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

Changes in medical end-of-life practices during the legalization process of euthanasia in Belgium

J. Bilsen and others

Social Sciences and Medicine, vol. 65, 2007, p. 803-808

In Belgium, following a debate in the Belgian Council for Bioethics in 1997, legalisation of euthanasia was put on the political agenda in 1999. In 2002 a law was passed allowing physicians to administer lethal drugs to adult patients under strict conditions. This paper investigates changes in decisions by doctors to administer drugs with possible or certain life shortening effects to terminally ill patients during the transition phase 1998-2001. By 2001 there was a substantial reduction in the incidence of euthanasia, the use of lethal drugs without the patient's consent, and the administration of life-shortening medication to alleviate suffering with the co-intention to hasten death, while use of such to alleviate suffering without life-shortening co-intention increased. Physicians also involved patients, family members and nurses more closely in the decision-making process. Finally, continuous deep sedation rose to an incidence of 8.2% in 2001.

Chronic disease management and the development of virtual communities

A.D. Smith

International Journal of Electronic Healthcare, vol. 3, 2007, p. 329-352

In the US, numbers of patients with chronic conditions are rising rapidly. It is argued that such patients could be cost-effectively helped to monitor and manage their illnesses using online information and tools delivered via the Internet. Such sites could also be used for the sale of equipment and medications and for the development of virtual communities through chat rooms, message boards, online meetings, etc. However care would have to be taken by providers to ensure that any personal health information stored by the site to facilitate personalisation of services was kept secure and that they complied with the Health Insurance Portability and Accessibility Act of 2001.

Comparing offers and take-ups of employee health insurance across race, gender and decade

J.R. Keene and A.H. Prokos

Sociological Inquiry, vol. 77, 2007, p. 425-459

The US healthcare system has evolved over time into an employer-based model such that most Americans who have health insurance are covered through employer-provided benefits, either through their own job or that of a family member. However, not all workers who have health benefits available to them elect to take them up. This article uses the 1992 and 2002 waves of the National Study of the Changing Workforce to investigate changes in access to, and employees' decisions to accept, take or purchase their employers' health insurance plans. Logistic regression analysis indicates that offers and take-ups of personal health benefits declined between 1992 and 2002, but these declines did not affect all workers equally.

Do people want to be autonomous patients? Preferred roles in treatment decision-making in several populations

R.B. Deber and others

Health Expectations, vol. 10, 2007, p. 248-258

This research uses secondary analysis from a series of studies, carried out in various clinical settings in Canada, to explore the role that patients would prefer in making treatment decisions. Contrary to consumerist rhetoric emanating from some bio ethicists, very few respondents wanted to assume an autonomous role. Most wished to share decision-making with trusted healthcare providers.

The major barriers and facilitators for the adoption and implementation of knowledge management in healthcare operations

N. Wickramasinghe, R.K. Bali and E. Geisler

International Journal of Electronic Healthcare, vol.3, 2007, p. 367-381

The US healthcare industry is facing numerous challenges in delivering high-quality, cost-effective treatments and is turning to knowledge management techniques and technologies to achieve this goal. This article outlines the barriers and facilitators to the adoption of knowledge management techniques in healthcare settings in general. It then presents a case study of how knowledge management could be used to improve the functioning of an orthopaedic operating theatre.

Microinsurance: working to solve healthcare disparities in developing countries: special issue

International Journal of Public Administration, vol. 30, 2007, p. 727-858

Microinsurance, in general, is the protection of low-income people against specific perils in exchange for regular premium payments proportionate to the likelihood and cost of the risk involved. The difference between microinsurance and regular insurance is that the former is open to those working in the informal sector of the economy. The research reported in this special issue focuses on the impact of microinsurance on self-employed women working in the informal sector in Tanzania, Uganda, Kenya and Senegal.

Public views on priority setting for high cost medications in public hospitals in Australia

G. Gallego and others

Health Expectations, vol. 10, 2007, p. 224-235

Provision of high cost medications in resource constrained Australian public hospitals may be challenging. Healthcare professionals in public hospitals make choices about which patients receive high cost medications or treatments in isolation from community views on prioritisation. This study was conducted to gather such views from members of the general public through a structured questionnaire. Participants considered factors such as treatment outcomes, quality of life and current health status when deciding hypothetically who should have access to high cost medications. Participants wanted resources to be allocated to provide 'the greatest benefit to the greatest number of people'.

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