Introduction

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Consumer-Driven Health Plans: New Developments and the Long Road Ahead

The continued rise in U.S. healthcare spending, along with growth in the number of uninsured, has spurred the move toward consumer-driven health plans. We review new legislation covering such plans, analyze their penetration in the marketplace, and predict their growth. We also use current information about plans that are compatible with Health Savings Accounts to compare them to traditional Preferred Provider Organization plans. Next, we discuss some concerns about the impact of these plans on vulnerable populations, such as the poor and sick. Finally, we suggest how consumer-driven health plans may help to improve the functioning of the healthcare market, especially by producing more transparent information on cost and quality. JEL Classification I110, I180     

Examining Medical Decision Making from a Marketing Perspective

This paper explores how consideration of the medical context can add newelements to marketing thought. Differences between the medical context andother consumer contexts are reviewed. The effects that the medical contexthas on the way traditional constructs such as involvement, affect andstress, uncertainty and satisfaction affect choice are discussed. Finally,emerging research in medical contexts where future discoveries could enhanceconsumer choice theory are presented.     

Incommensurate paradigms? Bridging the divide between technocrats and the lay public in health care planning: recent experience from Wales

The pressure on the UK National Health Service (NHS) to increase public involvement in the planning of future services has never been greater. Politicians and others argue that ‘lay wisdom’ has much to contribute, and that such involvement is essential if public confidence in the service is to be maintained. Many managers and clinicians, however, operating within an essentially technocratic paradigm, remain unconvinced. Their views are often reinforced by a lack of experience of methods for public involvement that can meet the many practical difficulties involved. Using Arnstein’s ‘ladder of citizen participation’, this paper describes the principal nuances of these two paradigms, explores the nature of the conflict between them, and assesses the extent to which they are really incommensurate. It then briefly describes some of the key methodological principles emerging from public involvement work in parts of the NHS in Wales, and assesses their potential to bridge the divide between the paradigms.     

Globalization and sustainable consumption of shrimp: consumers and governance in the global space of flows

The ongoing process of globalization in food provision is transforming the relationships between producers and consumers as well as the conventional role of governments in regulating the environment. Consumers are increasingly concerned about the environmental and social impacts of food production in developing countries and many are willing to take action. Conceptualizing globalization as the coming about of the network society offers an adequate basis for analysing transitions in food governance including new ways of consumer involvement. The case of shrimp produced through aquaculture in Thailand and consumed worldwide shows how innovative food governance arrangements appear in the context of global modernity. Authority and power in such arrangements are shifting away from national governments and towards producers, processors, traders and consumers along the supply chain.     

A critical review of primary health care reform in Bulgaria: impact on consumers

The Health Care System in Bulgaria is in a period of transition and is undergoing profound changes in financing, organization and ownership. A priority of this reform is to shift the focus of healthcare to the primary sector and to emphasize general practice. New legislation in support of this health care reform has been passed over the last few years. However, this legislation, although consistent with the global aims to be achieved, has proven to be contradictory in terms of its practical implementation. This has had a negative impact on health care consumers’ interests and rights. This paper evaluates the effects of primary health care reform in Bulgaria from the perspective of patient satisfaction. For this purpose, a major task to be fulfilled is to identify the contradictions emerging between the legislation outlining the reforms and the realities of practical implementation with respect to its impact on consumers. The methods applied include: a review of the legislation, a review of the practical progression of the reform process, and an assessment of the new developments in health care consumers’ interests and rights. Considerable contradictions have been found between the legal framework of health care reform in primary care and existing experiences, traditions and expectations. The legislation is inconsistent with the existing realities of healthcare provision. This is leading to turmoil in the health care system during its present transformation and is infringing upon consumers’ rights. Problems emerging in the process of reform need to be identified, and solutions need to be found and worked out as the reforms progress. An assessment system has to be developed to monitor the overall reform process and to evaluate the effectiveness and efficiency of the changes introduced. The impact on consumer and patient satisfaction should be an area of prime concern during these assessments.