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Lin W, Dong X, Hennessy J, Zhao J, Ma X. Exploring the Preferences of Parents of Children with Myopia in Rural China for Eye Care Services Under Privatization Policy: Evidence from a Discrete Choice Experiment. THE PATIENT 2024; 17:133-145. [PMID: 38072882 DOI: 10.1007/s40271-023-00660-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2023] [Indexed: 02/25/2024]
Abstract
OBJECTIVES This study aims to measure the preferences and valuations of parents of students with myopia parents for eye care service attributes in rural China, and to quantify the potential welfare impacts of privatization policy on children's eye care services. METHODS A discrete choice experiment was designed and implemented among a sample of parents of children with myopia in rural China. We randomly selected 350 participants from the list of subjects obtained from local town schools and family doctors using a random number table method. The participants were asked to choose between two hypothetical scenarios defined by five attributes: provider type, distance, price, lenses type, and refractionists' professional competencies. We estimate conditional logit and mixed logit models to approximate individual preferences for these attributes and estimate the welfare effects by calculating willingness to pay. RESULTS Respondents (n = 336) showed a significant preference for public providers of refractive error services, myopia control lenses, and professional refractionists (P < 0.01 for each). Consumer welfare losses due to a prohibition of the public provision of refractive error services could be compensated by improving the quality of products and services delivered by private providers. Lastly, both parent and child demographics and previous experience of eye care service consumption are important predictors of willingness to pay for refractive error services. CONCLUSIONS The privatization policy on children's eye care services would not cater to the preferences of rural consumers, inevitably leading to welfare losses. However, reduced consumer welfare could be compensated by improving the quality of products and service delivery from private providers. These results could help inform strategies to improve and reduce inequities in access to high-quality eye care services in rural China.
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Affiliation(s)
- Wen Lin
- College of Economics and Management, Nanjing Agricultural University, Nanjing, China
| | - Xiaodong Dong
- School of Public Health, Peking University, Beijing, 100191, China
- China Center for Health Development Studies, Peking University, Beijing, 100191, China
| | - Jack Hennessy
- The Fred Hollows Foundation, Melbourne, VIC, Australia
- Monash Business School, Centre for Health Economics, Monash University, Caulfield East, VIC, Australia
| | - Junling Zhao
- School of Public Health, Peking University, Beijing, 100191, China
- China Center for Health Development Studies, Peking University, Beijing, 100191, China
| | - Xiaochen Ma
- China Center for Health Development Studies, Peking University, Beijing, 100191, China.
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Goodair B, Reeves A. The effect of health-care privatisation on the quality of care. Lancet Public Health 2024; 9:e199-e206. [PMID: 38429019 DOI: 10.1016/s2468-2667(24)00003-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/30/2023] [Accepted: 01/05/2024] [Indexed: 03/03/2024]
Abstract
Over the past 40 years, many health-care systems that were once publicly owned or financed have moved towards privatising their services, primarily through outsourcing to the private sector. But what has the impact been of privatisation on the quality of care? A key aim of this transition is to improve quality of care through increased market competition along with the benefits of a more flexible and patient-centred private sector. However, concerns have been raised that these reforms could result in worse care, in part because it is easier to reduce costs than increase quality of health care. Many of these reforms took place decades ago and there have been numerous studies that have examined their effects on the quality of care received by patients. We reviewed this literature, focusing on the effects of outsourcing health-care services in high-income countries. We found that hospitals converting from public to private ownership status tended to make higher profits than public hospitals that do not convert, primarily through the selective intake of patients and reductions to staff numbers. We also found that aggregate increases in privatisation frequently corresponded with worse health outcomes for patients. Very few studies evaluated this important reform and there are many gaps in the literature. However, based on the evidence available, our Review provides evidence that challenges the justifications for health-care privatisation and concludes that the scientific support for further privatisation of health-care services is weak.
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Affiliation(s)
- Benjamin Goodair
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
| | - Aaron Reeves
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
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Michael T, Filc D, Davidovitch N. What motivates physicians to propose private services in a mixed private-public healthcare system? A mixed methods study. BMC Health Serv Res 2022; 22:51. [PMID: 35012548 PMCID: PMC8750864 DOI: 10.1186/s12913-022-07474-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022] Open
Abstract
Background Implementation of private elements, including private insurances, in public healthcare system is now common in many countries, and its impacts have been well studied. Little, however, is known about the motives leading physicians, major role players in the system, to promote the usage of private services. The aim of this study was to explore the various motives leading physicians within public systems to propose private services to their patients, while examining the possible associations to their specialty and level of commitment. Methods A total of 197 physicians from specialisms loaded more to private/public sectors participated in a cross-sectional telephone survey regarding their attitudes on their practices, private insurances, access to healthcare, and job satisfaction. The association between the likert scale questions to their recommendation to purchase private insurance, and the commitment they felt towards patients were analyzed using Generalized Estimating Equations (GEE) as well as logistic regression models. Results Our findings suggest physicians engaged in dual practice are less likely to promote private insurances among their patients if they are satisfied with their public job (OR = 0.92, 95%CI 0.89,0.94). Physicians perceived private insurances as beneficial for patients, were found likely to promote them (OR = 1.65, %95CI 1.16, 2.35). The commitment physicians felt toward patients who paid out-of-pocket money was associated to their sense of being trusted and valued (OR = 1.99, 95%CI 1.33, 2.88; OR = 1.5, 95%CI 1.05, 2.13 respectively). Conclusion This study suggests a deeper understanding of physicians’ daily experience of the private-public mix and it’s consequences, and could provide a platform for future studies. Further studies on physician’s role in health privatization processes are needed, and could aid policymakers in their efforts to strengthen healthcare systems around the world. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07474-9.
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Affiliation(s)
- Tal Michael
- School of Public Health, Ben-Gurion University of the Negev, POB 653, 84105, Be'er-Sheva, Israel.
| | - Dani Filc
- Department of Politics and Government, Ben-Gurion University of the Negev, Be'er- Sheva, Israel
| | - Nadav Davidovitch
- School of Public Health, Ben-Gurion University of the Negev, POB 653, 84105, Be'er-Sheva, Israel
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Ansmann L, Vennedey V, Hillen HA, Stock S, Kuntz L, Pfaff H, Mannion R, Hower KI, Cologne Research And Development Network CoRe-Net Study Group CRADNCNSG. Resource dependency and strategy in healthcare organizations during a time of scarce resources: evidence from the metropolitan area of cologne. J Health Organ Manag 2021; 35:211-227. [PMID: 34245141 PMCID: PMC9136866 DOI: 10.1108/jhom-12-2020-0478] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Healthcare systems are under pressure to improve their performance, while at the same time facing severe resource constraints, particularly workforce shortages. By applying resource-dependency-theory (RDT), we explore how healthcare organizations in different settings perceive pressure arising from uncertain access to resources and examine organizational strategies they deploy to secure resources. DESIGN/METHODOLOGY/APPROACH A cross-sectional survey of key decision-makers in different healthcare settings in the metropolitan area of Cologne, Germany, on perceptions of pressure arising from the environment and respective strategies was conducted. For comparisons between settings radar charts, Kruskal-Wallis test and Fisher-Yates test were applied. Additionally, correlation analyses were conducted. FINDINGS A sample of n = 237(13%) key informants participated and reported high pressure caused by bureaucracy, time constraints and recruiting qualified staff. Hospitals, inpatient and outpatient nursing care organizations felt most pressurized. As suggested by RDT, organizations in highly pressurized settings deployed the most vociferous strategies to secure resources, particularly in relation to personnel development. ORIGINALITY/VALUE This study is one of the few studies that focuses on the environment's impact on healthcare organizations across a variety of settings. RDT is a helpful theoretical foundation for understanding the environment's impact on organizational strategies. The substantial variations found between healthcare settings indicate that those settings potentially require specific strategies when seeking to address scarce resources and high demands. The results draw attention to the high level of pressure on healthcare organizations which presumably is passed down to managers, healthcare professionals, patients and relatives.
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Affiliation(s)
- Lena Ansmann
- Department of Health Services Research, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany
| | - Vera Vennedey
- Institute for Health Economics and Clinical Epidemiology, University Hospital Cologne, Cologne, Germany
| | - Hendrik Ansgar Hillen
- Department of Business Administration and Health Care Management, University of Cologne, Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, University Hospital Cologne, Cologne, Germany
| | - Ludwig Kuntz
- Department of Business Administration and Health Care Management, University of Cologne, Cologne, Germany
| | - Holger Pfaff
- Faculty of Human Sciences and Faculty of Medicine, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | - Russell Mannion
- Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Kira Isabel Hower
- Faculty of Human Sciences and Faculty of Medicine, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
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Dietermann K, Winter V, Schneider U, Schreyögg J. The impact of nurse staffing levels on nursing-sensitive patient outcomes: a multilevel regression approach. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:833-846. [PMID: 33871740 PMCID: PMC8214586 DOI: 10.1007/s10198-021-01292-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 03/12/2021] [Indexed: 05/29/2023]
Abstract
The goal of this study is to provide empirical evidence of the impact of nurse staffing levels on seven nursing-sensitive patient outcomes (NSPOs) at the hospital unit level. Combining a very large set of claims data from a German health insurer with mandatory quality reports published by every hospital in Germany, our data set comprises approximately 3.2 million hospital stays in more than 900 hospitals over a period of 5 years. Accounting for the grouping structure of our data (i.e., patients grouped in unit types), we estimate cross-sectional, two-level generalized linear mixed models (GLMMs) with inpatient cases at level 1 and units types (e.g., internal medicine, geriatrics) at level 2. Our regressions yield 32 significant results in the expected direction. We find that differentiating between unit types using a multilevel regression approach and including postdischarge NSPOs adds important insights to our understanding of the relationship between nurse staffing levels and NSPOs. Extending our main model by categorizing inpatient cases according to their clinical complexity, we are able to rule out hidden effects beyond the level of unit types.
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Affiliation(s)
- Karina Dietermann
- Hamburg Center for Health Economics, University of Hamburg, Esplanade 36, 20354 Hamburg, Germany
| | - Vera Winter
- Schumpeter School of Business and Economics, University of Wuppertal, Rainer-Gruenter-Str. 21, 42119 Wuppertal, Germany
| | - Udo Schneider
- Health Care Management at Techniker Krankenkasse, Bramfelder Straße 140, 22305 Hamburg, Germany
| | - Jonas Schreyögg
- Hamburg Center for Health Economics, University of Hamburg, Esplanade 36, 20354 Hamburg, Germany
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AlMubarak SH, Alfayez AS, Alanazi AT, Alwuhaimed LA, Bo Hamed SS. Autonomy, accountability, and competition: The privatisation of the Saudi health care system. J Taibah Univ Med Sci 2021; 16:144-151. [PMID: 33897319 PMCID: PMC8046962 DOI: 10.1016/j.jtumed.2020.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 11/01/2020] [Accepted: 11/15/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES This study aims to explore the perceptions of different stakeholders about the privatisation of the Saudi health care system. METHODS Using a qualitative case study design, we interviewed 21 administrators and clinical staff of a public hospital in the Eastern Province of the KSA and analysed all official documents relevant to this study. The analysis followed a thematic approach to provide an in-depth interpretation of the data. RESULTS Our analysis generated three main themes. The first was pertinent to the changes in the governance structure, with gradually increased autonomy from the government. The second reflected the necessity to introduce accountability within hospitals. The third described the cooperative relationship among the E1-Cluster hospitals as well as its competitive relationship with the private sector. CONCLUSION Our study demonstrates the interplay between newly introduced concepts of autonomy and accountability within the Saudi health care system. The findings of this study and their implications for research, practice, and policy are elaborated. Such an understanding is essential to improve the implementation process of privatisation and to recognise new dynamics that are shaping the health care system. The study contributes to the current scarce literature on health care reforms in KSA by reporting perceptions and experiences of key stakeholders.
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Affiliation(s)
- Sama’a H. AlMubarak
- Department of Health Information Management & Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, KSA
| | - Asma S. Alfayez
- Department of Health Information Management & Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, KSA
| | - Amal T. Alanazi
- Department of Health Information Management & Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, KSA
| | - Lolwah A. Alwuhaimed
- Department of Health Information Management & Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, KSA
| | - Sara S. Bo Hamed
- Department of Health Information Management & Technology, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, KSA
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Jeurissen PPT, Kruse FM, Busse R, Himmelstein DU, Mossialos E, Woolhandler S. For-Profit Hospitals Have Thrived Because of Generous Public Reimbursement Schemes, Not Greater Efficiency: A Multi-Country Case Study. INTERNATIONAL JOURNAL OF HEALTH SERVICES : PLANNING, ADMINISTRATION, EVALUATION 2021; 51:67-89. [PMID: 33107779 PMCID: PMC7756069 DOI: 10.1177/0020731420966976] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
For-profit hospitals' market share has increased in many nations over recent decades. Previous studies suggest that their growth is not attributable to superior performance on access, quality of care, or efficiency. We analyzed other factors that we hypothesized may contribute to the increasing role of for-profit hospitals. We studied the historical development of the for-profit hospital sector across 4 nations with contrasting trends in for-profit hospital market share: the United States, the United Kingdom, Germany, and the Netherlands. We focused on 3 factors that we believed might help explain why the role of for-profits grew in some nations but not in others: (1) the treatment of for-profits by public reimbursement plans, (2) physicians' financial interests, and (3) the effect of the political environment. We conclude that access to subsidies and reimbursement under favorable terms from public health care payors is an important factor in the rise of for-profit hospitals. Arrangements that aligned financial incentives of physicians with the interests of for-profit hospitals were important in stimulating for-profit growth in an earlier era, but they play little role at present. Remarkably, the environment for for-profit ownership seems to have been largely immune to political shifts.
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Affiliation(s)
- Patrick P. T. Jeurissen
- IQ Healthcare Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
- Ministry of Health, Welfare and Sport, The Hague, the Netherlands
| | - Florien M. Kruse
- IQ Healthcare Scientific Institute for Quality of Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Reinhard Busse
- Department of Health Care Management, Berlin University of Technology, Berlin, Germany
| | - David U. Himmelstein
- City University of New York at Hunter College, New York, New York, USA
- Harvard Medical School, Cambridge, Massachusetts, USA
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Sciences, London, UK
| | - Steffie Woolhandler
- City University of New York at Hunter College, New York, New York, USA
- Harvard Medical School, Cambridge, Massachusetts, USA
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8
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Kuwaiti AA, Al Muhanna FA. Challenges of privatizing academic medical centers in Saudi Arabia and appropriate strategies for implementation. INTERNATIONAL JOURNAL OF HEALTH GOVERNANCE 2020. [DOI: 10.1108/ijhg-06-2019-0048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeA crisis in the financial sustainability of the public healthcare sector often compels governments to consider privatization. The purpose of this paper is to summarize various strategies to overcome the challenges facing the privatization of academic medical centers (AMCs) in Saudi Arabia.Design/methodology/approachIn this paper, the authors discuss the challenges faced in privatizing AMCs in delivering their core functions such as patient care, medical education and research. Further, the appropriate strategies are listed to overcome these challenges in privatization of AMCs.FindingsThe authors described the benefits of privatization that include a reduction in the financial burden on government healthcare expenditure, quick decision making and creation of new financial models to improve healthcare services. On the other hand, the profit motive of private management could create pressure on patients and may divert AMCs from their primary objectives. Therefore, it is imperative for the government to develop and implement appropriate strategies that balance the benefits of privatizing AMCs with eliminating the negative impact of privatization on patient care, medical education and research.Originality/valueThough AMCs privatization is currently feasible in Saudi Arabia, appropriate strategies are essential to overcome the challenges of its implementation. The government should frame a uniform rules and regulations prior to privatizing public hospitals so that it will fulfill the purpose in an efficient manner.
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9
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Hospital staff shortages: Environmental and organizational determinants and implications for patient satisfaction. Health Policy 2020; 124:380-388. [PMID: 31973906 DOI: 10.1016/j.healthpol.2020.01.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 09/03/2019] [Accepted: 01/02/2020] [Indexed: 11/21/2022]
Abstract
Recent discussions and previous research often indicate that German hospitals are affected by a shortage of healthcare personnel on the labor market. However, until now, research has provided only limited insights into how environmental and organizational factors explain variations in staff shortages, how staff shortage measures relate to staffing ratios, and what relevance staff shortages have for patients. Regression analyses based on survey data of 104 German hospitals from 2015 to 2016, combined with labor market and patient satisfaction data, show that several environmental and organizational factors are significantly related to hospital staff shortages, measured by self-reports, vacancies, and turnover. These three measures of staff shortage do not correlate to the same degree for physicians and nurses, and none of the three significantly relate to nursing ratios, which indicates that the latter is a distinct concept rather than a direct consequence of staff shortage. The analyses further show that hospital staff shortages relate significantly to patient satisfaction with physician and nursing care. The findings suggest that hospitals are, to a certain extent, able to influence the degree to which they are affected by staff shortages and that hospitals' decisions about staffing levels depend on more than staff availability.
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10
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Kruse FM, Stadhouders NW, Adang EM, Groenewoud S, Jeurissen PPT. Do private hospitals outperform public hospitals regarding efficiency, accessibility, and quality of care in the European Union? A literature review. Int J Health Plann Manage 2018; 33:e434-e453. [PMID: 29498430 PMCID: PMC6033142 DOI: 10.1002/hpm.2502] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 01/18/2018] [Indexed: 11/07/2022] Open
Abstract
European countries have enhanced the scope of private provision within their health care systems. Privatizing services have been suggested as a means to improve access, quality, and efficiency in health care. This raises questions about the relative performance of private hospitals compared with public hospitals. Most systematic reviews that scrutinize the performance of the private hospitals originate from the United States. A systematic overview for Europe is nonexisting. We fill this gap with a systematic realist review comparing the performance of public hospitals to private hospitals on efficiency, accessibility, and quality of care in the European Union. This review synthesizes evidence from Italy, Germany, the United Kingdom, France, Greece, Austria, Spain, and Portugal. Most evidence suggests that public hospitals are at least as efficient as or are more efficient than private hospitals. Accessibility to broader populations is often a matter of concern in private provision: Patients with higher social-economic backgrounds hold better access to private hospital provision, especially in private parallel systems such as the United Kingdom and Greece. The existing evidence on quality of care is often too diverse to make a conclusive statement. In conclusion, the growth in private hospital provision seems not related to improvements in performance in Europe. Our evidence further suggests that the private (for-profit) hospital sector seems to react more strongly to (financial) incentives than other provider types. In such cases, policymakers either should very carefully develop adequate incentive structures or be hesitant to accommodate the growth of the private hospital sector.
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Affiliation(s)
- Florien M Kruse
- Celsus Academy for Sustainable Healthcare, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Niek W Stadhouders
- Celsus Academy for Sustainable Healthcare, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Eddy M Adang
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stef Groenewoud
- Celsus Academy for Sustainable Healthcare, IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Patrick P T Jeurissen
- Celsus Academy for Sustainable Healthcare, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.,Ministry of Health, Welfare, and Sport, The Hague, the Netherlands
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11
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Almeida ÁS. The role of private non-profit healthcare organizations in NHS systems: Implications for the Portuguese hospital devolution program. Health Policy 2017; 121:699-707. [PMID: 28433325 DOI: 10.1016/j.healthpol.2017.03.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 12/08/2016] [Accepted: 03/24/2017] [Indexed: 11/26/2022]
Abstract
The national health services (NHS) of England, Portugal, Finland and other single-payer universalist systems financed by general taxation, are based on the theoretical principle of an integrated public sector payer-provider. However, in practice one can find different forms of participation of non-public healthcare providers in those NHS, including private for profit providers, but also third sector non-profit organizations (NPO). This paper reviews the role of non-public non-profit healthcare organizations in NHS systems. By crossing a literature review on privatization of national health services with a literature review on the comparative performance of non-profit and for-profit healthcare organizations, this paper assesses the impact of contracting private non-profit healthcare organizations on the efficiency, quality and responsiveness of services, in public universal health care systems. The results of the review were then compared to the existing evidence on the Portuguese hospital devolution to NPO program. The evidence in this paper suggests that NHS health system reforms that transfer some public-sector hospitals to NPO should deliver improvements to the health system with minimal downside risks. The very limited existing evidence on the Portuguese hospital devolution program suggests it improved efficiency and access, without sacrificing quality.
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Affiliation(s)
- Álvaro S Almeida
- CEF.UP and Faculdade de Economia, Universidade do Porto, Rua Dr. Roberto Frias, 4200-464 Porto, Portugal.
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12
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Alkhamis AA. Critical analysis and review of the literature on healthcare privatization and its association with access to medical care in Saudi Arabia. J Infect Public Health 2017; 10:258-268. [PMID: 28343793 DOI: 10.1016/j.jiph.2017.02.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 02/09/2017] [Accepted: 02/18/2017] [Indexed: 11/28/2022] Open
Abstract
This paper is a review of the literature on hospitals privatization to assess the influence of privatization on access to medical care. The results are used to complete further analysis on the situation in Saudi Arabia. Over 979 references were initially identified through a database search, and an additional 237 were included from other sources. From these sources, only 11 articles were considered for review after excluding the ineligible articles, such as those that did not meet the hospitals privatization's definition or other exclusion criteria. There is weak evidence and low scientific validity supporting the argument that privatization could increase access to medical care. Prior to privatization, Saudi Arabia has to consider reforming its healthcare financing, including auditing and efficiency. After privatization, a policy has to be developed to ensure that the most vulnerable groups have access to good-quality healthcare while controlling costs for care providers.
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13
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Ren Y, Yang M, Li Q, Pan J, Chen F, Li X, Meng Q. Assessing dose-response effects of national essential medicine policy in China: comparison of two methods for handling data with a stepped wedge-like design and hierarchical structure. BMJ Open 2017; 7:e013247. [PMID: 28399510 PMCID: PMC5337672 DOI: 10.1136/bmjopen-2016-013247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVES To introduce multilevel repeated measures (RM) models and compare them with multilevel difference-in-differences (DID) models in assessing the linear relationship between the length of the policy intervention period and healthcare outcomes (dose-response effect) for data from a stepped-wedge design with a hierarchical structure. DESIGN The implementation of national essential medicine policy (NEMP) in China was a stepped-wedge-like design of five time points with a hierarchical structure. Using one key healthcare outcome from the national NEMP surveillance data as an example, we illustrate how a series of multilevel DID models and one multilevel RM model can be fitted to answer some research questions on policy effects. SETTING Routinely and annually collected national data on China from 2008 to 2012. PARTICIPANTS 34 506 primary healthcare facilities in 2675 counties of 31 provinces. OUTCOME MEASURES Agreement and differences in estimates of dose-response effect and variation in such effect between the two methods on the logarithm-transformed total number of outpatient visits per facility per year (LG-OPV). RESULTS The estimated dose-response effect was approximately 0.015 according to four multilevel DID models and precisely 0.012 from one multilevel RM model. Both types of model estimated an increase in LG-OPV by 2.55 times from 2009 to 2012, but 2-4.3 times larger SEs of those estimates were found by the multilevel DID models. Similar estimates of mean effects of covariates and random effects of the average LG-OPV among all levels in the example dataset were obtained by both types of model. Significant variances in the dose-response among provinces, counties and facilities were estimated, and the 'lowest' or 'highest' units by their dose-response effects were pinpointed only by the multilevel RM model. CONCLUSIONS For examining dose-response effect based on data from multiple time points with hierarchical structure and the stepped wedge-like designs, multilevel RM models are more efficient, convenient and informative than the multilevel DID models.
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Affiliation(s)
- Yan Ren
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Min Yang
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China
- West China Research Center for Rural Health Development, Sichuan University, Chengdu, Sichuan, People's Republic of China
- School of Medicine, University of Nottingham, Nottingham, UK
- Swinburne University of Technology, Victoria, Australia
| | - Qian Li
- West China Research Center for Rural Health Development, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jay Pan
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China
- West China Research Center for Rural Health Development, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Fei Chen
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Xiaosong Li
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Qun Meng
- Center for Health Statistical Information, National Health and Family Planning Commission of the People's Republic of China, Beijing, People's Republic of China
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