The Institute for Global Health and Development
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Item Healthcare human resources in crisis? : what Commonwealth countries can contribute towards a solution.(Henley Media Group in association with the Commonwealth Secretariat, 2007-05) McPake, BarbaraItem Two-tier charging strategies in public hospitals : implications for intra-hospital resource allocation and equity of access to hospital services(2007) McPake, Barbara; Hanson, Kara; Adam, ChristopherTwo-tier charging, the practice of offering separate qualities of service at different prices, is a growing practice in public hospitals internationally. This paper models two-tier charging as a Stackelberg game in which the Ministry of Health leads by setting prices and a representative hospital follows by setting quality levels to maximise surplus in response. Whether or not two-tier charging will secure cross-subsidy from superior to basic service users depends on the own and cross-quality effects of the demand functions for the two services. Under a range of assumptions, the policy will evoke cross-subsidy from basic to superior services.Item Making choices between prepayment and user charges in Zambia: What are the results for equity?(2007-11-23) Kondo, Masahide; McPake, BarbaraIn many low-income countries, user charges were introduced in the 1990s. As problems emerged of equity of access, interest grew in developing prepayment mechanisms to protect users from risk of out-of-pocket payments. In Zambia, a prepayment scheme did not generate sufficient revenue, due to abuses of its terms. An alternative scheme using discount cards (a set of coupons to cover episodes of care at discount) was devised. We aimed to understand the equity implications of prepayment and discount cards relative to user charges. We proposed models predicting roles of income, perceived health status, perceived quality of care and time preference in choice of payment mechanism and use of health services. We tested these models using three data sets that could be accessed or collected. It is concluded that relative to user charges, prepayment may facilitate access without incurring income-related equity losses. Evidence concerning discount cards was weaker. We concluded that they facilitate access to a lesser extent. Discount cards offer a credible intermediate solution between user charges and prepayment that avoid some problems associated with prepayment. However, since prepayment seems to be associated with the most positive outcomes, finding other solutions to their problems would be preferred. Copyright 2007 John Wiley & Sons, Ltd.Item Improving maternal health : getting what works to happen(Elsevier, 2007-11) Penn-Kekana, Loveday; McPake, Barbara; Parkhurst, JustinMaternal mortality reduction in many countries is unlikely despite the availability of inexpensive, efficacious interventions that are part of official policy. This article explores the reasons why, based on research on maternity services in Bangladesh, Russia, South Africa and Uganda. A simple dynamic responses model shows that the key to understanding challenges in implementation lies in the reflexive, complex and dynamic responses of health workers and community members to policies and programmes. These responses are dynamic- in that they arise due to forces from within and outside the system, and in turn exert forces of their own. They result in the difference between the health system that is envisaged in policy, and what is implemented by health workers and experienced by users. Programmes aiming to improve maternal health are not only technical but also social interventions that need to be evaluated as such, using methodologies that have been developed for evaluating complex social interventions whose aim is to bring about change. The components of effective programmes have been defined globally. However, in getting what works to happen, context matters. Thus, technical advisors need to give advice- more circumspectly, local programme managers must be capacitated to make programme-improving adjustments continuously, and the detail related to process, not just outcomes, must be documented in evaluations.Item Health economics : an international perspective(Taylor & Francis(Routledge), 2007) McPake, Barbara; Normand, CharlesBeginning with a look into simple models of supply and demand within health care, this key text moves on to techniques of cost-benefit analysis, and then compares differing health care systems around the world. Featuring an array of case studies based on systems from around the world, the book successfully bridges the divide between the insurance-based system employed in the United States, the publicly funded options more common in Europe and Canada, and the mixed arrangements characteristic of most developing countries. This informative textbook, essential for students on the ever-growing number of health economics courses internationally, will also be useful in other areas, such as public health studies, medicine and health science.Item Chapter 6: Human resources and the health sector(Oxford University Press, 2011-11) McPake, Barbara; Hanson, Kara; Smith, Richard