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Berkowitz O, Hooker RS, Nissanholtz-Gannot R, Zigdon A. Israeli Willingness to be Treated by a Physician Assistant. J Community Health 2020; 45:1283-1290. [DOI: 10.1007/s10900-020-00835-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Rao A, Dhahri AA, Razzaq H, Mokhtari E, Majeed A, Patel A. Algorithm-Based Online Software for Patients' Self-Referral to Breast Clinic as an Alternative to General Practitioner Referral Pathway. Cureus 2020; 12:e11740. [PMID: 33274168 PMCID: PMC7707138 DOI: 10.7759/cureus.11740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction The study aimed to assess the accuracy of online software in the use of self-referral to breast surgery clinics for patients with new signs and symptoms. The study also evaluated the appropriateness of GP referrals to breast clinics and evaluated patients' perceptions of an online self-referral portal to the breast clinic for the assessment of breast signs and symptoms. Design and methods The pilot study was divided into two phases. In the first phase, prospective questionnaire-based data was collected from patients who were referred by a GP and presented to the regional breast unit with new signs and symptoms for breast conditions, Princess Alexandra Hospital NHS Trust (May - October 2018). The questionnaire assessed the time at each stage required by the patient to have a visit at the breast unit. It also asked the patient's opinion about an online self-referral portal to the surgical clinic. They were given hypothetical scenarios to evaluate their understanding of breast conditions. In the second phase, the patients presenting to symptomatic breast clinics were provided with the iPad to fill in their medical information in the online software. The data was collected between July and October 2019. The software algorithm was based on the National Institute of Clinical Health and Excellence (NICE) guidelines for breast conditions (2015). Breast surgeons’ recommendations acted as a standard to evaluate the accuracy of GPs' referrals and software outcome for each patient. Results There were 80 patients (mean age 49.1 [SD: 17.7], all females) included in the first phase of the study. The most common clinical presentation was a breast lump (47.6%), followed by breast pain (26.9%) and nipple changes (7.9%). Breast surgeons considered appropriate 75.6% of the referrals made by the GP. Seventy-two percent of the patients got an urgent appointment to see their GP, and 94.8% of the patients were urgently referred by their GP to see the breast surgeon. Only 37.8% of the urgent referrals were correctly referred as urgent. Having a direct online referral system for breast conditions will be beneficial for patients was agreed by 78.4%. The majority (98.1%) of the participants answered correctly for the hypothetical questions requiring breast surgeon review. In the second phase, there were a total of 86 patients with a mean age of 43.9 (SD: 13.3). The most common presentation was breast lump (n=68, 79.1%) and other presentations included breast pain, nipple changes, and discharge. The GPs' accuracy of correct referral was 69.1%. One third (30.9%) of the referrals could have been managed in the community or as a routine review by the breast surgeon. In comparison, the online software's accuracy was 85.1% accurate (p=0.001). The accuracy for detecting patients who needed urgent breast clinic review was 100% for online software. Conclusion A large proportion of referrals could have been dealt with in the community or referred routinely. Patients would prefer a direct online referral system to the breast clinic. They understand red flag signs and symptoms. Online software has the potential to streamline patients for symptomatic breast clinics. It can reduce the burden on the GPs who are constantly under pressure to diagnose patients accurately and refer to the correct specialty appropriately within a short time.
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Affiliation(s)
- Ahsan Rao
- Breast Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, London, GBR
| | | | - Humayun Razzaq
- General Surgery, Southend University Hospital, Southend-on-Sea, GBR
| | - Eshagh Mokhtari
- Breast Surgery, Princess Alexandra Hospital NHS Trust, Harlow, GBR
| | - Azeem Majeed
- Primary Care and Public Health, Imperial College London School of Public Health, London, GBR
| | - Ashraf Patel
- Breast Surgery, Princess Alexandra Hospital NHS Trust, Harlow, GBR
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Bashir S, Nasir M. Tradeoff between efficiency and perceived quality: evidence from patient-level data. Int J Qual Health Care 2020; 32:591-598. [DOI: 10.1093/intqhc/mzaa098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Revised: 07/29/2020] [Accepted: 08/18/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
To estimate technical efficiency scores of District Headquarter Hospitals (DHQHs) for obstetric services and to explore the relationship between the efficiency of DHQHs and the patients’ satisfaction about the quality of services provided.
Design, Setting and Participants
Data from Health Facility Assessment (HFA) survey is used for efficiency measurement. The data on patient’s perceptions and other control variables are taken from Client Exit Interviews part of the HFA survey. Two-stage residual inclusion, Ordered Logistic Regression and Least square dummy variable techniques are used to investigate the relationship between technical efficiency and patients’ satisfaction level.
Main Outcome Measure(s) and Results
The average efficiency score for Pakistan’s DHQHs is 0.52, and not a single hospital is fully efficient. Moreover, the relationship between technical efficiency and patients’ satisfaction is found to be negative and statistically significant indicating that an increase in hospital efficiency tends to decrease patients’ satisfaction. The disaggregated analysis reveals that patients’ satisfaction associated with the healthcare provider attitude and communication is more affected by technical efficiency.
Conclusion
Patients’ satisfaction level is more sensitive to physician’s attitude and communication. This makes sense because the longer the consultation time, the more accurate the diagnosis would be. This, together with a comforting and confident physician, is likely to achieve better patients’ satisfaction.
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Affiliation(s)
- Saima Bashir
- Pakistan Institute of Development Economics Quaid-i-Azam University Campus, Islamabad 44000, Pakistan
| | - Muhammad Nasir
- Pakistan Institute of Development Economics Quaid-i-Azam University Campus, Islamabad 44000, Pakistan
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Lv Y, Fu Q, Shen X, Jia E, Li X, Peng Y, Yan J, Jiang M, Xiong J. Treatment Preferences of Residents Assumed to Have Severe Chronic Diseases in China: A Discrete Choice Experiment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228420. [PMID: 33203010 PMCID: PMC7697856 DOI: 10.3390/ijerph17228420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022]
Abstract
Objectives: This study aims to elicit the relative importance of treatment attributes that influence residents’ choice, assuming they are suffering severe non-communicable diseases (NCDs), to explore how they make trade-offs between these attributes and to estimate the monetary value placed on different attributes and attribute levels. Methods: A discrete choice experiment (DCE) was conducted with adults over 18 years old in China. Preferences were evaluated based on four treatment attributes: care provider, mode of service, distance to practice and cost. A mixed logit model was used to analyze the relative importance of the four attributes and to calculate the willingness to pay (WTP) for a changed attribute level. Results: A total of 93.47% (2019 of 2160) respondents completed valid questionnaires. The WTP results suggested that participants would be willing to pay CNY 822.51 (USD 124.86), CNY 470.54 (USD 71.41) and CNY 68.20 (USD 10.35) for services provided by experts, with integrated traditional Chinese medicine (TCM) and Western medicine (WM) and with a service distance <=30 min, respectively. Conclusions: The results suggested that mode of service, care provider, distance to practice and cost should be considered in priority-setting decisions. The government should strengthen the curative service capability in primary health facilities and give full play to the role of TCM in the prevention and treatment of severe chronic diseases.
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Affiliation(s)
- Yinghao Lv
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.L.); (X.S.); (E.J.); (X.L.); (Y.P.); (J.Y.); (M.J.)
| | - Qiang Fu
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St Louis, MO 63103, USA;
| | - Xiao Shen
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.L.); (X.S.); (E.J.); (X.L.); (Y.P.); (J.Y.); (M.J.)
| | - Erping Jia
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.L.); (X.S.); (E.J.); (X.L.); (Y.P.); (J.Y.); (M.J.)
| | - Xianglin Li
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.L.); (X.S.); (E.J.); (X.L.); (Y.P.); (J.Y.); (M.J.)
| | - Yingying Peng
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.L.); (X.S.); (E.J.); (X.L.); (Y.P.); (J.Y.); (M.J.)
| | - Jinghong Yan
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.L.); (X.S.); (E.J.); (X.L.); (Y.P.); (J.Y.); (M.J.)
| | - Mingzhu Jiang
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.L.); (X.S.); (E.J.); (X.L.); (Y.P.); (J.Y.); (M.J.)
| | - Juyang Xiong
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.L.); (X.S.); (E.J.); (X.L.); (Y.P.); (J.Y.); (M.J.)
- Correspondence:
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Has a critical mass of women resulted in gender equity in gynecologic surgery? Am J Obstet Gynecol 2020; 223:665-673. [PMID: 32585225 DOI: 10.1016/j.ajog.2020.06.038] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/29/2020] [Accepted: 06/18/2020] [Indexed: 11/23/2022]
Abstract
Gender equity in medicine and surgery has recently received widespread attention. Unlike surgical specialties that remain predominantly male, the majority of obstetrician-gynecologists have been women for nearly a decade, and women have composed the majority of trainees since the 1990s. Despite a critical mass of women, biases related to gender persist in the field. Professional and behavioral expectations of men and women gynecologists remain different for patients and workplace colleagues. Gender discrimination and sexual harassment are still experienced at high rates by both trainees and obstetrician-gynecologists in practice. In addition, in other surgical fields, women gynecologic surgeons face a gender wage gap that is unexplained by differences in experience, hours worked, or subspecialty training. Academic advancement and the attainment of leadership positions remain a challenge for many women. Policies related to pregnancy and parenting may disproportionately affect the careers of women gynecologists. This article presents peer-reviewed evidence relevant to gender equity in the workplace and suggests proactive interventions to ensure diversity and inclusion for gynecologic surgeons.
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Eye Care Provider Availability for the Medicare Population in U.S. States That Have Expanded Optometrist Scope of Practice. Optom Vis Sci 2020; 97:929-935. [PMID: 33110024 DOI: 10.1097/opx.0000000000001599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE Estimating a broader set of measures of local eye care provider availability than used in prior research offers information that is useful for policy decisions related to access to eye care. PURPOSE The purpose of this study was to examine whether policy-relevant information was gained when measures of local eye care provider availability in addition to the estimated travel time (ETT) to the closest provider were estimated for the population 65 years or older in Kentucky, New Mexico, and Oklahoma. These states have expanded surgical scope of practice for optometrists. METHODS This study used block group-level population data from the 2010 U.S. Decennial Census and eye care provider office address information from the 2016 Medicare Provider Utilization and Payment Data. Geographic information system analysis was used to calculate ETTs between individuals and eye care providers. Expanded measures of availability included the difference in ETT to an individual's second closest and closest ophthalmologist, the difference in ETT to an individual's closest ophthalmologist and closest optometrist, and whether only one ophthalmologist at the closest office accepted Medicare. Descriptive statistics were calculated for each state and by urbanicity. RESULTS Of the population 65 years or older in each state, between 10.8 (Kentucky) and 16.6% (Oklahoma) had a one-way ETT to the second closest ophthalmologist >15 minutes longer than to the closest ophthalmologist, between 21.1 (Kentucky) and 27.6% (Oklahoma) had a one-way ETT to the closest ophthalmologist >15 minutes longer than to the closest optometrist, and between 56.4 (Kentucky) and 70.0% (Oklahoma) had only one ophthalmologist at the closest office who accepted Medicare. Findings differed substantially by urbanicity. CONCLUSIONS Using a portfolio of travel time-based measures enhances the understanding of local eye care provider availability.
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Arslan IG, Huls SPI, de Bekker-Grob EW, Rozendaal R, Persoons MCT, Spruijt-van Hell ME, Bindels PJE, Bierma-Zeinstra SMA, Schiphof D. Patients', healthcare providers', and insurance company employees' preferences for knee and hip osteoarthritis care: a discrete choice experiment. Osteoarthritis Cartilage 2020; 28:1316-1324. [PMID: 32682071 DOI: 10.1016/j.joca.2020.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine patients', healthcare providers', and insurance company employees' preferences for knee and hip osteoarthritis (KHOA) care. DESIGN In a discrete choice experiment, patients with KHOA or a joint replacement, healthcare providers, and insurance company employees were repetitively asked to choose between KHOA care alternatives that differed in six attributes: waiting times, out of pocket costs, travel distance, involved healthcare providers, duration of consultation, and access to specialist equipment. A (panel latent class) conditional logit model was used to determine preference heterogeneity and relative importance of the attributes. RESULTS Patients (n = 648) and healthcare providers (n = 76) valued low out of pocket costs most, while insurance company employees (n = 150) found a joint consultation by general practitioner (GP) and orthopaedist most important. Patients found the duration of consultation less important than healthcare providers and insurance company employees did. Patients without a joint replacement were likely to prefer healthcare with low out of pocket costs. Patients with a joint replacement and/or low disease-specific quality of life were likely to prefer healthcare from an orthopaedist. Patients who already received healthcare for knee/hip problems were likely to prefer a joint consultation by GP and orthopaedist, and direct access to specialist equipment. CONCLUSIONS Patients, healthcare providers, and insurance company employees highly prefer a joint consultation by GP and orthopaedist with low out of pocket costs. Within patients, there is substantial preference heterogeneity. These results can be used by policy makers and healthcare providers to choose the most optimal combination of KHOA care aligned to patients' preferences.
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Affiliation(s)
- I G Arslan
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
| | - S P I Huls
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands; Erasmus Choice Modelling Centre, Erasmus University, Rotterdam, the Netherlands
| | - E W de Bekker-Grob
- Erasmus School of Health Policy & Management, Erasmus University, Rotterdam, the Netherlands; Erasmus Choice Modelling Centre, Erasmus University, Rotterdam, the Netherlands
| | - R Rozendaal
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - M C T Persoons
- CZ Health Insurance, Innovation and Advice, Tilburg, the Netherlands
| | | | - P J E Bindels
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Orthopaedics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
| | - D Schiphof
- Department of General Practice, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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Tsai TH, Huang N, Lin IF, Chou YJ. Severe diabetes complications among patients with diabetes with regular follow-up: Does care setting matter? J Eval Clin Pract 2020; 26:1212-1219. [PMID: 31691453 DOI: 10.1111/jep.13296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/24/2019] [Accepted: 09/25/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate diabetes outcomes by long-term trajectories of patients' care settings among diabetes patients with regular follow-up. RESEARCH DESIGN AND METHODS This longitudinal population-based cohort study used data from the National Health Insurance Research Database in Taiwan. The trajectories of diabetes care-seeking behaviours among newly diagnosed diabetes patients with regular follow-up were identified using a group-based trajectory model from 2000 to 2004. Severe diabetes complications were assessed for the period 2005-2010. Cox-proportional hazard method with a cumulative incidence function was applied. RESULTS Among the diabetes patients with regular follow-up during the first 5 years since diagnosis, 44.5% and 40.6% were persistently cared for in generalized care settings and specialized settings, respectively. Only 14.9% of them had shifted between different levels of care setting during the first 5 years. No significant difference in adverse outcomes was observed between patients who were persistently treated in generalized and specialized care settings. Significantly worse outcomes were observed among patients who shifted from generalized care settings to specialized settings (adjusted hazard ratio [aHR]=3.2, 95% confidence interval [CI]: 1.5, 6.8). In contrast, among the elderly, regular users of generalized care providers had a higher hazard of adverse outcomes than those of specialized care providers (aHR = 3.3, 95% CI: 1.0, 10.7). CONCLUSIONS Diabetes patients who were persistently treated in generalized care settings had health outcomes comparable to those who were persistently treated in specialized care settings. However, for elderly and less stable patients, regular diabetes care in specialized care settings was preferable.
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Affiliation(s)
- Tzu-Ho Tsai
- Institute of Public Health, School of Medicine, National Yang-Ming University, No. 115, Sec. 2, Li-Nong Street., Beitou District, Taipei City, 112, Taiwan.,Department of Intensive Care, Cheng-Hsin Hospital, No. 45, Cheng-Hsin Street., Beitou District, Taipei City, 112, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, No. 115, Sec. 2, Li-Nong Street., Beitou District, Taipei City, 112, Taiwan
| | - I-Feng Lin
- Institute of Public Health, School of Medicine, National Yang-Ming University, No. 115, Sec. 2, Li-Nong Street., Beitou District, Taipei City, 112, Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, School of Medicine, National Yang-Ming University, No. 115, Sec. 2, Li-Nong Street., Beitou District, Taipei City, 112, Taiwan
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Fu P, Wang Y, Liu S, Li J, Gao Q, Zhou C, Meng Q, Sylvia S. Analysing the preferences for family doctor contract services in rural China: a study using a discrete choice experiment. BMC FAMILY PRACTICE 2020; 21:148. [PMID: 32711467 PMCID: PMC7382837 DOI: 10.1186/s12875-020-01223-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/15/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Preliminary evaluations have found that family doctor contract services (FDCSs) have significantly controlled medical expenses, better managed chronic diseases, and increased patient satisfaction and service compliance. In 2016, China proposed the establishment of a family doctor system to carry out contract services, but studies have found the uptake and utilization of these services to be limited. This study aimed to investigate rural residents' preferences for FDCSs from the perspective of the Chinese public. METHODS A discrete choice experiment (DCE) was performed to elicit the preferences for FDCSs among rural residents in China. Attributes and levels were established based on a literature review and qualitative methods. Five attributes, i.e., cost, medicine availability, the reimbursement rate, family doctor competence, and family doctor attitude, were evaluated using a mixed logit model. RESULTS A total of 609 residents were included in the main DCE analysis. The respondents valued the high competence (coefficient 2.44, [SE 0.13]) and the good attitude (coefficient 1.42, [SE 0.09]) of family doctors the most. Cost was negatively valued (coefficient - 0.01, [SE 0.01]), as expected. Preference heterogeneity analysis was conducted after adjusting the interaction terms, and we found that rural residents with higher educational attainment prefer a good attitude more than their counterparts with lower educational attainment. The estimated willingness to pay (WTP) for "high" relative to "low" competence was 441.13 RMB/year, and the WTP for a provider with a "good" attitude relative to a "poor" attitude was 255.77 RMB/year. CONCLUSION The present study suggests that strengthening and improving the quality of primary health care, including the competence and attitudes of family doctors, should be prioritized to increase the uptake of FDCSs. The contract service package, including the annual cost, the insurance reimbursement rate and individualized services, should be redesigned to be congruent with residents having different health statuses and their stated preferences.
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Affiliation(s)
- Peipei Fu
- NHC Key Laboratory of Health Economics and Policy Research, School of Health Care Management, Shandong University, Jinan, 250012 China
| | - Yi Wang
- School of Public Health, Shandong University, Jinan, 250012 China
| | - Shimeng Liu
- Key Lab of Health Technology Assessment, National Health Comission, School of Public Health, Fudan University, Shanghai, China
| | - Jiajia Li
- School of Public Health, Shandong University, Jinan, 250012 China
| | - Qiufeng Gao
- Center for Experimental Economics in Education, Shaanxi Normal University, Xi’an, China
| | - Chengchao Zhou
- Key Lab of Health Economics and Policy Research, School of Public Health, Shandong University, 44 Wen-hua-xi Road, Jinan, 250012 Shandong China
| | - Qingyue Meng
- China Center for Health Development Studies, Peking University, No. 38 Xueyuan Road, Haidian District, Beijing, 100191 China
| | - Sean Sylvia
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina USA
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Rural Population Aging and the Hospital Utilization in Cities: The Rise of Medical Tourism in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134790. [PMID: 32635241 PMCID: PMC7369718 DOI: 10.3390/ijerph17134790] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/28/2020] [Accepted: 06/30/2020] [Indexed: 11/17/2022]
Abstract
The disparity of rural and urban hospital utilization has aroused much concern. With the improvement of their living standards, patients in rural areas have an emerging need for traveling across borders for better medical treatment in China. This paper reveals the medical tourism of rural residents towards urban hospitals driven by hospital needs and points out that such disparities may be caused by medical tourism. The ratio of people aged 65 and above in total rural populations was used to identify the potential target customers for medical tourism. Based on rural and urban datasets ranging from 2007-2017 on the provincial level, this paper presents a mobile treatment model and market concentration model with an ecological foundation. The feasible generalized least squared approach was used in the estimation of the fixed-effect regressions. The study found that there was a positive and significant relationship between rural old-age ratios and urban inpatient visits from different income groups. On average, a one percent rise in rural old-age ratio would increase the inpatient visits of urban hospitals by 138 thousand persons. There was also a positive and significant relationship between the rural old-age ratio and the market concentration of urban inpatient visits. It was found that the rural old-age ratio significantly influenced the market concentration of urban inpatient visits in the middle-high income regions. The research showed that each income group from the rural aged population had participated in medical tourism, traveled to urbanized regions and made inpatient visits to urbanized medical facilities. It was also indicated that the rural aged population, especially from the middle-high income groups had a positive and significant influence on the market concentration of urban inpatient visits in the province.
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Chen AT, Flaherty MG, Threats M. Attitudes, Provider and Treatment Selection of Complementary and Integrative Health among Individuals with Pain-Related Conditions. Complement Ther Med 2020; 51:102410. [PMID: 32507427 DOI: 10.1016/j.ctim.2020.102410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 02/03/2020] [Accepted: 04/10/2020] [Indexed: 11/15/2022] Open
Abstract
Complementary and integrative therapies are used by people to address many conditions, including pain-related conditions. There has been concern about the quality of online health information, including information pertaining to complementary and integrative health (CIH). In this qualitative interview study, we sought to investigate how individuals interact with CIH-related information online and how this might affect their subsequent behavior. We conducted semi-structured interviews with 14 individuals with chronic pain conditions. We report findings based on three main themes: individuals' beliefs about CIH; approach to CIH, including how people view provider information and personalize their CIH use strategy; and factors that affect trust in the information encountered. Overall, study participants believed there was value in CIH therapies and that treatments were effective. Many described experiences that had influenced their views of complementary therapies over time. We also found that individuals form impressions of CIH providers based on structural and personal characteristics, particularly cost and proximity, that are conveyed in information to which they are exposed. These findings have various implications. First, over time individuals with chronic pain conditions develop their own beliefs and attitudes, which play a role in their selection of providers and modalities relating to CIH. Health care providers should consider how people view information relating to, and make decisions about, CIH therapies and work collaboratively with patients to develop effective health management strategies. Information services should also consider patients' perspectives in developing websites and other informational materials.
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Affiliation(s)
- Annie T Chen
- Biomedical Informatics and Medical Education, University of Washington School of Medicine, UW Medicine South Lake Union, 850 Republican Street, Box 358047, Seattle, WA 98109, United States.
| | - Mary Grace Flaherty
- School of Information and Library Science, University of North Carolina at Chapel Hill, 216 Lenoir Drive, CB #3360, 100 Manning Hall, Chapel Hill, NC, 27599-3360, United States.
| | - Megan Threats
- School of Information and Library Science, University of North Carolina at Chapel Hill, 216 Lenoir Drive, CB #3360, 100 Manning Hall, Chapel Hill, NC, 27599-3360, United States.
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Jiang MZ, Fu Q, Xiong JY, Li XL, Jia EP, Peng YY, Shen X. Preferences heterogeneity of health care utilization of community residents in China: a stated preference discrete choice experiment. BMC Health Serv Res 2020; 20:430. [PMID: 32423447 PMCID: PMC7236293 DOI: 10.1186/s12913-020-05134-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Accepted: 03/20/2020] [Indexed: 11/27/2022] Open
Abstract
Background To tackle the issue with the low usage of primary healthcare service in China, it is essential to align resource distribution with the preferences of the community residents. There are few academic researches for describing residents’ perceived characteristics of healthcare services in China. This study aims to investigate the preferences of healthcare services utilization in community residents and explore the heterogeneity. The findings will be useful for the policy makers to take targeted measures to tailor the provision of healthcare services. Methods The face-to-face interviews and surveys were conducted to elicit four key attributes (care provider; mode of services; cost; travel time) of the preference from community residents for healthcare utilization. A rational test was presented first to confirm the consistency, and then 16 pairs of choice tasks with 12 sociodemographic items were given to the respondents. Two hypothetical options for each set, without an opt-out option, were presented in each choice task. The latent class analysis (LCA) was used to analyse the data. Results Two thousand one hundred sixty respondents from 36 communities in 6 cities were recruited for our study. 2019 (93.47%) respondents completed valid discrete choice experiment (DCE) questionnaires. The LCA results suggested that four groups of similar preferences were identified. The first group (27.29%) labelled as “Comprehensive consideration” had an even preference of all four attributes. The second group (37.79%) labelled as “Price-driven” preferred low-price healthcare services. The third group labelled as “Near distance” showed a clear preference for seeking healthcare services nearby. The fourth group (34.18%) labelled as “Quality seeker” preferred the healthcare service provided by experts. Willingness to pay (WTP) results showed that people were willing to accept CNY202.12($29.37) for Traditional Chinese Medicine (TCM) services and willing to pay CNY604.31($87.81) for the service provided by experts. Conclusions Our study qualitatively measures the distinct preferences for healthcare utilization in community residents in China. The results suggest that the care provider, mode of services, travel time and cost should be considered in priority setting decisions. The study, however, reveals substantial disagreement in opinion of TCM between different population subgroups.
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Affiliation(s)
- Ming-Zhu Jiang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Qiang Fu
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Ju-Yang Xiong
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
| | - Xiang-Lin Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Er-Ping Jia
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Ying-Ying Peng
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
| | - Xiao Shen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China
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Setoodefar M, Tabesh H, Tara F, Eslami S, Heshmati Nabavi F, Valizadeh Zare N, Taheri SH, Rajabzadeh Moghaddam MR, Etminani K. Measurement Model of Women's Preferences in Obstetrician and Gynecologist Selection in the Private Sector: Exploratory and Confirmatory Factor Analysis. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2020; 8:150-163. [PMID: 32309456 PMCID: PMC7153421 DOI: 10.30476/ijcbnm.2020.82278.1049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: The purpose of this study is to construct and validate a measurement model of women’s preferences in Obstetrician
and Gynecologist (OB/GYN) selection in the private sector of non-clinical parameters. Methods: This methodological study included 462 respondents in OB/GYN’s offices to a researcher-made questionnaire.
The patients visited 57 offices of OB/GYNs in the city of Mashhad in Iran and completed women’s preferences in OB/GYN selection
questionnaire over a 2-month period from January to February 2018. Exploratory Factor Analysis (EFA) was conducted to verify the
instrument’s construct validity. Confirmatory Factor Analysis (CFA) was used to test whether the data fit our hypothesized model obtained from EFA model. Results: The first draft of the questionnaire was prepared with 118 items based on literature review. The outcome of content validity
assessment was a 51-item questionnaire. Scale-Content Validity Index (S-CVI) turned out to be 0.80. The results of EFA yielded
an instrument with 33 items in six domains, which explained 52.657% of the total variance of the questionnaire. With performing
CFA, the 6-factor model with 29 items demonstrated a good fit with the data (CFI=0.952, CMIN/DF=1.613, RMSEA=0.036).
Availability and Accessibility, Communicational Skills, Office Environment, Recommendation by Others, Special Services,
and Cost and Insurance were found to define the women’s preferences in OB/GYN selection in private sector, Iran. Conclusion: The developed measurement model considers the patient’s preferences that influence decision-making process on OB/GYN selection.
It can provide useful knowledge for OB/GYNs and policymakers to design appropriate and efficient marketing strategies according to the consumer preferences priority.
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Affiliation(s)
- Masood Setoodefar
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamed Tabesh
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Tara
- Patient Safety Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Saeed Eslami
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Heshmati Nabavi
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Najmeh Valizadeh Zare
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyyed Hassan Taheri
- Department of Computer Sciences, School of Engineering, Khayyam University, Mashhad, Iran
| | | | - Kobra Etminani
- Department of Medical Informatics, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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van Leersum CM, Moser A, van Steenkiste B, Reinartz M, Stoffers E, Wolf JRLM, van der Weijden T. What matters to me - a web-based preference elicitation tool for clients in long-term care: a user-centred design. BMC Med Inform Decis Mak 2020; 20:57. [PMID: 32183786 PMCID: PMC7077015 DOI: 10.1186/s12911-020-1067-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 02/28/2020] [Indexed: 11/17/2022] Open
Abstract
Background During the process of decision-making for long-term care, clients are often dependent on informal support and available information about quality ratings of care services. However, clients do not take ratings into account when considering preferred care, and need assistance to understand their preferences. A tool to elicit preferences for long-term care could be beneficial. Therefore, the aim of this qualitative descriptive study is to understand the user requirements and develop a web-based preference elicitation tool for clients in need of long-term care. Methods We applied a user-centred design in which end-users influence the development of the tool. The included end-users were clients, relatives, and healthcare professionals. Data collection took place between November 2017 and March 2018 by means of meetings with the development team consisting of four users, walkthrough interviews with 21 individual users, video-audio recordings, field notes, and observations during the use of the tool. Data were collected during three phases of iteration: Look and feel, Navigation, and Content. A deductive and inductive content analysis approach was used for data analysis. Results The layout was considered accessible and easy during the Look and feel phase, and users asked for neutral images. Users found navigation easy, and expressed the need for concise and shorter text blocks. Users reached consensus about the categories of preferences, wished to adjust the content with propositions about well-being, and discussed linguistic difficulties. Conclusion By incorporating the requirements of end-users, the user-centred design proved to be useful in progressing from the prototype to the finalized tool ‘What matters to me’. This tool may assist the elicitation of client’s preferences in their search for long-term care.
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Affiliation(s)
- Catharina M van Leersum
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| | - Albine Moser
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.,Research Centre for Autonomy and Participation of Persons with a Chronic Illness, Zuyd University of Applied Sciences, P.O. Box 550, 6400 AN, Heerlen, The Netherlands
| | - Ben van Steenkiste
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Marion Reinartz
- Zorgbelang inclusief, P.O. Box 5310, 6802 EH, Arnhem, The Netherlands
| | - Esther Stoffers
- Burgerkracht Limburg, P.O. Box 5185, 6130 PD, Sittard, The Netherlands
| | - Judith R L M Wolf
- Impuls - Netherlands Center for Social Care Research, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB, 117, Nijmegen, The Netherlands
| | - Trudy van der Weijden
- Department of Family Medicine, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Centre, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
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Agazaryan N, Chow P, Lamb J, Cao M, Raldow A, Beron P, Hegde J, Steinberg M. The Timeliness Initiative: Continuous Process Improvement for Prompt Initiation of Radiation Therapy Treatment. Adv Radiat Oncol 2020; 5:1014-1021. [PMID: 33083664 PMCID: PMC7557132 DOI: 10.1016/j.adro.2020.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/22/2020] [Accepted: 01/24/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose The ambulatory patient experience is heavily influenced by wait times for provider care. Delayed patient visit start times may negatively affect overall satisfaction, and increased wait times affect the perception of the information, instructions, and treatment given by health care providers. Improving institutional practices overall requires the determination of the essential quality metrics that will make such an achievement possible. A protracted time leading up to the initiation of radiation therapy may promote poor satisfaction and perceived quality of care for both patients and referring providers alike, which may then create a barrier to patients being treated with radiation therapy. This institution piloted and sucessfully completed a study into improving the timeliness of initiation of patient radiation therapy for our patients. Methods and Materials This work sought to identify inefficiencies in radiation therapy treatment planning to shorten the time each patient waited for treatment. We examined the time between simulation to the start of the first fraction of treatment. This period includes simulation, contouring, treatment planning, and quality assurance of the plan. Results Before the study, the planning process would typically take 2 weeks. Target and organs-at-risk contouring were found to be the main inefficiency delaying treatment start dates. This delineating process includes drawing contours on radiologic images, typically computed tomography and magnetic resonance imaging. We focused on the time needed for the contouring process to be completed and took steps to increase efficiency. The length of time from simulation to contour approval was decreased by more than 60%, a reduction from an average of more than 4 days to less than 1.5 days. Overall planning time dropped from 2 weeks to less than 5 days. Conclusions Process improvements and implementation of task-specific tools improved the timeliness of patient treatments, reducing the overall planning time from simulation to treatments to less than 5 days. Continuous monitoring and modification of these processes revealed that the successes achieved toward better quality of care have been sustained.
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Affiliation(s)
- Nzhde Agazaryan
- Department of Radiation Oncology, UCLA, Los Angeles, California
| | - Phillip Chow
- Department of Radiation Oncology, UCLA, Los Angeles, California
| | - James Lamb
- Department of Radiation Oncology, UCLA, Los Angeles, California
| | - Minsong Cao
- Department of Radiation Oncology, UCLA, Los Angeles, California
| | - Ann Raldow
- Department of Radiation Oncology, UCLA, Los Angeles, California
| | - Phillip Beron
- Department of Radiation Oncology, UCLA, Los Angeles, California
| | - John Hegde
- Department of Radiation Oncology, UCLA, Los Angeles, California
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Chen Y, Ding S, Zheng H, Zhang Y, Yang S. Decision support for personalized hospital choice using the DEX hierarchical model with SMAA. Knowl Inf Syst 2020. [DOI: 10.1007/s10115-020-01448-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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117
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Bühn S, Holstiege J, Pieper D. Are patients willing to accept longer travel times to decrease their risk associated with surgical procedures? A systematic review. BMC Public Health 2020; 20:253. [PMID: 32075615 PMCID: PMC7031936 DOI: 10.1186/s12889-020-8333-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 02/06/2020] [Indexed: 11/16/2022] Open
Abstract
Background Distance to a hospital is an influencing factor for patients´ decision making when choosing a hospital for surgery. It is unclear whether patients prefer to travel further to regional instead of local hospitals if the risk associated with elective surgery is lower in the farther hospital. The aim of our systematic review was to investigate patient preferences for the location of care, taking into consideration surgical outcomes and hospital distance. Methods MEDLINE (PubMed), EconLit, PsycInfo and EMBASE were searched until November 2019. We included experimental choice studies in which participants were asked to make a hypothetical decision where to go for elective surgery when surgical risk and/or distance to the hospitals vary. There was no restriction on the type of intervention or study. Reviewers independently extracted data using a standardized form. The number and proportion of participants willing to accept additional risk to obtain surgery in the local hospital was recorded. We also extracted factors associated with the decision. Results Five studies exploring participants´ preferences for local care were included. In all studies, there were participants who, independently of a decreased mortality risk or a higher survival benefit in the regional hospital, adhered to the local hospital. The majority of the patients were willing to travel longer to lower their surgical risk. Older age and fewer years of formal education were associated with a higher risk tolerance in the local hospital. Conclusions Whether patients were willing to travel for a lower surgery-associated risk could not be answered in a straightforward manner. The studies we identified showed that decision making also relies on factors other than on rational information on risk or distance to hospital. Trial registration International prospective register of ongoing systematic reviews (PROSPERO): CRD42016033655. Registered 1 January 2016.
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Affiliation(s)
- Stefanie Bühn
- Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, University Witten/Herdecke, Ostmerheimer Str. 200, Building 38, D-51109, Cologne, Germany.
| | - Jakob Holstiege
- Central Research Institute of Ambulatory Health Care in Germany (Zi), Salzufer 8, D-10587, Berlin, Germany
| | - Dawid Pieper
- Institute for Research in Operative Medicine, Faculty of Health, School of Medicine, University Witten/Herdecke, Ostmerheimer Str. 200, Building 38, D-51109, Cologne, Germany
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Sever I, Verbič M, Klaric Sever E. Estimating Attribute-Specific Willingness-to-Pay Values from a Health Care Contingent Valuation Study: A Best-Worst Choice Approach. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:97-107. [PMID: 31562593 DOI: 10.1007/s40258-019-00522-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Willingness-to-pay (WTP) studies frequently use a contingent valuation (CV) method to determine the economic value of a good or service. However, a typical CV study is able to estimate the WTP for a good as a whole, but provides no information about the marginal WTP for different attributes of a good. OBJECTIVE The aim was to estimate marginal WTP for different attributes of a CV scenario. METHODS By using the data from an additional best-worst choice (BWC) experiment, we disaggregated the holistic WTP values for dental care, estimated using the CV method, into attribute-specific WTP values. The study was conducted at the School of Dental Medicine, University of Zagreb, Croatia. Dental school patients were surveyed from March 2016 to January 2017, and their WTP for dental care was estimated using either a CV survey (n = 242), which also included a BWC task, or a discrete choice experiment (DCE) survey (n = 275). RESULTS The largest marginal welfare estimate (€13.5) was obtained for the improvement in treatment explanation, followed by the improvements in staff behavior (€8.1) and waiting time in the office (€7.2), and by the changes in dental care provider (€3.4). These estimates were generally highly similar to the traditional marginal WTP estimates obtained with a traditional multi-profile DCE, after adjusting DCE estimates for non-attendance to the cost attribute. CONCLUSION Our BWC-CV framework may serve as a valuable alternative for estimating marginal WTP values for health care attributes when the choice behavior of respondents raises concerns for the validity of DCE estimates.
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Affiliation(s)
- Ivan Sever
- Institute for Tourism, Vrhovec 5, 10000, Zagreb, Croatia
| | - Miroslav Verbič
- School of Economics and Business, University of Ljubljana, Kardeljeva ploščad 17, 1000, Ljubljana, Slovenia.
- Institute for Economic Research, Kardeljeva ploščad 17, 1000, Ljubljana, Slovenia.
| | - Eva Klaric Sever
- School of Dental Medicine, Department of Endodontics and Restorative Dentistry, University of Zagreb, Gundulićeva 5, 10000, Zagreb, Croatia
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Delaforce A, Duff J, Munday J, Hardy J. Overcoming barriers to evidence-based patient blood management: a restricted review. Implement Sci 2020; 15:6. [PMID: 31952514 PMCID: PMC6969479 DOI: 10.1186/s13012-020-0965-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/06/2020] [Indexed: 01/31/2023] Open
Abstract
Background Blood transfusions are associated with a range of adverse patient outcomes, including coagulopathy, immunomodulation and haemolysis, which increase the risk of morbidity and mortality. Consideration of these risks and potential benefits are necessary when deciding to transfuse. Patient blood management (PBM) guidelines exist to assist in clinical decision-making, but they are underutilised. Exploration of barriers to the implementation and utilisation of the PBM guidelines is required. This study aimed to identify common barriers and implementation strategies used to implement PBM guidelines, with a comparison against current expert opinion. Methods A restricted review approach was used to identify the barriers to PBM guideline implementation as reported by health professionals and to review which implementation strategies have been used. Searches were undertaken in MEDLINE/PubMed, CINAHL, Embase, Scopus and the Cochrane library. The Consolidated Framework for Implementation Research (CFIR) was used to code barriers. The Expert Recommendations for Implementing Change (ERIC) tool was used to code implementation strategies, and subsequently, develop recommendations based on expert opinion. Results We identified 14 studies suitable for inclusion. There was a cluster of barriers commonly reported: access to knowledge and information (n = 7), knowledge and beliefs about the intervention ( = 7) and tension for change (n = 6). Implementation strategies used varied widely (n = 25). Only one study reported the use of an implementation theory, model or framework. Most studies (n = 11) had at least 50% agreement with the ERIC recommendations. Conclusions There are common barriers experienced by health professionals when trying to implement PBM guidelines. There is currently no conclusive evidence to suggest which implementation strategies are most effective. Further research using validated implementation approaches and improved reporting is required.
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Affiliation(s)
- Alana Delaforce
- The University of Newcastle, School of Nursing and Midwifery, University Drive, Callaghan, NSW, 2302, Australia. .,Mater Health Services, Level 6, Duncombe Building, Raymond Terrace, QLD, 4101, Australia.
| | - Jed Duff
- The University of Newcastle, School of Nursing and Midwifery, University Drive, Callaghan, NSW, 2302, Australia
| | - Judy Munday
- School of Nursing/Institute for Health and Biomedical Innovation, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, QLD, 4059, Australia.,Faculty of Health and Sports Sciences, The University of Agder, Grimstad, Norway
| | - Janet Hardy
- Mater Health Services, Level 6, Duncombe Building, Raymond Terrace, QLD, 4101, Australia
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Di Paolo M, Papi L, Malacarne P, Gori F, Turillazzi E. Healthcare-Associated Infections: Not Only a Clinical Burden, But a Forensic Point of View. Curr Pharm Biotechnol 2020; 20:658-664. [PMID: 31258073 DOI: 10.2174/1389201020666190618122649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 11/27/2018] [Accepted: 04/05/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Healthcare-associated infections (HCAIs) occur when patients receiving treatment in a health care setting develop an infection. They represent a major public health problem, requiring the integration of clinical medicine, pathology, epidemiology, laboratory sciences, and, finally, forensic medicine. METHODS The determination of cause of death is fundamental not only in the cases of presumed malpractice to ascertain the causal link with any negligent behavior both of health facilities and of individual professionals, but also for epidemiological purposes since it may help to know the global burden of HCAIs, that remains undetermined because of the difficulty of gathering reliable diagnostic data. A complete methodological approach, integrating clinical data by means of autopsy and histological and laboratory findings aiming to identify and demonstrate the host response to infectious insult, is mandatory in HCAIs related deaths. RESULTS Important tasks for forensic specialists in hospitals and health services centers are the promotion of transparency and open communication by health-care workers on the risk of HCAIs, thus facilitating patients' engagement and the implementation of educational interventions for professionals aimed to improve their knowledge and adherence to prevention and control measures. CONCLUSION HCAIs are a major problem for patient safety in every health-care facility and system around the world and their control and prevention represent a challenging priority for healthcare institution and workers committed to making healthcare safer. Clinicians are at the forefront in the war against HCAIs, however, also forensic pathologists have a remarkable role.
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Affiliation(s)
- Marco Di Paolo
- Section of Legal Medicine, Department of Surgical, Medical, Molecular Pathology and Critical Medicine, University of Pisa, Pisa, Italy
| | - Luigi Papi
- Section of Legal Medicine, Department of Surgical, Medical, Molecular Pathology and Critical Medicine, University of Pisa, Pisa, Italy
| | - Paolo Malacarne
- Unit of Anesthesia and Resuscitation, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy, University of Pisa, Via Roma 55, 56126 Pisa, Italy
| | - Federica Gori
- Section of Legal Medicine, Department of Surgical, Medical, Molecular Pathology and Critical Medicine, University of Pisa, Pisa, Italy
| | - Emanuela Turillazzi
- Section of Legal Medicine, Department of Surgical, Medical, Molecular Pathology and Critical Medicine, University of Pisa, Pisa, Italy
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Albolino S, Bellandi T, Cappelletti S, Di Paolo M, Fineschi V, Frati P, Offidani C, Tanzini M, Tartaglia R, Turillazzi E. New Rules on Patient's Safety and Professional Liability for the Italian Health Service. Curr Pharm Biotechnol 2020; 20:615-624. [PMID: 30961486 DOI: 10.2174/1389201020666190408094016] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/27/2018] [Accepted: 12/16/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The phenomenon of clinical negligence claims has rapidly spread to United States, Canada and Europe assuming the dimensions and the severity of a pandemia. Consequently, the issues related to medical malpractice need to be studied from a transnational perspective since they raise similar problems in different legal systems. METHODS Over the last two decades, medical liability has become a prominent issue in healthcare policy and a major concern for healthcare economics in Italy. The failures of the liability system and the high cost of healthcare have led to considerable legislative activity concerning medical malpractice liability, and a law was enacted in 2012 (Law no. 189/2012), known as the "Balduzzi Law". RESULTS The law tackles the mounting concern over litigation related to medical malpractice and calls for Italian physicians to follow guidelines. Briefly, the law provided for the decriminalisation of simple negligence of a physician on condition that he/she followed the guidelines and "good medical practice" while carrying out his/her duties, whilst the obligation for compensation, as defined by the Italian Civil Code, remained. Judges had to consider that the physician followed the provisions of the guidelines but nevertheless caused injury to the patient. CONCLUSION However, since the emission of the law, thorny questions remain which have attracted renewed interest and criticism both in the Italian courts and legal literature. Since then, several bills have been presented on the topic and these have been merged into a single text entitled "Regulations for healthcare and patient safety and for the professional responsibility of healthcare providers".
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Affiliation(s)
- Sara Albolino
- Regional Centre for Clinical Risk Management and Patient Safety, Florence, Italy
| | - Tommaso Bellandi
- Regional Centre for Clinical Risk Management and Patient Safety, Florence, Italy
| | - Simone Cappelletti
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Marco Di Paolo
- Section of Legal Medicine, Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa, Pisa, Italy
| | - Vittorio Fineschi
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Paola Frati
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome, Rome, Italy.,IRCCS Neuromed, Pozzilli, Italy
| | - Caterina Offidani
- Unit of Legal Medicine, Bambino Gesu Children's Hospital, IRCCS, P.za Sant'Onofrio 4, Rome, Italy
| | - Michela Tanzini
- Regional Centre for Clinical Risk Management and Patient Safety, Florence, Italy
| | - Riccardo Tartaglia
- Regional Centre for Clinical Risk Management and Patient Safety, Florence, Italy
| | - Emanuela Turillazzi
- Section of Legal Medicine, Department of Surgical Pathology, Medical, Molecular and Critical Area, University of Pisa, Pisa, Italy
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You CH, Kwon YD, Kang S. Sex Differences in Factors Affecting Hospital Outpatient Department Visits: Korea Health Panel Survey Data from 2009 to 2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16245028. [PMID: 31835589 PMCID: PMC6950096 DOI: 10.3390/ijerph16245028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/05/2019] [Accepted: 12/09/2019] [Indexed: 11/23/2022]
Abstract
This study intends to inspect the sex differences in proportion of hospital outpatient department (OPD) visits in overall outpatient (OP) visits using national panel data and to explore factors that influence the proportions by sex. This study analyzed data of the 2009–2016 Korea Health Panel Survey. Fractional logit regression was applied to analyze factors that affect proportion of hospital visits among outpatient visits. Analysis of related factors was carried out first for all analysis subjects and then by sex. The study data were provided by 7470 women (52.2%) and 6846 men (47.8%). The overall average number of OP visits was 13.0, and women showed a much higher frequency of visits (15.8) than men (9.9). The average proportion of hospital OPD visits among overall OP visits was 21.9%, and men showed a higher rate (25.1%) than women (19.5%). The analysis model including sociodemographic factors, economic factors, and health-related factors confirmed that men showed a higher rate of hospital usage than women. Type of medical security, household income, participation in economic activities, disability, and serious illnesses were significant variables for both sexes. Age, education level, marital status, and subscription to voluntary private health insurance were significant only for women, whereas region of residence was significant only for men. This study confirmed that there is a sex difference in proportion of hospital OPD visits and in the factors that affect the proportion of hospital OPD visits. Universal health coverage is provided through social health insurance, but there is a sex difference in hospital OPD visits, and factors related to socioeconomic status have a significant effect, especially on women’s selection of health care institutions. More attention should be given to sex differences in factors affecting health care utilization.
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Affiliation(s)
- Chang Hoon You
- Graduate School of Public Health, Yonsei University, Seoul 03722, Korea;
| | - Young Dae Kwon
- Department of Humanities and Social Medicine, College of Medicine and Catholic Institute for Healthcare Management, the Catholic University of Korea, Seoul 06591, Korea
- Correspondence: ; Tel.: +82-2-2258-8251; Fax: +82-2-2258-8257
| | - Sungwook Kang
- Department of Public Health, Daegu Haany University, Gyeongsan 38610, Korea;
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Sutherland K, Clatworthy M, Chang K, Rahardja R, Young SW. Risk Factors for Revision Anterior Cruciate Ligament Reconstruction and Frequency With Which Patients Change Surgeons. Orthop J Sports Med 2019; 7:2325967119880487. [PMID: 31799326 PMCID: PMC6873281 DOI: 10.1177/2325967119880487] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: Revision surgery is a known complication after anterior cruciate ligament
(ACL) reconstruction (ACLR), but the proportion of patients who seek a
different surgeon for their revision procedure is unknown. Purpose: To determine the rate and risk factors for revision ACLR in New Zealand and
to find the proportion of patients undergoing revision ACLR who see a
different surgeon compared with their primary procedure as well as the
factors that may influence this decision. Study Design: Case series; Level of evidence, 4. Methods: Data from New Zealand’s single government insurer, the Accident Compensation
Corporation (ACC), were analyzed. All primary ACLR procedures performed
between January 1, 2009, and December 31, 2014 were evaluated, and revision
ACLR procedures performed between January 1, 2009, and December 31, 2016,
were evaluated to allow for a minimum 2-year follow-up period. Cases
undergoing subsequent revision were divided into those with the same or a
different surgeon compared with the primary procedure. Risk factors for
revision and change of surgeons were assessed, including age, sex, time from
injury to surgery, time between primary and revision procedures, surgeon
volume, and ethnicity. Results: A total of 15,212 primary ACLR procedures were recorded in 14,926 patients.
The mean patient age was 29.2 years, and 61% were male patients. There were
676 subsequent revision procedures and 510 contralateral procedures during
the study period, resulting in a 5-year survival rate of 95.5% for the ACL
graft and 96.5% for the contralateral ACL. Risk factors for revision surgery
included male sex, age <20 years, and <1 year from injury to surgery.
Of the revision procedures, 44.5% (n = 301) were performed by a different
surgeon compared with primary ACLR. For primary ACLR procedures performed by
low-volume surgeons, 75.0% of patients requiring revision ACLR changed
surgeons, compared with 21.5% for high-volume surgeons (≤10 vs >50
primary ACLR/y; hazard ratio, 10.70 [95% CI, 6.01-19.05]; P
< .001). Other factors associated with change of surgeons included older
age, longer time between primary and revision surgery, and Asian and Maori
ethnicities. Conclusion: A significant proportion of patients change surgeons when requiring revision
ACLR. In the absence of formal follow-up systems such as registries,
surgeons, particularly those with a low volume of ACLRs, may underestimate
their personal revision rate.
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Affiliation(s)
| | | | - Kevin Chang
- University of Auckland, Auckland, New Zealand
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Shu Z, Han Y, Xiao J, Li J. Effect of medical insurance and family financial risk on healthcare utilisation by patients with chronic diseases in China: a cross-sectional study. BMJ Open 2019; 9:e030799. [PMID: 31748294 PMCID: PMC6887032 DOI: 10.1136/bmjopen-2019-030799] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVE To assess the joint cumulative effects of medical insurance and family health financial risk on healthcare utilisation among patients with chronic conditions in China. DESIGN A nationwide population-based case-control study with multinomial logistic regression was conducted and used to estimate the ORs of healthcare utilisation against type of medical insurance and family health financial risk using the Anderson model as a theoretical framework. SETTING China Family Panel Studies (CFPS) database. PARTICIPANTS The study sample included 5260 patients with chronic conditions identified from the 2014 CFPS database. MAIN OUTCOME MEASURES The participants were classified by their health insurance coverage: urban employee basic medical insurance (UEBMI), Gong Fei Medical Insurance (GFMI), new rural cooperative medical scheme (NCMS) and urban residents basic medical insurance. Healthcare utilisation was measured by assessing the care level provided by the health institutions selected by patients when they were sick. Health financial risk was measured using the cost of medical expenditures and annual family income over the past year. RESULTS Patients were more likely to choose hospital care than care from primary health centres. Patients with NCMS preferred primary healthcare, compared with patients with no medical insurance (OR 1.852, 95% CI 1.458 to 2.352). Patients with UEBMI and GFMI made use of hospital healthcare services (OR 2.654, 95% CI 1.85 to 3.81; OR 1.629, 95% CI 1.15 to 2.30, respectively). Patients who had medium or high financial risk were more likely to choose tertiary/specialised hospital care, compared with those at low financial risk (OR 1.629, 95% CI 1.15 to 2.30; OR 1.220, 95% CI 1.04 to 1.43, respectively). CONCLUSIONS The majority of patients chose hospital care in our sample. There was a joint effect and relationship between degree of family health financial risk and medical insurance on healthcare utilisation.
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Affiliation(s)
- Zhan Shu
- College of Public Administration, Central China Normal University, Wuhan, China
| | - Yu Han
- College of Public Administration, Central China Normal University, Wuhan, China
| | - Jinguang Xiao
- College of Public Administration, Central China Normal University, Wuhan, China
| | - Jian Li
- Institute of Medical Information, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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125
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Victoor A, Brabers AEM, van Esch TEM, de Jong JD. An assessment of the Dutch experience with health insurers acting as healthcare advisors. PLoS One 2019; 14:e0224829. [PMID: 31703085 PMCID: PMC6839849 DOI: 10.1371/journal.pone.0224829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/22/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION With managed competition, selective contracting and the appointing of preferred providers are important instruments for health insurers to improve their bargaining position in the healthcare purchasing market. Insurers can offer enrollees extra services, such as advice about their healthcare, to attract them, ensure that they remain loyal, and to channel them to preferred providers. We investigate which advice services insurers in the Dutch system of managed competition offer enrollees, how they inform them about services, and if enrollees use and appreciate them. MATERIALS AND METHODS From November to December 2017, two researchers independently analyzed the websites of all health insurers in the Netherlands. We also conducted a questionnaire study among 1,500 members (response 44.5%, N = 668) of the Nivel Dutch Health Care Consumer Panel. RESULTS AND DISCUSSION All insurers offer one or more services. Most enrollees do not know if their insurer offers advice (67-87% per service). Twelve per cent (N = 76) of the enrollees indicate that they ever made use of a service, mostly regarding the choice of provider (N = 42). Respondents who used healthcare advice were satisfied with it. Of all enrollees, 41% indicate that they would probably/certainly, contact their insurer for advice and 37% would appreciate it if their insurer approached them. Among enrollees, 40% indicated the potential advice has some or a major influence on their choice of insurer. CONCLUSIONS While all insurers offer at least one service, enrollees generally are unaware of them. Only a minority ever made use of such a service. However, a reasonable proportion do appreciate their insurers' advice services and indicate that they would like to have contact with their insurer if they need care. Insurers do not appear to make the best use of the potential for giving healthcare advice and need to think about ways to increase coverage of those services.
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Affiliation(s)
- A. Victoor
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
- * E-mail:
| | - A. E. M. Brabers
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
| | - T. E. M. van Esch
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
| | - J. D. de Jong
- Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands
- Maastricht University, Maastricht, the Netherlands
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Edwards KH, Franklin RC, Aitken P, Elcock M, Edwards MT. A Program Profile of Air Medical Transport in Regional Central Queensland, Australia. Air Med J 2019; 38:431-436. [PMID: 31843155 DOI: 10.1016/j.amj.2019.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the epidemiology of air medical patients and referral patterns in Central Queensland Hospital and Health Service (CQHHS). METHODS Analysis of air medical transport from January 2010 to December 2014. Air medical tasks within the local health service boundary were included. All patients transported on rotor or fixed wing aircraft for medical purposes were included. Patterns of air medical tasks in and out of the region by referring and receiving location, aircraft type, flight priority, time of day, month, sex, age, illness, and referral indexes were analyzed. RESULTS There were 11,456 air ambulance tasks in CQHHS region during the study period, an average of 2,291 retrievals per annum or 191 per month. Frequent referrals were to a tertiary facility, located 800 km across economic and political boundaries. Referral pattern indexes highlight a net patient flow of 1.2 to 1. Cardiology was the largest illness category (24%). Males represented 59% overall as well as patients 66 years and older (33%). Fixed wing aircraft carried out 87% of the tasks with a frequent response time of 6 to 24 hours. CONCLUSION Air medical transports are an integral part of the health system in Central Queensland communities with vast geographic distances. Identifying regional referral pattern rates and ratios aid in the planning of resource allocation.
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Affiliation(s)
| | | | - Peter Aitken
- James Cook University, Townsville, Queensland, Australia; Queensland Department of Health, Aeromedical Retrieval and Disaster Management Branch Queensland, Brisbane, Australia
| | - Mark Elcock
- Queensland Department of Health, Aeromedical Retrieval and Disaster Management Branch Queensland, Brisbane, Australia
| | - Mark Terrell Edwards
- James Cook University, Townsville, Queensland, Australia; LifeFlight Retrieval Medicine Australia, Brisbane, Australia; Queensland Health, Emergency Medicine Department, Rockhampton, Queensland, Australia
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127
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Chauhan V, Sharma A, Sagar M. Exploring patient choice in India: A study on hospital selection. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2019. [DOI: 10.1080/20479700.2019.1679520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Anand Sharma
- National Institute of Pharmaceutical Education and Research, Mohali, India
| | - Mahim Sagar
- Indian Institute of Technology, Delhi, India
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128
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Johnston S, Abelson J, Wong ST, Langton J, Hogel M, Burge F, Hogg W. Citizen perspectives on the use of publicly reported primary care performance information: Results from citizen-patient dialogues in three Canadian provinces. Health Expect 2019; 22:974-982. [PMID: 31074573 PMCID: PMC6803417 DOI: 10.1111/hex.12902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 04/05/2019] [Accepted: 04/06/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Performance measurement and reporting is proliferating in all sectors of the healthcare system, including primary care, despite a dearth of evidence on how the public uses reports on primary care performance. We explored how the public might use this information, to guide the development of effective reporting systems for primary care. METHODS We conducted six full-day deliberative dialogue sessions with a purposive sample of 56 citizen-patients across three Canadian provinces (British Columbia, Ontario and Nova Scotia). Participants identified how they would use publicly reported performance data. We conducted a thematic analysis of the data by region. RESULTS Common uses for primary care performance information emerged across all sessions. Participants most often discussed the utility of this information for community advocacy and participation in health system decision making. Similar barriers for using performance information to choose a primary care provider were identified in each region including the perceived lack of choice of providers and the high value placed on relationships with current providers. Finally, the value of public performance reporting in enhancing trust that people would receive good care was also a common theme. CONCLUSIONS Citizen-patient perspectives highlight that public reporting on primary care performance could promote the health system's responsiveness by enabling public engagement in decision making at the community level. The role of public reporting in promoting trust rather than empowering patient choice may reflect unique elements of the Canadian health system's context.
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Affiliation(s)
- Sharon Johnston
- Department of Family MedicineUniversity of OttawaOttawaOntarioCanada
- CT Lamont Primary Health Care Research CentreÉlisabeth Bruyère Research InstituteOttawaOntarioCanada
| | - Julia Abelson
- Department of Clinical Epidemiology & Biostatistics, Centre for Health Economics and Policy AnalysisMcMaster UniversityHamiltonOntarioCanada
| | - Sabrina T. Wong
- Centre for Health Services and Policy ResearchUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- School of NursingUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Julia Langton
- Centre for Health Services and Policy ResearchUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Mathew Hogel
- CT Lamont Primary Health Care Research CentreÉlisabeth Bruyère Research InstituteOttawaOntarioCanada
| | - Fred Burge
- Department of Family MedicineDalhousie UniversityHalifaxNova ScotiaCanada
| | - William Hogg
- Department of Family MedicineUniversity of OttawaOttawaOntarioCanada
- CT Lamont Primary Health Care Research CentreÉlisabeth Bruyère Research InstituteOttawaOntarioCanada
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129
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Sever I, Verbič M, Sever EK. Estimating willingness-to-pay for health care: A discrete choice experiment accounting for non-attendance to the cost attribute. J Eval Clin Pract 2019; 25:843-849. [PMID: 30677196 DOI: 10.1111/jep.13095] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 11/30/2018] [Accepted: 12/06/2018] [Indexed: 11/29/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES The literature suggests that discrete choice experiments (DCEs) are a preferable method for estimating willingness-to-pay (WTP) values, as they may avoid some biases often observed in contingent valuation surveys, such as protest and strategic behaviour. However, the choice studies have demonstrated that attribute non-attendance may be a serious issue that leads to biased WTP estimates. METHOD A DCE was used to estimate patients' WTP for dental care at the dental school clinic. The endogenous attribute attendance (EAA) model was used to estimate WTP for dental care attributes, while accounting for non-attendance to the cost attribute. RESULTS The EAA model revealed that almost every second respondent had ignored the cost attribute when making choices, indicating that patients were very sensitive to other characteristics of dental care. Dental care providers should pay particular attention to providing a detailed explanation of treatment to their patients, as this was the most valued attribute of dental care. The welfare estimates from the EAA model, which accounted for non-attendance to the cost attribute, were more than two times lower than welfare estimates from a traditional multinomial logit model and mixed logit model estimated in WTP space. CONCLUSIONS The findings raise concerns for derived WTP estimates in DCE studies that did not consider non-attendance to the cost attribute during the estimation process. Non-attendance to the cost attribute overestimates WTP values, even if being motivated by the true preferences of respondents.
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Affiliation(s)
- Ivan Sever
- Institute for Tourism, Zagreb, Croatia.,Faculty of Economics, University of Ljubljana, Ljubljana, Slovenia
| | - Miroslav Verbič
- Faculty of Economics, University of Ljubljana, Ljubljana, Slovenia.,Institute for Economic Research, Ljubljana, Slovenia
| | - Eva Klaric Sever
- Department of Endodontics and Restorative Dentistry, School of Dental Medicine, University of Zagreb, Zagreb, Croatia
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130
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Khalid F, Petro Brunal M, Sattar A, Laokri S, Jowett M, Raza W, Hotchkiss DR. Assessing the Efficiency of Sub-National Units in Making Progress Towards Universal Health Coverage: Evidence from Pakistan. Health Syst Reform 2019; 6:1-14. [PMID: 31567005 DOI: 10.1080/23288604.2019.1617026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The World Health Report 2010 encourages countries to reduce wastage and increase efficiency to achieve Universal Health Coverage (UHC). This research examines the efficiency of divisions (sub-provincial geographic units) in Pakistan in moving towards UHC using Data Envelop Analysis. We have used data from the Pakistan National Accounts 2011-12 and the Pakistan Social Living and Measurement Survey 2012-13 to measure per capita pooled public health spending in the divisions as inputs, and a set of UHC indicators (health service coverage and financial protection) as outputs. Sensitivity analysis for factors outside the health sector influencing health outcomes was conducted to refine the main model specification. Spider radar graphs were generated to illustrate differences between divisions with similar public spending but different performances for UHC. Pearson product-moment correlation was used to explore the strength and direction of the associations between proxy health systems organization variables and efficiency scores.The results showed a large variation in performance of divisions for selected UHC outputs. The results of the sensitivity analysis were also similar. Overall, divisions in Sindh province were better performing and divisions in Balochistan province were the least performing. Access to health care, the responsiveness of health systems, and patients' satisfaction were found to be correlated with efficiency scores.This research suggests that progress towards UHC is possible even at relatively low levels of public spending. Given the devolution of health system responsibilities to the provinces, this analysis will be a timely reference for provinces to gauge the performance of their divisions and plan the ongoing reforms to achieve UHC.
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Affiliation(s)
- Faraz Khalid
- Department of Global Community Health & Behavioral Sciences, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Maria Petro Brunal
- RSSH and RMNCAH Team, The Global Fund to Fight AIDS, Tuberculosis and Malaria, Geneva, Switzerland
| | - Abdul Sattar
- Vulnerability Assessment and Mapping (VAM) Unit, World Food Program, Islamabad, Pakistan
| | - Samia Laokri
- Department of Global Community Health & Behavioral Sciences, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Matthew Jowett
- Department of Health Systems Governance & Financing, World Health Organization, Geneva, Switzerland
| | - Wajeeha Raza
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - David R Hotchkiss
- Department of Global Community Health & Behavioral Sciences, Tulane University, School of Public Health and Tropical Medicine, New Orleans, LA, USA
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131
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Lu TC, Angell B, Dunn H, Ford B, White A, Keay L. Determining patient preferences in a glaucoma service: A discrete choice experiment. Clin Exp Ophthalmol 2019; 47:1146-1155. [PMID: 31397968 DOI: 10.1111/ceo.13606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 07/14/2019] [Accepted: 08/03/2019] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Patient perspectives are crucial in informing design of acceptable services. BACKGROUND This study determined patient preferences in glaucoma care. DESIGN A discrete choice experiment was used to evaluate the relative importance of out-of-pocket costs, waiting time, continuity of care, service location and expertise. PARTICIPANTS Ninety-eight glaucoma suspects or glaucoma patients were recruited from one public and two private clinics in Sydney. METHODS Twelve choice-tasks were presented in random order and forced-choice preferences were elicited. Choice data were analysed using a multinominal logit model (NLOGIT 4.0). MAIN OUTCOME MEASURES The relative importance and the likelihood of choosing services with each attribute were determined. Willingness-to-pay and willingness-to-wait were calculated. Analyses were stratified by whether the patient attended a public or private glaucoma clinic and other demographic features. RESULTS Choice was influenced by four or five attributes: greater clinician expertise, the same clinician each visit, lower out-of-pocket costs and shorter wait times (all P < .05). Respondents were willing to pay an additional (Australian dollars) $325 (95% confidence interval [CI] 188-389) to see a senior eye doctor, and $87 (95% CI 60-116) to see the same clinician each visit. Respondents were willing to wait for these attributes; however, the estimates had wide confidence intervals and were beyond the range tested. Private patients had a stronger preference for expertise and continuity of care compared to public patients. CONCLUSIONS AND RELEVANCE Expertise and continuity of care were important to glaucoma patients in this setting, and they were willing to pay out-of-pocket and concede longer waiting times to secure these preferences.
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Affiliation(s)
- Thomas Chengxuan Lu
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia.,Emergency Department, St George Hospital, Sydney, New South Wales, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Blake Angell
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Hamish Dunn
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Ophthalmology Department, Westmead Hospital, Sydney, New South Wales, Australia
| | - Belinda Ford
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia.,Ophthalmology Department, Westmead Hospital, Sydney, New South Wales, Australia
| | - Andrew White
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Ophthalmology Department, Westmead Hospital, Sydney, New South Wales, Australia
| | - Lisa Keay
- The George Institute for Global Health, UNSW Sydney, Sydney, New South Wales, Australia
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132
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Lu TC, Semsarian CR, White A, Dunn H, Angell B, Ford B, Keay L. Journey to glaucoma care - trusting but uncertain and uninformed: a qualitative study. Clin Exp Optom 2019; 103:484-489. [PMID: 31452269 DOI: 10.1111/cxo.12955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/02/2019] [Accepted: 07/18/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND This study aims to explore patient perspectives regarding their journey to glaucoma care and sought to understand the determinants that guide their access to tertiary glaucoma care. METHODS Twenty-nine patients who are glaucoma suspects or had definitive diagnosis of glaucoma were recruited from a large public glaucoma clinic and a private ophthalmology clinic in Sydney. Face-to-face, in-depth semi-structured interviews were conducted between April and December 2017. Interviews were recorded and transcribed verbatim. A framework method was used for thematic analysis of the data. RESULTS Thematic analysis resulted in the emergence of eight main themes. There was limited patient participation in decision making in their journey to glaucoma care. Consequently, there was great trust placed in the referring clinician. Patients valued their vision and therefore expressed a desire for high-quality care. They placed considerable trust in their specialist but were often unsure how to evaluate the quality of care received. Patients lacked an understanding of the cost of glaucoma care and for some, cost remained a barrier to the access of private care. There were variable experiences with waiting times and the journey to clinic, with many patients making concessions and requiring support to access care. CONCLUSION This study is the first qualitative study exploring the perspectives of glaucoma patients in Australia and the determinants of access to care. These findings support and can inform development of patient-centred models of care furthering patient trust and empowerment.
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Affiliation(s)
- Thomas C Lu
- The George Institute for Global Health, The University of New South Wales, Sydney, Australia.,Ophthalmology Department, Westmead Hospital, Sydney, Australia.,Emergency Department, St George Hospital, Sydney, Australia
| | | | - Andrew White
- School of Public Health, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Hamish Dunn
- School of Public Health, The University of Sydney, Sydney, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Blake Angell
- The George Institute for Global Health, The University of New South Wales, Sydney, Australia
| | - Belinda Ford
- The George Institute for Global Health, The University of New South Wales, Sydney, Australia.,Ophthalmology Department, Westmead Hospital, Sydney, Australia
| | - Lisa Keay
- The George Institute for Global Health, The University of New South Wales, Sydney, Australia.,School of Optometry, The University of New South Wales, Sydney, Australia
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133
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Tsai TH, Huang N, Lin IF, Chou YJ. Variation in the 11-year trajectories of medical care seeking behaviors in diabetes patients under a single payer system: persisting gaps to be filled. BMC Health Serv Res 2019; 19:580. [PMID: 31426781 PMCID: PMC6699076 DOI: 10.1186/s12913-019-4399-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 08/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Care-seeking behavior is widely acknowledged to have strong influences on health outcomes among individuals with chronic conditions including diabetes. Despite its dynamic nature, care seeking behavior are often considered as time invariant in most studies. The likelihood of patients changing their regularity and source of chronic care over time is often neglected. This study aimed to determine the long-term trajectories of care-seeking patterns of both care-seeking regularity and health provider choices; and their associated factors among patients with type 2 diabetes under the National Health Insurance (NHI) program in Taiwan. METHODS We utilized population-based data from the National Health Insurance Research Database (NHIRD) in Taiwan. Three thousand, nine hundred and eighty-seven adult patients with newly diagnosed type 2 diabetes in 1999 were enrolled in the cohort. We assessed their trajectories of regular care visits and sources of diabetes care from 2000 to 2010. A group-based trajectory model was applied. RESULTS Seven distinct groups of long-term care-seeking patterns were identified. Only 51.44% of patients with newly diagnosed diabetes had regularly visited their providers over time. Among them, 56.41 and 16.09% had persistently sought care from generalized and specialized providers, respectively. 27.50% had sought care from different levels of providers. Patients who were male, elderly, low-income, and had a higher baseline diabetes severity were significantly more likely to either continue with their irregular care-seeking behavior or fail to maintain their regular care seeking behavior over time. Those who were younger, had a higher socioeconomic status, and lived in an urban area were significantly more likely to persistently seek care from specialized care settings. CONCLUSIONS This study is the first population-based assessment of long-term care-seeking behaviors of type 2 diabetes patients under a single-payer system with a comprehensive benefit coverage. The most alarming finding was that, despite the existence of the comprehensive universal health insurance coverage in Taiwan, almost 50% of patients did not seek or maintain regular visits to providers over time as recommended. Understanding variations in the long-term trajectories of care adherence and sources of care may help to identify gaps in diabetes care management.
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Affiliation(s)
- Tzu-Ho Tsai
- Institute of Public Health, School of Medicine, National Yang-Ming University, No.115, Sec. 2, Linong Street, Taipei, Taiwan
- Department of Intensive Care, Cheng-Hsin Hospital, No. 45, Cheng Hsin Street, Taipei, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, No.115, Sec. 2, Linong Street, Taipei, Taiwan
| | - I-Feng Lin
- Institute of Public Health, School of Medicine, National Yang-Ming University, No.115, Sec. 2, Linong Street, Taipei, Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, School of Medicine, National Yang-Ming University, No.115, Sec. 2, Linong Street, Taipei, Taiwan
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Syed JS, Abello A, Nguyen J, Lee AJH, Desloges JJ, Leapman MS, Kenney PA. Outcomes for urologic oncology procedures: are there differences between academic and community hospitals? World J Urol 2019; 38:1187-1193. [PMID: 31420696 DOI: 10.1007/s00345-019-02902-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 08/02/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To compare the rate of hospital-based outcomes including costs, 30-day readmission, mortality, and length of stay in patients who underwent major urologic oncologic procedures in academic and community hospitals. METHODS We retrospectively reviewed the Vizient Database (Irving, Texas) from September 2014 to December 2017. Vizient includes ~ 97% of academic hospitals (AH) and more than 60 community hospitals (CH). Patients aged ≥ 18 with urologic malignancies who underwent surgical treatment were included. Chi square and Student t tests were used to compare categorical and continuous variables, respectively. RESULTS We identified a total of 37,628 cases. There were 33,290 (88%) procedures performed in AH and 4330 (12%) in CH. These included prostatectomy (18,540), radical nephrectomy (rNx) 8059, partial nephrectomy (pNx) (5287), radical cystectomy (4421), radical nephroureterectomy (rNu) (1006), and partial cystectomy (321). There were no significant differences in 30-day readmission rates or mortality for any procedure between academic and community hospitals (Table 1), p > 0.05 for all. Length of stay was significantly lower for radical cystectomy and prostatectomy in AH (p < 0.01 for both) and lower for rNx in CH (p = 0.03). The mean direct cost for index admission was significantly higher in AH for rNx, pNx, rNu, and prostatectomy. Case mix index was similar between the community and academic hospitals. CONCLUSION Despite academic and community hospitals having similar case complexity, direct costs were lower in community hospitals without an associated increase in readmission rates or deaths. Length of stay was shorter for cystectomy in academic centers.
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Affiliation(s)
- Jamil S Syed
- Department of Urology, Yale School of Medicine, PO Box 208058, New Haven, CT, 06520-8058, USA.
| | - Alejandro Abello
- Department of Urology, Yale School of Medicine, PO Box 208058, New Haven, CT, 06520-8058, USA
| | - Justin Nguyen
- Department of Urology, Yale School of Medicine, PO Box 208058, New Haven, CT, 06520-8058, USA
| | - Aidan J H Lee
- Department of Urology, Yale School of Medicine, PO Box 208058, New Haven, CT, 06520-8058, USA
| | - Juan-Javier Desloges
- Department of Urology, Yale School of Medicine, PO Box 208058, New Haven, CT, 06520-8058, USA
| | - Michael S Leapman
- Department of Urology, Yale School of Medicine, PO Box 208058, New Haven, CT, 06520-8058, USA
| | - Patrick A Kenney
- Department of Urology, Yale School of Medicine, PO Box 208058, New Haven, CT, 06520-8058, USA
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Roder-DeWan S, Gage AD, Hirschhorn LR, Twum-Danso NAY, Liljestrand J, Asante-Shongwe K, Rodríguez V, Yahya T, Kruk ME. Expectations of healthcare quality: A cross-sectional study of internet users in 12 low- and middle-income countries. PLoS Med 2019; 16:e1002879. [PMID: 31390364 PMCID: PMC6685603 DOI: 10.1371/journal.pmed.1002879] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 07/01/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND High satisfaction with healthcare is common in low- and middle-income countries (LMICs), despite widespread quality deficits. This may be due to low expectations because people lack knowledge about what constitutes good quality or are resigned about the quality of available services. METHODS AND FINDINGS We fielded an internet survey in Argentina, China, Ghana, India, Indonesia, Kenya, Lebanon, Mexico, Morocco, Nigeria, Senegal, and South Africa in 2017 (N = 17,996). It included vignettes describing poor-quality services-inadequate technical or interpersonal care-for 2 conditions. After applying population weights, most of our respondents lived in urban areas (59%), had finished primary school (55%), and were under the age of 50 (75%). Just over half were men (51%), and the vast majority reported that they were in good health (73%). Over half (53%) of our study population rated the quality of vignettes describing poor-quality services as good or better. We used multilevel logistic regression and found that good ratings were associated with less education (no formal schooling versus university education; adjusted odds ratio [AOR] 2.22, 95% CI 1.90-2.59, P < 0.001), better self-reported health (excellent versus poor health; AOR 5.19, 95% CI 4.33-6.21, P < 0.001), history of discrimination in healthcare (AOR 1.47, 95% CI 1.36-1.57, P < 0.001), and male gender (AOR 1.32, 95% CI 1.23-1.41, P < 0.001). The survey did not reach nonusers of the internet thus only representing the internet-using population. CONCLUSIONS Majorities of the internet-using public in 12 LMICs have low expectations of healthcare quality as evidenced by high ratings given to poor-quality care. Low expectations of health services likely dampen demand for quality, reduce pressure on systems to deliver quality care, and inflate satisfaction ratings. Policies and interventions to raise people's expectations of the quality of healthcare they receive should be considered in health system quality reforms.
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Affiliation(s)
- Sanam Roder-DeWan
- Harvard T. H. Chan School of Public Health, Department of Global Health and Population, Boston, Massachusetts, United States of America
- Ifakara Health Institute, Dar es Salaam, Tanzania
- UNICEF, Dar es Salaam, Tanzania
| | - Anna D. Gage
- Harvard T. H. Chan School of Public Health, Department of Global Health and Population, Boston, Massachusetts, United States of America
| | - Lisa R. Hirschhorn
- Northwestern University, Feinberg School of Medicine, Chicago, Illinois, United States of America
| | - Nana A. Y. Twum-Danso
- MAZA, Accra, Ghana
- Gillings School of Global Public Health, Department of Maternal and Child Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Jerker Liljestrand
- Bill & Melinda Gates Foundation, Seattle, Washington, United States of America
| | | | | | - Talhiya Yahya
- Quality Management Unit, Health Quality Assurance Department, Ministry of Health, Dar es Salaam, Tanzania
| | - Margaret E. Kruk
- Harvard T. H. Chan School of Public Health, Department of Global Health and Population, Boston, Massachusetts, United States of America
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136
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Goff SL, Garb JL, Guhn-Knight H, Priya A, Pekow PS, Lindenauer PK. Spatial analysis of factors influencing choice of paediatric practice for mothers from low-income and minority populations. J Paediatr Child Health 2019; 55:948-955. [PMID: 30548139 PMCID: PMC6555692 DOI: 10.1111/jpc.14322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 10/24/2018] [Accepted: 11/09/2018] [Indexed: 11/29/2022]
Abstract
AIM Publicly reported quality data theoretically enable parents to choose higher-performing paediatric practices. However, little is known about how parents decide where to seek paediatric care. We explored the relationship between geographic factors, care quality and choice of practice to see if the decision-making process could be described in terms of a 'gravity model' of spatial data. METHODS In the context of a randomised controlled trial, we used a geographic information system to calculate flow volume between practice locations and participants' homes, to locate subjects within a census tract, to determine distances between points and to perform exploratory mapping. Generalised linear modelling was then used to determine whether the data fit a gravity model, which is a spatial model that evaluates factors impacting travel from one set of locations to another. RESULTS A total of 662 women and 52 paediatric practices were included in the analysis. Proximity of a practice to home was the most important factor in choosing a practice (Z = -15.01, P < 0.001). Practice size was important to a lesser extent, with larger practices more likely to be chosen (Z = 8.96, P < 0.001). A practice's performance on quality measures was associated with choice only for women who had received an intervention to increase use of quality data (Z = 2.51, P < 0.05). CONCLUSIONS The gravity model and the concept of flow can help explain the choice of paediatric practice in a predominantly low-income, racially ethnic minority (non-White) urban population. This has important ramifications for the potential impact of publicly reported quality data.
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Affiliation(s)
- Sarah L Goff
- Department of Medicine, General Internal Medicine, Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School, Springfield, Massachusetts, United States.,Department of Medicine, University of Massachusetts Medical School, Springfield, Massachusetts, United States
| | - Jane L Garb
- Office of Research, Epidemiology and Biostatistics Core, University of Massachusetts Medical School, Springfield, Massachusetts, United States
| | - Haley Guhn-Knight
- Department of Medicine, General Internal Medicine, Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School, Springfield, Massachusetts, United States
| | - Aruna Priya
- Department of Medicine, General Internal Medicine, Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School, Springfield, Massachusetts, United States
| | - Penelope S Pekow
- Department of Medicine, General Internal Medicine, Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School, Springfield, Massachusetts, United States
| | - Peter K Lindenauer
- Department of Medicine, General Internal Medicine, Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School, Springfield, Massachusetts, United States.,Department of Medicine, University of Massachusetts Medical School, Springfield, Massachusetts, United States.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, United States
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Incidence estimation from sentinel surveillance data; a simulation study and application to data from the Belgian laboratory sentinel surveillance. BMC Public Health 2019; 19:982. [PMID: 31337363 PMCID: PMC6651902 DOI: 10.1186/s12889-019-7279-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 07/04/2019] [Indexed: 11/14/2022] Open
Abstract
Background Inverse probability weighting (IPW) methods can be used to estimate the total number of cases from the sample collected through sentinel surveillance. Central to these methods are the inverse weights which can be derived in several ways and, in this case, represent the probability that laboratory (lab) sentinel surveillance detects a lab-confirmed case. Methods We compare different weights in a simulation study. Weights are obtained from the proportion of participating labs over all labs. We adjust these weights for attractiveness and density of labs over population. The market share of sentinel labs, as estimated by the econometric Huff-model, is also considered. Additionally, we investigate the effect of not recognizing sentinel labs as sentinel labs when they report no cases. We estimate the bias associated with the different weights as the difference between the simulated number of cases and the estimate of this total from the sentinel sample. As motivating data examples, we apply an extended Huff-model to four pathogens under laboratory sentinel surveillance in Belgium between 2010 and 2015 and discuss the model fit. We estimate the total number of lab-confirmed cases associated with Rotavirus, influenza virus, Y. enterocolitica and Campylobacter spp.. The extended Huff-model takes the lab-concept, the number of reimbursements and the number of departments, lab-density, regional borders, distance and competition between labs in account. Results Estimates obtained with the Huff-model were most accurate in the more complex simulation scenarios as compared to other weights. In the data examples, several significant coefficients are identified, but the fit of the Huff-model to the Belgian sentinel surveillance data leaves much variability in market shares unexplained. Conclusion The Huff-model allows for estimation of the spatial and population coverage of sentinel surveillance and through IPW-methods also for the estimation of the total number of cases. The Huff-model‘s gravity function allows us to differentiate inside an area while estimating from the full dataset. Our data examples show that additional data on the participation to surveillance and practices of labs is necessary for a more accurate estimation.
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138
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Aydin MA, Gokcen HB. Factors considered by patients in provider selection for elective specialty surgery: A questionnaire-based survey. Int J Surg 2019; 69:43-48. [PMID: 31319232 DOI: 10.1016/j.ijsu.2019.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/14/2019] [Accepted: 07/05/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study was designed to comprehensively evaluate the factors considered by patients in provider selection for elective specialty surgery. MATERIALS AND METHODS A total of 200 patients (mean age 44.4 (range, 18.0-70.0) years, 51.0% were males), who were admitted to a tertiary care center for an elective surgery, participated on a voluntary basis in this cross-sectional questionnaire survey. The questionnaire form elicited items on sociodemographic characteristics of patients, characteristics of operation, factors contributing to physician selection by patients (physician-related factors, healthcare service/access related factors) and patients' view on factors contributing to physician selection. RESULTS Amongst the physician-related factors, attitude of physician (all items considered very important by majority of patients) was the factor most significantly contributed to physician selection as followed by reputation (recommendation of physician by former patients considered very important by 58.5%) or professional experience (presence of subspecialty certificate in surgery considered very important by 67.5%) and social media presence of the physician (comments and ratings of users about the physician considered very important by 26.5% of patients) of the physician. Patients considered hospital hygiene (75.5%) as the most significant healthcare service/access related factor in physician selection. Physician selection was considered to be of utmost importance in the treatment outcome by 95.5% of patients, while getting information about the physician before contacting her/him was considered important and actually performed for the current admission by 74% of patients. CONCLUSION In conclusion, our findings revealed that communicative skills of the physician, presence of subspecialty certificate in surgery, recommendations by former patients and comments and ratings of users were the leading factors contributed to physician selection by patients; being related to attitude, professional experience, reputation and social media presence of the physician, respectively. Hospital hygiene was the most significant healthcare service/access related factor contributed to physician selection.
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Affiliation(s)
- Mehmet Akif Aydin
- Department of General Surgery, Altinbas University Faculty of Medicine Medical Park Bahcelievler Hospital, Istanbul, Turkey.
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139
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Kobayashi D, Goto R, Tsugawa Y. Impact of improved price transparency on patients' demand of healthcare services. Soc Sci Med 2019; 235:112390. [PMID: 31325901 DOI: 10.1016/j.socscimed.2019.112390] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 06/28/2019] [Accepted: 06/29/2019] [Indexed: 01/23/2023]
Abstract
Evidence is limited and mixed as to how improved price transparency affects patients' demand for healthcare. Price transparency usually affects both the supply and the demand side of healthcare. However, in Japan-where healthcare providers cannot compete on prices-we can examine an independent impact of price transparency on patients' demand for healthcare. The aim of this study is to investigate the impact of improved price transparency on patients' demand for healthcare. We conducted an experiment by presenting patients with the "price list" of individual healthcare services. We provided the price list for a limited time and compared the healthcare spending and utilization of care between these patients who were provided the price list (patients who visited between the first and third week of January in 2016) versus those who were not (patients who visited during the same period in 2015 or 2017), adjusting for potential confounders. A total of 1053 patients were analyzed (27.5% were provided the price list). We found that improved price transparency was associated with a higher total cost per patient (adjusted difference, +16.1%; 95%CI, +0.6% to +34.0%; p = 0.04). We also found that improved price transparency was associated with higher costs related to laboratory tests and imaging studies, and a larger total number of items of blood tests and urine tests. By conducting an experiment in a real-world setting, we found that improved price transparency paradoxically increased the utilization of healthcare services in Japan. These findings suggest that when prices are relatively low, as is the case in Japan, reduced uncertainty about the prices of healthcare service may make patients comfortable requesting more healthcare services.
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Affiliation(s)
- Daiki Kobayashi
- Division of General Internal Medicine, Department of Medicine, St. Luke's International Hospital, Tokyo, Japan; Department of Epidemiology, St. Luke's International University Graduate School of Public Health, Tokyo, Japan.
| | - Rei Goto
- Keio University, Graduate School of Business Administration, Tokyo, Japan
| | - Yusuke Tsugawa
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
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140
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Wiegers TA, Hendriks M, Malanda U, de Boer D. Users' Experiences With Web-Based Health Care Information: Qualitative Study About Diabetes and Dementia Information Presented on a Governmental Website. J Med Internet Res 2019; 21:e11340. [PMID: 31287066 PMCID: PMC6643759 DOI: 10.2196/11340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 01/29/2019] [Accepted: 04/07/2019] [Indexed: 01/17/2023] Open
Abstract
Background Information on health and health care is abundant on the internet. To make informed choices, patients need reliable and easy-to-understand information about quality and availability of care providers and treatment options. However, the reliability of such Web-based information is difficult to assess. Objective This study aimed to test Web-based information about diabetes and dementia and specifically a new presentation format of care routes to see if people are able to understand and use the information. Methods Overall, 38 cognitive interviews were held; 20 people viewed the information about diabetes and 18 viewed the dementia information. Participants were asked what they would want to know about either diabetes or dementia, what choices they would want to make concerning their preferred care provider and treatment, and what information they would like to find to make these choices. They were then asked to view the relevant pages and comment on them. The interview was focused on general information about the condition, the care route, and the quality information for choosing a hospital. The interviews were transcribed verbatim and then systematically coded and ordered into themes. Results The themes that were developed for both Web pages during the analysis were information needs, findability, usability, comprehension and readability, recognizability, care route, quality information, and usefulness. Information needs were found to be very diverse and dependent on the personal situation and condition of the participant. Several participants were unable to find specific items because they were not where they expected them to be. Most participants were positive about the layout, font, and color scheme of the test pages. However, options of clicking through to another website and indications where information can be expanded and collapsed could be made clearer. Participants generally found the information easy to understand but felt a need for a more detailed explanation of the medical terms. Recognition of the information played an important role: participants assessed whether the information they found matched their experiences. The term care route meant little to most of the participants, but the layout of the care route itself was found to be clear. Not many respondents spontaneously went to the quality information, and a number of participants had difficulty understanding it. Overall, the participants thought the information on the website was useful and helpful. Conclusions The cognitive interviews gave numerous insights into how Web-based information is processed and understood. The care route offers a clear overview of the various stages as the condition progresses, but the name care route is not clear to everyone. We gained insight into differences between subgroups of people in terms of information needs, comprehension, and use of the information because the diversity within the group of participants was lower than expected.
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141
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Zhu J, Li J, Zhang Z, Li H. Patients' choice and preference for common disease diagnosis and diabetes care: A discrete choice experiment. Int J Health Plann Manage 2019; 34:e1544-e1555. [PMID: 31270879 DOI: 10.1002/hpm.2841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To examine the impact of policy incentives on patient's choice of health-care providers for primary care and to capture the preferences for general practitioner (GP) care. STUDY DESIGN Discrete choice experiment. METHODS A random sample of 704 adults and of 181 diabetics were independently surveyed to elicit patients' preferences for common disease diagnosis and diabetes care. Mixed logit regression was used for the analysis. RESULTS On average, the most valued attribute in GP care are the organizational factors related to whether the provider has sufficient medicine and equipment to provide capable primary care service. Policy incentives, such as reducing waiting time, providing prior expert access, and increasing Medicare reimbursement, can facilitate the utilization of the GP system. Significant preference heterogeneity was identified; specifically, patient preferences significantly differ with regard to demand for common disease diagnosis and diabetes care. CONCLUSION The identification of the preferences of specific groups in regard to GP care is an organizational and political imperative. Policy incentives are useful tools to guide patients' health care seeking behavior. To change the perceptions of Chinese patients with regard to health care, policy makers should consider the heterogeneous responses of residents to policy incentives and focus their efforts on key cohorts.
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Affiliation(s)
- Jingrong Zhu
- School of Management and Economics, Beijing Institute of Technology, Beijing, China.,College of Health and Human Development, Pennsylvania State University, State College, Pennsylvania, USA
| | - Jinlin Li
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
| | - Zengbo Zhang
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
| | - Hao Li
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
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142
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Visser LM, Benschop YW, Bleijenbergh IL, van Riel AC. Unequal Consumers: Consumerist healthcare technologies and their creation of new inequalities. ORGANIZATION STUDIES 2019. [DOI: 10.1177/0170840618772599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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143
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Li S, Hubner A. The Impact of Web-Based Ratings on Patient Choice of a Primary Care Physician Versus a Specialist: Randomized Controlled Experiment. J Med Internet Res 2019; 21:e11188. [PMID: 31254337 PMCID: PMC6625218 DOI: 10.2196/11188] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 01/04/2019] [Accepted: 05/11/2019] [Indexed: 11/13/2022] Open
Abstract
Background Physician review websites have empowered prospective patients to acquire information about physicians. However, little is known about how Web-based ratings on different aspects of a physician may affect patients’ selection of physicians differently. Objective The objectives of this study were to examine (1) how patients weigh ratings on a physician’s technical skills and interpersonal skills in their selection of physicians and (2) whether and how people’s choice of a primary care physician versus a specialist is affected differently by Web-based ratings. Methods A 2×2×2×2 between-subjects experiment was conducted. Over 600 participants were recruited through a crowdsourcing website and randomly assigned to view a mockup physician review Web page that contained information on a physician’s basic information and patients’ ratings. After reviewing the Web page, participants were asked to complete a survey on their perceptions of the physician and willingness to seek health care from the physician. Results The results showed that participants were more willing to choose a physician with higher ratings on technical skills than on interpersonal skills compared with a physician with higher ratings on interpersonal skills than on technical skills, t369.96=22.36, P<.001, Cohen d=1.22. In the selection of different types of physicians, patients were more likely to choose a specialist with higher ratings on technical skills than on interpersonal skills, compared with a primary care physician with the same ratings, F1,521=5.34, P=.021. Conclusions The findings suggest that people place more weight on technical skills than interpersonal skills in their selection of a physician based on their ratings on the Web. Specifically, people are more likely to make a compromise on interpersonal skills in their choice of a specialist compared with a primary care physician. This study emphasizes the importance of examining Web-based physician ratings in a more nuanced way in relation to the selection of different types of physicians. Trial Registration ISRCTN Registry ISRCTN91316463; http://www.isrctn.com/ISRCTN91316463
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Affiliation(s)
- Siyue Li
- College of Media and International Culture, Zhejiang University, Hangzhou, China
| | - Austin Hubner
- School of Communication, The Ohio State University, Columbus, OH, United States
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144
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Meese KA, Powers TL, Garman AN, Choi S, Hernandez SR. Country-of-origin and brand positioning for health care services. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2019. [DOI: 10.1108/ijphm-03-2018-0019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeThe purpose of this paper is to examine the relationship between country-of-origin (COO) and brand positioning in the context of the high-involvement service of health care. This paper compares and analyzes different positioning strategies used in Europe, North America and the Middle East.Design/methodology/approachThis paper uses content analysis of promotional materials for a sample of 168 health-care organizations located in 14 countries to identify brand positioning strategies used, such as foreign, local and global consumer culture positioning. A chi-square analysis and post hoc testing is used to examine how positioning strategies differ among regions.FindingsThe findings indicate that European and Middle Eastern health-care organizations most frequently use foreign consumer culture positioning, while North American institutions tend to use global consumer culture positioning. The findings indicate that health-care organizations in countries with a better reputation for care use different positioning strategies than in countries with a lesser reputation for quality care.Practical implicationsThe findings are of value to international advertising and marketing professionals and hospitals seeking to attract patients globally in a competitive marketplace. Hospitals must consider their positioning relative to both domestic and international competitors and the COO of their target audience.Originality/valueCOO is important in high-involvement service industries because consumers lack the information needed to evaluate service quality. Consumers may rely on COO and brand positioning signals more heavily relative to goods or low-involvement services. However, little prior research exists examining COO effects and brand positioning for high involvement services and for health care specifically. This paper makes a unique contribution by filling this gap.
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Patient-centered care factors and access to care: a path analysis using the Andersen behavior model. Public Health 2019; 171:41-49. [DOI: 10.1016/j.puhe.2019.03.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 03/19/2019] [Accepted: 03/29/2019] [Indexed: 11/21/2022]
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146
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Kuo RN, Chen W, Lin Y. Do informed consumers in Taiwan favour larger hospitals? A 10-year population-based study on differences in the selection of healthcare providers among medical professionals, their relatives and the general population. BMJ Open 2019; 9:e025202. [PMID: 31101695 PMCID: PMC6530349 DOI: 10.1136/bmjopen-2018-025202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Exploring whether medical professionals, who are considered to be 'informed consumers' in the healthcare system, favour large providers for elective treatments. In this study, we compare the inclination of medical professionals and their relatives undergoing treatment for childbirth and cataract surgery at medical centres, against those of the general population. DESIGN Retrospective study using a population-based matched cohort data. PARTICIPANTS Patients who underwent childbirth or cataract surgery between 1 January 2004 and 31 December 2013. PRIMARY AND SECONDARY OUTCOMES MEASURES We used multiple logistic regression to compare the ORs of medical professionals and their relatives undergoing treatment at medical centres, against those of the general population. We also compared the rate of 14-day re-admission (childbirth) and 14-day reoperation (cataract surgery) after discharge between these groups. RESULTS Multivariate analysis showed that physicians were more likely than patients with no familial connection to the medical profession to undergo childbirth at medical centres (OR 5.26, 95% CI 3.96 to 6.97, p<0.001), followed by physicians' relatives (OR 2.68, 95% CI 2.20 to 3.25, p<0.001). Similarly, physicians (OR 1.63, 95% CI 1.21 to 2.19, p<0.01) and their relatives (OR 1.43, 95% CI 1.13 to 1.81, p<0.01) were also more likely to undergo cataract surgery at medical centres. Physicians also tended to select healthcare providers who were at the same level or above the institution at which they worked. We observed no significant difference in 14-day re-admission rates after childbirth and no significant difference in 14-day reoperation rates after cataract surgery across patient groups. CONCLUSIONS Medical professionals and their relatives are more likely than the general population to opt for service at medical centres. Understanding the reasons that medical professionals and general populations both have a preferential bias for larger medical institutions could help improve the efficiency of healthcare delivery.
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Affiliation(s)
- Raymond N Kuo
- Institute of Health Policy and Management, National Taiwan University, Taipei City, Taiwan
- Innovation and Policy Centre for Population Health and Sustainable Environment, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - Wanchi Chen
- Institute of Health Policy and Management, National Taiwan University, Taipei City, Taiwan
| | - Yuting Lin
- National Health Insurance Administration, Taipei Division, Taipei City, Taiwan
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Abiodun O, Ovat F, Olu-Abiodun O. Provider-Related Predictors of Utilization of University Health Services in Nigeria. Ethiop J Health Sci 2019; 29:239-250. [PMID: 31011272 PMCID: PMC6460440 DOI: 10.4314/ejhs.v29i2.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The utilization of health services is an important policy concern in most developing countries. Many staff and students do not utilize the health services within the university system despite the availability of good quality services. This study investigated the provider-related factors related to utilization of university health service by staff and students in a privately owneduniversity in Nigeria. Methods The perception of the quality of a university health service was investigated among a cross-section of 600 university staff and students who were selected by a stratified random sampling scheme. A self-administered questionnaire-based study was conducted. The structure, process and output predictors of utilization of the university health facility were assessed. Data analysis was carried out using Stata I/C 15.0. Results The average age of the participants was 22.93±7.58 years. About two-thirds of them did not have opinion about the mortality and morbidity rates at the university health center. Significant proportions of the participants reported good perceptions about the structure and process quality of service indicators. Utilization of the university health center was predicted by some structure and process indicators namely; the availability/experience of staff (AOR 2.44; CI 1.67–3.58), the organization of healthcare (AOR 1.64; CI 1.11–2.41), the continuity of treatment (AOR 1.74; CI 1.12–2.70) and the waiting time (AOR 0.41; CI 0.28–0.61). Conclusion The utilization of university health services was predicted by availability/experience of staff, the organization of healthcare, the waiting time and the continuity of care. The structure-process-outcome approach discriminates between the students and staff who utilize the university health center and those who donot. It also suggests a complex interplay of factors in the prediction of choice of a health facility.
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Affiliation(s)
- Olumide Abiodun
- Department of Community Medicine, Babcock University, Ilishan, Nigeria.,Centre for Epidemiology and Clinical Research, Sagamu, Nigeria
| | - Faithman Ovat
- Benjamin Carson School of Medicine, Babcock University, Ilishan, Nigeria
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148
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Shmueli L, Davidovitch N, Pliskin JS, Hekselman I, Balicer RD, Greenfield G. Reasons, perceived outcomes and characteristics of second-opinion seekers: are there differences in private vs. public settings? BMC Health Serv Res 2019; 19:238. [PMID: 31014323 PMCID: PMC6480844 DOI: 10.1186/s12913-019-4067-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/05/2019] [Indexed: 01/29/2023] Open
Abstract
Background In most countries, patients can get a second opinion (SO) through public or private healthcare systems. There is lack of data on SO utilization in private vs. public settings. We aim to evaluate the characteristics of people seeking SOs in private vs. public settings, to evaluate their reasons for seeking a SO from a private physician and to compare the perceived outcomes of SOs given in a private system vs. a public system. Methods A cross-sectional national telephone survey, using representative sample of the general Israeli population (n = 848, response rate = 62%). SO utilization was defined as seeking an additional clinical opinion from a specialist within the same specialty, on the same medical concern. We modeled SO utilization in a public system vs. a private system by patient characteristics using a multivariate logistic regression model. Results 214 of 339 respondents who obtained a SO during the study period, did so in a private practice (63.1%). The main reason for seeking a SO from a private physician rather than a physician in the public system was the assumption that private physicians are more professional (45.7%). However, respondents who obtained a private SO were neither more satisfied from the SO (p = 0.45), nor felt improvement in their perceived clinical outcomes after the SO (p = 0.37). Low self-reported income group, immigrants (immigrated to Israel after 1989) and religious people tended to seek SOs from the public system more than others. Conclusions The main reason for seeking a SO from private physicians was the assumption that they are more professional. However, there were no differences in satisfaction from the SO nor perceived clinical improvement. As most of SOs are sought in the private system, patient misconceptions about the private market superiority may lead to ineffective resource usage and increase inequalities in access to SOs. Ways to improve public services should be considered to reduce health inequalities.
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Affiliation(s)
- Liora Shmueli
- Department of Health Systems Management, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel
| | - Nadav Davidovitch
- Department of Health Systems Management, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel
| | - Joseph S Pliskin
- Department of Health Systems Management, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel.,Department of Industrial Engineering and Management, Ben-Gurion University of the Negev, P.O. Box 653, 84105, Beer-Sheva, Israel
| | - Igal Hekselman
- Clalit Mushlam Health Insurance Systems, Clalit Health Services, 1 Ben Gurion, 5120149, Bnei Brak, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ran D Balicer
- Clalit Research Institute, Clalit Health Services, 101 Arlozorov, 62098, Tel-Aviv, Israel
| | - Geva Greenfield
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, The Reynolds Building, St. Dunstan's Road, London, W6 8RP, UK.
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149
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Zhu J, Li J, Zhang Z, Li H, Cai L. Exploring determinants of health provider choice and heterogeneity in preference among outpatients in Beijing: a labelled discrete choice experiment. BMJ Open 2019; 9:e023363. [PMID: 30948563 PMCID: PMC6500246 DOI: 10.1136/bmjopen-2018-023363] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE For a long time in China, public hospitals have been the most prominent provider of healthcare. However, recent policy reforms mean the private sector is experiencing rapid development. Thus, the purpose of this study is to detect whether the policies published by the government aimed to improve the quality of healthcare services were catering to patient's preferences. PARTICIPANTS AND METHODS Our work uses dental care as an example of services provided in outpatient setting and takes advantage of a labelled discrete choice experiment with a random sample of respondents from Beijing. Participants were asked to make a choice between four healthcare providers with different attributes. Mixed logit and latent class models were used for the analysis. RESULT Care provided by high-level private hospitals and community hospitals were valued RMB154 and 216 less, respectively, than care provided by class A tertiary hospitals, while the most disliked provider was private clinics. This was the most valued attribute of dental care. Respondents also value: lower waiting times, the option to choose their doctor, lower treatment costs, shorter travel times and a clean waiting room. However, when the level of provider was analysed, the prevailing notion that patients in China were always likely to choose public services than private services no longer holds. Four classes of patients with distinct preferences for dental care provider choice were identified, which can partly be explained by age, income, experience and Hukou status-a household registration permit. DISCUSSION The study to some extent challenged the overwhelming predominance of public healthcare providers in China. The preference heterogeneity we found was relatively large. Our findings are significant for providers in developing more specific services for patients and for policymakers in weighing the pros and cons of future initiatives in medical reform.
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Affiliation(s)
- Jingrong Zhu
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
| | - Jinlin Li
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
| | - Zengbo Zhang
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
| | - Hao Li
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
| | - Lingfei Cai
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
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150
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Alibrahim A, Wu S. Modelling competition in health care markets as a complex adaptive system: an agent-based framework. Health Syst (Basingstoke) 2019; 9:212-225. [PMID: 32939260 DOI: 10.1080/20476965.2019.1569480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Health market reforms necessitate continuous re-evaluation of initiatives, competitive regulations, and antitrust policies. Synergistic implications, evolution, and behaviour changes associated with the market competition are often overlooked due to methodological limitations. To rectify these limitations, parallels between defining features of health care markets (HCM) and complex adaptive systems (CAS) are drawn. The science of CAS develops complex system-level models of dynamic interactions to allow insights for heterogeneous agents and emergent behaviours. Agent-based modelling (ABM) is a computational tool of CAS science suitable for investigating competition in HCM. The proposed agent-based framework conceptualises agents, environment, and interactions, and formalises agent-specific attributes and modules that achieve agent roles to recreate HCM dynamics. The framework conceptualises competition in HCM into an implementable ABM for a CAS assessment, identifies data sources, and develops face-validity procedures. Developments in data, computational power, and decisions theory compel CAS approach to complement studies on pressing HCM issues.
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Affiliation(s)
- Abdullah Alibrahim
- Industrial & Management Systems Engineering College of Engineering & Petroleum Kuwait University
| | - Shinyi Wu
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA.,Daniel J. Epstein Department of Industrial & Systems Engineering, University of Southern California, Los Angeles, CA, USA.,Edward R. Roybal Institute on Aging, University of Southern California, Los Angeles, CA.,Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, USA
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