Suchergebnisse

Health care reform has been given the utmost importance on Turkey's policy agenda since the late 1980s. In 1989, the SPO's Master Plan Study (SPO, 1990), which was developed through a World Bank loan, introduced new concepts to the Turkish health care system. The Plan suggested splitting the functions of purchasing and provision, developing an internal market, implementing general health insurance, formulating a family medicine system at the primary health care level and giving autonomy to state hospitals. From 1990 to 1993, intensive efforts were undertaken to reshape the health care system in a way that reflected global trends and approaches. The World Bank had an important role in developing this process. The National Health Policy (Ministry of Health, 1993) presented the first comprehensive analysis of priority health care policies and also set out future strategies. However, a decade of political and economic instability (1993–2003) led to reform proposals that remained as blueprints with no concrete steps for implementation.

Reforming a public health service is a difficult proposition under the best circumstances. Attitudes of health workers and the expectant public have become entrenched over the years and major change is bound to produce reaction and resistance. The public has come to expect an unlimited service for free. What is not available in Malta is expected to be made available by referral to other centres abroad. In this article the author illustrates the lack of communication the Maltese Government has with the Maltese Medical Association with regards to the health reform. ; peer-reviewed

AbstractIn this article, we report results from a new study that surveyed a large, national sample of American adults about their willingness to pay for health reform. As in previous work, we find that self-identified Republicans, older Americans, and high-income Americans are less supportive of reform. However, these basic findings mask three important features of public opinion. First, income has a substantial effect on support for reform, even holding political affiliation constant. Indeed, income is the most important determinant of support for reform. Second, the negative effects of income on support for reform begin early in the income distribution, at annual family income levels of $25,000 to $50,000. Third, although older Americans have a less favorable view of reform than the young, much of their opposition is due to dislike of large policy changes than to reform per se.

The political rhetoric of the 2012 election suggested that Americans are deeply split over how to deliver and pay for health care. In fact, however, the election may have cleared the way for substantial reforms in health care delivery that will gradually enable the United States to finance effective health care for almost everyone at a sustainable cost. The election affirmed for the first time that almost everyone in the United States will have health insurance coverage and put to rest the idea that voters will tolerate radical change in the complex patchwork of health care financing that has evolved in the United States. The tasks remaining are improving the quality of health care delivered by increasing care coordination and reducing the growth of costs by moving away from fee‐for‐service delivery toward rewarding quality and value. These challenges are daunting but less ideologically fraught than health coverage expansion.

In this article, we report results from a new study that surveyed a large, national sample of American adults about their willingness to pay for health reform. As in previous work, we find that self-identified Republicans, older Americans, and high-income Americans are less supportive of reform. However, these basic findings mask three important features of public opinion. First, income has a substantial effect on support for reform, even holding political affiliation constant. Indeed, income is the most important determinant of support for reform. Second, the negative effects of income on support for reform begin early in the income distribution, at annual family income levels of $25,000 to $50,000. Third, although older Americans have a less favorable view of reform than the young, much of their opposition is due to dislike of large policy changes than to reform per se.

The design of a health care reform program requires contributions from many disciplines. While we know that all disciplines are equal, we are also aware that some are more equal than others. I believe the record would show that, at this time and in this nation, economics is one of the fields of study that is "more equal" than others. Why are economists so important? What impact does the presence of these economists have on the development of health reform legislation? What price—if any—do all of us pay for the under-representation of various other disciplines? Some of the answers to these and other questions can be found in the accompanying essays by persons whose knowledge and experience lies in the field of political science. I propose to try to address these matters from the vantage of the discipline in which I was educated—political economy, as it was known at Johns Hopkins when I studied there.It is not difficult to list some of the various factors that have propelled economists to the center of America's health care debate. Certainly it is the case that many of the issues raised by the health crisis and by proposals for health reform impinge on the economist's domain. Even without taking account of the imperialistic tendency of economists to view all of human behavior as that of rational economic actors and thus to lay claim to the study of virtually all human interactions, numerous matters do legitimately fall within the scope of economics and are of long-standing concern to economists.