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Biomedical subjects

C Ham

Publications and source records attributed to C Ham.

At least 55 records · Page 3Linked to original sources
PubMed1995

Synthesis: what can we learn from international experience?

International experience shows that rationing can occur through exclusions or through the use of guidelines. Oregon has chosen to ration by excluding certain services in order to move towards universal population coverage. New Zealand has avoided exclusions and has chosen to ration through the use of guidelines. The Netherlands is pursuing both approaches. The experience of these and other countries demonstrates that rationing is inherently difficult. Choices in health care can be informed by techniques drawn from economics and other disciplines but these techniques need to be used as part of debate and discussion in the process of arriving at decisions. Experts and the public can contribute to this process and strenuous efforts need to be made to ensure participation by a representative cross-section of the population. At its root priority setting is a political process shaped by beliefs and values. Increased transparency in decision making should promote greater accountability and increased public awareness of the nature of rationing.

Health Care Rationing↗
PubMed1995

International models of managed care.

Outside North America health care resources are raised in two main ways: (1) taxation (the Beveridge model) and (2) compulsory social insurance (the Bismarck model). In practice, most European countries rely on a mixture of the two. The author examines the degree to which recent reforms have promoted divergence or convergence of the North American and European systems.

Contract Services↗
PubMed1994

Managing the NHS market.

The purpose of the present NHS reforms is to introduce a managed market; developing some of the incentives for greater efficiency that are often found in markets while still being able to regulate proceedings to prevent market failures. If government intervenes too much there will be no incentive to improve efficiency and streamline operations: too little intervention may result in some areas having inadequate health service cover or monopoly powers abusing their position. Effective management of the NHS market requires eight core elements: openness of information, control of labour and capital markets, regulation of mergers and takeovers, arbitrating in disputes, protection of unprofitable functions such as research and development, overseeing national provision of health services, protection of basic principles of the NHS, and handling of closures and redundancy. Management of the market would best be performed by the NHS management executive and health authority purchasers acting within a framework set by politicians.

Economic Competition↗
PubMed1994

Health care reform in The Netherlands, Sweden, and the United Kingdom.

The experiences of three European countries that are actively engaged in reforming their health care systems--the Netherlands, Sweden, and the United Kingdom--point to a degree of convergence in the types of reforms being pursued. European experiences also offer a number of lessons for the United States. These include the importance of government intervention in the health care market to ensure universal coverage, the key role of primary care in ensuring access to basic health services and in containing costs, and the need to create a strong purchasing or insurance function to hold providers accountable on behalf of patients. The pace and scope of reform are affected significantly by the political process in each country.

Economic Competition↗
PubMed1994

Making the NHS reforms work for patients.

The jury is still out on the success--or failure--of the NHS reforms, writes Chris Ham. The way forward lies with the creation of strong, unified purchasing strategies and, in a climate of financial restraint, fresh approaches to service delivery to bridge the gap between supply and demand.

Cost Control↗
PubMed1993

The odd couple?

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Contract Services↗
PubMed1993

Priority setting in the NHS: reports from six districts.

District health authorities must make choices on the use of their funds and the priorities that should be pursued. In future they may be able to place greater weight on the views of local people and evidence on cost effectiveness of different services. This paper reviews developments in a recent study of six district health authorities with an interest in priority setting. On the whole they had avoided excluding services entirely from their contracts; they experienced difficulty in comparing different services, and made more progress by analysing priorities within individual service areas than by comparing quite different services. The absence of information to guide priority setting was a major problem. A major effort had been made to involve the public in decision making, and a range of tools and methods developed to support work on priority setting. The impact of the work done so far has varied; district health authorities are still at an early stage in developing their work on priority setting.

Decision Making↗
PubMed1993

Health care reform.

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Delivery of Health Care↗