Adam Oliver

Equity of access to health care: outlining the foundations for action

The Ministers of Health from Chile, Germany, Greece, New Zealand, Slovenia, Sweden, and the United Kingdom recently established The International Forum on Common Access to Health Care Services, based on a common belief that their citizens should enjoy universal and equitable access to good quality health care. The ministers intend to form a network to share thinking and evidence on healthcare improvements, with the specific aim of sustaining and promoting equitable access to health care. Despite a vast literature on the notion of equity of access, little agreement has been reached in the literature on exactly what this notion ought to mean. This article provides a brief description of the relevance of the access principle of equity, and summarises the research programme that is necessary for turning the principle into a useful, operational policy objective.

Using financial incentives to achieve healthy behaviour

Paying people to change their behaviour can work, at least in the short term. However, as Theresa Marteau, Richard Ashcroft, and Adam Oliver explain, there are many unanswered questions about this approach

Health technology assessment and its influence on health-care priority setting

In this article, we review the development of health technology assessment (HTA) in England and Wales, France, The Netherlands, and Sweden, and we summarize the reaction to these developments from a variety of different disciplinary and stakeholder perspectives (political science, sociology, economics, ethics, public health, general practice, clinical medicine, patients, and the pharmaceutical industry). We conclude that translating HTA into policy is a highly complex business and that, despite the growth of HTA over the past two decades, its influence on policy making, and its perceived relevance for people from a broad range of different perspectives, remains marginal.

The Veterans Health Administration: An American Success Story?

The Veterans Health Administration (VHA) provides health care for U.S. military veterans. By the early 1990s, the VHA had a reputation for delivering limited, poor-quality care, which led to health care reforms. By 2000, the VHA had substantially improved in terms of numerous indicators of process quality, and some evidence shows that its overall performance now exceeds that of the rest of U.S. health care. Recently, however, the VHA has started to become a victim of its own success, with increased demands on the system raising concerns from some that access is becoming overly restricted and from others that its annual budget appropriations are becoming excessive. Nonetheless, the apparent turnaround in the VHAs performance offers encouragement that health care that is both financed and provided by the public sector can be an effective organizational form.

From Nudging to Budging: Using Behavioural Economics to Inform Public Sector Policy

The use of behavioural economics to inform policy has over recent years been captured by those who advocate nudge interventions. Nudge is a non-regulatory approach that attempts to motivate individual behaviour change through subtle alterations in the choice environments that people face. It is argued in this article that government interventions ought to be more overt than that traditionally advocated by nudge adherents, and that governments should principally attempt to influence behaviour if the acts of those targeted are causing harm to others. With this in mind, governments can use the findings of behavioural economics, including present bias and loss aversion, to inform where and how to regulate directly against undesirable private sector activities. This behavioural economic-informed method of regulation is hereby termed budge, to indicate that, rather than nudging citizens, behavioural economics might be used more appropriately in the public sector to help inform regulation that budges harmful private sector activities.

European health systems reforms: looking backward to see forward?

In this article we outline the different schools of new institutionalism and a few other selected political science theories. Moreover, we relate the insights offered by a series of analyses of health sector change in a large number of European countries over the past twenty to thirty years to these theoretical frameworks. Our main conclusion is that it is unlikely that a single explanatory theory will ever be able to account for all of the health sector developments in any one country, let alone across many countries with diverse cultures, histories, institutions, and interest groups. Consequently, a real understanding of health sector change will require a recognition that different theoretical approaches will be more (or less) appropriate in some circumstances than in others.

Public-sector health-care reforms that work? A case study of the US Veterans Health Administration

The Veterans Health Administration (VHA) is the largest integrated health-care system in the USA, and provides public-sector care for honourably discharged veterans of the US armed forces. The panel sets out eligibility criteria for the VHA. The system is financed mostly from general taxation and can be characterised as a veteran-specific national health service. Since the 1970s, the quality of service provided by the VHA had been regarded as poor by almost all relevant stakeholders. However, in the past few years, the academic and popular press have reported a turnaround in the VHAs performance. This improvement can be attributed to a set of reforms that were gradually introduced from 1995. What could policy makers in other health-care systems learn from the VHAs story?

A Consideration of User Financial Incentives to Address Health Inequalities

Health inequalities and user financial incentives to encourage health-related behavior change are two topical issues in the health policy discourse, and this article attempts to combine the two; namely, we try to address whether the latter can be used to reduce the former in the contexts of the United Kingdom and the United States. Payments for some aspects of medical adherence may offer a promising way to address, to some extent, inequalities in health and health care in both countries. However, payments for more sustained behavior change, such as that associated with smoking cessation and weight loss, have thus far shown little long-term effect, although more research that tests the effectiveness of different incentive mechanism designs, informed by the findings of behavioral economics, ought to be undertaken. Many practical, political, ethical, and ideological objections can be waged against user financial incentives in health, and this article reviews a number of them, but the justifiability of and limits to these incentives require more academic and public discourse so as to gain a better understanding of the circumstances in which they can legitimately be used.

A case for the adoption of pharmacoeconomic guidelines in Japan.

In recent years, more and more Japanese pharmaceutical companies have been submitting pharmacoeconomic data to the government. following the official request that such data may help in setting pharmaceutical prices. The companies have cooperated because. by doing so. they could influence pricing decisions for new products. However, the quality of these data at present is considered to be poor and heavily biased.The introduction of pharmacoeconomic guidelines that outline a set of standardised factors to be included in evaluations are necessary, so that an appropriate comparison of the cost effectiveness of the many new drugs that are introduced into the Japanese market each year can be made. In addition to supporting the development of standardised guidelines, the Ministry of Health and Welfare should clarify how pharmacoeconomic data are to be used to aid policy decisions and also mandate the publication of pharmacoeconomic data.

Can financial incentives improve health equity

Evidence shows that they might, if targeted appropriately