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Biomedical subjects

B Abel-Smith

Publications and source records attributed to B Abel-Smith.

At least 19 recordsLinked to original sources
PubMed1997

Will managed care work in Europe?

This paper examines major trends in healthcare reforms in the European Union Member States during the last decade. It focuses on managed care developments and shows that, to a certain extent, managed care in Europe is moving towards a consensus. The paper analyses major trends observed across the European Union including the establishment of overall budgets for health services, separation of purchasers from providers, competition between providers, capitation payments for doctors, budget controls on pharmaceutical expenditure and priority-setting methodologies. It then discusses the potential introduction of new forms of managed care and the current weaknesses in information needs and systems. Finally, the policy-makers' dilemmas for resource allocation are examined and a frame-work for policy debate is suggested.

Cost Control↗
PubMed1994

Cost containment and health care reform: a study of the European Union.

This article gives a short summary of the organisation and financing of health services of the 12 Member States of the European Union. It then describes the latest developments in cost containment in each of the countries. The third section describes the new initiatives for reform in Spain, Italy, the Netherlands, Portugal and the United Kingdom. Finally, it gives a summary of the cost containment measures in the 12 countries, listing them under a set of headings. They are classified as budget control, alternatives to hospital care, cost sharing, influencing authorizing behaviour and limits on supply. The article shows the considerable convergence of policies which is developing. Overall budget control in some form is to be found in 8 of the countries. Where providers are paid by a number of different insurers, budgets are nevertheless applied to hospitals in three countries and in another only to public hospitals. Both Germany and France have used budgets to control other items of expenditure. Profits or the prices of drug companies are controlled in 8 countries and in one indirectly. Three have adopted reference price systems for drugs and another has taken powers to do so. Two have adopted or are moving towards provider markets.

Cost Control↗
PubMed1994

Employer's willingness to pay: the case for compulsory health insurance in Tanzania.

This article documents employers' expenditure on the arrangements for the health care of their employees in one of the least developed countries; Tanzania. The case for compulsory health insurance is considered in the light of the fact that only 3% of the population is employed in the formal sector and could be covered at first. It is shown from a survey of larger employers, outside government, that they were spending on average 11% of payroll on health care for their employees. This demonstrated their lack of satisfaction with the government health services. Nevertheless, those who could readily be covered by insurance were making considerable use of the more expensive government hospital services. It is argued that a compulsory health insurance scheme could be introduced for the formal sector of employment which would cover a wider range of health services at lower cost. The scheme would also have the desirable economic effect of lowering employers' labour costs while making it possible to improve the standards of the government health services.

Data Collection↗
PubMed1992

Health insurance in developing countries: lessons from experience.

Many developing countries are currently considering the possibility of introducing compulsory health insurance schemes. One reason is to attract more resources to the health sector. If those who, together with their employers, can pay for their health services and are made to do so by insurance, the limited tax funds can be concentrated on providing services for fewer people and thus improve coverage and raise standards. A second reason is dissatisfaction with existing services in which staff motivation is poor, resources are not used to best advantage and patients are not treated with sufficient courtesy and respect. This article describes the historical experience of the developed countries in introducing and steadily expanding the coverage of health insurance, sets out the consensus which has developed about health insurance (at least in Western European countries) and describes the different forms which health insurance can take. The aim is to bring out the advantages and disadvantages of different approaches from this experience, to set out the options for developing countries and to give warnings about the dangers of some approaches.

Contract Services↗
PubMed1992

Cost containment and new priorities in the European community.

This article reports on the author's survey of the cost-control measures for health care in 12 European countries during the period from 1983 to 1990. Among these countries the greatest convergence was in the use of the budget as a system of control, reinforced by manpower controls. Budgets were constructed to restrict hospital costs and payments to doctors practicing outside of hospitals. Another strategy was cost sharing for purchase of drugs and, in some cases, for dentistry. Most countries took steps to control expensive medical equipment; others, to restrict entry to medical schools. The European experience demonstrates the technical feasibility of the government's controlling health care costs by regulating supply rather than demand. The key to Europe's success in the use of monopsony power, whereby one purchaser dominates the market. The author contends that regulation works in Europe and questions whether the United States can exert similar control over its coalition of insurers and providers in order to rein in its health care expenses.

Ambulatory Care↗
PubMed1991

Financing health for all.

What is the most practicable system of charging people for health care? This article discusses the problem in the context of countries in Asia and Africa.

Africa↗
PubMed1989

Health economics in developing countries.

The interpretation of health economics chosen for this paper is broad. It includes the relation between economic and other factors in health development. This interpretation has been chosen lest the acceptance of a disciplinary approach in the commissioning of papers should have the unintended effect of excluding some key areas of research which require the consideration of crucial interrelationships between disciplines. The only justification for covering this area in a paper on economics rather than, for example, epidemiology is that increasingly there is and indeed has to be a heavy focus on costs in considering alternative paths to health development. The word 'research' is loosely interpreted and not restricted to the type of activity which could lead to the award of a PhD. The compilation of experience in many areas is, in the view of the author, a priority need, to plan where further research and experiment is needed.

Cost-Benefit Analysis↗
PubMed1988

The rise and decline of the early HMOs: some international experiences.

Consumer-controlled health insurance groups in northern Europe in the late nineteenth and early twentieth centuries resembled modern American HMOs in many ways. Fierceness of competition hindered European doctors' control of their own services, prompting them to organize physician-dominated insurance groups and to extend their power through means of licensure, boycott, and supportive government regulation. While patients thus gained the right to choose their own doctor, physicians were able to negotiate more favorable payment standards, including price discrimination by patients' income levels. The experience may foreshadow more ruthless operation of market principles among American HMOs, and raise questions about the HMO model's viability for Europe today.

Community Participation↗
PubMed1986

The world economic crisis. Part 1: Repercussions on health.

The widespread economic crisis has resulted in a fall in living standards in the western hemisphere of over 9% (1981-83) and in Sub-Saharan Africa they have fallen to the level of 1970. Food production in the African countries most seriously affected by drought dropped by 15% between 1981 and 1983. Living standards also fell in some countries in Europe and in some of the poorest countries of Asia. The high cost of fuel, the heavy burden of interest payments and unfavourable terms of trade in Africa and Latin America led to serious unemployment, devaluation of national currencies and formidable austerity policies. While some countries have succeeded in protecting their health services from cuts in public expenditure, in many others cuts in health budgets have been substantial. The effects of the crisis in some countries have amounted to the virtual disintegration of rural health services. There are limited data available to show what has been happening to levels of expenditure on health, but those presented here demonstrate that levels of health expenditure per head have fallen in many countries. The cumulative effects on health of increased poverty, unemployment, underemployment and famine, and the reduced capacity of health services to respond to health problems can be documented with facts for a number of countries in Latin America and Africa. Malnutrition has increased and improvements in infant mortality have been checked or reversed. The economic crisis has placed at risk the health of the most vulnerable.

Africa↗
PubMed1986

The world economic crisis. Part 2. Health manpower out of balance.

As outlined in the first part of this article in the last issue of the journal, many countries are facing severe constraints on health expenditure at the same time as they are trying to work towards Health for All by the Year 2000. Health manpower needs to be planned to secure maximum benefits from the limited resources available. Many medical schools train more doctors than are needed because quotas on medical places are either non-existent or set too high. Medical training may be oriented to high-technology, curative care and produce doctors ill equipped to fulfil the role demanded of them in the primary health care approach. Educational courses for paramedics and nurses are often insufficient and inappropriate. Countries which have previously lost trained doctors to attractive posts abroad now face the prospect of a flood of doctors looking for work in their home countries, now that opportunities for work abroad are being reduced. Such countries will find it difficult to reverse the bias in policy towards medical professionals, despite the waste caused by unemployment and inappropriate training among doctors. With limited budgets, there is a need for countries to plan ahead. To do this they must find ways of estimating future effective demand. The future balance of staff can then be planned on the basis of resources available and the relative costs of deploying various categories of health staff.

Data Collection↗
PubMed1985

Global perspective on health service financing.

Are there new sources of finance which Third World countries can tap to pay for Health for All? Is there anything valuable to be learnt in this respect from the experience of countries which are now developed? Countries have drifted into different ways of paying for health services, often without foreseeing the long run consequences. In many Third World countries the financing of services has been strongly influenced by their colonial past. This explains why many of them attempt to provide wholly free services and provide privileged services not only to the armed forces but to public servants as well. Introducing charges is one way of securing more revenue. It is noticeable that in some countries which were never colonized, there is a greater willingness to use charging and that this stimulates the growth of informal systems of voluntary health insurance. While many developed countries have made a transition from health insurance to universal services while retaining a considerable element of contributions from employers and employees, it is more difficult in political terms to introduce contributions unless those who contribute get something specific for them. The problem for developing countries contemplating the introduction of compulsory health insurance is to design systems which avoid all the problems which have manifested themselves in Europe, North America and on a wider scale in Latin America. These problems include the escalation of costs, failure to collect contributions due, the provision of 'paper' rights, bureaucratic obstacles to receiving care, different funds with varying rights, wholly separated services for insured persons, the bias to urban curative services and the separation of curative from preventive services.(ABSTRACT TRUNCATED AT 250 WORDS)

Africa↗
PubMed1985

Who is the odd man out?: the experience of Western Europe in containing the costs of health care.

Economic, demographic, and technological pressures have led at the same time to increased demands upon health services and the need to contain spending on health care. As the United States has focused singularly on an array of market mechanisms, Western European countries have each adopted a broader set of strategies along with limited de-insurance: innovative regulatory approaches and a move from compulsory health insurance models to flexible national health service models of providing health care. Pursuit of cost-containment in Western Europe has proceeded along with pursuit of quality and, above all else, equity.

Budgets↗