Health and development

Doctor Migration and World Health. By Oscar Gish. London: G. Bell & Sons, 1971. Pp. 151. £2.75.

Auxiliaries in Health Care. By N. R. E. Fendall. New York and London: Johns Hopkins Press, 1972. Pp. xiii + 200. $10.4 and £4.30.     

For Health,Strength, and Daily Food: The Dual Impact of Remittances and Public Health Expenditure on Household Health Spending and Child Health Outcomes

Abstract

Child and infant mortality in developing countries decreased 33.5 per cent and 30.9 per cent, respectively, during 1995–2009, while remittances and public health spending more than doubled. I examine how remittances and government health spending improve these child health outcomes. Neither government health spending nor remittances causally affect household health spending. Public health spending has an insignificant negative impact on mortality. The increase in remittances causally accounts for 32 per cent and 37 per cent of the decline in child and infant mortality, respectively. Remittances reduce mortality through improved living standards from the relaxation of households’ budget constraints.     

The Impact of SWAps on Health Aid Displacement of Domestic Health Expenditure

Recent research suggests that an additional $1 of health aid would displace – or crowd out – nearly the same amount in a recipient government’s own health expenditure. Implementing a Sector Wide Approach (SWAp) may exacerbate crowding out because recipient governments should face fewer constraints when allocating health aid. This paper uses rigorous panel data methods to investigate this hypothesised effect of SWAps. We find that SWAps provide not an exacerbating but a potentially protective effect, reducing displacement of government health expenditure. This suggests some aid dollars are more fungible than others, and the mechanism for aid delivery makes a difference.     

Health care and AIDS

The acquired immune deficiency syndrome (AIDS) is a harbinger for change in health care. There are many powerful forces poised to transform the industrialized health care structure of the twentieth century, and AIDS may act as either a catalyst or an amplifier for these forces. AIDS could, for example, swamp local resources and thereby help trigger national reform in a health care system that has already lost public confidence. AIDS can also hasten the paradigm shift that is occurring throughout health care. Many of the choices society will confront when dealing with AIDS carry implications beyond health care. Information about who has the disease, for example, already pits traditional individual rights against group interests. Future information systems could make discrimination based upon medical records a nightmare for a growing number of individuals. Yet these systems also offer the hope of accelerated progress against not only AIDS but other major health threats as well. The policy choices that will define society's response to AIDS can best be made in the context of a clearly articulated vision of a society that reflects our deepest values.     

奥巴马的医改政治

现任美国总统奥巴马在竞选期间中,曾向美国人民作出了许多许诺,医疗改革是其中的重中之重。这个问题的重要性和敏感性在于它是美国政治新自由主义与新保守主义政治角逐的焦点之一。美国是主要发达国家中唯一没有实行全民医保的国家,     

Achieving Equity in Health through Community-based Health Insurance: India's Experience with a Large CBHI Programme

This article analyses equity in enrolment, renewal of enrolment, and utilisation of community-based health insurance with special reference to the Yeshasvini health care programme. The analysis employs a primary survey conducted in rural Karnataka using a random sample of 4109 households. The study identifies quantifiable variables covering various dimensions of vulnerability and assesses their relationship with enrolment, renewal of enrolment, and utilisation using logistic regression techniques. The results demonstrate that inequities do exist even though they are less pronounced in utilisation than in enrolments and renewals. While community-based health insurance (CBHI) may be used as a mechanism to reach the disadvantaged population, they can not be considered as substitute for government-created health infrastructure.     

Health care and the elderly.

Western values have long emphasized an interventionist approach to problems of health and health care. Yet, as medical technology becomes increasingly expensive and as the number of older people grows, proposed changes often are now governed more by considerations of cost than by quality of services. This tension between cost and quality also affects public willingness to invest in social components of health care despite their importance in enhancing quality of life. The tension emerges in sharpest contrast as scarce resources are allocated by gatekeepers in health maintenance organizations and in the arrangements for long-term care. With respect to financing, what seems to be needed is a creative mix of voluntary inputs from the community, private initiatives, and new programs of public entitlements. With respect to quality of care, what has often been overlooked is the recognition that gains in the quality of life require programs that encourage older people's continued involvement and participation in social life and in active and healthy life-styles. This article discusses the evolving balance between these two types of interventions: the medical and the social.