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Lin PY, Kaplan W, Lin CH, Lee YH. Taiwan's National Health Insurance at the Emergency Department following the COVID-19 outbreak. Public Health Nurs 2023. [PMID: 36882994 DOI: 10.1111/phn.13186] [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: 11/28/2022] [Revised: 01/26/2023] [Accepted: 02/24/2023] [Indexed: 03/09/2023]
Abstract
Taiwan's National Health Insurance (NHI) is a widely acclaimed universal healthcare system. In the past few years, particularly following the COVID-19 outbreak, challenges related to maintaining the NHI system have surfaced. Since 2020, NHI has faced a series of challenges, including excessive patient visits to the hospital emergency department, a lack of an effective primary care and referral system, and a high turnover rate of healthcare workers. We review major problems related to Taiwan's NHI, emphasizing input from frontline healthcare workers. We provide recommendations for potential policies addressing the concerns around NHI, for example, strengthening the role of primary care services under the NHI administration, reducing the high turnover rate of healthcare workers, and increase the premium and copayments. We hope that this policy analysis may allow policymakers and scholars to understand both the merits and critical problems related to NHI from the clinical perspective.
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Affiliation(s)
- Pei-Ying Lin
- Taipei Veterans General Hospital, Taipei City, Taiwan.,National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | | | - Chia-Hung Lin
- Taipei Veterans General Hospital, Taipei City, Taiwan.,National Taiwan University, Taipei City, Taiwan
| | - Yen-Han Lee
- University of Central Florida, Orlando, Florida
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Coss-Mandiola J, Vanegas-López J, Rojas A, Dubó P, Campillay-Campillay M, Carrasco R. Accreditation of Quality in Primary Health Care in Chile: Perception of the Teams from Accredited Family Healthcare Centers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2477. [PMID: 36767844 PMCID: PMC9915018 DOI: 10.3390/ijerph20032477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/26/2023] [Accepted: 01/28/2023] [Indexed: 06/18/2023]
Abstract
This study aimed to investigate the perception of the health teams belonging to the Family Healthcare Centers (CESFAMs) that are accredited, regarding the process of implementation and the achievement of accreditation. A qualitative approach was applied, with contributions from grounded theory, through the technique of individual in-depth interviews and focus groups. The interviews were carried out in nine accredited CESFAMs. For the presentation, organization and analysis of the data, Atlas.ti V9 software was used. From the results, derived from the open phase of the analysis, obtained from the opinions of the participants, a total of 26 categories emerged relating to the facilitating and hindering factors of the process. From the axial phase, it was possible to establish central categories that were related to quality management policies, the structure of Primary Health Care (PHC), participation and co-construction, and leadership and change management. In conclusion, the discourse of the teams reveals the need to have necessary conditions for the accreditation process, which are mainly related to training, characteristics of the types of leadership and teamwork in harmony with the process. Finally, the study reveals a gap in the community participation in this process, which suggests continuing this line of research.
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Affiliation(s)
- Juan Coss-Mandiola
- Escuela de Obstetricia y Puericultura, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago 8320096, Chile
| | - Jairo Vanegas-López
- Escuela de Obstetricia y Puericultura, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago 8320096, Chile
| | - Alejandra Rojas
- Escuela de Obstetricia y Puericultura, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago 8320096, Chile
| | - Pablo Dubó
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó 7500015, Chile
| | - Maggie Campillay-Campillay
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó 7500015, Chile
| | - Raúl Carrasco
- Facultad de Ingeniería y Negocios, Universidad de Las Américas, Santiago 3981000, Chile
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Campillay-Campillay M, Calle-Carrasco A, Dubo P, Moraga-Rodríguez J, Coss-Mandiola J, Vanegas-López J, Rojas A, Carrasco R. Accessibility in People with Disabilities in Primary Healthcare Centers: A Dimension of the Quality of Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12439. [PMID: 36231740 PMCID: PMC9564706 DOI: 10.3390/ijerph191912439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/24/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023]
Abstract
The purpose of this research is to evaluate universal accessibility in primary healthcare (PHC) centers in the Atacama region, Chile, through an analytical cross-sectional study with a quality approach, which uses the external audit model with the application of a dichotomous comparison guideline, evaluating levels of compliance with four dimensions of universal accessibility described in the literature: participation, information, accessibility chain and architectural aspects. This was carried out in 18 PHC, and set as Lower Control Limit (LCL) of 70% to compare levels of compliance, and a hierarchical model and k-mean analysis were applied. Results: Very low compliance averages were obtained, 37.7% participation, 4% information, 44.4% access chain, and 63.9% architectural aspects, indicating a critical situation. Moreover, the cluster comparison allowed to observe that a group of healthcare centers complies more than other groups, which requires more attention. Conclusions: The low level of accessibility for people with disabilities may be associated with various factors that require further monitoring and analysis. However, low levels of accessibility require changing the way of relating to this vulnerable group of the population, and considering including them in the design and reasonable adjustments made in PHC centers. The findings from this research open the possibility for future research that increases understanding of how to reduce barriers in a such wide variety of forms of disability.
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Affiliation(s)
- Maggie Campillay-Campillay
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó 7500015, Chile
| | - Ana Calle-Carrasco
- Departamento de Kinesiología, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó 7500015, Chile
| | - Pablo Dubo
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó 7500015, Chile
| | - Jorge Moraga-Rodríguez
- Programa de Magíster en Metodología de Investigación Cualitativa para la Salud, Facultad de Ciencias de la Salud, Universidad de Atacama, Copiapó 7500015, Chile
| | - Juan Coss-Mandiola
- Escuela de Obstetricia y Puericultura, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Santiago 8320096, Chile
| | - Jairo Vanegas-López
- Escuela de Obstetricia y Puericultura, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Santiago 8320096, Chile
| | - Alejandra Rojas
- Escuela de Obstetricia y Puericultura, Facultad de Ciencias Médicas, Universidad de Santiago de Chile (USACH), Santiago 8320096, Chile
| | - Raúl Carrasco
- Facultad de Ingeniería y Negocios, Univerdidad de Las Américas, Santiago 3981000, Chile
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Garcés HO, Durán C, Espinosa E, Jerez A, Palominos F, Hinojosa M, Carrasco R. Monitoring of Thermal Comfort and Air Quality for Sustainable Energy Management inside Hospitals Based on Online Analytical Processing and the Internet of Things. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12207. [PMID: 36231507 PMCID: PMC9565032 DOI: 10.3390/ijerph191912207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/17/2022] [Accepted: 09/17/2022] [Indexed: 06/16/2023]
Abstract
There is a need to ensure comfortable conditions for hospital staff and patients from the point of view of thermal comfort and air quality so that they do not affect their performance. We consider the need for hospital employees and patients to enjoy conditions of greater well-being during their stay. This is understood as a comfortable thermal sensation and adequate air quality, depending on the task they are performing. The contribution of this article is the formulation of the fundamentals of a system and platform for monitoring thermal comfort and Indoor Air Quality (IAQ) in hospitals, based on an Internet of Things platform composed of a low-cost sensor node network that is capable of measuring critical variables such as humidity, temperature, and Carbon Dioxide (CO2). As part of the platform, a multidimensional data model with an On-Line Analytical Processing (OLAP) approach is presented that offers query flexibility, data volume reduction, as well as a significant reduction in query response times. The experimental results confirm the suitability of the platform's data model, which facilitates operational and strategic decision making in complex hospitals.
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Affiliation(s)
- Hugo O. Garcés
- Departamento Ingeniería Informática, Universidad Católica de la Santísima Concepción, Concepción 4090541, Chile
| | - Claudia Durán
- Departamento de Ingeniería Industrial, Facultad Ingeniería, Universidad Tecnológica Metropolitana, Santiago 7800002, Chile
| | - Eduardo Espinosa
- Department of Electrical Engineering, Faculty of Engineering, Universidad Católica de la Santísima Concepción, Concepción 4090541, Chile
| | | | - Fredi Palominos
- Departamento de Matemática y Ciencias de la Computación, Universidad de Santiago de Chile, Santiago 9170022, Chile
| | - Marcela Hinojosa
- Departamento de Tecnología Médica, Facultad de Medicina, Universidad de Concepción, Concepción 4070409, Chile
| | - Raúl Carrasco
- Facultad de Ingeniería y Negocios, Universidad de Las Américas, Santiago 7500975, Chile
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Characterization of Communes with Quality Accredited Primary Healthcare Centers in Chile. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159189. [PMID: 35954546 PMCID: PMC9368359 DOI: 10.3390/ijerph19159189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 11/17/2022]
Abstract
The accreditation process of primary healthcare centers in Chile has not had the same progress as in hospitals, which show high levels of compliance. The purpose of this research is to characterize the communes that have accredited family healthcare centers (CESFAMs) through socio-economic, municipal management, clinical management, and population variables by performing a principal components analysis (PCA) with biplot analysis and a grouping of communes through a hierarchical analysis. The biplot analysis and hierarchical analysis yielded the formation of three large groups of communes with accredited CESFAMs, characterized mainly by population size, number of people registered in the municipal health system, socioeconomic indicators, and financial management and clinical management variables. It was found that the communes that have accredited CESFAMs are characterized by dissimilar behavior in relation to the variables analyzed. Through the model used, it was possible to establish at least three groups of communes according to their behavior against these variables. Of these, the variables of a municipal financial nature were not decisive in achieving the accreditation of the CESFAMs of these communes. Therefore, it is possible that there are other variables or factors that could be facilitating the achievement of accreditation processes.
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Boone CE, Celhay P, Gertler P, Gracner T, Rodriguez J. How scheduling systems with automated appointment reminders improve health clinic efficiency. JOURNAL OF HEALTH ECONOMICS 2022; 82:102598. [PMID: 35172242 DOI: 10.1016/j.jhealeco.2022.102598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 01/03/2022] [Accepted: 01/28/2022] [Indexed: 06/14/2023]
Abstract
Missed clinic appointments or no-shows burden health care systems through inefficient use of staff time and resources. Scheduling software with automatic appointment reminders shows promise to improve clinics' management through timely cancellations and re-scheduling, but at-scale evidence is missing. We study a nationwide text message appointment reminder program in Chile implemented at primary care clinics for patients with chronic disease. Using longitudinal clinic-level data, we find that the program did not change the number of visits by chronic patients eligible to receive the reminder but visits from other patients ineligible to receive reminders increased by 5.0% in the first year and 7.4% in the second. Clinics treating more chronic patients and those with a relatively younger patient population benefited more from the program. Scheduling systems with automatic appointment reminders were effective in increasing clinics' ability to care for more patients, likely due to timely cancellations and re-scheduling.
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Affiliation(s)
| | - Pablo Celhay
- Escuela de Gobierno and Instituto de Economia, Pontifica Universidad Catolica de Chile
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