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Hadi YH, Hawsawi HB, Abu Aqil AI. Driving healthcare forward: The potential of mobile MRI and CT units in streamlining radiological services in Saudi Arabia - A narrative review. J Med Imaging Radiat Sci 2024; 55:101444. [PMID: 38986296 DOI: 10.1016/j.jmir.2024.101444] [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: 05/20/2024] [Accepted: 05/27/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND AND PURPOSE This narrative review focuses on the role of mobile MRI and CT units in addressing the challenges of healthcare accessibility and patient wait times in Saudi Arabia. It underscores the growing demand for diagnostic imaging amid infrastructural and geographical barriers, emphasizing mobile units as innovative solutions for enhancing radiological services across diverse Saudi landscapes. The purpose of this study is to assess how these mobile technologies can mitigate service delays, improve patient outcomes, and support healthcare delivery in remote or underserved areas, reflecting on global trends towards more dynamic, patient-centered healthcare models. METHODS This review utilizes an expanded database search and refined keywords to ensure comprehensive literature coverage. The study focused on peer-review articles and grey literatures that directly examined the impact of these mobile units on healthcare accessibility, wait times, and service delivery. A thematic analysis identified significant contributions to accessibility improvements, emergency responses, and rural healthcare, highlighting areas for further research and policy development. DISCUSSION Mobile units have advanced technical specifications with high-field magnets and multi-slice CT scanners on par with fixed facilities. They prioritize patient comfort and safety with examination areas, control rooms, and waiting areas. Telemedicine capabilities allow real-time image transmission to specialists. Strategic deployment can address workforce shortages by distributing services equitably. Mobile units represent cost-effective solutions to expand healthcare access without fixed infrastructure. CONCLUSION Integration of mobile MRI and CT units in Saudi Arabia can transform access to diagnostic imaging by decentralizing services and directly reaching patients, including rural areas. Evidence shows mobile units reduce diagnostic delays and optimize resource use. Despite challenges, strategic investments and collaborations can overcome obstacles to make radiological services more equitable, flexible and patient-focused in Saudi Arabia.
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Affiliation(s)
- Yasser H Hadi
- Department of Medical Imaging and Intervention, King Abdullah Medical City (KAMC), Muzdalifah Rd, Al Mashair, Makkah 24246, Saudi Arabia; Discipline of Medical Imaging and Radiation Therapy, School of Medicine, University College Cork, Brookfield, College Rd, University College, Cork, T12 AK54, Ireland.
| | - Hassan B Hawsawi
- Department of Medical Physics, King Abdullah Medical City (KAMC), Muzdalifah Rd, Al Mashair, Makkah 24246, Saudi Arabia
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Lo Moro G, Marengo N, Mara A, Paño Pardo JR, Hernandez S, Fusté E, Pujol M, Zotti CM, Limón E, Vicentini C. Antimicrobial stewardship programs in acute-care hospitals: A multicenter assessment of structure, process, and outcome indicators in Italy and Spain. J Infect Public Health 2024; 17:102457. [PMID: 38820893 DOI: 10.1016/j.jiph.2024.05.045] [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: 10/28/2023] [Revised: 05/03/2024] [Accepted: 05/21/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Antimicrobial stewardship (AMS) programs have been differently implemented across Europe. This study primarily aimed to compare AMS in two European regions. Secondarily, the study explored the COVID-19 pandemic impact on surrogate outcome indicators of AMS. METHODS A retrospective observational study was conducted in Piedmont (Italy) and Catalonia (Spain). AMS programs were compared through structure and process indicators in 2021. Changes in surrogate outcome indicators (antimicrobial usage; alcohol-based sanitizer consumption; antimicrobial resistance, AMR) from 2017 to 2021 described the pandemic impact. RESULTS Seventy-eight facilities provided structure and process indicators. Catalonia showed better structure scores (p < 0.001) and less dispersion in both indicators. The greatest areas to improve were accountability (Piedmont) and diversification of strategies (Catalonia). Overall, the regions reported consistent changes in outcome indicators. Antimicrobial usage decreased in 2020, returning to near-pre-pandemic levels in 2021. Alcohol-based sanitizer consumption surged in 2020, then dipped remaining above pre-pandemic levels. AMR trends were minimally affected. CONCLUSIONS The centralized approach of Catalonia ensured consistent attainment of quality objectives across all facilities, but it may limit facility-specific strategies. In Piedmont, accountability remain one of the most critical factors as in previous years. The pandemic did not substantially disrupt surrogate outcome measures of AMS. However, the data on AMR suggest that maintaining vigilance against this issue remains paramount.
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Affiliation(s)
- Giuseppina Lo Moro
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
| | - Noemi Marengo
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Alessandro Mara
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - José Ramón Paño Pardo
- Fundación Instituto de Investigación Sanitaria Aragón (IIS Aragón), Biomedical Research Centre of Aragón (CIBA), Zaragoza, Spain; Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Sergi Hernandez
- Centro Coordinador Programa VINCat, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ester Fusté
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Faculty of Nursing. University of Barcelona, Spain; Department of Pathology and Experimental Therapeutics, University of Barcelona and IDIBELL, Faculty of Medicine and Health Sciences University of Barcelona, L'Hospitalet de Llobregat, Spain
| | - Miquel Pujol
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; VINCat Program, Servei Català de la Salut, Barcelona, Spain
| | - Carla Maria Zotti
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
| | - Enric Limón
- Centro Coordinador Programa VINCat, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain; Department of Public Health, Mental Health and Maternal and Child Health Nursing, Faculty of Nursing. University of Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Costanza Vicentini
- Department of Public Health and Pediatrics, University of Turin, Turin, Italy
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Hemberg A, Landén J, Montgomery A, Holmberg H, Nordin P. Management of groin hernia repair in Sweden: A register-based comparative analysis of public and private healthcare providers. Scand J Surg 2024:14574969241242312. [PMID: 38590013 DOI: 10.1177/14574969241242312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
BACKGROUND Swedish healthcare is in a period of transition with an expanding private sector. This study compares quality of outcome after groin hernia repair performed in a public or private healthcare setting. METHODS A cohort study based on data from the Swedish National Hernia Register combined with Patient-Reported Outcome Measures (PROMs) 1 year after groin hernia repair. Between September 2012 and December 2018, a questionnaire was sent to all patients registered in the hernia register 1 year after surgery. Endpoints were reoperation for recurrence, chronic pain, and patient satisfaction. RESULTS From a total of 87,650 patients with unilateral groin hernia repair, 61,337 PROM answers (70%) were received from 71 public and 28 private healthcare providers. More females, acute and recurrent cases, and patients with high American Society of Anesthesiology (ASA) scores were operated under the national healthcare system. The private sector had more experience surgeons with higher annual volume per surgeon, shorter time on waiting lists, and shorter operation times. No difference was seen in patient satisfaction. Groin hernia repair performed in a private clinic was associated with less postoperative chronic pain (OR 0.85, 95% CI 0.8-0.91) but a higher recurrence rate (HR 1.41; 95% CI 1.26-1.59) in a multivariable logistic regression analysis. CONCLUSION Despite private clinics having a higher proportion of experienced surgeons and fewer complex cases, the recurrence rate was higher, whereas the risk for chronic postoperative pain was higher among patients treated in the public sector.
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Affiliation(s)
- Anders Hemberg
- Helsingborgs lasarett Kirurgen Charlotte Yhlens gata 10 251 87 Helsingborg Sweden
| | - Jakob Landén
- Department of Surgical and Perioperative Sciences, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Agneta Montgomery
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Henrik Holmberg
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Pär Nordin
- Department of Surgical and Perioperative Sciences, Faculty of Medicine, Umeå University, Umeå, Sweden
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Golinelli D, Sanmarchi F, Toscano F, Bucci A, Nante N. Analyzing the 20-year declining trend of hospital length-of-stay in European countries with different healthcare systems and reimbursement models. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2024:10.1007/s10754-024-09369-0. [PMID: 38512638 DOI: 10.1007/s10754-024-09369-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 02/10/2024] [Indexed: 03/23/2024]
Abstract
The study aims to investigate the last 20-year (2000-2019) of hospital length of stay (LOS) trends and their association with different healthcare systems (HS) among 25 European countries. A panel dataset was created using secondary data from Eurostat and Global Burden of Disease study databases, with dependent and control variables aggregated at the national level over a period of 20 years. A time trend analysis was conducted using a weighted least squares model for panel data to investigate the association between LOS, HS models [National Health Service (NHS), National Health Insurance, Social Health Insurance (SHI), and Etatist Social Health Insurance], healthcare reimbursement schemes [Prospective Global Budget (PGB), Diagnosis Related Groups (DRG), and Procedure Service Payment (PSP)], and control variables. The study showed a reduction of average LOS from 9.20 days in 2000 to 7.24 in 2019. SHI was associated with a lower LOS compared to NHS (b = - 0.6327, p < 0.05). Both DRG (b = 1.2399, p < 0.05) and PSP (b = 1.1677, p < 0.05) reimbursement models were positively associated with LOS compared to PGB. Our results confirmed the downward trend of LOS in the last 20 years, its multifactorial nature, and the influence of the SHI model of HS. This could be due to the financial incentives present in fee-for-service payment models and the role of competition in creating a market for healthcare services. These results offer insight into the factors influencing healthcare utilization and can inform the design of more effective, efficient, and sustainable HS.
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Affiliation(s)
- Davide Golinelli
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy
- Department of Life Sciences, Health and Healthcare Professions, Link Campus University, Rome, Italy
| | - Francesco Sanmarchi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - University of Bologna, Bologna, Italy.
| | - Fabrizio Toscano
- Department of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Andrea Bucci
- Department of Economics and Law, University of Macerata, Macerata, Italy
| | - Nicola Nante
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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Agada-Amade YA, Ogbuabor DC, Obikeze E, Eborieme E, Onwujekwe OE. Willingness to pay for haemodialysis among patients with chronic kidney disease in Abuja, Nigeria. BMC Nephrol 2024; 25:29. [PMID: 38262948 PMCID: PMC10807076 DOI: 10.1186/s12882-024-03459-4] [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: 12/15/2023] [Accepted: 01/06/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Evidence of willingness to pay for kidney replacement therapy is scarce in low-middle-income countries, including Nigeria's Formal Sector Social Health Insurance Programme. The study, therefore, assessed the willingness to pay for haemodialysis among chronic kidney disease patients in Abuja, Nigeria. METHODS The study adopted a cross-sectional survey design. We used the contingent valuation method to estimate the maximum stated willingness to pay (WTP) for haemodialysis among end-stage kidney disease (ESKD) patients. We obtained informed written consent from respondents before data collection. The socio-demographic characteristics and willingness to pay data were summarized using descriptive statistics. We evaluated the mean differences in respondents' WTP using Mann-Whitney and Kruskal-Wallis tests. All variables that had p < 0.25 in the bivariate analysis were included in the Generalized Linear Model (gamma with link function) to determine the predictors of the WTP for one's and another's haemodialysis. The level of significance in the final model was ρ < 0.05. RESULTS About 88.3% and 64.8% of ESKD patients were willing to pay for personal and altruistic haemodialysis, correspondingly. The mean annual WTP for haemodialysis for one's and altruistic haemodialysis was USD25,999.06 and USD 1539.89, respectively. Private hospital patients were likelier to pay for their haemodialysis (β = 0.39, 95%CI: 0.21 to 0.57, p < 0.001). Patients attending public-private partnership hospitals were less likely to pay for altruistic haemodialysis than those attending public hospitals (β = -1.65, 95%CI: -2.51 to -0.79, p < 0.001). CONCLUSIONS The willingness to pay for haemodialysis for themselves and others was high. The type of facility ESKD patients attended influenced their willingness to pay for haemodialysis. The findings highlight the need for policies to enhance affordable and equitable access to haemodialysis in Nigeria through pre-payment mechanisms and altruistic financing strategies.
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Affiliation(s)
- Yakubu Adole Agada-Amade
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria
- National Health Insurance Authority, Abuja, Nigeria
| | - Daniel Chukwuemeka Ogbuabor
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria.
- Department of Health Systems and Policy, Sustainable Impact Resource Agency, Enugu, Nigeria.
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria.
| | - Eric Obikeze
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Ejemai Eborieme
- Department of Psychiatry, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Obinna Emmanuel Onwujekwe
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu, Enugu State, Nigeria
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
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Yokoo P, Castro ADAE, Fonseca EKUN, Chate RC, Teles GBDS, de Queiroz MRG, Szarf G. COVID-19 pneumonia assessed at a private hospital, a field hospital, and a public-referral hospital: population analysis, chest computed tomography findings, and outcomes. Front Public Health 2024; 11:1280662. [PMID: 38235155 PMCID: PMC10793654 DOI: 10.3389/fpubh.2023.1280662] [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: 08/21/2023] [Accepted: 11/30/2023] [Indexed: 01/19/2024] Open
Abstract
Objective To compare a private quaternary referral hospital, a public tertiary hospital, and a field hospital dedicated to patients with COVID-19, regarding patients' characteristics, clinical parameters, laboratory, imaging findings, and outcomes of patients with confirmed diagnosis of COVID-19. Methods Retrospective multicenter observational study that assessed the association of clinical, laboratory and CT data of 453 patients with COVID-19, and also their outcomes (hospital discharge or admission, intensive care unit admission, need for mechanical ventilation, and mortality caused by COVID-19). Results The mean age of patients was 55 years (±16 years), 58.1% of them were male, and 41.9% were female. Considering stratification by the hospital of care, significant differences were observed in the dyspnea, fever, cough, hypertension, diabetes mellitus parameters, and CT score (p < 0.05). Significant differences were observed in ward admission rates, with a lower rate in the private hospital (40.0%), followed by the public hospital (74.1%), and a higher rate in the field hospital (89.4%). Regarding intensive care unit admission, there was a higher rate in the public hospital (25.2%), followed by the private hospital (15.5%), and a lower rate in the field hospital (9.9%). In the analysis of the discharge and death outcomes, it was found that there was a higher number of patients discharged from the private hospital (94.2%), compared to the field hospital (90.1%) and public hospital (82.3%) and a higher number of deaths in the public hospital (17.7%) compared to the private hospital and field hospital (5.8 and 0% respectively). Conclusion The analysis of the data regarding the population treated with COVID-19 during the first wave in different levels of care in the public and private health systems in the city of São Paulo revealed statistically significant differences between the populations, reflecting distinct outcomes.
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Kruk ME, Kapoor NR, Lewis TP, Arsenault C, Boutsikari EC, Breda J, Carai S, Croke K, Dayalu R, Fink G, Garcia PJ, Kassa M, Mohan S, Moshabela M, Nzinga J, Oh J, Okiro EA, Prabhakaran D, SteelFisher GK, Tarricone R, Garcia-Elorrio E. Population confidence in the health system in 15 countries: results from the first round of the People's Voice Survey. Lancet Glob Health 2024; 12:e100-e111. [PMID: 38096882 PMCID: PMC10716625 DOI: 10.1016/s2214-109x(23)00499-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 09/11/2023] [Accepted: 10/18/2023] [Indexed: 12/17/2023]
Abstract
Population confidence is essential to a well functioning health system. Using data from the People's Voice Survey-a novel population survey conducted in 15 low-income, middle-income, and high-income countries-we report health system confidence among the general population and analyse its associated factors. Across the 15 countries, fewer than half of respondents were health secure and reported being somewhat or very confident that they could get and afford good-quality care if very sick. Only a quarter of respondents endorsed their current health system, deeming it to work well with no need for major reform. The lowest support was in Peru, the UK, and Greece-countries experiencing substantial health system challenges. Wealthy, more educated, young, and female respondents were less likely to endorse the health system in many countries, portending future challenges for maintaining social solidarity for publicly financed health systems. In pooled analyses, the perceived quality of the public health system and government responsiveness to public input were strongly associated with all confidence measures. These results provide a post-COVID-19 pandemic baseline of public confidence in the health system. The survey should be repeated regularly to inform policy and improve health system accountability.
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Affiliation(s)
- Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Neena R Kapoor
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Todd P Lewis
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Catherine Arsenault
- Department of Global Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Eleni C Boutsikari
- Division of Country Health Policies and Systems, WHO Athens Quality of Care Office, WHO Regional Office for Europe, Athens, Greece
| | - João Breda
- Division of Country Health Policies and Systems, WHO Athens Quality of Care Office, WHO Regional Office for Europe, Athens, Greece
| | - Susanne Carai
- Division of Country Health Policies and Systems, WHO Athens Quality of Care Office, WHO Regional Office for Europe, Athens, Greece
| | - Kevin Croke
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Rashmi Dayalu
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Günther Fink
- Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute and University of Basel, Basel, Switzerland
| | - Patricia J Garcia
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Munir Kassa
- Minister's Office, Ministry of Health, Addis Ababa, Ethiopia
| | | | - Mosa Moshabela
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Jacinta Nzinga
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Juhwan Oh
- Seoul National University College of Medicine, Seoul, South Korea
| | - Emelda A Okiro
- Population and Health Impact Surveillance Group, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Gillian K SteelFisher
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Rosanna Tarricone
- Department of Social and Political Science, Bocconi University, Milan, Italy
| | - Ezequiel Garcia-Elorrio
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru; Health Care Quality and Patient Safety, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
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Pedersen ERG, Sudzina F, Rosati F. A multi-dimensional study of organisational boundaries and silos in the healthcare sector. Health Serv Manage Res 2023:9514848231218617. [PMID: 38011078 DOI: 10.1177/09514848231218617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Purpose: The aim of this study is to understand how healthcare practitioners experience organisational boundaries and silos in day-to-day operations. Based on a multi-dimensional scale of organisational boundaries, the study examines how organisational demarcation lines enable and constrain daily work tasks in the healthcare sector.Research design: The study is based on a quantitative and qualitative analysis of survey responses from 895 healthcare practitioners in Denmark.Results: The results indicate that tendencies toward organisational silos relate to systems and hierarchies (management-staff) rather than professions and departments. Moreover, the study identifies resource scarcity as an important undercurrent in the understanding of the respondents' perceptions of boundaries and silos.Conclusion: The study contributes to existing research by documenting the coordination and collaboration challenges linked to the multitude of demarcation lines in complex health organisations.
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Affiliation(s)
| | - Frantisek Sudzina
- Prague University of Economics and Business Faculty of Informatics and Statistics, Praha, Czech Republic
| | - Francesco Rosati
- Centre for Technology Entrepreneurship, Technical University of Denmark, Kgs. Lyngby, Denmark
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Garattini L, Badinella Martini M. Modeling European health systems: a theoretical exercise. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2023; 24:1249-1252. [PMID: 37665522 DOI: 10.1007/s10198-023-01628-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/23/2023] [Indexed: 09/05/2023]
Affiliation(s)
- L Garattini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy.
| | - Marco Badinella Martini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
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Shokr H, Rishworth A, Wilson K. Access to emergency care in Egypt: Tiered health care and manifestations of inequity. Soc Sci Med 2023; 336:116212. [PMID: 37783622 DOI: 10.1016/j.socscimed.2023.116212] [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: 12/20/2022] [Revised: 05/27/2023] [Accepted: 09/01/2023] [Indexed: 10/04/2023]
Abstract
Market-driven health care reforms and development strategies continue to drive the privatization of health care services across the world. When these measures are implemented, large disparities emerge and are maintained. Using a modified version of the access to care framework developed by Penchansky and Thomas, this paper examines the manifestations of inequity between private for-profit and public emergency care in the Greater Cairo Region and Asyut, Egypt. In-depth interviews with physicians working in both sectors reveals stark disparities in access between these two health care sectors in Egypt. Access issues identified include unaffordable care in the private sector, unavailable medical supplies and overcrowding in public hospitals, as well as a salary gap that drives health care workers from public to private practice, creating staffing shortages in public hospitals. The manifestations of these inequities are often severe, usually tangible, and according to health care providers, embodied in the experiences of service users.
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Affiliation(s)
- Hisham Shokr
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Andrea Rishworth
- Department of Geography, Geomatics, and Environment, University of Toronto Mississauga, Mississauga, Ontario, Canada.
| | - Kathi Wilson
- Department of Geography, Geomatics, and Environment, University of Toronto Mississauga, Mississauga, Ontario, Canada.
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Atiga O, Walters J, Pisa N. Challenges of medical commodity availability in public and private health care facilities in the Upper East Region of Ghana: a patient-centered perspective. BMC Health Serv Res 2023; 23:719. [PMID: 37393292 DOI: 10.1186/s12913-023-09717-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 06/19/2023] [Indexed: 07/03/2023] Open
Abstract
This article is a patient-centered comparison of medical ccommodities availability in public and private health care facilities in the Upper East (UER) of Ghana to determine if significant differences existed. A concurrent mixed method strategy was used where both quantitative and qualitative data were simultaneously collected, independently analysed and triangulated at the intepretation stage. Quantitative data were collected using a systematic sampling method where a total of 1500 patients (750 from public and 750 from private) health care facilities responded to the interviwer-administered questionnaires for this study. Exploratory factor analysis (EFA) was applied as a construct validation tool while a T-test was computed to compare if a significant difference existed between both type of patients. Qualitative data were collected from selected patients and heads of public and private healthcare facilities using an interview guide. The qualitative data were analysed using content analysis. The results indicated significant differences existed in the availability of medical commodities, frequency of medicine stock-outs, seasonality of medicine stock-outs, patients' reaction to medicine stock-outs and communication about the medicine stock-outs to patients of private and public facilities. The biggest difference between the two groups of patients was how communication of medicines stock-outs was communicated to them.Health care facility managers in the region must focus seriously on training staff on how to improve communication of medicines stock-outs to patients.
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Affiliation(s)
- Oswald Atiga
- Department of Transport and Supply Chain Management, University of Johannesburg, Auckland Park, South Africa.
- Department of Procurement and Logistics Management of the Bolgatanga Technical University, Bolgatanga, Upper East Region, Ghana.
| | - Jackie Walters
- Department of Transport and Supply Chain Management, University of Johannesburg, Auckland Park, South Africa
| | - Noleen Pisa
- Department of Transport and Supply Chain Management, University of Johannesburg, Auckland Park, South Africa
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Garattini L, Freemantle N, Nobili A, Mannucci PM. Conceptualizing a model for European health systems: the institutional framework. Intern Emerg Med 2023; 18:1213-1215. [PMID: 37014494 DOI: 10.1007/s11739-023-03261-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 03/21/2023] [Indexed: 04/05/2023]
Affiliation(s)
- L Garattini
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - N Freemantle
- Institute of Clinical Trials and Methodology, University College London, London, UK
| | - A Nobili
- Department of Health Policy, Institute for Pharmacological Research Mario Negri IRCCS, Milan, Italy
| | - P M Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Israeli A, Hod K, Mezer E. Characteristics and differences of strabismus surgeries performed in private versus public settings: a national multicenter study. Int Ophthalmol 2023:10.1007/s10792-023-02725-y. [PMID: 37083871 DOI: 10.1007/s10792-023-02725-y] [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: 12/12/2022] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE To investigate and compare the demographics, diagnoses, and surgical procedure types of strabismus repair in public and private hospitals in Israel in order to highlight possible disparities between them. METHODS Retrospective descriptive study included all strabismus surgeries in seven private hospitals, compared with two large public university-affiliated hospitals from June 2016 to June 2021. Electronic medical records were directly retrieved to produce an anonymized database. RESULTS During the study period 2420 operations were performed. Patients who underwent strabismus surgery in public hospitals were older and had shorter procedures (p < 0.001 and p = 0.004, respectively). The median number of operated muscles and the prevalence of bilateral procedures were higher in private hospitals (p < 0.001 and p < 0.001, respectively). Surgery for common strabismus, especially esotropia, was more prevalent in private (p < 0.001), whereas surgery for vertical strabismus, cranial nerve palsies and complex syndromes were performed more often in public hospitals (p < 0.001, p = 0.008, and p < 0.001, respectively). Rectus recession and inferior oblique (IO) anteriorization were more predominant in private hospitals (p = 0.002 and p < 0.001, respectively), while recuts advancement and IO myectomies were more prevalent in public ones (p = 0.001 and p < 0.001, respectively). Reoperations were far more common in public hospitals (27.2% vs 6.2%, p < 0.0001). This was true across most age groups. CONCLUSIONS Candidates for strabismus surgery in private hospitals in Israel are often younger, with more common diagnoses, and are usually referred for simpler procedures.
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Affiliation(s)
- Asaf Israeli
- Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Keren Hod
- Department of Academy and Research, Assuta Medical Center, Tel-Aviv, Israel
| | - Eedy Mezer
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
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14
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Including mental health care in a model of European health system. Epidemiol Psychiatr Sci 2023; 32:e12. [PMID: 36803918 PMCID: PMC9971856 DOI: 10.1017/s2045796023000057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
The management of a health system is a matter of economics and business administration because of the costs induced by goods and services delivered. Economics teaches us that the positive effects induced by competition in free markets cannot be expected in health care, which is a classic example of market failure from both demand and supply sides. The most sensible key concepts to refer for managing a health system are funding and provision. While the logical solution for the first variable is universal coverage through general taxation, the second one requires a deeper understanding. Integrated care is the modern approach that better supports the choice in favour of the public sector also for service provision. A major threat against this approach is dual practice legally allowed for health professionals, which inevitably raises financial conflicts of interest. An exclusive contract of employment for civil servants should be the sine qua non for providing public services effectively and efficiently. Integrated care is particularly important for long-term chronic illnesses associated with high levels of disability, such as neurodegenerative diseases and mental disorders, where the mix of health and social services needed can be very complex. Nowadays the growing number of community-dwelling patients with multiple physical and mental health needs is the major challenge for the European health systems. This happens also in public health systems, which should provide universal health coverage in principle, and the case of mental disorders is striking. In the light of this theoretical exercise, we strongly believe that a public National Health and Social Service should be the most indicated model for both funding and providing health and social care in modern societies. The big challenge of the common model of European health system here envisaged would be to limit the negative influences of politics and bureaucracy.
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Xue Q, Xu DR, Cheng TC, Pan J, Yip W. The relationship between hospital ownership, in-hospital mortality, and medical expenses: an analysis of three common conditions in China. Arch Public Health 2023; 81:19. [PMID: 36765426 PMCID: PMC9911958 DOI: 10.1186/s13690-023-01029-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 01/21/2023] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND Private hospitals expanded rapidly in China since 2009 following its national health reform encouraging private investment in the hospital sector. Despite long-standing debates over the performance of different types of hospitals, empirical evidence under the context of developing countries remains scant. We investigated the disparities in health care quality and medical expenses among public, private not-for-profit, and private for-profit hospitals. METHODS A total of 64,171 inpatients (51,933 for pneumonia (PNA), 9,022 for heart failure (HF) and 3,216 for acute myocardial infarction (AMI)) who were admitted to 528 secondary hospitals in Sichuan province, China, during the fourth quarters of 2016, 2017, and 2018 were selected for this study. Multilevel logistic regressions and multilevel linear regressions were utilized to assess the relationship between hospital ownership types and in-hospital mortality, as well as medical expenses for PNA, HF, and AMI, after adjusting for relevant hospital and patient characteristics, respectively. RESULTS The private not-for-profit (adjusted OR, 1.69; 95% CI, 1.08, 2.64) and for-profit (adjusted OR, 1.67; 95% CI, 1.06, 2.62) hospitals showed higher in-hospital mortality than the public ones for PNA, but not for AMI and HF. No significant differences were found in medical expenses across hospital ownership types for AMI, but the private not-for-profit was associated with 9% higher medical expenses for treating HF, while private not-for-profit and for-profit hospitals were associated with 10% and 11% higher medical expenses for treating PNA than the public hospitals. No differences were found between the private not-for-profit and private for-profit hospitals both in in-hospital mortality and medical expenses across the three conditions. CONCLUSION The public hospitals had at least equal or even higher healthcare quality and lower medical expenses than the private ones in China, while private not-for-profit and for-profit hospitals had similar performances in these aspects. Our results added evidences on hospitals' performances among different ownership types under China's context, which has great potential to inform the optimization of healthcare systems implemented among developing countries confronted with similar challenges.
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Affiliation(s)
- Qingping Xue
- grid.413856.d0000 0004 1799 3643School of Public Health, Chengdu Medical College, Chengdu, China ,grid.13291.380000 0001 0807 1581Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, China
| | - Dong Roman Xu
- grid.284723.80000 0000 8877 7471Center for World Health Organization Studies and Department of Health Management, School of Health Management of Southern Medical University, Guangzhou, China ,grid.284723.80000 0000 8877 7471Acacia Lab for Implementation Research, SMU Institute for Global Health (SIGHT), Dermatology Hospital of Southern Medical University (SMU), Guangzhou, China
| | - Terence C. Cheng
- grid.38142.3c000000041936754XHarvard TH Chan School of Public Health, Boston, USA
| | - Jay Pan
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China. .,School of Public Administration, Sichuan University, Chengdu, China.
| | - Winnie Yip
- grid.38142.3c000000041936754XHarvard TH Chan School of Public Health, Boston, USA
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16
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Pedersen ERG, Sudzina F. Relationship between citizens' perspective on digital health and underlying health risks. Digit Health 2023; 9:20552076231191045. [PMID: 37529542 PMCID: PMC10387710 DOI: 10.1177/20552076231191045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/13/2023] [Indexed: 08/03/2023] Open
Abstract
Objective Digital health has been gaining widespread attention but has not been fully integrated into the existing healthcare system. However, it remains unclear whether the new digital health solutions align with users' needs and wants. This study examines how citizens perceive the functionalities of digital health and how different health risks influence their perception. Methods Using an online survey, data are collected from over 4000 Danish citizens. The data are analysed using linear regression models. Results The results show how users' perceptions of digital health differ significantly. Users are highly interested in data sharing across different healthcare stakeholders but less interested in online health communities. The results also show that the support for digital health is correlated with various health risks, including age, smoking and social network. However, health risks do not have uniform relationship with the perceived value of digital health. Conclusions While developing and implementing new digital health solutions, it is important to consider the perceptions of people who are expected to benefit from such solutions. This study contributes to the literature by deepening the knowledge of how citizens with different risk profiles perceive the multitude of digital health tools being introduced in the healthcare sector.
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17
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Danielsen E, Gulati S, Salvesen Ø, Ingebrigtsen T, Nygaard ØP, Solberg TK. Clinical outcomes after surgery for cervical radiculopathy performed in public and private hospitals : a nationwide relative effectiveness study. Bone Joint J 2023; 105-B:64-71. [PMID: 36587250 PMCID: PMC9948431 DOI: 10.1302/0301-620x.105b1.bjj-2022-0591.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AIMS The number of patients undergoing surgery for degenerative cervical radiculopathy has increased. In many countries, public hospitals have limited capacity. This has resulted in long waiting times for elective treatment and a need for supplementary private healthcare. It is uncertain whether the management of patients and the outcome of treatment are equivalent in public and private hospitals. The aim of this study was to compare the management and patient-reported outcomes among patients who underwent surgery for degenerative cervical radiculopathy in public and private hospitals in Norway, and to assess whether the effectiveness of the treatment was equivalent. METHODS This was a comparative study using prospectively collected data from the Norwegian Registry for Spine Surgery. A total of 4,750 consecutive patients who underwent surgery for degenerative cervical radiculopathy and were followed for 12 months were included. Case-mix adjustment between those managed in public and private hospitals was performed using propensity score matching. The primary outcome measure was the change in the Neck Disability Index (NDI) between baseline and 12 months postoperatively. A mean difference in improvement of the NDI score between public and private hospitals of ≤ 15 points was considered equivalent. Secondary outcome measures were a numerical rating scale for neck and arm pain and the EuroQol five-dimension three-level health questionnaire. The duration of surgery, length of hospital stay, and complications were also recorded. RESULTS The mean improvement from baseline to 12 months postoperatively of patients who underwent surgery in public and private hospitals was equivalent, both in the unmatched cohort (mean NDI difference between groups 3.9 points (95% confidence interval (CI) 2.2 to 5.6); p < 0.001) and in the matched cohort (4.0 points (95% CI 2.3 to 5.7); p < 0.001). Secondary outcomes showed similar results. The duration of surgery and length of hospital stay were significantly longer in public hospitals. Those treated in private hospitals reported significantly fewer complications in the unmatched cohort, but not in the matched cohort. CONCLUSION The clinical effectiveness of surgery for degenerative cervical radiculopathy performed in public and private hospitals was equivalent 12 months after surgery.Cite this article: Bone Joint J 2023;105-B(1):64-71.
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Affiliation(s)
- Elisabet Danielsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway,Correspondence should be sent to Elisabet Danielsen. E-mail:
| | - Sasha Gulati
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway,National Advisory Unit on Spinal Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Øyvind Salvesen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tor Ingebrigtsen
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway,Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of North Norway, Tromsø, Norway,Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Øystein P. Nygaard
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway,National Advisory Unit on Spinal Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Tore K. Solberg
- Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway,Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of North Norway, Tromsø, Norway
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18
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Lazzerini M, Valente EP, Covi B, Rozée V, Costa R, Otelea MR, Abderhalden-Zellweger A, Węgrzynowska M, Linden K, Arendt M, Brigidi S, Miani C, Pumpure E, Radetic J, Drandic D, Cerimagic A, Nedberg IH, Liepinaitienė A, Rodrigues C, de Labrusse C, Baranowska B, Zaigham M, Castañeda LM, Batram-Zantvoort S, Jakovicka D, Ruzicic J, Juciūtė S, Santos T, Gemperle M, Tataj-Puzyna U, Elden H, Mizgaitienė M, Lincetto O, Sacks E, Mariani I. Rates of instrumental vaginal birth and cesarean and quality of maternal and newborn health care in private versus public facilities: Results of the IMAgiNE EURO study in 16 countries. Int J Gynaecol Obstet 2022; 159 Suppl 1:22-38. [PMID: 36530007 PMCID: PMC10108180 DOI: 10.1002/ijgo.14458] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To explore the quality of maternal and newborn care (QMNC) during the COVID-19 pandemic by facility type among 16 European countries, comparing rates of instrumental vaginal birth and cesarean. METHODS Women who gave birth in the WHO European Region from March 1, 2020, to February 7, 2022, answered a validated online questionnaire. Rates of instrumental birth, instrumental vaginal birth, and cesarean, and a QMNC index were calculated for births in public versus private facilities. RESULTS Responses from 25 206 participants were analyzed. Women giving birth in private compared with public facilities reported significantly more frequent total cesarean (32.5% vs 19.0%; aOR 1.70; 95% CI 1.52-1.90), elective cesarean (17.3% vs 7.8%; aOR 1.90; 95% CI 1.65-2.19), and emergency cesarean before labor (7.4% vs 3.9%; aOR 1.39; 95% CI 1.14-1.70) (P < 0.001 for all comparisons), with analyses by country confirming these results. QMNC index results were heterogeneous across countries and regions in the same country and were largely affected by geographical distribution of regions rather than by type of facility alone. CONCLUSION The study confirms that births in private facilities have higher odds of cesarean. It also suggests that QMNC should be closely monitored in all facilities to achieve high-quality care, independent of facility type or geographical distribution. CLINICALTRIALS GOV IDENTIFIER NCT04847336.
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Affiliation(s)
- Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Emanuelle Pessa Valente
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Benedetta Covi
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Virginie Rozée
- Sexual and Reproductive Health and Rights Research Unit, Institut National d'Études Démographiques (INED), Paris, France
| | - Raquel Costa
- Epidemiology Research Unit (EPIUnit), Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal.,Lusófona University/HEI-Lab: Digital Human-environment Interaction Labs, Lisbon, Portugal
| | - Marina Ruxandra Otelea
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.,SAMAS Association, Bucharest, Romania
| | - Alessia Abderhalden-Zellweger
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Maria Węgrzynowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Karolina Linden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maryse Arendt
- Beruffsverband vun de Laktatiounsberoderinnen zu Lëtzebuerg asbl (Professional Association of Lactation Consultants in Luxembourg), Luxembourg, Luxembourg
| | - Serena Brigidi
- Department of Anthropology, Philosophy and Social Work, Medical Anthropology Research Center (MARC), Rovira i Virgili University (URV), Tarragona, Spain
| | - Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Elizabete Pumpure
- Department of Obstetrics and Gynecology, Riga Stradins University, Rīga, Latvia.,Riga Maternity Hospital, Rīga, Latvia
| | | | | | | | | | | | - Carina Rodrigues
- Epidemiology Research Unit (EPIUnit), Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Claire de Labrusse
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Mehreen Zaigham
- Department of Obstetrics and Gynecology, Institution of Clinical Sciences Lund, Lund University, Lund and Skåne University Hospital, Malmö, Sweden
| | | | - Stephanie Batram-Zantvoort
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | | | | | - Simona Juciūtė
- Kaunas University of Applied Sciences, Kaunas, Lithuania
| | - Teresa Santos
- Universidade Europeia, Lisbon, Portugal.,Plataforma CatólicaMed/Centro de Investigação Interdisciplinar em Saúde (CIIS) da Universidade Católica Portuguesa, Lisbon, Portugal
| | - Michael Gemperle
- Research Institute of Midwifery, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Urszula Tataj-Puzyna
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Helen Elden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marija Mizgaitienė
- Kaunas Hospital of the Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ornella Lincetto
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Emma Sacks
- Department of International Health, Johns Hopkins University, Baltimore, Massachusetts, USA
| | - Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
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Kenny C, Regan J, Balding L, Higgins S, O'Leary N, Kelleher F, McDermott R, Armstrong J, Mihai A, Tiernan E, Westrup J, Thirion P, Walsh D. Dysphagia in Solid Tumors Outside the Head, Neck or Upper GI Tract: Clinical Characteristics. J Pain Symptom Manage 2022; 64:546-554. [PMID: 36058400 DOI: 10.1016/j.jpainsymman.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 01/04/2023]
Abstract
CONTEXT Dysphagia is common in cancer, but underlying pathophysiology and manifestations within patients are unknown. OBJECTIVES To examine dysphagia characteristics in those with solid malignancies outside the head, neck and upper gastrointestinal tract. METHODS Seventy-three individuals with dysphagia (46 male, 27 female, aged 37-91) were recruited from a parent trial conducted in two acute hospitals and one hospice. Cranial nerve function, Oral Health Assessment Tool (OHAT), Mann Assessment of Swallowing Ability (MASA) and Functional Oral Intake Scale (FOIS) evaluated swallow profile. RESULTS Only 9/73 (12%) had documented dysphagia prior to study enrollment. MASA risk ratings found n=61/73 (84%) with dysphagia risk and n=22/73 (30%) with aspiration risk. Food texture modification was required for n=34/73 (47%), fluid texture modification for n=1/73 (1%). Compensatory strategies for food were needed by n=13/73 (18%) and for fluids by n=24/73 (33%). Cranial nerve deficits were present in n=43/73 (59%). Oral health problems were common, with xerostomia in two-thirds. Worse dysphagia on MASA was associated with disease progression, affecting hospice, and palliative care the most. Worse performance status was indicative of poorer MASA raw score (P<0.001, OR 2.2, 95% CI 1.5-3.4), greater risk of aspiration (P=0.005, OR 2.1, 95% CI 1.3-3.6) and lower FOIS (P=0.004, OR 2.0, 95% CI 1.2-3.2). CONCLUSION Dysphagia management in those with cancer requires robust assessment to uncover clinically important needs like food texture modification and safe swallowing advice. Better assessment tools should be developed for this purpose. Oral health problems should be routinely screened in this population since they exacerbate dysphagia.
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Affiliation(s)
- Ciarán Kenny
- Department of Clinical Speech and Language Studies (C.K., J.R.), Trinity College Dublin, Ireland; Academic Department of Palliative Medicine (C.K., D.W.), Our Lady's Hospice & Care Services, Ireland; School of Medicine (C.K., D.W.), Trinity College Dublin, Ireland.
| | - Julie Regan
- Department of Clinical Speech and Language Studies (C.K., J.R.), Trinity College Dublin, Ireland
| | - Lucy Balding
- Department of Palliative Medicine (L.B., S.H., N.O.), Our Lady's Hospice & Care Services, Ireland
| | - Stephen Higgins
- Department of Palliative Medicine (L.B., S.H., N.O.), Our Lady's Hospice & Care Services, Ireland
| | - Norma O'Leary
- Department of Palliative Medicine (L.B., S.H., N.O.), Our Lady's Hospice & Care Services, Ireland
| | | | - Ray McDermott
- Tallaght University Hospital (F.K., R.M.), Ireland; Beacon Hospital (R.M., J.A., A.M., E.T., J.W., P.T.), Ireland
| | - John Armstrong
- Beacon Hospital (R.M., J.A., A.M., E.T., J.W., P.T.), Ireland
| | - Alina Mihai
- Beacon Hospital (R.M., J.A., A.M., E.T., J.W., P.T.), Ireland
| | - Eoin Tiernan
- Beacon Hospital (R.M., J.A., A.M., E.T., J.W., P.T.), Ireland
| | | | - Pierre Thirion
- Beacon Hospital (R.M., J.A., A.M., E.T., J.W., P.T.), Ireland
| | - Declan Walsh
- Academic Department of Palliative Medicine (C.K., D.W.), Our Lady's Hospice & Care Services, Ireland; School of Medicine (C.K., D.W.), Trinity College Dublin, Ireland; Department of Supportive Oncology (D.W.), Levine Cancer Institute, Atrium Health, North Carolina, USA
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20
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Hamroun A, Speyer E, Ayav C, Combe C, Fouque D, Jacquelinet C, Laville M, Liabeuf S, Massy ZA, Pecoits-Filho R, Robinson BM, Glowacki F, Stengel B, Frimat L. Barriers to conservative care from patients' and nephrologists' perspectives: the CKD-REIN study. Nephrol Dial Transplant 2022; 37:2438-2448. [PMID: 35026014 DOI: 10.1093/ndt/gfac009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Conservative care is increasingly considered an alternative to kidney replacement therapy for kidney failure management, mostly among the elderly. We investigated its status and the barriers to its implementation from patients' and providers' perspectives. METHODS We analysed data from 1204 patients with advanced chronic kidney disease (CKD) [estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2] enrolled at 40 nationally representative nephrology clinics (2013-16) who completed a self-administered questionnaire about the information they received and their preferred treatment option, including conservative care, if their kidneys failed. Nephrologists (n = 137) also reported data about their clinics' resources and practices regarding conservative care. RESULTS All participating facilities reported they were routinely able to offer conservative care, but only 37% had written protocols and only 5% had a person or team primarily responsible for it. Overall, 6% of patients were estimated to use conservative care. Among nephrologists, 82% reported they were fairly or extremely comfortable discussing conservative care, but only 28% usually or always offered this option for older (>75 years) patients approaching kidney failure. They used various terminology for this care, with conservative management and non-dialysis care mentioned most often. Among patients, 5% of those >75 years reported receiving information about this option and 2% preferring it. CONCLUSIONS Although reported by nephrologists to be widely available and easily discussed, conservative care is only occasionally offered to older patients, most of whom report they were not informed of this option. The lack of a person or team responsible for conservative care and unclear information appear to be key barriers to its implementation.
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Affiliation(s)
- Aghilès Hamroun
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe Epidémiologie Clinique, CESP, Villejuif, France.,Lille University, University Hospital of Lille, Nephrology Department, Lille, France
| | - Elodie Speyer
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe Epidémiologie Clinique, CESP, Villejuif, France
| | - Carole Ayav
- CHRU-Nancy, INSERM, CIC 1433, Epidémiologie Clinique, Nancy, France
| | - Christian Combe
- Service de Néphrologie Transplantation Dialyse Aphérèse, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.,Inserm U1026, Université de Bordeaux, Bordeaux, France
| | - Denis Fouque
- Service de Néphrologie, Centre Hospitalier Lyon Sud, Pierre-Bénite, France.,Université Claude Bernard Lyon 1, Carmen INSERM U1060, Pierre-Bénite, France
| | | | - Maurice Laville
- Université Claude Bernard Lyon 1, Carmen INSERM U1060, Pierre-Bénite, France
| | - Sophie Liabeuf
- Service de Pharmacologie Clinique, Département de recherche clinique CHU Amiens-Picardie, Amiens, France.,Laboratoire MP3CV, EA7517, Université de Picardie Jules Verne, Amiens, France
| | - Ziad A Massy
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe Epidémiologie Clinique, CESP, Villejuif, France.,Service de néphrologie, Hôpital Ambroise Paré, AP-HP, Boulogne-Billancourt, France
| | | | | | - François Glowacki
- Lille University, University Hospital of Lille, Nephrology Department, Lille, France
| | - Bénédicte Stengel
- Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm, Équipe Epidémiologie Clinique, CESP, Villejuif, France
| | - Luc Frimat
- Service de Néphrologie, CHRU de Nancy, Vandoeuvre-lès-Nancy, France.,Université de Lorraine, APEMAC, Nancy, France
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21
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von Schudnat C, Lahmann B, Schoeneberg KP, Albors-Garrigos J, De-Miguel-Molina M. Impact of a digitized workflow for knee endoprothesis implantations on hospital-specific ratios. Technol Health Care 2022; 31:955-968. [PMID: 36442162 DOI: 10.3233/thc-220395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND: The continuous decrease of healthcare resources requires hospitals to improve efficiency while striving to improve quality standards that deliver better patient outcomes. OBJECTIVE: The objective of this study was to analyze whether the implementation of digital support systems during orthopedic surgery positively affected clinical processes and quality ratios. METHODS: A retrospective case-control study of 297 knee joint replacement procedures was conducted between 2015 and 2020. Thirty-five patients were allocated to the treatment and control groups after they were identified with exact matching and estimation of the propensity score. Both groups were balanced regarding the selected covariates. The effect of the surgical procedure manager (SPM) on the incidence of acute haemorrhagic anaemia between the two groups was evaluated with a t-test, and the odds ratio was calculated. RESULTS: SPM-supported surgery has no significant influence on the incidence of acute haemorrhagic anaemia but leads to significantly shorter hospital stay (1.93 days), changeover (4.14 minutes) and recovery room time (20.20 minutes). In addition, it reduces the standard deviation of operation room times. CONCLUSIONS: The study concludes that SPM enhances surgical efficiency and maintains quality outcomes. To overcome their increasing financial pressure hospital management should commercially evaluate the implementation of digital support systems.
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Affiliation(s)
- Christian von Schudnat
- Department of Business Organization, Faculty of Business Management, Universitat Politecnica de Valencia, Valencia, Spain
| | - Benjamin Lahmann
- Department of Statistics and Operation Analysis, Faculty of Business and Economics, Mendel University in Brno, Brno, Czech Republic
| | - Klaus-Peter Schoeneberg
- Department of Economic and Social Sciences, Berliner Hochschule für Technik, Berlin, Germany
| | - Jose Albors-Garrigos
- Department of Business Organization, Faculty of Business Management, Universitat Politecnica de Valencia, Valencia, Spain
| | - María De-Miguel-Molina
- Department of Business Organization, Faculty of Business Management, Universitat Politecnica de Valencia, Valencia, Spain
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22
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Exploring differences between public and private providers in primary care: findings from a large Swedish region. HEALTH ECONOMICS, POLICY AND LAW 2022:1-15. [DOI: 10.1017/s1744133122000251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
This study contributes to the sparse literature on differences between public and private primary care practices (PCCs). The purpose was to explore if differences in performance and characteristics between public and PCCs persist over time in a welfare market with patient choice and provider competition, where public and private providers operate under similar conditions. The analysis is based on data from a national patient survey and administrative registries in a large Swedish region, covering PCC observations in 2010 and 2019, i.e., the year after and 10 years after introducing choice and competition in the region. The findings suggest that differences across owner types tend to decrease over time in welfare markets. Differences in patients' experiences, PCC size, patient mix and the division of labour have decreased or disappeared between 2010 and 2019. There were small but significant differences in process measures of quality in 2019; public PCCs complied better with prescription guidelines. While the results demonstrate a convergence between public and private PCCs in regards to their characteristics and performance, differences in patients' experiences in regards to socioeconomic conditions persisted. Such unwarranted variation calls for continued attention from policy makers and further research about causes.
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23
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Danielsen E, Mjåset C, Ingebrigtsen T, Gulati S, Grotle M, Rudolfsen JH, Nygaard ØP, Solberg TK. A nationwide study of patients operated for cervical degenerative disorders in public and private hospitals. Sci Rep 2022; 12:12856. [PMID: 35896806 PMCID: PMC9329342 DOI: 10.1038/s41598-022-17194-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 07/21/2022] [Indexed: 11/16/2022] Open
Abstract
During the last decades, there has been an increase in the rate of surgery for degenerative disorders of the cervical spine and in the use of supplementary private health insurance. Still, there is limited knowledge about the differences in characteristics of patients operated in public and private hospitals. Therefore, we aimed at comparing sociodemographic-, clinical- and patient management data on patients operated for degenerative cervical radiculopathy and degenerative cervical myelopathy in public and private hospitals in Norway. This was a cross-sectional study on patients in the Norwegian Registry for Spine Surgery operated for degenerative cervical radiculopathy and degenerative cervical myelopathy between January 2012 and December 2020. At admission for surgery, we assessed disability by the following patient reported outcome measures (PROMs): neck disability index (NDI), EuroQol-5D (EQ-5D) and numerical rating scales for neck pain (NRS-NP) and arm pain (NRS-AP). Among 9161 patients, 7344 (80.2%) procedures were performed in public hospitals and 1817 (19.8%) in private hospitals. Mean age was 52.1 years in public hospitals and 49.7 years in private hospitals (P < 0.001). More women were operated in public hospitals (47.9%) than in private hospitals (31.6%) (P < 0.001). A larger proportion of patients in private hospitals had high education (≥ 4 years of college or university) (42.9% vs 35.6%, P < 0.001). Patients in public hospitals had worse disease-specific health problems than those in private hospitals: unadjusted NDI mean difference was 5.2 (95% CI 4.4 – 6.0; P < 0.001) and adjusted NDI mean difference was 3.4 (95% CI 2.5 – 4.2; P < 0.001), and they also had longer duration of symptoms (P < 0.001). Duration of surgery (mean difference 29 minutes, 95% CI 27.1 – 30.7; P < 0.001) and length of hospital stay (mean difference 2 days, 95% CI 2.3 – 2.4; P < 0.001) were longer in public hospitals. In conclusion, patients operated for degenerative cervical spine in private hospitals were healthier, younger, better educated and more often men. They also had less and shorter duration of symptoms and seemed to be managed more efficiently. Our findings indicate that access to cervical spine surgery in private hospitals could be skewed in favour of patients with higher socioeconomic status.
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Affiliation(s)
- Elisabet Danielsen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
| | | | - Tor Ingebrigtsen
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of North Norway, Tromsø, Norway.,Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Sasha Gulati
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Margreth Grotle
- Centre for Intelligent Musculoskeletal Health, Faculty of Health Science, Oslo Metropolitan University, Oslo, Norway.,Communication Unit for Musculoskeletal Disorders (FORMI), Oslo University Hospital, Oslo, Norway
| | - Jan Håkon Rudolfsen
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Øystein P Nygaard
- Department of Neurosurgery, St. Olavs Hospital, Trondheim, Norway.,Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.,National Advisory Unit on Spinal Surgery, St. Olavs Hospital, Trondheim, Norway
| | - Tore K Solberg
- Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Neurosurgery and the Norwegian Registry for Spine Surgery (NORspine), University Hospital of North Norway, Tromsø, Norway
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24
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de Guzman AB, de Castro BV, Laguilles-Villafuerte S, Clemente-Faustino JA, Serrano JO, Angcahan DZ. Portrait of Filipino healthcare workers' discrimination experiences during the early part of the COVID-19 pandemic. J Med Imaging Radiat Sci 2022; 53:396-403. [PMID: 35753993 PMCID: PMC9189115 DOI: 10.1016/j.jmir.2022.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/27/2022] [Accepted: 06/07/2022] [Indexed: 12/16/2022]
Abstract
Background At the core of a global health crisis, healthcare workers are tasked to perform crucial and life-threatening roles. Despite the heavy-laden responsibilities amid COVID-19 pandemic, these workers are subjected to various forms of stigma and discrimination. Objectives The primary intent of this paper is to investigate the existence of discrimination among healthcare workers during COVID-19 pandemic in the Philippines. Further, it aims to test the following hypotheses: (1) Discrimination experiences among Filipino healthcare workers are dependent on certain demographic characteristics; and (2) Discrimination experiences vary significantly according to the type of healthcare workers. Methods This exploratory study used a two-part survey questionnaire consisting of the baseline data of the respondents and an 8-point Likert-type scale to identify the different forms of discrimination experienced by Filipino healthcare workers. Data yielded by the instruments were descriptively (frequency, mean and percentage) and inferentially (Pearson R, Kendall tau, t-test, and One-Way Analysis of Variance) treated. Results Among the Filipino healthcare workers, the Radiologic Technologists experienced the most forms of discriminatory acts, followed by Nurses and Medical Technologists. Those who work in high-risk duty assignments experienced the most discriminatory incidents such as insulting gestures and physical/social loathing, social media bashing and offensive jokes. Conclusion The discrimination experienced by Filipino healthcare workers is a valuable platform for health policy interventions at the local and global levels to safeguard the physical, social and psychological well-being of healthcare workers, especially in battling the COVID-19 pandemic.
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Affiliation(s)
- Allan B de Guzman
- The Graduate School, University of Santo Tomas, Philippines; Research Center for Social Sciences and Education, University of Santo Tomas, 2/F Thomas Aquinas Research Complex, Espana, Boulevard, Manila 1015, Philippines; College of Tourism and Hospitality Management, University of Santo Tomas, Philippines.
| | - Belinda V de Castro
- The Graduate School, University of Santo Tomas, Philippines; Research Center for Social Sciences and Education, University of Santo Tomas, 2/F Thomas Aquinas Research Complex, Espana, Boulevard, Manila 1015, Philippines; College of Commerce and Business Administration, University of Santo Tomas, Philippines
| | | | - Julie Ann Clemente-Faustino
- The Graduate School, University of Santo Tomas, Philippines; College of Social Sciences and Philosophy, Bulacan State University, Philippines
| | - Jennifer O Serrano
- The Graduate School, University of Santo Tomas, Philippines; Quirino State University-Cabarroguis, Philippines
| | - Darwin Z Angcahan
- The Graduate School, University of Santo Tomas, Philippines; Rizal Medical Center, Pasig, Philippines
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25
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Al-Hanawi MK, Makuta IF. Changes in productivity in healthcare services in the Kingdom of Saudi Arabia. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2022; 20:3. [PMID: 35078512 PMCID: PMC8788065 DOI: 10.1186/s12962-022-00338-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 01/12/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Amid the rising demand for healthcare services in Saudi Arabia, there is a need to monitor, evaluate, and improve performance in the delivery of these services. In this regard, the aim of this study was to estimate changes in total factor productivity (TFP) in healthcare services across the health system administrative regions in Saudi Arabia from 2006 to 2018. The contributions of changes in efficiency and technology to the observed changes in TFP were further evaluated. METHODS The data used for this study were extracted from annual Ministry of Health Statistical Yearbooks for the period of 2006-2018. TFP changes were estimated using the Malmquist Productivity Index, in which technology frontiers were constructed through data envelopment analysis. The changes in TFP were decomposed into changes in technology, changes in pure technical efficiency, and changes in scale efficiency following the Färe-Grosskopf-Norris-Zhang method. As robustness checks, we used bootstrapping to construct intervals and applied alternative decomposition methods. The changes in TFP and its sources were also compared between public and private hospitals. RESULTS Over the period from 2006 to 2018, TFP for healthcare services has decreased on average by 5.6% per year solely on account of a technical regress. Public hospitals registered a higher deterioration in productivity (6.0% per year) than private hospitals (4.8% per year). CONCLUSION Using the available resources, there is potential for realising gains in productivity of healthcare services by addressing existing technological challenges. Since the decline in TFP is entirely a problem of technical regress, the primary solution should focus on strategies for achieving technical progress (innovation) through investment in more or better machinery, equipment, and structures for healthcare service provision.
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Affiliation(s)
- Mohammed Khaled Al-Hanawi
- Department of Health Services and Hospital Administration, Faculty of Economics and Administration, King Abdulaziz University, Jeddah, Saudi Arabia.
- Health Economics Research Group, King Abdulaziz University, Jeddah, Saudi Arabia.
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26
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Adewole DA, Reid S, Oni T, Adebowale AS. Factors Influencing Satisfaction with Service Delivery Among National Health Insurance Scheme Enrollees in Ibadan, Southwest Nigeria. J Patient Exp 2022; 9:23743735221074186. [PMID: 35097189 PMCID: PMC8793442 DOI: 10.1177/23743735221074186] [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] [Indexed: 11/30/2022] Open
Abstract
Perceived quality of care is a determinant of uptake of health services. This study aimed to assess the determinants of quality of care of enrollees in the National Health Insurance Scheme (NHIS) in Nigeria. The outcome was satisfaction with health care services, which was used as a proxy for quality. Findings will assist in the intervention to enhance enrollment in the scheme and for universal health coverage attainment. This was a descriptive cross-sectional study conducted among enrollees in selected NHIS facilities in Ibadan, Nigeria. Data on satisfaction with health care were collected among selected 432 enrollees with the aid of an adapted semi-structured WHO-USAID interviewer-administered questionnaire. Data were analyzed using chi-square and multiple logistic regression models (α = 0.05). Among predictors of satisfaction with health services were younger age (OR = 1.85, 95% CI = 1.05–3.25, p = .024), working in the private sector (OR = 1.84, 95% CI = 1.03–3.28, p = .022), and seeking information about quality of services prior enrollment (OR = 1.63, 95% CI = 1.04−2.53, p = .013). Targeted intervention based on the findings of this study should be implemented to improve satisfaction with the services offered.
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Affiliation(s)
- David Ayobami Adewole
- Department of Health Policy and Management, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Steve Reid
- Primary Health Care Directorate, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Tolu Oni
- Medical Research Council Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Ayo Stephen Adebowale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
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27
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Zhu X, Du Y, He W, Dai J, Chen M, Yao P, Chen H, Ren H, Fang Y, Tan S, Lu Y. Ophthalmic services in Shanghai 2017: a cataract-centric city-wide government survey. BMC Health Serv Res 2021; 21:1043. [PMID: 34600508 PMCID: PMC8487503 DOI: 10.1186/s12913-021-07048-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 09/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background Demand for eye care has increased in recent decades in China due to rapid socioeconomic development and demographic shift. Knowledge of output and productivity of ophthalmic services would allow policymakers to optimize resource allocation, and is therefore essential. This study sought to map the landscape of ophthalmic services available in Shanghai, China. Methods In 2018, a government-led survey was conducted of all 86 tertiary/secondary hospitals and five major private hospitals providing eye care in Shanghai in the form of electronic questionnaire, which encompassed ophthalmic services (outpatient and emergency room [ER] visit, inpatient admissions, and surgical volume) and service productivity in terms of annual outpatient and ER visits per doctor, inpatient admissions per bed, and surgical volume per doctor. Comparisons were made among different levels of hospitals with categorical variables tested by Chi-square analysis. Results The response rate was 85.7%. The Eye and Ear, Nose, and Throat (EENT) Hospital was the largest tertiary specialty hospital, and alone contributed to the highest 21.0% of annual ophthalmic outpatient and ER visits (visits per doctor: 5460), compared with other 26 tertiary hospitals, 46 secondary hospitals and five private hospitals (visits per doctor: 3683, 4651 and 1876). The annual inpatient admission was 20,103, 56,992, 14,090, and 52,047 for the EENT Hospital, all the other tertiary hospitals, secondary hospitals and five private hospitals, respectively. Turnover rates were highest for the EENT Hospital and private hospitals. The average surgical volume at the EENT Hospital was 72,666, exceeding that of private (15,874.8) and other tertiary hospitals (3366.7). The EENT Hospital and private hospitals performed 16,982 (14.2%) and 55,538 (46.6%) of all cataract surgeries. Proportions of both complicated cataractous cases and complicated cataract surgeries at the EENT Hospital was the highest, followed by other tertiary and secondary/private hospitals (P < 0.0001). Conclusions In Shanghai, public providers dominate ophthalmic services especially for complicated cases, with almost one fifth of services provided by the EENT Hospital alone, while private sectors, though not large in number, still effectively help meet large proportions of eye care demand. Optimization of hierarchical medical system is warranted to improve the efficiency and standardization of ophthalmic services. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07048-1.
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Affiliation(s)
- Xiangjia Zhu
- Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University; Key Laboratory of Myopia, Ministry of Health; Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University; Key NHC key Laboratory of Myopia, Fudan University; Chinese Academy of Medical Sciences, 83 Fenyang Road, Shanghai, 200031, China.,Shanghai Medical Quality Control Management Center, 1477 West Beijing Road, Shanghai, 200040, China
| | - Yu Du
- Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University; Key Laboratory of Myopia, Ministry of Health; Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University; Key NHC key Laboratory of Myopia, Fudan University; Chinese Academy of Medical Sciences, 83 Fenyang Road, Shanghai, 200031, China
| | - Wenwen He
- Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University; Key Laboratory of Myopia, Ministry of Health; Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University; Key NHC key Laboratory of Myopia, Fudan University; Chinese Academy of Medical Sciences, 83 Fenyang Road, Shanghai, 200031, China
| | - Jinhui Dai
- Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University; Key Laboratory of Myopia, Ministry of Health; Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University; Key NHC key Laboratory of Myopia, Fudan University; Chinese Academy of Medical Sciences, 83 Fenyang Road, Shanghai, 200031, China
| | - Minjie Chen
- Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University; Key Laboratory of Myopia, Ministry of Health; Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University; Key NHC key Laboratory of Myopia, Fudan University; Chinese Academy of Medical Sciences, 83 Fenyang Road, Shanghai, 200031, China
| | - Peijun Yao
- Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University; Key Laboratory of Myopia, Ministry of Health; Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University; Key NHC key Laboratory of Myopia, Fudan University; Chinese Academy of Medical Sciences, 83 Fenyang Road, Shanghai, 200031, China
| | - Han Chen
- Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University; Key Laboratory of Myopia, Ministry of Health; Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University; Key NHC key Laboratory of Myopia, Fudan University; Chinese Academy of Medical Sciences, 83 Fenyang Road, Shanghai, 200031, China
| | - Hui Ren
- Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University; Key Laboratory of Myopia, Ministry of Health; Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University; Key NHC key Laboratory of Myopia, Fudan University; Chinese Academy of Medical Sciences, 83 Fenyang Road, Shanghai, 200031, China
| | - Yuan Fang
- Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University; Key Laboratory of Myopia, Ministry of Health; Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University; Key NHC key Laboratory of Myopia, Fudan University; Chinese Academy of Medical Sciences, 83 Fenyang Road, Shanghai, 200031, China
| | - Shensheng Tan
- Shanghai Medical Quality Control Management Center, 1477 West Beijing Road, Shanghai, 200040, China
| | - Yi Lu
- Eye Institute of Eye and Ear, Nose, and Throat Hospital of Fudan University; Key Laboratory of Myopia, Ministry of Health; Key Laboratory of Visual Impairment and Restoration of Shanghai, Fudan University; Key NHC key Laboratory of Myopia, Fudan University; Chinese Academy of Medical Sciences, 83 Fenyang Road, Shanghai, 200031, China. .,Shanghai Medical Quality Control Management Center, 1477 West Beijing Road, Shanghai, 200040, China.
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Multilevel Zero-One Inflated Beta Regression Model for the Analysis of the Relationship between Exogenous Health Variables and Technical Efficiency in the Spanish National Health System Hospitals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910166. [PMID: 34639468 PMCID: PMC8508497 DOI: 10.3390/ijerph181910166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022]
Abstract
Background: This article proposes a methodological innovation in health economics for the second stage analysis of technical efficiency in hospitals. It investigates the relationship between the installed capacity in regions and hospitals and their ownership structure. Methods: A multilevel zero-one inflated beta regression model is employed to model pure technical efficiency more adequately than other models frequently used in econometrics. Results: Compared to publicly managed hospitals, the mean efficiency index of hospitals with public-private partnership (PPP) formulas was 4.27-fold. This figure was 1.90-fold for private hospitals. Concerning the efficiency frontier, the odds ratio (OR) of PPP models vs. public hospitals was 42.06. The OR of private hospitals vs. public hospitals was 8.17. A one standard deviation increase in the percentage of beds in intensive care units increases the odds of being situated on the efficiency frontier by 50%. Conclusions: The proportion of hospital beds in intensive care units relates to a higher chance of being on the efficiency frontier. Hospital ownership structure is related to the mean efficiency index of Spanish National Health Service hospitals, as well as the odds of being situated on the efficiency frontier.
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Pennestrì F, Gaudioso A, Jani A, Bottinelli E, Banfi G. Is administered competition suitable for dealing with a public health emergency? Lessons from the local healthcare system at the centre of early COVID-19 outbreak in Italy. Cent Eur J Public Health 2021; 29:109-116. [PMID: 34245550 DOI: 10.21101/cejph.a6533] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 03/23/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The Lombardy Region, Italy, was the most severely affected by the COVID-19 outbreak. In absence of effective treatments and with basic hygiene measures made mandatory, Lombardy response to COVID-19 relied on its healthcare system characteristics, the administered competition or "quasi-market" model. The aim of the study was to review the strengths and weaknesses of Lombardy's response during the first wave of the COVID-19 epidemic, to explore whether the healthcare model influenced crisis management and describe which policies could help to contain future outbreaks. The results are expected to provide similar healthcare systems with lessons to avoid mistakes and learn from best practice. METHODS Data for quantitative analyses on the performance of the Lombardy and Veneto Regions healthcare systems were derived from existing government sources including the Italian Civil Protection Agency and the Ministry of Health. RESULTS Lombardian quasi-market model, traditionally characterized by a strong hospital network, was held responsible for many suboptimal outcomes. According to critics, years of disinvestments in community care resulted in a hospital overload. However, the same model was responsible for other positive outcomes which have been substantially neglected, such as the opportunity to test for effective containment treatments in a safe environment and rapidly extend the number of beds. CONCLUSIONS The performance of a quasi-market model against public health emergencies largely depends on integration between policy-makers and balance between healthcare providers, which require clear regulation. Reducing institutional fragmentation between levels of governance, improving the coordination of healthcare facilities and adopting telemedicine technologies are means by which healthcare networks could strengthen their resilience against future outbreaks.
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Affiliation(s)
| | | | - Anant Jani
- Oxford Martin School, University of Oxford, Oxford, United Kingdom
| | | | - Giuseppe Banfi
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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Gabrani J, Schindler C, Wyss K. Perspectives of Public and Private Primary Healthcare Users in Two Regions of Albania on Non-Clinical Quality of Care. J Prim Care Community Health 2021; 11:2150132720970350. [PMID: 33243061 PMCID: PMC7705804 DOI: 10.1177/2150132720970350] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: Aiming to tackle the rise of non-communicable diseases and an ageing population, Albania is engaged in boosting primary healthcare services and quality of care. The patients’ perspectives on their experience with public and private providers are, however, missing, although their viewpoints are critical while shaping the developing services. Consequently, we analyze perceptions of users of primary healthcare as it relates to non-clinical quality of care and the association to sociodemographic characteristics of patients and the type of provider. Methods: A facility-based survey was conducted in 2018 using the World Health Organization responsiveness questionnaire which is based on a 4-point scale along with 8 non-clinical domains of quality of care. The data of 954 patients were analyzed through descriptive statistics and linear mixed regression models. Results: Similar mean values were reported on total scale of the quality of care for private and public providers, also after sociodemographic adjustments. The highest mean score was reported for the domain “communication” (3.75) followed by “dignity” (3.65), while the lowest mean scores were given for “choice” (2.89) and “prompt attention” (3.00). Urban governmental PHC services were rated significantly better than private outpatient clinics in “coordination of care” (2.90 vs 2.12, P < .001). In contrast, private outpatient clinics were judged significantly better than urban PHC clinics in “confidentiality” (3.77 vs 3.38, P = .04) and “quality of basic amenities” (3.70 vs 3.02, P < .001). “Autonomy” was reported as least important attribute of quality. Conclusion: While the perception of non-clinical care quality was found to be high and similar for public and private providers, promptness and coordination of care require attention to meet patient’s expectations on good quality of care. There is a need to raise the awareness on autonomy and the involvement of patients’ aspects concerning their health.
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Affiliation(s)
- Jonila Gabrani
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
| | | | - Kaspar Wyss
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Basel, Switzerland
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Ruiz-Mallorquí MV, Aguiar-Díaz I, González- López Valcárcel B. Arrangements with the NHS for providing healthcare services: do they improve financial performance of private for-profit hospitals in Spain? HEALTH ECONOMICS REVIEW 2021; 11:9. [PMID: 33689038 PMCID: PMC7944633 DOI: 10.1186/s13561-021-00304-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 02/02/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND In developed countries around the world there is a trend to enhance the public-private collaboration in healthcare. In Spain, a decentralized country with a NHS funded with taxes and universal coverage, commissioning to for-profit private hospitals the production of healthcare services to specific patients that are publicly insured is a traditional practice. Around 43% of the for-profit private hospitals in Spain have a commissioning agreement with the NHS to diagnose or treat patients on public tariffs. These revenues represent 26% of the total revenues of private for-profit hospitals. The research question of this study is if commissioning with the NHS improves the financial performance of private-for-profit hospitals in Spain. METHODS With a long panel (2000-2017) of for-profit hospitals we estimate a model for the financial performance (return on assets) using commissioning as main explanatory variable and other variables as control (variables financial indicators and structural information). Specific models are estimated for subgroups of hospitals according to size and specialization. The models are estimated by panel regression with fixed effects and GMM as robustness. RESULTS Private for-profit hospitals that have commissioning with NHS obtain higher financial performance than no-commissioning hospitals. This effect varies depending on hospital size and type (hospital specialization), the advantage being more relevant for general hospitals and particularly for hospital with at least 50 beds. CONCLUSIONS Commissioning with the NHS is a promising source of financial profitability for general acute private for-profit hospitals. The evidence provided by this study may orientate the NHS in the regulation and negotiation of commissioning contracts in healthcare.
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Affiliation(s)
- María Victoria Ruiz-Mallorquí
- Department of Financial Economy and Accounting, Faculty of Economy, Business and Tourism, University of Las Palmas de Gran Canaria, 35017 Las Palmas, Spain
| | - Inmaculada Aguiar-Díaz
- Department of Financial Economy and Accounting, Faculty of Economy, Business and Tourism, University of Las Palmas de Gran Canaria, 35017 Las Palmas, Spain
| | - Beatriz González- López Valcárcel
- Department of Quantitative Methods for Economics and Management, Faculty of Economy, Business and Tourism, University of Las Palmas de Gran Canaria, 35017 Las Palmas, Spain
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Altalhi N, Alnaimi H, Chaouali M, Alahmari F, Alabdulkareem N, Alaama T. Top four types of sentinel events in Saudi Arabia during the period 2016-19. Int J Qual Health Care 2021; 33:6134106. [PMID: 33576805 DOI: 10.1093/intqhc/mzab026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 01/31/2021] [Accepted: 02/12/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND This study discusses the summary, investigation and root causes of the top four sentinel events (SEs) in Saudi Arabia (SA) that occurred between January 2016 and December 2019, as reported by the Ministry of Health (MOH) and private hospitals through the MOH SE reporting system (SERS). It is intended for use by legislators, health-care facilities and the public to shed light on areas that still need improvement to preserve patient safety. OBJECTIVES The purpose of this study is to review the most common SEs reported by the MOH and private hospitals between the years 2016 and 2019 to assess the patterns and identify risk areas and the common root causes of these events in order to promote country-wide learning and support services that can improve patient safety. METHODS In this retrospective descriptive study, the data were retrieved from the SERS, which routinely collects records from both MOH and private hospitals in SA. SEs were analyzed by type of event, location, time, patient demographics, outcome and root causes. RESULTS There were 727 SEs during this period, 38.4% of which were under the category of unexpected patient death, 19.4% under maternal death, 11.7% under unexpected loss of limb or function and 9.9% under retained instruments or sponge. Common root causes were related to policies and procedures, guidelines, miscommunication between health-care facilities, shortage of staff and lack of competencies. CONCLUSION Given these results, efforts should focus on improving the care of deteriorating patients in general wards, ICU (Intensive Care Units) admission/discharge criteria and maternal, child and surgical safety. The results also highlighted the problem of underreporting of SEs, which needs to be addressed and improved. Linking data sources such as claims and patient complaints databases and electronic medical records to the national reporting system must also be considered to ensure an optimal estimation of the number of events.
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Affiliation(s)
- Nasser Altalhi
- Deputy General Director, Ministry of Health, Quality and Patient Safety, Zarga Alyamamah St, Al Murabba, Riyadh 12628, Kingdom of Saudi Arabia
| | - Haifa Alnaimi
- Risk and Business Continuity Manager, Tawal Telecom Limited, Zarga Alyamamah St, Al Murabba, Riyadh 12628, Kingdom of Saudi Arabia
| | - Mafaten Chaouali
- Model of Care & Clinical Service Lines, Quality and Risk Management, Al-Madinah Health Cluster, General Directorate of Health, Madina Munawara 42313, Kingdom of Saudi Arabia
| | - Falaa Alahmari
- Quality and patient safety department, Ministry of Health, Quality and Patient Safety, Zarga Alyamamah St, Al Murabba, Riyadh 12628, Kingdom of Saudi Arabia
| | - Noor Alabdulkareem
- Quality and patient safety department, Ministry of Health, Quality and Patient Safety, Zarga Alyamamah St, Al Murabba, Riyadh 12628, Kingdom of Saudi Arabia
| | - Tareef Alaama
- Deputy Minister for Therapeutic Affairs, Ministry of Health, Deputyship of Therapeutic Affairs, Zarga Alyamamah St, Al Murabba, Riyadh 12628, Kingdom of Saudi Arabia.,Assistant Professor and Consultant of Internal Medicine & Geriatric Medicine, King Abdulaziz University, Zarga Alyamamah St, Al Murabba, Jeddah, Riyadh 12628, Kingdom of Saudi Arabia
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A comparative study of quality of health care services of public and private hospitals in Ghana. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01479-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Quantifying the impact of COVID-19 on chronic pain services in the Republic of Ireland. Ir J Med Sci 2021; 191:7-11. [PMID: 33544332 PMCID: PMC7862046 DOI: 10.1007/s11845-021-02509-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 01/06/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION During the COVID-19 pandemic, most medical services were shut down and resources were redistributed. Closures included pain management departments where many staff were redeployed. The aim of this study was to assess the impact of COVID-19 on chronic pain services in the Republic of Ireland. METHODS An online survey was sent to pain consultants working in public hospitals in the Republic of Ireland between the 22nd and 28th September 2020. RESULTS We received responses from 18 consultants from all 15 public hospitals in the Republic of Ireland with chronic pain services. Procedural volume during lockdown fell to 26% of pre-COVID levels. This had recovered somewhat by the time of the survey to 71%. Similarly, in-person outpatient clinic volume fell to 10% of per-COVID numbers and recovered to 50%. On average, 39% of public hospital activity was made up for by the availability of private hospitals. This varied significantly across the country. The use of telemedicine increased significantly during the pandemic. Before COVID, on average, 13% of outpatient clinic volume was composed of telephone or video consultations. This increased to 46% at the time of the survey. CONCLUSION This survey of consultant pain physicians in the Republic of Ireland has revealed how chronic pain services have been affected during the pandemic and how they have evolved.
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Ayiko R, Mujasi PN, Abaliwano J, Turyareeba D, Enyaku R, Anguyo R, Odoch W, Bakibinga P, Aliti T. Levels, trends and determinants of technical efficiency of general hospitals in Uganda: data envelopment analysis and Tobit regression analysis. BMC Health Serv Res 2020; 20:916. [PMID: 33023598 PMCID: PMC7539474 DOI: 10.1186/s12913-020-05746-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 09/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND General hospitals provide a wide range of primary and secondary healthcare services. They accounted for 38% of government funding to health facilities, 8.8% of outpatient department visits and 28% of admissions in Uganda in the financial year 2016/17. We assessed the levels, trends and determinants of technical efficiency of general hospitals in Uganda from 2012/13 to 2016/17. METHODS We undertook input-oriented data envelopment analysis to estimate technical efficiency of 78 general hospitals using data abstracted from the Annual Health Sector Performance Reports for 2012/13, 2014/15 and 2016/17. Trends in technical efficiency was analysed using Excel while determinants of technical efficiency were analysed using Tobit Regression Model in STATA 15.1. RESULTS The average constant returns to scale, variable returns to scale and scale efficiency of general hospitals for 2016/17 were 49% (95% CI, 44-54%), 69% (95% CI, 65-74%) and 70% (95% CI, 65-75%) respectively. There was no statistically significant difference in the efficiency scores of public and private hospitals. Technical efficiency generally increased from 2012/13 to 2014/15, and dropped by 2016/17. Some hospitals were persistently efficient while others were inefficient over this period. Hospital size, geographical location, training status and average length of stay were statistically significant determinants of efficiency at 5% level of significance. CONCLUSION The 69% average variable returns to scale technical efficiency indicates that the hospitals could generate the same volume of outputs using 31% (3439) less staff and 31% (3539) less beds. Benchmarking performance of the efficient hospitals would help to guide performance improvement in the inefficient ones. There is need to incorporate hospital size, geographical location, training status and average length of stay in the resource allocation formula and adopt annual hospital efficiency assessments.
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Affiliation(s)
- Rogers Ayiko
- The Foundation for African Empowerment, P. O. Box 116, Arusha, Tanzania
| | - Paschal N. Mujasi
- Department of Economics and Business, Universitat Pompeu Fabra, Barcelona School of Management, Balmes 132, 08001 Barcelona, Spain
| | - Joyce Abaliwano
- Makerere University Business School, Plot 21 A, Port Bell Rd, Kampala, Uganda
| | - Dickson Turyareeba
- Makerere University Business School, Plot 21 A, Port Bell Rd, Kampala, Uganda
| | - Rogers Enyaku
- Community Resource Development Initiative, P. O. Box 6653, Kampala, Uganda
| | - Robert Anguyo
- Department of International Public Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA UK
- Faculty of Health Sciences, Nile University, P.O Box 1070, Arua, Uganda
| | - Walter Odoch
- East Central and Southern Africa Health Community, 157 Olorien, Njiro Road ECSA-HC, P.O. Box 1009, Arusha, Tanzania
| | - Pauline Bakibinga
- African Population & Health Research Center, Manga Close, Off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya
| | - Tom Aliti
- Ministry of Health, Plot 6, Lourdel Road, Nakasero, P.O Box 7272, Kampala, Uganda
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Farley BJ, Shear BM, Lu V, Walworth K, Gray K, Kirsch M, Clements JM. Rural, urban, and teaching hospital differences in hip fracture mortality. J Orthop 2020; 21:453-458. [PMID: 32982100 DOI: 10.1016/j.jor.2020.08.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/29/2020] [Accepted: 08/31/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction Hip fractures remain one of the most prevalent and deadly conditions afflicting those 65 years and older. For other health conditions (e.g. myocardial infarction), hospital location is associated with poorer health outcomes. To our knowledge, no study has investigated the relationship between hip fracture morality rate in the United States between urban and rural hospital settings. Methods A retrospective cohort study was conducted to examine differences in in-hospital mortality between groups treated in rural, urban-teaching, and urban-non-teaching hospitals, as well as public and private hospitals. Mortality rates were also compared for variances between surgical treatment, sex, insurance, patient location, race, and income. Discharge data was collected for 256,240 inpatient stays from the 2012 National Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. Results Odds of mortality were 14.6% greater in rural hospital hip fracture patients compared to Urban/Non-Teaching centers (p < 0.05). Conclusions Results from this study lend support to necessitate further research investigating prospective barriers to care of those in rural settings. This may point to limitations in resources and trained medical and surgical specialists in rural hospitals and need for continued research to mitigate such findings.
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Affiliation(s)
- Brendan J Farley
- Central Michigan University, College of Medicine, Mt. Pleasant, MI, USA
| | - Brian M Shear
- Central Michigan University, College of Medicine, Mt. Pleasant, MI, USA
| | - Vivian Lu
- Central Michigan University, College of Medicine, Mt. Pleasant, MI, USA
| | - Kyla Walworth
- Central Michigan University, College of Medicine, Mt. Pleasant, MI, USA
| | - Kevin Gray
- Central Michigan University, College of Medicine, Mt. Pleasant, MI, USA
| | - Matt Kirsch
- Central Michigan University, College of Medicine, Mt. Pleasant, MI, USA
| | - John M Clements
- Central Michigan University, College of Medicine, Mt. Pleasant, MI, USA
- Michigan State University, College of Human Medicine, Division of Public Health, Flint, MI, USA
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Ortega-Díaz MI, Ocaña-Riola R, Pérez-Romero C, Martín-Martín JJ. Multilevel Analysis of the Relationship between Ownership Structure and Technical Efficiency Frontier in the Spanish National Health System Hospitals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165905. [PMID: 32823922 PMCID: PMC7459985 DOI: 10.3390/ijerph17165905] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 11/29/2022]
Abstract
Objective: To evaluate the relationship between the ownership structure of hospitals and the possibility of their being positioned on the frontier of technical efficiency in the economic crisis period 2010–2012, adjusting for hospital variables and regional characteristics in the areas where the Spanish National Health System (SNHS) hospitals are located. Methods: 230 National Health System hospitals were studied over the two-year period 2010–2012 according to their ownership structure—public hospitals, private hospitals and public–private partnership (PPP)—data envelopment analysis orientated to inputs was used to measure the overall technical efficiency, pure efficiency and efficiency of scale. A generalised linear mixed model (GLMM) with binomial distribution and logit link function was used to analyse the hospital and regional variables associated with positioning on the frontier. Results: There are substantial differences between the average pure technical efficiency of public, private and PPP hospitals, as well as a greater number of PPP models being positioned on the efficiency frontier (91.67% in 2012). The odds of being positioned on the frontier are 41.7 times higher in PPP models than in public hospitals. The average annual household income per region is related to the greater odds of hospitals being positioned on the frontier of efficiency. Conclusions: During the most acute period of recession in the Spanish economy, PPP formulas favoured hospital efficiency, by increasing the odds of being positioned on the frontier of efficiency when compared to private and public hospitals. The position on the frontier of efficiency of a hospital is related to the wealth of its region.
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Affiliation(s)
- Mª Isabel Ortega-Díaz
- Departamento de Economía, Universidad de Jaén, Edificio D-3, Campus Las Lagunillas s/n, 23071 Jaén, Spain;
| | - Ricardo Ocaña-Riola
- Escuela Andaluza de Salud Pública, Cuesta del Observatorio 4, Campus Universitario de Cartuja, 18011 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, Doctor Azpitarte 4, 18012 Granada, Spain;
| | - Carmen Pérez-Romero
- Escuela Andaluza de Salud Pública, Cuesta del Observatorio 4, Campus Universitario de Cartuja, 18011 Granada, Spain;
- Correspondence: ; Tel.: +34-958-02-74-10
| | - José Jesús Martín-Martín
- Instituto de Investigación Biosanitaria ibs.GRANADA, Doctor Azpitarte 4, 18012 Granada, Spain;
- Departamento de Economía Aplicada, Universidad de Granada, Facultad de Ciencias Económicas y Empresariales, Campus Universitario de Cartuja s/n, 18071 Granada, Spain
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Levaggi L, Levaggi R. Is there scope for mixed markets in the provision of hospital care? Soc Sci Med 2020; 247:112810. [PMID: 31986453 DOI: 10.1016/j.socscimed.2020.112810] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 01/09/2020] [Accepted: 01/17/2020] [Indexed: 11/26/2022]
Abstract
Market oriented reforms in hospital care have produced a variety of quasi markets that differ for the type of providers that are allowed to compete. Mixed markets, where public hospitals compete alongside private ones, are increasingly common, but the literature does not agree on their performances and their desirability. We review the contributions in this field by proposing a common framework which allows to account for the different approaches proposed to model public hospitals. In this paper we show under which conditions mixed markets perform better in terms of average quality, and we review the empirical literature to determine whether these conditions are met. In general, pure forms (private or public competition) are superior to mixed markets, unless patients interpret public hospitals as reference suppliers, and quality of care is important. The empirical evidence on these key questions shows that public hospitals behave differently from private organisations, but they are not necessarily less efficient. Research into patients choices seems to suggest that ownership is a value, but the empirical literature is still rather scant. From a policy point of view, our review suggests that there does not seem to be a clear answer to whether this market form should be used. Local conditions are going to play an important role.
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Affiliation(s)
- Laura Levaggi
- Faculty of Science and Technology, Free University of Bolzano, Piazza Università 5, Bolzano, Italy.
| | - Rosella Levaggi
- Department of Economics and Management, University of Brescia, Italy.
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Kenny C, Regan J, Balding L, Higgins S, O'Leary N, Kelleher F, McDermott R, Armstrong J, Mihai A, Tiernan E, Westrup J, Thirion P, Walsh D. Dysphagia Prevalence and Predictors in Cancers Outside the Head, Neck, and Upper Gastrointestinal Tract. J Pain Symptom Manage 2019; 58:949-958.e2. [PMID: 31445137 DOI: 10.1016/j.jpainsymman.2019.06.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 06/23/2019] [Accepted: 06/24/2019] [Indexed: 01/14/2023]
Abstract
CONTEXT Dysphagia is usually associated with malignancies of the head, neck, and upper gastrointestinal tract but also occurs in those with tumors outside anatomic swallow regions. It can lead to aspiration pneumonia, malnutrition, reduced quality of life, and psychosocial distress. No studies have yet reliably described dysphagia prevalence in those with malignancies outside anatomic swallow regions. OBJECTIVE The objective of this study was to establish the prevalence and predictors of dysphagia in adults with solid malignancies outside the head, neck, and upper gastrointestinal tract. METHODS A cross-sectional, observational study using consecutive sampling was conducted. There were 385 participants (mean age 66 ± 12 years) with 21 different primary cancer sites from two acute hospitals and one hospice. Locoregional disease was present in 33%, metastatic in 67%. Dysphagia was screened by empirical questionnaire and confirmed through swallow evaluation. Demographic and clinical predictors were determined by univariate and multivariate binary regression. RESULTS Dysphagia occurred in 19% of those with malignancies outside anatomic swallow regions. Prevalence was 30% in palliative care and 32% in hospice care. Dysphagia was most strongly associated with cough, nausea, and worse performance status. It was also associated with lower quality of life and nutritional difficulties. CONCLUSION Dysphagia was common and usually undiagnosed before study participation. It occurred at all disease stages but coincided with functional decline. It may therefore represent a cancer frailty marker. Oncology and palliative care services should routinely screen for this symptom. Timely dysphagia identification and management may improve patient well-being and prevent adverse effects like aspiration pneumonia and weight loss.
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Affiliation(s)
- Ciarán Kenny
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland; Academic Department of Palliative Medicine, Our Lady's Hospice & Care Services, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland.
| | - Julie Regan
- Department of Clinical Speech and Language Studies, Trinity College, Dublin, Ireland
| | - Lucy Balding
- Department of Palliative Medicine, Our Lady's Hospice & Care Services, Dublin, Ireland
| | - Stephen Higgins
- Department of Palliative Medicine, Our Lady's Hospice & Care Services, Dublin, Ireland
| | - Norma O'Leary
- Department of Palliative Medicine, Our Lady's Hospice & Care Services, Dublin, Ireland
| | | | - Ray McDermott
- Tallaght University Hospital, Dublin, Ireland; Beacon Hospital, Dublin, Ireland
| | | | | | | | | | | | - Declan Walsh
- Academic Department of Palliative Medicine, Our Lady's Hospice & Care Services, Dublin, Ireland; School of Medicine, Trinity College, Dublin, Ireland; Department of Supportive Oncology, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
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Mokienko A. Effects of a reimbursement change and travel times on the delivery of private and public radiology services in Norway: a register-based longitudinal study of Norwegian claims data. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2019; 17:22. [PMID: 31636513 PMCID: PMC6796397 DOI: 10.1186/s12962-019-0190-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 09/27/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The variation in the impact of the 2008 reimbursement change for Norwegian radiology providers, depending on the travel times to private and public providers in different municipalities, was examined. The activity-based fund allocation for radiology providers was reduced from approximately 50% to 40%, which was compensated by an increased basic grant. The hypothesis was that the Norwegian population would be affected by the reimbursement change unevenly depending on their distances to different types of the providers. METHODS The study of the effect of the reimbursement change and travel time difference between private and public radiology providers in Norway (Time_difference) on the number of the services was performed using fixed-effects regressions applied to panel data at the municipality level with monthly observations for the period 2007-2010. RESULTS After the reimbursement change, the number of private services decreased more than the number of public services. Private services declined after 2008, but the absolute value of the effect was smaller as the Time_difference became greater. The number of public services increased as the Time_difference grew. The total number of services decreased until the Time_difference was equal to 40 min and increased for time differences greater than 40 min. CONCLUSIONS The messages for policymakers are as follows. Populations that only had private providers nearby were more affected by the reimbursement change in terms of a reduced number of services. The reimbursement change contributed to the reallocation of patients from private to public providers. The difference between the centralities of municipalities in their consumption patterns was reduced and the difference between different Regional Health Authorities was increased due to the reimbursement change.
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Affiliation(s)
- Anastasia Mokienko
- Department of Health Management and Health Economics, University of Oslo, P.O. Box 1089, Blindern, 0317 Oslo, Norway
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Xie Y, Liang D, Huang J, Jin J. Hospital Ownership and Hospital Institutional Change: A Qualitative Study in Guizhou Province, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16081460. [PMID: 31022966 PMCID: PMC6517928 DOI: 10.3390/ijerph16081460] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/21/2019] [Accepted: 04/22/2019] [Indexed: 11/16/2022]
Abstract
Objectives: To qualitatively compare the influence of different ownership which is considered as a kind of institutional environment in public hospitals, private hospitals, and mixed-ownership hospitals on hospital governance structure and organizational behavior. Design: Qualitative descriptive study, using semi-structured, in-depth interviews and thematic template analysis, theoretically informed by critical realism. Participants: 27 key informants including national policymakers in charge of the health sector, influential researchers, local administrators responsible for implementing policies, and hospital managers who are experienced in institutional change. Results: Hospital ownership has a significant influence on hospitals in terms of decision-making power allocation, residual ownership allocation, market entry level, accountability, and social functions. These five aspects in hospital organizational structure incentivize hospitals to adapt to the internal and external environment of the hospital organization-such as market environment, governance, and financing arrangements-affect the behavior of the hospital organization, and ultimately affect the efficiency of hospital operation and quality of service. The incentives under the public system are relatively distorted. Private hospitals have poor performance in failing their social functions due to their insufficient development ability. Compared to them, mixed ownership hospitals have a better performance in terms of incentive mechanism and organizational development. Conclusion: Public hospitals should improve the governance environment and decision-making structure, so as to balance their implementation of social functions and achieve favorable organizational development. For private hospitals, in addition to the optimization of the policy environment, attempts should be made to strengthen their supervision. The development of mixed-ownership hospitals should be oriented towards socialized governance.
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Affiliation(s)
- Yu Xie
- School of Public Health, Fudan University/Key Lab of Health Technology Assessment, National Health Commission, Shanghai 200032, China.
| | - Di Liang
- Department of Family Medicine and Public Health, University of California, San Diego, CA 92093, USA.
| | - Jiayan Huang
- School of Public Health, Fudan University/Key Lab of Health Technology Assessment, National Health Commission, Shanghai 200032, China.
| | - Jiajie Jin
- School of Public Health, Fudan University/Key Lab of Health Technology Assessment, National Health Commission, Shanghai 200032, China.
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Bach-Mortensen AM, Montgomery P. Does sector matter for the quality of care services? A secondary analysis of social care services regulated by the Care Inspectorate in Scotland. BMJ Open 2019; 9:e022975. [PMID: 30772845 PMCID: PMC6398786 DOI: 10.1136/bmjopen-2018-022975] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Social services are increasingly commissioned to third and for-profit sector providers, but little is known about whether and how these changes influence quality indicators. We assessed quality-related outcomes across for-profit, public and third sector organisations delivering social care services. DESIGN A secondary analysis was conducted on publically available data collected by the independent regulator of social care organisations in Scotland. All outcomes are reported as predicted probabilities derived from multivariate logistic regression coefficients. Generalised ordered logit models are utilised for the quality domains and the risk assessment score and logistic regression for whether complaints or requirements were issued to organisations. SETTING Organisations inspected by the Care Inspectorate in Scotland. POPULATION 13 310 social care organisations (eg, nursing homes and day care organisations). PRIMARY OUTCOMES The quality and risk domains collected by the Care Inspectorate and complaints and requirements issued to organisations within the last 3 years. RESULTS Controlling for multiple factors, we find that public and third sector providers performed consistently and statistically significantly better than for-profit organisations on most outcomes. For example, for-profit services were the most likely to be rated as high and medium risk (6.9% and 13.2%, respectively), and the least likely to be classified as low risk (79.9%). Public providers had the highest probability of being categorised as low risk (91.1%), and the lowest probability of having their services classified as medium (6.9%) and high risk (2%), followed by third sector providers (86%, 8.5% and 4.5%, respectively). Public providers performed better than third sector providers in some outcomes, but differences were relatively low and inconsistent. CONCLUSION Public and third sector providers were rated considerably higher than their for-profit counterparts on most observed outcomes. Regulators might use this information to consider how social care providers across sector are incentivised to manage their resources.
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Affiliation(s)
| | - Paul Montgomery
- Department of Social Policy, Sociology and Criminology, University of Birmingham, Birmingham, UK
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Affiliation(s)
- Livio Garattini
- CESAV, Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, Ranica 24020, Italy
| | - Anna Padula
- CESAV, Centre for Health Economics, Institute for Pharmacological Research Mario Negri IRCCS, Ranica 24020, Italy
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