A shrinking state? Politics,economics and private health care in Thailand

This article explores the political and economic forces involved in the development of privatization policies within the health care sector in Thailand. It is suggested that many of the motivating factors behind private sector growth are outside of the health sector; the general macroeconomic environment and tax incentives have stimulated private sector expansion. Within the Ministry of Public Health a preoccupation with improving care in rural areas and an unclear policy line on the private sector has facilitated this expansion. Only recently has private sector growth come to the policy agenda. During this lag period a number of interest groups have developed. It will be difficult to overcome these entrenched interests in order to change policy direction. Meanwhile, problems of rapid cost inflation and inequity face the Thai health care system. Although this case study focuses upon the health care sector in Thailand it would appear relevant both to other sectors and to other countries. The relationship between development models based upon pro-private, pro-market tenets and the establishment of a satisfactory social policy is questioned.     

Can ministries of health support primary health care? Some suggestions for structural reorganization and planning

Patrick Vaughan is Reader in health care epidemiology, Gill Walt is Lecturer in health policy and Anne Mills is Lecturer in health economics, at the Evaluation and Planning Centre for Health Care, London School of Hygiene and Tropical Medicine, Gower Street, London WC1, United Kingdom. A previous version of this paper was prepared for the Commonwealth Secretariat, London, for the Conference of Commonwealth Health Ministers held in Ottawa, Canada, in October 1983.     

The decentralization of primary health care delivery in Chile

The article argues that during the 1980s the process of decentralization in Chile under the military government of General Pinochet shifted the delivery of primary health care to the municipal level. Despite the return to more democratic forms of government in 1990 the overall structure of local‐level service delivery has remained largely unchanged. The municipalities have retained responsibility for service delivery but resources remain centrally determined. In an attempt to enhance accessibility, choice and the responsiveness of the system to individual and local need, reform has been made to the financial transfer mechanisms and a new model of primary health care delivery has recently been introduced. However, problems of resourcing and implementation limit the effectiveness of some of the changes that have accompanied decentralization. Problems have resulted in primary health care delivery because administrative decentralization has not been accompanied by fiscal decentralization, nor effective political decentralization. Copyright © 2001 John Wiley & Sons, Ltd.     

Government stewardship and primary health care in Guatemala since 1996

This article analyzes the role of government stewardship in the expansion of primary health care in post‐conflict Guatemala. By the time the Peace Accords were signed in 1996, the country's primary health care system was scarcely functioning with virtually no services available in rural indigenous areas. To address this gaping void/deficiency, the Ministry of Public Health and Social Assistance (MSPAS) embarked on a progressive expansion of primary services aimed at covering the majority of rural poor. Through a series of legal, policy, and program reforms up to 2014, the MSPAS dramatically expanded primary coverage and greatly improved basic health indicators for the entire population. To succeed in this effort, the MSPAS and its partners needed to simultaneously grow their stewardship capacity to oversee and develop the primary health system. On the basis of recent health systems strengthening literature, we propose a stewardship framework of 6 critical functions and use it to analyze the gains in government capacity that enabled the achievement of many of the country's primary health goals. Of the 6 stewardship functions, “building relationships, coalitions, and partnerships” especially with civil society organizations stands out as one of the keys to MSPAS success.     

The district and support for primary health care: The management experience from large-scale projects

With the implementation of primary health care policies the need for more effective management support at the intermediate or district level has become apparent, but experience is poorly documented. This article reviews the management experience of large-scale district-level projects in Ghana, India, Iran, Korea, Philippines, Thailand and Zaïre. The lessons point to a strong need to strengthen district-level management and for greater decentralization. These in turn will require a review of the present organizational health structures and the strengthening of national-level planning and management capacity.     

The quest for a better performing health system: Public expertise and corporate management recipes in France

Though the government pledged to cut the public deficit from 7.7% of the gross domestic product in 2010 to 3% by 2013, thereby responding to EU Normative power, health expenditures continue to rise, because public demands are higher and more social problems are handled in the health care setting. With French budget deficit threatening France's credit rating, novel instruments were needed. These included corporate management recipes (e.g., pay for performance contracts, patient volume targets, and management by objectives), new compensation mechanisms (e.g., activity‐based accounting and a nationwide scale of health care costs) and far‐reaching laws (e.g., the 2009 HPST bill). Our approach investigates some critical elements of the French health care system. We focus on primary (e.g., family physicians and General Practitioners) and secondary (e.g., hospital and specialty) care. We explore how policies such as the standardization of health services, the regrouping of health policy decisions within the larger Regional Health Agencies, affected citizens' engagement and physicians' autonomy. A French welfare elite pursued a hybrid strategy, regulating quasi‐markets of care providers in a postcompetitive government, while creating supportive conditions for a vibrant private hospital sector. Reforms also emphasized evidenced‐based policy, outputs‐rather than outcome‐measurement, and performance evaluation in a bid to streamline the delivery of health services.     

Proposed: a comprehensive health care system for the poor.

More than half the poor are not covered by Medicaid, the program designed to serve them. Louise Russell outlines a program that would make health care available to all of the poor.     

The economics of AIDS-related health insurance regulations: Interest group influence and ideology

The projected growth in the U.S. in the number of persons with AIDS has created concern about sources of financing the costs of health care services for persons with AIDS. Private health insurers have modified or considered modifying underwriting practices in response to the AIDS epidemic, but several state governments have developed significant regulatory constraints on AIDS-related underwriting practices. We model the state government's decision to impose AIDS-related regulatory constraints (HIV testing restrictions, restrictions on the use of information about sexual orientation, and mandated AIDS coverage). We find that HIV-testing restrictions tend to be more likely in states with relatively high AIDS prevalence rates and insurance industries that are relatively weak politically. States with prevailing attitudes favorable to persons with AIDS (i.e., relatively liberal states) are more likely than other states to impose HIV-testing restrictions. Measures of prevailing attitudes (ideology) appear to be the primary determinants of regulations prohibiting questions about sexual orientation, but economic interests are the primary determinants of mandated AIDS coverage.The authors would like to acknowledge the helpful comments and suggestions of Ned Becker, Janet Bronstein, David Colby, Patrick Donnelly, Roger Faith, Robert Hughes, Robert McGuire, Delfi Mondragón, Mike Morrisey, Jack Nelson and an anonymous reviewer, with the usual disclaimer.     

Strategies for controlling health care costs. National Governors' Association

Putting a lid on health costs is a job that states can and must tackle. There are many options available and many states are already testing them. But success in this arena will require strong leadership and cooperation among key state officials.     

创新特色抓党建 立足专业谋发展

加强高校党建工作是夯实党的执政基础、构建和谐社会和高校自身发展的需要。新形势下要做好高校党建工作,必须努力加强党建工作队伍建设,搞好思想政治教育,抓好党员教育管理。     

Income, assets, and health insurance: economic resources for meeting acute health care needs of the aged.

In this article, the authors use data from the Survey of Income and Program Participation (SIPP) to examine the relationship between economic resources and acute health care needs among the aged. The circumstances of individuals who rely on Medicare as their only form of health insurance are considered in detail because they are potentially more vulnerable when faced with health care expenses. Particular attention is given to the amount of family income and personal contingency assets held by this group and the level of out-of-pocket liability for acute care they might have been expected to face in 1984. The authors point out that their research findings would be strengthened by linkage of a more current SIPP data set to Medicare program records and the development of Medicaid eligibility simulation capability in the SIPP context.     

The evaluation of economic development conflict is present: Projects where military investing in health care in el salvador

Increasingly, U.S. policymakers have proposed development projects in areas of the world undergoing rapid, disruptive, and often violent challenges to existing political regimes. The U.S. government typically requires that these projects undergo an economic evaluation before they can be implemented. While benefit-cost theory and practice have made substantial gains over the last 20 years, they are more easily and aptly applied to stable economic and political conditions. This paper raises several issues concerning the theory and practice of benefit-analysis in an environment where there is political instability and military conflict. The discussion is illustrated by reference a proposed health care project in El Salvador. I t concludes summarizing the options available to policy analysts who conduct evaluations in such situations.