Associations between structures, processes and outcomes in inter-municipal cooperation in out-of-hours services in Norway: A survey study

Assessment of the satisfaction with public health insurance programs by patients with chronic diseases in China: a structural equation modeling approach

BACKGROUND

China has successfully sustained its universal health insurance coverage over the past decade. Although patient satisfaction has been recognized as an important indicator to measure the performance of insurance programs in China, there is a lack of evidence on how patients with chronic diseases are satisfied with China's public health insurance programs and whether their satisfaction differs by type of insurance. We aimed to fill the evidence gap.

METHODS

We established a hypothetical model that comprised patients' awareness of insurance policies, the fulfillment of patients' expectations of insurance benefits, patients' perceived value of health insurance coverage, patients' satisfaction with health insurance programs, patients' complaints, and trust in health insurance programs. We performed a confirmatory factor analysis by using a structural equation modeling (SEM) approach to examine the hypothesized model. A model-testing survey in 10 tertiary hospitals was conducted between June and October 2018, with a valid sample of 922 insured patients with chronic diseases.

RESULTS

The SEM model, with good fit indices, showed that patients' awareness of health insurance policies, insurance program's fulfillment of expectations, and patients' perceived value of insurance coverage, positively predicted patient satisfaction (P < 0.01). The fulfillment of patients' expectations of insurance benefits was the major predictor of satisfaction with health insurance (coefficient = 0.593, P < 0.001), while the patients' perceived value of insurance coverage had the largest impact on their trust in health insurance (coefficient = 0.409, P < 0.01). Compared to patients with Urban-Rural Resident Basic Medical Insurance, Urban Employee Basic Medical Insurance enrollees had a higher degree of satisfaction with insurance on average (P < 0.01). Despite differences in the degree of satisfaction, the main findings from the SEM were also proved by the multi-group analysis.

CONCLUSIONS

Our findings highlight the importance of incorporating patients' perceived value as part of the ongoing efforts to increase satisfaction with health insurance by patients, especially those who have chronic diseases. Policymakers are also suggested to formulate evidence-informed reimbursement policies that meet patients' expectations.

Asymmetry in inter-municipal cooperation in health services - How does it affect service quality and autonomy?

Throughout Europe, local health services are increasingly being provided through various forms of inter-municipal cooperation (IMC). One of the most common forms of IMC is when small municipalities delegate the operational responsibility for providing health services to a larger host municipality. However, despite the size asymmetry usually inherent in this type of IMC, this aspect has largely been neglected in the existing literature, which mainly focuses on the size of individual municipalities. Based on data from 97 partner municipalities and 25 host municipalities in Norway, this study examines how varying degrees of size asymmetry between them affect the perceived service quality and loss of autonomy resulting from IMC in health services. From the perspective of the relatively smaller partner municipalities, the results suggest that these are likely to benefit greatly from size asymmetry in terms of improved service quality, although this would appear to be at the expense of losing decision-making autonomy to their host. However, from the perspective of the relatively larger hosts municipalities, this type of asymmetry is likely to affect service quality negatively while having no effect on decision-making autonomy.

Complementarity of Communication and Coordination in Ensuring Effectiveness of Emergency Management Networks

Inter-organizational communication, coordination, and network effectiveness have long been of great interest. However, the level of their complexity and situational dependencies still create challenges for researchers and public managers. It is usually assumed that inter-organizational communication leads to inter-organizational coordination, but little is known how these processes interact and complement each other. This article aims at identifying relationships linking these processes and analyzing their impact on effectiveness of emergency management networks. Achieving the goal of the article based on the survey questionnaire conducted with 83 experts. The results were analyzed using the principal components analysis (PCA), correlation analysis, hierarchical clustering, and partial least-square path modeling (PLS-PM). The analyses conducted allow for identifying the dimensions of the research processes, and relationships linking them. This was the basis for building the research models testing how relationships between inter-organizational communication and coordination influence the effectiveness of emergency management networks. Comparing analyzed models points to complementarity, parallelism, and the possibility of a non-sequential course of inter-organizational communication and coordination.