A review of the ‘welfare state’ and alternative ways of delivering health care

Abstract

There was no such thing as a public policy for quality health care in the inception of what we now address as the 'welfare state'. The main objectives of those supporting the idea, epitomized by the 'freedom from want' that Beveridge postulated in his now famous November 1942 Report on Social Insurance and Allied Services, was to extend the benefits of social insurance, that is access to services such as health care, to every individual. In the same fashion, post World War II initiatives in Latin America somewhat disregarded the intrinsic quality of health care services, provided they were distributed equally, at least among the urban people. Therefore, it is licit to ascertain that the main, albeit implicit, quality feature of health care was access, that is the ability to reach the entire population with the available services. The health care reform movement following the welfare state crisis, from the Jackson Hole group and Einthoven's managed competition in the United States to the internal markets proposals in different European countries, started when universal coverage had been achieved where it had been pursued, and disregarded elsewhere. In other words, access as a measure of health care quality was not the point. Instead, the subject of both academic research and administrative initiatives was the quality of the health services effectively provided to the population. Furthermore, the World Health Organization in its World Health Report 2000 explicitly excluded access as an item to be assessed in the process of evaluating health systems, although many countries had not achieved, nor were even near, universal coverage. Therefore, notwithstanding the relevance of the continuous quality improvement of the health services actually delivered to the people, access should always be the first quality concern to those health systems lacking universal coverage of the population they are supposed to serve.

Publics’ Perceptions of Community Pharmacists and Satisfaction with Pharmacy Services in Al-Madinah City, Saudi Arabia: A Cross Sectional Study

“…Patient satisfaction is one of the indicators of the quality of medical and pharmacy services provided in health care settings. Several studies have investigated patient satisfaction and attitudes toward community pharmacy services [ 24 , 43 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 ]. These studies revealed that satisfaction with community pharmacy services was greatly dependent on several factors, including the location of the community pharmacy, the promptness of services, and the pharmacist’s knowledge.…”

Health Care Privatization in Latin America: Comparing Divergent Privatization Approaches in Chile, Colombia, and Mexico

“…This framework, inspired by Otto von Bismarck's social reforms in nineteenthcentury Germany, introduced compulsory employer, employee, and government contributions to finance social insurance programs in different Latin American countries (Mera 2002). Social security initially included civil and other public servants, then other urban workers and later their dependents.…”

“…Social security initially included civil and other public servants, then other urban workers and later their dependents. This health care organization model was expected to reach universal coverage once the benefits of economic modernization trickled down to the majority of the population (Mera 2002). To provide limited health care coverage to individuals who remained ineligible for social security benefits (i.e., those who worked in the informal economic sector and their dependents), governments in the region created safety nets administered by national or regional governments (Barrientos and Santibanez 2009).…”

Pricing behaviour of pharmacies after market deregulation for OTC drugs: The case of Germany

“…These variables include the sales volumes of the respective drugs in each pharmacy as the basis for bulk discounts; one-time offers or special bonus programmes; quality of service delivery, as higher prices might be a result of the pharmacists' efforts to provide additional consulting services to compensate for higher labour costs; and storage costs resulting from the number of OTC products in stock [20].…”