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Biomedical subjects

R B Saltman

Publications and source records attributed to R B Saltman.

At least 19 recordsLinked to original sources
PubMed2001

A methodological note on combining health and social care expenditures into a single statistic for policy-making purposes.

Current national expenditure series in the health sector focus predominantly on spending for medical services. However, as the percentage of elderly individuals grows, national policy makers will increasingly require an expenditure series which includes combined expenditure for social care as well as medical expenditures. In one country, Sweden, national policy makers have begun to relate policy decisions to a 12.0% (1996) figure for combined health and social care expenditures. Calculating such a combined figure presents a number of methodological issues, such as which social care services to include and how to reflect donated care from relatives and friends. An international comparison of this new health and social care figure would enable national decision makers to judge better the efficiency and effectiveness of current policy.

Benchmarking↗
PubMed2000

The concept of stewardship in health policy.

There is widespread agreement that both the configuration and the application of state authority in the health sector should be realigned in the interest of achieving agreed policy objectives. The desired outcome is frequently characterized as a search for good governance serving the public interest. The present paper examines the proposal in The World Health Report 2000 that the concept of stewardship offers the appropriate basis for reconfiguration. We trace the development of stewardship from its initial religious formulation to more recent ecological and sociological permutations. Consideration is given to the potential of stewardship for encouraging state decision-making that is both normatively based and economically efficient. Various dilemmas that could impede or preclude such a shift in state behaviour are examined. We conclude that the concept of stewardship holds substantial promise if adequately developed and effectively implemented.

Guidelines as Topic↗
PubMed1997

The context for health reform in the United Kingdom, Sweden, Germany, and the United States.

The success of health policy initiatives can be strongly influenced by the political, social, and cultural context within which a health care system operates. This study explores the similarities and differences in the background context of the four countries considered in this supplement: Sweden, the United Kingdom, Germany, and the United States. It concludes that there are considerable differences in the background context among these four countries, which help to explain their differing structural and organizational approaches to issues of pharmaceutical and home care policy.

Cultural Characteristics↗
PubMed1997

Equity and distributive justice in European health care reform.

Equity is a central objective of most European health care systems, yet equity, particularly in the form of distributive justice, has not been a central objective of many recent health sector reforms. This article considers three aspects of the relationship between equity and recent health reforms. After defining what is meant by equity in the health sector, the author briefly examines available evidence on present levels of equality then discusses the equity implications of ongoing reforms in European health care systems.

Europe↗
PubMed1995

System reform in integrated health systems.

As the debate progresses on health care reform and the ultimate form of the U.S. system, important lessons can be drawn from examinations of other health care systems. From the U.S. perspective, European health systems appear to have a certain homogeneity about them. Americans tend to look at all European arrangements as single-source financing systems. Because these systems all provide universal coverage, the assumption is that there must be a strong cohesion and similarity among them. Viewed from the European perspective, the reality appears to be rather different. In this article, the health cae systems of Nordic countries are analyzed in terms of their differences both from other European systems and from the United States approach.

Data Collection↗
PubMed1994

Patient choice and patient empowerment in northern European health systems: a conceptual framework.

The issue of patient choice presents a complicated challenge to publicly operated health systems. Increased patient choice can strengthen the citizen's commitment to traditional welfare state objectives, or alternatively, it can severely damage that commitment, depending upon the design of the choice mechanism and the structural context within which patient choice occurs. For patient choice to be linked to true empowerment, choice must reinforce rather than undercut the accountability of health care providers to the population they serve. This article explores the basic issues involved in empowering patients within publicly operated health systems. The author first reviews the conceptual components that could or should be incorporated within the notion of empowered patients, then examines what would be required to actually empower patients within health systems, defined in terms of expanding not only logistical choice but also clinical influence and decision-making participation. The article concludes with a wide-ranging analysis of the impact of potential policies and mechanisms on the long-term objectives in achieving democratically accountable health care systems.

Cross-Cultural Comparison↗
PubMed1992

Single-source financing systems. A solution for the United States?

Although tax-based and social insurance-based forms of single-source financing differ in how they raise funds, they share a common set of structural characteristics. In particular, they both enable publicly accountable authorities to control aggregate expenditure levels by creating a countervailing power to pressures for increased expenditures from providers. While major reform initiatives are under way in European single-source financing systems, these initiatives have so far sought to improve the efficiency, effectiveness, and/or responsiveness to patterns of service delivery without reducing their commitment to universal access to necessary care. The article concludes with a review of the advantages and disadvantages that could accompany the introduction of a single-source financing system in the United States.

Canada↗
PubMed1992

Reforming Swedish health care in the 1990s: the emerging role of 'public firms'.

A growing number of Swedish county councils have started to develop more flexible methods by which to produce and deliver health services. This paper explores the current status of this reform process both empirically and conceptually. Empirically, it draws upon data obtained by a 1990 questionnaire from all 26 county councils to chart the level of movement across the entire system. Conceptually, it distills from this reform activity a key element that provides an organizational basis for the future, namely the transformation of provider institutions into 'public firms'. The paper concludes that while the precise outcome may be hard to predict, the reform process itself is well underway.

Delivery of Health Care↗
PubMed1992

Recent health policy initiatives in Nordic countries.

Health care systems in Sweden, Finland, and Denmark are in the midst of substantial organizational reconfiguration. Although retaining their tax-based single source financing arrangements, they have begun experiments that introduce a limited measure of competitive behavior in the delivery of health services. The emphasis has been on restructuring public operated hospitals and health centers into various forms of public firms, rather than on the privatization of ownership of institutions. If successful, the reforms will enable these Nordic countries to combine their existing macroeconomic controls with enhanced microeconomic efficiency, effectiveness, and responsiveness to patients.

Contract Services↗
PubMed1991

Towards a Swedish health policy for the 1990s: planned markets and public firms.

The Swedish health system has entered a period of major structural transformation. Most county councils have begun to experiment with new service delivery mechanisms, and the governing Social Democratic Party has proposed wide-ranging reforms intended to improve the efficiency, quality, and responsiveness of all public human services. This paper draws upon key elements in the current Swedish debate to develop an alternative policy model for publicly operated health systems in general. We argue that the limitations of existing planning and market based policy models can be overcome by an approach constructed upon 'planned markets'. This alternative model involves restructuring publicly operated systems into an intentionally designed network of 'public firms' that engage in a socially as well as economically efficient process of 'public competition'. The model harnesses patient choice of provider as the driving mechanism to enhance both production efficiency and democratic participation within the Swedish health system.

Economic Competition↗
PubMed1991

Emerging trends in the Swedish health system.

The Swedish health care system has embarked upon a broad process of organizational reform. Confronted by increasing pressures from an aging population, intensive new medical technology, and tightly constrained public sector budgets, Swedish county councils have begun to experiment with new models of health service delivery that incorporate specific elements adapted from market-oriented approaches. This article briefly reviews two of the more influential organizational models presently in place or under development in different counties, and assesses the revised role for health planning that these reforms will require at both county and national levels.

Health Planning↗
PubMed1990

Competition and reform in the Swedish health system.

Sweden has had success containing its overall rate of health expenditures without compromising its citizens' well-being. Nevertheless, the country's health system has recently faced organizational problems, including queues for elective surgery; inadequate continuity of care; shortages of personnel; and pressures from patients for greater influence over care. County councils have begun experiments in "comparative competition" among public and/or private providers, to expand patient choices, and to link the choices to providers' salaries and institutional budgets. If these experiments in planned market approaches prove effective, Sweden may again serve as a model for publicly operated health systems.

Economic Competition↗
PubMed1989

Public competition versus mixed markets: an analytic comparison.

Issues of internal organizational efficiency and effectiveness continue to dominate debate within health care systems in Northern Europe. This article focuses on political as well as economic aspects of two recent proposals for 'strategic reform' in tax-based publicly operated health systems: public competition and mixed markets. The theoretical underpinning of each model is examined, and the likely impact upon long-term health system development is compared.

Consumer Behavior↗
PubMed1989

Re-organizing primary medical care in Finland: the personal doctor program.

This article reports the results of an evaluation of the 'Personal Doctor Program' in Finland, a demonstration project to re-structure the primary medical activities of general practitioners within publicly operated health centers. The goal of the personal doctor program is to achieve the clinical advantages and performance incentives of enrolling each citizen on a specific general practitioners's list, but within the broader team-based and demographic responsibility framework of a primary health center. The background and methodology of the project is presented, followed by the methodology and analysis of the evaluation itself. The two key conclusions from this assessment suggest that the personal doctor approach considerably improved the quality of primary medical care within the health center, and that publicly salaried physicians produce at least the same overall value as their privately employed counterparts.

Data Collection↗
PubMed1989

Hospital policy in The Netherlands: the parameters of structural stalemate.

The Dutch hospital sector has recently been the subject of two divergent national policy initiatives. Following a mixed experience with regulation in the mid-1980s, the national government has now taken the first steps in a radical shift toward market-based competition. This article suggests that neither official strategy can address the fundamental structural and cultural factors that shape institutional behavior in the Dutch hospital system. Drawing upon empirical evidence from two 1987 hospital case studies, this article contends that Dutch hospital management reflects a precentralized insularity which, in turn, sharply reduces the likelihood that either publicly or privately framed decentralized strategies can be successfully implemented.

Health Policy↗