Explaining health care system change: problem pressure and the emergence of "hybrid" health care systems

In this article, we will further the explanation of the state's changing role in health care systems belonging to the Organisation for Economic Cooperation and Development (OECD). We build on our analysis of twenty-three OECD countries, which reveals broad trends regarding governments' role in financing, service provision, and regulation. In particular, we identified increasing similarities between the three system types we delineate as National Health Service (NHS), social health insurance, and private health insurance systems. We argue that the specific health care system type is an essential contributor to these changes. We highlight that health care systems tend to feature specific, type-related deficiencies, which cannot be solved by routine mechanisms. As a consequence, non-system-specific elements and innovative policies are implemented, which leads to the emergence of "hybrid" systems and indicates a trend toward convergence, or increasing similarities. We elaborate this hypothesis in two steps. First, we describe system-specific deficits of each health care system type and provide an overview of major adaptive responses to these deficits. The adaptive responses can be considered as non-system-specific interventions that broaden the portfolio of regulatory policies. Second, we examine diagnosis-related groups (DRGs) as a common approach for financing hospitals efficiently, which are nevertheless shaped by type-specific deficiencies and reform requirements. In the United States' private insurance system, DRGs are mainly used as a means of hierarchical cost control, while their implementation in the English NHS system is to increase productivity of hospital services. In the German social health insurance system, DRGs support competition as a means to control self-regulated providers. Thus, DRGs contribute to the hybridization of health care systems because they tend to strengthen coordination mechanisms that were less developed in the existing health care systems.     

Portugal: report recommends needle exchange or safe injection sites

A report released in late 2003 by Portugal's Justice Ombudsman (Provedor de Justi?a) recommends that Portugal set up needle exchange programs or safe injection sites in prisons.     

Supervised injection sites: Minister of Health ready to review applications for pilot research projects

Since 1 January 2003, Health Canada has been prepared to receive proposals for pilot supervised injection sites (SISs). Vancouver has already indicated that it will submit a proposal within a few months. Other cities that have expressed an interest in opening SISs include Montréal, Québec, Winnipeg, and Victoria.     

House of Commons committee releases report on Canada's drug strategy

On 17 May 2001, the House of Commons created a Special Committee on Non-Medical Use of Drugs based on a motion introduced by Randy White, Canadian Alliance MP (Langley-Abbottsford) and gave it a very broad mandate to study "the factors underlying or relating to the non-medical use of drugs in Canada" and to propose recommendations aimed at reducing "the dimensions of the problem involved in such use." In December 2002, the Committee released its report, entitled Policy for the New Millennium: Working Together to Redefine Canada's Drug Strategy. The report contains many good recommendations, but fails to deal adequately with the fundamental harms caused by Canada's drug laws and federal government inaction. Far better is the supplementary report written by NDP MP Libby Davies (Vancouver East), which contains an excellent, informed critique of the report. The supplementary report from the official opposition, written by MPs Randy White and Kevin Sorenson (Crowfoot, Alberta) also makes for interesting, if troubling, reading--it is based nearly exclusively on fiction rather than facts and science.     

Warsaw Declaration on HIV/AIDS and injection drug use adopted

Explosive epidemics of HIV among injection drug users are occurring in both developing and developed countries. Globally, it is estimated that 10 percent of HIV infections are attributable to injection drug use, but this proportion is increasing, and is much higher in many countries. Effective interventions exist to prevent the spread of HIV among injection drug users, but in most countries they are being adopted too slowly, or not at all. On 14 November 2003, the Warsaw Declaration: A Framework for Effective Action on HIV/ADS and Injection Drug Use, was adopted at the 2nd International Policy Dialogue on HIV/AIDS. Its purpose is to provide a framework for--finally--"mounting an effective response that will slow and eventually stop the HIV/AIDS epidemic among injecting drug users worldwide."