Resource allocation in public hospitals: is it effective?

Will urban scale affect health services inequity? The empirical evidence from cities in China

Background

The equity of public resources triggered by city shrinkage is a global challenge. Significantly, the impact of city shrinkage on the allocation of health service resources needs to be better understood. This study explores the impact of population change on government investment and health service delivery in shrinking cities.

Data and method

Using data from China's Urban Statistical Yearbook (2010-2020), we employ regression discontinuity (RD) and fixed-effect models to examine the causal relationship between city shrinkage and health service provision.

Result

Shrinking cities show significant disparities in health resources, particularly in bed numbers (-1,167.58, p < 0.05) and doctor availability (-538.54, p < 0.05). Economic development (p < 0.01) and financial autonomy (p < 0.01) influence hospital bed distribution. Investments in public services (primary schools and teachers, p < 0.01) affect health resource delivery. Robustness tests support our results.

Conclusion

This study reveals how city shrinkage disrupts health service provision and equity, establishing a causal relationship between city shrinkage/expansion and health resource allocation, emphasizing the imbalance caused by urban population changes. City expansion intensifies competition for health resources, while shrinking cities struggle to provide adequate resources due to government reluctance. Policymakers should adapt health resource allocation strategies to meet patient demands in changing urban landscapes.

Impact of the Italian Healthcare Outcomes Program (PNE) on the Care Quality of the Poorest Performing Hospitals

One of the main aims of the Italian National Healthcare Outcomes Program (Programma Nazionale Esiti, PNE) is the identification of the hospitals with the lowest performance, leading them to improve their quality. In order to evaluate PNE impact for a subset of outcome indicators, we evaluated whether the performance of the hospitals with the lowest scores in 2016 had significantly improved after five years. The eight indicators measured the risk-adjusted likelihood of the death of each patient (adjusted relative risk-RR) 30 days after the admission for acute myocardial infarction, congestive heart failure, stroke, chronic obstructive pulmonary disease, chronic kidney disease, femur fracture or lung and colon cancer. In 2016, the PNE identified 288 hospitals with a very low performance in at least one of the selected indicators. Overall, 51.0% (n = 147) of these hospitals showed some degree of improvement in 2021, and 27.4% of them improved so much that the death risk of their patients fell below the national mean value. In 34.7% of the hospitals, however, the patients still carried a mean risk of death >30% higher than the average Italian patient with the same disease. Only 38.5% of the hospitals in Southern Italy improved the scores of the selected indicators, versus 68.0% in Northern and Central Italy. Multivariate analyses, adjusting for the baseline performance in 2016, confirmed univariate results and showed a significantly lower likelihood of improvement with increasing hospital volume. Despite the overall methodological validity of the PNE system, current Italian policies and actions aimed at translating hospital quality scores into effective organizational changes need to be reinforced with a special focus on larger southern regions.

Evaluation of Medical Carrying Capacity for Megacities from a Traffic Analysis Zone View: A Case Study in Shenzhen, China

Sustainable Development Goals propose to build inclusive, safe, resilient, and sustainable cities and human settlements, which requires us to scientifically evaluate the carrying capacity of current urban public service facilities, but there is still a lack of in-depth exploration of urban public medical service facilities. Therefore, this paper, within the mobile phone signaling data, improved the potential model and carrying capacity evaluation model of public medical facilities, explored the spatial pattern distribution of public medical resources in Shenzhen, and analyzed the current situation of carrying capacity of public medical resources. The study showed that: (1) the overall spatial distribution of public medical resources in Shenzhen is uneven, showing a pattern of multicenter aggregation and multilevel development; (2) the service potential of public medical facilities has obvious spatial variations, with Futian District, Dapeng New District, and Nanshan District showing more obvious high-gravitational-value aggregation centers; (3) medical facilities in Shenzhen are never empty, but the problems of medical underloading and overloading are severe, and spatial allocation and utilization efficiency need to be further optimized. The research results can provide a scientific basis for the research on the allocation and sustainable construction of medical resources in megacities.

"Perspectives on financing population-based health care towards Universal Health Coverage among employed individuals in Ghanzi district, Botswana: A qualitative study"

BACKGROUND

Globally, about 150 million people experience catastrophic healthcare expenditure services annually. Among low and middle income countries, out-of-pocket expenditure pushes about 100 million people into poverty annually. In Botswana, 83 % of the general population and 58 % of employed individuals do not have medical aid coverage. Moreover, inequity allocation of financial resources between health services suggests marginalization of population-based health care services (i.e. diseases prevention and health promotion). The purpose of the study is to explore perspectives on employed individuals regarding financing population based health care interventions towards Universal Health Coverage (UHC) in order to make recommendations to the Ministry of Health on health financing options to cover population-based health services.

METHODS

A qualitative design grounded in interpretivist epistemology through social constructivism lens was critical for exploring perspectives of employed individuals. Through purposive and snowballing sampling techniques, a total of 15 respondents including 8 males and 7 females were recruited and interviewed using a semi-structured format. Their age ranged from 23 to 59 years with a median of 36 years. Data was analyzed using Thematic Content Analysis technique.

RESULTS

Use of social constructivism lens enabled to classify emerging themes into population coverage, health services coverage and financial protection issues. Despite broad understanding of health coverage schemes among participants, knowledge appears insignificant in increasing enrolment. Participants indicated limited understanding of UHC concepts, however showed willingness to embrace UHC upon brief description. Main thematic issues raised include: exclusion of population-based health services from coverage scheme; disparity in financial protection and health services coverage among enrollees; inability to sustain contracted employees; and systematic exclusion of unemployed individuals and informal sector employees.

CONCLUSION

Increasing enrolment in health coverage schemes requires targeted campaign for information dissemination through use of myriads mass media including: social networks, TV, Radio and others. Moreover, re-designing health insurance schemes is critical in order to include population-based interventions; expand uptake of unemployed and informal sector employees; flexibility in monthly premiums payment plan and use of technology to increase access to payment points. Further study need to evaluate the content of health financing policy in Botswana measured against the World Health Organization Universal Health Coverage conceptual requirements for Low and Middle Income Countries.

To what extent does recurrent government health expenditure in Uganda reflect its policy priorities?

BACKGROUND

The National Health Policy 2000 - 2009 and Health sector strategic plans I & II emphasized that Primary Health Care (PHC) would be the main strategy for national development and would be operationalized through provision of the minimum health care package. Commitment was to spend an increasing proportion of the health budget for the provision of the basic minimum package of health services which was interpreted to mean increasing spending at health centre level. This analysis was undertaken to gain a better understanding of changes in the way recurrent funding is allocated in the health sector in Uganda and to what extent it has been in line with agreed policy priorities.

METHODS

Government recurrent wage and non-wage expenditures - based on annual releases by the Uganda Ministry of Finance, Planning and Economic Development were compiled for the period 1997/1998 to financial year 2007/2008. Additional data was obtained from a series of Ministry of Health annual health sector reports as well as other reports. Data was verified by key government officials in Ministry of Finance, Planning and Economic Development and Ministry of Health. Analysis of expenditures was done at sector level, by the different levels in the health care system and the different levels of care.

RESULTS

There was a pronounced increase in the amount of funds released for recurrent expenditure over the review period fueled mainly by increases in the wage component. PHC services showed the greatest increase, increasing more than 70 times in ten years. At hospital level, expenditures remained fairly constant for the last 10 years with a slight reduction in the wage component.

CONCLUSION

The policy aspiration of increasing spending on PHC was attained but key aspects that would facilitate its realization were not addressed. At any given level of funding for the health sector, there is need to work out an optimal balance in investment in the different inputs to ensure efficiency in health spending. Equally important is the balance in investment between hospitals and health centers. There is a need to look comprehensively at what it takes to provide PHC services and invest accordingly.