Tools from the new institutional economics for reforming the delivery of veterinary services

The new institutional economics offers a range of analytical tools and insights which can be used in restructuring the animal health services of a country. This paper discusses three of the most important--externalities, transaction costs and asymmetric (unequal) information. These tools can be used to craft a system which is sensitive to the particular institutional heritage of a country and to its political, social and economic realities. Institutions are important in this process and the best way for one society is often not the optimal choice for another.     

Reproductive health care: delivery of services and organizational structure

Delivery of reproductive health care is discussed with respect to accessibility, competence, effectiveness, accountability and evaluation of services. 4 essential components of service organization are identified (organization, administration, staff and community) and discussed. Evaluation objectives and responsibilities are also discussed.     

The new institutional economics of privatising veterinary services in Africa.

The authors review a number of critical issues in the structural reform of animal health services for both small and non-commercial livestock producers in Africa and highlight several problems that others concerned with the privatisation of this service area have tended to neglect. Most notably, attention is called to the following: a) the need to retain a central role for paraprofessionals in the new delivery system b) the important and problematic relationship between the veterinary and paraveterinary professions c) the importance of developing state contracting procedures for assisting the private delivery of animal health services that will avoid the problems of local monopoly d) the central role that professionalism will have to play in this area, if collective goods and the public interest are to be served.     

Equity of access to health care services: theory and evidence from the UK

The pursuit of equity of access to health care is a central objective of many health care systems. This paper first sets out a general theoretical framework within which equity of access can be examined. It then applies the framework by examining the extent to which research evidence has been able to detect systematic inequities of access in UK, where equity of access has been a central focus in the National Health Service since its inception in 1948. Inequity between socio-economic groups is used as an illustrative example, and the extent of inequity of access experienced is explored in each of five service areas: general practitioner consultations; acute hospital care; mental health services; preventative medicine and health promotion; and long-term health care. The paper concludes that there appear to be important inequities in access to some types of health care in the UK, but that the evidence is often methodologically inadequate, making it difficult to draw firm conclusions. In particular, it is difficult to establish the causes of inequities which in turn limits the scope for recommending appropriate policy to reduce inequities of access. The theoretical framework and the lessons learned from the UK are of direct relevance to researchers from other countries seeking to examine equity of access in a wide variety of institutional settings.     

Risks and benefits in health care: the view from economics

This paper discusses the meaning of the term risk from the economic perspective. It argues that some consumer decisions about insurance and the use of medical care are consistent with the economic model, but many are not. When decisions are inconsistent, real-world democratic governments' ability to intervene is limited by politicians' desire to please voters. The choice of incomplete insurance coverage in private markets is often said to present a case for governmental intervention, but the choice of insurance design in the Medicare drug benefit shows that the political process also may fail to select insurance that is optimal from an economic viewpoint.     

The logic of transaction cost economics in health care organization theory

Health care is, at its core, comprised of complex sequences of transactions among patients, providers, and other stakeholders; these transactions occur in markets as well as within systems and organizations. Health care transactions serve one of two functions: the production of care (i.e., the laying on of hands) or the coordination of that care (i.e., scheduling, logistics). Because coordinating transactions is integral to care delivery, it is imperative that they are executed smoothly and efficiently. Transaction cost economics (TCE) is a conceptual framework for analyzing health care transactions and quantifying their impact on health care structures (organizational forms), processes, and outcomes.     

药品回扣的制度经济学分析

“药品回扣“已成为社会关注的热点,它的存在有多方面的复杂因素,试图从新制度经济学的角度,从信息不对称导致的机会主义行为和交易费用两方面分析造成药品回扣的原因并提出相应的治理措施.     

Domestic and institutional violence in health services: women's experiences

Developed in state capitals Recife, Salvador and Aracaju, in three state maternity hospitals, this quantitative study aimed at identifying the manifestations of domestic and institutional violence suffered by women assisted in subprograms of the Program of Integral Assistance to the Woman's Health. Data collection was performed by using a semi-structured form. The sample featured young women, housewives, and those that are economically dependant on their significant others. Most women experience matrimonial violence, and financial dependency is the most often mentioned reason to bear it. The lack of vacancies characterized institutional violence due to omission. Research showed that experiencing such violence brings health problems to women, or aggravates them.     

Evaluation of the technology of health care delivery under new economics

The development and improvement of technology in health care delivery and its utilization in applied public health is a prerequisite for improving the quality of curative and diagnostic process, rational use of material and technical resources and medical personnel of curative and preventive establishments under new economic methods of public health management. The volume standards of health care delivery comprising the standard, optimum sets of measures for patients including the list of diagnostic and treatment procedures can be considered as the main instrument and the major criteria in evaluating the completeness and quality of health care delivery at hospital stage and at different regional levels.     

Changing approaches in women's health: new insights and new pitfalls in prenatal preventive care

In this article, we contend that the standard definition of risk factors in pregnancy is not the neutral or technical process that women may assume it to be, but is colored by the prejudice of its context: a capitalist and patriarchal society. In such a society, only paid work is valued, and thus there is little study of the ill effects of housework on pregnant women; such a study would mean considering and possibly changing our sex-biased division of labor. Physicians and the mass media stress risk factors such as smoking, while omitting to mention that drugs prescribed by doctors are not always safe, and some are prescribed for years before-and even after-their harmful effects are known. Further examples are given from the field of childbirth, and we advance the hypothesis that, especially in fee-for-service medical systems, the physician can represent a risk factor. "Information" is often offered as the solution for pregnancy risks, the responsibility for this being the woman's. The mystification and narrowness of such a victim-blaming approach are evident. The key factor in prenatal preventive care is the mother's level of education: to admit this would be to acknowledge the need for change of a social system that keeps women in ignorance. We point out the limitations of the proposed individualistic solutions and conclude that, in redefining risk factors for women and their babies, we must analyze our society in feminist terms and in terms of social class.     

Improving the distribution of health care services by understanding nurse job choice decisions

The application of multi-attribute choice models in the field of nursing provides a method for health care administrators to use in coping with the high level of turnover and nurse shortage. By segmenting respondents via multi-attribute model importance characteristics, the problems of reducing turnover and attracting nurses can be approached with greater efficiency and effectiveness. This study found that the use of multi-attribute models for predicting employment, and for segmenting and nurses' attitudes toward hospital employment, can be applied in a meaningful and usable fashion.     

Epidemiology and assessment of health care services: new research trends

This article begins by analyzing the difficulty that Clinical Medicine, Epidemiology, and Health Planning and Administration have in dealing with the dynamic, complex social dimensions characterizing the technological organization of the diagnostic and therapeutic process, necessary for the production of health services' knowledge about diseases, a difficulty which has become more evident with the increasingly frequent and varied assessments in health care. The latest tendencies in "health services research" are analyzed, along with a priorization of effectiveness and outcomes, seeking to respond to the identified problems through a redefinition of objects and methodologies.     

Paradigms and research programmes: is it time to move from health care economics to health economics?

As an applied subdiscipline of economics, health economics has flourished, defining itself as the study of how scarce health care resources may be used to meet our needs. This evolutionary pathway has led to health economists adopting a very 'medical' model of health, in which the predominant production function for health is health care. This paper sets out policy challenges to health economics which have arisen in light of growing recognition by governments of the socioeconomic determinants of health and their stated commitment to tackle inequalities in health. It reviews Thomas Kuhn's theory of paradigm shift and Imre Lakatos' theory of scientific research programmes in the natural sciences, favouring the latter as an explanation of the evolution of the subdiscipline of health economics. The paper brings together four recently published visions of the future of health economics-visions that are almost exclusively focused on the production, organization and distribution of health care. In contrast to these visions, in Lakatosian terms, this paper challenges the subdiscipline's core 'positive heuristic', i.e. the set of imperatives which determines how the research programme should unfold, how it may be defended, its scope and boundaries. This paper argues that health economics will need to evolve to embrace a more socioeconomic model of health and, to this end, offers for debate an expansion of Williams' diagrammatic representation of the subdiscipline. It concludes by asking whether the magnitude and the magnetism of health care policy issues will continue to prove too strong to allow health economists, should they wish, to steer their research and educational programmes more directly towards 'health' rather than 'health care' as the relevant social want.     

Estimating the monetary value of health care: lessons from environmental economics

In the recent past, considerable effort in health economics has been made on applying stated preference methods such as contingent valuation and choice experiments. Despite this increased use, there is still considerable scepticism concerning the value of these approaches. The application of contingent valuation in environmental economics has a long history and has been widely accepted. Whilst choice experiments were introduced to the environmental and health economics literature at a similar time, the wider acceptance of monetary measures of benefit in environmental economics has meant that they have also been more widely applied. The purpose of this paper is to identify some of the key issues and debates that have taken place in the environmental economics literature, summarise the state of the art with respect to these issues, and consider how health economists have addressed these issues. Important areas for future research in health economics are identified.     

Political, institutional, and organizational evaluation of primary health care with an emphasis on comprehensiveness

This article presents part of the data from an evaluation of primary care, implemented as part of research funded by the Brazilian Ministry of Health in 2005. Thirty-one municipalities from the States of Minas Gerais and Espírito Santo comprised the study sample. Data collected with qualitative methods (interviews and documents) were summarized, with the production of a set of categorical variables. The article presents the distribution of values for the variables by municipality. The variables were submitted to correspondence analysis, which showed their internal validity. The article also provides observations on relevant aspects of the field. In conclusion, the evaluation demonstrates advances in the Family Health Strategy in Brazil, with important contributions to the Project for Expansion and Consolidation of the Family Health Strategy, despite persistent obstacles, particularly related to human resources in the family health strategies and local use of the data produced.