Health policy
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To determine how equitable enrolment and utilization of community-based health insurance is in two communities with varying levels of success in implementing the scheme. ⋯ Enrolment was generally low and contributions were retrogressive. The average premiums were also small. However, there was equitable enrolment and utilization of services. Efforts need to be made to increase the number of enrolees, so as to increase the pool of funds and risks. Payments by enrolees especially in poor and rural communities should be supplemented by subsidies from government and donors in order to ensure equitable financial risk protection.
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New Zealand has a mixed public-private funded primary care system. In the last decade, considerable effort has gone into reducing the financial barriers to primary care, with some targeting of greater public funding of practices in more deprived areas. In this paper we explore the association of socio-demographic factors with affiliation with a primary care provider (PCP), and specifically examine the association with deprivation. Affiliation refers to having a doctor, nurse or medical centre one could go to if need arises. ⋯ Affiliation to a PCP is a measure of potential access to primary care. Overall, our data provide some support for the hypothesis that people with high health needs have high rates of affiliation with a PCP (e.g., elderly, women, Māori and those in poor health). The results also suggest that current health policies in New Zealand, with their emphasis on a strong primary health care system, are ensuring that people with greater health care needs are affiliated with a PCP.
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Smoking cessation is usually mentioned last in the chain of established measures to improve Tobacco Control. This seems logical, as smoking cessation is a secondary or tertiary preventative measure only. In the recently proposed Tobacco Control Scale (TCS) using 6 Tobacco Control measures pricing is considered most important, and smoking cessation least important. ⋯ There is also strong evidence that smoking cessation is cost-effective, especially when comparing costs involved in addressing other important health risk factors, such as hyperlipidemia and arterial hypertension. Finally, the role of smoking cessation in helping to decrease social acceptability of smoking should not be underrated as every smoker who quits sets an example for other smokers to follow or for children not to start. In summary, smoking cessation continues to be of paramount importance among Tobacco Control measures, and should get more emphasis especially in health care settings.
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Comparative Study
Comparison of outcomes and costs after hip fracture surgery in three hospitals that have different care systems in Japan.
Hip fracture is a medical and socioeconomic problem among the 65 years and older population in Japan. Length of hospital stay in Japan is much longer than other developed countries, and the Japanese government has tried to reduce length of stay in order to reduce medical expenditures. The objective of this study was to compare outcomes and costs of health care services for patients with hip fracture surgery among three hospitals with different care systems in Japan. ⋯ Patients' outcomes (mortality and ambulatory ability) after discharge were comparable. Hospitals that had shorter lengths of stay reduced costs to themselves, but did not reduce overall costs including care after discharge; however, costs were even higher because patients stayed in subsequent hospitals longer and/or used more elders' care services. Reducing the length of stay in the initial acute care hospitals could be just a method of cost-shifting to subsequent care services and is unlikely to bring an overall cost-savings to the Japanese health care system.
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To discuss the background, nature and facilitating and hindering factors of the privatisation process in health care in Slovenia. ⋯ Slovenia's privatisation in health care is focused on primary health care and on health expenditures. Controversies over its extent kept privatisation contained and controlled. Today's share of private provision of health services remains at the conservative end of the European Union. Private expenditures for health services increased considerably, while privatisation of health infrastructure and management has so far been limited. Concerns about the future course of privatisation relate to the issues of equity, fairness and solidarity.