Click here to skip to content

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

Funding pharmaceutical innovation through direct tax credits

K.M. Lybecker and R.A. Freeman

Health Economics, Policy and Law, vol. 2, 2007, p. 267-284

Rising pharmaceutical prices, increasing demand for more effective drugs and growing public outrage over the costs of prescription drugs have heightened criticism of the drug companies. Consequently, the efficiency of the patent system as a mechanism for encouraging the development of new drugs is being re-examined. The authors propose an alternative to the existing patent system, which would instead reward innovating firms with tax credits in exchange for pricing at the marginal cost of production and distribution. The concept is based on the assumption that innovation that benefits society at large may be financed publicly. As an industry which produces a social good characterised by high fixed costs, high information and regulatory costs, and relatively low marginal costs of production, pharmaceuticals are well suited to such a mechanism.

Governing global health: challenge, response, innovation

A. F. Cooper, J. L. Kirton, and T. Schrecker (editors)

Aldershot: Ashgate, 2007

Recently global health issues have leapt to the forefront of the international agenda and are now an everyday concern around the world. Re-emerging diseases such as polio and tuberculosis, long thought to be on the verge of elimination, are now coupled with the devastation of newly emerging ones such as SARS and avian influenza. In addition, the shock of bioterrorism has given a tragic poignancy to the importance of studying the failure of the global health governance system. The book studies the global challenges and responses to these issues, as well as the roles of central institutions such as the World Health Organization, the World Trade Organization and the G8.

Health promotion practice: building empowered communities

G. Laverack

Maidenhead: Open University, 2007

Power and empowerment are two complex concepts that are central to health promotion practice. People experience empowerment in many different ways and this book explains an approach that has been used by health promoters to intentionally build and evaluate empowerment. The book provides a special focus on communities and is illustrated throughout with useful field experiences in the United Kingdom, Asia, North America, the Pacific region and Africa. The book aims to provide the reader with:

  • An understanding of the key concepts of power and empowerment and the link to improved health outcomes in the context of health promotion programmes
  • An understanding of practical approaches that can be used in health promotion programming to build and evaluate empowered communities
  • Case study examples of how communities can be empowered in practice

Healthcare financing and utilization of maternal health services in developing countries

M.E. Kruk and others

Health Policy and Planning, vol. 22, 2007, p. 303-310

The Millennium Development Goals call for a 75% reduction in maternal mortality between 1991 and 2015. Skilled birth attendance and emergency obstetric care, including Caesarean section, are two of the most important interventions to reduce maternal mortality. The authors conducted a cross-national analysis to determine the association between government versus private financing of health services and utilisation of antenatal care, skilled birth attendants and Caesarean section in 42 developing countries. Greater government participation in health financing and higher levels of health spending are associated with increased utilisation of two maternal health services: skilled birth attendants and Caesarean section. While government financing is associated with better access to some essential maternal health services, greater absolute levels of spending will be required if developing countries are to reach the Millennium Development Goal on maternal mortality.

The impact of a reproductive health franchise on client satisfaction in rural Nepal

S. Agha and others

Health Policy and Planning, vol. 22, 2007, p. 320-328

In recent years there has been considerable interest in the franchising of reproductive health services in developing countries. This model of service delivery consists of a network of providers that deliver a standard set of services under an umbrella brand. The franchiser permits the participating provider to use the umbrella brand as long as the franchisee provides care that conforms to expected quality standards. This study evaluates the impact of a nurse and paramedic reproductive health franchise in rural Nepal on client satisfaction and utilisation of services. Results suggest that client perceptions of the quality of reproductive health services delivered through rural providers improve when these providers become part of a franchise that emphasises quality of care.

Implementation and use of an electronic health record: measuring relevance and participation in four hospitals

C.P. Katsma and others

International Journal of Healthcare Technology and Management, vol. 8, 2007, p. 625-643

Electronic health records (EHRs) promise to solve major information provision problems, but their actual adoption has been slow and many end-users are still satisfied by paper records. This paper investigates barriers to the adoption of electronic health records through detailed case studies of their implementation in four hospitals. Existing research suggests that relevance and participation have significant influence on the successful adoption of IT innovations. The study applies this insight to investigating the effect of relevance and participation on successful diffusion of EHRs within hospitals. It is concluded that the relevance of EHRs for end users does not go beyond administrative convenience. This is insufficient to encourage their widespread use. For more extensive diffusion, EHRs should contribute more to improving quality of care.

Markets and medical care: the United States, 1993-2005

J. White

Milbank Quarterly, vol.85, 2007, p.395-448

Since 1993 the United States has seen extensive, though not particularly coherent, attempts to fix its financing of healthcare through versions of market forces. In spite of these reforms healthcare costs have continued to rise and the percentage of Americans with insurance coverage has fallen. The basic attributes of a modern market - relatively unrestrained pursuit of profit on the part of providers, extensive shopping for services and broad access to capital - do not appear to be helping the healthcare system to attain its goals of equitable and efficient service delivery.

The organization of decision-making and the dynamics of policy drift: a Canadian health sector example

A. Gildiner

Social Policy and Administration, vol. 41, 2007, p. 505-524

Ontario's rehabilitation service has been transformed from being almost entirely state run in the late 1980s to being almost entirely in private hands little more than a decade later. This occurred without any overt or explicit change in health policy. This article uses the lens of policy drift to explore the transition. It concludes that the shift was able to happen because the institutions in place to deal with the rehabilitation of people dislocated from the labour market developed along fragmented lines. Over the latter part of the century, responsibility for the rehabilitation health service was divided between three different ministries and their associated policy networks. This fragmentation of decision-making facilitated radical change. Ideas were also critical to the story, particularly new ideas about what constituted a proper balance between tort and no-fault benefits under the car accident casualty policy, and ideas about return-to-work strategies under workers' compensation policy. It was also considered that responsibility for rehabilitation of injured employees lay with employers only if the injury occurred at work, with commercial insurers only if a contract for risk trade-offs had been purchased, and with public health insurers only if the previous conditions did not pertain.

The political economy of Chinese health reform

W.C. Hsaio

Health Economics, Policy and Law, vol.2, 2007, p. 241-249

In this editorial the author argues that there has been a failure in the relationship between top political leaders and the health bureaucracy. The leaders may wish to pursue reforms that promote the public interest to maintain themselves in power, but these may be at odds with the interests of health bureaucrats. In China the health bureaucracy, hospital directors and physicians are closely allied. The health bureaucracy derives its power and influence from the grass-roots support of hospitals and physicians. This close alliance of medical interests is powerful enough to pursue its own agenda rather than that of the political leaders. Consequently, healthcare reform may benefit the medical profession and the bureaucrats more than the population.

Public/private partnerships for prescription drug coverage: policy formulation and outcomes in Quebec's universal drug insurance program, with comparisons to the Medicare prescription drug program in the United States

M.-P. Pomey and others

Milbank Quarterly, vol. 85, 2007, p. 469-498

Since 1997 all residents of Quebec have been required by law to have drug insurance coverage to protect them against the high costs of prescription drugs. Depending on their employment status, they must be covered either by a private insurer or by Quebec's public health insurance agency. All private plans must meet certain requirements set out by provincial law. For example, all must cover the drugs listed in the Quebec Formulary and beneficiaries cannot be required to pay more than C$881 per year for drug costs, including both deductibles and co-payments. This article outlines the history and development of the Quebec regime from 1970 and draws parallels between the factors that led to its emergence and those that led to the passage of the passage of the Medicare Prescription Drug Improvement and Modernization Act in the US.

Rethinking palliative care: a Social Role Valorisation approach

P. Sinclair

Bristol: Policy Press, 2007

The book argues that palliative care does not deliver on its aims to value people who are dying and make death and dying a natural part of life. It draws from wider social science perspectives and critically and specifically applies these perspectives to palliative care and its dominant medical model. Applying Social Role Valorisation, it argues for the de-institutionalisation of palliative care and the development of an alternative framework to the approaches found in hospices, palliative care units and community-based palliative care services. It offers a new conceptualisation of death and loss that refines and expands modern understandings in a way that also resonates with traditional religious views concerning death. Finally, it advises a fundamental change in the concept of palliative care, the way support and services are organised and in the day to day practice of palliative care.

Rewarding excellence and efficiency in Medicare payments

K. Davis and S. Guterman

Milbank Quarterly, vol. 85, 2007, p. 449-468

Medicare needs to improve the quality of the clinical care that it buys and its cost-effectiveness so as to better meet the needs of its beneficiaries and to enable it to stay solvent. To reach these goals, financial incentives should be introduced that reward healthcare providers for excellent and efficient care throughout a patient's illness. This article examines problems with the way that Medicare now pays and the wide variation in its utilization and costs with no apparent relation to outcomes; discusses Medicare's tests of new ways to reward higher quality and/or greater efficiency; and outlines a new payment policy for Medicare that would build on these initiatives to align physicians' incentives with desired improvements in quality and efficiency. The payment strategy would move to a blended fee-for-service and case-rate system that would encourage better, more coordinated and more efficient care.

Sociology of health and health care. 4th ed.

S. Taylor and D. Field (editors)

Oxford: Blackwell, 2007

The book explores the nature of sociology and sociological research and their application to health and health care. It explores the impact of current social contexts on health and healthcare and recent developments in healthcare policy and addresses their implications for nursing and inter-professional working. This fourth edition is organised in four parts: the nature of sociology and sociological research; the social patterning of health and disease; the social aspects of illness and dying; and the organisation and delivery of health care. It also examines new approaches to understanding social inequalities in health and experiences of chronic illness and dying

Who switches sickness funds in Israel?

A. Shmueli, J. Bendelac and L. Achdut

Health Economics, Policy and Law, vol. 2, 2007, p. 251-265

On January 1st 1995 a National Insurance Law was enacted in Israel that introduced competition on the basis of quality of service between the four national sickness funds. Israelis do not pay contributions directly to their sickness funds, so competition on price is not relevant. Health care is universal and no (explicit) risk selection is allowed. Since 1998 the sickness funds have been allowed to offer a range of supplementary insurance policies to their members which cover treatments not in the standard package. These policies have become a major service on which the funds compete. It was expected that some level of consumer mobility would be observed in the new managed market. However, since 1998 sickness funds' switching rate has been stable at around 1% of the population. The low switching rate is explained by limited real options and similarity in the sickness funds' functioning, as well as reluctance to change providers. This article aims to characterise the 1% of the population who switch sickness funds in relation to the stayers, and to examine the implications for public policy.

Search Welfare Reform on the Web