Health Equity: 11/01/07

Thursday, November 1, 2007

[EQ] Sustainability of Healthcare Financing in the Western Balkans

Sustainability of Healthcare Financing in the Western Balkans:

An Overview of Progress and Challenges

Caryn Bredenkamp. Michele Gragnolati

The World Bank Europe and Central Asia Region - Human Development Department

October 2007

Available online as PDF [36p.] at:
http://www-wds.worldbank.org/servlet/WDSContentServer/WDSP/IB/2007/10/09/000158349_20071009154058/Rendered/PDF/wps4374.pdf

“…..This paper explores the major challenges to the sustainability of health sector financing in the countries of the Western Balkans – Albania, Bosnia and Herzegovina, the Former Yugoslav Republic of Macedonia, Montenegro, Serbia and the province of Kosovo. It focuses on how the incentives created by the different elements of the healthcare financing system affect the behavior of healthcare providers and individuals, and the resulting inefficiencies in revenue collection and expenditure containment.

The paper analyzes patterns of healthcare expenditure, finding that there is some evidence of cost containment, but that current expenditure levels – while similar to that in EU countries as a share of GDP – are low in per capita terms and the fiscal space to increase expenditures is extremely limited. It also examines the key drivers of current healthcare expenditure and the most significant barriers to revenue generation, identifying some key health reforms that countries in the sub-region could consider in order to enhance the efficiency and sustainability of their health systems. Data are drawn from international databases, country institutions, and household surveys…”

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[EQ] Toward Higher-Performance Health Systems: Adults Health Care Experiences In Seven Countries

Toward Higher-Performance Health Systems: Adults’ Health Care Experiences In Seven Countries, 2007

Cathy Schoen, Robin Osborn, Michelle M. Doty, Meghan Bishop, Jordon Peugh and Nandita Murukutla

Health Affairs, 26, no. 6 – November 2007: w717-w734

Available onlineFull Text at: http://content.healthaffairs.org/cgi/content/full/26/6/w717

“….This 2007 survey compares adults’ health care experiences in Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States. In all countries, the study finds that having a "medical home" that is accessible and helps coordinate care is associated with significantly more positive experiences.

There were wide country differences in access, after-hours care, and coordination but also areas of shared concern. Patient-reported errors were high for those seeing multiple doctors or having multiple chronic illnesses. The United States stands out for cost-related access barriers and less-efficient care. …”

“….Looking forward, the seven countries we studied face the sharedchallenge of how to integrate care in an era of specializationand shortages of primary care physicians. Achieving better carecoordination will likely require designs that include a mixof formally integrated organizations, co-locating or sharingservices, and connecting through information systems. Agingpopulations and medical science advances will likely requireworkforce as well as system innovations to improve health andmeet population needs. Developing medical-home approaches offersthe potential to move toward higher performance….”

Cathy Schoen is a senior vice president at the Commonwealth Fund in New York City. Other Commonwealth Fund authors are Robin Osborn (vice president, International Health Policy and Practice), Michelle Doty (associate director of research), and Meghan Bishop (assistant director for research and programs, International Health Policy and Practice).
Jordon Peugh is research director at Harris Interactive in New York City; Nandita Murukutla is research manager there.

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[EQ] Homelessness - multiple faces, multiple responsibilities

Homelessness - multiple faces, multiple responsibilities

Ministry of Health and Social Affairs, Sweden, 1 November 2007

Available online as PDF file [16p.] at: http://www.sweden.gov.se/content/1/c6/09/14/05/83ea8069.pdf

The Sweden Government has presented a strategy to combat homelessness and exclusion from the housing market Homelessness - multiple faces, multiple responsibilities. The strategy covers 2007-2009. Its purpose is to establish a structure that clarifies that multiple actors at national, regional and also local level have a responsibility and a role to play in work to address homelessness and exclusion from the housing market. By specifying a clear direction for action, a broad approach and clear joint work, the strategy represents a higher level of ambition….”

“….Homelessness does not describe a person but the situation a person finds himself or herself in for a shorter or longer period of time. The concept is commonly

used to describe a person who is sleeping rough or has to use emergency accommodation or a hostel. The National Board of Health and Welfare uses a

wider definition that includes people who currently have somewhere to stay but whose housing situation is uncertain in various respects. One example is when a

person is in prison or has been admitted to a treatment unit or supported accommodation in the social services, a county council or some other care provider and does not have any accommodation arranged before being discharged.

The Board also counts people who are living involuntarily with relatives, friends or acquaintances or have temporary subletting contracts (less than three months at the time of measurement) and who have sought assistance or been in contact with the social services or some other organisation on account of this….”

The Government’s strategy contains four objectives for future work:

1) Everyone has to be guaranteed a roof over their head and be offered further coordinated action based on their individual needs.

2) The number of women and men who have been admitted to or registered at a prison or treatment unit or have supported
accommodation or are staying in care homes and do not have any accommodation arranged before being discharged has to decrease.

3) Entry into the ordinary housing market has to be facilitated for women and men who are in housing ladders, training flats or other
forms of accommodation provided by the social services or other actors.

4) The number of evictions has to decrease and no children are to be evicted

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