Delhi's health system exceptionalism: inadequate progress for a global capital city.

OBJECTIVES: India has proclaimed commitment to the goal of Universal Health Coverage and Delhi, the National Capital Territory, has increased investment in public health and other health services over the past decade. The research investigates whether Delhi's increased investment in health over this period is associated with a reduction in premature deaths, after the age of 1 year, which could have been avoided with better access to effective health care interventions (amenable mortality). STUDY DESIGN: A population-based study of changes in amenable mortality (AM) in Delhi over the 2003-2013 period. METHODS: To calculate AM, a list of International Classification of Disease (ICD) codes from the published literature was relied upon. In defining AM in India, an upper age limit of 69 years was adopted, rather than the more common limit of 74 years. Population estimates and vital statistics were downloaded from the Delhi Statistical Handbook. Deaths by cause and age, including medical certification, are from the Vital Statistics site of the Delhi Government. To age-adjust these data, the direct method was employed, using weights derived from the 2010 United Nations world standard population. RESULTS: The research found that, between 2004 and 2013, the age-adjusted rate of AM rose from 0.87 to 1.09. The leading causes of death in both years were septicemia and tuberculosis. Maternal mortality is well above the global level for middle-income countries. CONCLUSION: Recent investments in public health and health care and the capacity to leverage them to improve access to effective care have not been sufficient to overcome the crushing poverty and inequalities within Delhi. Large and growing numbers of residents die prematurely each year due to causes that are amenable to public health and health care interventions.

The once and future health system in the former Yugoslavia: myths and realities.

This paper debunks three widely believed myths about the former Yugoslavia's health care system: that it was characterized by: (1) social ownership of "self-managing" provider organizations; (2) a commitment to primary health care; and (3) a faith in what might be called the "march of progress"--the health system's continuous expansion and improvement. In contrast to this picture, we present an alternative view and conclude with a word of caution for American consultants and health care reformers in Eastern European countries and newly independent states: If universal health coverage is to be maintained, beware of reforms that do no more than substitute private for public organizational forms.

Health care under French national health insurance.

Several elements of the French health system--the predominance of office-based medical practice, the mix of private and public hospitals, the use of patient cost sharing, direct payment of physicians by patients, and financing derived from payroll taxes--closely resemble aspects of the U.S. health system. There are four major differences between the two systems: the French system covers more than 99 percent of the population; the prices of health services in French are lower than in the United States; the volume of most services is higher than in the United States; and French health care spending per capita is lower than in the United States. Recently enacted and proposed reforms in France likely will strengthen existing health spending targets and utilization controls.

Updating the fee schedule for physician reimbursement: a comparative analysis of France, Germany, Canada, and the United States.

Based on an analysis of the fee schedule update process in France, the Federal Republic of Germany and Canada, this article draws a number of inferences and interpretations and concludes with a discussion of the major weaknesses and strengths of the United States.

The marriage of national health insurance and la médicine libérale in France: a costly union.

In France, as in the United States, the problems of controlling health care costs are seemingly intractable. The incongruity of private provision with public financing is traced to adherence to competing and contradictory policies-solidarity and liberal-pluralism. This "marriage" of ideologies has been costly, and efforts to stem rising prices have resulted in political stalemate.