medicine for its more expensive branded equivalent unless the customer refuses or the physician forbids the substitution, which they may do for therapeutic reasons. This study explored how patients and physicians view the 2003 reform through two patient questionnaire surveys and interviews with physicians. Results showed that patients thought generic substitution to be a good idea on grounds of cost saving, and that physicians had accepted it.

For public service or money: understanding geographical imbalances in the health workforce

P. Serneels and others

Health Policy and Planning, vol. 22, 2007, p. 128-138

Implementation of cost-effective interventions to improve health in developing countries is adversely affected by lack of human resources. This paper explores what can be done to improve human resource availability in rural areas. It analyses the willingness to work in rural areas of final year nursing and medical students in Ethiopia. The survey reported in the article uncovered two main determinants of willingness to work in a rural area: the income of the parents' household and the students' desire to help the poor. However two-thirds of the nursing students and 90% of the medics wanted to work in an urban area in the long run, because of better promotion prospects and better access to education for children and further training for the professional. There is evidence that health professionals could be encouraged to work in rural areas through the offer of higher salaries.

German physicians 'on strike': shedding light on the roots of physician dissatisfaction

K. Janus and others

Health Policy, vol. 82, 2007, p. 357-365

Over the past few years, students in Germany have been dropping out of medical school at increasing rates, and the number of physicians choosing to work abroad or in non-medical professions has been growing. In order to shed light on the roots of physician dissatisfaction, the authors surveyed physicians at Hanover Medical School. Results suggest that as well as offering financial rewards, policies need to be implemented that reduce the time burden on physicians, and enhance physicians' participation in the development of patient care management processes and in managerial decisions that affect patient care.

The global human right to health: dream or possibility?

T. H. MacDonald

Oxford: Radcliffe, 2007

The book argues that the major causes of ill-health are not bacteria and viruses, or even war and natural disasters, but poverty. If the immensely complex problems of global inequities in wealth could be solved, the health inequities would largely vanish. The issue is not a simple one. This book sets out, among other things, to break down the communication barriers between the 'professionals' (doctors, economists and international bankers) and the ordinary person who looks with dismay at international injustice but feels totally inadequate in the face of it. The book suggests alternatives to neoliberal approaches to global finance and international trade, which are inextricably linked to the looming environmental crisis.

How to get better value healthcare

J. A. Muir Gray

Oxford: Offox, 2007

The need to secure better value healthcare has come to dominate the agenda of clinicians, patients, and those who must manage and pay for healthcare in the 21st century. Better informed patients, an ageing population, new or resurgent diseases, the consequences of modern lifestyles, and the ever-increasing technical progress of modern medicine have all combined to place unsustainable pressures on healthcare costs worldwide. The book lists the key questions about value that must be addressed, and outlines how they can be answered by:

  1. Better knowledge management
  2. Stronger system of care
  3. Central engagement of patients
  4. Continuous quality improvement

The impact of hospital financing on length of stay: evidence from Austria

E. Theurl and H. Winner

Health Policy, vol. 82, 2007, p. 375-389

In 1997 Austria implemented a new hospital financing system which replaced the old per diem-based payment scheme with a per case-based one. This paper assesses whether the reform has influenced length of stay in hospital. Data were analysed for 20 diagnostic groups from the nine Austrian provinces for the period 1989 to 2003. Findings suggest that the change led to a substantial decrease in average length of stay in hospital.

Implementing accountability for reasonableness: the case of pharmaceutical reimbursement in Sweden

S. Jansson

Health Economics, Policy and Law, vol.2, 2007, p. 153-171

A central drug review body, the Swedish Pharmaceutical Benefits Board (LFN) was introduced in 2002. The LFN is charged with making decisions on the reimbursement status of medical products, mainly pharmaceuticals, based on applications from drug companies. This paper aims to:

  1. describe the priority-setting procedure for new drugs at the LFN
  2. analyse the outcome of the procedure in terms of decisions and the relative importance of ethical principles
  3. examine the reactions of stakeholders.

The study suggests that LFN's implementation of a process that fulfils the conditions of accountability for reasonableness has facilitated the development of a priority-setting procedure for decision-making in relation to reimbursement for new drugs that is perceived as fair and legitimate by major stakeholders.

Improving access to hospital care for the poor: comparative analysis of four health equity funds in Cambodia

M. Noirhomme and others

Health Policy and Planning, vol.22, 2007, p. 246-262

There is a large body of evidence that user fees in the health sector create exclusion. Health equity funds attempt to improve access to health care services for the poorest by paying the provider on their behalf. This paper reviews four hospital-based health equity funds in Cambodia and draws lessons for their future operation. The four schemes had a positive impact on the volume of utilisation of hospital services by the poorest patients. They now account for 7-52% of total hospital use. The use of hospitals by paying patients has remained constant in the same period. It is concluded that the health equity fund model is a pro-poor health financing policy, compatible with user fees. It appears superior to traditional waiver systems in terms of health service utilisation by targeted groups.

Intergovernmental health policy decisions in Brazil: cooperation strategies for political mediation

A.S. Miranda

Health Policy and Planning, vol.22, 2007, p.186-192

Brazil is a federation made up of 26 states, one federal district and over 5500 municipalities with political, administrative and financial autonomy. In order to facilitate both decentralisation and the integration of health policies, the National Joint Health Management Committee, in which the national, state and municipal governments are equally represented, was set up in 1991 by ministerial decree. Between 1994 and 1995 26 State Joint Health Management Committees were set up with equal representation of state and municipal health managers. Over the last 10 years the joint intergovernmental health management committees have developed administrative regulations for the establishment of Brazil's Unified Health System.

Labor market effects of employer-provided health insurance

K. Sherstyuk, Y. Wachsman and G. Russo

Economic Inquiry, vol. 45, 2007, p. 538-556

Most individuals who have health insurance in the United States obtain it through their employer. Some states, such as Hawaii, require private employers to provide health insurance for certain categories of workers, for example those who work more than 20 hours a week. This article presents the results of a laboratory experiment which investigated the effects of alternative health insurance regulations on competitive labour market performance. Results suggested that mandating health insurance for all workers creates labour market distortions, whereas mandating the insurance only for full-time workers leads to both a higher coverage than under no mandate and an increased number of part-time workers.

Money no excuse for hampering progress

R. Allmark

Health Service Journal, vol.117, July 26th 2007, p. 18-19

Report of an interview with Mark McClellan, former White House policy adviser, in which he discusses progress of healthcare reform in the US and worldwide. There is growing concern about the escalating costs of healthcare and public dissatisfaction with the mismatch between what they pay out and the quality of care received. Dr McClellan believes that there will be a move towards a preventative approach, in which people are empowered to make lifestyle choices that will improve their overall health and reduce their medical bills. Widespread public education will be needed to make this happen.

Neither seen nor heard: children and homecare policy in Canada

E. Peter and others

Social Science and Medicine, vol. 64, 2007, p. 1624-1635

As a result of health system restructuring and public preferences, more acute and long-term healthcare services for children with disabilities and complex medical needs are provided at home in Canada. Families are providing and coordinating this care with minimal publicly funded home care and respite services. This paper highlights some of the shortcomings of current policy and describes a new method of policy analysis with an explicit focus on ethics. Three forms of analysis, descriptive, conceptual and normative, are applied to documents describing the various aspects of Canadian home care policy. The descriptive analysis showed that the needs of children and youth are rarely mentioned in home healthcare policy documents, but are addressed under broader social policies that are directed at the family. The conceptual analysis revealed four aspects of the values that underlie home care policy: home and community care as ideal; the importance of independence and self-care for citizens; family as primary care provider; and citizenship as entitlement to rights and justice. A normative framework based on critical healthcare ethics is then used to make recommendations to redress the current imbalance between family and state support.

Obesity, business and public policy

Z. J. Acs and A. Lyles (editors)

Cheltenham: Elgar, 2007

The effects of obesity have become practically ubiquitous in the US. This book aims to provide an alternative framework through which to explore the important and controversial obesity debate that has spilled over from the medical community. To this end, the contributors present a multidisciplinary portrait of this complex problem. They explore the rising trend in obesity in the US in terms of its significant economic and social consequences. The web of underlying causes of the 'infrastructure of obesity', according to the book, lies with public policy decisions, economic factors and profit opportunities as well as the more obvious nutrition and health choices of individuals. Prevention and treatment of this now global pandemic are then tackled from the perspectives of businesses, governments, society and the individual. The taxation, marketing, cultural, ethical and institutional dimensions of obesity are also addressed.

Organizational innovations and health care decentralization: a perspective from Spain

G. Lopez-Casasanovas

Health Economics, Policy and Law, vol. 2, 2007, p. 223-232

In Spain, central government has delegated responsibility for healthcare to regional authorities (Autonomous Communities). The regional health authorities are controlled by a range of political parties with different ideologies. Consequently, each Autonomous Community has introduced changes in healthcare provision based on the dominant party's policies and vision of how the Spanish healthcare system should develop. This decentralisation has led to marked variations in healthcare spending between regions. This diversity has led to fears of a lack of commitment to a national health service and concerns about an ultimate loss of social cohesion. This article describes the experience of regional reforms in Catalonia from 1981 to the present.

Patient cost-sharing and social inequalities in access to health care in three Western European countries

L. Lostao and others

Social Science and Medicine, vol. 65, 2007, p. 367-376

This study evaluates the association between social class and health service use in France, Germany and Spain, three countries with universal health care coverage but different cost-sharing systems. In France, patients share the cost of both physician visits and hospitalisation, in Germany they share the cost of hospitalisation, and in Spain there is no system of patient cost-sharing. Findings suggest that patient cost-sharing reduces the frequency of physician visits and that this decrease is greater in the low social classes, whereas the effect of co-payment for hospitalisation on the frequency of hospital admission is not clear.

Patient reactions to hospital choice in Norway, Denmark and Sweden

K. Vrangbæk and others

Health Economics, Policy and Law, vol. 2, 2007, p. 125-152

This article is a comparative study of three Scandinavian countries which have all provided the individual patient with extensive rights to choose the hospital in which he/she wishes to receive treatment. This paper presents and analysis of the utilisation of the opportunity to choose between hospitals in the three countries. The analysis reveals that few patients have actually chosen to be treated outside their local area, possibly due to limited information and insufficient support from GPs.

Patient satisfaction with health services in Bangladesh

S.S. Andaleeb and others

Health Policy and Planning, vol. 22, 2007, p. 263-273

Concern over the quality of health services in Bangladesh has led to loss of faith in public and private hospitals, low use of public health facilities, and an increasing outflow of patients to hospitals in neighbouring countries. This study attempts to identify the determinants of patient satisfaction with public, private and foreign hospitals. The service orientation of doctors was found to be the strongest factor influencing patient satisfaction with hospitals. Service orientation of nurses was also important for ensuring patient satisfaction in Bangladesh, but the dearth of nurses is a continuing problem. Foreign hospitals were rated highest on all service dimensions.

Pricing and reimbursement of in-patient drugs in seven European countries: a comparative analysis

L. Garattini, D. Cornago and P. de Compadri

Health Policy, vol. 82, 2007, p. 330-339

The primary objective of health authorities in the EU seems to be to control public pharmaceutical expenditures which tend to rise far beyond budgets and have become a major concern for national policymakers. Cost containment is part of a wider strategy aimed at making allocation more efficient by reducing the economic resources absorbed by mature drugs on the one hand and rewarding investment in innovative medicines on the other. This article aims to assess regulations applied by seven EU governments to reward potentially innovative drugs within cost containment measures.

Scaling up priority health interventions in Tanzania: the human resources challenge

C. Kurowski and others

Health Policy and Planning, vol. 22, 2007, p.113-127

The Millennium Development Goals set targets for the improvement of health in developing countries by 2015. Effective and often cheap interventions exist to fulfil these goals. The authors explored the human resources challenges of expanding the coverage of such interventions in Tanzania, one of the poorest countries in the world. Human resources for health requirements were estimated using the innovative QTP (service quantity, tasks and productivity) model. Results showed that scaling up interventions in order to meet targets set by the Millennium Development Goals will require human resources far in excess of those likely to be available in 2015. Governments will therefore have to adjust globally set targets for service coverage and health outcomes to reflect local realities.

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