The impact of the 1997-98 East Asian economic crisis on health and health care in Indonesia

This article identifies the effects of the 1997-98 East Asian economic crisis on health care use and health status in Indonesia. The article places the findings in the context of a framework showing the complex cause and effect relationships underlying the effects of economic downturns on health and health care. The results are based on primary analysis of Indonesian household survey data and review of a wide range of sources from the Indonesian government and international organizations. Comparisons are drawn with the effects of the crisis in Thailand. The devaluation of the Indonesian currency, the Rupiah, led to inflation and reduced real public expenditures on health. Households' expenditures on health also decreased, both in absolute terms and as a percentage of overall spending. Self-reported morbidity increased sharply from 1997 to 1998 in both rural and urban areas of Indonesia. The crisis led to a substantial reduction in health service utilization during the same time period, as the proportion of household survey respondents reporting an illness or injury that sought care from a modern health care provider declined by 25%. In contrast to Indonesia, health care utilization in Thailand actually increased during the crisis, corresponding to expansion in health insurance coverage. The results suggest that social protection programmes play a critical role in protecting populations against the adverse effects of economic downturns on health and health care.     

The economic crisis and its impact on health and health care in Latin America and the Caribbean

The economic crisis that struck most Latin American and Caribbean countries beginning in 1982 has caused sharp reductions in domestic investment and in imports; domestic consumption has been less affected, while public sector spending has responded in different degrees in different countries. In general, public spending on health decreased, sometimes quite dramatically, but some countries were able to maintain the real value of noninvestment spending for health by central governments. It is much harder to tell what may have happened to output of health services, and still harder to know how health status has been affected. Scattered evidence suggests two conclusions. First, worsened economic conditions can seriously damage health status, with effects on infant mortality and on the patterns of disease and death, especially for children. Second, these repercussions do not have to occur, and public programs designed specifically to maintain basic health services and to assure adequate nutrition are effective in offsetting the worst consequences of economic hardship.     

Global health and the global economic crisis

Although the resources and knowledge for achieving improved global health exist, a new, critical paradigm on health as an aspect of human development, human security, and human rights is needed. Such a shift is required to sufficiently modify and credibly reduce the present dominance of perverse market forces on global health. New scientific discoveries can make wide-ranging contributions to improved health; however, improved global health depends on achieving greater social justice, economic redistribution, and enhanced democratization of production, caring social institutions for essential health care, education, and other public goods. As with the quest for an HIV vaccine, the challenge of improved global health requires an ambitious multidisciplinary research program.     

金融危机与中国卫生保健改革：危机与机遇

全球金融危机将对我国的医疗卫生事业产生不利影响：尽管我国不会出现政府卫生投入下降的情况,但是居民个人卫生投入存在下降趋势;卫生服务利用率可能会下降,居民轻视预防保健的倾向将更加明显;居民健康状况可能会恶化,健康不公平将加剧。我国应将金融危机转化为改革良机,实施初级卫生保健总战略,密切监测评估危机带来的影响,确保并增加卫生投入,坚定不移地贯彻实施新“医改”方案。     

The health care reform in Portugal: Outcomes from both the New Public Management and the economic crisis

The Portuguese health system concentrates most of its activity in a National Health Service, created in 1979 to promote universal and general access. The National Health Service should ensure equity, efficiency, and quality of all health care delivered services. This study assesses the impact of health care policies between 2002 and 2017, focusing on 3 timeframes: the adoption and adaptation of New Public Management principles to the health care sector (2002 to 2010), the economic and financial crisis period (2011‐2015), and the postcrisis recovery period (2016‐2017). The current study evaluates the main policy measures in the health sector, presenting their impacts in terms of access, efficiency, accountability, and costs over those 3 economic periods. It was verified that not all the measures implemented by the successive governments obtained the desired outcomes, generating even costs increase, apart from the austerity period in which health expenditure showed a significant reduction because of the financial constraints.     

Managed competition and the health care crisis

The politics of health care reform has created gridlock despite public support for control of increasing costs, expanded coverage, and greater patient satisfaction. Managed care has become the watchword for meeting such goals, despite serious doubts about its ability to succeed. The author examines the pitfalls of managed care, particularly in regard to cost containment and patient satisfaction.     

Escalation of the nurse-physician conflict: registered care technologists and the economic crisis

Rivalry between nurses and physicians has been escalating in recent years. The American Medical Association's (AMA's) recent proposal to deal with the nursing shortage by introducing a non-nurse bedside care technician to be called a registered care technologist has met with strong opposition from the American Nurses' Association (ANA). This article suggests that limiting the analysis of this debate to changes taking place within the health sector is problematic. The determining constraints are not endogenous to the health sector, but are located in the broader macroeconomic context. The object, herein, is to locate the AMA's proposal and the ANA's response in the light of the macroeconomic crisis that is forcing the U.S. economy, including the health sector, to restructure. This restructuring generates increasing rivalry and conflict as firms and workers vie to consolidate, and where possible, to expand their relative power in the face of generally declining and qualitatively changing circumstances.     

The health care solution: understanding the crisis and the cure

Following is Part I of an excerpt from the soon-to-be released book, "The Health Care Solution: Understanding the Crisis and the Cure" by CAHHS CEO/President C. Duane Dauner. Dauner paves the road to reform in his book by providing a step-by-step solution to ending the nation's health care crisis.     

Impact of economic crisis on cause-specific mortality in South Korea

BACKGROUND: Economic changes can be powerful determinants of health. In the late 1990s, South Korea experienced a steep economic decline. This study examines whether the massive economic changes affected trends in all-cause and cause-specific mortality in South Korea. METHOD: Mid-year population estimates of 5 year age groups (denominators) and death certificate data (numerators) from the National Statistical Office of Korea were used to compute cause-specific age-standardized mortality rates before and after the economic crisis. RESULTS: All-cause mortality continued to decrease in both sexes and all age groups during the crisis. Cerebrovascular accidents, stomach cancer, and liver disease contributed most to this decline. A remarkable decrease in transport accident mortality rates was also observed. The most salient increase in mortality was suicidal death. Mortality from homicide, pneumonia, and alcohol dependence increased during the economic crisis, but these accounted for a small proportion of total mortality. CONCLUSIONS: Short-term mortality effects of the South Korean economic crisis were relatively small. It appears that any short-term effects of the economic decline were overwhelmed by the momentum of large declines in causes of death such as stroke, stomach cancer, and liver disease, which are probably related to exposures with much longer aetiological periods. However, this study focused on rather immediate mortality effects and follow-up studies are needed to elucidate any longer-term health effects of the South Korean economic crisis.     

Impact of Medicare's prospective payment system and the farm crisis on the health care of the elderly: a case study.

The spectrum of health care for the rural elderly has been negatively affected by recent changes in Medicare reimbursement policies and by the farm crisis. This case study examined the effects of these changes on the ability of rural hospitals, the aging network, and care-givers to provide adequate and continuous care to the elderly. In this case study, three gaps in services were found: a lack of programs designed to meet the needs of terminally ill patients and their families; a lack of education during the crucial transitional period between hospital discharge and home; and a lack of services and programs for the chronically-ill older adult. More studies are needed to determine if similar service gaps will be found in other rural communities. If so, public attention should be focused on possible solutions.     

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.     

The Polish country profile: economic crisis and inequalities in health

Class position based on educational level is strongly associated with health status in Poland. Whilst infant mortality continues to fall, life expectancy at age 45 is lower particularly for males. Cause of death analysis shows a steady but slow fall in poverty-type diseases and a big increase in deaths from circulatory diseases and malignant neoplasms. Multiple regression analyses suggest that the main causal factors in inequality result from economic failure, differences in living conditions and lifestyles rather than from the evident inefficiencies in the health-care system itself. But there are significant inequalities in access to health care and especially to quality care.