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At least 109 records · Page 6Linked to original sources
PubMedDate not supplied

The political process and the private health sector's role in Vietnam.

Vietnam has experienced a period of economic and political transition from a command economy to one of market socialism. This transition has precipitated a shift in the policies concerning the private sector, as well as increased demand for services from the private health sector. The private sector has evolved, though more rapidly in the Ho Chi Minh City area, with the passing of laws and regulations concerning private practice. The policy maker's concern is to maintain the equity gains realized under the public health system while using the private sector growth to make improvements in the system's efficiency. The political process enabling expansion of the private health sector has been slow, and will continue to be measured as it seeks to create a national health system with a rational integration of the public and private sectors.

Developing Countries↗
PubMedDate not supplied

Indigence and access to health care in sub-Saharan Africa.

Access to health care services for the poor and indigent is hampered by current policies of health care financing in sub-Saharan Africa. This paper reviews the issue as it is discussed in the international literature. No real strategies seem to exist for covering the health care of the indigent. Frequently, definitions of poverty and indigence are imprecise, the assessment of indigence is difficult for conceptual and technical reasons, and, therefore, the actual extent of indigence in Africa is not well known. Explicit policies rarely exist, and systematic evaluation of experiences is scarce. Results in terms of adequately identifying the indigent, and of mechanisms to improve indigents' access to health care, are rather deceiving. Policies to reduce poverty, and improve indigents' access to health care, seem to pursue strategies of depoliticizing the issue of social injustice and inequities. The problem is treated in a 'technical' manner, identifying and implementing 'operational' measures of social assistance. This approach, however, cannot resolve the problem of social exclusion, and, consequently, the problem of excluding large parts of African populations from modern health care. Therefore, this approach has to be integrated into a more 'political' approach which is interested in the process of impoverishment, and which addresses the macro-economic and social causes of poverty and inequity.

Africa South of the Sahara↗
PubMed2007

Health systems in East Asia: what can developing countries learn from Japan and the Asian Tigers?

The health systems of Japan and the Asian Tigers (Hong Kong, Korea, Singapore and Taiwan), and the recent reforms to them, provide many potentially valuable lessons to East Asia's developing countries. All five systems have managed to keep a check on health spending despite their different approaches to financing and delivery. These differences are reflected in the progressivity of health finance, but the precise degree of progressivity of individual sources and the extent to which households are vulnerable to catastrophic health payments depend on the design features of the system - the height of any ceilings on social insurance contributions, the fraction of health spending covered by the benefit package, the extent to which the poor face reduced copayments, whether there are caps on copayments, and so on. On the delivery side, too, Japan and the Tigers offer some interesting lessons. Singapore's experience with corporatizing public hospitals - rapid cost and price inflation, a race for the best technology, and so on - illustrates the difficulties of corporatization. Korea's experience with a narrow benefit package illustrates the danger of providers shifting demand from insured services with regulated prices to uninsured services with unregulated prices. Japan, in its approach to rate setting for insured services, has managed to combine careful cost control with fine-tuning of profit margins on different types of care. Experiences with DRGs in Korea and Taiwan point to cost-savings but also to possible knock-on effects on service volume and total health spending. Korea and Taiwan both offer important lessons for the separation of prescribing and dispensing, including the risks of compensation costs outweighing the cost savings caused by more 'rational' prescribing, and cost-savings never being realized because of other concessions to providers, such as allowing them to have onsite pharmacists.

Delivery of Health Care↗
PubMed1993

Equity and efficiency in Italian health care.

Health care finance and provision in Italy is unusual by international standards: public financing relies heavily on both general taxation and social insurance, and although the vast majority of expenditure is publicly financed, the majority of care is provided by the private sector. The system suffers, however, from a chronic failure to control expenditures and its record on perinatal and infant mortality is poor. Hospitals in Italy have a low bed-occupancy rate by international standards and the per diem system of reimbursing private hospitals encourages unduly long stays. Costs per inpatient day are high by international standards, but costs per admission are close to the OECD average. Ambulatory care costs are extremely low, but this appears to be due to the fact that GPs see so many patients that their role is inevitably mainly administrative. Consumption of medicines is extremely high, but because the cost per item is low, expenditure per capita is not unduly high. Despite the emphasis on social insurance, the financing system appears to be progressive. There is evidence of inequalities in health in Italy, and some evidence that health care is not provided equally to those in the same degree of need.

Ambulatory Care↗
PubMed2003

Eliciting several willingness to pay in a single contingent valuation survey: application to health care.

The usual implementation of contingent valuation (CV), in the context of priorities setting for allocation of public funds in health care, is to develop as many surveys as there are programmes, i.e. to perform separate evaluations (SE). In the EuroWill project, three health programmes (for heart disease, breast cancer and a service of helicopter ambulance) were however simultaneously evaluated, i.e. a joint evaluation (JE) was performed. The paper examines the issue of the econometric techniques that should be used to estimate WTP values obtained in the context of JE by comparing the application of independent OLS regressions for each programme versus simultaneous estimations using seemingly unrelated regressions (SUR) on data of the French EuroWill survey. It shows that separate estimations may lead to misspecifications because they cannot take into account that JE exogenously provides a reference structure to the respondent which affects the estimates of WTP for each programme. Therefore, the potential advantage of JE versus SE as an elicitation technique in CV studies applied to health care (to better control the referents used by respondents for evaluating different programmes) only holds if simultaneous rather than independent techniques are used in the estimation of WTPs.

Air Ambulances↗
PubMed2004

Health insurance and treatment seeking behaviour: evidence from a low-income country.

This paper analyses the effect of being insured under the voluntary component of Vietnamese Health Insurance, on patterns of treatment seeking behaviour. A multinomial logit model is estimated using household survey data from three provinces in Vietnam. Decisions regarding both the type of provider sought and type of care received are analysed. Insurance status is treated as both exogenous and endogenous to account for potential selection bias. The results indicate that, overall, insured patients are more likely to use outpatient facilities, and public providers, an effect that is particularly strong at lower income levels.

Adult↗
PubMed2005

Public and private pharmaceutical spending as determinants of health outcomes in Canada.

Canadian per capita drug expenditures increased markedly in recent years and have become center stage in the debate on health care cost containment. To inform public policy, these costs must be compared with the benefits provided by these drugs. This paper measures the statistical relationship between drug spending in Canadian provinces and overall health outcomes. The analysis relies on more homogenous data and includes a more complete set of controls for confounding factors than previous studies. Results show a strong statistical relationship between drug spending and health outcomes, especially for infant mortality and life expectancy at 65. This relationship is almost always stronger for private drug spending than for public drug spending. The analysis further indicates that substantially better health outcomes are observed in provinces where higher drug spending occurs. Simulations show that if all provinces increased per capita drug spending to the levels observed in the two provinces with the highest spending level, an average of 584 fewer infant deaths per year and over 6 months of increased life expectancy at birth would result.

Aged↗
PubMed2005

Inequality decomposition and geographic targeting with applications to China and Vietnam.

How far are income-related inequalities in the health sector due to gaps between poor and less poor areas, rather than due to differences between poor and less poor people within areas? This note sets out a method for answering this question, and illustrates it with two empirical examples. The disproportionate accrual of health subsidies to Vietnam's better-off is found to be largely due to the fact that richer provinces have larger per capita subsidies, while pro-rich inequalities in health insurance coverage in rural China are found to be largely due to the fact that better-off villages have been more successful at preventing the collapse of their insurance schemes.

Catchment Area, Health↗
PubMedDate not supplied

Community financing of drugs in Sub-Saharan Africa.

'Health for all by the year 2000' is unlikely to be achieved in a number of Third World countries, including those in Sub-Saharan Africa, if reliance is placed solely on the public health budget. This article looks at a range of alternative and additional sources of revenue and, in particular, at the scope for community financing of drugs. Developments in the region are reviewed for their insights into the strengths and weaknesses of each financing scheme; and, as a guide to shaping policies that make an appropriate choice of method of health care financing.

Africa↗
PubMedDate not supplied

Health services financing in Poland.

The right to a free health service is identified as one of the founding rules of socialism; yet other sources of funding, both public and private, should not be neglected. This article reviews the major sources of financing health services in Poland. In particular, a description is made of the size and composition of funding from non-governmental sources including: quasi-budget funds, other funds, and out-of-pocket payments; and some proposals are made for change. Further work is needed in developing the criteria by which policy choices can be made, and in developing the information base; at the same time, political and social criteria will still be very important, not least on the issue of user charges.

Financing, Government↗
PubMedDate not supplied

Health sector reform and STD/AIDS control in resource poor settings--the case of Tanzania.

Integration in health sector reform tends to mean horizontal interaction between vertical programmes. This can result in a larger more complex system than a set of individual vertical programmes. This article looks at the HIV/AIDS programme in Tanzania and the possible impact of system-wide health sector reform involving 'decentralization' and horizontal integration. It implies that the build-up to reform is likely to be costly, at least initially (although eventually the system may become more cost-effective). Integration can thus save resources, but it will also demand additional inputs, and may lead to reduced service output if operations depend on horizontal functions that fail to deliver. The objective of reform must be to create a reasonably sized, well-balanced, system which aims to maximize the output of quality services, both preventive and curative, and to facilitate community efforts to improve health. It is doubtful whether present reform efforts in Tanzania will contribute to more effective services, if not based on a more thorough analysis adapted to the local situation and given considerably more resources, both human and financial. There is also a risk that key preventive programmes, such as those aimed at the control of STD/AIDS, will be further weakened because of both integration with subsequent dependence on poorly functioning horizontal units and reduction in allocated resources.

Acquired Immunodeficiency Syndrome↗