Suchergebnisse

Discusses the potential impact of various health care reforms on Los Angeles, CA. A number of circumstances distinguish the health care situation in Los Angeles from that of the rest of the country: disproportionately high level of uninsured residents, rapid growth of private & public managed care, a substantial surplus of hospital beds & specialist physicians, an underfunded county-operated health system in need of new facilities, a large legal immigration population in need of culturally & linguistically sensitive services, a large population of undocumented residents, & a 6-year economic recession & rise in unemployment. It is argued that health insurance reform, federalization of Medicaid, nonmandatory subsidies for the purchase of private health insurance, & voluntary medical savings accounts advocated by the US Congress would not have a substantial effect on Los Angeles's greatest problem, ie, its large number of uninsured residents. The recently defeated proposal by the Bill Clinton administration, with its emphasis on universal or nearly universal care, could have reduced this problem, but no solutions have been offered to the dilemma of undocumented persons. It is argued that the problem could be at least minimally handled through limited low-cost coverage for doctor visits, immunizations, & hospital stays. 5 Tables, 20 References. T. Sevier

"This chapter analyses the Europeanization of German social policy, focusing on the sectors of old-age pensions and health care. It argues that indirect EU effects rather than direct pressures have mattered. These indirect effects have amplified global and domestic pressures on German social policy arrangements. Their impact has been differential, as they have been mediated by properties of the policy sector and by political institutions. European integration has contributed to the transformation in pension generosity and finances by making the status quo-generous public pensions-more difficult to sustain and by making the alternative-a partial transition to private funded pensions-more attractive. The EU was not causally important with regard to reforms weakening the male-breadwinner orientation of the pensions system, although the previous system did not fit well with EU gender equality policies. European integration has contributed to the incremental changes in health care only indirectly and marginally. Since 1975, the traditional German social model has lost coherence, but has not yet been replaced by a new model. EU pressures have been too weak to foster a fully fledged transformation of social policy and too diffuse to lead to convergence towards a European social model. There are good reasons to believe, however, that European integration will matter more in social policy in the next decade." (author's abstract)

Evaluates the 1993 German health care legislation, the Gesundheitsstrukturgesetz, as a success in medical reform. The policy was passed quickly, despite a longstanding reform blockade; & it achieved cross-party support & excluded organized interests. The budgets allotted almost guaranteed cost containment, but structural factors, such as cost pressures & institutional factors reflecting the nature of health governance, challenged containment. The collective power of doctors has been weakened, & medical practice is now required to be transparent & to consider economics as well as clinical practice needs. The position of the insurance funds has been strengthened as the state's role in setting the parameters of self-administration has grown. The Gesundheitsstrukturgesetz strengthened hierarchical, state-centered health care governance & proved to be a political & programmatic success in the short term & a combination of success & failure in the medium term. 3 Figures. L. A. Hoffman

This paper reviews current issues in health care policy and reform in Croatia. It analyses the microeconomic foundations of health care (characteristics of health as an essential good, market and government failures in allocation of health care services); the role of health care in the process of European Union accession; the status of health care in Croatia (health status of the population, demographic trends, health care resources); microeconomic and macroeconomic aspects of
health care financing; and recent reform proposals for the health care sector. On this basis a number of recommendations for health care reform in Croatia are formulated. The proposals refer to financial sustainability of health care in the medium and long term; the mix of general taxes and mandatory health insurance contributions as sources of public funding; the mix of public and private funding; the impact of different financing instruments on the operations of health care providers; labour market effects of different financing methods; and the political economy of health care reform.

The United Nations Sustainable Development Goals appoint that all Member States have agreed to try to achieve Universal Health Coverage by 2030. This includes financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines for all. The World Health Organisation has defined the Universal Health Coverage as a priority, which means that all people can use the preventive, curative, rehabilitative and palliative health care services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship. The classic approach of the unmet medical needs is defined as the total self-reported unmet needs for medical care for the following three reasons: financial barriers, waiting times, too far to travel. According to the Eurostat data, overall range of unmet medical needs in Latvia is the highest of the European Union countries, however, the accessibility of health services depends on a multitude of factors that relate to the health system and also to the patients themselves. Therefore the Multi-criteria decision analysis approach could be acceptable for assessment of the unmet medical needs. The data on unmet medical needs for Latvia should be additionally evaluated, taking into account the "therapeutic need", which refers to the need for a better treatment than the treatment currently reimbursed, from the perspective of the patient. Apart from therapeutic need, the concept of societal need should be investigated, which refers to the need for a better treatment than the currently available treatment for societal reasons.

Discusses primary health care reform in Spain to explore the influence of medical professionals in the state's attempts to reform the health care system. Both professional & private provider associations have worked through demonstrations, strikes, judicial appeals, & personal political connections to delay government control of medical services, & a large number of public physicians have chosen to remain outside the new network of care. Spain's autonomous regions have had varying results, with Navarra a high performer in the primary care field, & Galicia & Catalonia blocking policy implementation. The dangers of open confrontation with interest groups at the macropolitical level in the early stages of a reform effort were recognized. The government eliminated compulsory integration of doctors & did not force implementation by each region. Political visibility was reduced at the microlevel by narrowing the groups receiving selective negative incentives. On an institutional developmental level, the size & quality of public primary care manpower & infrastructure was progressively increased. The Spanish experience demonstrates circumstances where the federalist form of government faces difficulties in achieving welfare state development. 3 Tables, 1 Figure. L. A. Hoffman

Considers how women's health is impacted by their status, roles, & rights in the larger society, & describes how efforts to improve women's health can benefit from larger human-rights-oriented efforts. Inequalities in women's health are linked to inequities in their opportunities for equal pay for equal work, education, & political participation. Guidelines for the promotion of women's health are outlined, along with the provisions of national laws & international covenants designed to protect women's health rights. The most pressing health problems facing contemporary women are reviewed, including human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), domestic violence, rape, male child sex preferences, female genital mutilation/circumcision, adolescent pregnancy & access to family planning, & general reproductive rights/access to pharmaceuticals. Implications for global health policy are considered. K. Hyatt Stewart

After empirically detailing correlations between health differentials & poverty in the US, an overview of health care services access is provided in terms of insurance. The failure of the health care market is driven by its failure to efficiently allocate resources, the uncertainty faced by those who need care, spillover costs & benefits, supply-side dynamics, & inherent risks of medical research. A discussion of public insurance coverage focuses on Medicaid & Medicare, the State Children's Health Insurance Program, & various federal & state programs. Private, employer-based plans are also touched on before turning to an assessment of problems that low-income groups have in obtaining health care. Lack of coverage is more prevalent among (nonelderly) low-income groups; related health care utilization issues are described, highlighting costs & health problems. Difficulties confronting Medicaid recipients are delineated, noting that the medical welfare system as a whole acts as merely a substitute for private health insurance. It is also noted that health insurance alone may not be enough if one is poor; adequate care can still be wanting. In addition, low-income workers by virtue of low marginal tax rates can find themselves inadequately covered by employer-based plans. Four sets of policies proposed for health care services restructuring are cited, & the challenges to any reform addressed. Incremental reforms are suggested as a way to ameliorate the problem. 4 Tables, 6 Figures. J. Zendejas

Examines the impact on women's/children's health of recent economic crises in the Dominican Republic & Cuba, drawing on demographic, economic, epidemiological, & anthropological data, as well as firsthand observations, 1986-1992, & key informant interviews. It is shown that rising costs for food & medical care resulting from international lending & trade policies are associated with increases in malnutrition, infectious disease, & maternal mortality. It is contended that the general decline in health status of women & children indicates a reversal of significant improvements made since the 1980s in both countries, especially the Dominican Republic. In addition, dissimilar causes, costs, & consequences of economic restructuring in both countries reflect their historical, political, & ideological differences. The Cuban government struggled to keep its capital in community-based primary health care & preventive medicine, while rural & primary health care were denied support by the Dominican Republic government, which directed its limited resources to urban hospitals. Difficulties involved in obtaining statistics from Cuba are discussed. 1 Table, 46 References. J. Lindroth

Assesses postcommunist reforms of the health care professions in the Czech Republic. The socialist health care system in Czechoslovakia was characterized by state centralization, low pay, & low autonomy for doctors. Nursing was not defined as a profession, & its income was below the average industrial wage. Health care reform was made a major priority by the postcommunist government, with mandatory health insurance serving as the central topic in reform debates. Three successive reform documents, & initial steps in implementing them, have indicated that the state control will continue, despite the goal of privatization. Further, health professionals have played a minor role in the reform process. In comparison to their status in the communist system, health professionals have become more visible, but the state continues to dominate the health care system. 12 References. D. M. Smith

The article examines the reforms made to the Mexican health care system during the 1990s. The authors analyze how international ideas, models, & financing affected reform initiatives, & how Mexican experts' adapted foreign models to better suit Mexico. Finally, the authors describe the resulting reforms & the controversy that surrounds them. References. B. Boyce