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Full-Text Articles in Law
Balancing Regional Government Health Mandateswith Federal Economic Imperatives: Perspectives Fromnova Scotia And Illinois, John Blum
Dalhousie Law Journal
This article focuses on current health policy changes in Canada and the United States at the federal and regionallevels. The Canadian discussion centres on the integrity of the Canada Health Act in the era of the Canada Health and Social Transfer, and the strategies that provincial governments have pursued to cope with persistent funding constraints. On the American side, the article examines the role of private sector managed care plans in filling a health policy void resulting from the demise of the Clinton Health Security Act. Two specific regional government health reform initiatives in Nova Scotia and Illinois are discussed …
"Cinderella" Services In The Nhs Internal Market:Does Contracting Make A Difference?, David Hughes, Siobhan Mcclelland, Lesley Griffiths
"Cinderella" Services In The Nhs Internal Market:Does Contracting Make A Difference?, David Hughes, Siobhan Mcclelland, Lesley Griffiths
Dalhousie Law Journal
This paper examines the impact of the NHS internal market reforms on an aspect of equity in the British system that features little in recent policy commentary: the allocation of resources between acute services for the entire population and nonacute services for the elderly, the mentally ill, and the disabled (the so-called "Cinderella" services). The authors' research on health planning and contracting in the NHS in Wales suggests that patterns of services have remained largely unchanged, and that pressures in the reformed system, such as the Patient's Charter initiative, prevent any major reallocation of resources away from the acute sector. …
The Impact Of The Purchaser Provider Funding Model Inthe U.K. On The Independence Of Persons With Disabilities:Implications For Canada, Sandra G. Leggat, Gaétan S. Tardif
The Impact Of The Purchaser Provider Funding Model Inthe U.K. On The Independence Of Persons With Disabilities:Implications For Canada, Sandra G. Leggat, Gaétan S. Tardif
Dalhousie Law Journal
Through large-scale system restructuring, a number of jurisdictions around the world have adopted a purchaserprovider approach to the funding and delivery of health care services. In this model, a decision-making body, such as a regional board, is provided with a budget to purchase health care services on behalf of, and in response to the identified needs of a defined population. This paper reviews the purchaser provider funding model of the United Kingdom and comments on the impact of this system on the health needs of individuals with disabilities. Generally, the purchaser provider split in the U.K. appears to have resulted …
Accountability Of Health Service Providers:Comparing Internal Markets And Managedcompetition Reform Models, Colleen M. Flood
Accountability Of Health Service Providers:Comparing Internal Markets And Managedcompetition Reform Models, Colleen M. Flood
Dalhousie Law Journal
A numberof countries, including the U.K., NewZealand, the Netherlands, and the U.S., have attempted to reform their health care systems using "internal market" or "managed competition" reform models. These models signal a departure from reliance on passive indemnity payers or insurers and require proactive purchasers to intervene actively and manage allocation decisions made by physicians. The author explores how these models will ensure the accountability of these new decision-makers to the citizens and patients they ultimately represent. Neither model is found to address accountability issues sufficiently. However, the managed competition model offers the promise of tailoring market (exit), political (voice) …
A Comparative Analysis Of The Reforms In Europeanhealth Care Systems, Thomas Rathwell
A Comparative Analysis Of The Reforms In Europeanhealth Care Systems, Thomas Rathwell
Dalhousie Law Journal
Most countries in Europe are at various stages in the process of reforming their health care systems. Instead of different and more diverse systems emerging, the health reform process has resulted in a convergence on "managed competition" as the only acceptable means for delivering health care. After briefly describing the historical context, this paper examines the nature and scope of the reform process in Europe. The major features of the reforms are cost-containment and a reduction in the role of the state. There have been few systematic attempts to measure the extent to which expectations are being realized. The paper …
Lessons From Away:An Interdisciplinary Collectionof Studies Exploring Whatcanada May Learn From Othercountries' Experiences Withhealth Care Reforms, Colleen M. Flood
Lessons From Away:An Interdisciplinary Collectionof Studies Exploring Whatcanada May Learn From Othercountries' Experiences Withhealth Care Reforms, Colleen M. Flood
Dalhousie Law Journal
The Canadian health care system is considered a shining example of what it is to be Canadian: to aspire to social justice goals and to achieve those goals at a reasonable cost.' Canadians take great pride in that, by any measure, their health care system is superior to the piece-meal, expensive, and unjust U.S. health care system.
Common Problems, Different "Solutions": Learningfrom International Approaches To Improving Medicalservices Access For Underserved Populations, Morris Barer, Laura Wood
Common Problems, Different "Solutions": Learningfrom International Approaches To Improving Medicalservices Access For Underserved Populations, Morris Barer, Laura Wood
Dalhousie Law Journal
Canada shares with most OECD countries the problems associated with inequitable geographic access to physician services, and improving the geographic distribution of physicians is a policy preoccupation of all ministries of health in Canada today. Recent court challenges by newly-entering physicians to physician supply controls in B. C. and New Brunswick have brought the issue into sharp relief. The authors explore the degree to which the provinces have adopted common approaches to addressing these problems, and whether Canadian policy-makers have learned from international experience. The recent judgment in the Waldman case in B.C. is analyzed in terms of likely implications …
Managed Competition Reform In The Netherlandsand Its Lessons For Canada, Frederik T. Schut, Herbert Egm Hermans
Managed Competition Reform In The Netherlandsand Its Lessons For Canada, Frederik T. Schut, Herbert Egm Hermans
Dalhousie Law Journal
This article provides an economic and legal perspective on the managed competition reforms within the Netherlands. After an examination of the rationale and the main features of the reforms, a number of problems and dilemmas that were encountered during the implementation process will be highlighted. The authors conclude that although the logic of the managed competition model is appealing, its implementation is quite complicated and requires a strong government with a continued commitment to set and enforce the rules of competition. If these preconditions are not met, the prospects of a successful introduction of managed competition are bleak. Despite its …
In Search Of Universality, Equity, Comprehensivenessand Competition: Health Care Reform And Managedcompetition In Israel, Carmel Shalev, David Chinitz
In Search Of Universality, Equity, Comprehensivenessand Competition: Health Care Reform And Managedcompetition In Israel, Carmel Shalev, David Chinitz
Dalhousie Law Journal
Israel's ongoing health reform provides lessons regarding attempts to combine universal coverage under national health insurance with a version of managed competition. Based on principles of 'justice, equality and mutual aid," Israel's National Health Insurance Law, 1994 guarantees access to a broad basket of basic services to be provided by four competing sick funds, and the availability of resources adequate to finance the basket. The new rights of citizens to universal coverage and to move freely among sick funds constituted a major policy breakthrough. However, successive amendments to the Law reflect continuing controversy over the amount of resources required to …