Efficiency in Matching Markets with Regional Caps: The Case of the Japan Residency Matching Program

In an attempt to increase the placement of medical residents to rural hospitals, the Japanese government recently introduced "regional caps" which restrict the total number of residents matched within each region of the country. The government modified the deferred acceptance mechanism incorporating the regional caps. This paper shows that the current mechanism may result in avoidable ineffciency and instability and proposes a better mechanism that improves upon it in terms of effciency and stability while meeting the regional caps. More broadly, the paper contributes to the general research agenda of matching and market design to address practical problems.medical residency matching, regional caps, the rural hospital theorem, sta- bility, strategy-proofness, matching with contracts

Are incentives everything? payment mechanisms for health care providers in developing countries

This paper assesses the extent to which provider payment mechanisms can help developing countries address their leading health care problems. It first identifies four key problems in the health care systems in developing countries: 1) public facilities, which provide the bulk of secondary and tertiary health care services in most countries, offer services of poor quality; 2) providers cannot be enticed to rural and urban marginal areas, leaving large segments of the population without adequate access to health care; 3) the composition of health services offered and consumed is sub-optimal; and 4) coordination in the delivery of care, including referrals, second opinions, and teamwork, is inadequate. The paper examines each problem in turn and assesses the extent to which changes in provider payments might address it.Health Economics&Finance,Health Systems Development&Reform,Public Health Promotion,Health Monitoring&Evaluation,Early Child and Children's Health,Health Monitoring&Evaluation,HealthEconomics&Finance,Health Systems Development&Reform,Environmental Economics&Policies,Housing&Human Habitats

Effects of the New Cooperative Medical Scheme on village doctor’s prescribing behaviour in Shandong Province

Objective: To assess the effects of China’s new community health insurance, the New Cooperative Medical Scheme (NCMS), on village doctors’ prescribing behaviour. NCMS began in 2003. Method, In 2005 we conducted a quasi-experimental case-control study in Shandong Province, and collected information from 2,271 patient visits in 30 village health stations. Results, NCMS has adversely influenced prescribing behaviour of village doctors. Average number of drugs prescribed, percentage of prescriptions containing antibiotics, number of antibiotics per prescription, percentage of patients given injections, and average per prescription cost were consistently higher in NCMS village health stations than non-NCMS. Within NCMS villages, prescribing behaviour towards insured patients was significantly different to the uninsured. Conclusion, Over-prescribing is common in villages with and without health insurance, with grave concerns for service quality and drug-use safety. Policy implications are NCMS should be redesigned to exert more influence on health providers, with incentives for cost containment and service quality. Stricter regulatory environment for prescriptions is necessary to counter irrational drug-use and ensure people’s access to effective care at reasonable cost.

To Reform Medicare, Reform Incentives and Organization

Alain C. Enthoven's paper, To Reform Medicare, Reform Incentives And Organization, explains how the principles of cost-responsible consumer choice among competing health-insurance plans, sometimes called "managed competition," can both improve quality and reduce cost in the federal government's Medicare program

Changing healthcare systems in Asia

Outline of key changes in healthcare systems in Asia including company developments and trade union action

Managing Equipment for Emergency Obstetric Care in Rural Hospitals

In resource poor countries substantial sums of money, from governments and international donors, are used to purchase equipment for health facilities. WHO estimates that 50-80% of such equipment remains non-functional. This article is based on the experiences from various projects in developing countries in Asia and Africa. The key issues in the purchase, distribution, installation, management and maintenance of equipment for emergency obstetric care (EmOC) services are identified and discussed. Some positive examples are described to show how common equipment management problems are solved.

Privatisation of ambulance, emergency and firefighting services in Europe – a growing threat?

This paper examines the extent of privatisation in the ambulance, emergency and firefighting services in Europe, and the companies involved

International Profiles of Health Care Systems

Compares the healthcare systems of Australia, Canada, Denmark, England, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the United States, including spending, use of health information technology, and coverage

The impacts of corporatisation of healthcare on medical practice and professionals in Maharashtra, India

A heterogeneous private sector dominates healthcare provision in many middle-income countries. In India the contemporary period has seen this sector undergo corporatisation processes characterised by emergence of large private hospitals and the takeover of medium-sized and charitable hospitals by corporate entities. Little is known about the operations of these private providers and the effects on healthcare professions as employment shifts from practitioner-owned small and medium hospitals to larger corporate settings. This article uses data from a mixed-methods study in two large cities in Maharashtra, India, to consider the implications of these contemporary changes for the medical profession. Data were collected from semi-structured interviews with 43 respondents who have detailed knowledge of healthcare in Maharashtra, and from a witness seminar on the topic of transformation in Maharashtra’s healthcare system. Transcripts from the interviews and witness seminar were analysed thematically through a combination of deductive and inductive approaches. Our findings point to a restructuring of medical practice in Maharashtra as training shifts towards private education and employment to those corporate hospitals. The latter is fuelled by substantial personal indebtedness, dwindling appeal of government employment, reduced opportunities to work in smaller private facilities, and the perceived benefits of work in larger providers. We describe a ‘re-professionalisation’ of medicine encompassing changes in employment relations, performance targets and constraints placed on professional autonomy within the private healthcare sector, that is accompanied by trends in cost inflation, medical malpractice, and distrust in doctor-patient relationships. The accompanying ‘re-stratification’ within this part of the profession affords prestige and influence to ‘star doctors’ while eroding the status and opportunity for young and early career doctors. The research raises important questions about the role that government and medical professionals’ bodies can, and should, play in contemporary transformation of private healthcare, and the implications of these trends for health systems more broadly