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Liu X, Zhang L, Fan X, Chen W. Impact of family doctor system on diabetic patients with distinct service utilisation patterns: a difference-in-differences analysis based on group-based trajectory modelling. BMJ Glob Health 2024; 9:e014717. [PMID: 39313253 PMCID: PMC11418535 DOI: 10.1136/bmjgh-2023-014717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 09/06/2024] [Indexed: 09/25/2024] Open
Abstract
INTRODUCTION This study examines the impact of China's family doctor system (FDS) on healthcare utilisation and costs among diabetic patients with distinct long-term service utilisation patterns. METHODS Conducted in City A, eastern China, this retrospective cohort study used data from the Health Information System and Health Insurance Claim Databases, covering diabetic patients from 1 January 2014 to 31 December 2019.Patients were categorised into service utilisation trajectories based on quarterly outpatient visits to community health centres (CHCs) and secondary/tertiary hospitals from 2014 to 2017 using group-based trajectory models. Propensity score matching within each trajectory group matched FDS-enrolled patients (intervention) with non-enrolled patients (control). Difference-in-differences analysis compared outcomes between groups, with a SUEST test for cross-model comparison. Outcomes included outpatient visits indicator, costs indicator and out-of-pocket (OOP) expenses. RESULTS Among 17 232 diabetic patients (55.21% female, mean age 62.85 years), 13 094 were enrolled in the FDS (intervention group) and 4138 were not (control group). Patients were classified into four trajectory groups based on service utilisation from 2014 to 2017: (1) low overall outpatient utilisation, (2) high CHC visits, (3) high secondary/tertiary hospital visits and (4) high overall outpatient utilisation. After enrolled in FDS From 2018 to 2019, the group with high secondary/tertiary hospital visits saw a 6.265 increase in CHC visits (225.4% cost increase) and a 3.345 decrease in hospital visits (55.5% cost reduction). The high overall utilisation group experienced a 4.642 increase in CHC visits (109.5% cost increase) and a 1.493 decrease in hospital visits. OOP expenses were significantly reduced across all groups. CONCLUSION The FDS in China significantly increases primary care utilisation and cost, while reducing hospital visits and costs among diabetic patients, particularly among patients with historically high hospital usage. Policymakers should focus on enhancing the FDS to further encourage primary care usage and improve chronic disease management.
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Affiliation(s)
- Xinyi Liu
- School of Public Health, Fudan University, Shanghai, China
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Luying Zhang
- School of Public Health, Fudan University, Shanghai, China
| | - Xianqun Fan
- Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wen Chen
- School of Public Health, Fudan University, Shanghai, China
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Zeng W, Tao W, Yang Y, Li Y, Lu B, Zhao Q, Li Z, Wang M, Shui Z, Wen J. Perceived knowledge, attitudes and practices regarding the medical consortium among medical staff in Sichuan, China: a cross-sectional survey. BMC Health Serv Res 2023; 23:1318. [PMID: 38031073 PMCID: PMC10688012 DOI: 10.1186/s12913-023-10146-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 10/14/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND In China, fragmented and inefficient health care systems are common while quality resources are limited. To promote an organized, efficient system, the government launched a medical consortium policy to vertically integrate health care through the collaboration of different levels of medical care. Logically, medical staff's knowledge, attitudes and practices (KAP) regarding the consortium are critical for its development. The objective of this study was to explore the KAP regarding the medical consortium among medical staff in a medical consortium in Sichuan Province, China. METHODS A cross-sectional survey was conducted. In total, 690 medical staff members in 3 cities of Sichuan Province, China, were interviewed from November 2018 to December 2018. The questionnaire consisted of 18 items, including 4 items related to perceived knowledge, 4 items related to attitudes and 2 items related to practices, and was rated on a 5-point Likert scale (one = strongly disagree/do not know, five = strongly agree/know). RESULTS The effective response sample was 640 copies of the questionnaire, and most medical staff members (92.50%) knew about the cooperation with other hospitals in the medical consortium. Medical staff scored differently on each item in the questionnaire, with the highest score being the item 'agreeing with the ward rounds and clinical teaching and training organized by the leading hospital' (4.54 ± 0.76), and the lowest score being the item 'frequency in participating in ward rounds and clinical teaching organized by the leading hospital' (2.83 ± 1.36). In addition, the effect of demographic characteristics on KAP was evaluated by stepwise multiple regression analysis, and a significant positive correlation was found between all the studied variables by Spearman's correlation (p < 0.05). CONCLUSIONS This study showed that the attitudes toward and knowledge of the medical consortium significantly contribute to practices, satisfaction with the support work performed by the leading hospital and agreement of improvement after joining the medical consortium. Thus, to improve medical staff's KAP and satisfaction, publicity and educational programs in medical consortia are necessary, and the leading hospital should attach importance to the informatization construction and demand of different medical staff members. CLINICAL TRIAL REGISTRATION There are no clinical trials in this study.
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Affiliation(s)
- Wenqi Zeng
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wenjuan Tao
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanlin Yang
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yong Li
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bingqing Lu
- Evidence-based Medical Center, Hospital of Chengdu University of Traditional Chinese Medicine (Traditional Chinese Medicine Hospital of Sichuan), Chengdu, Sichuan, China
| | - Qian Zhao
- Department of Medical Administration, Chengdu Municipal Health Commission, Chengdu, Sichuan, China
| | - Zhuyue Li
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Miao Wang
- Department of Public Affairs Development, West China Hospital, Sichuan University, Chengdu, China
| | - Zhanglin Shui
- Outpatient Department, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jin Wen
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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O'Connor RC, Worthman CM, Abanga M, Athanassopoulou N, Boyce N, Chan LF, Christensen H, Das-Munshi J, Downs J, Koenen KC, Moutier CY, Templeton P, Batterham P, Brakspear K, Frank RG, Gilbody S, Gureje O, Henderson D, John A, Kabagambe W, Khan M, Kessler D, Kirtley OJ, Kline S, Kohrt B, Lincoln AK, Lund C, Mendenhall E, Miranda R, Mondelli V, Niederkrotenthaler T, Osborn D, Pirkis J, Pisani AR, Prawira B, Rachidi H, Seedat S, Siskind D, Vijayakumar L, Yip PSF. Gone Too Soon: priorities for action to prevent premature mortality associated with mental illness and mental distress. Lancet Psychiatry 2023; 10:452-464. [PMID: 37182526 DOI: 10.1016/s2215-0366(23)00058-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/17/2023] [Accepted: 02/28/2023] [Indexed: 05/16/2023]
Abstract
Globally, too many people die prematurely from suicide and the physical comorbidities associated with mental illness and mental distress. The purpose of this Review is to mobilise the translation of evidence into prioritised actions that reduce this inequity. The mental health research charity, MQ Mental Health Research, convened an international panel that used roadmapping methods and review evidence to identify key factors, mechanisms, and solutions for premature mortality across the social-ecological system. We identified 12 key overarching risk factors and mechanisms, with more commonalities than differences across the suicide and physical comorbidities domains. We also identified 18 actionable solutions across three organising principles: the integration of mental and physical health care; the prioritisation of prevention while strengthening treatment; and the optimisation of intervention synergies across social-ecological levels and the intervention cycle. These solutions included accessible, integrated high-quality primary care; early life, workplace, and community-based interventions co-designed by the people they should serve; decriminalisation of suicide and restriction of access to lethal means; stigma reduction; reduction of income, gender, and racial inequality; and increased investment. The time to act is now, to rebuild health-care systems, leverage changes in funding landscapes, and address the effects of stigma, discrimination, marginalisation, gender violence, and victimisation.
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Affiliation(s)
- Rory C O'Connor
- Suicidal Behaviour Research Laboratory, School of Health & Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
| | | | - Marie Abanga
- Hope for the Abused and Battered, Douala, Cameroon
| | | | | | - Lai Fong Chan
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Helen Christensen
- Faculty of Medicine & Health, University of New South Wales, Sydney and the Black Dog Institute, Sydney, NSW, Australia
| | - Jayati Das-Munshi
- Department of Psychological Medicine, King's College London, London, UK; Institute of Psychiatry, Psychology, and Neuroscience, and Centre for Society and Mental Health, King's College London, London, UK; South London and Maudsley NHS Trust, London, UK
| | - James Downs
- Royal College of Psychiatrists, UK and Faculty of Wellbeing, Education, and Language Studies, Open University, Milton Keynes, UK
| | | | | | - Peter Templeton
- The William Templeton Foundation for Young People's Mental Health, Cambridge, UK
| | - Philip Batterham
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | | | | | - Simon Gilbody
- York Mental Health and Addictions Research Group, University of York, York, UK
| | - Oye Gureje
- WHO Collaborating Centre for Research and Training in Mental Health, Neuroscience, Drug and Alcohol Abuse, University of Ibadan, Ibadan, Nigeria
| | - David Henderson
- Department of Psychiatry, Boston University School of Medicine, Boston Medical Center, Boston, MA, USA
| | - Ann John
- Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Murad Khan
- Brain & Mind Institute, Aga Khan University, Karachi, Pakistan
| | - David Kessler
- Bristol Population Health Science Institute, Centre for Academic Mental Health, Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Olivia J Kirtley
- Center for Contextual Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium
| | | | - Brandon Kohrt
- Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA
| | - Alisa K Lincoln
- Institute for Health Equity and Social Justice Research, Northeastern University, Boston, MA, USA
| | - Crick Lund
- Health Services and Population Research Department, King's College London, London, UK; Centre for Global Mental Health, King's College London, London, UK
| | - Emily Mendenhall
- Edmund A Walsh School of Foreign Service, Georgetown University, Washington, DC, USA
| | - Regina Miranda
- Hunter College, Department of Psychology, The Graduate Center, City University of New York, New York, NY, USA
| | - Valeria Mondelli
- Department of Psychological Medicine, King's College London, London, UK
| | - Thomas Niederkrotenthaler
- Department of Social and Preventive Medicine, Suicide Research & Mental Health Promotion Unit, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - David Osborn
- Division of Psychiatry, University College London and Camden and Islington NHS Foundation Trust, London, UK
| | - Jane Pirkis
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Anthony R Pisani
- University of Rochester Center for the Study and Prevention of Suicide, SafeSide Prevention, Rochester, NY, USA
| | | | | | - Soraya Seedat
- Department of Psychiatry, Faculty of Medicine and Health Sciences, SAMRC Genomics of Brain Disorders Unit, Stellenbosch University, Cape Town, South Africa
| | - Dan Siskind
- Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
| | | | - Paul S F Yip
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong Special Administrative Region, China
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Associations between literacy and attitudes toward artificial intelligence–assisted medical consultations: The mediating role of perceived distrust and efficiency of artificial intelligence. COMPUTERS IN HUMAN BEHAVIOR 2023. [DOI: 10.1016/j.chb.2022.107529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Integrated Care for Multimorbidity Population in Asian Countries: A Scoping Review. Int J Integr Care 2022; 22:22. [PMID: 35414805 PMCID: PMC8932356 DOI: 10.5334/ijic.6009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 02/28/2022] [Indexed: 11/20/2022] Open
Abstract
Background: The complex needs of patients with multiple chronic diseases call for integrated care (IC). This scoping review examines several published Asian IC programmes and their relevant components and elements in managing multimorbidity patients. Method: A scoping review was conducted by searching electronic databases encompassing Medline, Embase, Scopus, and Web of Science. Three key concepts – 1) integrated care, 2) multimorbidity, and 3) Asian countries – were used to define searching strategies. Studies were included if an IC programme in Asia for multimorbidity was described or evaluated. Data extraction for IC components and elements was carried out by adopting the SELFIE framework. Results: This review yielded 1,112 articles, of which 156 remained after the title and abstract screening and 27 studies after the full-text screening – with 23 IC programmes identified from seven Asian countries. The top 5 mentioned IC components were service delivery (n = 23), workforce (n = 23), leadership and governance (n = 23), monitoring (n = 15), and environment (n = 14); whist financing (n = 9) was least mentioned. Compared to EU/US countries, technology and medical products (Asia: 40%, EU/US: 43%-100%) and multidisciplinary teams (Asia: 26%, EU/US: 50%–81%) were reported less in Asia. Most programmes involved more micro-level elements that coordinate services at the individual level (n = 20) than meso- and macro-level elements, and programmes generally incorporated horizontal and vertical integration (n = 14). Conclusion: In the IC programmes for patients with multimorbidity in Asia, service delivery, leadership, and workforce were most frequently mentioned, while the financing component was least mentioned. There appears to be considerable scope for development. Highlights
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Liang LL, Tussing AD, Huang N, Tsai SL. Incentives for physician teams: Effectiveness of performance feedback and payment distribution methods. Health Policy 2021; 125:1377-1384. [PMID: 34334226 DOI: 10.1016/j.healthpol.2021.07.007] [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: 04/11/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/29/2022]
Abstract
Best practices in team-based incentive design remain underexplored. This study examines under group-based pay-for-performance, how managers incentivize physicians for teamwork through internal feedback and payment distribution methods. In collaboration with Taiwan Association of Family Medicine, authors conducted a national survey of physician groups, with a response rate of 48.3%. Multilevel linear regression was applied to 134 groups, collectively consisting of 1,245 physicians in Taiwan. The outcome variables were two manager-rated scores for group performance on achieving (a) comprehensive, coordinated, continuous care, and (b) patient health improvement. The results indicate that providing each physician feedback on peer performance is superior to not providing it; when providing peer information within a group, concealing identities is superior to revealing them. These findings imply that application of the principle of social comparison can be effective; however, caution should be taken when disclosure of identifiable peer performance may intensify peer competition and undermine care coordination in team-based models. Further, groups that distribute payments equally among physicians perform better than groups that distributed payment proportionally to physicians' patient shares. The findings are germane to small teams, where physicians do not have full control over care processes and outcomes, and need to work cooperatively to maximize group-based payment.
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Affiliation(s)
- Li-Lin Liang
- Department of Business Management, National Sun Yat-sen University, No.70 Lien-Hai Rd., Kaohsiung 804, Taiwan; Research Center for Epidemic Prevention, National Yang Ming Chiao Tung University, No.155, Sec. 2, Li‑Nong Street, Taipei 112, Taiwan.
| | - A Dale Tussing
- Department of Economics, Syracuse University, 900 South Crouse Ave. Syracuse, NY 13244, USA
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, No.155, Sec. 2, Li‑Nong Street, Taipei 112, Taiwan
| | - Shu-Ling Tsai
- National Health Insurance Administration, Ministry of Health and Welfare, No.140, Sec.3, Hsinyi Rd., Taipei 106, Taiwan
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Huang FY, Ho CH, Liao JY, Hsiung CA, Yu SJ, Zhang KP, Chen PJ. Medical care needs for patients receiving home healthcare in Taiwan: Do gender and income matter? PLoS One 2021; 16:e0247622. [PMID: 33630929 PMCID: PMC7906386 DOI: 10.1371/journal.pone.0247622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 02/09/2021] [Indexed: 11/19/2022] Open
Abstract
Studies about medical care needs for home healthcare (HHC) previously focused on disease patterns but not gender and income differences. We used the Taiwan National Health Research Insurance Database from 1997 to 2013 to examine trends in medical care needs for patients who received HHC, and the gender and income gaps in medical care needs, which were represented by resource utilization groups (RUG). We aimed to clarify three questions: 1. Are women at a higher level of medical care needs for HHC than men, 2. Does income relate to medical care needs? 3. Is the interaction term (gender and income) related to the likelihood of medical care needs? Results showed that the highest level of medical care need in HHC was reducing whereas the basic levels of medical care need for HHC are climbing over time in Taiwan during 1998 and 2013. The percentages of women with income-dependent status in RUG1 to RUG4 are 26.43%, 26.24%, 30.68%, and 32.07%, respectively. Women were more likely to have higher medical care needs than men (RUG 3: odds ratio, OR = 1.17, 95% confidence interval, CI = 1.10-1.25; RUG4: OR = 1.13, 95% CI = 1.06-1.22) in multivariates regression test. Compared to the patients with the high-income status, patients with the income-dependent status were more likely to receive RUG3 (OR = 2.34, 95% CI = 1.77-3.09) and RUG4 (OR = 1.98, 95% CI = 1.44-2.71). The results are consistent with the perspectives of fundamental causes of disease and feminization of poverty theory, implying gender and income inequalities in medical care needs. Policymakers should increase public spending for delivering home-based integrated care resources, especially for women with lower income, to reduce the double burden of female poverty at the higher levels of medical care needs for HHC.
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Affiliation(s)
- Fang-Yi Huang
- Department of Social and Policy Sciences, Yuan Ze University, Taoyuan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
- Cancer Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Jung-Yu Liao
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chao A. Hsiung
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | | | | | - Ping-Jen Chen
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, United Kingdom
- Department of Family Medicine and Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Liang LL, Huang N, Shen YJ, Chen AYA, Chou YJ. Do patients bypass primary care for common health problems under a free-access system? Experience of Taiwan. BMC Health Serv Res 2020; 20:1050. [PMID: 33208148 PMCID: PMC7677770 DOI: 10.1186/s12913-020-05908-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background A common challenge for free-access systems is that people may bypass primary care and seek secondary care through self-referral. Taiwan’s government has undertaken various initiatives to mitigate bypass; however, little is known about whether the bypass trend has decreased over time. This study examined the extent to which patients bypass primary care for treatment of common diseases and factors associated with bypass under Taiwan’s free-access system. Methods This repeated cross-sectional study analyzed data from Taiwan’s National Health Insurance Research Database. A random sample of 1 million enrollees was drawn repeatedly from the insured population during 2000–2017. To capture visits beyond the community level, the bypass rate was defined as the proportion of self-referred visits to the top two levels of providers, namely academic medical centers and regional hospitals, among all visits to all providers. Subgroup analyses were conducted for visits with a single diagnosis. Logistic regressions were used to investigate factors associated with bypass. Results The standardized bypass rate for all diseases analyzed exhibited a decreasing trend. In 2017, it was low for common cold (0.7–1.3%), moderate for hypertension (14.0–29.5%), but still high for diabetes (32.0–47.0%). Moreover, the likelihood of bypass was higher for male, patients with higher salaries or comorbidities, and in areas with more physicians practicing in large hospitals or less physicians working in primary care facilities. Conclusions Although the bypass trend has decreased over time, continuing efforts may be required to reduce bypass associated with chronic diseases. Both patient sociodemographic and market characteristics were associated with the likelihood of bypass. These results may help policymakers to develop strategies to mitigate bypass. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05908-w.
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Affiliation(s)
- Li-Lin Liang
- Department of Business Management, National Sun Yat-sen University, No. 70, Lienhai Rd, Kaohsiung, 804, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang-Ming University, No.155, Section 2, Li-Nong Street, Taipei, 112, Taiwan
| | - Yi-Jung Shen
- Institute of Hospital and Health Care Administration, National Yang-Ming University, No.155, Section 2, Li-Nong Street, Taipei, 112, Taiwan
| | - Annie Yu-An Chen
- RAND Corporation, 1766 Main Street, Santa Monica, CA, USA.,Pardee RAND Graduate School, 1766 Main Street, Santa Monica, CA, USA
| | - Yiing-Jenq Chou
- Institute of Public Health, National Yang-Ming University, No.155, Sec. 2, Li-Nong St., Beitou Dist, Taipei, 112, Taiwan.
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Hanson K, Rasanathan K, George A. The State of Health Policy and Systems Research: Reflections From the 2018 5th Global Symposium. Health Policy Plan 2020; 34:ii1-ii3. [PMID: 31723960 DOI: 10.1093/heapol/czz113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 12/22/2022] Open
Affiliation(s)
- Kara Hanson
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, UK
| | | | - Asha George
- Health Systems Global, 0179 Kavsadze str. 3, Office 5, Tbilisi, Georgia.,School of Public Health, University of the Western Cape, Robert Sobukwe Road, Bellville, Cape Town, South Africa
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