ISSN:0749-6753    

DOI:10.1002/hpm.4740050402

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractMany Western European countries are moving toward privatization of their health care systems. The United States' health care system, since it is almost entirely privatized, is therefore worthy of study. Doing so raises several questions. How is privatization being managed in the US? How could its management be improved? What management lessons must be kept in mind if it is to be used effectively? What potential pitfalls should European countries consider as they move toward greater privatization?With operating costs, European countries must avoid the mistakes that have led to dramatic increases in annual health care costs in the US, simultaneous with reductions in access and quality. Doing so requires designing systems that promote hospital behavior consistent with a country's health objectives.With capital costs, an approach must be designed that allows policy‐makers to work closely with both managers and physicians in order to make strategically sound choices about access and quality. Such an approach will require physicians to incorporate their clinical judgments into community standards of care, and to adopt aregional(rather than an institutional or personal) perspective in the determination of any incremental capital expenditures.By making regulation proactive and strategic, rather than punitive, health policymakers in Western Europe can achieve the best privatization has to offer without feeling the sting of its unintended consequences. In so doing they can help to move their health systems toward achieving the multiple and illusive goals of access, quality and reasonable cos

ISSN:0749-6753    

DOI:10.1002/hpm.4740050403

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractThe financing and/or provision of health insurance by government has a theoretical basis: it stems from market failure in the private health insurance market; and, from externalities in the consumption of health care by the poor. Government health insurance, or national health insurance (NHI) may be analysed by using five criteria: who are the beneficiaries?; efficiency effects; the equity of financing; the level of administrative costs; and, political acceptability. In the last five years, Ghana, Zimbabwe and Nigeria have each considered proposals for NHI. However, each proposal shows design flaws, when analysed in the light of the five criteria above. This article first considers types of health insurance in Sub‐Saharan Africa, and why NHI, with cost recovery as an essential component, might be desirable. A following section present an outline of the NHI proposals in Ghana, Zimbabwe and Nigeria and points out the design flaws. A final section builds upon the theoretically‐good aspects of the three proposals, and considers some alternate approaches to NHI that these three countries and other countries in the Sub‐Sahara might want to con

ISSN:0749-6753    

DOI:10.1002/hpm.4740050404

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

摘要:

AbstractThis paper looks at what happened in Ghana following increases in government health service charges in 1983 and 1985. A combination of analysis of records, interviews and discussion with community groups was used.Utilization in rural areas was affected drastically by the substantial increase of 1985. The effect on urban utilization was less extreme and less durable. The age composition of users changed. After the 1985 increase, proportionately more of the 15‐45 age group used the government services—this was particularly at the expense of the over‐45s. The population was obviously concerned with the cost of health care, but were even more concerned about the quality of care and receiving value‐for‐money. They were unwilling to pay if drug supplies were unreliable or staff behaved unpleasantly.Some problems were encountered with implementing the policy of charges. Many facilities did not spend the revenue to which they were entitled—an interesting point, as the existence of the skill to spend money is often tacitly assumed!Charges also had significant indirect resource consequences. Reduced utilization freed up staff time which should be used to provide other services, particularly preventive ones. This opportunity has not, as yet, been exploited.Fee revenue can be dangerously attractive, particularly if it is administratively more accessible than general government allocations. There is a danger that revenue collection becomes a disproportionately important evaluative criterion in a system which is, after all, ultimately intended to improve he

ISSN:0749-6753    

DOI:10.1002/hpm.4740050405

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

ISSN:0749-6753    

DOI:10.1002/hpm.4740050406

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

ISSN:0749-6753    

DOI:10.1002/hpm.4740050407

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

ISSN:0749-6753    

DOI:10.1002/hpm.4740050408

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY

ISSN:0749-6753    

DOI:10.1002/hpm.4740050401

出版商:Wiley Subscription Services, Inc., A Wiley Company    

年代:1990

数据来源: WILEY