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Broihanne MH, Plotkina D, Kleimeier S, Göritz AS, Hoffmann AOI. How COVID-19 illness perceptions and individual shocks are associated with trust during the COVID-19 pandemic in Australia, France, Germany, and South Africa. Health Policy 2024:105178. [PMID: 39379222 DOI: 10.1016/j.healthpol.2024.105178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 08/27/2024] [Accepted: 09/30/2024] [Indexed: 10/10/2024]
Abstract
The COVID-19 pandemic jeopardized individuals' health and economic stability, and the associated shocks might have decreased individuals' trust. In this paper, we study the relationship between subjective perceptions of the pandemic and individuals' institutional and interpersonal trust (e.g., trust towards the government or health representatives), while considering objective health and economic shocks due to the pandemic as drivers. We collected data across Australia, France, Germany, and South Africa during a later stage of the COVID-19 pandemic (i.e., from mid-April to early-June 2021) when individuals had time to personally experience the pandemic and its effects. COVID-19 illness perception was associated with lower institutional and interpersonal trust. The health shock of having experienced COVID-19 was associated with higher interpersonal trust, while economic shocks were associated with lower institutional trust when they were due to the pandemic. The results suggest that public policy interventions in a later stage of a pandemic should consider objective economic and health outcomes as well as subjective ones, such as individual's perceptions. Authorities should communicate in a way that helps concerned people understand that they can take control of their health and the possibility of infection, and reassure them that health measures such as vaccination can help prevent the spread of the virus.
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Affiliation(s)
- Marie-Hélène Broihanne
- University of Strasbourg, EM Strasbourg Business School, 61 Avenue de la Forêt Noire, 67085 Strasbourg, France.
| | - Daria Plotkina
- University of Strasbourg, EM Strasbourg Business School, 61 Avenue de la Forêt Noire, 67085 Strasbourg, France.
| | - Stefanie Kleimeier
- Maastricht University, School of Business and Economics, Tongersestraat 53, 6211 LM Maastricht, the Netherlands.
| | - Anja S Göritz
- University of Augsburg, Department of Behavioral Health Technology, Alter Postweg 101 (bureau Center Messe), 86159 Augsbourg, Germany.
| | - Arvid O I Hoffmann
- University of Adelaide, Adelaide Business School, 10 Pulteney Street, SA 5005, Adelaide, Australia.
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2
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van der Geest SA, Varkevisser M. Steering them softly with a quality label? A case study analysis of a patient channelling strategy without financial incentives. Int J Health Plann Manage 2024. [PMID: 39180759 DOI: 10.1002/hpm.3836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 07/06/2024] [Accepted: 07/19/2024] [Indexed: 08/26/2024] Open
Abstract
Steering patients to lower priced and/or higher quality providers can increase the value of a healthcare system. In a managed care setting, health insurers may use financial incentives for this purpose. However, introducing cost-sharing differences among providers may cause enrolee discontent, which may result in disenrollment. Simply informing and guiding enrolees to preferred providers without financial incentives may therefore be an attractive alternative for insurers. But the effectiveness of such a soft channelling strategy is unclear. This paper investigates whether a Dutch health insurer's strategy of designating preferred hospitals for breast cancer surgery and for inguinal hernia repair affected its enrolees' hospital choices. In October 2008, preferred hospitals received a quality label ('TopCare') because of their high-quality performances in previous years. The insurer recommended these hospitals to enrolees without a financial incentive. Individual patient-level claims data from the insurer over a 5-year period (2006-2010) and a conditional logit choice model was used. Our study samples for breast cancer surgery and inguinal hernia repair included 7985 and 17,292 patients, respectively. It is found that for both procedures, patients ex ante already had a certain preference for the hospitals designated by the insurer as top-quality providers, even when considering possible additional travel time. Also, for both procedures, patient choice did not differ significantly before and after the launch of the TopCare label. The quality label did not increase patient demand for preferred hospitals. Thus, the insurer's strategy to steer patients to preferred hospital alternatives without a financial incentive was not effective.
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Affiliation(s)
- Stéphanie A van der Geest
- Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Marco Varkevisser
- Erasmus School of Health Policy & Management (ESHPM), Erasmus University Rotterdam, Rotterdam, Netherlands
- Erasmus Centre for Health Economics Rotterdam (EsCHER), Erasmus University Rotterdam, Rotterdam, Netherlands
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3
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Maarse H, Jeurissen P. Healthcare reform in the Netherlands: after 15 years of regulated competition. HEALTH ECONOMICS, POLICY, AND LAW 2024:1-12. [PMID: 38299305 DOI: 10.1017/s1744133123000385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
This article discusses the results and prospects of the market reform in Dutch health care which came into force in 2006. Attention is paid to the results of the health insurance reform, the experience with the shift from passive to active purchasing and the impact of the reform on healthcare provision and cost control respectively. Other topics discussed are the consequences of the reform for administrative costs, institutional trust in health insurance, and the power balance in health care after reform. The central message is that the high expectations of the market reform have not come true. Dutch health care features a high degree of hybridity and there are indications that the system is becoming ever more hybrid: the system operates much less market-like than the market frame suggests. Currently, the policy narrative on the reform is changing. Policymakers and policy documents underscore the need for cooperation in provider networks and more state direction. The Dutch experience with health care reform illustrates the pendulum theory. After a period of a belief in competition and less state direction the pendulum in policymaking swings back to a belief in cooperation and a pro-active role of the state.
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Affiliation(s)
- Hans Maarse
- Faculty of Health Sciences, Medicine and Life Sciences, Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
| | - Patrick Jeurissen
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare, Nijmegen, The Netherlands
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Meijer MA, Brabers AEM, de Jong JD. Social context matters: The role of social support and social norms in support for solidarity in healthcare financing. PLoS One 2023; 18:e0291530. [PMID: 37708164 PMCID: PMC10501638 DOI: 10.1371/journal.pone.0291530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 08/31/2023] [Indexed: 09/16/2023] Open
Abstract
In many European countries, including the Netherlands, the healthcare system is financed according to the principles of solidarity. It is important, therefore, that public support for solidarity in healthcare financing is sufficient in order to ensure that people remain willing to contribute towards solidarity-based systems. The high willingness to contribute to the healthcare costs of others in the Netherlands suggests that support is generally high. However, there are differences between groups. Previous research has focused on mechanisms at the individual and institutional level to explain these differences. However, people's social context may also play a role. Little research has been conducted into this. To fill this gap, we examined the role of perceived social support and social norms in order to explain differences in the willingness to contribute to other people's healthcare costs. In November 2021, we conducted a survey study in which a questionnaire was sent to a representative sample of 1,500 members of the Dutch Healthcare Consumer Panel. This was returned by 837 panel members (56% response rate). Using logistic regression analysis, we showed that people who perceive higher levels of social support are more willing to contribute to the healthcare costs of others. We also found that the willingness to contribute is higher when someone's social context is more supportive of healthcare systems that are financed according to the principles of solidarity. This effect does not differ between people who perceive low and high levels of social support. Our results suggest that, next to the individual and institutional level, the social context of people has to be taken into consideration in policy and research addressing support for solidarity in healthcare financing.
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Affiliation(s)
- Marloes A. Meijer
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Anne E. M. Brabers
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Judith D. de Jong
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
- Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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5
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Minheere A, Lambrechts W, Mampaey J, Stough T, Caniëls MCJ, Semeijn J. Patient Power and Empowerment: Mitigating Elements of Valuable Patient Participation in Healthcare Collaboratives. Behav Sci (Basel) 2023; 13:bs13040347. [PMID: 37102861 PMCID: PMC10136329 DOI: 10.3390/bs13040347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/22/2023] [Accepted: 04/03/2023] [Indexed: 04/28/2023] Open
Abstract
During the last decade, the public healthcare sector has had to deal with increased competition, a growing influence of patient associations, and a necessity to deliver health services more efficiently and effectively. Despite recognising the patient participant's role as a critical stakeholder in value creation, there is a limited body of research on the influence and power of patient participants. This article focuses on regional health improvement collaboratives that aim to develop coordinated, multi-stakeholder solutions to their healthcare cost and quality problems. They meet regularly and include health professionals, health insurance providers, and patient participants. In this article, we explore the relationships between these stakeholders and patient participants' interpersonal dimensions regarding empowerment and valuable collaboration. Data were collected through stakeholder observations during meetings of three regional health improvement collaboratives, as well as through semi-structured interviews with the patient participants involved in these cases. Results show that patient participants can be empowered on a personal level. However, this does not imply that patient participants are empowered within the group dynamics. Interpersonal relationships constitute a crucial hidden aspect of building trust. More dialogue and inquiry are needed to examine how patient engagement is enacted and positioned within healthcare collaboratives.
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Affiliation(s)
- Anja Minheere
- Faculty of Management, Open Universiteit of the Netherlands, 6419 AT Heerlen, The Netherlands
| | - Wim Lambrechts
- Faculty of Management, Open Universiteit of the Netherlands, 6419 AT Heerlen, The Netherlands
| | - Jelle Mampaey
- Faculty of Management, Open Universiteit of the Netherlands, 6419 AT Heerlen, The Netherlands
| | - Talia Stough
- Faculty of Management, Open Universiteit of the Netherlands, 6419 AT Heerlen, The Netherlands
| | - Marjolein C J Caniëls
- Faculty of Management, Open Universiteit of the Netherlands, 6419 AT Heerlen, The Netherlands
| | - Janjaap Semeijn
- Faculty of Management, Open Universiteit of the Netherlands, 6419 AT Heerlen, The Netherlands
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Meijer MA, Brabers AEM, de Jong JD. Has public support for solidarity in healthcare financing in the Netherlands changed over time? A repeated cross-sectional study. Health Policy 2023; 131:104762. [PMID: 36933452 DOI: 10.1016/j.healthpol.2023.104762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 02/28/2023] [Accepted: 03/04/2023] [Indexed: 03/14/2023]
Abstract
It is argued that solidarity-based healthcare systems are under pressure and that public support is decreasing. It can, therefore, be expected that support for solidarity in healthcare financing has diminished over time. However, little research has been conducted into this. To fill this gap, we used survey data from 2013, 2015, 2017, 2019, and 2021 to examine changes in public support for solidarity in healthcare financing in the Netherlands over time. This was operationalised as the own willingness and the expected willingness of others to contribute to other people's healthcare costs. Using logistic regression analysis, we found that the own willingness to contribute has slightly increased among the general population over time, although this was not observed in all subgroups. No change in the expected willingness of others to contribute was observed. Our results suggest that the willingness to contribute to other people's healthcare costs has, at least, not decreased over time. A majority of the Dutch population remains willing to share the burden of healthcare costs, indicating support for the principles of the solidarity-based healthcare system. However, not all people are willing to contribute to the healthcare costs of others. In addition, we do not know how much people want to pay. Further research into these topics is necessary.
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Affiliation(s)
- Marloes A Meijer
- Nivel, Netherlands Institute for Health Services Research. Otterstraat 118, 3513 CR Utrecht, the Netherlands.
| | - Anne E M Brabers
- Nivel, Netherlands Institute for Health Services Research. Otterstraat 118, 3513 CR Utrecht, the Netherlands
| | - Judith D de Jong
- Nivel, Netherlands Institute for Health Services Research. Otterstraat 118, 3513 CR Utrecht, the Netherlands; Maastricht University. Duboisdomein 30, 6229 GT Maastricht, the Netherlands
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7
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Lewandowski R, Goncharuk AG, Cirella GT. Assessing trust with injected health information in Poland’s healthcare system: Lay people versus healthcare workers. JOURNAL OF TRUST RESEARCH 2023. [DOI: 10.1080/21515581.2023.2182313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
Affiliation(s)
- Roman Lewandowski
- Institute of Management and Quality Science, Faculty of Economics, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
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8
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Auener SL, Jeurissen PPT, Lok DJA, van Duijn HJ, van Pol PEJ, Westert GP, van Dulmen SA. Use of regional transmural agreements to support the right care in the right place for patients with chronic heart failure-a qualitative study. Neth Heart J 2023; 31:109-116. [PMID: 36507945 PMCID: PMC9742644 DOI: 10.1007/s12471-022-01740-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Chronic heart failure (CHF) poses a major challenge for healthcare systems. As these patients' needs vary over time in intensity and complexity, the coordination of care between primary and secondary care is critical for them to receive the right care in the right place. To support the continuum of care needed, Dutch regional transmural agreements (RTAs) between healthcare providers have been developed. However, little is known about how the stakeholders have experienced the development and use of these RTAs. The aim of this study was to gain insight into how stakeholders have experienced the development and use of RTAs for CHF and explore which factors affected this. METHODS We interviewed 25 stakeholders from 9 Dutch regions based on the Measurement Instrument for Determinants of Innovations framework. Interview recordings were transcribed verbatim and analysed through open thematic coding. RESULTS In most cases, the RTA development was considered relatively easy. However, the participants noted that sustainable use of the RTAs faced different complexities and influencing factors. These barriers concerned the following themes: education of primary care providers, referral process, patients' willingness, relationships between healthcare providers, reimbursement by health insurance companies, electronic health record (EHR) systems and outcomes. CONCLUSION Some complexities, such as reimbursement and EHR systems, are likely to benefit from specialised support or a national approach. On a regional level, interregional learning can improve stakeholders' experiences. Future research should focus on quantitative effects of RTAs on outcomes and potential financing models for projects that aim to transition care from one setting to another.
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Affiliation(s)
- Stefan L. Auener
- grid.10417.330000 0004 0444 9382Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
| | - Patrick P. T. Jeurissen
- grid.10417.330000 0004 0444 9382Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
| | - Dirk J. A. Lok
- grid.413649.d0000 0004 0396 5908Department of Cardiology, Deventer Hospital, Deventer, The Netherlands
| | | | - Petra E. J. van Pol
- grid.440209.b0000 0004 0501 8269Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Gert P. Westert
- grid.10417.330000 0004 0444 9382Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
| | - Simone A. van Dulmen
- grid.10417.330000 0004 0444 9382Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
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9
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van der Hulst FJP, Brabers AEM, de Jong JD. The relation between trust and the willingness of enrollees to receive healthcare advice from their health insurer. BMC Health Serv Res 2023; 23:52. [PMID: 36653840 PMCID: PMC9850786 DOI: 10.1186/s12913-022-09016-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/28/2022] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In a healthcare system based on managed competition, it is important that health insurers are able to channel enrollees to preferred providers. This results in incentives for healthcare providers to improve the quality and reduce the price of care. One of the instruments to guide enrollees to preferred providers is by providing healthcare advice. In order to use healthcare advice as an effective instrument, it is important that enrollees accept the health insurer as a healthcare advisor. As trust in health insurers is not high, this may be an obstacle for enrollees to be receptive to the health insurer's advice. This study aims to investigate the association between trust in the health insurer and the willingness to receive healthcare advice from the health insurer in the Netherlands. In terms of receiving healthcare advice, we examine both enrollees' willingness to approach the health insurer themselves and their willingness to be approached by the health insurer. METHODS In February 2021, a questionnaire was sent to a representative sample of the Dutch population. The questionnaire was completed by 885 respondents (response rate 59%). Respondents were asked about their willingness to receive healthcare advice, and trust in the health insurer was measured using a validated multiple item scale. Logistic regression models were conducted to analyse the results. RESULTS Enrollees with more trust in the health insurer were more willing to approach their health insurer for healthcare advice (OR = 1.07, p = 0.00). In addition, a higher level of trust in the health insurer is significantly associated with the odds that enrollees would like it/really appreciate it if their health insurer actively approached them with healthcare advice (OR = 1.07, p = 0.00). The role of trust in the willingness to receive healthcare advice is not proven to differ between groups with regard to educational levels, health status or age. CONCLUSIONS This study confirms that trust plays a role in the willingness to receive healthcare advice from the health insurer. The association between the two emphasizes the importance to increase enrollees' trust in the health insurer. As a result, health insurers may be better able to fulfil their role as healthcare advisor.
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Affiliation(s)
- Frank J. P. van der Hulst
- grid.416005.60000 0001 0681 4687Nivel, the Netherlands Institute for Health Services Research, Otterstraat 118-124, 3513 CR Utrecht, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Anne E. M. Brabers
- grid.416005.60000 0001 0681 4687Nivel, the Netherlands Institute for Health Services Research, Otterstraat 118-124, 3513 CR Utrecht, PO Box 1568, 3500 BN Utrecht, the Netherlands
| | - Judith D. de Jong
- grid.416005.60000 0001 0681 4687Nivel, the Netherlands Institute for Health Services Research, Otterstraat 118-124, 3513 CR Utrecht, PO Box 1568, 3500 BN Utrecht, the Netherlands ,grid.5012.60000 0001 0481 6099Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
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10
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Wu JJ, Talley PC, Kuo KM, Chen JL. Antecedents, Consequences, and the Role of Third Parties in the Trust Repair Process: Evidence Taken from Orthodontics. Healthcare (Basel) 2022; 10:healthcare10101811. [PMID: 36292258 PMCID: PMC9601550 DOI: 10.3390/healthcare10101811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 09/16/2022] [Accepted: 09/18/2022] [Indexed: 12/03/2022] Open
Abstract
Orthodontic treatment has popularized in Taiwan. Healthcare institutions can be responsive in their coping strategies and determine whether third-party intervention should take place involving medical disputes related to orthodontics in order to repair patient trust. This study draws on orthodontic treatment to explore the effect of various trust repair strategies employed by healthcare institutions and third-party involvement positively affecting outcomes related to trust repair. Patients were recruited among those who have undergone orthodontic treatments, and 353 valid scenario-based questionnaires were collected through an online survey. Results revealed that: (1) the affective and informational repair strategies positively impacted trust repair while the functional repair strategy did not; (2) trust repair positively impacted patient satisfaction/word-of-mouth and mediated between repair strategies and satisfaction/word-of-mouth; and (3) third-party involvement moderated the relationship between trust repair and word-of-mouth. The findings suggest that rather than receiving monetary compensation, patients usually prefer that healthcare institutions acknowledge their fault, offer apologies, and engage in active communications to clarify the causes of medical dispute. Further, an objective third party should be involved to mediate the medical disputes to afford satisfaction all around.
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Affiliation(s)
- Jyh-Jeng Wu
- Department of Business Management, National United University, Miaoli 360301, Taiwan
| | - Paul C. Talley
- Department of Applied English, I-Shou University, Kaohsiung City 84001, Taiwan
| | - Kuang-Ming Kuo
- Department of Business Management, National United University, Miaoli 360301, Taiwan
- Correspondence:
| | - Jia-Lin Chen
- Department of Business Management, National United University, Miaoli 360301, Taiwan
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11
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Holterman S, Hettinga M, Buskens E, Lahr M. Factors Influencing Procurement of Digital Healthcare: A Case Study in Dutch District Nursing. Int J Health Policy Manag 2022; 11:1883-1893. [PMID: 34634888 PMCID: PMC9808215 DOI: 10.34172/ijhpm.2021.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 08/23/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Digital health is considered a promising solution in keeping health care accessible and affordable. However, implementation is often complex and sustainable funding schemes are lacking. Despite supporting policy, scaling up innovative forms of health care progresses much slower than intended in Dutch national framework agreements. The aim of this study is to identify factors that influence the procurement of digital health particular in district nursing. METHODS A case study approach was used, in which multiple stakeholder perspectives are compared using thematic framework analysis. The case studied was the procurement of digital health in Dutch district nursing. Literature on implementation of digital health, public procurement and payment models was used to build the analytic framework. We analysed fourteen interviews (secondary data), two focus groups organised by the national task force procurement and eight governmental and third-party reports. RESULTS Five themes emerged from the analysis: 1) rationale 2) provider-payer relationship, 3) resources, 4) evidence, and 5) the payment model. Per theme a number of factors were identified, mostly related to the design and functioning of the Dutch health system and to the implementation process at providers' side. CONCLUSION This study identified factors influencing the procurement of digital health in Dutch district nursing. The findings, however, are not unique for digital health, district nursing or the Dutch health system. The results presented will support policy makers, and decision makers to improve procurement of digital health. Investing in better relationships between payer and care provider organisations and professionals is an important next step towards scaling digital health.
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Affiliation(s)
- Sander Holterman
- Health Technology Assessment Unit, Department of Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands
- Research Group IT Innovations in Healthcare, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Marike Hettinga
- Research Group IT Innovations in Healthcare, Windesheim University of Applied Sciences, Zwolle, The Netherlands
| | - Erik Buskens
- Health Technology Assessment Unit, Department of Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands
- Department of Operations, Faculty of Economics & Business, University of Groningen, Groningen, The Netherlands
| | - Maarten Lahr
- Health Technology Assessment Unit, Department of Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands
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Maljichi D, Limani B, Spier TE, Angjelkoska V, Stojković Zlatanović S, Maljichi D, Alloqi Tahirbegolli I, Tahirbegolli B, Kulanić A, Agolli Nasufi I, Kovač-Orlandić M. (Dis)trust in doctors and public and private healthcare institutions in the Western Balkans. Health Expect 2022; 25:2015-2024. [PMID: 35781914 PMCID: PMC9327848 DOI: 10.1111/hex.13562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/20/2022] [Accepted: 06/18/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Considering the geopolitical changes in the six Western Balkan countries—Albania, Bosnia and Herzegovina, Kosovo, Montenegro, North Macedonia and Serbia—over the last three decades, particularly as it concerns the progress and changes in the healthcare systems, we argue that there is a need for a detailed analysis of people's trust in those healthcare systems and healthcare providers. Methods In this cross‐sectional, intercountry study, we examine the trust trends of Western Balkans citizens in medical doctors and public and private healthcare institutions from 25 July 2021 to 30 October 2021, with 3789 participants using a self‐reported questionnaire, and Google Forms. Snowball sampling is used to collect data from six Western Balkans countries: Albania, Bosnia and Herzegovina, Kosovo, Montenegro, North Macedonia and Serbia. Findings The primary findings of our study show that citizens in the Western Balkans have a low level of trust in their healthcare system (X̄ = 4.3/10). Medical doctors working in private healthcare institutions, on the other hand, are afforded a higher level of trust (X̄ = 6.6/10) than those working in public healthcare institutions (X̄ = 5.7/10). In the event that they or their family members need to visit a health institution, half of the study participants would choose private healthcare institutions over public ones. We found a statistically significant difference between countries on the mean points from the questions concerning one's trust in the healthcare system, private healthcare institutions and medical doctors working in public and private sectors (p < .05). Conclusion Despite its limitations, this study is the first cross‐sectional research on the ‘trust interface’ among western Balkan citizens, revealing that they have low trust in their healthcare systems. Public Contribution The information in this manuscript was gathered on the level of 3789 citizens from six Western Balkan countries. Before we began collecting data, we conducted a piloting procedure with 40 citizens who were clients of health institutions to validate the data collection questionnaire.
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Affiliation(s)
- Driton Maljichi
- Social Science Department, University St. Cyril and Methodius, Skopje, North Macedonia
| | - Blerim Limani
- Liberal Arts Department, American University of Middle East, Kuwait City, Kuwait
| | - Troy E Spier
- English Department, Universidad San Francisco de Quito, Quito, Ecuador
| | - Violeta Angjelkoska
- Faculty of Communication and IT, American University of Europe-FON, Skopje, North Macedonia
| | | | - Drita Maljichi
- Management in Tourism and Hospitality Department, Pjeter Budi College, Prishtina, Kosovo
| | - Iliriana Alloqi Tahirbegolli
- Department of Health Institutions and Services Management
- Nursing Department, Heimerer College, Prishtina, Kosovo.,Hematology Clinic, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - Bernard Tahirbegolli
- Department of Health Institutions and Services Management
- Nursing Department, Heimerer College, Prishtina, Kosovo.,National Sports Medicine Centre, Prishtina, Kosovo
| | - Ahmed Kulanić
- Institute for Bosniak Studies, Sarajevo, Bosnia and Herzegovina.,Research Center for Neighbouring Countries and Regions, Istanbul Ticaret University, Istanbul, Turkey
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To what degree are health insurance enrollees in the Netherlands aware of the restrictive conditions attached to their policies? Health Policy 2022; 126:693-703. [DOI: 10.1016/j.healthpol.2022.05.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 04/22/2022] [Accepted: 05/15/2022] [Indexed: 11/21/2022]
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Noort BAC, van der Vaart T, Ahaus K. Orchestration versus bookkeeping: How stakeholder pressures drive a healthcare purchaser's institutional logics. PLoS One 2021; 16:e0258337. [PMID: 34644324 PMCID: PMC8513887 DOI: 10.1371/journal.pone.0258337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 09/26/2021] [Indexed: 11/18/2022] Open
Abstract
Background Healthcare purchasers such as health insurers and governmental bodies are expected to strategically manage chronic care chains. In doing so, purchasers can contribute to the goal of improving task division and collaboration between chronic care providers as has been recommended by numerous studies. However, healthcare purchasing research indicates that, in most countries, purchasers still struggle to fulfil a proactive, strategic approach. Consequently, a typical pattern occurs in which care improvement initiatives are instigated, but not transformed into regular care. By acknowledging that healthcare purchasers are embedded in a care chain of stakeholders who have different, sometimes conflicting, interests and, by taking an institutional logics lens, we seek to explain why achieving strategic purchasing and sustainable improvement is so elusive. Method and findings We present a longitudinal case study in which we follow a health insurer and care providers aiming to improve the care of patients with Chronic Obstructive Pulmonary Disease (COPD) in a region of the Netherlands. Taking a theoretical lens of institutional logics, our aim was to answer ‘how stakeholder pressures influence a purchaser’s use of institutional logics when pursuing the right care at the right place’. The insurer by default predominantly expressed a bookkeeper’s logic, reflecting a focus on controlling short-term care costs by managing individual providers. Over time, a contrasting orchestrator’s logic emerged in an attempt to achieve chain-wide improvement, striving for better health outcomes and lower long-term costs. We established five types of stakeholder pressure to explain the shift in logic adoption: relationship pressures, cost pressures, medical demands, public health demands and uncertainty. Linking the changes in logic over time with stakeholder pressures showed that, firstly, the different pressures interact in influencing the purchaser. Secondly, we saw that the lack of intra-organisational alignment affects how the purchaser deals with the different stakeholder pressures. Conclusions By highlighting the purchaser’s difficult position in the care chain and the consequences of their own internal responses, we now better understand why the intended orchestrator’s logic and thereby a strategic approach to purchasing chronic care proves unsustainable within the Dutch healthcare system of managed competition.
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Affiliation(s)
- Bart A. C. Noort
- Faculty of Economics and Business, Department of Operations, University of Groningen, Groningen, The Netherlands
- * E-mail:
| | - Taco van der Vaart
- Faculty of Economics and Business, Department of Operations, University of Groningen, Groningen, The Netherlands
| | - Kees Ahaus
- Health Services Management and Organisation, School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Lewandowski R, Goncharuk AG, Cirella GT. Restoring patient trust in healthcare: medical information impact case study in Poland. BMC Health Serv Res 2021; 21:865. [PMID: 34429101 PMCID: PMC8383260 DOI: 10.1186/s12913-021-06879-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 08/03/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND This study empirically evaluates the influence of medical information on patient trust at the physician level, the medical profession, hospitals, and with the payer. Restoring patient trust in a medical setting in Poland appears to be significantly affected due to the COVID-19 pandemic. Patient trust improves results from medical treatment, raises perception of healthcare performance, and smoothens the overall functionality of healthcare systems. METHODS In order to study trust volatility, patients took part in a three-stage experiment designed via: (1) measured level of trust, (2) randomly dividing participants into two groups-control (i.e., re-examination of level of trust) and experimental (i.e., being exposed to a piece of certain manipulative information), and (3) checking whether observational changes were permanent. RESULTS Results indicate that in the experimental group the increase of trust was noticed in the payer (27.7%, p < 0.001), hospitals (10.9%, p = 0.011), and physicians (decrease of 9.2%, p = 0.036). CONCLUSION The study indicated that in Poland medical information is likely to influence patient trust in healthcare while interpersonal and social trust levels may be related to increases of trust in hospitals and in the payer versus decreases in physicians.
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Affiliation(s)
- Roman Lewandowski
- Faculty of Management, University of Social Sciences, Lodz, Poland
- Voivodeship Rehabilitation Hospital for Children in Ameryka, Ameryka, Poland
| | - Anatoliy G Goncharuk
- Department of Management, International Humanitarian University, Odessa, Ukraine.
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van Dijk TST, van der Scheer WKW, Janssen RTJMR. Power, legitimacy and urgency: Unravelling the relationship between Dutch healthcare organisations and their financial stakeholders. Health Policy 2021; 125:1077-1084. [PMID: 34088522 DOI: 10.1016/j.healthpol.2021.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 09/30/2022]
Abstract
Healthcare organisations rely on their financial stakeholders for capital to invest in state-of-the-art buildings, equipment, innovation and the delivery of healthcare services. Nevertheless, relations between healthcare organisations and their financial stakeholders have not been well studied. Here, we studied the relations between Dutch healthcare organisations and two of their main financial stakeholders (banks and health insurers) against the backdrop of system reforms and the financial crisis. We conducted a survey of healthcare executives to evaluate their relations with banks and health insurers in terms of power, legitimacy and urgency. These three attributes are based on the salience model of Mitchel, Agle and Wood (1997). We further tested for differences in power, legitimacy and urgency across organisational sector and size. The results showed that healthcare organisations value banks as legitimate stakeholders with a well-demarcated influence and a clear-cut function. The relationship with health insurers is more complex. Healthcare organisations experience considerable influence from health insurers but question the legitimacy of their claims. Since health insurers play a crucial role in the Dutch healthcare system, these findings question the workability of the relationship between healthcare organisations and health insurers and the position of health insurers in the overall healthcare sector. Our results are relevant to countries with public-private health systems and contribute to the development of the salience model by showing the individual value of stakeholder attributes and the relevance of context.
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Affiliation(s)
- T S Tessa van Dijk
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands.
| | - W K Wilma van der Scheer
- Erasmus Centre for Healthcare Management, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - R T J M Richard Janssen
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, the Netherlands; Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
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Wilson NA, Reich AJ, Graham J, Bhatt DL, Nguyen LL, Weissman JS. Patient perspectives on the need for implanted device information: Implications for a post-procedural communication framework. Health Expect 2021; 24:1391-1402. [PMID: 33974346 PMCID: PMC8369078 DOI: 10.1111/hex.13273] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/05/2021] [Accepted: 04/15/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Shared decision making and patient-centred communication have become part of pre-procedural decisions and perioperative care across medical specialties. However, gaps exist in patient communication about the implanted device received and the benefits in sharing information about their procedure and device. OBJECTIVE To understand the patients' knowledge of identifying information for their implanted devices and perspectives on sharing their implanted device information. METHODS Four focus groups were conducted with patients who had received a cardiac or vascular implanted device from one of the study sites within the previous 6 months. Data were transcribed and thematically analysed. RESULTS Five themes emerged: lack of awareness of identifying information on implanted devices; value of information on implanted devices; varying trust with sharing device information; perceived risk with sharing device information; and lack of consensus on a systematic process for tracking implanted devices. DISCUSSION Patients desire post-procedural information on their implanted device and a designated plan for longitudinal follow-up, but lack trust and perceive risk with broadly sharing their implanted device information. CONCLUSION After receiving an implanted device, post-procedural patient communication needs to be expanded to include identifying information on the device including the unique device identifier, how long-term tracking will be supported and the process for notification in case of a problem with the device. This communication should also include education on how sharing device information supports patients' long-term health care, post-market safety surveillance and research. PATIENT OR PUBLIC CONTRIBUTION The research team included members who were also patients with implanted devices.
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Affiliation(s)
- Natalia A Wilson
- College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Amanda J Reich
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Deepak L Bhatt
- Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Louis L Nguyen
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Joel S Weissman
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
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Lemmers AL, van der Voort PHJ. Trust in Intensive Care Patients, Family, and Healthcare Professionals: The Development of a Conceptual Framework Followed by a Case Study. Healthcare (Basel) 2021; 9:208. [PMID: 33671940 PMCID: PMC7919028 DOI: 10.3390/healthcare9020208] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/04/2021] [Accepted: 02/10/2021] [Indexed: 11/17/2022] Open
Abstract
Intensive care patients experience anxiety, pain, uncertainty, and total dependency. In general, it is important to develop trust between the healthcare professionals (HCPs), patients, and their family. Trust building in the ICU setting is challenging because of the time sensitivity of decision making and the dependency of patients on health care professionals. The objectives of this study are the development of a trust framework and then to use this framework in a case study in the intensive care. In three steps we developed a comprehensive trust framework from the literature concerning trust. First, we identified the elements of trust. Second, we adapted and integrated the dimensions to six concepts to construct the trust framework. Third, these concepts are incorporated into a comprehensive trust framework. In a case study we explored the facilitators and barriers within this framework in eight semi-open interviews with healthcare professionals and eight patients or partners. Trust was first explored inductively and then deductively. We showed that HCPs, patients, and family have largely the same perspective regarding the facilitators of trust, in which communication emerged as the most important one. Other facilitators are maintaining an open feedback culture for HCPs and being aware of patients' physical and informational privacy. Patients want to be approached as an individual with individual needs. Dishonesty and differences in values and norms were the most important barriers. To contribute to a positive perception of health delivery and to avoid conflicts between HCP and patients or their family we formulated five practical recommendations.
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Affiliation(s)
- Anne Lotte Lemmers
- Department of Intensive Care, OLVG Hospital, P.O. Box 95500, 1090HM Amsterdam, The Netherlands;
| | - Peter H. J. van der Voort
- Department of Critical Care, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
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de Vries H, Vahl J, Muris J, Evers S, van der Horst H, Cheung KL. Effects of the reform of the Dutch healthcare into managed competition: Results of a Delphi study among experts. Health Policy 2020; 125:27-33. [PMID: 33189409 DOI: 10.1016/j.healthpol.2020.10.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 09/17/2020] [Accepted: 10/18/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND In 2006 a major healthcare reform was introduced in the Netherlands, implying managed competition. This study explored the level of consensus on the outcomes and desired changes of this new system, and differences between stakeholder groups. METHODS A three-round Delphi-study was conducted among Dutch healthcare insurers, health economists, and professionals in general practice (GP) care and mental health (MH) care. In the first round, 20 experts indicated the most important advantages and disadvantages of the Dutch managed competition, and desired changes. Experts in the second (n = 106) and third round (N = 88) rated the importance of the 88 factors identified in the first round. RESULTS Only healthcare insurers reached consensus on important advantages (i.e. improved efficiency; room for choice). Health economists reached almost no consensus on any factors. GP and MH-care professionals reached most consensus on disadvantages (i.e. focus on price over quality, increased bureaucracy) and desired changes (i.e. reduce bargaining power of healthcare insurers; increase attention for care of complex patients); half of them suggested abolishment of managed competition. CONCLUSION GP and MH-care professionals were most dissatisfied and suggested several changes or even abolishment of the 2006 reform; healthcare insurers mentioned some benefits. This level of dissatisfaction among health care professionals indicates that there is room for improvement, preferably developed in conjunction with stakeholders.
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Affiliation(s)
- Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, the Netherlands.
| | - Jos Vahl
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, the Netherlands
| | - Jean Muris
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, the Netherlands
| | - Silvia Evers
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Henriëtte van der Horst
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Free University Amsterdam, the Netherlands
| | - Kei Long Cheung
- Health Behaviour Change Research Group, Department of Health Sciences, College of Health and Life Sciences, Brunel University London, United Kingdom
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Abstract
Policy Points Strategically purchasing health care has been and continues to be a popular policy idea around the world. Key asymmetries in information, market power, political power, and financial power hinder the effective implementation of strategic purchasing. Strategic purchasing has consistently failed to live up to its promises for these reasons. Future strategies based on strategic purchasing should tailor their expectations to its real effectiveness. CONTEXT Strategic purchasing of health care has been a popular policy idea around the world for decades, with advocates claiming that it can lead to improved quality, patient satisfaction, efficiency, accountability, and even population health. In this article, we report the results of an inquiry into the implementation and effects of strategic purchasing. METHODS We conducted three in-depth case studies of England, the Netherlands, and the United States. We reviewed definitions of purchasing, including its slow acquisition of adjectives such as strategic, and settled on a definition of purchasing that distinguishes it from the mere use of contracts to regulate stable interorganizational relationships. The case studies review the career of strategic purchasing in three different systems where its installation and use have been a policy priority for years. FINDINGS No existing health care system has effective strategic purchasing because of four key asymmetries: market power asymmetry, information asymmetry, financial asymmetry, and political power asymmetry. CONCLUSIONS Further investment in policies that are premised on the effectiveness of strategic purchasing, or efforts to promote it, may not be worthwhile. Instead, policymakers may need to focus on the real sources of power in a health care system. Policy for systems with existing purchasing relationships should take into account the asymmetries, ways to work with them, and the constraints that they create.
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Affiliation(s)
| | | | - EWOUT VAN GINNEKEN
- European Observatory on Health Systems and PoliciesBerlin University of Technology
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Noort BAC, Ahaus K, van der Vaart T, Chambers N, Sheaff R. How healthcare systems shape a purchaser's strategies and actions when managing chronic care. Health Policy 2020; 124:628-638. [PMID: 32444204 DOI: 10.1016/j.healthpol.2020.03.009] [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: 01/29/2019] [Revised: 03/27/2020] [Accepted: 03/29/2020] [Indexed: 11/29/2022]
Abstract
Healthcare purchasing organisations in both insurance-based and tax-based healthcare systems struggle to improve chronic care. A key challenge for purchasers is to deal with the chain of multiple providers involved in caring for patients with complex needs. To date, most research has focused on differences between healthcare systems in terms of regulation, tools and the freedom that healthcare purchasers have. However, this does not explain how such different healthcare system characteristics lead to different purchasing strategies and actions. A better understanding of this link between system characteristics and purchaser behaviour would assist policymakers seeking to improve healthcare purchasing. This multiple case study conducted in England, Sweden and the Netherlands examines the link between the different healthcare systems' characteristics and the purchasers' strategies and actions when managing chronic care chains. Purchasers' strategies and actions varied in terms of the purchaser's engagement, strategic lens and influencing style. Our findings suggest that differences in purchaser competition, purchaser governance and patient choice in healthcare systems are key factors in explaining a purchaser's strategies and actions when pursuing improvements in chronic care. This study contributes to knowledge on what shapes the purchaser's role, and shows how policymakers in both insurance- and tax-based regimes can improve healthcare purchasing.
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Affiliation(s)
- Bart A C Noort
- University of Groningen, Faculty of Economics and Business, the Netherlands.
| | - Kees Ahaus
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, the Netherlands
| | - Taco van der Vaart
- University of Groningen, Faculty of Economics and Business, the Netherlands
| | - Naomi Chambers
- Alliance Manchester Business School, University of Manchester, United Kingdom
| | - Rod Sheaff
- University of Plymouth, Faculty of Business, School of Law, Criminology and Government, United Kingdom
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