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Biomedical subjects

G Bloom

Publications and source records attributed to G Bloom.

At least 19 recordsLinked to original sources
PubMed2001

Equity in health in unequal societies: meeting health needs in contexts of social change.

The paper explores the implications for health policy of the segmentation of society into social groups with very different levels of income and wealth. Discourses on equity in health are presently dominated by a debate between 'European' and 'American' models of health delivery. This has led to a focus on ideal outcomes rather than practical options for organising and financing health services in poor countries undergoing rapid change. The paper argues for a more explicit acknowledgement of the dynamic character of health development and the political nature of the negotiations regarding the use of government powers. Unregulated markets for health care are neither equitable nor efficient. Government must play a role in supporting the organisation of health services used by different social groups. Countries with low levels of inequality may be able to provide universal access to relatively sophisticated health services. Otherwise, governments need to operate within a segmented system. This means the negotiation of strategies to reduce the burden of sickness and premature death, whilst meeting the needs of different social groups. The discussion is organised in terms of the powers of government to require individuals and institutions to transfer resources for social uses, enforce regulations and generate and disseminate information. The paper concludes that governments committed to equity-enhancing health development need to increase their capacity to facilitate coalition building and manage change. It proposes an international public health legal framework that might include a definition of minimum standards for certain health services, to be underwritten by national and international financial commitments.

Developing Countries↗
PubMed1999

Rural health prepayment schemes in China: towards a more active role for government.

A large majority of China's rural population were members of health prepayment schemes in the 1970's. Most of these schemes collapsed during the transition to a market economy. Some localities subsequently reestablished schemes. In early 1997 a new government policy identified health prepayment as a major potential source of rural health finance. This paper draws on the experience of existing schemes to explore how government can support implementation of this policy. The decision to support the establishment of health prepayment schemes is part of the government's effort to establish new sources of finance for social services. It believes that individuals are more likely to accept voluntary contributions to a prepayment scheme than tax increases. The voluntary nature of the contributions limits the possibilities for risk-sharing and redistribution between rich and poor. This underlines the need for the government to fund a substantial share of health expenditure out of general revenues, particularly in poor localities. The paper notes that many successful prepayment schemes depend on close supervision by local political leaders. It argues that the national programme will have to translate these measures into a regulatory system which defines the responsibilities of scheme management bodies and local governments. A number of prepayment schemes have collapsed because members did not feel they got value for money. Local health bureaux will have to cooperate with prepayment schemes to ensure that health facilities provide good quality services at a reasonable cost. Users' representatives can also monitor performance. The paper concludes that government needs to clarify the relationship between health prepayment schemes and other actors in rural localities in order to increase the chance that schemes will become a major source rural health finance.

China↗
PubMed1999

Health expenditure and finance: who gets what?

The methods used in South Africa's first comprehensive review of health finance and expenditure are outlined. Special measures were adopted to make the process acceptable to all concerned during a period of profound political transition. The estimation of indicators of access to public sector resources for districts sorted by per capita income allowed the health care problems of disadvantaged communities to be highlighted.

Costs and Cost Analysis↗
PubMed1998

Primary health care meets the market in China and Vietnam.

China and Vietnam developed low cost rural health services between the 1950s and the mid-1970s. These services contributed to substantial improvements in health. Both countries have been liberalising their economies for a number of years. Partly as a result of these changes health facilities have become increasingly dependent on user charges, and they have gained considerable independence from political or bureaucratic control. There has also been a growth in private provision. This has given people a wider choice of health services, but costs have risen and there are greater differences in access to medical care. The Chinese and Vietnamese governments face fundamental questions about the future development of the health sector.

China↗
PubMed1998

Towards equity in health in an unequal society.

South Africa is one of the world's most unequal societies and its health sector mirrors these inequalities. Since the first democratic elections in 1994 the government has been under enormous pressure to diminish disparities between population groups in access to health services. This paper documents the structural inequalities in the health sector and discusses the strategic options that are being considered for reducing them. The overall level of health expenditure is high, amounting to 8.5% of GDP. However, less than 40% of expenditure is on public health services and three quarters of that is on acute care hospitals. A more detailed analysis of public health expenditure reveals large differences between census districts. The districts where household incomes are low tend to have fewer public health services. Public health expenditure per capita was lower than the estimated cost of providing basic primary health care in a fifth of districts. The most urgent need is to improve the services likely to reduce excess mortality and morbidity. This will involve additional funding of primary health service services, particularly in underserved localities. Government cannot increase public health rapidly and it will have to re-allocate funding from hospitals. The paper discusses options for achieving this, including the introduction of social health insurance. It argues that restructuring the health sector is complex and there is a risk of failure. Governments should base their strategies on a good understanding of the health sector and of the likely impact of different reform options.

Health Care Rationing↗
PubMed1998

Drug prescribing in rural health facilities in China: implications for service quality and cost.

Overuse of drugs in rural areas of China has led to a growing concern regarding service quality and cost. The study found evidence of high levels of drug use in some rural health facilities in comparison with a number of other developing countries. Such a result was significantly associated with the government policy of financing health care, regulation and monitoring of health services, and users' attitudes and behaviour. It underlines the need for measures to be taken in China to improve drug use in order to allow its population access to effective care at reasonable cost.

China↗
PubMed1997

Health sector reform: lessons from China.

As a result of China's transition to a socialist market economy, its rural health services have undergone many of the changes commonly associated with health sector reform. These have included a decreased reliance on state funding, decentralisation of public health services, increased autonomy of health facilities, increased freedom of movement of health workers, and decreased political control. These changes have been associated with growing inequality in access to health services, increases in the cost of medical care, and the deterioration of preventive programmes in some poor areas. This paper argues that the government's strategy for addressing these problems has overemphasised the identification of new sources of revenue and has paid inadequate attention to factors that influence provider behaviour. The strategy also does not address contextual issues such as public sector employment practices and systems of local government finance. Other countries can learn from China's experience by taking a systematic approach to the formulation and implementation of strategies for health sector reform.

China↗
PubMed1997

Health human resource development in rural China.

China has made significant progress in increasing the quantity of health workers in rural areas. Attention is shifting to improving the quality of health workers. This article documents several features of health workers in rural China. Many have not received formal training to a level implied by their rank and title, and there is no clear relationship between the skills of health workers and the functions they perform. Many better-qualified personnel have left lower level health facilities for more attractive employment in higher level and urban facilities. A system of professional licensing is currently being considered that will link educational requirements to employment and promotion. This article outlines some of the issues that should be taken into consideration in formulating this system. In particular, licensing may have unequal impacts on rich and poorer areas. This article argues that other regulatory measures will be necessary if licensing is to be an effective mechanism for controlling the quality of health workers, and contribute to the provision of affordable health services in both rich and poor areas.

China↗
PubMed1997

The impact of China's health sector reform on county hospitals.

The article describes the impact of China's health sector reform on relatively small hospitals in rural counties. It uses one county hospital to illustrate how pressures to increase revenue, combined with distortionary pricing policies, have led to cost increases. It argues that the introduction of hospital insurance could accelerate the cost increases unless measures are taken to control costs. These measures will include improvements to hospital management and changes to mechanisms of payment for hospital services. Government will have to play an active role to ensure that county hospitals serve the needs of rural people.

China↗
PubMed1996

Value for money in South African health care: findings of a review of health expenditure and finance.

This article highlights the most striking findings of a review of health expenditure and finance in South Africa in 1992/3. The level of national expenditure on health care, and the distribution of resources between the public and private sectors, are discussed first. Then the article highlights the maldistribution of financial, physical and human resources on a geographic basis, racially and between levels of care. The cost of redressing inequities, at least at the primary care level, is mentioned in the context of seeking options for additional sources of finance. The article concludes by examining the planning prerequisites for successful reform.

Financial Support↗
PubMed1995

Cooperative medical schemes in contemporary rural China.

Improvements in rural health care in China in the 1950s, 1960s and 1970s were largely due to the development of cooperative medical schemes (CMSs) and the establishment of a three-tier rural health network. Since the economic reforms were instituted in the late 1970s, the financing and delivery of rural health services have seen many changes, some positive, others not. Most CMSs have collapsed. In the absence of CMSs, the rural population has to pay for health care out-of-pocket and poor families have greater difficulty in getting access to essential health care. In the meantime, emphases of health services have tended to shift from lower to higher levels, from preventive to curative services, and from planning and management to market forces. This paper outlines the evolution of CMSs, reasons for their collapse, and their likely impact on rural health services. The main focus is on the development of a new generation of rural cooperative health care schemes, given their importance in the process of consolidating the rural three-tier health network after the impact of the economic reforms: the characteristics of some schemes, the apparent conditions for success, and government policy towards the development of cooperative health care financing are presented.

China↗
PubMed1993

Financing health care in rural China: preliminary report of a nationwide study.

One unforeseen consequence of the change from collective to household production in rural China has been that the financial basis of the rural health services has been eroded. The majority of peasants now pay for health care on a fee-for-service basis. A major initiative aimed at the establishment of prepayment schemes for funding rural health services is underway. A nationwide survey which compared health utilization and expenditure under different financing mechanisms was carried out in 1988. This paper presents the preliminary findings of that study. There is evidence that hospital charges were a barrier to inpatient care for those not covered by an insurance scheme. The data were less clearcut with regard to access to outpatient care. There is a need for further study which focuses on poor households and those living in remote villages. The study found that drug charges are an important source of revenue for the rural health services. The impact of this on prescription practices is an area which requires additional research. The cost of rural health services was relatively low. It is feasible to finance them almost entirely out of local resources in the more developed regions. The situation in the poorer provinces is more complicated. In spite of the fact that average health expenditure was almost 5% of household income in 1988, there was evidence of lack of access. This suggests that it may be more difficult to develop prepayment schemes to cover the full range of rural health services in the less developed regions.

China↗
PubMed1989

The right equipment... in working order.

Careful planning of the procurement and maintenance of equipment is essential if the potential benefits of medical technology are to be realized.

Developing Countries↗
PubMed1985

Two models for change in the health services in Zimbabwe.

The health situation in pre-Independence Zimbabwe was much as elsewhere in the Third World. While the majority suffered excess mortality and morbidity, the affluent enjoyed a health status similar to that of the populations of developed countries. The health services also showed the familiar pattern, with expenditure concentrated on sophisticated facilities in the towns, leaving the rural majority with practically no services at all. With the coming of Majority Rule, the previous pattern of controlling access to facilities on the basis of race could not continue. Two broad routes forward were defined. On the one hand, the private doctors, the private insurance companies, and the settler state proposed a model based on improving urban facilities, depending on a trickle-down to eventually answer the needs of the rural people. On the other hand, the post-Independence Ministry of Health advocated a policy of concentrating on developing services in the rural areas. The pattern of the future health service will depend on the capacity of the senior health planners and on the enthusiasm of front-line health workers but, of overriding importance will be the political commitment to answer the needs of the majority and the outcome of the inevitable struggle for access to scarce health sector resources.

Community Health Workers↗