1
|
García-Corchero JD, Jiménez-Rubio D. How do policy levers shape the quality of a national health system? J Policy Model 2022; 44:203-221. [PMID: 34703065 PMCID: PMC8529896 DOI: 10.1016/j.jpolmod.2021.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 04/23/2021] [Accepted: 09/12/2021] [Indexed: 06/13/2023]
Abstract
Poor quality of care may have a detrimental effect on access and take-up and can become a serious barrier to the universality of health services. This consideration is of particular interest in view of the fact that health systems in many countries must address a growing public-sector deficit and respond to increasing pressures due to COVID-19 and aging population, among other factors. In line with a rapidly emerging literature, we focus on patient satisfaction as a proxy for quality of health care. Drawing on rich longitudinal and cross-sectional data for Spain and multilevel estimation techniques, we show that in addition to individual level differences, policy levers (such as public health spending and the patient-doctor ratio, in particular) exert a considerable influence on the quality of a health care system. Our results suggest that policymakers seeking to enhance the quality of care should be cautious when compromising the level of health resources, and in particular, health personnel, as a response to economic downturns in a sector that traditionally had insufficient human resources in many countries, which have become even more evident in the light of the current health crisis. Additionally, we provide evidence that the increasing reliance on the private health sector may be indicative of inefficiencies in the public system and/or the existence of features of private insurance which are deemed important by patients.
Collapse
Affiliation(s)
- Juan David García-Corchero
- Departamento de Economía Aplicada, Facultad de Ciencias Económicas y Empresariales, Campus de Cartuja, Spain
| | - Dolores Jiménez-Rubio
- Departamento de Economía Aplicada, Facultad de Ciencias Económicas y Empresariales, Campus de Cartuja, Spain
| |
Collapse
|
2
|
Shrestha A, Maharjan R, Karmacharya BM, Bajracharya S, Jha N, Shrestha S, Aryal A, Baral PP, Bhatt RD, Bhattarai S, Bista D, Citrin D, Dhimal M, Fitzpatrick AL, Jha AK, Karmacharya RM, Mali S, Neupane T, Oli N, Pandit R, Parajuli SB, Pradhan PMS, Prajapati D, Pyakurel M, Pyakurel P, Rai BK, Sapkota BP, Sapkota S, Shrestha A, Shrestha AP, Shrestha R, Sharma GN, Sharma S, Spiegelman D, Suwal PS, Thapa B, Vaidya A, Xu D, Yan LL, Koju R. Health system gaps in cardiovascular disease prevention and management in Nepal. BMC Health Serv Res 2021; 21:655. [PMID: 34225714 PMCID: PMC8258928 DOI: 10.1186/s12913-021-06681-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 05/31/2021] [Indexed: 01/19/2023] Open
Abstract
Background Cardiovascular diseases (CVDs) are the leading cause of deaths and disability in Nepal. Health systems can improve CVD health outcomes even in resource-limited settings by directing efforts to meet critical system gaps. This study aimed to identify Nepal’s health systems gaps to prevent and manage CVDs. Methods We formed a task force composed of the government and non-government representatives and assessed health system performance across six building blocks: governance, service delivery, human resources, medical products, information system, and financing in terms of equity, access, coverage, efficiency, quality, safety and sustainability. We reviewed 125 national health policies, plans, strategies, guidelines, reports and websites and conducted 52 key informant interviews. We grouped notes from desk review and transcripts’ codes into equity, access, coverage, efficiency, quality, safety and sustainability of the health system. Results National health insurance covers less than 10% of the population; and more than 50% of the health spending is out of pocket. The efficiency of CVDs prevention and management programs in Nepal is affected by the shortage of human resources, weak monitoring and supervision, and inadequate engagement of stakeholders. There are policies and strategies in place to ensure quality of care, however their implementation and supervision is weak. The total budget on health has been increasing over the past five years. However, the funding on CVDs is negligible. Conclusion Governments at the federal, provincial and local levels should prioritize CVDs care and partner with non-government organizations to improve preventive and curative CVDs services. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06681-0.
Collapse
Affiliation(s)
- Archana Shrestha
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal. .,Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, USA. .,Institute for Implementation Science and Health, Kathmandu, Nepal. .,Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal.
| | - Rashmi Maharjan
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal.,Department of Nursing and Midwifery, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Biraj Man Karmacharya
- Department of Public Health, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal.,Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Swornim Bajracharya
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Niharika Jha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Soniya Shrestha
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Anu Aryal
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal.,Nyaya Health Nepal, Kathmandu, Nepal
| | - Phanindra Prasad Baral
- Department of Health Services, Non Communicable Diseases and Mental Health Section, Epidemiology and Disease Control Division, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Rajendra Dev Bhatt
- Department of Biochemistry, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal.,Faculty of Medical Sciences, School of Health Sciences, Wuhan University, Wuhan, China
| | - Sanju Bhattarai
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Durga Bista
- Department of Pharmacy, Kathmandu University, Dhulikhel, Kavre, Nepal
| | - David Citrin
- Possible, New York, NY, USA.,Department of Global Health, University of Washington, Seattle, WA, USA.,Department of Anthropology, University of Washington, Seattle, WA, USA.,Medic, Seattle, WA, USA.,Icahn School of Medicine at Mount Sinai, Arnhold Institute for Global Health, New York, NY, USA
| | - Meghnath Dhimal
- Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal
| | - Annette L Fitzpatrick
- Departments of Family Medicine, Epidemiology, and Global Health, University of Washington, Seattle, USA
| | | | - Robin Man Karmacharya
- Department of Surgery (Cardio Thoracic and Vascular unit), Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Sushmita Mali
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Tamanna Neupane
- Nepal Health Research Council, Ramshah Path, Kathmandu, Nepal
| | - Natalia Oli
- Department of Community Medicine, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | - Rajan Pandit
- Department of Physiology, Nepal Medical College and Teaching Hospital, Attarkhel, Kathmandu, Nepal
| | - Surya Bahadur Parajuli
- Department of Community Medicine, Birat Medical College and Teaching Hospital, Biratnagar, Morang, Nepal
| | - Pranil Man Singh Pradhan
- Department of Community Medicine, Maharajgunj Medical Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Dipanker Prajapati
- Department of Cardiology, Shahid Gangalal National Heart Centre, Kathmandu, Nepal.,Department of Cardiology, National Academy of Health Sciences, Bir Hospital, Mahaboudha, Kathmandu, Nepal
| | - Manita Pyakurel
- School of Public Health, Central University of Nicaragua, Managua, Nicaragua
| | - Prajjwal Pyakurel
- School of Public Health and Community Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Binuka Kulung Rai
- Department of Community Programs, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Bhim Prasad Sapkota
- Health Coordination Division, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal.,Teaching & Training Unit, Division of Infectious Diseases and Tropical Medicine, University Hospital, LMU, Munich, Germany.,Center for International Health (CIH), Ludwig-Maximilians-Universität, Munich, Germany
| | - Sujata Sapkota
- Department of Pharmacy, Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | - Abha Shrestha
- Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Anmol Purna Shrestha
- Department of General Practice and Emergency Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal
| | - Rajeev Shrestha
- Department of Pharmacology, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal.,Pharmacovigilance unit/ Research and Development Division, Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| | - Guna Nidhi Sharma
- Policy, Planning and Monitoring Division, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Sumitra Sharma
- Department of Nursing, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal.,School of Nursing, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Donna Spiegelman
- Center for Methods in Implementation and Preventive Science and Department of Biostatistics, Yale School of Public Health, New Haven, USA
| | - Punya Shori Suwal
- Department of Public Health, Nepal Institute of Health Sciences, Stupa Health Care Center Cooperative Limited, Jorpati, Kathmandu, Nepal
| | - Bobby Thapa
- Department of Nursing, Nepalgunj Nursing Campus, Institute of Medicine, Tribhuvan University, Banke, Nepalgunj, Nepal
| | - Abhinav Vaidya
- Department of Community Medicine, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | - Dong Xu
- Global Health Institute, Sun Yat-Sen University, Guangzhou, China
| | - Lijing L Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, China.,Peking University School of Global Health and Development, Beijing, China
| | - Rajendra Koju
- Dean, Kathmandu University School of Medical Sciences, Dhulikhel, Kavre, Nepal.,Department of Medicine (Cardiology), Dhulikhel Hospital Kathmandu University Hospital, Dhulikhel, Kavre, Nepal
| |
Collapse
|
3
|
Mboera LEG, Rumisha SF, Mbata D, Mremi IR, Lyimo EP, Joachim C. Data utilisation and factors influencing the performance of the health management information system in Tanzania. BMC Health Serv Res 2021; 21:498. [PMID: 34030696 PMCID: PMC8146252 DOI: 10.1186/s12913-021-06559-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 05/20/2021] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Health Management Information System (HMIS) is a set of data regularly collected at health care facilities to meet the needs of statistics on health services. This study aimed to determine the utilisation of HMIS data and factors influencing the health system's performance at the district and primary health care facility levels in Tanzania. METHODS This cross-sectional study was carried out in 11 districts and involved 115 health care facilities in Tanzania. Data were collected using a semi-structured questionnaire administered to health workers at facility and district levels and documented using an observational checklist. Thematic content analysis approach was used to synthesise and triangulate the responses and observations to extract essential information. RESULTS A total of 93 healthcare facility workers and 13 district officials were interviewed. About two-thirds (60%) of the facility respondents reported using the HMIS data, while only five out of 13 district respondents (38.5%) reported analysing HMIS data routinely. The HMIS data were mainly used for comparing performance in terms of services coverage (53%), monitoring of disease trends over time (50%), and providing evidence for community health education and promotion programmes (55%). The majority (41.4%) of the facility's personnel had not received any training on data management related to HMIS during the past 12 months prior to the survey. Less than half (42%) of the health facilities had received supervisory visits from the district office 3 months before this assessment. Nine district respondents (69.2%) reported systematically receiving feedback on the quality of their reports monthly and quarterly from higher authorities. Patient load was described to affect staff performance on data collection and management frequently. CONCLUSION Inadequate analysis and poor data utilisation practices were common in most districts and health facilities in Tanzania. Inadequate human and financial resources, lack of incentives and supervision, and lack of standard operating procedures on data management were the significant challenges affecting the HMIS performance in Tanzania.
Collapse
Affiliation(s)
- Leonard E G Mboera
- SACIDS Foundation for One Health, Sokoine University of Agriculture, P.O. Box 3297, Chuo Kikuu, Morogoro, Tanzania.
| | - Susan F Rumisha
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania.,Malaria Atlas Project, Geospatial Health and Development, Telethon Kids Institute, West Perth, Western Australia
| | - Doris Mbata
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
| | - Irene R Mremi
- SACIDS Foundation for One Health, Sokoine University of Agriculture, P.O. Box 3297, Chuo Kikuu, Morogoro, Tanzania.,National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
| | - Emanuel P Lyimo
- National Institute for Medical Research, Headquarters, Dar es Salaam, Tanzania
| | - Catherine Joachim
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| |
Collapse
|
4
|
Desta BF, Abitew A, Beshir IA, Argaw MD, Abdlkader S. Leadership, governance and management for improving district capacity and performance: the case of USAID transform: primary health care. BMC Fam Pract 2020; 21:252. [PMID: 33276728 PMCID: PMC7718658 DOI: 10.1186/s12875-020-01337-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 11/29/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Primary health care (PHC) in Ethiopia serves as the main entry point for preventive, promotive and curative health services. The district health office is responsible for the planning, implementation and evaluation of all district health activities. In addition, district health offices manage service delivery facilities working on provision of PHC - primary hospitals, health centers and health posts. As the leader of the health care system tier, district health management must ensure direction, alignment and commitment within teams and organizations and make sure that achievements are consistent with the vision, values and strategy of the organization. USAID Transform: Primary Health Care provides diverse support to improve district health manager competencies including in-service trainings followed by planning and implementation of performance improvement projects and on-the-job mentoring and support. METHODS This study was conducted to compare district level capacity and performances between leadership, management and governance (LMG) and non-LMG districts. Project outcome monitoring data that shows the performance of districts was collected from 284 districts from January to December 2019. The study was carried out using a comparative-cross sectional study design, which assessed and compared district health office level indicators. Districts were classified into two categories: LMG and non-LMG districts. The study compared data from 94 LMG and 190 non-LMG districts. Propensity score matching was used to control the effect of differences between LMG and non-LMG districts. RESULTS Results of the independent samples t-test revealed that LMG districts scored better average performances of 61.8 ± 121.45 standard deviation (SD) compared to non-LMG districts 56.89 ± 110.39 SD, with t (282243) = - 3.407317 and p < 0.001, two-tailed. The difference of 4.9 percentage unit in the average performance indicated a statistically significant difference between the LMG and non-LMG districts. CONCLUSION District level leadership development program contributes to improving district capacity, structure and management practices, and quality of care.
Collapse
Affiliation(s)
- Binyam Fekadu Desta
- USAID Transform: Primary Health Care, JSI Training & Research Institute Inc. in Ethiopia, P.O. Box 1392, 1110, Addis Ababa, Ethiopia.
| | - Azeb Abitew
- USAID Transform: Primary Health Care, JSI Training & Research Institute Inc. in Ethiopia, P.O. Box 1392, 1110, Addis Ababa, Ethiopia
| | - Ismael Ali Beshir
- USAID Transform: Primary Health Care, JSI Training & Research Institute Inc. in Ethiopia, P.O. Box 1392, 1110, Addis Ababa, Ethiopia
| | - Mesele Damte Argaw
- USAID Transform: Primary Health Care, JSI Training & Research Institute Inc. in Ethiopia, P.O. Box 1392, 1110, Addis Ababa, Ethiopia
| | - Sualiha Abdlkader
- USAID Transform: Primary Health Care, JSI Training & Research Institute Inc. in Ethiopia, P.O. Box 1392, 1110, Addis Ababa, Ethiopia
| |
Collapse
|
5
|
Qin VM, McPake B, Raban MZ, Cowling TE, Alshamsan R, Chia KS, Smith PC, Atun R, Lee JT. Rural and urban differences in health system performance among older Chinese adults: cross-sectional analysis of a national sample. BMC Health Serv Res 2020; 20:372. [PMID: 32366235 PMCID: PMC7197140 DOI: 10.1186/s12913-020-05194-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 04/06/2020] [Indexed: 12/16/2022] Open
Abstract
Background Despite improvement in health outcomes over the past few decades, China still experiences striking rural-urban health inequalities. There is limited research on the rural-urban differences in health system performance in China. Method We conducted a cross-sectional analysis to compare health system performance between rural and urban areas in five key domains of the health system: effectiveness, cost, access, patient-centredness and equity, using data from the WHO Study on Global AGEing and adult health (SAGE), China. Multiple logistic and linear regression models were used to assess the first four domains, adjusting for individual characteristics, and a relative index of inequality (RII) was used to measure the equity domain. Findings Compared to urban areas, rural areas had poorer performance in the management and control of hypertension and diabetes, with more than 50% lower odds of having breast (AOR = 0.44; 95% CI: 0.30, 0.64) and cervical cancer screening (AOR = 0.49; 95% CI: 0.29, 0.83). There was better performance in rural areas in the patient-centredness domain, with more than twice higher odds of getting prompt attention, respect, clarity of the communication with health provider and involvement in decision making of the treatment in inpatient care (AOR = 2.56, 2.15, 2.28, 2.28). Although rural residents incurred relatively less out-of-pocket expenditures (OOPE) for outpatient and inpatient services than urban residents, they were more likely to incur catastrophic expenditures on health (AOR = 1.30; 95% CI 1.16, 1.44). Wealth inequality was found in many indicators related to the effectiveness, costs and access domains in both rural and urban areas. Rural areas had greater inequalities in the management of hypertension and coverage of cervical cancer (RII = 7.45 vs 1.64). Conclusion Our findings suggest that urban areas have achieved better prevention and management of non-communicable disease than rural areas, but access to healthcare was equivalent. A better understanding of the causes of the observed variations is needed to develop appropriate policy interventions which address these disparities.
Collapse
Affiliation(s)
- Vicky Mengqi Qin
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | - Barbara McPake
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Magdalena Z Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Thomas E Cowling
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Riyadh Alshamsan
- Department of Primary Care and Public Health, School of Public Health, Imperial College, London, UK
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Peter C Smith
- Centre for Health Economics, University of York, York, UK.,Imperial College London, London, UK
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, USA.,Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - John Tayu Lee
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia.,Department of Primary Care and Public Health, School of Public Health, Imperial College, London, UK
| |
Collapse
|
6
|
Nkwanyana NM, Voce AS. Are there decision support tools that might strengthen the health system for perinatal care in South African district hospitals? A review of the literature. BMC Health Serv Res 2019; 19:731. [PMID: 31640655 PMCID: PMC6805543 DOI: 10.1186/s12913-019-4583-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 10/09/2019] [Indexed: 11/20/2022] Open
Abstract
Background South Africa has a high burden of perinatal deaths in spite of the availability of evidence-based interventions. The majority of preventable perinatal deaths occur in district hospitals and are mainly related to the functioning of the health system. Particularly, leadership in district hospitals needs to be strengthened in order to decrease the burden of perinatal mortality. Decision-making is a key function of leaders, however leaders in district hospitals are not supported to make evidence-based decisions. The aim of this research was to identify health system decision support tools that can be applied at district hospital level to strengthen decision-making in the health system for perinatal care in South Africa. Methods A structured approach, the systematic quantitative literature review method, was conducted to find published articles that reported on decision support tools to strengthen decision-making in a health system for perinatal, maternal, neonatal and child health. Articles published in English between 2003 and 2017 were sought through the following search engines: Google Scholar, EBSCOhost and Science Direct. Furthermore, the electronic databases searched were: Academic Search Complete, Health Source – Consumer Edition, Health Source – Nursing/Academic Edition and MEDLINE. Results The search yielded 6366 articles of which 43 met the inclusion criteria for review. Four decision support tools identified in the articles that met the inclusion criteria were the Lives Saved Tool, Maternal and Neonatal Directed Assessment of Technology model, OneHealth Tool, and Discrete Event Simulation. The analysis reflected that none of the identified decision support tools could be adopted at district hospital level to strengthen decision-making in the health system for perinatal care in South Africa. Conclusion There is a need to either adapt an existing decision support tool or to develop a tool that will support decision-making at district hospital level towards strengthening the health system for perinatal care in South Africa.
Collapse
Affiliation(s)
- Ntombifikile Maureen Nkwanyana
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, George Campbell Building Room 215, Howard Campus, Durban, KwaZulu-Natal Province, South Africa.
| | - Anna Silvia Voce
- Discipline of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, George Campbell Building Room 215, Howard Campus, Durban, KwaZulu-Natal Province, South Africa
| |
Collapse
|
7
|
Menear M, Blanchette MA, Demers-Payette O, Roy D. A framework for value-creating learning health systems. Health Res Policy Syst 2019; 17:79. [PMID: 31399114 PMCID: PMC6688264 DOI: 10.1186/s12961-019-0477-3] [Citation(s) in RCA: 110] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 07/15/2019] [Indexed: 01/08/2023] Open
Abstract
Background Interest in value-based healthcare, generally defined as providing better care at lower cost, has grown worldwide, and learning health systems (LHSs) have been proposed as a key strategy for improving value in healthcare. LHSs are emerging around the world and aim to leverage advancements in science, technology and practice to improve health system performance at lower cost. However, there remains much uncertainty around the implementation of LHSs and the distinctive features of these systems. This paper presents a conceptual framework that has been developed in Canada to support the implementation of value-creating LHSs. Methods The framework was developed by an interdisciplinary team at the Institut national d’excellence en santé et en services sociaux (INESSS). It was informed by a scoping review of the scientific and grey literature on LHSs, regular team discussions over a 14-month period, and consultations with Canadian and international experts. Results The framework describes four elements that characterise LHSs, namely (1) core values, (2) pillars and accelerators, (3) processes and (4) outcomes. LHSs embody certain core values, including an emphasis on participatory leadership, inclusiveness, scientific rigour and person-centredness. In addition, values such as equity and solidarity should also guide LHSs and are particularly relevant in countries like Canada. LHS pillars are the infrastructure and resources supporting the LHS, whereas accelerators are those specific structures that enable more rapid learning and improvement. For LHSs to create value, such infrastructures must not only exist within the ecosystem but also be connected and aligned with the LHSs’ strategic goals. These pillars support the execution, routinisation and acceleration of learning cycles, which are the fundamental processes of LHSs. The main outcome sought by executing learning cycles is the creation of value, which we define as the striking of a more optimal balance of impacts on patient and provider experience, population health and health system costs. Conclusions Our framework illustrates how the distinctive structures, processes and outcomes of LHSs tie together with the aim of optimising health system performance and delivering greater value in health systems. Electronic supplementary material The online version of this article (10.1186/s12961-019-0477-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Matthew Menear
- Institut national d'excellence en santé et en services sociaux (INESSS), Quebec, Canada. .,Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Landry-Poulin Pavilion, 2525 chemin de la Canardière, Quebec, QC, G1J 0A4, Canada.
| | | | | | - Denis Roy
- Institut national d'excellence en santé et en services sociaux (INESSS), Quebec, Canada
| |
Collapse
|
8
|
Prenissl J, Jaacks LM, Mohan V, Manne-Goehler J, Davies JI, Awasthi A, Bischops AC, Atun R, Bärnighausen T, Vollmer S, Geldsetzer P. Variation in health system performance for managing diabetes among states in India: a cross-sectional study of individuals aged 15 to 49 years. BMC Med 2019; 17:92. [PMID: 31084606 PMCID: PMC6515628 DOI: 10.1186/s12916-019-1325-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/15/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Understanding where adults with diabetes in India are lost in the diabetes care cascade is essential for the design of targeted health interventions and to monitor progress in health system performance for managing diabetes over time. This study aimed to determine (i) the proportion of adults with diabetes in India who have reached each step of the care cascade and (ii) the variation of these cascade indicators among states and socio-demographic groups. METHODS We used data from a population-based household survey carried out in 2015 and 2016 among women and men aged 15-49 years in all states of India. Diabetes was defined as a random blood glucose (RBG) ≥ 200 mg/dL or reporting to have diabetes. The care cascade-constructed among those with diabetes-consisted of the proportion who (i) reported having diabetes ("aware"), (ii) had sought treatment ("treated"), and (iii) had sought treatment and had a RBG < 200 mg/dL ("controlled"). The care cascade was disaggregated by state, rural-urban location, age, sex, household wealth quintile, education, and marital status. RESULTS This analysis included 729,829 participants. Among those with diabetes (19,453 participants), 52.5% (95% CI, 50.6-54.4%) were "aware", 40.5% (95% CI, 38.6-42.3%) "treated", and 24.8% (95% CI, 23.1-26.4%) "controlled". Living in a rural area, male sex, less household wealth, and lower education were associated with worse care cascade indicators. Adults with untreated diabetes constituted the highest percentage of the adult population (irrespective of diabetes status) aged 15 to 49 years in Goa (4.2%; 95% CI, 3.2-5.2%) and Tamil Nadu (3.8%; 95% CI, 3.4-4.1%). The highest absolute number of adults with untreated diabetes lived in Tamil Nadu (1,670,035; 95% CI, 1,519,130-1,812,278) and Uttar Pradesh (1,506,638; 95% CI, 1,419,466-1,589,832). CONCLUSIONS There are large losses to diabetes care at each step of the care cascade in India, with the greatest loss occurring at the awareness stage. While health system performance for managing diabetes varies greatly among India's states, improvements are particularly needed for rural areas, those with less household wealth and education, and men. Although such improvements will likely have the greatest benefits for population health in Goa and Tamil Nadu, large states with a low diabetes prevalence but a high absolute number of adults with untreated diabetes, such as Uttar Pradesh, should not be neglected.
Collapse
Affiliation(s)
- Jonas Prenissl
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany. .,Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Lindsay M Jaacks
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Public Health Foundation of India, New Delhi, Delhi NCR, India
| | - Viswanathan Mohan
- Madras Diabetes Research Foundation & Dr. Mohan's Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Jennifer Manne-Goehler
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Division of Infectious Diseases, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Justine I Davies
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Education Campus, University of Witwatersrand, Johannesburg, Gauteng, South Africa.,Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Ashish Awasthi
- Indian Institute of Public Health, Gandhinagar, Gujarat, India
| | - Anne Christine Bischops
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Harvard Medical School, Harvard University, Boston, MA, USA
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130/3, 69120, Heidelberg, Germany.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Africa Health Research Institute, Mtubatuba, KwaZulu-Natal, South Africa
| | - Sebastian Vollmer
- Department of Economics and Centre for Modern Indian Studies, University of Goettingen, Göttingen, Germany
| | - Pascal Geldsetzer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
9
|
Sabot K, Wickremasinghe D, Blanchet K, Avan B, Schellenberg J. Use of social network analysis methods to study professional advice and performance among healthcare providers: a systematic review. Syst Rev 2017; 6:208. [PMID: 29058638 PMCID: PMC5651641 DOI: 10.1186/s13643-017-0597-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 10/02/2017] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Social network analysis quantifies and visualizes relationships between and among individuals or organizations. Applications in the health sector remain underutilized. This systematic review seeks to analyze what social network methods have been used to study professional communication and performance among healthcare providers. METHODS Ten databases were searched from 1990 through April 2016, yielding 5970 articles screened for inclusion by two independent reviewers who extracted data and critically appraised each study. Inclusion criteria were study of health care worker professional communication, network methods used, and patient outcomes measured. The search identified 10 systematic reviews. The final set of articles had their citations prospectively and retrospectively screened. We used narrative synthesis to summarize the findings. RESULTS The six articles meeting our inclusion criteria described unique health sectors: one at primary healthcare level and five at tertiary level; five conducted in the USA, one in Australia. Four studies looked at multidisciplinary healthcare workers, while two focused on nurses. Two studies used mixed methods, four quantitative methods only, and one involved an experimental design. Four administered network surveys, one coded observations, and one used an existing survey to extract network data. Density and centrality were the most common network metrics although one study did not calculate any network properties and only visualized the network. Four studies involved tests of significance, and two used modeling methods. Social network analysis software preferences were evenly split between ORA and UCINET. All articles meeting our criteria were published in the past 5 years, suggesting that this remains in clinical care a nascent but emergent research area. There was marked diversity across all six studies in terms of research questions, health sector area, patient outcomes, and network analysis methods. CONCLUSION Network methods are underutilized for the purposes of understanding professional communication and performance among healthcare providers. The paucity of articles meeting our search criteria, lack of studies in middle- and low-income contexts, limited number in non-tertiary settings, and few longitudinal, experimental designs, or network interventions present clear research gaps. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015019328.
Collapse
Affiliation(s)
- Kate Sabot
- The Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK. .,Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Deepthi Wickremasinghe
- The Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Karl Blanchet
- Department of Global Health, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Bilal Avan
- The Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Joanna Schellenberg
- The Centre for Maternal, Adolescent, Reproductive and Child Health (MARCH), London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| |
Collapse
|
10
|
Fekri O, Leeb K, Gurevich Y. Systematic approach to evaluating and confirming the utility of a suite of national health system performance (HSP) indicators in Canada: a modified Delphi study. BMJ Open 2017; 7:e014772. [PMID: 28404612 PMCID: PMC5775456 DOI: 10.1136/bmjopen-2016-014772] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Evaluating an existing suite of health system performance (HSP) indicators for continued reporting using a systematic criteria-based assessment and national consensus conference. DESIGN Modified Delphi approach with technical and leadership groups, an online survey of stakeholders and convening a national consensus conference. SETTING A national health information steward, the Canadian Institute for Health Information (CIHI). PARTICIPANTS A total of 73 participants, comprised 61 conference attendants/stakeholders from across Canada and 12 national health information steward staff. PRIMARY AND SECONDARY OUTCOME MEASURES Indicator dispositions of retention, additional stakeholder consultation, further redevelopment or retirement. RESULTS 4 dimensions (usability, importance, scientific soundness and feasibility) typically used to select measures for reporting were expanded to 18 criteria grouped under the 4 dimensions through a process of research and testing. Definitions for each criterion were developed and piloted. Once the definitions were established, 56 of CIHI's publicly reported HSP indicators were evaluated against the criteria using modified Delphi approaches. Of the 56 HSP indicators evaluated, 9 measures were ratified for retirement, 7 were identified for additional consultation and 3 for further research and development. A pre-Consensus Conference survey soliciting feedback from stakeholders on indicator recommendations received 48 responses (response rate of 79%). CONCLUSIONS A systematic evaluation of HSP indicators informed the development of objective recommendations for continued reporting. The evaluation was a fruitful exercise to identify technical considerations for calculating indicators, furthering our understanding of how measures are used by stakeholders, as well as harmonising actions that could be taken to ensure relevancy, reduce indicator chaos and build consensus with stakeholders.
Collapse
Affiliation(s)
- Omid Fekri
- Canadian Institute for Health Information, Toronto, Ontario, Canada
| | - Kira Leeb
- Canadian Institute for Health Information, Toronto, Ontario, Canada
| | - Yana Gurevich
- Canadian Institute for Health Information, Toronto, Ontario, Canada
| |
Collapse
|
11
|
Abstract
Background The perceived responsiveness of a healthcare system reflects its ability to satisfy reasonable expectations of the public with respect to non-medical services. Recently, there has been increasing attention paid to responsiveness in evaluating the performance of a healthcare system in a variety of service settings. However, the factors that affect the responsiveness have been inconclusive so far and measures of improved responsiveness have not always thoroughly considered the factors. The aim of this study was to evaluate both the responsiveness of the healthcare system in Jiangsu Province, China, the factors that influence responsiveness and the measures of improved responsiveness considering it, as determined by a responsiveness survey. Methods A multistage, stratified random sampling method was used to select 1938 adult residents of Jiangsu Province in 2011. Face-to-face interviews were conducted using a self-designed questionnaire modeled on the World Health Organization proposal. The final analysis was based on 1783 (92%) valid questionnaires. Canonical correlation analysis was used to assess the factors that affect responsiveness. Results The average score of all responsiveness-related domains in the surveyed healthcare system was satisfactory (7.50 out of a maximum 10.0). The two highest scoring domains were dignity and confidentiality, and the two lowest scoring domains choice and prompt attention. The factors affecting responsiveness were age, regional economic development level, and geographic area (urban vs. rural). The responsiveness regarding basic amenities was rated worse by the elderly than by younger respondents. Responsiveness ranked better by those with a poorer economic status. Choice in cities was better than in rural regions. Conclusions The responsiveness of the Jiangsu healthcare system was considered to be satisfactory but could be improved by offering greater choice and providing more prompt attention. Perceptions of healthcare system responsiveness differ with age, regional economic development level, and geographic area (urban vs. rural). Measures to increase the perceived level of responsiveness include better service at higher level hospitals, shorter waiting time, more hospitals in rural regions, an improved medical environment, and provision of infrastructures that makes the medical environments more comfortable. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-1980-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jianqian Chao
- Department of Medical insurance, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Boyang Lu
- Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Hua Zhang
- Department of Medical insurance, Key Laboratory of Environmental Medicine Engineering of Ministry of Education, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Liguo Zhu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Hui Jin
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing, Jiangsu, China
| | - Pei Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Southeast University, Nanjing, Jiangsu, China.
| |
Collapse
|
12
|
Abstract
Introduction One of the principal goals of any health care system is to improve health through the provision of clinical and public health services. Decentralization as a reform measure aims to improve inputs, management processes and health outcomes, and has political, administrative and financial connotations. It is argued that the robustness of a health system in achieving desirable outcomes is contingent upon the width and depth of ‘decision space’ at the local level. Studies have used different approaches to examine one or more facets of decentralization and its effect on health system functioning; however, lack of consensus on an acceptable framework is a critical gap in determining its quantum and quality. Theorists have resorted to concepts of ‘trust’, ‘convenience’ and ‘mutual benefits’ to explain, define and measure components of governance in health. In the emerging ‘continuum of health services’ model, the challenge lies in identifying variables of performance (fiscal allocation, autonomy at local level, perception of key stakeholders, service delivery outputs, etc.) through the prism of decentralization in the first place, and in establishing directed relationships among them. Methods This focused review paper conducted extensive web-based literature search, using PubMed and Google Scholar search engines. After screening of key words and study objectives, we retrieved 180 articles for next round of screening. One hundred and four full articles (three working papers and 101 published papers) were reviewed in totality. We attempted to summarize existing literature on decentralization and health systems performance, explain key concepts and essential variables, and develop a framework for further scientific scrutiny. Themes are presented in three separate segments of dimensions, difficulties and derivatives. Results Evaluation of local decision making and its effect on health system performance has been studied in a compartmentalized manner. There is sparse evidence about innovations attributable to decentralization. We observed that in India, there is very scant evaluative study on the subject. We didn’t come across a single study examining the perception and experiences of local decision makers about the opportunities and challenges they faced. The existing body of evidences may be inadequate to feed into sound policy making. The principles of management hinge on measurement of inputs, processes and outputs. In the conceptual framework we propose three levels of functions (health systems functions, management functions and measurement functions) being intricately related to inputs, processes and outputs. Each level of function encompasses essential elements derived from the synthesis of information gathered through literature review and non-participant observation. We observed that it is difficult to quantify characteristics of governance at institutional, system and individual levels except through proxy means. Conclusion There is an urgent need to sensitize governments and academia about how best more objective evaluation of ‘shared governance’ can be undertaken to benefit policy making. The future direction of enquiry should focus on context-specific evidence of its effect on the entire spectrum of health system, with special emphasis on efficiency, community participation, human resource management and quality of services.
Collapse
Affiliation(s)
- Bhuputra Panda
- Public Health Foundation of India, IIPH-Bhubaneswar, Bhubaneswar, India.
| | | |
Collapse
|
13
|
McMurray J, Zhu L, McKillop I, Chen H. Ontological modeling of electronic health information exchange. J Biomed Inform 2015; 56:169-78. [PMID: 26065983 DOI: 10.1016/j.jbi.2015.05.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Revised: 04/19/2015] [Accepted: 05/28/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Investments of resources to purposively improve the movement of information between health system providers are currently made with imperfect information. No inventories of system-level electronic health information flows currently exist, nor do measures of inter-organizational electronic information exchange. METHODS Using Protégé 4, an open-source OWL Web ontology language editor and knowledge-based framework, we formalized a model that decomposes inter-organizational electronic health information flow into derivative concepts such as diversity, breadth, volume, structure, standardization and connectivity. RESULTS The ontology was populated with data from a regional health system and the flows were measured. Individual instance's properties were inferred from their class associations as determined by their data and object property rules. It was also possible to visualize interoperability activity for regional analysis and planning purposes. A property called Impact was created from the total number of patients or clients that a health entity in the region served in a year, and the total number of health service providers or organizations with whom it exchanged information in support of clinical decision-making, diagnosis or treatment. Identifying providers with a high Impact but low Interoperability score could assist planners and policy-makers to optimize technology investments intended to electronically share patient information across the continuum of care. Finally, we demonstrated how linked ontologies were used to identify logical inconsistencies in self-reported data for the study.
Collapse
Affiliation(s)
- J McMurray
- School of Public Health and Health Systems, University of Waterloo, Canada; School of Business & Economics/Health Studies, Wilfrid Laurier University, Canada.
| | - L Zhu
- School of Public Health and Health Systems, University of Waterloo, Canada
| | - I McKillop
- School of Public Health and Health Systems, University of Waterloo, Canada; David R Cheriton School of Computer Science, University of Waterloo, Canada
| | - H Chen
- School of Public Health and Health Systems, University of Waterloo, Canada; David R Cheriton School of Computer Science, University of Waterloo, Canada
| |
Collapse
|
14
|
Brigo F, Igwe SC, Ausserer H, Tezzon F, Nardone R, Otte WM. Epilepsy-related stigma in European people with epilepsy: correlations with health system performance and overall quality of life. Epilepsy Behav 2015; 42:18-21. [PMID: 25513766 DOI: 10.1016/j.yebeh.2014.11.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 10/30/2014] [Accepted: 11/15/2014] [Indexed: 10/24/2022]
Abstract
We aimed to relate the percentages of encountered epilepsy-related stigma in people with epilepsy with quantitative indicators of the quality of health systems and quality of life by country in Europe. The epilepsy-related stigma percentages were obtained from the largest population-based study in people with epilepsy available. We correlated percentages of people with perceived stigma per European country with data on the country's overall health system performance, health expenditure per capita in international dollars, and the Economist Intelligence Unit's quality-of-life index. We found a nonsignificant trend towards negative correlation between the epilepsy-related stigma percentage and the overall health system performance (r=-0.16; p=0.57), the health expenditure per capita in international dollars (r=-0.24; p=0.4), and the Economist Intelligence Unit's quality-of-life index (r=-0.33; p=0.91). Living in a European country with a better health system performance and higher health expenditure per capita does not necessarily lead to a reduction in perceived epilepsy-related discrimination, unless the public health system invests on awareness programs to increase public knowledge and reduce stigma.
Collapse
Affiliation(s)
- Francesco Brigo
- Department of Neurological and Movement Sciences, Section of Clinical Neurology, University of Verona, Italy; Department of Neurology, Franz Tappeiner Hospital, Merano, Italy.
| | - Stanley C Igwe
- Department of Neuro-Psychiatry, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | - Harald Ausserer
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - Frediano Tezzon
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy
| | - Raffaele Nardone
- Department of Neurology, Franz Tappeiner Hospital, Merano, Italy; Department of Neurology, Christian Doppler Clinic, Paracelsus Medical University, Salzburg, Austria
| | - Willem M Otte
- Department of Pediatric Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, The Netherlands; Biomedical MR Imaging and Spectroscopy Group, Image Sciences Institute, University Medical Center Utrecht, The Netherlands
| |
Collapse
|
15
|
Franken M, Koolman X. Health system goals: a discrete choice experiment to obtain societal valuations. Health Policy 2013; 112:28-34. [PMID: 23357376 DOI: 10.1016/j.healthpol.2012.12.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 12/20/2012] [Accepted: 12/21/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To improve previous approaches to health system goals valuation. METHODS We reviewed literature on health system performance and previous comparative performance assessments, and combined this with literature on process utility to create a theoretical foundation for health system goals. We used a discrete choice experiment to elicit goal weights. To obtain social justice weights respondents were placed behind a 'veil of ignorance'. To ensure that respondents understood their task, we instructed them in a classroom setting. RESULTS We identified five health system goals. All five goals significantly affected choice behavior. An equitable distribution of health obtained the highest weight (0.34), followed by average level of health (0.29) and financial fairness (0.24). Both process outcomes (utility derived from the process and its distribution) received much lower weights (0.07 and 0.06, respectively). CONCLUSIONS Our framework adds to that of the World Health Organization. We demonstrated the feasibility of measuring societal valuation of health system goals with a multi-attribute technique based on trade-offs. Our weights placed much greater emphasis on health and health inequality than on process outcomes. Our study improves the methodology of international health system performance comparison and thereby enhances global evidence-based health policy information.
Collapse
Affiliation(s)
- Margreet Franken
- Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, The Netherlands.
| | | |
Collapse
|