WorldWideScience

Sample records for public healthcare delivery

  1. Preconception healthcare delivery at a population level: construction of public health models of preconception care.

    Science.gov (United States)

    Shannon, Geordan D; Alberg, Corinna; Nacul, Luis; Pashayan, Nora

    2014-08-01

    A key challenge of preconception healthcare is identifying how it can best be delivered at a population level. To review current strategies of preconception healthcare, explore methods of preconception healthcare delivery, and develop public health models which reflect different preconception healthcare pathways. Preconception care strategies, programmes and evaluations were identified through a review of Medline and Embase databases. Search terms included: preconception, pre-pregnancy, intervention, primary care, healthcare, model, delivery, program, prevention, trial, effectiveness, congenital disorders OR abnormalities, evaluation, assessment, impact. Inclusion criteria for review articles were: (1) English, (2) human subjects, (3) women of childbearing age, (4) 1980–current data, (5) all countries, (6) both high risk and universal approaches, (7) guidelines or recommendations, (8) opinion articles, (9) experimental studies. Exclusion criteria were: (1) non-human subjects, (2) non-English, (3) outside of the specified timeframe, (4) articles on male healthcare. The results of the literature review were synthesised into public health models of care: (1) primary care; (2) hospital-based and inter-conception care; (3) specific preconception care clinics; and, (4) community outreach. Fifteen evaluations of preconception care were identified. Community programmes demonstrated a significant impact on substance use, folic acid supplementation, diabetes optimization, and hyperphenylalaninemia. An ideal preconception visits entail risk screening, education, and intervention if indicated. Subsequently, four public health models were developed synthesizing preconception care delivery at a population level. Heterogeneity of risk factors, health systems and strategies of care reflect the lack of consensus about the best way to deliver preconception care. The proposed models aim to reflect differing aspects of preconception healthcare delivery.

  2. Constraints, challenges and prospects of public-private partnership in health-care delivery in a developing economy.

    Science.gov (United States)

    Anyaehie, Usb; Nwakoby, Ban; Chikwendu, C; Dim, Cc; Uguru, N; Oluka, Cpi; Ogugua, C

    2014-01-01

    In Nigeria, concerns on the quality and financing of health-care delivery especially in the public sector have initiated reforms including support for public-private partnerships (PPP) at the Federal Ministry of Health. Likewise, Enugu State has developed a draft policy on PPP since 2005. However, non-validation and non-implementation of this policy might have led to loss of interest in the partnership. The aim of this study was to provide evidence for planning the implementation of PPP in Enugu State health system via a multi-sectoral identification of challenges, constraints and prospects. Pre-tested questionnaires were administered to 466 respondents (251 health workers and 215 community members), selected by multi-stage sampling method from nine Local Government Areas of Enugu State, Nigeria, over a study period of April 2011 to September 2011. Data from the questionnaires were collated manually and quantitative data analyzed using SPSS version 15 (Chicago, IL, USA). Only 159 (34.1%, 159/466) of all respondents actually understood the meaning of PPP though 251 (53.9%) of them had claimed knowledge of the concept. This actual understanding was higher among health workers (57.8%, 145/251) when compared with the community members (6.5%, 14/215) (P < 0.001). Post-PPP enlightenment reviews showed a more desire for PPP implementation among private health-care workers (89.4%, 101/113) and community leaders/members (55.4%, 119/215). PPP in health-care delivery in Enugu State is feasible with massive awareness, elaborate stakeholder's engagements and well-structured policy before implementation. A critical challenge will be to convince the public sector workers who are the anticipated partners to accept and support private sector participation.

  3. Steering healthcare service delivery: a regulatory perspective.

    Science.gov (United States)

    Prakash, Gyan

    2015-01-01

    The purpose of this paper is to explore regulation in India's healthcare sector and makes recommendations needed for enhancing the healthcare service. The literature was reviewed to understand healthcare's regulatory context. To understand the current healthcare system, qualitative data were collected from state-level officials, public and private hospital staff. A patient survey was performed to assess service quality (QoS). Regulation plays a central role in driving healthcare QoS. India needs to strengthen market and institutional co-production based approaches for steering its healthcare in which delivery processes are complex and pose different challenges. This study assesses current healthcare regulation in an Indian state and presents a framework for studying and strengthening regulation. Agile regulation should be based on service delivery issues (pull approach) rather than monitoring and sanctions based regulatory environment (push approach). Healthcare pitfalls across the world seem to follow similar follies. India's complexity and experience is useful for emerging and developed economies. The author reviewed around 70 publications and synthesised them in healthcare regulatory contexts. Patient's perception of private providers could be a key input towards steering regulation. Identifying gaps across QoS dimensions would be useful in taking corrective measures.

  4. Improving the effectiveness of service delivery in the public healthcare sector: the case of ophthalmology services in Malaysia.

    Science.gov (United States)

    Foo, Chee Yoong; Lim, Ka Keat; Sivasampu, Sheamini; Dahian, Kamilah Binti; Goh, Pik Pin

    2015-08-28

    Rising demand of ophthalmology care is increasingly straining Malaysia's public healthcare sector due to its limited human and financial resources. Improving the effectiveness of ophthalmology service delivery can promote national policy goals of population health improvement and system sustainability. This study examined the performance variation of public ophthalmology service in Malaysia, estimated the potential output gain and investigated several factors that might explain the differential performance. Data for 2011 and 2012 on 36 ophthalmology centres operating in the Ministry of Health hospitals were used in this analysis. We first consulted a panel of ophthalmology service managers to understand the production of ophthalmology services and to verify the production model. We then assessed the relative performance of these centres using Data Envelopment Analysis (DEA). Efficiency scores (ES) were decomposed into technical, scale, and congestion component. Potential increase in service output was estimated. Sensitivity analysis of model changes was performed and stability of the result was assessed using bootstrap approach. Second stage Tobit regression was conducted to determine if hospital type, availability of day services and population characteristics were related to the DEA scores. In 2011, 33% of the ophthalmology centres were found to have ES > 1 (mean ES = 1.10). Potential output gains were 10% (SE ± 2.92), 7.4% (SE ± 2.06), 6.9% (SE ± 1.97) if the centres could overcome their technical, scale and congestion inefficiencies. More centres moved to the performance frontier in 2012 (mean ES = 1.07), with lower potential output gain. The model used has good stability. Robustness checks show that the DEA correctly identified low performing centres. Being in state hospital was significantly associated with better performance. Using DEA to benchmarking service performance of ophthalmology care could provide insights for policy

  5. Factors influencing HPV vaccine delivery by healthcare professionals at public health posts in São Paulo, Brazil.

    Science.gov (United States)

    Figueroa-Downing, Daniella; Baggio, Maria Luiza; Baker, Misha L; Dias De Oliveira Chiang, Ellen; Villa, Luisa L; Eluf Neto, Jose; Evans, Dabney P; Bednarczyk, Robert A

    2017-01-01

    To assess the association between Brazilian healthcare providers' characteristics and their knowledge, perceptions, and practices regarding the HPV vaccine. An observational cross-sectional study was conducted at five public health posts in São Paulo between July 28 and August 8, 2014. Healthcare professionals directly involved in patient care were asked to complete a written survey. Factors associated with routine verification of HPV vaccination status were evaluated using Poisson regression. Among 200 participants included, 74 (38.5%) reported never and 70 (36.5%) reported always asking about HPV immunization status. Doctors were significantly less likely to report always asking than were community health agents (5/39 [12.8%] vs 32/60 [53.3%]; adjusted prevalence ratio [aPR] 0.25 [95% confidence interval (CI) 0.07-0.91]). Knowledge about the correct dosing schedule was associated with always rather than never verifying vaccination status (aPR 2.46 [95% CI 1.06-5.70]). Knowledge and attitude played secondary roles in influencing HPV vaccine verification. Community health agents were crucial for vaccine promotion; continued education and support of this group is essential for the sustained success of HPV immunization efforts in Brazil. © 2016 International Federation of Gynecology and Obstetrics.

  6. Integration of research and practice to improve public health and healthcare delivery through a collaborative 'Health Integration Team' model - a qualitative investigation.

    Science.gov (United States)

    Redwood, Sabi; Brangan, Emer; Leach, Verity; Horwood, Jeremy; Donovan, Jenny L

    2016-06-22

    Economic considerations and the requirement to ensure the quality, safety and integration of research with health and social care provision have given rise to local developments of collaborative organisational forms and strategies to span the translational gaps. One such model - the Health Integration Team (HIT) model in Bristol in the United Kingdom (UK) - brings together National Health Service (NHS) organisations, universities, local authorities, patients and the public to facilitate the systematic application of evidence to promote integration across healthcare pathways. This study aimed to (1) provide empirical evidence documenting the evolution of the model; (2) to identify the social and organisational processes and theory of change underlying healthcare knowledge and practice; and (3) elucidate the key aspects of the HIT model for future development and translation to other localities. Contemporaneous documents were analysed, using procedures associated with Framework Analysis to produce summarised data for descriptive accounts. In-depth interviews were undertaken with key informants and analysed thematically. Comparative methods were applied to further analyse the two data sets. One hundred forty documents were analysed and 10 interviews conducted with individuals in leadership positions in the universities, NHS commissioning and provider organisations involved in the design and implementation of the HIT model. Data coalesced around four overarching themes: 'Whole system' engagement, requiring the active recruitment of all those who have a stake in the area of practice being considered, and 'collaboration' to enable coproduction were identified as 'process' themes. System-level integration and innovation were identified as potential 'outcomes' with far-reaching impacts on population health and service delivery. The HIT model emerged as a particular response to the perceived need for integration of research and practice to improve public health and

  7. Engineering the system of healthcare delivery

    National Research Council Canada - National Science Library

    Rouse, William B; Cortese, Denis A

    2010-01-01

    "As the United States continues to debate reform of its healthcare system, this book argues that providing health insurance for all without improving the delivery system will not improve the current...

  8. Six Sigma in healthcare delivery.

    Science.gov (United States)

    Liberatore, Matthew J

    2013-01-01

    The purpose of this paper is to conduct a comprehensive review and assessment of the extant Six Sigma healthcare literature, focusing on: application, process changes initiated and outcomes, including improvements in process metrics, cost and revenue. Data were obtained from an extensive literature search. Healthcare Six Sigma applications were categorized by functional area and department, key process metric, cost savings and revenue generation (if any) and other key implementation characteristics. Several inpatient care areas have seen most applications, including admission, discharge, medication administration, operating room (OR), cardiac and intensive care. About 42.1 percent of the applications have error rate as their driving metric, with the remainder focusing on process time (38 percent) and productivity (18.9 percent). While 67 percent had initial improvement in the key process metric, only 10 percent reported sustained improvement. Only 28 percent reported cost savings and 8 percent offered revenue enhancement. These results do not favorably assess Six Sigma's overall effectiveness and the value it offers healthcare. Results are based on reported applications. Future research can include directly surveying healthcare organizations to provide additional data for assessment. Future application should emphasize obtaining improvements that lead to significant and sustainable value. Healthcare staff can use the results to target promising areas. This article comprehensively assesses Six Sigma healthcare applications and impact.

  9. Implementation of Fee-Free Maternal Health-Care Policy in Ghana: Perspectives of Users of Antenatal and Delivery Care Services From Public Health-Care Facilities in Accra.

    Science.gov (United States)

    Anafi, Patricia; Mprah, Wisdom K; Jackson, Allen M; Jacobson, Janelle J; Torres, Christopher M; Crow, Brent M; O'Rourke, Kathleen M

    2018-01-01

    In 2008, the government of Ghana implemented a national user fee maternal care exemption policy through the National Health Insurance Scheme to improve financial access to maternal health services and reduce maternal as well as perinatal deaths. Although evidence shows that there has been some success with this initiative, there are still issues relating to cost of care to beneficiaries of the initiative. A qualitative study, comprising 12 focus group discussions and 6 interviews, was conducted with 90 women in six selected urban neighborhoods in Accra, Ghana, to examine users' perspectives regarding the implementation of this policy initiative. Findings showed that direct cost of delivery care services was entirely free, but costs related to antenatal care services and indirect costs related to delivery care still limit the use of hospital-based midwifery and obstetric care. There was also misunderstanding about the initiative due to misinformation created by the government through the media.We recommend that issues related to both direct and indirect costs of antenatal and delivery care provided in public health-care facilities must be addressed to eliminate some of the lingering barriers relating to cost hindering the smooth operation and sustainability of the maternal care fee exemption policy.

  10. Financing public healthcare institutions in Ghana.

    Science.gov (United States)

    Akortsu, Mercy Akosua; Abor, Patience Aseweh

    2011-01-01

    The financing of healthcare services has been of a major concern to all governments in the face of increasing healthcare costs. For developing countries, where good health is considered a poverty reduction strategy, it is imperative that the hospitals used in the delivery of healthcare services are well financed to accomplish their tasks. The purpose of this paper is to examine how public hospitals in Ghana are financed, and the challenges facing the financing modes adopted. To achieve the objectives of the study, one major public healthcare institution in Ghana became the main focus. The findings of the study revealed that the main sources of financing the public healthcare institution are government subvention, internally-generated funds and donor-pooled funds. Of these sources, the internally generated fund was regarded as the most reliable, and the least reliable was the donor-pooled funds. Several challenges associated with the various financing sources were identified. These include delay in receipt of government subvention, delay in the reimbursement of services provided to subscribers of health insurance schemes, influence of government in setting user fees, and the specifications to which donor funds are put. The findings of this study have important implications for improving the financing of public healthcare institutions in Ghana. A number of recommendations are provided in this regard.

  11. Harnessing the privatisation of China's fragmented health-care delivery.

    Science.gov (United States)

    Yip, Winnie; Hsiao, William

    2014-08-30

    Although China's 2009 health-care reform has made impressive progress in expansion of insurance coverage, much work remains to improve its wasteful health-care delivery. Particularly, the Chinese health-care system faces substantial challenges in its transformation from a profit-driven public hospital-centred system to an integrated primary care-based delivery system that is cost effective and of better quality to respond to the changing population needs. An additional challenge is the government's latest strategy to promote private investment for hospitals. In this Review, we discuss how China's health-care system would perform if hospital privatisation combined with hospital-centred fragmented delivery were to prevail--population health outcomes would suffer; health-care expenditures would escalate, with patients bearing increasing costs; and a two-tiered system would emerge in which access and quality of care are decided by ability to pay. We then propose an alternative pathway that includes the reform of public hospitals to pursue the public interest and be more accountable, with public hospitals as the benchmarks against which private hospitals would have to compete, with performance-based purchasing, and with population-based capitation payment to catalyse coordinated care. Any decision to further expand the for-profit private hospital market should not be made without objective assessment of its effect on China's health-policy goals. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. Situation Analysis of Healthcare Service Delivery using ...

    African Journals Online (AJOL)

    ISML5

    7. No. 1, AARSE 2017 Special Edition, January 2017. 75. Situation Analysis of ... then becomes a major bottleneck to proper planning and policy formulation in healthcare delivery. ... Uganda Annual Health Sector Performance Report for Financial Year 2014/15 ... government's strategy of taking services closer to the people.

  13. Improving Outcomes in the Nigeria Healthcare Sector through Public ...

    African Journals Online (AJOL)

    PPP) model in the Country's healthcare sector. Public - Private Interaction offers opportunity of leveraging private sector investment in the sector and further enhances improvements in service delivery as well as increases access to quality ...

  14. PUBLIC FINANCING OF HEALTHCARE SERVICES

    Directory of Open Access Journals (Sweden)

    Agnieszka Bem

    2013-10-01

    Full Text Available Healthcare in Poland is mainly financed by public sector entities, among them the National Health Fund (NFZ, state budget and local government budgets. The task of the National Health Fund, as the main payer in the system, is chiefly currently financing the services. The state budget plays a complementary role in the system, and finances selected groups of services, health insurance premiums and investments in healthcare infrastructure. The basic role of the local governments is to ensure access to the services, mostly by performing ownership functions towards healthcare institutions.

  15. Utilizing Health Information Technology to Support Universal Healthcare Delivery: Experience of a National Healthcare System.

    Science.gov (United States)

    Syed-Abdul, Shabbir; Hsu, Min-Huei; Iqbal, Usman; Scholl, Jeremiah; Huang, Chih-Wei; Nguyen, Phung Anh; Lee, Peisan; García-Romero, Maria Teresa; Li, Yu-Chuan Jack; Jian, Wen-Shan

    2015-09-01

    Recent discussions have focused on using health information technology (HIT) to support goals related to universal healthcare delivery. These discussions have generally not reflected on the experience of countries with a large amount of experience using HIT to support universal healthcare on a national level. HIT was compared globally by using data from the Ministry of the Interior, Republic of China (Taiwan). Taiwan has been providing universal healthcare since 1995 and began to strategically implement HIT on a national level at that time. Today the national-level HIT system is more extensive in Taiwan than in many other countries and is used to aid administration, clinical care, and public health. The experience of Taiwan thus can provide an illustration of how HIT can be used to support universal healthcare delivery. In this article we present an overview of some key historical developments and successes in the adoption of HIT in Taiwan over a 17-year period, as well as some more recent developments. We use this experience to offer some strategic perspectives on how it can aid in the adoption of large-scale HIT systems and on how HIT can be used to support universal healthcare delivery.

  16. Analysis and Improvement of Healthcare Delivery Processes in ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    ... delivery processes given the district's limited human and financial resources. ... Throughout this period of instability and unrest, Lacor Hospital has delivered critical ... and; strengthen the hospital's decision-making around healthcare delivery ...

  17. Evaluation of chloroquine as a potent anti-malarial drug: issues of public health policy and healthcare delivery in post-war Liberia.

    Science.gov (United States)

    Massaquoi, Moses B F; Kennedy, Stephen B

    2003-02-01

    Chloroquine-resistant plasmodium falciparum malaria is a serious public health threat that is spreading rapidly across Sub-Saharan Africa. It affects over three quarters (80%) of malarial endemic countries. Of the estimated 300-500 million cases of malaria reported annually, the vast majority of malarial-related morbidities occur among young children in Africa, especially those concentrated in the remote rural areas with inadequate access to appropriate health care services. In Liberia, in vivo studies conducted between 1993 and 2000 observed varying degrees of plasmodium falciparum malaria infections that were resistant to chloroquine, including sulfadiazine-pyrimethamine. As the country emerges from a prolonged civil war, the health care delivery system may not be adequately prepared to implement an effective nation-wide malarial control strategy. As a result, the management of uncomplicated malaria in Liberia poses a significant public health challenge for the government-financed health care delivery system. Therefore, based on extensive literature review, we report the failure of chloroquine as an effective first-line drug for the treatment of uncomplicated plasmodium falciparum malaria in Liberia and recommend that national health efforts be directed at identifying alternative drug(s) to replace it.

  18. Innovation in Healthcare Delivery: Commentary on an Evolutionary Approach.

    Science.gov (United States)

    Fields, Anthony L A

    2015-01-01

    Zwarenstein (2015) proposes a novel approach to healthcare innovation that parallels biological evolution, based on stimulation and reward of multiple small competing innovation projects conducted in the field by decentralized teams. Projects would be designed with explicit outcome targets and results would be widely disseminated and publicly available. More successful projects would be grown and spread. Critical to the model is accepting and reporting failure as well as success, for the benefit of future project design. Examining biological evolution for lessons for healthcare delivery innovation illuminates the need for diversity among healthcare systems to achieve optimum application of best practice interventions across jurisdictions with differing population, provider and facility characteristics. However, careful coordination will be needed to achieve the balance between diversity and harmony across jurisdictions necessary for effective governance and interaction. There are important methodological issues to be addressed to reduce the uncertainty inherent in comparisons of results among discrete innovation projects, especially when observed improvements over the baseline are modest. As well as evolutionary improvement in healthcare outcomes, the model should progressively increase decentralized capacity and expertise in innovation processes.

  19. Public healthcare interests require strict competition enforcement.

    Science.gov (United States)

    Loozen, Edith M H

    2015-07-01

    Several countries have introduced competition in their health systems in order to maintain the supply of high quality health care in a cost-effective manner. The introduction of competition triggers competition enforcement. Since healthcare is characterized by specific market failures, many favor healthcare-specific competition enforcement in order not only to account for the competition interest, but also for the healthcare interests. The question is whether healthcare systems based on competition can succeed when competition enforcement deviates from standard practice. This paper analyzes whether healthcare-specific competition enforcement is theoretically sound and practically effective. This is exemplified by the Dutch system that is based on regulated competition and thus crucially depends on getting competition enforcement right. Governments are responsible for correcting market failures. Markets are responsible for maximizing the public healthcare interests. By securing sufficient competitive pressure, competition enforcement makes sure they do. When interpreted according to welfare-economics, competition law takes into account both costs and benefits specific market behavior may have for healthcare. Competition agencies and judiciary are not legitimized to deviate from standard evidentiary requirements. Dutch case law shows that healthcare-specific enforcement favors the healthcare undertakings concerned, but to the detriment of public health care. Healthcare-specific competition enforcement is conceptually flawed and counterproductive. In order for healthcare systems based on competition to succeed, competition enforcement should be strict. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  20. Components of Maternal Healthcare Delivery System Contributing to ...

    African Journals Online (AJOL)

    Components of Maternal Healthcare Delivery System Contributing to Maternal Deaths ... transcripts were analyzed using a directed approach to content analysis. Excerpts were categorized according to three main components of the maternal ...

  1. Environmental sustainability in European public healthcare.

    Science.gov (United States)

    Chiarini, Andrea; Vagnoni, Emidia

    2016-01-01

    Purpose - The purpose of this paper is to enlarge the debate concerning the influence of leadership on environmental sustainability implementation in European public healthcare organisations. Design/methodology/approach - This paper is a viewpoint. It is based on preliminary analysis of European standards dedicated to environmental sustainability and their spread across Europe in public healthcare organisations. Viewpoints concerning leadership are then discussed and asserted. Findings - This paper found a limited implementation of standards such as Green Public Procurement criteria, Eco-Management and Audit Scheme and ISO 14001 in public healthcare. Some clues indicate that the lack of implementation is related to leadership and management commitment. Originality/value - For the first time, this paper investigates relationships between leadership and environmental sustainability in European public healthcare opening further avenues of research on the subject.

  2. Improving Outcomes in the Nigeria Healthcare Sector through Public ...

    African Journals Online (AJOL)

    Nigeria's healthcare sector over the years has continued to degenerate with health indicators ... in service delivery as well as increases access to quality healthcare. ... Key words: Nigeria, Healthcare Sector, Health Outcomes, Health Indicators, ...

  3. Artificial Intelligence and Public Healthcare Service Innovation

    DEFF Research Database (Denmark)

    Sun, Tara Qian; Medaglia, Rony

    Public healthcare ecosystems are complex networks of diverse actors that are subject to pressures to innovate, also a result of technological advancements. Artificial Intelligence (AI), in particular, has the potential to transform the way hospitals, doctors, patients, government agencies...

  4. Healthcare service delivery: a literature review

    CSIR Research Space (South Africa)

    Arhete, LE

    2016-05-01

    Full Text Available African government is in the process of implementing a multibillion rand national health insurance (NHI) programme intended to revamp the entire national health system to among others, ensure affordability and accessibility to healthcare. The purpose...

  5. Situation Analysis of Healthcare Service Delivery using ...

    African Journals Online (AJOL)

    ISML5

    Geography plays an important role in planning and allocation of healthcare resources for an effective and efficient ... utilization and gaps in resource allocation, and to develop propositions to support the health policy. Facility survey and .... Figure 2. Location of health centres against population density in Sironko district ...

  6. Benchmarking and Learning in Public Healthcare

    DEFF Research Database (Denmark)

    Buckmaster, Natalie; Mouritsen, Jan

    2017-01-01

    This research investigates the effects of learning-oriented benchmarking in public healthcare settings. Benchmarking is a widely adopted yet little explored accounting practice that is part of the paradigm of New Public Management. Extant studies are directed towards mandated coercive benchmarking...

  7. Assessment of the administration of healthcare service delivery in ...

    African Journals Online (AJOL)

    The study examined the structure and mode of administration in Obafemi Awolowo University Teaching Hospitals Complex Ile-Ife Nigeria; and also assessed the impact of the structure and mode of administration on the service delivery in the hospital. These were with a view to assessing the administration of healthcare ...

  8. Public trust in the healthcare system in a developing country.

    Science.gov (United States)

    Peters, Dexnell; Youssef, Farid F

    2016-04-01

    Broadly defined, trust in the healthcare system is concerned with how the public perceives the system and the actors therein as it pertains to their ability to both deliver services and seek the best interests of their clientele. Trust is important because it impacts upon a range of health behaviors including compliance and ultimately affects the ability of the healthcare system to meet its goals. While several studies exist on public trust within the developed world, few studies have explored this issue in developing countries. This paper therefore assesses public trust in the healthcare system of a developing small island nation, Trinidad and Tobago. A cross-sectional survey of adults was conducted using a questionnaire that has been successfully used across Europe. We report that trust levels in the healthcare system in Trinidad and Tobago are relatively low with less than 50% of persons indicating fair trust in the healthcare system. In addition, individual health professionals also did not score highly with lowest scores found for nurses and complementary therapists. Results on four out of five dimensions of trust also demonstrated scores significantly lower than those reported in more developed nations. Open-ended comments supported these findings with the majority of persons indicating a lack of confidence in the healthcare system. These results may reflect the reality in the wider developing world, and we suggest that bolstering trust is a needed area of focus in the delivery of healthcare services throughout the nation. Copyright © 2014 John Wiley & Sons, Ltd. Copyright © 2014 John Wiley & Sons, Ltd.

  9. Benchmarking and Learning in Public Healthcare

    DEFF Research Database (Denmark)

    Buckmaster, Natalie; Mouritsen, Jan

    2017-01-01

    This research investigates the effects of learning-oriented benchmarking in public healthcare settings. Benchmarking is a widely adopted yet little explored accounting practice that is part of the paradigm of New Public Management. Extant studies are directed towards mandated coercive benchmarking...... applications. The present study analyses voluntary benchmarking in a public setting that is oriented towards learning. The study contributes by showing how benchmarking can be mobilised for learning and offers evidence of the effects of such benchmarking for performance outcomes. It concludes that benchmarking...... can enable learning in public settings but that this requires actors to invest in ensuring that benchmark data are directed towards improvement....

  10. Patient-centredness in integrated healthcare delivery systems - needs, expectations and priorities for organised healthcare systems.

    Science.gov (United States)

    Juhnke, Christin; Mühlbacher, Axel C

    2013-01-01

    Patient-centred healthcare is becoming a more significant success factor in the design of integrated healthcare systems. The objective of this study is to structure a patient-relevant hierarchy of needs and expectations for the design of organised healthcare delivery systems. A questionnaire with 84 items was conducted with N = 254 healthcare experts and N = 670 patients. Factor analyses were performed using SPSS©18. The number of factors retained was controlled by Kaiser's criterion, validation of screeplots and interpretability of the items. Cronbach's α was used to assess the internal consistency of the subscales. Exploratory factor analysis led to 24 factors in the expert sample and 20 in the patient sample. After analysing the screeplots, confirmatory factor analyses were computed for 7-factor solutions accounting for 42.963% of the total variance and Kaiser-Meyer-Olkin of 0.914 for the patients (experts: 38.427%, Kaiser-Meyer-Olkin = 0.797). Cronbach's α ranged between 0.899 and 0.756. Based on the analysis, coordinated care could be differentiated into seven dimensions: access, data and information, service and infrastructure, professional care, interpersonal care, individualised care, continuity and coordination. The study provides insight into patient and experts expectations towards the organisation of integrated healthcare delivery systems. If providers and payers can take into account patient needs and expectations while implementing innovative healthcare delivery systems, greater acceptance and satisfaction will be achieved. In the best case, this will lead to better adherence resulting in better clinical outcomes.

  11. The effect of healthcare delivery privatisation on avoidable mortality: longitudinal cross-regional results from Italy, 1993-2003.

    Science.gov (United States)

    Quercioli, Cecilia; Messina, Gabriele; Basu, Sanjay; McKee, Martin; Nante, Nicola; Stuckler, David

    2013-02-01

    During the 1990s, Italy privatised a significant portion of its healthcare delivery. The authors compared the effectiveness of private and public sector healthcare delivery in reducing avoidable mortality (deaths that should not occur in the presence of effective medical care). The authors calculated the average rate of change in age-standardised avoidable mortality rates in 19 of Italy's regions from 1993 to 2003. Multivariate regression models were used to analyse the relationship between rates of change in avoidable mortality and levels of spending on public versus private healthcare delivery, controlling for potential demographic and economic confounders. Greater spending on public delivery of health services corresponded to faster reductions in avoidable mortality rates. Each €100 additional public spending per capita on NHS delivery was independently associated with a 1.47% reduction in the rate of avoidable mortality (p=0.003). In contrast, spending on private sector services had no statistically significant effect on avoidable mortality rates (p=0.557). A higher percentage of spending on private sector delivery was associated with higher rates of avoidable mortality (p=0.002). The authors found that neither public nor private sector delivery spending was significantly associated with non-avoidable mortality rates, plausibly because non-avoidable mortality is insensitive to healthcare services. Public spending was significantly associated with reductions in avoidable mortality rates over time, while greater private sector spending was not at the regional level in Italy.

  12. Healthcare delivery systems: designing quality into health information systems.

    Science.gov (United States)

    Joyce, Phil; Green, Rosamund; Winch, Graham

    2007-01-01

    To ensure that quality is 'engineered in' a holistic, integrated and quality approach is required, and Total Quality Management (TQM) principles are the obvious foundations for this. This paper describes a novel approach to viewing the operations of a healthcare provider where electronic means could be used to distribute information (including electronic fund settlements), building around the Full Service Provider core. Specifically, an approach called the "triple pair flow" model is used to provide a view of healthcare delivery that is integrated, yet detailed, and that combines the strategic enterprise view with a business process view.

  13. The impact of the consumer on healthcare delivery.

    Science.gov (United States)

    Scott, Cheryl M

    2003-01-01

    The authors of the lead articles are correct that the customer experience should be at the forefront of our attention and work in healthcare delivery. Expanding our current definitions of customer satisfaction and patient safety to include the important intangibles of "experience" will be key. However, a singular focus on patient or consumer experience is not enough in the long run. A solid business model and an understanding of the healthcare market dynamics are also required. The promises we make in support of our business strategy are at the core of how we interact with our patients, how we ensure their safety, and how we build their loyalty. Our work as healthcare leaders should be to keep those promises.

  14. From Data to Improved Decisions: Operations Research in Healthcare Delivery.

    Science.gov (United States)

    Capan, Muge; Khojandi, Anahita; Denton, Brian T; Williams, Kimberly D; Ayer, Turgay; Chhatwal, Jagpreet; Kurt, Murat; Lobo, Jennifer Mason; Roberts, Mark S; Zaric, Greg; Zhang, Shengfan; Schwartz, J Sanford

    2017-11-01

    The Operations Research Interest Group (ORIG) within the Society of Medical Decision Making (SMDM) is a multidisciplinary interest group of professionals that specializes in taking an analytical approach to medical decision making and healthcare delivery. ORIG is interested in leveraging mathematical methods associated with the field of Operations Research (OR) to obtain data-driven solutions to complex healthcare problems and encourage collaborations across disciplines. This paper introduces OR for the non-expert and draws attention to opportunities where OR can be utilized to facilitate solutions to healthcare problems. Decision making is the process of choosing between possible solutions to a problem with respect to certain metrics. OR concepts can help systematically improve decision making through efficient modeling techniques while accounting for relevant constraints. Depending on the problem, methods that are part of OR (e.g., linear programming, Markov Decision Processes) or methods that are derived from related fields (e.g., regression from statistics) can be incorporated into the solution approach. This paper highlights the characteristics of different OR methods that have been applied to healthcare decision making and provides examples of emerging research opportunities. We illustrate OR applications in healthcare using previous studies, including diagnosis and treatment of diseases, organ transplants, and patient flow decisions. Further, we provide a selection of emerging areas for utilizing OR. There is a timely need to inform practitioners and policy makers of the benefits of using OR techniques in solving healthcare problems. OR methods can support the development of sustainable long-term solutions across disease management, service delivery, and health policies by optimizing the performance of system elements and analyzing their interaction while considering relevant constraints.

  15. Impact of managed care on healthcare delivery practices: the perception of healthcare administrators and clinical practitioners.

    Science.gov (United States)

    Tietze, Mari F

    2003-01-01

    Managed care has introduced changes, such as cost effectiveness, access to care, and quality of care, to many components of the U.S. healthcare delivery system. These changes have affected how healthcare administrators and clinical practitioners perceive the impact of managed care on healthcare delivery practices. A survey was initiated to explore whether the perceptions of administrators differed from those of practitioners and to discover which organizational variables could explain the difference. A descriptive, cross-sectional survey design was used for the target population of administrators and practitioners in high, moderate, and low managed-care-penetration markets. Two investigator-developed instruments--the Managed Care Perceptions Inventory (MCPI) and the MCPI-Demographic--and an intact centralization of decision-making assessment subscale were used for data collection. Administrators had a statistically significant, more positive perception of the impact of managed care on healthcare delivery than did practitioners. When the distinction between administrator and practitioner was not used as a grouping factor, managed care market penetration, nonprofit status, and years in current employment position were factors that had statistically significant associations with a more positive perception of managed care. Based on these findings, both administrators and practitioners have a role in maintaining awareness regarding their perceptions and should work collaboratively to address issues of concern. Similarly, promoting trust and commitment at the organizational level is important. Recommendations for further research are also provided.

  16. Patient-centeredness in Integrated healthcare delivery systems - Needs, expectations and priorities for organized healthcare systems

    Directory of Open Access Journals (Sweden)

    Christin Juhnke

    2013-11-01

    Full Text Available Introduction: Patient-centred healthcare is becoming a more significant success factor in the design of integrated healthcare systems. The objective of this study is to structure a patient-relevant hierarchy of needs and expectations for the design of organised healthcare delivery systems. Methods: A questionnaire with 84 items was conducted with N = 254 healthcare experts and N = 670 patients. Factor analyses were performed using SPSS©18. The number of factors retained was controlled by Kaiser's criterion, validation of screeplots and interpretability of the items. Cronbach's α was used to assess the internal consistency of the subscales. Results: Exploratory factor analysis led to 24 factors in the expert sample and 20 in the patient sample. After analysing the screeplots, confirmatory factor analyses were computed for 7-factor solutions accounting for 42.963% of the total variance and Kaiser–Meyer–Olkinof 0.914 for the patients (experts: 38.427%, Kaiser–Meyer–Olkin = 0.797. Cronbach's α ranged between 0.899 and 0.756. Based on the analysis, coordinated care could be differentiated into seven dimensions: access, data and information, service and infrastructure, professional care, interpersonal care, individualised care, continuity and coordination. Conclusion and Discussion: The study provides insight into patient and experts expectations towards the organisation of integrated healthcare delivery systems. If providers and payers can take into account patient needs and expectations while implementing innovative healthcare delivery systems, greater acceptance and satisfaction will be achieved. In the best case, this will lead to better adherence resulting in better clinical outcomes.

  17. Patient-centeredness in Integrated healthcare delivery systems - Needs, expectations and priorities for organized healthcare systems

    Directory of Open Access Journals (Sweden)

    Christin Juhnke

    2013-11-01

    Full Text Available Introduction: Patient-centred healthcare is becoming a more significant success factor in the design of integrated healthcare systems. The objective of this study is to structure a patient-relevant hierarchy of needs and expectations for the design of organised healthcare delivery systems.Methods: A questionnaire with 84 items was conducted with N = 254 healthcare experts and N = 670 patients. Factor analyses were performed using SPSS©18. The number of factors retained was controlled by Kaiser's criterion, validation of screeplots and interpretability of the items. Cronbach's α was used to assess the internal consistency of the subscales.Results: Exploratory factor analysis led to 24 factors in the expert sample and 20 in the patient sample. After analysing the screeplots, confirmatory factor analyses were computed for 7-factor solutions accounting for 42.963% of the total variance and Kaiser–Meyer–Olkinof 0.914 for the patients (experts: 38.427%, Kaiser–Meyer–Olkin = 0.797. Cronbach's α ranged between 0.899 and 0.756. Based on the analysis, coordinated care could be differentiated into seven dimensions: access, data and information, service and infrastructure, professional care, interpersonal care, individualised care, continuity and coordination.Conclusion and Discussion: The study provides insight into patient and experts expectations towards the organisation of integrated healthcare delivery systems. If providers and payers can take into account patient needs and expectations while implementing innovative healthcare delivery systems, greater acceptance and satisfaction will be achieved. In the best case, this will lead to better adherence resulting in better clinical outcomes.

  18. Influence of organizational culture on quality healthcare delivery.

    Science.gov (United States)

    Carney, Marie

    2011-01-01

    The purpose of this paper is to identify if aspects of organizational culture may indicate a new terrain in the cultural influences-quality healthcare relationship. This research stems from the author's belief that viewing the role of head of department or directorate as pivotal to health care management is critical to health care planning and quality healthcare delivery. Interviews were undertaken among 50 professional clinician and non-clinician managers working in the role of head of department, in acute care hospitals in Ireland. The sample was drawn from the total population of 850 managers, utilized in a previous survey study. Organizational culture is more complex than was previously thought. Several cultural influences such as excellence in care delivery, ethical values, involvement, professionalism, value-for-money, cost of care, commitment to quality and strategic thinking were found to be key cultural determinants in quality care delivery. Health care managers perceive that in order to deliver quality focused care they need to act in a professional, committed manner and to place excellence at the forefront of care delivery, whilst at the same time being capable of managing the tensions that exist between cost effectiveness and quality of care. These tensions require further research in order to determine if quality of care is affected in a negative manner by those tensions. Originality relates to the new cultural terrain presented in this paper that recognizes the potential of health service managers to influence the organizations' culture and through this influence to take a greater part in ensuring that quality health care is delivered to their patients. It also seems to be important that value-for-money is viewed as an ethical means of delivering healthcare, and not as a conflict between quality and cost.

  19. Reinventing Emergency Department Flow via Healthcare Delivery Science.

    Science.gov (United States)

    DeFlitch, Christopher; Geeting, Glenn; Paz, Harold L

    2015-01-01

    Healthcare system flow resulting in emergency departments (EDs) crowding is a quality and access problem. This case study examines an overcrowded academic health center ED with increasing patient volumes and limited physical space for expansion. ED capacity and efficiency improved via engineering principles application, addressing patient and staffing flows, and reinventing the delivery model. Using operational data and staff input, patient and staff flow models were created, identifying bottlenecks (points of inefficiency). A new flow model of emergency care delivery, physician-directed queuing, was developed. Expanding upon physicians in triage, providers passively evaluate all patients upon arrival, actively manage patients requiring fewer resources, and direct patients requiring complex resources to further evaluation in ED areas. Sustained over time, ED efficiency improved as measured by near elimination of "left without being seen" patients and waiting times with improvement in door to doctor, patient satisfaction, and total length of stay. All improvements were in the setting on increased patient volume and no increase in physician staffing. Our experience suggests that practical application of healthcare delivery science can be used to improve ED efficiency. © The Author(s) 2015.

  20. Private Sector in Indian Healthcare Delivery: Consumer Perspective and Government Policies to promote private Sector

    Directory of Open Access Journals (Sweden)

    Utkarsh Shah, Ragini Mohanty

    2011-01-01

    Full Text Available This research paper attempts to collate literature from various sources, in an attempt to answer three pertinent questions related to healthcare in India. Firstly, what is it meant by ‘private sector’ in healthcare delivery system of India, secondly how has the private sector evolved over the decades and what has been the role of the government in propelling the growth. Finally, the paper tries to highlight some of the factors that have promoted the growth of private sector in India with specific reference to quality of medical care. The paper explicitly indicates that the deficiencies in the public health delivery system of India, was the key to growth of private infrastructure in healthcare.The shift of hospital industry for ‘welfare orientation’ to ‘business orientation’ was marked by the advent of corporate hospitals, supported by various policy level initiatives made by the government. Today, there are over 20 international healthcare brands in India with several corporate hospitals.However, a large section of the ‘private healthcare delivery segment’ is scattered and quality of medical care continues to remain a matter of concern. This paper tracks the various government initiatives to promote private investment in healthcare and attempts to explore the reasons for preference of the private sector. Surprisingly, in contrast to contemporary belief, quality of medical care doesn’t seem to be the leading cause for preference of the private sector. Except for a few select corporate and trust hospitals, quality of medical care in private sector seems to be poor and at times compromised.

  1. Education of healthcare professionals and the public.

    Science.gov (United States)

    McNulty, Cliodna A M; Cookson, Barry D; Lewis, Michael A O

    2012-07-01

    In the winter of 2007-08 a new public-facing antimicrobial campaign was agreed by the Advisory Committee on Antimicrobial Resistance and Healthcare-Associated Infection (ARHAI) Education sub-Group (later divided into subgroups for professional and public education): it comprised posters with a positive message on how the public could help themselves when they had a cold. However, the poster campaign, used in isolation in England, did not improve antibiotic use; therefore, the Public Education sub-Group took forward educational approaches to change the behaviour of the public and health professionals. Professionals have been encouraged to give patients clear information about the likely duration of symptoms, self-care, and benefits and harms of antibiotics, reinforcing the public poster campaigns in surgeries, hospitals and pharmacies. Since 2008, campaigns have been launched in England to coincide with European Antibiotic Awareness Day (EAAD) on 18 November, using Department of Health and EAAD materials. Professional education has been facilitated by the 2008 National Institute for Health and Clinical Excellence respiratory tract infection delayed prescribing guidance for general practitioners. A toolkit of materials for medicines management teams, to facilitate good antimicrobial stewardship in primary care (ASPIC), is being taken forward by the Public Education sub-Group and professional societies. After advice from ARHAI, in 2009 the General Medical Council requested that all postgraduate deans and Royal Colleges ensure infection prevention and control and antimicrobial prescribing become standard practice implemented in all clinical settings, and that they are emphasized strongly in undergraduate and postgraduate medical training. ARHAI has also taken a keen interest in reviewing, advising and leading on a number of European Union initiatives dealing with professional education.

  2. Public-private partnerships and new models of healthcare access

    NARCIS (Netherlands)

    Lange, Joep M. A.; Schellekens, Onno P.; Lindner, Marianne; van der Gaag, Jacques

    2008-01-01

    PURPOSE OF REVIEW: The aim of this article is to lay the ground for the engagement and support of a well managed and effectively regulated private sector in the delivery of healthcare in sub-Saharan Africa. RECENT FINDINGS: About 60% of healthcare financing in sub-Saharan Africa comes from private

  3. Patient assessment within the context of healthcare delivery packages

    DEFF Research Database (Denmark)

    Rossen, Camilla Blach; Buus, Niels; Stenager, Egon

    2016-01-01

    . RESULTS: We constructed five interrelated categories: 1. "Standardized assessing", 2. "Flexibility", which has two sub-categories, 2.1. "Diagnostic options" and 2.2. "Time and organization", and, finally, 3. "Resisting the frames". The process of assessment required all participants to perform...... is a tool for creating coordination, continuity and efficient pathways; each step is pre-booked, and the package has a well-defined content within a predefined category of diseases. The aim of this study was to investigate how assessment processes took place within the context of healthcare delivery...... the predefined work in the specified way at the specified time. Multidisciplinary teamwork was essential for the success of the process. The local organization of the packages influenced the assessment process, most notably the pre-defined scope of relevant diseases targeted by the package. The inflexible frames...

  4. [Beyond the horizon of health-care delivery - medical marketing].

    Science.gov (United States)

    Hoffmann, M; Großterlinden, L G; Rueger, J M; Ruecker, A H

    2014-12-01

    The progress in medical health care and demographic changes cause increasing financial expenses. The rising competitive environment on health-care delivery level calls for economisation and implementation of a professional marketing set-up in order to ensure long-term commercial success. The survey is based on a questionnaire-analysis of 100 patients admitted to a trauma department at a university hospital in Germany. Patients were admitted either for emergency treatment or planned surgical procedures. Competence and localisation represent basic criteria determing hospital choice with a varying focus in each collective. Both collectives realise a trend toward economisation, possibly influencing medical care decision-making. Patients admitted for planned surgical treatment are well informed about their disease, treatment options and specialised centres. The main source of information is the internet. Both collectives claim amenities during their in-hospital stay. Increasing economisation trends call for a sound and distinct marketing strategy. The marketing has to be focused on the stakeholders needs. Concomitant factors are patient satisfaction, the establishment of cooperation networks and maintenance/improvement of medical health-care quality. Georg Thieme Verlag KG Stuttgart · New York.

  5. Demand for private healthcare in a universal public healthcare system: empirical evidence from Sri Lanka.

    Science.gov (United States)

    Pallegedara, Asankha; Grimm, Michael

    2017-11-01

    This paper examines healthcare utilization behaviour in Sri Lanka with special emphasis on the choice between costly private and free public healthcare services. We use a data set that combines nationwide household survey data and district level healthcare supply data. Our findings suggest that even with universal public healthcare policy, richer people tend to use private sector healthcare services rather than public services. We also find significant regional and ethnic discrepancies in healthcare access bearing the risk of social tensions if these are further amplified. Latent class analysis shows in addition that the choice between private and public sector healthcare significantly differs between people with and without chronic diseases. We find in particular that chronically ill people rely for their day-to-day care on the public sector, but for their inpatient care they turn more often than non-chronically ill people to the private sector, implying an additional financial burden for the chronically ill. If the observed trend continues it may not only increase further the health-income gradient in Sri Lanka but also undermine the willingness of the middle class to pay taxes to finance public healthcare. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. Mental Healthcare Delivery in London-Middlesex Ontario - The Next Frontier.

    Science.gov (United States)

    Velji, Karima; Links, Paul

    2016-01-01

    The next frontier for mental healthcare delivery will be focused on three facets of innovation, namely structure, process and outcome. The structure innovation will seek to develop new models of care delivery between the two hospitals and with the community. The process innovation will focus on embedding strategies to adopt a recovery and rehabilitation approach to care delivery. Lastly, the outcome innovation will use system wide quality improvement methods to drive breakthrough performance in mental healthcare.

  7. Patients, the public and priorities in healthcare

    National Research Council Canada - National Science Library

    Littlejohns, Peter; Rawlins, Michael

    2009-01-01

    "Sharing the costs of ill health is the mark of a civilised society. However, every society has limited healthcare resources, and must therefore make finely balanced decisions on how best to allocate...

  8. Migration of women from the Philippines: implications for healthcare delivery.

    Science.gov (United States)

    Tejero, Lourdes Marie S; Fowler, Cathrine

    2012-01-01

    Filipinos have been an important part of the global workforce since the first half of the twentieth century. The initial migration of primarily men has shifted to an increasing numbers of women in recent decades. These changes are primarily attributed to a high demand for domestic workers, nurses and occupations that are female dominated. In 2005, about 70% of the international Labour migrants are women from the Philippines. Living in a foreign land, these women face challenges that affect their physical, emotional and social well being. Especially on their first year living abroad, these women experience significant stress which affects their health as they adjust to a new work environment, culture, social norms, diet, and weather. The emotional strain can be greater for those who have left their families behind in the Philippines and aggravated by the financial need to send money to them. Striking examples, such as the homicide rate of Filipino women married to Australian men being 5.6 times higher than that of Australian-born women, underscores the importance of supportive health care environments and appreciating socio-cultural factors. In the delivery of healthcare services to migrant women, it is critical to consider the unique socio-cultural background of women as well as health beliefs and practices.

  9. The Impact of General Strike on Government Healthcare Delivery in Kerala State in India

    Directory of Open Access Journals (Sweden)

    Aasems Jacob

    2016-01-01

    Full Text Available General strike (also known as hartal is used as a mode of protest by organizations and political parties in India. It is generally thought that hartals negatively impact the healthcare delivery in a society. We used the Right to Information Act to obtain data from government health centers in Kerala state in India for four hartal days (H-day and two control days (A-day and B-day for each H-day, from sixteen health centers including 6 Community Health Center (CHC, 6 Secondary Health Center (SHC, and 4 Tertiary Health Center (THC. Data on emergency room visits was available for six HCs. 15 HCs had a statistically significant decrease in the number of outpatient visits on H-day. There was no difference in the number of outpatient visits between the two control days (A and B in 15 HCs, suggesting the lack of a posthartal surge in visits. Median decrease in outpatient visits in CHCs, SHCs, and THCs was 50.4%, 59.5%, and 47.4%, respectively. Hartal did not impact the number of emergency room visits in 6 out of 7 health centers assessed. Our study identified a significant harmful impact on government healthcare delivery due to hartals in Kerala. These findings have major public health implications.

  10. Public Healthcare Organizations: Leadership or Management?

    Directory of Open Access Journals (Sweden)

    Maite Martínez-Gonzalez

    2016-11-01

    Full Text Available This article studies the type of leadership that managers are currently exercising in the Catalan health system in Catalonia. A questionnaire (MQL-5X was sent to 120 people occupying management positions in healthcare centers and hospitals as well as 14 others who also hold such positions in these healthcare centers and hospitals, were interviewed. The mixed methods research design attests that the Catalan health system is managed through a structure of simultaneous transformational and transactional leadership. However, the efficacy of this system is conditioned purely by the communicative competence that a manager may or may not possess, as the system itself makes no effort to encourage transformational leadership. Transformation leadership inspires positive change, conveys a clear vision and enhances morale, motivation and job performance. It galvanizes a team into changing their expectations and perceptions and motivates them to work towards common goals.

  11. Approaches to organizing public relations functions in healthcare.

    Science.gov (United States)

    Guy, Bonnie; Williams, David R; Aldridge, Alicia; Roggenkamp, Susan D

    2007-01-01

    This article provides health care audiences with a framework for understanding different perspectives of the role and functions of public relations in healthcare organizations and the resultant alternatives for organizing and enacting public relations functions. Using an example of a current issue receiving much attention in US healthcare (improving rates of organ donation), the article provides examples of how these different perspectives influence public relations goals and objectives, definitions of 'public', activities undertaken, who undertakes them and where they fit into the organizational hierarchy.

  12. Maternal healthcare in context: A qualitative study of women's tactics to improve their experience of public healthcare in rural Burkina Faso

    DEFF Research Database (Denmark)

    Østergaard, Lise Rosendal

    2015-01-01

    their chances of having a positive experience with public maternal healthcare. The synthesis of the cases shows that, in a context of poverty and social insecurity, women employ five tactics: establishing good relations with health workers, being mindful of their ‘health booklet’, attending prenatal care......Improving the use of public maternal health facilities to prevent maternal death is a priority in developing countries. Accumulating evidence suggests that a key factor in choosing a facility-based delivery is the collaboration and the communication between healthcare providers and women....... This article attempts to provide a fine-grained understanding of health system deficiencies, healthcare provider practices and women's experiences with maternal public healthcare. This article presents findings from ethnographic research conducted in the Central-East Region of Burkina Faso over a period...

  13. Public Healthcare Services - Component of Tertiary Economy

    Directory of Open Access Journals (Sweden)

    Mircea Bunaciu

    2016-05-01

    Full Text Available The field of public health care is a major social objective in all countries of the world. The public health care assistance reflects an effort organised to protect and promote the health of population, being achievable through political-legislative measures, programs and strategies addressed to the forums in the field of public health, as well as by establishing an organisational framework that would favour the provision of medical services requested by the population. The implementation of the objectives of health policy and strategy is done by the Ministry of Public Health as central authority in the field of public health, and local actions of public health are developed and implemented by the county authorities of public health. Public health authorities in the ascribed territory operate under the subordination of the public health authorities. Also, the county public health authorities coordinate locally the implementation of the activities arising from obligations assumed under the Treaty of Accession of Romania to the European Union and the plans for implementing the Community instruments relating to health.

  14. Improving the Quality and Cost of Healthcare Delivery: The Potential of Radio Frequency Identification (RFID) Technology

    Science.gov (United States)

    Vilamovska, Anna-Marie

    2010-01-01

    The study investigated whether an upcoming class of health information technology (HIT) can be used to address currently outstanding issues in the quality and cost of healthcare delivery. Expert interviews and a literature review were used to describe the 2009 universe of in- and outpatient healthcare RFID applications and to identify those…

  15. Using the Bologna Score to assess normal delivery healthcare

    Directory of Open Access Journals (Sweden)

    Isaiane da Silva Carvalho

    Full Text Available Abstract OBJECTIVE Describing the obstetric care provided in public maternity hospitals during normal labour using the Bologna Score in the city of Natal, Northeastern Brazil. METHOD A quantitative cross-sectional study conducted with 314 puerperal women. Data collection was carried out consecutively during the months of March to July 2014. RESULTS Prenatal care was provided to 95.9% of the mothers, beginning around the 1st trimester of pregnancy (72.3% and having seven or more consultations (51%. Spontaneous vaginal delivery was planned for 88.2% women. All laboring women were assisted by a health professional, mostly by a physician (80.6%, and none of them obtained 5 points on the Bologna Score due to the small percentage of births in non-supine position (0.3% and absence of a partogram (2.2%. A higher number of episiotomies were observed among primiparous women (75.5%. CONCLUSION The score obtained using the Bologna Index was low. Thus, it is necessary to improve and readjust the existing obstetrical model.

  16. The political economy of healthcare reform in China: negotiating public and private.

    Science.gov (United States)

    Daemmrich, Arthur

    2013-01-01

    China's healthcare system is experiencing significant growth from expanded government-backed insurance, greater public-sector spending on hospitals, and the introduction of private insurance and for-profit clinics. An incremental reform process has sought to develop market incentives for medical innovation and liberalize physician compensation and hospital finance while continuing to keep basic care affordable to a large population that pays for many components of care out-of-pocket. Additional changes presently under consideration by policymakers are likely to further restructure insurance and the delivery of care and will alter competitive dynamics in major healthcare industries, notably pharmaceuticals, medical devices, and diagnostic testing. This article describes the institutional history of China's healthcare system and identifies dilemmas emerging as the country negotiates divisions between public and private in healthcare. Building on this analysis, the article considers opportunities for public-private partnerships and greater systems integration to reconcile otherwise incommensurable approaches to rewarding innovation and improving access. The article concludes with observations on the public function of health insurance and its significance to further development of China's healthcare system.

  17. Accounting System in Croatian Public Healthcare Organizations: an Empirical Analysis

    Directory of Open Access Journals (Sweden)

    Davor VAŠIČEK

    2010-06-01

    Full Text Available In considering the adequacy of adopting accruals and IPSASs, this paper tests the appropriateness of existing modified accrual accounting and financial reporting system in Croatian public healthcare sector. The paper indicates that accounting information system contains discrepancies and constraints in assuring true and fair view of organization’s financial position and performance. Our statistics confirms low level of cost and managerial accounting methods development, and external and internal financial reporting convergence.Having in mind its specificities, we argue that Croatian public healthcare sector represents a segmental accounting subsystem within the integral public sector accounting framework, where accruals implementation might prove justifiable.

  18. Reforming primary healthcare: from public policy to organizational change.

    Science.gov (United States)

    Gilbert, Frédéric; Denis, Jean-Louis; Lamothe, Lise; Beaulieu, Marie-Dominique; D'amour, Danielle; Goudreau, Johanne

    2015-01-01

    Governments everywhere are implementing reform to improve primary care. However, the existence of a high degree of professional autonomy makes large-scale change difficult to achieve. The purpose of this paper is to elucidate the change dynamics and the involvement of professionals in a primary healthcare reform initiative carried out in the Canadian province of Quebec. An empirical approach was used to investigate change processes from the inception of a public policy to the execution of changes in professional practices. The data were analysed from a multi-level, combined contextualist-processual perspective. Results are based on a longitudinal multiple-case study of five family medicine groups, which was informed by over 100 interviews, questionnaires, and documentary analysis. The results illustrate the multiple processes observed with the introduction of planned large-scale change in primary care services. The analysis of change content revealed that similar post-change states concealed variations between groups in the scale of their respective changes. The analysis also demonstrated more precisely how change evolved through the introduction of "intermediate change" and how cycles of prescribed and emergent mechanisms distinctively drove change process and change content, from the emergence of the public policy to the change in primary care service delivery. This research was conducted among a limited number of early policy adopters. However, given the international interest in turning to the medical profession to improve primary care, the results offer avenues for both policy development and implementation. The findings offer practical insights for those studying and managing large-scale transformations. They provide a better understanding of how deliberate reforms coexist with professional autonomy through an intertwining of change content and processes. This research is one of few studies to examine a primary care reform from emergence to implementation

  19. Value Creation from Public Healthcare IS

    DEFF Research Database (Denmark)

    Schlichter, Bjarne Rerup; Svejvig, Per; Andersen, Povl Erik Rostgaard

    2014-01-01

    value. During the project, specific key performance indicators (KPIs) were identified and a baseline was established for the stroke process. The outcome is a framework for measuring IS public value as: professional, organizational, patient-perceived and employee-perceived quality as well as learning...

  20. Depression and diabetes: Treatment and health-care delivery

    DEFF Research Database (Denmark)

    Petrak, Frank; Baumeister, Harald; Skinner, Timothy C.

    2015-01-01

    © 2015 Elsevier Ltd. Despite research efforts in the past 20 years, scientific evidence about screening and treatment for depression in diabetes remains incomplete and is mostly focused on North American and European health-care systems. Validated instruments to detect depression in diabetes......, which are often implemented through collaborative care and stepped-care approaches. The evidence for improved glycaemic control in the treatment of depression by use of selective serotonin reuptake inhibitors or psychological approaches is conflicting; only some analyses show small to moderate...... improvements in glycaemic control. More research is needed to evaluate treatment of different depression subtypes in people with diabetes, the cost-effectiveness of treatments, the use of health-care resources, the need to account for cultural differences and different health-care systems, and new treatment...

  1. Using grey literature to prepare pharmacy students for an evolving healthcare delivery system.

    Science.gov (United States)

    Happe, Laura E; Walker, Desiree'

    2013-05-13

    To assess the impact of using "grey literature" (information internally produced in print or electronic format by agencies such as hospitals, government, businesses, etc) rather than a textbook in a course on healthcare delivery systems on students' perception of the relevance of healthcare delivery system topics and their ability to identify credible sources of this information. A reading from the grey literature was identified and assigned to the students for each topic in the course. Pre- and post-course survey instruments were used for the assessment. Students reported healthcare delivery systems topics to be moderately relevant to the profession of pharmacy on both the pre- and post-course survey instruments. Students' knowledge of current and credible sources of information on healthcare delivery system topics significantly improved based on self-reports and scores on objective assessments (pgrey literature in a course on healthcare delivery systems can be used to ensure that information in the pharmacy school curriculum is the most current and credible information available.

  2. Using the Bologna Score to assess normal delivery healthcare.

    Science.gov (United States)

    Carvalho, Isaiane da Silva; Brito, Rosineide Santana de

    2016-01-01

    Describing the obstetric care provided in public maternity hospitals during normal labour using the Bologna Score in the city of Natal, Northeastern Brazil. A quantitative cross-sectional study conducted with 314 puerperal women. Data collection was carried out consecutively during the months of March to July 2014. Prenatal care was provided to 95.9% of the mothers, beginning around the 1st trimester of pregnancy (72.3%) and having seven or more consultations (51%). Spontaneous vaginal delivery was planned for 88.2% women. All laboring women were assisted by a health professional, mostly by a physician (80.6%), and none of them obtained 5 points on the Bologna Score due to the small percentage of births in non-supine position (0.3%) and absence of a partogram (2.2%). A higher number of episiotomies were observed among primiparous women (75.5%). The score obtained using the Bologna Index was low. Thus, it is necessary to improve and readjust the existing obstetrical model. Descrever a assistência obstétrica prestada em maternidades públicas municipais durante o parto normal na cidade de Natal, Nordeste do Brasil, com uso do Índice de Bologna. Estudo transversal com abordagem quantitativa, desenvolvido com 314 puérperas. A coleta de dados processou-se de forma consecutiva durante os meses de março a julho de 2014. A assistência pré-natal foi prestada a 95,9% das puérperas, com início em torno do 1º trimestre de gestação (72,3%) e realização de sete ou mais consultas (51%). O parto vaginal espontâneo foi planejado para 88,2% mulheres. Todas as parturientes foram assistidas por um profissional de saúde, especialmente pelo médico (80,6%) e nenhuma obteve 5 pontos no Índice de Bologna em virtude dos baixos percentuais de partos em posição não supina (0,3%) e ausência do partograma (2,2%). Houve maior número de episiotomias em primíparas (75,5%). A pontuação obtida por meio do Índice de Bologna foi baixa. Desse modo, é preciso melhorar e

  3. Crowding and delivery of healthcare in emergency departments: the European perspective.

    LENUS (Irish Health Repository)

    Jayaprakash, Namita

    2009-11-01

    Emergency department (ED) crowding is a multifactorial problem, resulting in increased ED waiting times, decreased patient satisfaction and deleterious domino effects on the entire hospital. Although difficult to define and once limited to anecdotal evidence, crowding is receiving more attention as attempts are made to quantify the problem objectively. It is a worldwide phenomenon with regional influences, as exemplified when analyzing the problem in Europe compared to that of the United States. In both regions, an aging population, limited hospital resources, staff shortages and delayed ancillary services are key contributors; however, because the structure of healthcare differs from country to country, varying influences affect the issue of crowding. The approach to healthcare delivery as a right of all people, as opposed to a free market commodity, depends on governmental organization and appropriation of funds. Thus, public funding directly influences potential crowding factors, such as number of hospital beds, community care facilities, and staffing. Ultimately ED crowding is a universal problem with distinctly regional root causes; thus, any approach to address the problem must be tailored to regional influences.

  4. The challenges of leading change in health-care delivery from the front-line.

    Science.gov (United States)

    Byers, Vivienne

    2017-09-01

    The public sector is facing turbulent times and this challenges nurses, who are expected to serve both patient interests and the efficiency drives of their organisations. In the context of implementing person-centred health policy, this paper explores the evolving role of front-line nurses as leaders and champions of change. Nurses can be seen to have some autonomy in health-care delivery. However, they are subject to systems of social control. In implementing person-centred policy, nurses can be seen to be doing the best they can within a constrained environment. A survey of nursing practice in person-centred health-policy implementation is presented. Despite much being written about managing health-professional resistance to policy implementation, there is a gap between what is being asked of nurses and the resources made available to them to deliver. In this milieu, nurses are utilising their discretion and leading from the front-line in championing change. Empowering nurses who seek to lead patient involvement could be the key to unlocking health-care improvement. Health services tend to be over-managed and under-led and there is a need to harness the potential of front-line nurses by facilitating leadership development through appropriate organisational support. © 2015 John Wiley & Sons Ltd.

  5. Leaving a mark on healthcare delivery with operations analysis

    NARCIS (Netherlands)

    Vanberkel, P.T.; Golden, B.L.; Seidmann, A.; Zonderland, Maartje Elisabeth; Boucherie, Richardus J.; Hans, Elias W.

    In the Dutch context, we see similar problems as outlined in Green’s (2012) commentary and also an increased interest by healthcare providers to use operations analysis to confront them. In this commentary, we provide our take on the same problems to extend the discussion and to highlight additional

  6. The public healthcare sector and governance in South Africa

    Directory of Open Access Journals (Sweden)

    Melody Brauns

    2015-05-01

    Full Text Available This article reviews literature on governance in order to facilitate an analysis of the governance of the South African public healthcare sector. Some of the key theoretical perspectives have been presented on how best to organise the state and its bureaucracy. Theorists have long interrogated in what way public institutions foster or impede economic growth. Evans and Rauch point out for example, that the role of bureaucratic authority structures in facilitating economic growth has been a sociological concern since Max Weber’s classic contributions almost 100 years ago. These debates and others are explored in this article with specific reference to the provision of equitable public healthcare. Weber’s theory on rational bureaucracy as well as New Public Management will be reviewed as these theories offer two distinct approaches to governance

  7. The public healthcare sector and governance in South Africa

    OpenAIRE

    Melody Brauns

    2015-01-01

    This article reviews literature on governance in order to facilitate an analysis of the governance of the South African public healthcare sector. Some of the key theoretical perspectives have been presented on how best to organise the state and its bureaucracy. Theorists have long interrogated in what way public institutions foster or impede economic growth. Evans and Rauch point out for example, that the role of bureaucratic authority structures in facilitating economic growth has been a soc...

  8. Viability of healthcare service delivery alternatives for the Australian mining sector.

    Science.gov (United States)

    Williams, Patricia A H; Giles, Margaret

    2012-01-01

    The changing and demanding nature of the mining workforce in rural and remote Australia brings unique challenges to the delivery of healthcare services. In an attempt to control costs whilst delivering cost effective and quality healthcare, new models of delivery must be considered. For a workforce that is fly-in/fly-out, the provision of healthcare is problematic given the lack of consistency in location. A cost-benefit framework is analysed comparing three models of service provision using travel to a major location, locum services and remote health monitoring. Ultimately, new models of care must be considered to address the issues of increasing workforce turnover, to cater for rising healthcare costs, and to improve the health of such communities.

  9. Information resources assessment of a healthcare integrated delivery system.

    Science.gov (United States)

    Gadd, C. S.; Friedman, C. P.; Douglas, G.; Miller, D. J.

    1999-01-01

    While clinical healthcare systems may have lagged behind computer applications in other fields in the shift from mainframes to client-server architectures, the rapid deployment of newer applications is closing that gap. Organizations considering the transition to client-server must identify and position themselves to provide the resources necessary to implement and support the infrastructure requirements of client-server architectures and to manage the accelerated complexity at the desktop, including hardware and software deployment, training, and maintenance needs. This paper describes an information resources assessment of the recently aligned Pennsylvania regional Veterans Administration Stars and Stripes Health Network (VISN4), in anticipation of the shift from a predominantly mainframe to a client-server information systems architecture in its well-established VistA clinical information system. The multimethod assessment study is described here to demonstrate this approach and its value to regional healthcare networks undergoing organizational integration and/or significant information technology transformations. PMID:10566414

  10. Information resources assessment of a healthcare integrated delivery system.

    Science.gov (United States)

    Gadd, C S; Friedman, C P; Douglas, G; Miller, D J

    1999-01-01

    While clinical healthcare systems may have lagged behind computer applications in other fields in the shift from mainframes to client-server architectures, the rapid deployment of newer applications is closing that gap. Organizations considering the transition to client-server must identify and position themselves to provide the resources necessary to implement and support the infrastructure requirements of client-server architectures and to manage the accelerated complexity at the desktop, including hardware and software deployment, training, and maintenance needs. This paper describes an information resources assessment of the recently aligned Pennsylvania regional Veterans Administration Stars and Stripes Health Network (VISN4), in anticipation of the shift from a predominantly mainframe to a client-server information systems architecture in its well-established VistA clinical information system. The multimethod assessment study is described here to demonstrate this approach and its value to regional healthcare networks undergoing organizational integration and/or significant information technology transformations.

  11. Economic incentives to promote innovation in healthcare delivery.

    Science.gov (United States)

    Luft, Harold S

    2009-10-01

    Economics influences how medical care is delivered, organized, and progresses. Fee-for-service payment encourages delivery of services. Fee-for-individual-service, however, offers no incentives for clinicians to efficiently organize the care their patients need. Global capitation provides such incentives; it works well in highly integrated practices but not for independent practitioners. The failures of utilization management in the 1990s demonstrated the need for a third alternative to better align incentives, such as bundling payment for an episode of care. Building on Medicare's approach to hospital payment, one can define expanded diagnosis-related groups that include all hospital, physician, and other costs during the stay and appropriate preadmission and postdischarge periods. Physicians and hospitals voluntarily forming a new entity (a care delivery team) would receive such bundled payments along with complete flexibility in allocating the funds. Modifications to gainsharing and antikickback rules, as well as reforms to malpractice liability laws, will facilitate the functioning of the care delivery teams. The implicit financial incentives encourage efficient care for the patient; the episode focus will facilitate measuring patient outcomes. Payment can be based on the resources used by those care delivery teams achieving superior outcomes, thereby fostering innovation improving outcomes and reducing waste.

  12. The Indiana University Center for Healthcare Innovation and Implementation Science: Bridging healthcare research and delivery to build a learning healthcare system.

    Science.gov (United States)

    Azar, Jose; Adams, Nadia; Boustani, Malaz

    2015-01-01

    In the United States, it is estimated that 75,000 deaths every year could be averted if the healthcare system implemented high quality care more effectively and efficiently. Patient harm in the hospital occurs as a consequence of inadequate procedures, medications and other therapies, nosocomial infections, diagnostic evaluations and patient falls. Implementation science, a new emerging field in healthcare, is the development and study of methods and tools aimed at enhancing the implementation of new discoveries and evidence into daily healthcare delivery. The Indiana University Center for Healthcare Innovation and Implementation Science (IU-CHIIS) was launched in September 2013 with the mission to use implementation science and innovation to produce great-quality, patient-centered and cost-efficient healthcare delivery solutions for the United States of America. Within the first 24 months of its initiation, the IU-CHIIS successfully scaled up an evidence-based collaborative care model for people with dementia and/or depression, successfully expanded the Accountable Care Unit model positively impacting the efficiency and quality of care, created the first Certificate in Innovation and Implementation Science in the US and secured funding from National Institutes of Health to investigate innovations in dementia care. This article summarizes the establishment of the IU-CHIIS, its impact and outcomes and the lessons learned during the journey. Copyright © 2015. Published by Elsevier GmbH.

  13. Measurement of integrated healthcare delivery: a systematic review of methods and future research directions

    Directory of Open Access Journals (Sweden)

    Martin Strandberg-Larsen

    2009-02-01

    Full Text Available Background: Integrated healthcare delivery is a policy goal of healthcare systems. There is no consensus on how to measure the concept, which makes it difficult to monitor progress. Purpose: To identify the different types of methods used to measure integrated healthcare delivery with emphasis on structural, cultural and process aspects. Methods: Medline/Pubmed, EMBASE, Web of Science, Cochrane Library, WHOLIS, and conventional internet search engines were systematically searched for methods to measure integrated healthcare delivery (published – April 2008. Results: Twenty-four published scientific papers and documents met the inclusion criteria. In the 24 references we identified 24 different measurement methods; however, 5 methods shared theoretical framework. The methods can be categorized according to type of data source: a questionnaire survey data, b automated register data, or c mixed data sources. The variety of concepts measured reflects the significant conceptual diversity within the field, and most methods lack information regarding validity and reliability. Conclusion: Several methods have been developed to measure integrated healthcare delivery; 24 methods are available and some are highly developed. The objective governs the method best used. Criteria for sound measures are suggested and further developments should be based on an explicit conceptual framework and focus on simplifying and validating existing methods.

  14. Fairness in healthcare finance and delivery: what about Tunisia?

    Science.gov (United States)

    Abu-Zaineh, Mohammad; Arfa, Chokri; Ventelou, Bruno; Ben Romdhane, Habiba; Moatti, Jean-Paul

    2014-07-01

    Anecdotal evidence on hidden inequity in health care in North African countries abounds. Yet firm empirical evidence has been harder to come by. This article fills the gap. It presents the first analysis of equity in the healthcare system using the particular case of Tunisia. Analyses are based on an unusually rich source of data taken from the Tunisian HealthCare Utilization and Morbidity Survey. Payments for health care are derived from the total amount of healthcare spending which was incurred by households over the last year. Utilization of health care is measured by the number of physical units of two types of services: outpatient and inpatient. The measurement of need for health care is apprehended through a rich set of ill-health indicators and demographics. Findings are presented and compared at both the aggregate level, using the general summary index approach, and the disaggregate level, using the distribution-free stochastic dominance approach. The overall picture is that direct out-of-pocket payments, which constitute a sizeable share in the current financing mix, emerge to be a progressive means of financing health care overall. Interestingly, however, when statistical testing is applied at the disaggregate level progressivity is retained over the top half of the distribution. Further analyses of the distributions of need for--and utilization of--two types of health care--outpatient and inpatient--reveal that the observed progressivity is rather an outcome of the heavy use, but not need, for health care at the higher income levels. Several policy relevant factors are discussed, and some recommendations are advanced for future reforms of the health care in Tunisia. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

  15. Healthcare public key infrastructure (HPKI) and non-profit organization (NPO): essentials for healthcare data exchange.

    Science.gov (United States)

    Takeda, Hiroshi; Matsumura, Yasushi; Nakagawa, Katsuhiko; Teratani, Tadamasa; Qiyan, Zhang; Kusuoka, Hideo; Matsuoka, Masami

    2004-01-01

    To share healthcare information and to promote cooperation among healthcare providers and customers (patients) under computerized network environment, a non-profit organization (NPO), named as OCHIS, was established at Osaka, Japan in 2003. Since security and confidentiality issues on the Internet have been major concerns in the OCHIS, the system has been based on healthcare public key infrastructure (HPKI), and found that there remained problems to be solved technically and operationally. An experimental study was conducted to elucidate the central and the local function in terms of a registration authority and a time stamp authority by contracting with the Ministry of Economics and Trading Industries in 2003. This paper describes the experimental design with NPO and the results of the study concerning message security and HPKI. The developed system has been operated practically in Osaka urban area.

  16. The role of short messaging service in supporting the delivery of healthcare: An umbrella systematic review.

    Science.gov (United States)

    Househ, Mowafa

    2016-06-01

    Short messaging service (SMS) messages may present a convenient and cost-effective method to support healthcare interventions. This work assesses the effects of short messaging service on various healthcare interventions found in systematic reviews. The search strategy was based on two key concepts: short messaging service and healthcare delivery. The initial search was conducted in December 2012 and was updated in June 2013. Of the 550 identified references, 13 systematic reviews met the inclusion criteria, of which 8 were published in peer-reviewed journals and 5 were retrieved from the Cochrane library. Data analysis shows that low to moderate research evidence exists on the benefits of short messaging service interventions for appointment reminders, promoting health in developing countries and preventive healthcare. In many interventions, however, there were a few studies that were of high quality, and most of the studies were rated from low to moderate quality or had no rating at all. Healthcare organizations, policy makers, or clinicians using short messaging service messages to support healthcare interventions should (1) implement interventions that have been found to work in healthcare settings, (2) continue evaluating short messaging service interventions that have not been adequately assessed, and (3) improve collaboration between various healthcare entities to develop studies targeted at specific populations to evaluate the long-term impact of short messaging service on healthcare outcomes. © The Author(s) 2014.

  17. Assessment of the Ehlanzeni District health transport and logistics function: Enhancing rural healthcare delivery systems

    CSIR Research Space (South Africa)

    Mashiri, MAM

    2009-07-01

    Full Text Available This paper seeks to establish a baseline against which to assess the impacts of the ‘Ehlanzeni District Health Transport Function’ for the district’s healthcare service delivery output, and by extension, health and welfare outcomes. The main...

  18. Transforming Healthcare Delivery: Integrating Dynamic Simulation Modelling and Big Data in Health Economics and Outcomes Research

    NARCIS (Netherlands)

    Marshall, Deborah A.; Burgos-Liz, Lina; Pasupathy, Kalyan S.; Padula, William V.; IJzerman, Maarten Joost; Wong, Peter K.; Higashi, Mitchell K.; Engbers, Jordan; Wiebe, Samuel; Crown, William; Osgood, Nathaniel D.

    2016-01-01

    In the era of the Information Age and personalized medicine, healthcare delivery systems need to be efficient and patient-centred. The health system must be responsive to individual patient choices and preferences about their care, while considering the system consequences. While dynamic simulation

  19. Perceived quality of healthcare delivery in a rural District of Ghana ...

    African Journals Online (AJOL)

    Objective: The study aimed at finding out clients' perceptions of the quality of healthcare delivery at the district level in rural Ghana, using the Komenda-Edina- Eguafo-Abrem District as a case study. Design: 803 patients were purposively selected and interviewed after visits to health facilities using a pretested questionnaire, ...

  20. Public and private health-care financing with alternate public rationing rules.

    Science.gov (United States)

    Cuff, Katherine; Hurley, Jeremiah; Mestelman, Stuart; Muller, Andrew; Nuscheler, Robert

    2012-02-01

    We develop a model to analyze parallel public and private health-care financing under two alternative public sector rationing rules: needs-based rationing and random rationing. Individuals vary in income and severity of illness. There is a limited supply of health-care resources used to treat individuals, causing some individuals to go untreated. Insurers (both public and private) must bid to obtain the necessary health-care resources to treat their beneficiaries. Given individuals' willingnesses-to-pay for private insurance are increasing in income, the introduction of private insurance diverts treatment from relatively poor to relatively rich individuals. Further, the impact of introducing parallel private insurance depends on the rationing mechanism in the public sector. We show that the private health insurance market is smaller when the public sector rations according to need than when allocation is random. Copyright © 2010 John Wiley & Sons, Ltd.

  1. Quality improvement in healthcare delivery utilizing the patient-centered medical home model.

    Science.gov (United States)

    Akinci, Fevzi; Patel, Poonam M

    2014-01-01

    Despite the fact that the United States dedicates so much of its resources to healthcare, the current healthcare delivery system still faces significant quality challenges. The lack of effective communication and coordination of care services across the continuum of care poses disadvantages for those requiring long-term management of their chronic conditions. This is why the new transformation in healthcare known as the patient-centered medical home (PCMH) can help restore confidence in our population that the healthcare services they receive is of the utmost quality and will effectively enhance their quality of life. Healthcare using the PCMH model is delivered with the patient at the center of the transformation and by reinvigorating primary care. The PCMH model strives to deliver effective quality care while attempting to reduce costs. In order to relieve some of our healthcare system distresses, organizations can modify their delivery of care to be patient centered. Enhanced coordination of services, better provider access, self-management, and a team-based approach to care represent some of the key principles of the PCMH model. Patients that can most benefit are those that require long-term management of their conditions such as chronic disease and behavioral health patient populations. The PCMH is a feasible option for delivery reform as pilot studies have documented successful outcomes. Controversy about the lack of a medical neighborhood has created concern about the overall sustainability of the medical home. The medical home can stand independently and continuously provide enhanced care services as a movement toward higher quality care while organizations and government policy assess what types of incentives to put into place for the full collaboration and coordination of care in the healthcare system.

  2. Healthcare librarians and the delivery of critical appraisal training: barriers to involvement.

    Science.gov (United States)

    Maden-Jenkins, Michelle

    2011-03-01

      Many healthcare librarians are undertaking training in critical appraisal but a significant number are not cascading the training to their end-users.   To examine the barriers to healthcare librarian involvement in delivering critical appraisal training.   A questionnaire survey of 57 library services across 48 NHS Trust Library Services in north west England followed up with 21 semi-structured interviews.   Two types of barriers were noted: extrinsic barriers (organisational, environmental, training, role expectations) and intrinsic barriers (knowledge, skills, attitude).   These barriers are not mutually exclusive and by overcoming one of them it does not necessarily follow that healthcare librarians will engage in delivering critical appraisal skills training. The challenge lies in developing strategies to deal effectively with these barriers to encourage and support healthcare librarians in the delivery of critical appraisal training at a level at which they feel confident and able. © 2010 The authors. Health Information and Libraries Journal © 2010 Health Libraries Group.

  3. Activity-based costing of health-care delivery, Haiti.

    Science.gov (United States)

    McBain, Ryan K; Jerome, Gregory; Leandre, Fernet; Browning, Micaela; Warsh, Jonathan; Shah, Mahek; Mistry, Bipin; Faure, Peterson Abnis I; Pierre, Claire; Fang, Anna P; Mugunga, Jean Claude; Gottlieb, Gary; Rhatigan, Joseph; Kaplan, Robert

    2018-01-01

    To evaluate the implementation of a time-driven activity-based costing analysis at five community health facilities in Haiti. Together with stakeholders, the project team decided that health-care providers should enter start and end times of the patient encounter in every fifth patient's medical dossier. We trained one data collector per facility, who manually entered the time recordings and patient characteristics in a database and submitted the data to a cloud-based data warehouse each week. We calculated the capacity cost per minute for each resource used. An automated web-based platform multiplied reported time with capacity cost rate and provided the information to health-facilities administrators. Between March 2014 and June 2015, the project tracked the clinical services for 7162 outpatients. The cost of care for specific conditions varied widely across the five facilities, due to heterogeneity in staffing and resources. For example, the average cost of a first antenatal-care visit ranged from 6.87 United States dollars (US$) at a low-level facility to US$ 25.06 at a high-level facility. Within facilities, we observed similarly variation in costs, due to factors such as patient comorbidities, patient arrival time, stocking of supplies at facilities and type of visit. Time-driven activity-based costing can be implemented in low-resource settings to guide resource allocation decisions. However, the extent to which this information will drive observable changes at patient, provider and institutional levels depends on several contextual factors, including budget constraints, management, policies and the political economy in which the health system is situated.

  4. Innovations in health service delivery: the corporatization of public hospitals

    National Research Council Canada - National Science Library

    Harding, April; Preker, Alexander S

    2003-01-01

    ... hospitals play a critical role in ensuring delivery of health services, less is known about how to improve the efficiency and quality of care provided. Much can be learned in this respect from the experiences of hospital reforms initiated during the 1990s. Innovations in Health Service Delivery: The Corporatization of Public Hospitals is an a...

  5. Alternative Public Service Delivery Models in Health, Water and ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    The literature on public service delivery alternatives has to date been highly localized, sector specific and lacking in methodological consistency. This project seeks to analyze health, water and electricity delivery models in Africa, Asia and Latin America in order to identify and document successful alternatives to ...

  6. Rethinking the delivery of public services to citizens

    National Research Council Canada - National Science Library

    Seidle, F. Leslie

    1995-01-01

    ... Sector Reform and Service Delivery in the Antipodes New Zealand: Transforming the State Australia: a Concerted Program of Management Reform Conclusion Notes 75 Chapter Four The Canadian Federal Government and Service Delivery Issues Perceptions of Service from the Federal Government The Mulroney Government and Public Service 2000 Special Operati...

  7. Transforming Healthcare Delivery: Integrating Dynamic Simulation Modelling and Big Data in Health Economics and Outcomes Research.

    Science.gov (United States)

    Marshall, Deborah A; Burgos-Liz, Lina; Pasupathy, Kalyan S; Padula, William V; IJzerman, Maarten J; Wong, Peter K; Higashi, Mitchell K; Engbers, Jordan; Wiebe, Samuel; Crown, William; Osgood, Nathaniel D

    2016-02-01

    In the era of the Information Age and personalized medicine, healthcare delivery systems need to be efficient and patient-centred. The health system must be responsive to individual patient choices and preferences about their care, while considering the system consequences. While dynamic simulation modelling (DSM) and big data share characteristics, they present distinct and complementary value in healthcare. Big data and DSM are synergistic-big data offer support to enhance the application of dynamic models, but DSM also can greatly enhance the value conferred by big data. Big data can inform patient-centred care with its high velocity, volume, and variety (the three Vs) over traditional data analytics; however, big data are not sufficient to extract meaningful insights to inform approaches to improve healthcare delivery. DSM can serve as a natural bridge between the wealth of evidence offered by big data and informed decision making as a means of faster, deeper, more consistent learning from that evidence. We discuss the synergies between big data and DSM, practical considerations and challenges, and how integrating big data and DSM can be useful to decision makers to address complex, systemic health economics and outcomes questions and to transform healthcare delivery.

  8. An Organizational Model for Excellence in Healthcare Delivery: Evidence From Winners of the Baldrige Quality Award.

    Science.gov (United States)

    Griffith, John R

    Winners of the Baldrige National Quality Award in healthcare have documented top quartile clinical outcomes and patient satisfaction across a variety of American communities and a full spectrum of care. Their results also show high levels of satisfaction among physicians, nurses, and other workers, as well as effective financial performance. The managerial methods they use-collectively, the Baldrige model-are consistent with organizational theory literature and are found across all winners. The winners have sustained excellence after winning and expanded it by acquisition of other healthcare organizations.The model differs substantially from traditional management approaches in healthcare delivery. It is a comprehensive program that emphasizes a shared focus on excellence, systematically responsive management, evidence-based medicine, multidimensional measures and negotiated goals, improvement of work processes, thorough training, and extensive rewards. The model could be expanded on a much larger scale. Doing so successfully would substantially improve the quality and cost of healthcare, as well as the satisfaction and commitment of care providers and other staff. The opportunity deserves further study and trial by large healthcare delivery systems, insurers, and consulting companies.

  9. Can delivery systems use cost-effectiveness analysis to reduce healthcare costs and improve value?

    Science.gov (United States)

    Savitz, Lucy A; Savitz, Samuel T

    2016-01-01

    Understanding costs and ensuring that we demonstrate value in healthcare is a foundational presumption as we transform the way we deliver and pay for healthcare in the U.S. With a focus on population health and payment reforms underway, there is increased pressure to examine cost-effectiveness in healthcare delivery. Cost-effectiveness analysis (CEA) is a type of economic analysis comparing the costs and effects (i.e. health outcomes) of two or more treatment options. The result is expressed as a ratio where the denominator is the gain in health from a measure (e.g. years of life or quality-adjusted years of life) and the numerator is the incremental cost associated with that health gain. For higher cost interventions, the lower the ratio of costs to effects, the higher the value. While CEA is not new, the approach continues to be refined with enhanced statistical techniques and standardized methods. This article describes the CEA approach and also contrasts it to optional approaches, in order for readers to fully appreciate caveats and concerns. CEA as an economic evaluation tool can be easily misused owing to inappropriate assumptions, over reliance, and misapplication. Twelve issues to be considered in using CEA results to drive healthcare delivery decision-making are summarized. Appropriately recognizing both the strengths and the limitations of CEA is necessary for informed resource allocation in achieving the maximum value for healthcare services provided.

  10. Private Sector in Indian Healthcare Delivery: Consumer Perspective and Government Policies to promote private Sector

    OpenAIRE

    Utkarsh Shah, Ragini Mohanty

    2011-01-01

    This research paper attempts to collate literature from various sources, in an attempt to answer three pertinent questions related to healthcare in India. Firstly, what is it meant by ‘private sector’ in healthcare delivery system of India, secondly how has the private sector evolved over the decades and what has been the role of the government in propelling the growth. Finally, the paper tries to highlight some of the factors that have promoted the growth of private sector in India with spec...

  11. Decision-making strategies: ignored to the detriment of healthcare training and delivery?

    Science.gov (United States)

    Desmond, Chris; Brubaker, Kathryn A; Ellner, Andrew L

    2013-01-01

    Context : People do not always make health-related decisions which reflect their best interest - best interest being defined as the decision they would make if they carefully considered the options and fully understood the information available. A substantial literature has developed in behavioral economics and social psychology that seeks to elucidate the patterns in individual decision-making. While this is particularly relevant to healthcare, the insights from these fields have only been applied in a limited way. To address the health challenges of the twenty-first century, healthcare providers and healthcare systems designers need to more fully understand how individuals are making decisions. Methods : We provide an overview of the theories of behavioral economics and social psychology that relate to how individuals make health-related decisions. The concentration on health-related decisions leads to a focus on three topics: (1) mental shortcuts and motivated reasoning; (2) implications of time; and (3) implications of affect. The first topic is relevant because health-related decisions are often made in a hurry without a full appreciation of the implications and the deliberation they warrant. The second topic is included because the link between a decision and its health-related outcomes can involve a significant time lag. The final topic is included because health and affect are so often linked. Findings : The literature reviewed has implications for healthcare training and delivery. Selection for medical training must consider the skills necessary to understand and adapt to how patients make decisions. Training on the insights garnered from behavioral economics and social psychology would better prepare healthcare providers to effectively support their clients to lead healthy lives. Healthcare delivery should be structured to respond to the way in which decisions are made. Conclusions : These patterns in decision-making call into question basic assumptions

  12. User contributions and public extension delivery modes ...

    African Journals Online (AJOL)

    The high recurrent costs faced by the public extension service constraint the number of visits farmers receive. This study examined a number of extension communication channels through which farmers received farm management services/information from the public extension agent. The idea was, first, to find out the ...

  13. Specialist participation in healthcare delivery transformation: influence of patient self-referral.

    Science.gov (United States)

    Aliu, Oluseyi; Sun, Gordon; Burke, James; Chung, Kevin C; Davis, Matthew M

    2014-01-01

    Improving coordination of care and containing healthcare costs are prominent goals of healthcare reform. Specialist involvement in healthcare delivery transformation efforts like Accountable Care Organizations (ACOs) is necessary to achieve these goals. However, patients’ self-referrals to specialists may undermine care coordination and incur unnecessary costs if patients frequently receive care from specialists not engaged in such healthcare delivery transformation efforts. Additionally, frequent self-referrals may also diminish the incentive for specialist participation in reform endeavors like ACOs to get access to a referral base. To examine recent national trends in self-referred new visits to specialists. A descriptive cross-sectional study of new ambulatory visits to specialists from 2000 to 2009 using data from the National Ambulatory Medical Care Survey. We calculated nationally representative estimates of the proportion of new specialist visits through self-referrals among Medicare and private insurance beneficiaries. We also estimated the nationally representative absolute number of self-referred new specialist visits among both groups of beneficiaries. Among Medicare and private insurance beneficiaries, self-referred visits declined from 32.2% (95% confidence interval [CI], 24.0%-40.4%) to 19.6% (95% CI, 13.9%-23.3%) and from 32.4% (95% CI, 27.9%-36.8%) to 24.1% (95% CI,18.8%-29.4%), respectively. Hence, at least 1 in 5 and 1 in 4 new visits to specialists among Medicare and private insurance beneficiaries, respectively, are self-referred. The current considerable rate of self-referred new specialist visits among both Medicare and private insurance beneficiaries may have adverse implications for organizations attempting to transform healthcare delivery with improved care coordination.

  14. Changing public service delivery: Learning in co-creation

    NARCIS (Netherlands)

    W.H. Voorberg (William); V.J.J.M. Bekkers (Victor); Timeus, K. (Krista); Tonurist, P. (Piret); L.G. Tummers (Lars)

    2017-01-01

    textabstractCo-creation – where citizens and public organizations work together to deal with societal issues – is increasingly considered as a fertile solution for various public service delivery problems. During cocreation, citizens are not mere consumers, but are actively engaged in building

  15. Changing public service delivery: learning in co-creation

    NARCIS (Netherlands)

    Voorberg, William; Bekkers, Victor; Timeus, Krista; Tonurist, Piret; Tummers, L.G.

    2017-01-01

    Co-creation – where citizens and public organizations work together to deal with societal issues – is increasingly considered as a fertile solution for various public service delivery problems. During co-creation, citizens are not mere consumers, but are actively engaged in building resilient

  16. Improving the delivery of care and reducing healthcare costs with the digitization of information.

    Science.gov (United States)

    Noffsinger, R; Chin, S

    2000-01-01

    In the coming years, the digitization of information and the Internet will be extremely powerful in reducing healthcare costs while assisting providers in the delivery of care. One example of healthcare inefficiency that can be managed through information digitization is the process of prescription writing. Due to the handwritten and verbal communication surrounding prescription writing, as well as the multiple tiers of authorizations, the prescription drug process causes extensive financial waste as well as medical errors, lost time, and even fatal accidents. Electronic prescription management systems are being designed to address these inefficiencies. By utilizing new electronic prescription systems, physicians not only prescribe more accurately, but also improve formulary compliance thereby reducing pharmacy utilization. These systems expand patient care by presenting proactive alternatives at the point of prescription while reducing costs and providing additional benefits for consumers and healthcare providers.

  17. The challenges of healthcare delivery to people with multiple sclerosis in Iran.

    Science.gov (United States)

    Yazdannik, Ahmadreza; Abolhassani, Shahla; Taleghani, Fariba; Zamani, Ahmadreza

    2015-01-01

    Multiple sclerosis (MS) is a chronic disease prevalent in young and middle-aged people. Patients with MS often have numerous complicated needs and, consequently, require a broad range of health services. Results of a number of studies indicate that patients' needs are only partially met. This study was conducted to explore the challenges of healthcare delivery to patients with MS in Iran. In this qualitative case study, 43 participants selected through purposeful sampling were interviewed using semi-structured method in the cities of Isfahan and Tehran in 2012-2013. Besides the interview, documentations relevant to healthcare delivery were collected from different sources, including websites of all Iranian universities of medical sciences, insurance organizations, patients' weblogs, news agencies, the MS Center forum for MS patients, and MS Payam bimonthly. The data were analyzed through the constant comparative analysis. The data were categorized into four main categories, including functional challenges (diagnosis problems, failure to pay attention to patient needs, failure to follow-up, and miscommunication), administrative challenges (resource allocation and supervision), policy-making challenges (lack of comprehensive services, bureaucracy, and problems in provision of medications), and structural challenges (difficult access to services, lack of comprehensive centers, space limit, and long wait). Despite all attempts of governmental and nongovernmental organizations for healthcare delivery to MS patients, these services cannot satisfy all needs of the patients. In this regard, service providers and administrators should pay more attention to the needs and expectations of patients and their families.

  18. Integration of social media with healthcare big data for improved service delivery

    Directory of Open Access Journals (Sweden)

    Sibulela Mgudlwa

    2018-04-01

    Full Text Available Background: In the last decade, social media users across the world have crossed 1 billion, making it one of the fastest growing sources of big data. Also, people needing healthcare continue to increase in every society. Through accessibility, communication and interaction between health practitioners and patients, this type of ever-growing, social media subscriber–based platform can be of significant use in improving healthcare delivery to society. However, users encounter serious challenges in their attempts to make use of social media and big data for health-related services. The challenges are primarily caused by factors such as integration, complexity, security and privacy. The challenges are mainly owing to the sensitive nature of the healthcare environment, as a result of personalisation and privacy of information.   Objectives: The objectives of the study were to examine and gain a better understanding of the complexities that are associated with the use of social media and healthcare big data, through influencing factors, and to develop a framework that can be used to improve health-related services to the patients.   Methods: The interpretivist approach was employed, within which qualitative data were collected. This included documents and existing literature in the areas of social media and healthcare big data. To have a good spread of both previous and current state of events within the phenomena being studied, literature published between 2006 and 2016 were gathered. The data were interpretively analysed.   Results: Based on the analysis of the data, factors of influence were found, which were used to develop a model. The model illustrates how the factors of influence can enable and at the same time constrain the use of social media for healthcare services. The factors were interpreted from which a framework was developed. The framework is intended to guide integration of social media with healthcare big data through which

  19. Public Information and African Traditional Communication Delivery ...

    African Journals Online (AJOL)

    This paper is an analysis of how African traditional communication and the literature produced about it portray African traditional communication. The analysis premises an interest to ascertain whether the portrayal is in a perspective showing traditional media as capable of playing expected public information role. Drawing ...

  20. Using mobile technology to optimize disease surveillance and healthcare delivery at mass gatherings: a case study from India's Kumbh Mela.

    Science.gov (United States)

    Kazi, Dhruv S; Greenough, P Gregg; Madhok, Rishi; Heerboth, Aaron; Shaikh, Ahmed; Leaning, Jennifer; Balsari, Satchit

    2017-09-01

    Planning for mass gatherings often includes temporary healthcare systems to address the needs of attendees. However, paper-based record keeping has traditionally precluded the timely application of collected clinical data for epidemic surveillance or optimization of healthcare delivery. We evaluated the feasibility of harnessing ubiquitous mobile technologies for conducting disease surveillance and monitoring resource utilization at the Allahabad Kumbh Mela in India, a 55-day festival attended by over 70 million people. We developed an inexpensive, tablet-based customized disease surveillance system with real-time analytic capabilities, and piloted it at five field hospitals. The system captured 49 131 outpatient encounters over the 3-week study period. The most common presenting complaints were musculoskeletal pain (19%), fever (17%), cough (17%), coryza (16%) and diarrhoea (5%). The majority of patients received at least one prescription. The most common prescriptions were for antimicrobials, acetaminophen and non-steroidal anti-inflammatory drugs. There was great inter-site variability in caseload with the busiest hospital seeing 650% more patients than the least busy hospital, despite identical staffing. Mobile-based health information solutions developed with a focus on user-centred design can be successfully deployed at mass gatherings in resource-scarce settings to optimize care delivery by providing real-time access to field data. © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health.

  1. Bringing Big Data to the Forefront of Healthcare Delivery: The Experience of Carolinas HealthCare System.

    Science.gov (United States)

    Dulin, Michael F; Lovin, Carol A; Wright, Jean A

    2017-01-01

    The use of big data to transform care delivery is rapidly becoming a reality. To deliver on the promise of value-based care, providers must know the key drivers of wellness at the patient and community levels, as well as understand resource constraints and opportunities to improve efficiency in the health-care system itself. Data are the linchpin. By gathering the right data and finding innovative ways to glean knowledge, we can improve clinical care, advance the health of our communities, improve the lives of our patients, and operate more efficiently. At Carolinas HealthCare System-one of the nation's largest health-care systems, with nearly 12 million patient encounters annually at more than 900 care locations-we have made substantial investments to establish a centralized data and analytics infrastructure that is transforming the way we deliver care across the continuum. Although the impetus and vision for our program have evolved over the past decade, our efforts coalesced into a strategic, centralized initiative with the launch of the Dickson Advanced Analytics (DA) group in 2012. DA has yielded significant gains in our ability to use data, not only for reporting purposes and understanding our business but also for predicting outcomes and informing action.While these efforts have been successful, the path has not been easy. Effectively harnessing big data requires navigating myriad technological, cultural, operational, and other hurdles. Building a program that is feasible, effective, and sustainable takes concerted effort and a rigorous process of continuous self-evaluation and strategic adaptation.

  2. Bringing Big Data to the Forefront of Healthcare Delivery: The Experience of Carolinas HealthCare System.

    Science.gov (United States)

    Dulin, Michael F; Lovin, Carol A; Wright, Jean A

    2016-01-01

    The use of big data to transform care delivery is rapidly becoming a reality. To deliver on the promise of value-based care, providers must know the key drivers of wellness at the patient and community levels, as well as understand resource constraints and opportunities to improve efficiency in the healthcare system itself. Data are the linchpin. By gathering the right data and finding innovative ways to glean knowledge, we can improve clinical care, advance the health of our communities, improve the lives of our patients, and operate more efficiently. At Carolinas HealthCare System-one of the nation's largest healthcare systems, with nearly 12 million patient encounters annually at more than 900 care locations-we have made substantial investments to establish a centralized data and analytics infrastructure that is transforming the way we deliver care across the continuum. Although the impetus and vision for our program have evolved over the past decade, our efforts coalesced into a strategic, centralized initiative with the launch of the Dickson Advanced Analytics (DA2) group in 2012. DA2 has yielded significant gains in our ability to use data, not only for reporting purposes and understanding our business but also for predicting outcomes and informing action.While these efforts have been successful, the path has not been easy. Effectively harnessing big data requires navigating myriad technological, cultural, operational, and other hurdles. Building a program that is feasible, effective, and sustainable takes concerted effort and a rigorous process of continuous self-evaluation and strategic adaptation.

  3. Women veterans' healthcare delivery preferences and use by military service era: findings from the National Survey of Women Veterans.

    Science.gov (United States)

    Washington, Donna L; Bean-Mayberry, Bevanne; Hamilton, Alison B; Cordasco, Kristina M; Yano, Elizabeth M

    2013-07-01

    The number of women Veterans (WVs) utilizing the Veterans Health Administration (VA) has doubled over the past decade, heightening the importance of understanding their healthcare delivery preferences and utilization patterns. Other studies have identified healthcare issues and behaviors of WVs in specific military service eras (e.g., Vietnam), but delivery preferences and utilization have not been examined within and across eras on a population basis. To identify healthcare delivery preferences and healthcare use of WVs by military service era to inform program design and patient-centeredness. Cross-sectional 2008-2009 survey of a nationally representative sample of 3,611 WVs, weighted to the population. Healthcare delivery preferences measured as importance of selected healthcare features; types of healthcare services and number of visits used; use of VA or non-VA; all by military service era. Military service era differences were present in types of healthcare used, with World War II and Korea era WVs using more specialty care, and Vietnam era-to-present WVs using more women's health and mental health care. Operations Enduring Freedom, Iraqi Freedom, New Dawn (OEF/OIF/OND) WVs made more healthcare visits than WVs of earlier military eras. The greatest healthcare delivery concerns were location convenience for Vietnam and earlier WVs, and cost for Gulf War 1 and OEF/OIF/OND WVs. Co-located gynecology with general healthcare was also rated important by a sizable proportion of WVs from all military service eras. Our findings point to the importance of ensuring access to specialty services closer to home for WVs, which may require technology-supported care. Younger WVs' higher mental health care use reinforces the need for integration and coordination of primary care, reproductive health and mental health care.

  4. Patient assessment within the context of healthcare delivery packages: A comparative analysis.

    Science.gov (United States)

    Rossen, Camilla Blach; Buus, Niels; Stenager, Egon; Stenager, Elsebeth

    2016-01-01

    Due to an increased focus on productivity and cost-effectiveness, many countries across the world have implemented a variety of tools for standardizing diagnostics and treatment. In Denmark, healthcare delivery packages are increasingly used for assessment of patients. A package is a tool for creating coordination, continuity and efficient pathways; each step is pre-booked, and the package has a well-defined content within a predefined category of diseases. The aim of this study was to investigate how assessment processes took place within the context of healthcare delivery packages. The study used a constructivist Grounded Theory approach. Ethnographic fieldwork was carried out in three specialized units: a mental health unit and two multiple sclerosis clinics in Southern Denmark, which all used assessment packages. Several types of data were sampled through theoretical sampling. Participant observation was conducted for a total of 126h. Formal and informal interviews were conducted with 12 healthcare professionals and 13 patients. Furthermore, audio recordings were made of 9 final consultations between physicians and patients; 193min of recorded consultations all in all. Lastly, the medical records of 13 patients and written information about packages were collected. The comparative, abductive analysis focused on the process of assessment and the work made by all the actors involved. In this paper, we emphasized the work of healthcare professionals. We constructed five interrelated categories: 1. "Standardized assessing", 2. "Flexibility", which has two sub-categories, 2.1. "Diagnostic options" and 2.2. "Time and organization", and, finally, 3. "Resisting the frames". The process of assessment required all participants to perform the predefined work in the specified way at the specified time. Multidisciplinary teamwork was essential for the success of the process. The local organization of the packages influenced the assessment process, most notably the pre

  5. Funding New Zealand's public healthcare system: time for an honest appraisal and public debate.

    Science.gov (United States)

    Keene, Lyndon; Bagshaw, Philip; Nicholls, M Gary; Rosenberg, Bill; Frampton, Christopher M; Powell, Ian

    2016-05-27

    Successive New Zealand governments have claimed that the cost of funding the country's public healthcare services is excessive and unsustainable. We contest that these claims are based on a misrepresentation of healthcare spending. Using data from the New Zealand Treasury and the Organisation for Economic Cooperation and Development (OECD), we show how government spending as a whole is low compared with most other OECD countries and is falling as a proportion of GDP. New Zealand has a modest level of health spending overall, but government health spending is also falling as a proportion of GDP. Together, the data indicate the New Zealand Government can afford to spend more on healthcare. We identify compelling reasons why it should do so, including forecast growing health need, signs of increasing unmet need, and the fact that if health needs are not met the costs still have to be borne by the economy. The evidence further suggests it is economically and socially beneficial to meet health needs through a public health system. An honest appraisal and public debate is needed to determine more appropriate levels of healthcare spending.

  6. Building a middle-range theory of free public healthcare seeking in sub-Saharan Africa: a realist review.

    Science.gov (United States)

    Robert, Emilie; Samb, Oumar Mallé; Marchal, Bruno; Ridde, Valéry

    2017-09-01

    Realist reviews are a new form of knowledge synthesis aimed at providing middle-range theories (MRTs) that specify how interventions work, for which populations, and under what circumstances. This approach opens the 'black box' of an intervention by showing how it triggers mechanisms in specific contexts to produce outcomes. We conducted a realist review of health user fee exemption policies (UFEPs) in sub-Saharan Africa (SSA). This article presents how we developed both the intervention theory (IT) of UFEPs and a MRT of free public healthcare seeking in SSA, building on Sen's capability approach. Over the course of this iterative process, we explored theoretical writings on healthcare access, services use, and healthcare seeking behaviour. We also analysed empirical studies on UFEPs and healthcare access in free care contexts. According to the IT, free care at the point of delivery is a resource allowing users to make choices about their use of public healthcare services, choices previously not generally available to them. Users' ability to choose to seek free care is influenced by structural, local, and individual conversion factors. We tested this IT on 69 empirical studies selected on the basis of their scientific rigor and relevance to the theory. From that analysis, we formulated a MRT on seeking free public healthcare in SSA. It highlights three key mechanisms in users' choice to seek free public healthcare: trust, risk awareness and acceptability. Contextual elements that influence both users' ability and choice to seek free care include: availability of and control over resources at the individual level; characteristics of users' and providers' communities at the local level; and health system organization, governance and policies at the structural level. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

  7. Delivery of public services in ethnic minority states: Gender equality ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Delivery of public services in ethnic minority states: Gender equality and decentralization in Myanmar. In 2017, to sustain Myanmar's democratic transition, IDRC and Global Affairs Canada ... and staff from the University of Toronto's Munk School of Global Affairs (Asia ... Ideas from the global climate change hotspot research.

  8. Transforming trauma healthcare delivery in rural areas by use of an integrated call center.

    Science.gov (United States)

    Agrawal, Deepak

    2012-01-01

    There is poor penetration of trauma healthcare delivery in rural areas. On the other hand, mobile penetration in India is now averaging 80% with most families having access to mobile phone. The aim of this study was to assess the implementation and socioeconomic impact of a call center in providing healthcare delivery for patients with head and spinal injuries. This was a prospective observational study carried out over a 6-month period at a level I trauma Center in New Delhi, India. A nine-seater call center was outsourced to a private company and the hospital's electronic medical records were integrated with the call-center operations. The call center was given responsibility of maintaining appointments and scheduling clinics for the whole hospital as well as ensuring follow-up visits. Trained call-center staff handled simple patient queries and referred the rest via email to concerned doctors. A telephonic survey was done prior to the start of call-center operations and after 3 months to assess for user satisfaction. The initial cost of outsourcing the call center was Rs 1.6 lakhs (US$ 4000), with a recurring cost of Rs 80,000 (US$ 2000) per month. A total of 484 patients were admitted in the department of Neurosurgery during the study period. Of these, 63% (n=305) were from rural areas. Patients' overall experience for clinic visits improved markedly following implementation of call center. Patient satisfaction for follow-up visits increased from a mean of 32-96%. Ninety-five percent patients reported a significant decrease in waiting time in clinics 80.4% reporting improved doctor-patient interaction. A total of 52 visits could be postponed/cancelled for patients living in far flung areas resulting in major socioeconomic benefits to these families. As shown by our case study, call centers have the potential to revolutionize delivery of trauma healthcare to rural areas in an extremely cost-effective manner.

  9. Patient Populations, Clinical Associations, and System Efficiency in Healthcare Delivery System

    Science.gov (United States)

    Liu, Yazhuo

    The efforts to improve health care delivery usually involve studies and analysis of patient populations and healthcare systems. In this dissertation, I present the research conducted in the following areas: identifying patient groups, improving treatments for specific conditions by using statistical as well as data mining techniques, and developing new operation research models to increase system efficiency from the health institutes' perspective. The results provide better understanding of high risk patient groups, more accuracy in detecting disease' correlations and practical scheduling tools that consider uncertain operation durations and real-life constraints.

  10. Public Service Delivery in Hybrid Organisations : public management reform and horizontalisation as main challenges for public leaders

    NARCIS (Netherlands)

    Kuitert, L.; Volker, L.

    2016-01-01

    The public sector has been subject to some major movements the last 15 years. In public service delivery a trend called socialisation, leading to the displacement between public and private, is most crucial. A withdrawing government and privatization led to increased collaboration between public and

  11. Operations and quality management for public service delivery improvement.

    Directory of Open Access Journals (Sweden)

    Paulin Mbecke

    2014-10-01

    Full Text Available Public service management reforms have not yet contributed to poverty eradication and generally socio-economic development of many African countries. The reforms suggested and implemented to date still prove to be weak in addressing the many challenges faced by the public service in delivering goods and services to the population. The failure of the current public service management calls for a consideration of business-driven approaches and practices that facilitate effectiveness, efficiency, competitiveness and flexibility in goods and services provision. The critical social theory methodology and the literature review technique described and raised awareness on service delivery chaos in South Africa. A public service reform that focuses on operations and quality management is one of the ways of improving and sustaining service delivery in South Africa. Operations management is an essential tool for the planning, execution, control, monitoring and evaluation of production processes. Quality management, in the other hand, is essential to ensure best quality of goods and services produced by the public service within acceptable time and available resources to meet or exceed people’s expectations. The operations and quality management framework proposed in this article is a potential alternative to the current service delivery crisis in South Africa.

  12. Ranking of healthcare programmes based on health outcome, health costs and safe delivery of care in hospital pharmacy practice.

    Science.gov (United States)

    Brisseau, Lionel; Bussières, Jean-François; Bois, Denis; Vallée, Marc; Racine, Marie-Claude; Bonnici, André

    2013-02-01

    To establish a consensual and coherent ranking of healthcare programmes that involve the presence of ward-based and clinic-based clinical pharmacists, based on health outcome, health costs and safe delivery of care. This descriptive study was derived from a structured dialogue (Delphi technique) among directors of pharmacy department. We established a quantitative profile of healthcare programmes at five sites that involved the provision of ward-based and clinic-based pharmaceutical care. A summary table of evidence established a unique quality rating per inpatient (clinic-based) or outpatient (ward-based) healthcare programme. Each director rated the perceived impact of pharmaceutical care per inpatient or outpatient healthcare programme on three fields: health outcome, health costs and safe delivery of care. They agreed by consensus on the final ranking of healthcare programmes. A ranking was assigned for each of the 18 healthcare programmes for outpatient care and the 17 healthcare programmes for inpatient care involving the presence of pharmacists, based on health outcome, health costs and safe delivery of care. There was a good correlation between ranking based on data from a 2007-2008 Canadian report on hospital pharmacy practice and the ranking proposed by directors of pharmacy department. Given the often limited human and financial resources, managers should consider the best evidence available on a profession's impact to plan healthcare services within an organization. Data are few on ranking healthcare programmes in order to prioritize which healthcare programme would mostly benefit from the delivery of pharmaceutical care by ward-based and clinic-based pharmacists. © 2012 The Authors. IJPP © 2012 Royal Pharmaceutical Society.

  13. Value Chains of Public and Private Health-care Services in a Small EU Island State: A SWOT Analysis

    Science.gov (United States)

    Buttigieg, Sandra C.; Schuetz, Marcus; Bezzina, Frank

    2016-01-01

    The global financial and macroeconomic crisis of 2008/2009 and the ensuing recessions obliged policy makers to maximize use of resources and cut down on waste. Specifically, in health care, governments started to explore ways of establishing collaborations between the public and private health-care sectors. This is essential so as to ensure the best use of available resources, while securing quality of delivery of care as well as health systems sustainability and resilience. This qualitative study explores complementary and mutual attributes in the value creation process to patients by the public and private health-care systems in Malta, a small European Union island state. A workshop was conducted with 28 professionals from both sectors to generate two separate value chains, and this was followed by an analysis of strengths, weaknesses, opportunities, and threats (SWOT). The latter revealed several strengths and opportunities, which can better equip health-policy makers in the quest to maximize provision of health-care services. Moreover, the analysis also highlighted areas of weaknesses in both sectors as well as current threats of the external environment that, unless addressed, may threaten the state’s health-care system sustainability and resilience to macroeconomic shocks. The study goes on to provide feasible recommendations aimed at maximizing provision of health-care services in Malta. PMID:27683658

  14. Value Chains of Public and Private Health-care Services in a Small EU Island State: A SWOT Analysis.

    Science.gov (United States)

    Buttigieg, Sandra C; Schuetz, Marcus; Bezzina, Frank

    2016-01-01

    The global financial and macroeconomic crisis of 2008/2009 and the ensuing recessions obliged policy makers to maximize use of resources and cut down on waste. Specifically, in health care, governments started to explore ways of establishing collaborations between the public and private health-care sectors. This is essential so as to ensure the best use of available resources, while securing quality of delivery of care as well as health systems sustainability and resilience. This qualitative study explores complementary and mutual attributes in the value creation process to patients by the public and private health-care systems in Malta, a small European Union island state. A workshop was conducted with 28 professionals from both sectors to generate two separate value chains, and this was followed by an analysis of strengths, weaknesses, opportunities, and threats (SWOT). The latter revealed several strengths and opportunities, which can better equip health-policy makers in the quest to maximize provision of health-care services. Moreover, the analysis also highlighted areas of weaknesses in both sectors as well as current threats of the external environment that, unless addressed, may threaten the state's health-care system sustainability and resilience to macroeconomic shocks. The study goes on to provide feasible recommendations aimed at maximizing provision of health-care services in Malta.

  15. Challenges in healthcare delivery in an economic downturn, in the Republic of Ireland.

    Science.gov (United States)

    Carney, Marie

    2010-07-01

    The purpose of the present study was to discuss some of effects of the downturn in the Irish economy and to demonstrate that in the face of economic difficulties innovation in health care is still occurring. Staff that are managing and delivering healthcare need to know the challenges facing them and have an awareness of the importance of maintaining interest in innovative practice in turbulent times. Information obtained from several sources including government papers, the nursing regulatory board and quality authority documents and current best practice articles. Information was evaluated based on the study's aim. Issues emerging were that current challenges facing Irish health care delivery relate mainly to economic, clinical management, education and information technology factors and further reductions in the cost base of health care delivery remains focused on value for money. In the face of the economic downturn Ireland is achieving health targets and is now sitting in 13th place on the European health index, down from number 28 in 2008. This improvement in position has resulted from several new innovative work practices. As a result of cost reduction measures in place nurse managers will face greater challenges than ever before in meeting the objectives of the healthcare transformation programme.

  16. Age of diagnosis of congenital hearing loss: Private v. public healthcare sector.

    Science.gov (United States)

    Butler, I R T; Ceronio, D; Swart, T; Joubert, G

    2015-11-01

    The age of diagnosis of congenital hearing loss is one of the most important determinants of communication outcome. A previous study by the lead author had evaluated the performance of the public health services in Bloemfontein, South Africa (SA), in this regard. This study aimed to examine whether the private health services in the same city were any better. To determine whether the age of diagnosis of congenital hearing loss (CHL) in children seen in the private healthcare sector in Bloemfontein, Free State Province, SA, was lower than that in the public healthcare system in the same city. A comparative study design was utilised and a retrospective database review conducted. Data obtained from this study in the private healthcare sector were compared with data from a previous study in the public healthcare sector using the same study design. Forty-eight children aged private healthcare sector during the study period; 33/47 (70.2%) did not undergo hearing screening at birth. The median age of diagnosis of DHI in the private healthcare sector was 2.24 years, and this was statistically significantly lower than the median age of diagnosis of 3.71 years in the public healthcare sector (pprivate healthcare sector was 3.01 years in children who were not screened at birth, and 1.25 years in those who were screened at birth. This difference was statistically significant (pprivate healthcare sector who were not screened at birth (median 3.01 years) with that in children in the public healthcare sector (median 3.71 years). This difference was statistically significant (pprivate healthcare sector than in the public healthcare sector. With the social and economic benefits of early intervention in cases of DHI well established internationally, SA healthcare providers in both the public and private sectors need to develop screening, diagnostic and (re)habilitation services for children with hearing impairment.

  17. Beyond patient care: the impact of healthcare reform on job satisfaction in the Ethiopian public healthcare sector.

    Science.gov (United States)

    Manyazewal, Tsegahun; Matlakala, Mokgadi C

    2017-02-03

    While healthcare reform has been a central attention for local governments, its impact on job satisfaction is poorly understood. This study aimed to determine the impact of healthcare reform on job satisfaction in the public healthcare sector in Ethiopia. The study was designed as a facility-based cross-sectional survey of healthcare professionals and carried out in all public hospitals in central Ethiopia which have been implementing healthcare reform (n = 5). All healthcare professionals in the hospitals who were involved in the reform from the inception (n = 476) were purposively sourced to complete a self-administered questionnaire adapted from a framework proposed for measuring job satisfaction of health professionals in sub-Saharan Africa. Kaiser-Meyer-Olkin and Bartlett's tests were conducted to measure sampling adequacy and sphericity for factor analysis. Likert's transformation formula was used to numerically analyse the satisfaction level of the respondents and to determine the cut-off value of satisfaction levels. Non-parametric and multiple logistic regression analysis were conducted to determine predictors of job satisfaction. A total of 410 healthcare professionals completed the survey, representing an 88% response rate. The median and mean job satisfaction scores were 50 and 49, respectively, on a scale 1-100, which was equivalent to 'Job dissatisfied' on the Likert scale. Only 25% of respondents perceived job satisfaction due to implementation of the reform. Moral satisfaction (adjusted odds ratio (aOR), 177.65; 95% confidence interval (CI), 59.54-530.08), management style (aOR, 4.02; 95% CI, 1.49-10.83), workload (aOR, 2.42; 95% CI, 0.93-6.34), and task (aOR, 5.49; 95% CI, 2.31-13.07) were the most significant predictors. Job satisfaction results were significantly different among the study hospitals (χ 2  = 30.56, p < .001). The healthcare reform significantly and negatively influences public healthcare professionals' job

  18. Medical capability team: the clinical microsystem for combat healthcare delivery in counterinsurgency operations.

    Science.gov (United States)

    Clark, Susz; Van Steenvort, Jon K

    2008-01-01

    Today's operational environment in the support of counterinsurgency operations requires greater tactical and operational flexibility and diverse medical capabilities. The skills and organizations required for full spectrum medical operations are different from those of the past. Combat healthcare demands agility and the capacity for rapid change in clinical systems and processes to better support the counterinsurgency environment. This article proposes the Army Medical Department (AMEDD) develop and implement the medical capability team (MCT) for combat healthcare delivery. It discusses using the concept of the brigade combat team to develop medical capability teams as the unit of effectiveness to transform frontline care; provides a theoretical overview of the MCT as a "clinical microsystem"; discusses MCT leadership, training, and organizational support, and the deployment and employment of the MCT in a counterinsurgency environment. Additionally, this article proposes that the AMEDD initiate the development of an AMEDD Combat Training Center of Excellence to train and validate the MCTs. The complexity of combat healthcare demands an agile and campaign quality AMEDD with joint expeditionary capability in order to promote the best patient outcomes in a counterinsurgency environment.

  19. Harmony in health sector: a requirement for effective healthcare delivery in Nigeria.

    Science.gov (United States)

    Osaro, Erhabor; Charles, Adias Teddy

    2014-09-01

    Harmony is defined as the pleasing combination of elements of a system to form an all-inclusive, all involving and more productive team. The aim of this present review was to investigate the factors militating against harmony among healthcare professional in the Nigerian healthcare delivery system. This review was carried out by searching through literature on the topic that bother on harmony among health professions in the health sector. Literature search and reports from previous studies indicates that harmony among health workers is pivotal to improving the health indices. However, available evidence suggests that unlike in the developed world, health care professionals do not collaborate well together in Nigeria because of the claim of superiority of a particular health professional over others. This has often resulted in inter-professional conflict which is threatening to tear the health sector apart to the detriment of the patients. The Nigeria health system should be based on team work. Health professionals from a variety of disciplines should work together to deliver the best possible healthcare services to all Nigerians. All members of the team are equally valuable and essential to the smooth running of hospitals. Hospitals should ideally be headed by health administrators or by a qualified member of any of the professions in the health sector. Copyright © 2014 Hainan Medical College. Published by Elsevier B.V. All rights reserved.

  20. 'Where is the public health sector?' Public and private sector healthcare provision in Madhya Pradesh, India.

    Science.gov (United States)

    De Costa, Ayesha; Diwan, Vinod

    2007-12-01

    This paper aims to empirically demonstrate the size and composition of the private health care sector in one of India's largest provinces, Madhya Pradesh. It is based on a field survey of all health care providers in Madhya Pradesh (60.4 million in 52,117 villages and 394 towns). Seventy-five percent of the population is rural and 37% live below poverty line. This survey was done as part of the development of a health management information system. The distribution of health care providers in the province with regard to sector of work (public/private), rural-urban location, qualification, commercial orientation and institutional set-up are described. Of the 24,807 qualified doctors mapped in the survey, 18,757 (75.6%) work in the private sector. Fifteen thousand one hundred forty-two (80%) of these private physicians work in urban areas. The 72.1% (67793) of all qualified paramedical staff work in the private sector, mostly in rural areas. The paper empirically demonstrates the dominant heterogeneous private health sector and the overall the disparity in healthcare provision in rural and urban areas. It argues for a new role for the public health sector, one of constructive oversight over the entire health sector (public and private) balanced with direct provision of services where necessary. It emphasizes the need to build strong public private partnerships to ensure equitable access to healthcare for all.

  1. Creating value-focused healthcare delivery systems: Part three--Core competencies.

    Science.gov (United States)

    Beveridge, R N

    1997-01-01

    Value is created through the delivery of high-quality, cost--effective healthcare services. The ability to create value from the providers' perspective is facilitated through the development and implementation of essential, customer-focused core competencies. These core competencies include customer relationship management, payer/provider relationship management, disease management, outcomes management, financial/cost management, and information management. Customer relationship management is the foundation upon which all core competencies must be built. All of the core competencies must focus on the needs of the customers, both internal and external. Structuring all processes involved in the core competencies from the perspective of the customer will ensure that value is created throughout the system. Payer/provider relationship management will become a crucial pillar for healthcare providers in the future. As more vertical integration among providers occurs, the management of the relationships among providers and with payers will become more important. Many of the integration strategies being implemented across the country involve the integration of hospitals, physicians, and payers to form accountable health plans. The relationships must be organized to form "win/win" situations, where all parties are focused on a shared vision of creating value and none of the parties benefits at the expense of the others. Disease management in creating value requires that we begin examining the disease process along the entire continuum. Not only must providers be able to provide high-quality acute and chronic care, but they must also begin to focus more heavily on programs of prevention. Value is created throughout the system through reducing the prevalence and incidence of disease. Only through managing the full continuum of health will value be created throughout the healthcare delivery system. Outcomes management ensures that the outcomes are the highest quality at a cost

  2. Optimal healthcare delivery to care homes in the UK: a realist evaluation of what supports effective working to improve healthcare outcomes.

    Science.gov (United States)

    Gordon, Adam L; Goodman, Claire; Davies, Sue L; Dening, Tom; Gage, Heather; Meyer, Julienne; Schneider, Justine; Bell, Brian; Jordan, Jake; Martin, Finbarr C; Iliffe, Steve; Bowman, Clive; Gladman, John R F; Victor, Christina; Mayrhofer, Andrea; Handley, Melanie; Zubair, Maria

    2018-01-05

    care home residents have high healthcare needs not fully met by prevailing healthcare models. This study explored how healthcare configuration influences resource use. a realist evaluation using qualitative and quantitative data from case studies of three UK health and social care economies selected for differing patterns of healthcare delivery to care homes. Four homes per area (12 in total) were recruited. A total of 239 residents were followed for 12 months to record resource-use. Overall, 181 participants completed 116 interviews and 13 focus groups including residents, relatives, care home staff, community nurses, allied health professionals and General Practitioners. context-mechanism-outcome configurations were identified explaining what supported effective working between healthcare services and care home staff: (i) investment in care home-specific work that legitimises and values work with care homes; (ii) relational working which over time builds trust between practitioners; (iii) care which 'wraps around' care homes; and (iv) access to specialist care for older people with dementia. Resource use was similar between sites despite differing approaches to healthcare. There was greater utilisation of GP resource where this was specifically commissioned but no difference in costs between sites. activities generating opportunities and an interest in healthcare and care home staff working together are integral to optimal healthcare provision in care homes. Outcomes are likely to be better where: focus and activities legitimise ongoing contact between healthcare staff and care homes at an institutional level; link with a wider system of healthcare; and provide access to dementia-specific expertise. © The Author(s) 2018. Published by Oxford University Press on behalf of the British Geriatrics Society.

  3. Transforming trauma healthcare delivery in rural areas by use of an integrated call center

    Directory of Open Access Journals (Sweden)

    Deepak Agrawal

    2012-01-01

    Full Text Available Introduction: There is poor penetration of trauma healthcare delivery in rural areas. On the other hand, mobile penetration in India is now averaging 80% with most families having access to mobile phone. Aims and Objectives: The aim of this study was to assess the implementation and socioeconomic impact of a call center in providing healthcare delivery for patients with head and spinal injuries. Materials and Methods: This was a prospective observational study carried out over a 6-month period at a level I trauma Center in New Delhi, India. A nine-seater call center was outsourced to a private company and the hospital′s electronic medical records were integrated with the call-center operations. The call center was given responsibility of maintaining appointments and scheduling clinics for the whole hospital as well as ensuring follow-up visits. Trained call-center staff handled simple patient queries and referred the rest via email to concerned doctors. A telephonic survey was done prior to the start of call-center operations and after 3 months to assess for user satisfaction. Results: The initial cost of outsourcing the call center was Rs 1.6 lakhs (US$ 4000, with a recurring cost of Rs 80,000 (US$ 2000 per month. A total of 484 patients were admitted in the department of Neurosurgery during the study period. Of these, 63% (n=305 were from rural areas. Patients′ overall experience for clinic visits improved markedly following implementation of call center. Patient satisfaction for follow-up visits increased from a mean of 32-96%. Ninety-five percent patients reported a significant decrease in waiting time in clinics 80.4% reporting improved doctor-patient interaction. A total of 52 visits could be postponed/cancelled for patients living in far flung areas resulting in major socioeconomic benefits to these families. Conclusions: As shown by our case study, call centers have the potential to revolutionize delivery of trauma healthcare to

  4. Transforming trauma healthcare delivery in rural areas by use of an integrated call center

    Science.gov (United States)

    Agrawal, Deepak

    2012-01-01

    Introduction: There is poor penetration of trauma healthcare delivery in rural areas. On the other hand, mobile penetration in India is now averaging 80% with most families having access to mobile phone. Aims and Objectives: The aim of this study was to assess the implementation and socioeconomic impact of a call center in providing healthcare delivery for patients with head and spinal injuries. Materials and Methods: This was a prospective observational study carried out over a 6-month period at a level I trauma Center in New Delhi, India. A nine-seater call center was outsourced to a private company and the hospital's electronic medical records were integrated with the call-center operations. The call center was given responsibility of maintaining appointments and scheduling clinics for the whole hospital as well as ensuring follow-up visits. Trained call-center staff handled simple patient queries and referred the rest via email to concerned doctors. A telephonic survey was done prior to the start of call-center operations and after 3 months to assess for user satisfaction. Results: The initial cost of outsourcing the call center was Rs 1.6 lakhs (US$ 4000), with a recurring cost of Rs 80,000 (US$ 2000) per month. A total of 484 patients were admitted in the department of Neurosurgery during the study period. Of these, 63% (n=305) were from rural areas. Patients’ overall experience for clinic visits improved markedly following implementation of call center. Patient satisfaction for follow-up visits increased from a mean of 32-96%. Ninety-five percent patients reported a significant decrease in waiting time in clinics 80.4% reporting improved doctor-patient interaction. A total of 52 visits could be postponed/cancelled for patients living in far flung areas resulting in major socioeconomic benefits to these families. Conclusions: As shown by our case study, call centers have the potential to revolutionize delivery of trauma healthcare to rural areas in an

  5. Virtualized healthcare delivery: understanding users and their usage patterns of online medical consultations.

    Science.gov (United States)

    Jung, Changmi; Padman, Rema

    2014-12-01

    Virtualization of healthcare delivery via patient portals has facilitated the increasing interest in online medical consultations due to its benefits such as improved convenience and flexibility, lower cost, and time savings. Despite this growing interest, adoption by both consumers and providers has been slow, and little is known about users and their usage and adoption patterns. To learn characteristics of online healthcare consumers and understand their patterns of adoption and usage of online clinical consultation services (or eVisits delivered via the portal) such as adoption time for portal users, whether adoption hazard changes over time, and what factors influence patients to become early/late adopters. Using online medical consultation records between April 1, 2009 and May 31, 2010 from four ambulatory practices affiliated with a major healthcare provider, we conduct simple descriptive analysis to understand the users of online clinical consults and their usage patterns. Multilevel Logit regression is employed to measure the effect of patient and primary care provider characteristics on the likelihood of eVisit adoption by the patient, and survival analysis and Ordered Logit regression are applied to study eVisit adoption patterns that delineate elements describing early or late adopters. On average, eVisit adopters are younger and predominantly female. Their primary care providers participate in the eVisit service, highlighting the importance of physician's role in encouraging patients to utilize the service. Patients who are familiar with the patient portal are more likely to use the service, as are patients with more complex health issues. Younger and female patients have higher adoption hazard, but gender does not affect the decision of adopting early vs. late. These adopters also access the patient portal more frequently before adoption, indicating that they are potentially more involved in managing their health. The majority of eVisits are submitted

  6. Determinants of Healthcare Utilisation and Out-of-Pocket Payments in the Context of Free Public Primary Healthcare in Zambia

    Directory of Open Access Journals (Sweden)

    Felix Masiye

    2016-12-01

    Full Text Available Background Access to appropriate and affordable healthcare is needed to achieve better health outcomes in Africa. However, access to healthcare remains low, especially among the poor. In Zambia, poor access exists despite the policy by the government to remove user fees in all primary healthcare facilities in the public sector. The paper has two main objectives: (i to examine the factors associated with healthcare choices among sick people, and (ii to assess the determinants of the magnitude of out-of-pocket (OOP payments related to a visit to a health provider. Methods This paper employs a multilevel multinomial logistic regression to model the determinants of an individual’s choice of healthcare options following an illness. Further, the study analyses the drivers of the magnitude of OOP expenditure related to a visit to a health provider using a two-part generalised linear model. The analysis is based on a nationally representative healthcare utilisation and expenditure survey that was conducted in 2014. Results Household per capita consumption expenditure is significantly associated with increased odds of seeking formal care (odds ratio [OR] = 1.12, P = .000. Living in a household in which the head has a higher level of education is associated with increased odds of seeking formal healthcare (OR = 1.54, P = .000 and (OR = 1.55, P = .01, for secondary and tertiary education, respectively. Rural residence is associated with reduced odds of seeking formal care (OR = 0.706, P = .002. The magnitude of OOP expenditure during a visit is significantly dependent on household economic wellbeing, distance from a health facility, among other factors. A 10% increase in per capita consumption expenditure was associated with a 0.2% increase in OOP health expenditure while every kilometre travelled was associated with a K0.51 increase in OOP health expenditure. Conclusion Despite the removal of user fees on public primary healthcare in Zambia, access to

  7. Comparative performance of private and public healthcare systems in low- and middle-income countries: a systematic review.

    Directory of Open Access Journals (Sweden)

    Sanjay Basu

    Full Text Available INTRODUCTION: Private sector healthcare delivery in low- and middle-income countries is sometimes argued to be more efficient, accountable, and sustainable than public sector delivery. Conversely, the public sector is often regarded as providing more equitable and evidence-based care. We performed a systematic review of research studies investigating the performance of private and public sector delivery in low- and middle-income countries. METHODS AND FINDINGS: Peer-reviewed studies including case studies, meta-analyses, reviews, and case-control analyses, as well as reports published by non-governmental organizations and international agencies, were systematically collected through large database searches, filtered through methodological inclusion criteria, and organized into six World Health Organization health system themes: accessibility and responsiveness; quality; outcomes; accountability, transparency, and regulation; fairness and equity; and efficiency. Of 1,178 potentially relevant unique citations, data were obtained from 102 articles describing studies conducted in low- and middle-income countries. Comparative cohort and cross-sectional studies suggested that providers in the private sector more frequently violated medical standards of practice and had poorer patient outcomes, but had greater reported timeliness and hospitality to patients. Reported efficiency tended to be lower in the private than in the public sector, resulting in part from perverse incentives for unnecessary testing and treatment. Public sector services experienced more limited availability of equipment, medications, and trained healthcare workers. When the definition of "private sector" included unlicensed and uncertified providers such as drug shop owners, most patients appeared to access care in the private sector; however, when unlicensed healthcare providers were excluded from the analysis, the majority of people accessed public sector care. "Competitive

  8. Comparative Performance of Private and Public Healthcare Systems in Low- and Middle-Income Countries: A Systematic Review

    Science.gov (United States)

    Basu, Sanjay; Andrews, Jason; Kishore, Sandeep; Panjabi, Rajesh; Stuckler, David

    2012-01-01

    Introduction Private sector healthcare delivery in low- and middle-income countries is sometimes argued to be more efficient, accountable, and sustainable than public sector delivery. Conversely, the public sector is often regarded as providing more equitable and evidence-based care. We performed a systematic review of research studies investigating the performance of private and public sector delivery in low- and middle-income countries. Methods and Findings Peer-reviewed studies including case studies, meta-analyses, reviews, and case-control analyses, as well as reports published by non-governmental organizations and international agencies, were systematically collected through large database searches, filtered through methodological inclusion criteria, and organized into six World Health Organization health system themes: accessibility and responsiveness; quality; outcomes; accountability, transparency, and regulation; fairness and equity; and efficiency. Of 1,178 potentially relevant unique citations, data were obtained from 102 articles describing studies conducted in low- and middle-income countries. Comparative cohort and cross-sectional studies suggested that providers in the private sector more frequently violated medical standards of practice and had poorer patient outcomes, but had greater reported timeliness and hospitality to patients. Reported efficiency tended to be lower in the private than in the public sector, resulting in part from perverse incentives for unnecessary testing and treatment. Public sector services experienced more limited availability of equipment, medications, and trained healthcare workers. When the definition of “private sector” included unlicensed and uncertified providers such as drug shop owners, most patients appeared to access care in the private sector; however, when unlicensed healthcare providers were excluded from the analysis, the majority of people accessed public sector care. “Competitive dynamics” for

  9. Comparative performance of private and public healthcare systems in low- and middle-income countries: a systematic review.

    Science.gov (United States)

    Basu, Sanjay; Andrews, Jason; Kishore, Sandeep; Panjabi, Rajesh; Stuckler, David

    2012-01-01

    Private sector healthcare delivery in low- and middle-income countries is sometimes argued to be more efficient, accountable, and sustainable than public sector delivery. Conversely, the public sector is often regarded as providing more equitable and evidence-based care. We performed a systematic review of research studies investigating the performance of private and public sector delivery in low- and middle-income countries. Peer-reviewed studies including case studies, meta-analyses, reviews, and case-control analyses, as well as reports published by non-governmental organizations and international agencies, were systematically collected through large database searches, filtered through methodological inclusion criteria, and organized into six World Health Organization health system themes: accessibility and responsiveness; quality; outcomes; accountability, transparency, and regulation; fairness and equity; and efficiency. Of 1,178 potentially relevant unique citations, data were obtained from 102 articles describing studies conducted in low- and middle-income countries. Comparative cohort and cross-sectional studies suggested that providers in the private sector more frequently violated medical standards of practice and had poorer patient outcomes, but had greater reported timeliness and hospitality to patients. Reported efficiency tended to be lower in the private than in the public sector, resulting in part from perverse incentives for unnecessary testing and treatment. Public sector services experienced more limited availability of equipment, medications, and trained healthcare workers. When the definition of "private sector" included unlicensed and uncertified providers such as drug shop owners, most patients appeared to access care in the private sector; however, when unlicensed healthcare providers were excluded from the analysis, the majority of people accessed public sector care. "Competitive dynamics" for funding appeared between the two sectors, such

  10. Healthcare-associated infections: challenges to public health in Brazil.

    Science.gov (United States)

    Padoveze, Maria Clara; Fortaleza, Carlos Magno Castelo Branco

    2014-12-01

    This study presents a critical evaluation of the scientific literature related to this subject, aiming to assess the policies and administrative issues regarding the prevention and magnitude of healthcare-associated infections and discuss the challenges for their prevention in Brazil. The topics discussed included historical and administrative issues, challenges imposed by the characteristics of the healthcare system and the territorial dimension, laboratorial support limitations, costs, institutional culture, professional qualification, and patient engagement. It is urgent to hold a nationwide discussion among government representatives, institutions, and healthcare workers and users to overcome these challenges.

  11. Public perceptions of key performance indicators of healthcare in Alberta, Canada.

    Science.gov (United States)

    Northcott, Herbert C; Harvey, Michael D

    2012-06-01

    To examine the relationship between public perceptions of key performance indicators assessing various aspects of the health-care system. Cross-sequential survey research. Annual telephone surveys of random samples of adult Albertans selected by random digit dialing and stratified according to age, sex and region (n = 4000 for each survey year). The survey questionnaires included single-item measures of key performance indicators to assess public perceptions of availability, accessibility, quality, outcome and satisfaction with healthcare. Cronbach's α and factor analysis were used to assess the relationship between key performance indicators focusing on the health-care system overall and on a recent interaction with the health-care system. The province of Alberta, Canada during the years 1996-2004. Four thousand adults randomly selected each survey year. Survey questions measuring public perceptions of healthcare availability, accessibility, quality, outcome and satisfaction with healthcare. Factor analysis identified two principal components with key performance indicators focusing on the health system overall loading most strongly on the first component and key performance indicators focusing on the most recent health-care encounter loading most strongly on the second component. Assessments of the quality of care most recently received, accessibility of that care and perceived outcome of care tended to be higher than the more general assessments of overall health system quality and accessibility. Assessments of specific health-care encounters and more general assessments of the overall health-care system, while related, nevertheless comprise separate dimensions for health-care evaluation.

  12. Technical quality of delivery care in private- and public-sector health facilities in Enugu and Lagos States, Nigeria.

    Science.gov (United States)

    Hirose, Atsumi; Yisa, Ibrahim O; Aminu, Amina; Afolabi, Nathanael; Olasunmbo, Makinde; Oluka, George; Muhammad, Khalilu; Hussein, Julia

    2018-06-01

    Private-sector providers are increasingly being recognized as important contributors to the delivery of healthcare. Countries with high disease burdens and limited public-sector resources are considering using the private sector to achieve universal health coverage. However, evidence for the technical quality of private-sector care is lacking. This study assesses the technical quality of maternal healthcare during delivery in public- and private-sector facilities in resource-limited settings, from a systems and programmatic perspective. A summary index (the skilled attendance index, SAI), was used. Two-staged cluster sampling with stratification was used to select representative samples of case records in public- and private-sector facilities in Enugu and Lagos States, Nigeria. Information to assess criteria was extracted, and the SAI calculated. Linear regression models examined the relationship between SAI and the private and public sectors, controlling for confounders. The median SAI was 54.8% in Enugu and 85.7% in Lagos. The private for-profit sector's SAI was lower than and the private not-for-profit sector's SAI was higher than the public sector in Enugu [coefficient = -3.6 (P = 0.018) and 12.6 (P private for-profit sector's SAI was higher and the private not-for-profit sector's SAI was lower than the public sector [3.71 (P = 0.005) and -3.92 (P private for-profit providers' care was poorer than public providers where the public provision of care was weak, while private for-profit facilities provided better technical quality care than public facilities where the public sector was strong and there was a relatively strong regulatory body. Our findings raise important considerations relating to the quality of maternity care, the public-private mix and needs for regulation in global efforts to achieve universal healthcare.

  13. Knowledge, attitudes, and practices regarding dengue infection among public sector healthcare providers in Machala, Ecuador

    OpenAIRE

    Handel, Andrew S.; Ayala, Efra?n Beltr?n; Borbor-Cordova, Mercy J.; Fessler, Abigail G.; Finkelstein, Julia L.; Espinoza, Roberto Xavier Robalino; Ryan, Sadie J.; Stewart-Ibarra, Anna M.

    2016-01-01

    Background Dengue fever is a rapidly emerging infection throughout the tropics and subtropics with extensive public health burden. Adequate training of healthcare providers is crucial to reducing infection incidence through patient education and collaboration with public health authorities. We examined how public sector healthcare providers in a dengue-endemic region of Ecuador view and manage dengue infections, with a focus on the 2009 World Health Organization (WHO) Dengue Guidelines. Metho...

  14. Redesigning mental healthcare delivery: is there an effect on organizational climate?

    Science.gov (United States)

    Joosten, T C M; Bongers, I M B; Janssen, R T J M

    2014-02-01

    Many studies have investigated the effect of redesign on operational performance; fewer studies have evaluated the effects on employees' perceptions of their working environment (organizational climate). Some authors state that redesign will lead to poorer organizational climate, while others state the opposite. The goal of this study was to empirically investigate this relation. Organizational climate was measured in a field experiment, before and after a redesign intervention. At one of the sites, a redesign project was conducted. At the other site, no redesign efforts took place. Two Dutch child- and adolescent-mental healthcare providers. Professionals that worked at one of the units at the start and/or the end of the intervention period. The main intervention was a redesign project aimed at improving timely delivery of services (modeled after the breakthrough series). Scores on the four models of the organizational climate measure, a validated questionnaire that measures organizational climate. Our analysis showed that climate at the intervention site changed on factors related to productivity and goal achievement (rational goal model). The intervention group scored worse than the comparison group on the part of the questionnaire that focuses on sociotechnical elements of organizational climate. However, observed differences were so small, that their practical relevance seems rather limited. Redesign efforts in healthcare, so it seems, do not influence organizational climate as much as expected.

  15. Household coping strategies for delivery and related healthcare cost: findings from rural Bangladesh.

    Science.gov (United States)

    Hoque, Mohammad Enamul; Dasgupta, Sushil Kanta; Naznin, Eva; Al Mamun, Abdullah

    2015-10-01

    This study aims to measure the economic costs of maternal complication and to understand household coping strategies for financing maternal healthcare cost. A household survey of the 706 women with maternal complication, of whom 483 had normal delivery, was conducted to collect data at 6 weeks and 6 months post-partum. Data were collected on socio-economic information of the household, expenditure during delivery and post-partum, coping strategies adopted by households and other related information. Despite the high cost of health care associated with maternal complications, the majority of families were capable of protecting consumption on non-health items. Around one-third of households spent more than 20% of their annual household expenditure on maternal health care. Almost 50% were able to avoid catastrophic spending because of the coping strategies that they relied on. In general, households appeared resilient to short-term economic consequences of maternal health shocks, due to the availability of informal credit, donations from relatives and selling assets. While richer households fund a greater portion of the cost of maternal health care from income and savings, the poorer households with severe maternal complication resorted to borrowing from local moneylenders at high interest, which may leave them vulnerable to financial difficulties. Financial protection, especially for the poor, may benefit households against economic consequences of maternal complication. © 2015 John Wiley & Sons Ltd.

  16. Enhancing the nurses' role in healthcare delivery through strategic management: recognizing its importance or not?

    Science.gov (United States)

    Carney, Marie

    2009-09-01

    To determine the importance of strategy in nursing management and to establish if strategic management has entered the lexicon of nurses' vocabulary. Developing and managing strategy is a critical success factor for health care managers. It remains unclear if nurse managers view strategy development as their role. A review of scholarly International nursing and management literature, available through CINAHL and PUBMED Data Bases was undertaken. The titles of 1063 articles, published between 1997 and 2007 were examined in order to determine the profile of strategy in those titles. Documentary analysis was undertaken on a random sample of 250 of those articles and on the full text of a further 100. Less than 10% of journal titles contained the word strategy. What was presented as strategy was in the majority of cases describing policy, administration or management. Little formal strategy theory was evident. The nursing profession does not appear to have adopted the terms strategy or strategic management to any great extent. Nurse Managers could play a greater role in enhancing healthcare delivery if an understanding of, and acceptance of the importance of strategy in health care delivery was promoted.

  17. Workforce diversity among public healthcare workers in Nigeria: Implications on job satisfaction and organisational commitment

    Directory of Open Access Journals (Sweden)

    Ayodotun Stephen Ibidunni

    2018-06-01

    Full Text Available The aim of this research was to present a data article that identify the relationship between workforce diversity, job satisfaction and employee commitment among public healthcare workers in Nigeria. Copies of structured questionnaire were administered to 133 public healthcare workers from the Lagos state ministry of health in Nigeria. Using descriptive and structural equation modelling statistical analysis, the data revealed the relationship between workforce diversity and job satisfaction, workforce diversity and organisational commitment, and the role of job satisfaction on organisational commitment was also established. Keywords: Workforce diversity, Job satisfaction, Employee commitment, Public healthcare, Diversity management

  18. Contribution of Sudanese medical diaspora to the healthcare delivery system in Sudan: exploring options and barriers.

    Science.gov (United States)

    Abdalla, Fayrouz Mohammed; Omar, Maye Abu; Badr, Elsheikh Elsiddig

    2016-06-30

    Medical diaspora options, including the engagement of expatriate physicians in development efforts within their home country, are being called for to reverse the effects of brain drain from developing countries. This paper presents the results of a study exploring the potential contributions for the Sudanese Medial Diaspora Options to the healthcare delivery system (HCDS) in Sudan, focusing on the options of temporal and permanent returns and the likely obstacles faced in their implementation. This was a cross-sectional study using a mixed methods design including quantitative and qualitative approaches. For the quantitative approach, the study, which focused on the possible contribution of the diaspora to healthcare delivery in Sudan, was based on an online survey using random purposive and snowballing sampling techniques involving 153 Sudanese physicians working in Saudi Arabia and other Gulf States, the United Kingdom, the Republic of Ireland, and the United States of America. The qualitative approach involved in-depth interviews with returnee physicians and key informants in Sudan, focusing on the return experiences, the barriers for return, and the options to improve future contributions. Despite contributions of the Sudanese medical diaspora being of a small scale considering the size of the phenomenon, as well as infrequent and not appropriately organized, their inputs to academia and the links built with overseas institutions and specialist clinical services were nevertheless remarkable. The main barrier to temporal return was inappropriate organization by the local counterparts, while those for permanent return of physicians were poor work environment, insufficient financial payment, unsecured accommodation, and offspring education. The study identified short-term return as a feasible option considering the country's current conditions. Proper coordination mechanisms for short-term returns and facilitation of permanent return through stakeholders

  19. Quality of the ophthalmological service to outpatients of the public and private healthcare systems.

    Science.gov (United States)

    Hercos, Benigno Vicente Santos; Berezovsky, Adriana

    2017-01-01

    To compare perceptions of the quality of ophthalmological services offered to outpatients from the public healthcare system to those from the private healthcare system, and to determine which measures are seen as necessary and a priority for improving the quality of care. This was a prospective observational study on 200 patients, 101 and 99 of whom were from the public and private healthcare systems, respectively. All patients underwent an ophthalmological examination at an ophthalmology hospital in Belo Horizonte, Minas Gerais, Brazil. Personal interviews were conducted using two structured questionnaires adapted from the modified SERVQUAL scale. Overall, patients from the private healthcare system were significantly more dissatisfied than those from the public healthcare system. In both systems, reliability was considered to be the most important determinant of quality, and it presented the highest level of dissatisfaction. Satisfaction with the public healthcare system was significantly greater than that with the private healthcare system in terms of the tangibles, reliability, responsiveness, and assurance determinants of the SERVQUAL scale. Institutions must plan, execute, evaluate, and monitor measures that seek to improve the overall patient satisfaction with the quality of services provided, particularly in the private healthcare system, and special attention must be paid to reliability in both healthcare systems. The identification and monitoring of the quality of healthcare services through the periodic use of the SERVQUAL scale may provide healthcare managers with information so that they can identify, plan, and monitor necessary and priority measures. This could be a key strategy for improving the quality of outpatient health services in the public and private systems.

  20. Estimating the cost of healthcare delivery in three hospitals in southern ghana.

    Science.gov (United States)

    Aboagye, A Q Q; Degboe, A N K; Obuobi, A A D

    2010-09-01

    The cost burden (called full cost) of providing health services at a referral, a district and a mission hospital in Ghana were determined. Standard cost-finding and cost analysis tools recommended by World Health Organization are used to analyse 2002 and 2003 hospital data. Full cost centre costs were computed by taking into account cash and non-cash expenses and allocating overhead costs to intermediate and final patient care centres. The full costs of running the mission hospital in 2002 and 2003 were US$600,295 and US$758,647 respectively; for the district hospital, the respective costs were US$496,240 and US$487,537; and for the referral hospital, the respective costs were US$1,160,535 and US$1,394,321. Of these, overhead costs ranged between 20% and 42%, while salaries made up between 45% and 60%. Based on healthcare utilization data, in 2003 the estimated cost per outpatient attendance was US$ 2.25 at the mission hospital, US$ 4.51 at the district hospital and US$8.5 at the referral hospital; inpatient day costs were US$ 6.05, US$ 9.95 and US$18.8 at the respective hospitals. User fees charged at service delivery points were generally below cost. However, some service delivery points have the potential to recover their costs. Salaries are the major cost component of the three hospitals. Overhead costs constitute an important part of hospital costs and must be noted in efforts to recover costs. Cost structures are different at different types of hospitals. Unit costs at service delivery points can be estimated and projected into the future.

  1. Healthcare

    Science.gov (United States)

    Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.

    2012-01-01

    This report, provides detailed analyses and projections of occupations in healthcare fields, and wages earned. In addition, the important skills and work values associated with workers in those fields of healthcare are discussed. Finally, the authors analyze the implications of research findings for the racial, ethnic, and class diversity of the…

  2. The root causes of ineffective and inefficient healthcare technology management in Benin public health sector

    NARCIS (Netherlands)

    Houngbo, T.; Zweekhorst, M.B.M.; Bunders- Aelen, J.G.F.; Coleman, H.L.S.; Medenou, D.; Dakpanon, L.Y.; de Cock Buning, Tjard

    2017-01-01

    This study aims to identify the root causes and solutions of main problems facing Healthcare Technology Management in Benin׳s public health sector. Conducted in Benin from 2008 to 2010, two surveys were used with key actors in Healthcare Technology Management. The first survey was based on 377

  3. The LIFEspan model of transitional rehabilitative care for youth with disabilities: healthcare professionals' perspectives on service delivery.

    Science.gov (United States)

    Hamdani, Yani; Proulx, Meghann; Kingsnorth, Shauna; Lindsay, Sally; Maxwell, Joanne; Colantonio, Angela; Macarthur, Colin; Bayley, Mark

    2014-01-01

    LIFEspan is a service delivery model of continuous coordinated care developed and implemented by a cross-organization partnership between a pediatric and an adult rehabilitation hospital. Previous work explored enablers and barriers to establishing the partnership service. This paper examines healthcare professionals' (HCPs') experiences of 'real world' service delivery aimed at supporting transitional rehabilitative care for youth with disabilities. This qualitative study - part of an ongoing mixed method longitudinal study - elicited HCPs' perspectives on their experiences of LIFEspan service delivery through in-depth interviews. Data were categorized into themes of service delivery activities, then interpreted from the lens of a service integration/coordination framework. Five main service delivery themes were identified: 1) addressing youth's transition readiness and capacities; 2) shifting responsibility for healthcare management from parents to youth; 3) determining services based on organizational resources; 4) linking between pediatric and adult rehabilitation services; and, 5) linking with multi-sector services. LIFEspan contributed to service delivery activities that coordinated care for youth and families and integrated inter-hospital services. However, gaps in service integration with primary care, education, social, and community services limited coordinated care to the rehabilitation sector. Recommendations are made to enhance service delivery using a systems/sector-based approach.

  4. Commercial versus in-situ usability testing of healthcare information systems: towards "public" usability testing in healthcare organizations.

    Science.gov (United States)

    Kushniruk, Andre W; Borycki, Elizabeth M; Kannry, Joseph

    2013-01-01

    The need for improved usability in healthcare IT has been widely recognized. In addition, methods from usability engineering, including usability testing and usability inspection have received greater attention. Many vendors of healthcare software are now employing usability testing methods in the design and development of their products. However, despite this, the usability of healthcare IT is still considered to be problematic and many healthcare organizations that have purchased systems that have been tested at vendor testing sites are still reporting a range of usability and safety issues. In this paper we explore the distinction between commercial usability testing (conducted at centralized vendor usability laboratories and limited beta test sites) and usability testing that is carried out locally within healthcare organizations that have purchased vendor systems and products (i.e. public "in-situ" usability testing). In this paper it will be argued that both types of testing (i.e. commercial vendor-based testing) and in-situ testing are needed to ensure system usability and safety.

  5. Regulation for delivery of subsidies for public relations and safety

    International Nuclear Information System (INIS)

    1981-01-01

    This rule is established under the provisions of the law for the proper enforcement of subsidy budgets and the ordinance for the execution of this law, and to practice these provisions. It is applied to subsidies for the expenses of popularizing the knowledge of atomic power generation to inhabitants in the surrounding areas of atomic power generating facilities, investigation on the security of inhabitants in these areas, communication and coordination concerning the safety of such facilities during and after their installation and other expenses of establishing the facilities for public relations to inhabitants in the surrounding areas of these facilities. Basic terms are defined, such as atomic power generating facility, facility related to atomic power generation, and place of business. Subsidies are delivered to prefectures, cities, towns and villages where atomic power generating facilities are or are expected to be set up, prefectures including cities, towns and villages adjacent to those where such facilities are or are expected to be established, and prefectures which include the surrounding areas of those facilities. The limits of subsidies are stipulated in the lists attached. The terms of delivery vary according to the kinds of atomic power generating facilities and related facilities. Prefectures or cities, towns and villages which intend to apply for the delivery of subsidies shall file specified applications attached with the explanation of subsidy business outlines to the director of the ministry or agency concerned. Decision and conditions of delivery, reports on the situations and results of business and other concerned matters are defined, respectively. (Okada, K.)

  6. Two decades of reforms. Appraisal of the financial reforms in the Russian public healthcare sector.

    Science.gov (United States)

    Gordeev, Vladimir S; Pavlova, Milena; Groot, Wim

    2011-10-01

    This paper reviews the empirical evidence on the outcomes of the financial reforms in the Russian public healthcare sector. A systematic literature review identified 37 relevant publications that presented empirical evidence on changes in quality, equity, efficiency and sustainability in public healthcare provision due to the Russian public healthcare financial reforms. Evidence suggests that there are substantial inter-regional inequalities across income groups both in terms of financing and access to public healthcare services. There are large efficiency differences between regions, along with inter-regional variations in payment and reimbursement mechanisms. Informal and quasi-formal payments deteriorate access to public healthcare services and undermine the overall financing sustainability. The public healthcare sector is still underfinanced, although the implementation of health insurance gave some premises for future increases of efficiency. Overall, the available empirical data are not sufficient for an evidence-based evaluation of the reforms. More studies on the quality, equity, efficiency and sustainability impact of the reforms are needed. Future reforms should focus on the implementation of cost-efficiency and cost-control mechanisms; provide incentives for better allocation and distribution of resources; tackle problems in equity in access and financing; implement a system of quality controls; and stimulate healthy competition between insurance companies. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

  7. How can insulin initiation delivery in a dual-sector health system be optimised? A qualitative study on healthcare professionals' views.

    Science.gov (United States)

    Lee, Ping Yein; Lee, Yew Kong; Ng, Chirk Jenn

    2012-04-30

    The prevalence of type 2 diabetes is increasing at an alarming rate in developing countries. However, glycaemia control remains suboptimal and insulin use is low. One important barrier is the lack of an efficient and effective insulin initiation delivery approach. This study aimed to document the strategies used and proposed by healthcare professionals to improve insulin initiation in the Malaysian dual-sector (public-private) health system. In depth interviews and focus group discussions were conducted in Klang Valley and Seremban, Malaysia in 2010-11. Healthcare professionals consisting of general practitioners (n = 11), medical officers (n = 8), diabetes educators (n = 3), government policy makers (n = 4), family medicine specialists (n = 10) and endocrinologists (n = 2) were interviewed. We used a topic guide to facilitate the interviews, which were audio recorded, transcribed verbatim and analysed using a thematic approach. Three main themes emerged from the interviews. Firstly, there was a lack of collaboration between the private and public sectors in diabetes care. The general practitioners in the private sector proposed an integrated system for them to refer patients to the public health services for insulin initiation programmes. There could be shared care between the two sectors and this would reduce the disproportionately heavy workload at the public sector. Secondly, besides the support from the government health authority, the healthcare professionals wanted greater involvement of non-government organisations, media and pharmaceutical industry in facilitating insulin initiation in both the public and private sectors. The support included: training of healthcare professionals; developing and disseminating patient education materials; service provision by diabetes education teams; organising programmes for patients' peer group sessions; increasing awareness and demystifying insulin via public campaigns; and subsidising glucose

  8. The 2014-2015 Ebola virus disease outbreak and primary healthcare delivery in Liberia: Time-series analyses for 2010-2016.

    Science.gov (United States)

    Wagenaar, Bradley H; Augusto, Orvalho; Beste, Jason; Toomay, Stephen J; Wickett, Eugene; Dunbar, Nelson; Bawo, Luke; Wesseh, Chea Sanford

    2018-02-01

    The aim of this study is to estimate the immediate and lasting effects of the 2014-2015 Ebola virus disease (EVD) outbreak on public-sector primary healthcare delivery in Liberia using 7 years of comprehensive routine health information system data. We analyzed 10 key primary healthcare indicators before, during, and after the EVD outbreak using 31,836 facility-month service outputs from 1 January 2010 to 31 December 2016 across a census of 379 public-sector health facilities in Liberia (excluding Montserrado County). All indicators had statistically significant decreases during the first 4 months of the EVD outbreak, with all indicators having their lowest raw mean outputs in August 2014. Decreases in outputs comparing the end of the initial EVD period (September 2014) to May 2014 (pre-EVD) ranged in magnitude from a 67.3% decrease in measles vaccinations (95% CI: -77.9%, -56.8%, p sector primary healthcare system has made strides towards recovery from the 2014-2015 EVD outbreak. All primary healthcare indicators tracked have recovered to pre-EVD levels as of November 2016. Yet, for most indicators, it took more than 1 year to recover to pre-EVD levels. During this time, large losses of essential primary healthcare services occurred compared to what would have been expected had the EVD outbreak not occurred. The disruption of malaria case management during the EVD outbreak may have resulted in increased malaria cases. Large and sustained investments in public-sector primary care health system strengthening are urgently needed for EVD-affected countries.

  9. Mental healthcare delivery in rural Greece: A 10-year account of a mobile mental health unit

    Directory of Open Access Journals (Sweden)

    Vaios Peritogiannis

    2017-01-01

    Full Text Available Introduction: Patients living in rural and remote areas may have limited access to mental healthcare due to lack of facilities and socioeconomic reasons, and this is the case of rural areas in Eastern Europe countries. In Greece, community mental health service delivery in rural areas has been implemented through the development of the Mobile Mental Health Units (MMHUs. Methods: We present a 10-year account of the operation of the MMHU of the prefectures of Ioannina and Thesprotia (MMHU I-T and report on the impact of the service on mental health delivery in the catchment area. The MMHU I-T is a multidisciplinary community mental health team which delivers services in rural and mountainous areas of Northwest Greece. Results: The MMHU I-T has become an integral part of the local primary care system and is well known to the population of the catchment area. By the end of 2016, the majority of patients (60% were self-referred or family-referred, compared to 24% in the first 2 years. Currently, the number of active patients is 293 (mean age 63 years, 49.5% are older adults, and the mean caseload for each member of the team is 36.6. A significant proportion of patients (28% receive care with regular domiciliary visits, and the provision of home-based care was correlated with the age of the patients. Within the first 2 years of operation of the MMHU I-T hospitalizations of treatment, engaged patients were reduced significantly by 30.4%, whereas the treatment engagement rates of patients with psychotic disorders were 67.2% in 5 years. Conclusions: The MMHU I-T and other similar units in Greece are a successful paradigm of a low-cost service which promotes mental health in rural, remote, and deprived areas. This model of care may be informative for clinical practice and health policy given the ongoing recession and health budget cuts. It suggests that rural mental healthcare may be effectively delivered by integrating generic community mental health

  10. How can insulin initiation delivery in a dual-sector health system be optimised? A qualitative study on healthcare professionals’ views

    Directory of Open Access Journals (Sweden)

    Lee Ping Yein

    2012-04-01

    Full Text Available Abstract Background The prevalence of type 2 diabetes is increasing at an alarming rate in developing countries. However, glycaemia control remains suboptimal and insulin use is low. One important barrier is the lack of an efficient and effective insulin initiation delivery approach. This study aimed to document the strategies used and proposed by healthcare professionals to improve insulin initiation in the Malaysian dual-sector (public–private health system. Methods In depth interviews and focus group discussions were conducted in Klang Valley and Seremban, Malaysia in 2010–11. Healthcare professionals consisting of general practitioners (n = 11, medical officers (n = 8, diabetes educators (n = 3, government policy makers (n = 4, family medicine specialists (n = 10 and endocrinologists (n = 2 were interviewed. We used a topic guide to facilitate the interviews, which were audio recorded, transcribed verbatim and analysed using a thematic approach. Results Three main themes emerged from the interviews. Firstly, there was a lack of collaboration between the private and public sectors in diabetes care. The general practitioners in the private sector proposed an integrated system for them to refer patients to the public health services for insulin initiation programmes. There could be shared care between the two sectors and this would reduce the disproportionately heavy workload at the public sector. Secondly, besides the support from the government health authority, the healthcare professionals wanted greater involvement of non-government organisations, media and pharmaceutical industry in facilitating insulin initiation in both the public and private sectors. The support included: training of healthcare professionals; developing and disseminating patient education materials; service provision by diabetes education teams; organising programmes for patients’ peer group sessions; increasing awareness and demystifying

  11. Public Health Risks from Mismanagement of Healthcare Wastes in Shinyanga Municipality Health Facilities, Tanzania

    Directory of Open Access Journals (Sweden)

    Kizito Kuchibanda

    2015-01-01

    Full Text Available The increase of healthcare facilities in Shinyanga municipality has resulted in an increase of healthcare wastes, which poses serious threats to the environment, health workers, and the general public. This research was conducted to investigate management practices of healthcare wastes in Shinyanga municipality with a view of assessing health risks to health workers and the general public. The study, which was carried out in three hospitals, involved the use of questionnaires, in-depth interview, and observation checklist. The results revealed that healthcare wastes are not quantified or segregated in all the three hospitals. Healthcare wastes at the Shinyanga Regional Referral Hospital are disposed of by on-site incineration and burning and some wastes are disposed off-site. At Kolandoto DDH only on-site burning and land disposal are practiced, while at Kambarage UHC healthcare solid wastes are incinerated, disposed of on land disposal, and burned. Waste management workers do not have formal training in waste management techniques and the hospital administrations pay very little attention to appropriate management of healthcare wastes. In light of this, it is evident that management of healthcare solid wastes is not practiced in accordance with the national and WHO’s recommended standards.

  12. Value-based contracting innovated Medicare advantage healthcare delivery and improved survival.

    Science.gov (United States)

    Mandal, Aloke K; Tagomori, Gene K; Felix, Randell V; Howell, Scott C

    2017-02-01

    In Medicare Advantage (MA) with its CMS Hierarchical Condition Categories (CMS-HCC) payment model, CMS reimburses private plans (Medicare Advantage Organizations [MAOs]) with prospective, monthly, health-based or risk-adjusted, capitated payments. The effect of this payment methodology on healthcare delivery remains debatable. How value-based contracting generates cost efficiencies and improves clinical outcomes in MA is studied. A difference in contracting arrangements between an MAO and 2 provider groups facilitated an intervention-control, preintervention-postintervention, difference-in-differences approach among statistically similar, elderly, community-dwelling MA enrollees within one metropolitan statistical area. Starting in 2009, for intervention-group MA enrollees, the MAO and a provider group agreed to full-risk capitation combined with a revenue gainshare. The gainshare was based on increases in the Risk Adjustment Factor (RAF), which modified the CMS-HCC payments. For the control group, the MAO continued to reimburse another provider group through fee-for-service. RAF, utilization, and survival were followed until December 31, 2012. The intervention group's mean RAF increased significantly (P based visits (P based care for these MA enrollees with multiple comorbidities, a 6% survival benefit with a 32.8% lower hazard of death (P Value-based contracting can drive utilization patterns and improve clinical outcomes among chronically ill, elderly MA members.

  13. mHealth: Knowledge and use among doctors and nurses in public secondary health-care facilities of Lagos, Nigeria

    Directory of Open Access Journals (Sweden)

    Bukola Samuel Owolabi

    2018-01-01

    Full Text Available Objectives: Mobile health (mHealth is gaining importance worldwide, changing and improving the way healthcare and services are provided, but its role is just emerging in Nigeria. This study aimed to assess the knowledge and use of mHealth among health workers and the provisions for its use in public secondary health-care facilities of Lagos State, Nigeria. Methods: The study was a descriptive cross-sectional study carried out among 65 doctors and 135 nurses selected using a two-staged sampling method. Data were collected with pretested self-administered questionnaires and analyzed with EpiInfo™ 7. Results: Majority (doctors 84.6%, nurses 91.1% had not heard of the term “mHealth,” but most (doctors 96.9%, nurses 87.4% were aware of the use of mobile phones in health-care delivery. Only three (27.3% (health call centers/health-care telephone helpline, appointment reminders, and mobile telemedicine out of 11 mHealth components listed were mostly known. Most doctors simply used patient monitoring/surveillance and mobile telemedicine, while nurses mainly used treatment compliance and appointment reminder services. Majority were willing to use more mHealth services if available in their hospital. All the doctors and 97% of nurses had mobile phones. However, only about one-quarter (27.5% had smartphones with applications used for mHealth purposes. Conclusions: Knowledge, awareness, and use of mHealth services were low. Doctors and nurses should be enlightened and trained on ways to use mHealth services to improve health-care delivery, mHealth services should be made available in the hospitals, and use of smartphones encouraged as they portend better adaptability for mHealth use.

  14. Emerging nicotine delivery products. Implications for public health.

    Science.gov (United States)

    Benowitz, Neal L

    2014-02-01

    The idea of clean nicotine delivery systems that would satisfy nicotine craving and promote smoking cessation has been considered as a possible public health tool for many years. Nicotine medications have been useful for smoking cessation but have not found widespread popularity among smokers, perhaps because of slow nicotine delivery and other sensory characteristics that differ from cigarettes. Traditional smokeless tobacco delivers as much nicotine as cigarettes and has been advocated for harm reduction but contains carcinogenic nitrosamines and has not been proven to promote cessation. Furthermore, there is concern that dual use of smokeless tobacco and cigarettes may inhibit quitting smoking. Newer oral dissolvable tobacco products contain lower levels of toxicants than other smokeless tobacco but also deliver much less nicotine and have not been popular with consumers. Electronic cigarettes that aerosolize nicotine without generating toxic tobacco combustion products have become quite popular and hold promise as a way to attract smokers away from cigarettes, although efficacy in promoting smoking cessation has not yet been demonstrated. There are concerns about safety of long-term use, and there is evidence that youth, including nonsmokers, are taking up e-cigarette use. E-cigarettes are marketed for use when one cannot smoke conventional cigarettes, and such use might result in more persistent cigarette smoking. Although their benefits and risks are being vigorously debated, e-cigarettes or other clean nicotine delivery devices could play an important role as an adjunct to a U.S. Food and Drug Administration regulatory intervention to make cigarettes less addictive and in this context could contribute to the end of cigarette smoking and smoking-induced disease.

  15. Patients’ perception of quality service delivery of public hospitals in Nigeria using analytical hierarchy process

    Directory of Open Access Journals (Sweden)

    Emmanuel Olateju Oyatoye

    2016-07-01

    Full Text Available Introduction: Patients are recently more aware and conscious. This is because of the belief that a high level of quality can translate into patient satisfaction. This is critical for healthcare providers as they deal with life. This recognition by both the service provider and service receivers made the government to establish units of service commission (SERVICOM in each of the governmental agencies including hospitals in Nigeria to monitor the level of quality of service delivery. However, to what extent do patients’ perceptions about health services seem to have been largely recognized remain unclear by health care providers, despite the (SERVICOM units in public institutions in Nigeria? Method: A cross-sectional analytical study using convenient sample method, based on the fact that not every patient of the selected hospitals can be chosen, was performed on 400 patients who received health services at four different public hospitals in Ogun state Nigeria. The selection of these hospitals was based on the zones in the state (Egba, Ijebu, Remo and Yewa area of Ogun-state. The instrument was a valid and reliable analytical hierarchy process based questionnaire containing five service quality dimensions. Data were analyzed using SPSS, Expert choice and Microsoft Excel software to determine the perception of patients towards service quality delivery in pairwise comparison of judgment consistent at less than 10%. Results:The results showed the composite priorities of the patients’ perception with respect to determinants of the patients’ perception towards quality of services delivered in the public hospitals in Nigeria. The most important factor to patients was the reliability dimension with composite priority 0.24 or 24% followed by the responsiveness dimension with 0.22 assurance dimension 0.21, tangibility dimension with 0.21, and the least determinant factor was the empathy dimension with 0.1101. Conclusion: Based on the results, the

  16. [Public health stewardship and governance regarding the Colombian healthcare system, 2012-2013].

    Science.gov (United States)

    Roth-Deubel, André N; Molina-Marín, Gloria

    2013-01-01

    Analysing decision-making concerning public health issues regarding the Colombian healthcare system from a market economy-based approach. This study involved applying Glaser and Strauss's grounded theory in six Colombian cities during 2012: Bogotá, Barranquilla, Bucaramanga, Leticia, Medellin and Pasto. 120 individual interviews were conducted with professionals involved in decision-making, running public healthcare programmes and making policy within public and private institutions. Fourteen focus groups were held with community organisation leaders. The findings suggested national and municipal health authorities' weak stewardship and ineffective governance regarding public healthcare policy and programmes, related to a lack of staff trained in public health management issues. In turn, this was related to political parties' interference and private insurers' particular interests and the structural fragmentation of functions and actors within the health system, thereby limiting public health development. A new axiology is necessary for achieving effective governance (I.e. cooperation between Colombian Healthcare Social Security System actors) to overcome current incompetence and financial self-interest predominating within the Colombian healthcare system.

  17. [Private health insurance in Brazil: approaches to public/private patterns in healthcare].

    Science.gov (United States)

    Sestelo, José Antonio de Freitas; Souza, Luis Eugenio Portela Fernandes de; Bahia, Lígia

    2013-05-01

    This article draws on a previous review of 270 articles on private health plans published from 2000 to 2010 and selects 17 that specifically address the issue of the relationship between the public and private healthcare sectors. Content analysis considered the studies' concepts and terms, related theoretical elements, and predominant lines of argument. A reading of the argumentative strategies detected the existence of a critical view of the modus operandi in the public/private relationship based on Social Medicine and the theoretical tenets of the Brazilian Health Reform Movement. The study also identified contributions based on neoliberal business approaches that focus strictly on economic issues to discuss private health insurance. Understanding the public/private link in healthcare obviously requires the development of a solid empirical base, analyzed with adequate theoretical assumptions due to the inherent degree of complexity in the public/private healthcare interface.

  18. An evaluation of the development of a marketing strategy in mental healthcare delivery

    NARCIS (Netherlands)

    Bierbooms, J.J.P.A.; Bongers, I.M.B.; van Oers, J.A.M.

    2014-01-01

    Background Budget restrictions and increasing market forces within the Dutch mental healthcare sector have been forcing mental healthcare providers to manifest the added value of their quality of care. This calls for the development of the marketing skills of a mental healthcare provider, which can

  19. Public-Privat e Partnership in the System of Regional Healthcare Financing

    Directory of Open Access Journals (Sweden)

    Margarita Yur’evna Molchanova

    2016-05-01

    Full Text Available Healthcare financing reform in the Russian Federation, besides its positive consequences, has led to the emergence of several major organizational and economic problems that hinder the expansion of financing sources for this sphere, which also involves public-private partnership (PPP. The paper highlights the regional specifics of such healthcare projects compared to similar projects of other spheres of the national economy. The author describes the problems of PPP projects implementation in healthcare; they include the insufficiency of substantiation of public-private partnership application in healthcare, and the absence of typical models for establishment of relations between PPP participants. The paper presents the healthcare priorities put forward by the author; these priorities are based on the theory of the life cycle of a service. The author presents her own model for organizing a regional concession, which is the most common form of public-private partnership in healthcare so far. The cluster brings together on a voluntary basis the legally independent organizations that are interested in improving the quality and increasing the accessibility of health services. These can include medical institutions of various forms of ownership located in the region, clinics, facilities, institutions that train healthcare workers, authorities, etc. The author shows that a favorable environment for the formation and implementation of PPP projects can be created under the cluster approach to the organization of healthcare. When establishing the medical cluster, the main task is to organize interaction between all its subjects in the interest of the overall development of healthcare in the region and the implementation of one’s own interests

  20. Integrating and rationalizing public healthcare services as a source of cost containment in times of economic crises.

    Science.gov (United States)

    Pettoello-Mantovani, Massimo; Namazova-Baranova, Leyla; Ehrich, Jochen

    2016-02-24

    Serious concern has been raised about the sustainability of public health care systems of European Nations and ultimately about the health of European citizens, as a result of the economic crisis that has distressed Europe since 2008. The severe economic crisis of the Euro zone, which is still afflicting Europe in 2016, has in fact threatened to equally impact public health services of nations presenting either a weak or a strong domestic growth. On behalf of the European Paediatric Association, the Union of National European Societies and Associations, the authors of the Commentary debates the relationship between the effects of economic instability and health, through the report on an article recently published in the Italian Journal of Pediatrics, which emphasized the importance of integrating existing public health care services, otherwise independently provided by public hospitals, and Primary Care Paediatric networks. The interconnections between the effects of economic instability and health are briefly commented, following the observation that these two factors are not yet fully understood, and that the definition of proper solutions to be applied in circumstances, where health is negatively impacted by periods of economic distress, is still open for discussion. Furthermore it is noted that the pressure to "deliver more for less" often seems to be the driving force forging the political strategic decisions in the area of pediatric healthcare, rather than social, cultural, and economic sensitivity and competences. Thus, the delivery of appropriate pediatric healthcare seems not to be related exclusively to motivations aimed to the benefit of children, but more often to other intervening factors, including economic, and political rationales. The conclusions emphasize that local European experiences suggest that positive and cost effective healthcare programs are possible, and they could serve as a model in the development of effective cross-border regional

  1. New challenges of public health: bringing the future of personalised healthcare into focus.

    Science.gov (United States)

    Ricciardi, Walter; Boccia, Stefania

    2017-10-01

    The greater personalization of healthcare represents a driver of innovation for research, and for the healthcare systems and industries as a whole. Still policy-makers, healthcare professionals, citizens and private companies need to take some steps to realize the potential for such a radical shift. In this paper, we illustrate the challenges, the benefits and consequences that might accompany the implementation of personalized healthcare, and the steps that policy-makers and practitioners would need to take to realise its potential. Six main prerequisites for radical change in healthcare are presented, that include achieving better genetic literacy for professionals and for the public; engaging citizen in the discourse; improved governance, consent and trust in healthcare; feeding and harnessing the data-knowledge cycle for better health; adopting and adapting the Health Technology Assessment framework for the evaluation of the new technologies; and retaining humanity and community in health and care. Some of these concepts originate from a discussion on the future of health and healthcare, looking at least 15-20 years into the future, that we had at the end of 2016 at Ickworth with an international group of experts, under the aegis of the PHG Foundation. © The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  2. The Healthcare and Public Health Sector Challenges and Strategies to Conducting Sector Wide Assessments

    OpenAIRE

    Meyer, Harry

    2008-01-01

    Our Healthcare and Public Health (HPH) sector is vast, complex and essential to virtually all other sectors of our nation’s infrastructure. Without a healthy workforce modern society quickly grinds to a halt. The often messy networks of healthcare providers, insurance companies, emergency departments, pharmaceutical manufactures and other equally important actors are bound together in fragile alliances to maintain and restore basic health. Thus the HPH sector becomes an important cog in the w...

  3. Performance management of the public healthcare services in Ireland: a review.

    Science.gov (United States)

    Mesabbah, Mohammed; Arisha, Amr

    2016-01-01

    Performance Management (PM) processes have become a potent part of strategic and service quality decisions in healthcare organisations. In 2005, the management of public healthcare in Ireland was amalgamated into a single integrated management body, named the Health Service Executive (HSE). Since then, the HSE has come up with a range of strategies for healthcare developments and reforms, and has developed a PM system as part of its strategic planning. The purpose of this paper is to review the application of PM in the Irish Healthcare system, with a particular focus on Irish Hospitals and Emergency Services. An extensive review of relevant HSE's publications from 2005 to 2013 is conducted. Studies of the relevant literature related to the application of PM and of international best practices in healthcare performance systems are also presented. PM and performance measurement systems used by the HSE include many performance reports designed to monitor performance trends and strategic goals. Issues in the current PM system include inconsistency of measures and performance reporting, unclear strategy alignment, and deficiencies in reporting (e.g. feedback and corrective actions). Furthermore, PM processes have not been linked adequately into Irish public hospitals' management systems. The HSE delivers several services such as mental health, social inclusion, etc. This study focuses on the HSE's PM framework, with a particular interest in acute hospitals and emergency services. This is the first comprehensive review of Irish healthcare PM since the introduction of the HSE. A critical analysis of the HSE reports identifies the shortcomings in its current PM system.

  4. Will the NP workforce grow in the future? New forecasts and implications for healthcare delivery.

    Science.gov (United States)

    Auerbach, David I

    2012-07-01

    The nurse practitioner (NP) workforce has been a focus of considerable policy interest recently, particularly as the Patient Protection and Affordable Care Act may place additional demands on the healthcare professional workforce. The NP workforce has been growing rapidly in recent years, but fluctuation in enrollments in the past decades has resulted in a wide range of forecasts. To forecast the future NP workforce using a novel method that has been applied to the registered nurse and physician workforces and is robust to fluctuating enrollment trends. An age-cohort regression-based model was applied to the current and historical workforce, which was then forecasted to future years assuming stable age effects and a continuation of recent cohort trends. A total of 6798 NPs who were identified as having completed NP training in the National Sample Survey of Registered Nurses between 1992 and 2008. The future workforce is projected to grow to 244,000 in 2025, an increase of 94% from 128,000 in 2008. If NPs are defined more restrictively as those who self-identify their position title as "NP," supply is projected to grow from 86,000 to 198,000 (130%) over this period. The large projected increase in NP supply is higher and more grounded than other forecasts and has several implications: NPs will likely fulfill a substantial amount of future demand for care. Furthermore, as the ratio of NPs to Nurse Practitioners to physicians will surely grow, there could be implications for quality of care and for the configuration of future care delivery systems.

  5. Value-Based Health Care Delivery, Preventive Medicine and the Medicalization of Public Health

    OpenAIRE

    Vilhelmsson, Andreas

    2017-01-01

    The?real paradigm shift for healthcare is often stated to include a transition from accentuating health care production and instead emphasize patient value by moving to a??value-based health care delivery?. In this transition, personalized medicine is sometimes referred to as almost a panacea in solving the current and future health challenges.?In theory, the progress of precision medicine sounds uncontroversial and most welcomed with its promise of?a better healthcare for all, with real bene...

  6. Last Mile Towards Efficient Healthcare Delivery in Switzerland: eHealth Enabled Applications Could Speed Up the Care Process.

    Science.gov (United States)

    Deng, Yihan; Bürkle, Thomas; Holm, Jürgen; Zetz, Erwin; Denecke, Kerstin

    2018-01-01

    A precise and timely care delivery depends on an efficient triage performed by primary care providers and smooth collaboration with other medical specialities. In recent years telemedicine gained increasing importance for efficient care delivery. It's use, however, has been limited by legal issues, missing digital infrastructures, restricted support from health insurances and the digital divide in the population. A new era towards eHealth and telemedicine starts with the establishment of national eHealth regulations and laws. In Switzerland, a nation-wide digital infrastructure and electronic health record will be established. But appropriate healthcare apps to improve patient care based on this infrastructure remain rare. In this paper, we present two applications (self-anamnesis and eMedication assistant) for eHealth enabled care delivery which have the potential to speed up diagnosis and treatment.

  7. Interactions: Trade Policy and Healthcare Reform After Chaoulli v. Quebec: Is it time for Canada to acknowledge the fragile boundary between health and trade policies and strengthen the separation between private and public health insurance?

    OpenAIRE

    Crawford, Mark

    2006-01-01

    The insulation of Canada’s healthcare system from trade treaty obligations is crucial to the legitimacy of Canada’s trade policy. Legal analysis has suggested, however, that competitive and for-profit delivery of the kind contemplated by the Kirby Report and some provinces may make healthcare more vulnerable to challenges under NAFTA and GATS. The Government of Canada has tried to counter this interpretation by stressing the importance of public financing as the principal criterion for exempt...

  8. Workforce diversity among public healthcare workers in Nigeria: Implications on job satisfaction and organisational commitment.

    Science.gov (United States)

    Ibidunni, Ayodotun Stephen; Falola, Hezekiah Olubusayo; Ibidunni, Oyebisi Mary; Salau, Odunayo Paul; Olokundun, Maxwell Ayodele; Borishade, Taiye Tairat; Amaihian, Augusta Bosede; Peter, Fred

    2018-06-01

    The aim of this research was to present a data article that identify the relationship between workforce diversity, job satisfaction and employee commitment among public healthcare workers in Nigeria. Copies of structured questionnaire were administered to 133 public healthcare workers from the Lagos state ministry of health in Nigeria. Using descriptive and structural equation modelling statistical analysis, the data revealed the relationship between workforce diversity and job satisfaction, workforce diversity and organisational commitment, and the role of job satisfaction on organisational commitment was also established.

  9. Patients' appraisals of public and private healthcare: a qualitative study of physiotherapy and osteopathy.

    Science.gov (United States)

    Bradbury, Katherine J; Bishop, Felicity L; Yardley, Lucy; Lewith, George

    2013-10-01

    Patients have previously reported differences in their experiences of treatments received in the public and private sectors; it remains unclear whether such perceived differences are particular to or shared across different interventions. This study explored whether patients' appraisals of public and private treatments are similar when appraising a complementary therapy (osteopathy) compared to a mainstream therapy (physiotherapy). Thirty-five qualitative interviews were analysed thematically. Patients' appraisals varied by health-care sector and therapy type: physiotherapy was appraised more negatively in the National Health Service than the private sector but osteopathy was appraised similarly within both health-care sectors. Potential reasons for this are discussed.

  10. Harnessing the Potential to Quantify Public Preferences for Healthcare Priorities through Citizens’ Juries

    Directory of Open Access Journals (Sweden)

    Jennifer A. Whitty

    2014-07-01

    Full Text Available Despite progress towards greater public engagement, questions about the optimal approach to access public preferences remain unanswered. We review two increasingly popular methods for engaging the public in healthcare priority-setting and determining their preferences; the Citizens’ Jury (CJ and Discrete Choice Experiment (DCE. We discuss the theoretical framework from which each method is derived, its application in healthcare, and critique the information it can provide for decision-makers. We conclude that combining deliberation of an informed public via CJs and quantification of preferences using DCE methods, whilst it remains to be tested as an approach to engaging the public in priority-setting, could potentially achieve much richer information than the application of either method in isolation.

  11. The construction of a public key infrastructure for healthcare information networks in Japan.

    Science.gov (United States)

    Sakamoto, N

    2001-01-01

    The digital signature is a key technology in the forthcoming Internet society for electronic healthcare as well as for electronic commerce. Efficient exchanges of authorized information with a digital signature in healthcare information networks require a construction of a public key infrastructure (PKI). In order to introduce a PKI to healthcare information networks in Japan, we proposed a development of a user authentication system based on a PKI for user management, user authentication and privilege management of healthcare information systems. In this paper, we describe the design of the user authentication system and its implementation. The user authentication system provides a certification authority service and a privilege management service while it is comprised of a user authentication client and user authentication serves. It is designed on a basis of an X.509 PKI and is implemented with using OpenSSL and OpenLDAP. It was incorporated into the financial information management system for the national university hospitals and has been successfully working for about one year. The hospitals plan to use it as a user authentication method for their whole healthcare information systems. One implementation of the system is free to the national university hospitals with permission of the Japanese Ministry of Education, Culture, Sports, Science and Technology. Another implementation is open to the other healthcare institutes by support of the Medical Information System Development Center (MEDIS-DC). We are moving forward to a nation-wide construction of a PKI for healthcare information networks based on it.

  12. PARTICIPATORY GOVERNANCE IN THE PUBLIC HEALTHCARE SYSTEMS OF THE SCANDINAVIAN AND BALTIC COUNTRIES

    Directory of Open Access Journals (Sweden)

    Stefanescu Aurelia

    2011-12-01

    Full Text Available The diminished trust of citizens in the public sector, the increased complexity of policy issues and the reforms in accordance with the new public management principles generate the need of focusing more extensively on participatory governance. Participatory governance can be defined as the genuine engagement of citizens and other organizations in the formulation of policies and strategies, in the decision-making process from the public sector and in the implementation of the decisions. The present paper's objectives are to define the concept of participatory governance, to argue in favor of implementing it in the public sector and to find to what extent public healthcare institutions from Scandinavian and Baltic countries publish information on participatory governance and how they perceive community engagement. The research findings are that the information on participatory governance disclosed on the websites of relevant institutions from within the Scandinavian and Baltic public healthcare systems is scarce. The countries with the greatest concern for community engagement are Denmark and Sweden. It is argued that there should be a shift in focus within the public sector in general and within the healthcare system in particular, so that citizens are genuinely involved in the relevant processes and their satisfaction is indeed at an adequate level.

  13. Saving for delivery through technology: an inquiry into an electronic commitment savings product for maternal healthcare in Kenya.

    Science.gov (United States)

    van Bastelaer, Thierry; Woodman, Benjamin; Chatterji, Minki; Long, David

    2016-10-01

    Many women in low-income countries cannot afford maternal healthcare services. Changamka, a Kenyan company, developed an electronic, stored-value card to help pregnant women save for maternal healthcare at a Nairobi hospital. This paper reports results from a mixed-methods process evaluation of the card's implementation. The study found high levels of uptake and identified several benefits of the program, such as facilitating payment for services. The evaluation also identified several challenges. Most users completed only one transaction before discontinuing card use; only 6% of women who acquired the card used it to pay for delivery, and slightly less than 1% used it as it was originally intended-to pay for several antenatal care visits and for delivery. According to respondents, the main reason for this discontinuation was a lack of understanding about how to use the card. Users were, on average, of a higher socioeconomic and educational status than non-card users. Most users obtained the card in their third trimester, and among those who used the card to save for delivery, most started to do so too late in pregnancy to accumulate sufficient savings to pay for that service. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  14. [Autonomy for financial management in public and private healthcare facilities in Brazil].

    Science.gov (United States)

    Santos, Maria Angelica Borges dos; Madeira, Fátima Carvalho; Passos, Sonia Regina Lambert; Bakr, Felipe; Oliveira, Klivia Brayner de; Andreazzi, Marco Antonio Ratzsch de

    2014-01-01

    Autonomy in financial management is an advantage in public administration. A 2009 National Healthcare Facility Survey showed that 3.9% of Brazil's 52,055 public healthcare facilities had some degree of financial autonomy. Such autonomy was more common in inpatient facilities (17.8%), those managed by State governments (26.3%), and in Southern Brazil (6.6%). Autonomy was mainly partial (for resources in specific areas, relating to small outlays, consumables and capital goods, and outsourced services or personnel). 74.3% of 2,264 public facilities with any financial autonomy were under direct government administration. Financial autonomy in public healthcare facilities appears to be linked to local political decisions and not necessarily to the facility's specific legal and administrative status. However, legal status displays distinct scopes of autonomy - those under direct government administration tend to be less autonomous, and those under private businesses more autonomous; 85.8% of the 45,394 private healthcare facilities reported that they were financially autonomous.

  15. Healthcare waste management in Uganda: management and generation rates in public and private hospitals in Kampala

    NARCIS (Netherlands)

    Mugambe, R.K.; Ssempebwa, J.C.; Tumwesigye, N.M.; Vliet, van B.J.M.; Adedimeji, A.

    2012-01-01

    Aim The aim of this study was to assess the management, characteristics and generation of healthcare waste (HCW) in public and private hospitals in Kampala City, Uganda. Methods We employed mainly qualitative methods through the use of a waste inventory, observations, document review and key

  16. The role of information technology as a complementary resource in healthcare integrated delivery systems.

    Science.gov (United States)

    Thrasher, Evelyn H; Revels, Mark A

    2012-01-01

    As in many industries, it is recognized that there is a need to increase the use of information technology (IT) in the healthcare industry. However, until now, this has not occurred. In fact, some say that IT in healthcare has consistently fallen far short of expectations. The purpose of this study was to illuminate the need for a more holistic view of healthcare network integration and demonstrate that simply applying the latest technology to the network is not adequate for improving overall effectiveness. The study results showed that the more holistic view has to include management commitment, of complementarity between IT integration and organizational integration, and continued investments.

  17. To serve or to leave: a question faced by public sector healthcare providers in Pakistan.

    Science.gov (United States)

    Mir, Ali Mohammad; Shaikh, Muhammad Saleem; Rashida, Gul; Mankani, Neha

    2015-11-25

    The availability of properly trained and motivated providers is a prerequisite for provision of easily accessible healthcare. Pakistan has been listed by the World Health Organization in its World Health Report 2006 as one of 57 countries with a critical health workforce deficiency. This study examines the factors associated with the willingness of public sector healthcare providers to leave government service and recommends measures that can be adopted to attract and retain staff in the country's public healthcare system. A stratified, random sampling methodology was adopted to recruit a nationally representative sample of 1,296 public sector healthcare providers, including paramedics, medical doctors, and specialists. A semi-structured questionnaire was used to interview these providers. Logistic regressions measured the association with determinants of their willingness to leave the public health sector for better prospects elsewhere. A third of all healthcare providers who were interviewed were of the view that, provided the opportunity, they would leave government service. The odds of willingness to leave service were highest among providers from the region of Azad Jammu and Kashmir (adjusted odds ratio [AOR] = 4.33; 95% CI, 2.49-7.54) followed by the province of Balochistan (AOR = 4.21; 95% CI, 2.41-7.33), and the region of Gilgit Baltistan (AOR = 3.34; 95% CI, 1.67-6.67). Providers who expressed dissatisfaction in the manner their performance was evaluated and those who were dissatisfied with the current salary, each had higher odds of considering leaving government service (AOR = 1.67; 95% CI, 1.18-2.40 and AOR = 2.03; 95% CI, 1.47-2.81, respectively). Providers who reported experiencing interference in their work by influential politicians of the area were more inclined to leave (AOR = 1.44; 95% CI, 1.05-1.98). This study clearly highlights the need to implement more focused strategies in the public healthcare system in Pakistan in

  18. Public stewardship of private for-profit healthcare providers in low- and middle-income countries

    Science.gov (United States)

    Wiysonge, Charles S; Abdullahi, Leila H; Ndze, Valantine N; Hussey, Gregory D

    2016-01-01

    Background Governments use different approaches to ensure that private for-profit healthcare services meet certain quality standards. Such government guidance, referred to as public stewardship, encompasses government policies, regulatory mechanisms, and implementation strategies for ensuring accountability in the delivery of services. However, the effectiveness of these strategies in low- and middle-income countries (LMICs) have not been the subject of a systematic review. Objectives To assess the effects of public sector regulation, training, or co-ordination of the private for-profit health sector in low- and middle-income countries. Search methods For related systematic reviews, we searched the Cochrane Database of Systematic Reviews (CDSR) 2015, Issue 4; Database of Abstracts of Reviews of Effectiveness (DARE) 2015, Issue 1; Health Technology Assessment Database (HTA) 2015, Issue 1; all part of The Cochrane Library, and searched 28 April 2015. For primary studies, we searched MEDLINE, Epub Ahead of Print, In-Process & Other Non-Indexed Citations, MEDLINE Daily and MEDLINE 1946 to Present, OvidSP (searched 16 June 2016); Science Citation Index and Social Sciences Citation Index 1987 to present, and Emerging Sources Citation Index 2015 to present, ISI Web of Science (searched 3 May 2016 for papers citing included studies); Cochrane Central Register of Controlled Trials (CENTRAL), 2015, Issue 3, part of The Cochrane Library (including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register) (searched 28 April 2015); Embase 1980 to 2015 Week 17, OvidSP (searched 28 April 2015); Global Health 1973 to 2015 Week 16, OvidSP (searched 30 April 2015); WHOLIS, WHO (searched 30 April 2015); Science Citation Index and Social Sciences Citation Index 1975 to present, ISI Web of Science (searched 30 April 2015); Health Management, ProQuest (searched 22 November 2013). In addition, in April 2016, we searched the reference lists of relevant

  19. Do senior management cultures affect performance? Evidence from Italian public healthcare organizations.

    Science.gov (United States)

    Prenestini, Anna; Lega, Federico

    2013-01-01

    Healthcare organizations are often characterized by diffuse power, ambiguous goals, and a plurality of actors. In this complex and pluralistic context, senior healthcare managers are expected to provide strategic direction and lead their organizations toward their goals and performance targets. The present work explores the relationship between senior management team culture and performance by investigating Italian public healthcare organizations in the Tuscany region. Our assessment of senior management culture was accomplished through the use of an established framework and a corresponding tool, the competing values framework, which supports the idea that specific aspects of performance are related to a dominant management culture. Organizational performance was assessed using a wide range of measures collected by a multidimensional performance evaluation system, which was developed in Tuscany to measure the performance of its 12 local health authorities (LHAs) and four teaching hospitals (THs). Usable responses were received from 80 senior managers of 11 different healthcare organizations (two THs and nine LHAs). Our findings show that Tuscan healthcare organizations are characterized by various dominant cultures: developmental, clan, rational, and hierarchical. These variations in dominant culture were associated with performance measures. The implications for management theory, professional practice, and public policy are discussed.

  20. Web-based integrated public healthcare information system of Korea: development and performance.

    Science.gov (United States)

    Ryu, Seewon; Park, Minsu; Lee, Jaegook; Kim, Sung-Soo; Han, Bum Soo; Mo, Kyoung Chun; Lee, Hyung Seok

    2013-12-01

    The Web-based integrated public healthcare information system (PHIS) of Korea was planned and developed from 2005 to 2010, and it is being used in 3,501 regional health organizations. This paper introduces and discusses development and performance of the system. We reviewed and examined documents about the development process and performance of the newly integrated PHIS. The resources we analyzed the national plan for public healthcare, information strategy for PHIS, usage and performance reports of the system. The integrated PHIS included 19 functional business areas, 47 detailed health programs, and 48 inter-organizational tasks. The new PHIS improved the efficiency and effectiveness of the business process and inter-organizational business, and enhanced user satisfaction. Economic benefits were obtained from five categories: labor, health education and monitoring, clinical information management, administration and civil service, and system maintenance. The system was certified by a patent from the Korean Intellectual Property Office and accredited as an ISO 9001. It was also reviewed and received preliminary comments about its originality, advancement, and business applicability from the Patent Cooperation Treaty. It has been found to enhance the quality of policy decision-making about regional healthcare at the self-governing local government level. PHIS, a Web-based integrated system, has contributed to the improvement of regional healthcare services of Korea. However, when it comes to an appropriate evolution, the needs and changing environments of community-level healthcare service and IT infrastructure should be analyzed properly in advance.

  1. Realist synthesis of educational interventions to improve nutrition care competencies and delivery by doctors and other healthcare professionals

    Science.gov (United States)

    Mogre, Victor; Scherpbier, Albert J J A; Stevens, Fred; Aryee, Paul; Cherry, Mary Gemma; Dornan, Tim

    2016-01-01

    Objective To determine what, how, for whom, why, and in what circumstances educational interventions improve the delivery of nutrition care by doctors and other healthcare professionals work. Design Realist synthesis following a published protocol and reported following Realist and Meta-narrative Evidence Synthesis: Evolving Standards (RAMESES) guidelines. A multidisciplinary team searched MEDLINE, CINAHL, ERIC, EMBASE, PsyINFO, Sociological Abstracts, Web of Science, Google Scholar and Science Direct for published and unpublished (grey) literature. The team identified studies with varied designs; appraised their ability to answer the review question; identified relationships between contexts, mechanisms and outcomes (CMOs); and entered them into a spreadsheet configured for the purpose. The final synthesis identified commonalities across CMO configurations. Results Over half of the 46 studies from which we extracted data originated from the USA. Interventions that improved the delivery of nutrition care improved skills and attitudes rather than just knowledge; provided opportunities for superiors to model nutrition care; removed barriers to nutrition care in health systems; provided participants with local, practically relevant tools and messages; and incorporated non-traditional, innovative teaching strategies. Operating in contexts where student and qualified healthcare professionals provided nutrition care in developed and developing countries, these interventions yielded health outcomes by triggering a range of mechanisms, which included feeling competent, feeling confident and comfortable, having greater self-efficacy, being less inhibited by barriers in healthcare systems and feeling that nutrition care was accepted and recognised. Conclusions These findings show how important it is to move education for nutrition care beyond the simple acquisition of knowledge. They show how educational interventions embedded within systems of healthcare can improve

  2. Value-Based Health Care Delivery, Preventive Medicine and the Medicalization of Public Health.

    Science.gov (United States)

    Vilhelmsson, Andreas

    2017-03-01

    The real paradigm shift for healthcare is often stated to include a transition from accentuating health care production and instead emphasize patient value by moving to a 'value-based health care delivery'. In this transition, personalized medicine is sometimes referred to as almost a panacea in solving the current and future health challenges. In theory, the progress of precision medicine sounds uncontroversial and most welcomed with its promise of a better healthcare for all, with real benefits for the individual patient provided a tailored and optimized treatment plan suitable for his or her genetic makeup. And maybe, therefore, the assumptions underpinning personalized medicine have largely escaped questioning. The use of personalized medicine and the use of digital technologies is reshaping our health care system and how we think of health interventions and our individual responsibility. However, encouraging individuals to engage in preventive health activities possibly avoids one form of medicalization (clinical), but on the other hand, it takes up another form (preventive medicine and 'self-care') that moves medical and health concerns into every corner of everyday life. This ought to be of little value to the individual patient and public health. We ought to instead demand proof of these value ideas and the lacking research. Before this is in place critical appraisal and cynicism are requisite skills for the future. Otherwise, we are just listening to visionaries when we put our future health into their hands and let personalized solutions reach into people's everyday life regardless of patient safety and integrity.

  3. Guidebook : using public transportation to facilitate last mile package delivery.

    Science.gov (United States)

    2017-03-01

    This guidebook is designed to inform rural transit operators of how to implement a package delivery service using information and input gathered from the state-of-the practice scan, the fact-finding questionnaire, and stakeholder workshops. The guide...

  4. Cesarean delivery practices in teaching public and non- government ...

    African Journals Online (AJOL)

    admin

    previous cesarean section scar and other non medical indications like .... from the delivery record of the year 2011 (from January ... Confidentiality and privacy of all data were highly ..... monitoring, and lack of facility for electronic fetal heart.

  5. Toward a Nationwide Mobile-Based Public Healthcare Service System with Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    Chien-wen Shen

    2016-01-01

    Full Text Available This paper describes the development of a nationwide public healthcare service system with the integration of cloud technology, wireless sensor networks, and mobile technology to provide citizens with convenient and professional healthcare services. The basic framework of the system includes the architectures for the user end of wireless physiological examinations, for the regional healthcare cloud, and for national public healthcare service system. Citizens with chronic conditions or elderly people who are living alone can use the wireless physiological sensing devices to keep track of their health conditions and get warning if the system detects abnormal signals. Through mobile devices, citizens are able to get real-time health advice, prompt warning, health information, feedback, personalized support, and intervention ubiquitously. With the long-term tracking data for physiological sensing, reliable prediction models for epidemic diseases and chronic diseases can be developed for the government to respond to and control diseases immediately. Besides, such a nationwide approach enables government to have a holistic understanding of the public health information in real time, which is helpful to establish effective policies or strategies to prevent epidemic diseases or chronic diseases.

  6. The CRACK programme: a scientific alliance for bridging healthcare research and public health policies in Italy

    Directory of Open Access Journals (Sweden)

    Giovanni Corrao

    2013-09-01

    Full Text Available Healthcare utilisation databases, and other secondary data sources, have been used with growing frequency to assess health outcomes and healthcare interventions worldwide. Their increased popularity as a research tool is due to their timely availability, the large patient populations covered, low cost, and applicability for studying real-world clinical practice. Despite the need to measure Italian National Health Service performance both at regional and national levels, the wealth of good quality electronic data and the high standards of scientific research in this field, healthcare research and public health policies seem to progress along orthogonal dimensions in Italy. The main barriers to the development of evidence-based public health include the lack of understanding of evidence-based methodologies by policy makers, and of involvement of researchers in the policy process. The CRACK programme was launched by some academics from the Lombardy Region. By extensively using electronically stored data, epidemiologists, biostatisticians, pharmacologists and clinicians applied methods and evidence to several issues of healthcare research. The CRACK programme was based on their intention to remove barriers that thwart the process of bridging methods and findings from scientific journals to public health practice. This paper briefly describes aim, articulation and management of the CRACK programme, and discusses why it might find articulated application in Italy.

  7. Mental healthcare need and service utilization in older adults living in public housing.

    Science.gov (United States)

    Simning, Adam; van Wijngaarden, Edwin; Fisher, Susan G; Richardson, Thomas M; Conwell, Yeates

    2012-05-01

    Anxiety and depression in socioeconomically disadvantaged older adults frequently go unrecognized and untreated. This study aims to characterize mental illness and its treatment in older adult public housing residents who have many risk factors for anxiety and depression. Cross-sectional study. Public housing high-rises in Rochester, New York. One hundred ninety residents aged 60 years and older. Anxiety and depression were assessed using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, GAD-7, and Patient Health Questionnaire. We obtained information on mental healthcare from medication review and self-report. Participants had a median age of 66 years, 58% were women, 80% were black, and 92% lived alone. Many participants (31%) were in need of mental healthcare: 21% had syndromal and 11% had subsyndromal anxiety or depression. Mental healthcare need was associated with younger age; intact cognitive functioning; impairments in instrumental activities of daily living (IADL); more medical illness; decreased mobility; smaller social network size; more severe life events; and increased utilization of medical, human, and informal services. Of those with mental healthcare need, most were not receiving it. Compared with residents receiving mental healthcare, residents with untreated need were more likely to be men and have less IADL impairment, medical illness, severe life events, onsite social worker use, and human services utilization. Mental illness was common and largely untreated in public housing residents. Increasing collaboration between medical, mental, and human services is needed to improve identification, treatment, and ultimately prevention of late-life mental illness in this community setting.

  8. Toward a Learning Health-care System - Knowledge Delivery at the Point of Care Empowered by Big Data and NLP.

    Science.gov (United States)

    Kaggal, Vinod C; Elayavilli, Ravikumar Komandur; Mehrabi, Saeed; Pankratz, Joshua J; Sohn, Sunghwan; Wang, Yanshan; Li, Dingcheng; Rastegar, Majid Mojarad; Murphy, Sean P; Ross, Jason L; Chaudhry, Rajeev; Buntrock, James D; Liu, Hongfang

    2016-01-01

    The concept of optimizing health care by understanding and generating knowledge from previous evidence, ie, the Learning Health-care System (LHS), has gained momentum and now has national prominence. Meanwhile, the rapid adoption of electronic health records (EHRs) enables the data collection required to form the basis for facilitating LHS. A prerequisite for using EHR data within the LHS is an infrastructure that enables access to EHR data longitudinally for health-care analytics and real time for knowledge delivery. Additionally, significant clinical information is embedded in the free text, making natural language processing (NLP) an essential component in implementing an LHS. Herein, we share our institutional implementation of a big data-empowered clinical NLP infrastructure, which not only enables health-care analytics but also has real-time NLP processing capability. The infrastructure has been utilized for multiple institutional projects including the MayoExpertAdvisor, an individualized care recommendation solution for clinical care. We compared the advantages of big data over two other environments. Big data infrastructure significantly outperformed other infrastructure in terms of computing speed, demonstrating its value in making the LHS a possibility in the near future.

  9. Understanding the organization of public health delivery systems: an empirical typology.

    Science.gov (United States)

    Mays, Glen P; Scutchfield, F Douglas; Bhandari, Michelyn W; Smith, Sharla A

    2010-03-01

    Policy discussions about improving the U.S. health care system increasingly recognize the need to strengthen its capacities for delivering public health services. A better understanding of how public health delivery systems are organized across the United States is critical to improvement. To facilitate the development of such evidence, this article presents an empirical method of classifying and comparing public health delivery systems based on key elements of their organizational structure. This analysis uses data collected through a national longitudinal survey of local public health agencies serving communities with at least 100,000 residents. The survey measured the availability of twenty core public health activities in local communities and the types of organizations contributing to each activity. Cluster analysis differentiated local delivery systems based on the scope of activities delivered, the range of organizations contributing, and the distribution of effort within the system. Public health delivery systems varied widely in organizational structure, but the observed patterns of variation suggested that systems adhere to one of seven distinct configurations. Systems frequently migrated from one configuration to another over time, with an overall trend toward offering a broader scope of services and engaging a wider range of organizations. Public health delivery systems exhibit important structural differences that may influence their operations and outcomes. The typology developed through this analysis can facilitate comparative studies to identify which delivery system configurations perform best in which contexts.

  10. Knowledge and attitudes of doctors towards e-health use in healthcare delivery in government and private hospitals in Northern Uganda: a cross-sectional study.

    Science.gov (United States)

    Olok, Geoffrey Tabo; Yagos, Walter Onen; Ovuga, Emilio

    2015-11-04

    E-health is an essential information sharing tool in healthcare management and delivery worldwide. However, utilization of e-health may only be possible if healthcare professionals have positive attitudes towards e-health. This study aimed to determine the relationships between healthcare professionals' attitudes towards e-health, level of ICT skills and e-Health use in healthcare delivery in government and private hospitals in northern Uganda. Cross-sectional survey design was used. Sixty-eight medical doctors in three government hospitals and four private hospitals in Northern Uganda participated in the study. A pretested self-administered questionnaire was used to collect the required data. Data was analysed using SPSS software Version 19. Out of the 68 respondents, 39 (57.4 %) reported access to computer and 29 (48.5 %) accessed Internet in the workplace. Majority of healthcare professionals had positive attitudes towards e-health attributes (mean 3.5). The level of skills was moderate (mean 3.66), and was the most important and significant predictor of ICT use among healthcare professionals (r = .522, p < .001); however, attitudes towards e-health attributes did not contribute significantly in predicting e-health use. The findings suggest need for hospitals managements to strengthen e-health services in healthcare delivery in Northern Uganda.

  11. The Potential of Internet of Things to Improve the Quality of Healthcare Delivery

    Directory of Open Access Journals (Sweden)

    Cornel TURCU,

    2012-01-01

    Full Text Available Radio Frequency Identification (RFID technology is gaining significant momentum for tracking and tracing patients. The existing solutions for patient traceability are mostly centralized and closed-loop (effective only in small-scale RFID tracking applications. Lately, there has been a tendency to tag surrounding physical objects and to adopt various solutions that enable them to communicate with one another and with Information and Communications Technology (ICT systems. This leads to a new concept named the Internet of Things (IoT, in which objects are associated with useful digital information. IoT can bring multiple benefits to healthcare through the use of information from distributed resources such as dedicated devices, RFID tags, sensors/detectors, intelligent equipment, etc. IoT is likely to have impact on many applications in healthcare subfields such as, elderly and patient care, medical supply chain, logistic, asset management, drug counterfeit detection, etc. This paper deals with aspects related to technologies used in healthcare, and with the various challenges healthcare faces during transition from RFID to IoT.

  12. Alternative Public Service Delivery Models in Health, Water and ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    This project seeks to analyze health, water and electricity delivery models in Africa, Asia and Latin America in order to identify and document successful alternatives to commercialization. Researchers will draw up a set of ... Documents. Environmental and water management law in post-apartheid South Africa. Documents.

  13. Alternative Public Service Delivery Models in Health, Water and ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    This project seeks to analyze health, water and electricity delivery models in Africa, Asia and Latin America in order to identify and document successful alternatives to commercialization. ... Contradictions in municipal transformation from apartheid to democracy : the battle over local water privatization in South Africa.

  14. Public and Healthcare Professionals’ Knowledge and Attitudes toward Binge Eating Disorder: A Narrative Review

    Science.gov (United States)

    Reas, Deborah Lynn

    2017-01-01

    Binge eating disorder (BED) is characterized by recurrent binge eating and marked distress in the absence of inappropriate compensatory behaviors for weight control. BED is prevalent in men and women, is associated with elevated psychosocial and functional impairment, and is associated strongly with obesity and related medical comorbidities. The aim is to provide a brief, state-of-the-art review of the major and recent findings to inform educational and awareness campaigns, stigma reduction interventions, as well as current clinical practice and future research. A narrative approach was used to synthesize emerging literature on the public and healthcare professionals’ knowledge and attitudes toward individuals with BED in comparison to other eating disorders (EDs) or mental illness. A total of 13 articles were reviewed. Nine studies investigated community samples and four studies investigated healthcare professionals. The reviewed literature suggested that BED is perceived by the public as less impairing, less severe, and “easier-to-treat” than other EDs. Attitudes and beliefs reflecting perceived blameworthiness and lack of self-discipline were ascribed to vignettes with BED. Community studies indicated a low level of public awareness that BED constitutes a discreet eating disorder. The literature on healthcare professionals’ knowledge and attitudes toward BED remains very limited. The few existing studies suggest encouraging trends in recognition and diagnostic accuracy, yet there remains a need for increased clinical awareness of BED-associated medical complications and knowledge of full BED diagnostic criteria. PMID:29160843

  15. The Healthcare Public System – Does Standardization Withhold the Bucket from Leaking?

    Directory of Open Access Journals (Sweden)

    Biţoiu Teodora

    2017-12-01

    Full Text Available The public healthcare system is heavily influenced by the 3C trilemma - cost - coverage - choice. The paper’s argument tackles the fact that should the public decision on improving capacity be leaning towards universal coverage in would result in efficiency losses and, in an attempt to control the costs it would limit patients’ choice. Should priority be given to performance or value? The present paper deals with the compromise between the equity and efficiency, a leaky bucket that becomes more visible in the struggle to build capacity and intervene in the market by setting standards. Setting healthcare standards is a global concern, the 3rd Sustainable Development Goal is a clear proof of that the aim to emphasise and better analyse two of the most influential variables: efficiency and equity. All in all, what we argue is that the current leaky bucket is a trade-off between choice, coverage, and cost. For a complex public service like healthcare, targeting a full coverage and multiple choice would incur huge costs and, cutting costs considerably restricts both the choice and coverage. The cost is influenced by the production capacity use when the activity has large fixed costs.

  16. Public and Healthcare Professionals’ Knowledge and Attitudes toward Binge Eating Disorder: A Narrative Review

    Directory of Open Access Journals (Sweden)

    Deborah Lynn Reas

    2017-11-01

    Full Text Available Binge eating disorder (BED is characterized by recurrent binge eating and marked distress in the absence of inappropriate compensatory behaviors for weight control. BED is prevalent in men and women, is associated with elevated psychosocial and functional impairment, and is associated strongly with obesity and related medical comorbidities. The aim is to provide a brief, state-of-the-art review of the major and recent findings to inform educational and awareness campaigns, stigma reduction interventions, as well as current clinical practice and future research. A narrative approach was used to synthesize emerging literature on the public and healthcare professionals’ knowledge and attitudes toward individuals with BED in comparison to other eating disorders (EDs or mental illness. A total of 13 articles were reviewed. Nine studies investigated community samples and four studies investigated healthcare professionals. The reviewed literature suggested that BED is perceived by the public as less impairing, less severe, and “easier-to-treat” than other EDs. Attitudes and beliefs reflecting perceived blameworthiness and lack of self-discipline were ascribed to vignettes with BED. Community studies indicated a low level of public awareness that BED constitutes a discreet eating disorder. The literature on healthcare professionals’ knowledge and attitudes toward BED remains very limited. The few existing studies suggest encouraging trends in recognition and diagnostic accuracy, yet there remains a need for increased clinical awareness of BED-associated medical complications and knowledge of full BED diagnostic criteria.

  17. US Health Care Reform and Transplantation, Part II: impact on the public sector and novel health care delivery systems.

    Science.gov (United States)

    Axelrod, D A; Millman, D; Abecassis, M M

    2010-10-01

    The Patient Protection and Affordable Care Act passed in 2010 will result in dramatic expansion of publically funded health insurance coverage for low-income individuals. It is estimated that of the 32 million newly insured, 16 million will obtain coverage through expansion of the Medicaid Program, and the remaining 16 million will purchase coverage through their employer or newly legislated insurance exchanges. While the Act contains numerous provisions to improve access to private insurance as discussed in Part I of this analysis, public sector coverage will significantly be affected. The cost of health care reform will be borne disproportionately by Medicare, which faces nearly $500 billion in cuts to be identified by a new independent board. Transplant centers should be concerned about the impact of the reform on the financial aspects of transplantation. In addition, this legislation also utilizes the Medicare Program to drive reform of the health care delivery system, by encouraging the development of integrated Accountable Care Organizations, experimentation with new 'models' of healthcare delivery, and expanded support for Comparative Effectiveness Research. Transplant providers, including transplant centers and physicians/surgeons need to lead this movement, drawing on our experience providing comprehensive multidisciplinary care under global budgets with publically reported outcomes.

  18. Scaling of an information system in a public healthcare market--infrastructuring from the vendor's perspective.

    Science.gov (United States)

    Johannessen, Liv Karen; Obstfelder, Aud; Lotherington, Ann Therese

    2013-05-01

    The purpose of this paper is to explore the making and scaling of information infrastructures, as well as how the conditions for scaling a component may change for the vendor. The first research question is how the making and scaling of a healthcare information infrastructure can be done and by whom. The second question is what scope for manoeuvre there might be for vendors aiming to expand their market. This case study is based on an interpretive approach, whereby data is gathered through participant observation and semi-structured interviews. A case study of the making and scaling of an electronic system for general practitioners ordering laboratory services from hospitals is described as comprising two distinct phases. The first may be characterized as an evolving phase, when development, integration and implementation were achieved in small steps, and the vendor, together with end users, had considerable freedom to create the solution according to the users' needs. The second phase was characterized by a large-scale procurement process over which regional healthcare authorities exercised much more control and the needs of groups other than the end users influenced the design. The making and scaling of healthcare information infrastructures is not simply a process of evolution, in which the end users use and change the technology. It also consists of large steps, during which different actors, including vendors and healthcare authorities, may make substantial contributions. This process requires work, negotiation and strategies. The conditions for the vendor may change dramatically, from considerable freedom and close relationships with users and customers in the small-scale development, to losing control of the product and being required to engage in more formal relations with customers in the wider public healthcare market. Onerous procurement processes may be one of the reasons why large-scale implementation of information projects in healthcare is difficult

  19. Public Value Creation Enabled by Healthcare IS Projects – a resource-based-view

    DEFF Research Database (Denmark)

    Schlichter, Bjarne Rerup; Svejvig, Per; Laursen, Markus

    Creation of value from IT projects is a recurring theme that has diffused into healthcare information sys-tems (HIS). By applying a resource-based-view on findings from a study on the optimisation project of an integrated health information system (HIS) we develop a framework of capabilities needed...... in a public HIS setting to create value. The framework consists of Professional- , Organisational-, Patient Perceived- and Employee Perceived-Value dimensions. HIS is partly overlooked in the public management literature and the aspect of emergence and (personal as well as organisational) learning plays...... an important role in the creation value in HIS-projects....

  20. Mobile phones: the next step towards healthcare delivery in rural India?

    Science.gov (United States)

    DeSouza, Sherwin I; Rashmi, M R; Vasanthi, Agalya P; Joseph, Suchitha Maria; Rodrigues, Rashmi

    2014-01-01

    Given the ubiquity of mobile phones, their use to support healthcare in the Indian context is inevitable. It is however necessary to assess end-user perceptions regarding mobile health interventions especially in the rural Indian context prior to its use in healthcare. This would contextualize the use of mobile phone communication for health to 70% of the country's population that resides in rural India. To explore the acceptability of delivering healthcare interventions through mobile phones among users in a village in rural Bangalore. This was an exploratory study of 488 mobile phone users, residing in a village, near Bangalore city, Karnataka, South India. A pretested, translated, interviewer-administered questionnaire was used to obtain data on mobile phone usage patterns and acceptability of the mobile phone, as a tool for health-related communication. The data is described using basic statistical measures. The primary use of mobile phones was to make or receive phone calls (100%). Text messaging (SMS) was used by only 70 (14%) of the respondents. Most of the respondents, 484 (99%), were willing to receive health-related information on their mobile phones and did not consider receiving such information, an intrusion into their personal life. While receiving reminders for drug adherence was acceptable to most 479 (98%) of our respondents, 424 (89%) preferred voice calls alone to other forms of communication. Nearly all were willing to use their mobile phones to communicate with health personnel in emergencies and 367 (75%) were willing to consult a doctor via the phone in an acute illness. Factors such as sex, English literacy, employment status, and presence of chronic disease affected preferences regarding mode and content of communication. The mobile phone, as a tool for receiving health information and supporting healthcare through mHealth interventions was acceptable in the rural Indian context.

  1. Mobile Phones: The Next Step towards Healthcare Delivery in Rural India?

    Science.gov (United States)

    DeSouza, Sherwin I.; Rashmi, M. R.; Vasanthi, Agalya P.; Joseph, Suchitha Maria; Rodrigues, Rashmi

    2014-01-01

    Background Given the ubiquity of mobile phones, their use to support healthcare in the Indian context is inevitable. It is however necessary to assess end-user perceptions regarding mobile health interventions especially in the rural Indian context prior to its use in healthcare. This would contextualize the use of mobile phone communication for health to 70% of the country's population that resides in rural India. Objectives To explore the acceptability of delivering healthcare interventions through mobile phones among users in a village in rural Bangalore. Methods This was an exploratory study of 488 mobile phone users, residing in a village, near Bangalore city, Karnataka, South India. A pretested, translated, interviewer-administered questionnaire was used to obtain data on mobile phone usage patterns and acceptability of the mobile phone, as a tool for health-related communication. The data is described using basic statistical measures. Results The primary use of mobile phones was to make or receive phone calls (100%). Text messaging (SMS) was used by only 70 (14%) of the respondents. Most of the respondents, 484 (99%), were willing to receive health-related information on their mobile phones and did not consider receiving such information, an intrusion into their personal life. While receiving reminders for drug adherence was acceptable to most 479 (98%) of our respondents, 424 (89%) preferred voice calls alone to other forms of communication. Nearly all were willing to use their mobile phones to communicate with health personnel in emergencies and 367 (75%) were willing to consult a doctor via the phone in an acute illness. Factors such as sex, English literacy, employment status, and presence of chronic disease affected preferences regarding mode and content of communication. Conclusion The mobile phone, as a tool for receiving health information and supporting healthcare through mHealth interventions was acceptable in the rural Indian context. PMID

  2. Market segmentation for multiple option healthcare delivery systems--an application of cluster analysis.

    Science.gov (United States)

    Jarboe, G R; Gates, R H; McDaniel, C D

    1990-01-01

    Healthcare providers of multiple option plans may be confronted with special market segmentation problems. This study demonstrates how cluster analysis may be used for discovering distinct patterns of preference for multiple option plans. The availability of metric, as opposed to categorical or ordinal, data provides the ability to use sophisticated analysis techniques which may be superior to frequency distributions and cross-tabulations in revealing preference patterns.

  3. Mobile phones: the next step towards healthcare delivery in rural India?

    Directory of Open Access Journals (Sweden)

    Sherwin I DeSouza

    Full Text Available BACKGROUND: Given the ubiquity of mobile phones, their use to support healthcare in the Indian context is inevitable. It is however necessary to assess end-user perceptions regarding mobile health interventions especially in the rural Indian context prior to its use in healthcare. This would contextualize the use of mobile phone communication for health to 70% of the country's population that resides in rural India. OBJECTIVES: To explore the acceptability of delivering healthcare interventions through mobile phones among users in a village in rural Bangalore. METHODS: This was an exploratory study of 488 mobile phone users, residing in a village, near Bangalore city, Karnataka, South India. A pretested, translated, interviewer-administered questionnaire was used to obtain data on mobile phone usage patterns and acceptability of the mobile phone, as a tool for health-related communication. The data is described using basic statistical measures. RESULTS: The primary use of mobile phones was to make or receive phone calls (100%. Text messaging (SMS was used by only 70 (14% of the respondents. Most of the respondents, 484 (99%, were willing to receive health-related information on their mobile phones and did not consider receiving such information, an intrusion into their personal life. While receiving reminders for drug adherence was acceptable to most 479 (98% of our respondents, 424 (89% preferred voice calls alone to other forms of communication. Nearly all were willing to use their mobile phones to communicate with health personnel in emergencies and 367 (75% were willing to consult a doctor via the phone in an acute illness. Factors such as sex, English literacy, employment status, and presence of chronic disease affected preferences regarding mode and content of communication. CONCLUSION: The mobile phone, as a tool for receiving health information and supporting healthcare through mHealth interventions was acceptable in the rural Indian

  4. Healthcare librarians and the delivery of critical appraisal training: attitudes, level of involvement and support.

    Science.gov (United States)

    Maden-Jenkins, Michelle

    2010-12-01

    Although healthcare librarians are undertaking training in critical appraisal skills, what is not so clear is the impact of the training on the understanding and dissemination of these skills. This study aims to examine the attitudes of healthcare librarians towards delivering critical appraisal training and their level of involvement. A questionnaire survey of 57 library services across 48 NHS Trust Library Services in north-west England followed up with 21 semi-structured interviews. Seventy-three per cent of respondents felt that they ought to be involved in delivering critical appraisal training, however less than a third (29%) are actually involved. Librarians are involved in critical appraisal facilitation at various levels. Debate continues over the extent of librarian involvement in delivering critical appraisal training. As long as healthcare librarians recognise their own capabilities and identify the boundaries within which they feel comfortable then there is no reason why they should not be involved in delivering critical appraisal training. © 2010 The authors. Health Information and Libraries Journal © 2010 Health Libraries Group.

  5. The welfare implications of public healthcare financing: a macro-micro simulation analysis of Uganda.

    Science.gov (United States)

    Kabajulizi, Judith; Keogh-Brown, Marcus R; Smith, Richard D

    2017-12-01

    Studies on global health and development suggest that there is a strong correlation between the burden of disease and a country's level of income. Poorer countries tend to suffer more deaths from preventable causes such as communicable, maternal, perinatal and nutritional conditions, compared with high-income countries. In low-income countries, the government health expenditure share in the general government budget is low and out-of-pocket payments for healthcare relatively high. They also rely heavily on external resources for health funding, yet sustainability of external resource flows is not guaranteed. This article explores increasing public healthcare funding from domestic resources mobilization, and evaluates the impact of measures to achieve this on sectoral growth and poverty reduction rates in Uganda using a dynamic computable general equilibrium model. This article shows that increasing the government health budget share, facilitates expanded healthcare services, improved population health, higher sectoral growth and reduced poverty. The agricultural sector is predicted to post the highest growth when compared with services and industry sectors under both domestic taxation and aid funding scenarios, while national poverty is predicted to decline from 31 to 12% of the population by 2020. This article demonstrates that the most effective measure is to frontload investment in healthcare and generate additional domestic funding for health from a household tax earmarked for health. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. Public stewardship of private for-profit healthcare providers in low- and middle-income countries.

    Science.gov (United States)

    Wiysonge, Charles S; Abdullahi, Leila H; Ndze, Valantine N; Hussey, Gregory D

    2016-08-11

    Governments use different approaches to ensure that private for-profit healthcare services meet certain quality standards. Such government guidance, referred to as public stewardship, encompasses government policies, regulatory mechanisms, and implementation strategies for ensuring accountability in the delivery of services. However, the effectiveness of these strategies in low- and middle-income countries (LMICs) have not been the subject of a systematic review. To assess the effects of public sector regulation, training, or co-ordination of the private for-profit health sector in low- and middle-income countries. For related systematic reviews, we searched the Cochrane Database of Systematic Reviews (CDSR) 2015, Issue 4; Database of Abstracts of Reviews of Effectiveness (DARE) 2015, Issue 1; Health Technology Assessment Database (HTA) 2015, Issue 1; all part of The Cochrane Library, and searched 28 April 2015. For primary studies, we searched MEDLINE, Epub Ahead of Print, In-Process & Other Non-Indexed Citations, MEDLINE Daily and MEDLINE 1946 to Present, OvidSP (searched 16 June 2016); Science Citation Index and Social Sciences Citation Index 1987 to present, and Emerging Sources Citation Index 2015 to present, ISI Web of Science (searched 3 May 2016 for papers citing included studies); Cochrane Central Register of Controlled Trials (CENTRAL), 2015, Issue 3, part of The Cochrane Library (including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register) (searched 28 April 2015); Embase 1980 to 2015 Week 17, OvidSP (searched 28 April 2015); Global Health 1973 to 2015 Week 16, OvidSP (searched 30 April 2015); WHOLIS, WHO (searched 30 April 2015); Science Citation Index and Social Sciences Citation Index 1975 to present, ISI Web of Science (searched 30 April 2015); Health Management, ProQuest (searched 22 November 2013). In addition, in April 2016, we searched the reference lists of relevant articles, WHO International Clinical

  7. 'The public is too subjective': public involvement at different levels of health-care decision making.

    Science.gov (United States)

    Litva, Andrea; Coast, Joanna; Donovan, Jenny; Eyles, John; Shepherd, Michael; Tacchi, Jo; Abelson, Julia; Morgan, Kieran

    2002-06-01

    There are a number of impulses towards public participation in health care decision making including instrumentalist, communitarian, educative and expressive impulses and the desire for increased accountability. There has, however, been little research looking systematically at the public's preferences for being involved in particular types of rationing decisions, nor indeed, has there been a critical examination of the degree of involvement desired by the public. The research reported here uses findings from focus groups and in-depth interviews to explore these questions. Eight focus groups were conducted with a total of 57 informants, four amongst randomly selected members of the public and four with informants from health and non-health related organisations. Nineteen interviews were conducted to allow the elaboration of focus group comments, to probe views more deeply and to pursue emerging themes. The findings show variations in the willingness of members of the public to be involved in health care decisions and consistency across the different forms of the public as represented by the focus groups with randomly selected citizens and pre-existing organisations. There was a strong desire in all the groups for the public to be involved both at the system and programme levels, with much less willingness to be involved at the individual level. At the system and programme levels informants generally favoured consultation, without responsibility for decisions, but with the guarantee that their contribution would be heard and that decisions taken following consultation would be explained. At the patient level informants felt that the public should participate only by setting criteria for deciding between potential beneficiaries of treatment. The public has much to contribute, particularly at the system and programme levels, to supplement the inputs of health care professionals.

  8. Spirituality and healthcare: Towards holistic peoplecentred ...

    African Journals Online (AJOL)

    Healthcare in South Africa is in a crisis. Problems with infrastructure, management, human resources and the supply of essential medicines are at a critical level. This is compounded by a high burden of disease and disparity in levels of service delivery, particularly between public and private healthcare. The government ...

  9. Public health, healthcare, health and inequality in health in the Nordic countries

    DEFF Research Database (Denmark)

    Christiansen, Terkel; Lauridsen, Jørgen Trankjær; Kifmann, Mathias

    2018-01-01

    -economic equality in health. Each of the five countries has established extensive public health programmes, although with somewhat different measures to increase health of the populations. We compare these countries to the UK and Germany by using data from the European Social Survey for 2002 and 2012 in addition......All five Nordic countries emphasize equal and easy access to healthcare, assuming that increased access to healthcare leads to increased health. It is the purpose of the present study to explore to which extent the populations of these countries have reached good health and a high degree of socio...... to OECD statistics for the same years. Health is measured by self-assessed health in five categories, which is transformed to a cardinal scale using Swedish time trade-off (TTO) weights. As socio-economic measures we use household income and length of education. Socio-economic inequality in health...

  10. Punishment at the Frontlines of Public Service Delivery

    DEFF Research Database (Denmark)

    Pedersen, Mogens Jin; Stritch, Justin Michael; Thuesen, Frederik

    2018-01-01

    that affects clients can occasionally be marked by racial biases and disparities. Drawing on the Racial Classification Model (RCM) for a theoretical model, this article examines how client ethnicity shapes public employees’ decisions to sanction clients. Using Danish employment agencies as our empirical......Many public welfare programs give public employees discretionary authority to dispense sanctions when clients do not follow or comply with the policies and procedures required for receiving welfare benefits. Yet research also shows that public employees’ use of discretion in decision making...... and caseworkers’ decisions to sanction clients. While we find no moderation effects for ethnicity or gender, work experience appears to diminish the influence of client ethnicity on the caseworkers’ sanctioning decisions. Overall, our studies support the likelihood that ethnic minority clients will be punished...

  11. Funding issues and the delivery of public library services in Nigeria ...

    African Journals Online (AJOL)

    This paper examined the impact of government public expenditure on education and the effect of special funding in enhancing the delivery of public library services in Nigeria. secondary data were collected from the websites of the Central Bank of Nigeria (CBN) and Education Trust Fund (ETF.). Results from the regression ...

  12. Caring Wisely: A Program to Support Frontline Clinicians and Staff in Improving Healthcare Delivery and Reducing Costs.

    Science.gov (United States)

    Gonzales, Ralph; Moriates, Christopher; Lau, Catherine; Valencia, Victoria; Imershein, Sarah; Rajkomar, Alvin; Prasad, Priya; Boscardin, Christy; Grady, Deborah; Johnston, S

    2017-08-01

    We describe a program called "Caring Wisely"®, developed by the University of California, San Francisco's (UCSF), Center for Healthcare Value, to increase the value of services provided at UCSF Health. The overarching goal of the Caring Wisely® program is to catalyze and advance delivery system redesign and innovations that reduce costs, enhance healthcare quality, and improve health outcomes. The program is designed to engage frontline clinicians and staff-aided by experienced implementation scientists-to develop and implement interventions specifically designed to address overuse, underuse, or misuse of services. Financial savings of the program are intended to cover the program costs. The theoretical underpinnings for the design of the Caring Wisely® program emphasize the importance of stakeholder engagement, behavior change theory, market (target audience) segmentation, and process measurement and feedback. The Caring Wisely® program provides an institutional model for using crowdsourcing to identify "hot spot" areas of low-value care, inefficiency and waste, and for implementing robust interventions to address these areas. © 2017 Society of Hospital Medicine.

  13. The Dilemma of Accountability and Good Governance for Improved Public Service Delivery in Nigeria

    Directory of Open Access Journals (Sweden)

    Kehinde David Adejuwon

    2012-12-01

    Full Text Available The public sector in Nigeria is irrefutably beset with gross  incompetence and ineffective management. Perplexing difficulties endure in the Nigerian public sector in spite of a number of reform programmes that have been designed to enhance efficient and effective service delivery for almost two decades. The fact that public service has failed dismally to achieve its laudable objectives is the reason for the vote of no confidence passed on its administrators by majority of the Nigerian populace. The article examines the dilemma of accountability and good governance in Nigeria and demonstrates that the critical point in achieving meaningful developments in the country intrinsically lay with improved service delivery in the public sector. The basic reason why the public service has become the scorn of the people is because for too long, both the government and public servants have paid lip service to the crucial issue of effective and efficient service delivery. The article argues that improved service delivery will improve both the performance and the image of public service and re-awaken the citizens’ interest and trust in them to do business with public servants. It suggests that  in order to bring sanity back to the Nigerian Public Service,  all unprofessional tendencies such as ethnicity bias and nepotism in appointments and promotions, lack of security of tenure of office, and appointment of non-career public servants into key positions in the public service must stop. Also,  effective service delivery must be tailored to the circumstances of Nigeria. The study made use of secondary data obtained from various sources. It therefore concludes that without a reawakening of the culture of accountability and transparency lost over the years, the trusting relationship needed to forge between the government and the governed for the actualization of good governance will not materialize.

  14. Planning of public healthcare facility using a location allocation modelling: A case study

    Science.gov (United States)

    Shariff, S. Sarifah Radiah; Moin, Noor Hasnah; Omar, Mohd

    2014-09-01

    Finding the correct location of any facility and determining the demands which are to be assigned to it is very crucial in public health service. This is to ensure that the public gain maximum benefits. This article analyzes the previous location decisions of public primary healthcare (PHC) facilities in the district of Kuala Langat, Malaysia. With total population of 220214 (in 2010), the PHC in the district is currently served by 28 facilities. The percentages of total population covered (in 2007) within the maximum allowable distance of 3km and 5km are 69.7 percent and 77.8 percent respectively. This is very low compared to the Malaysian National Health Policy of Health for All or 100 percent coverage. The determination of health facility location should be planned carefully to further increase effective primary health service to the nation that is required for economic sustainability.

  15. The public-private partnership regulatory support of the healthcare sector in Ukraine

    Directory of Open Access Journals (Sweden)

    N. G. Gojda

    2013-10-01

    Full Text Available Summary: Article is devoted to the legislation review of the public-private partnership projects of the healthcare sector inUkraine. Authors focused attention on the basic problems of public-private partnership projects inUkraine. Objective: Analysis of the legal framework provides the possibility of public-private partnerships in health care ofUkraine and confirms the relevance of the scientific concept of development of public-private partnerships in health care ofUkraine. Methods: There were used periodic data of legal, economic and medical research publications inUkraine and CIS countries on regulatory support public-private partnerships. Results: The researches in many countries have proven the established of state regulatory bodies that carefully study various aspects of the business partnership in the services of provision of health care. Developed numerical models as simple infrastructure projects implement business participation in providing non-medical services (construction, hotels and utilities, technical re-equipment etc. to complex integrated models that involve the transfer of important state functions to private partner (strategic planning, highly specialized medical care, research, medical education, etc.. Conclusion: The development of public-private partnerships in health care of Ukraine is possible only in condition of further improvement of legislation to the line with the norms and principles of international law, providing a clear and coordinated cooperation of all branches and friendly to business partnership administrative environment.

  16. Implementing standards for the interoperability among healthcare providers in the public regionalized Healthcare Information System of the Lombardy Region.

    Science.gov (United States)

    Barbarito, Fulvio; Pinciroli, Francesco; Mason, John; Marceglia, Sara; Mazzola, Luca; Bonacina, Stefano

    2012-08-01

    Information technologies (ITs) have now entered the everyday workflow in a variety of healthcare providers with a certain degree of independence. This independence may be the cause of difficulty in interoperability between information systems and it can be overcome through the implementation and adoption of standards. Here we present the case of the Lombardy Region, in Italy, that has been able, in the last 10 years, to set up the Regional Social and Healthcare Information System, connecting all the healthcare providers within the region, and providing full access to clinical and health-related documents independently from the healthcare organization that generated the document itself. This goal, in a region with almost 10 millions citizens, was achieved through a twofold approach: first, the political and operative push towards the adoption of the Health Level 7 (HL7) standard within single hospitals and, second, providing a technological infrastructure for data sharing based on interoperability specifications recognized at the regional level for messages transmitted from healthcare providers to the central domain. The adoption of such regional interoperability specifications enabled the communication among heterogeneous systems placed in different hospitals in Lombardy. Integrating the Healthcare Enterprise (IHE) integration profiles which refer to HL7 standards are adopted within hospitals for message exchange and for the definition of integration scenarios. The IHE patient administration management (PAM) profile with its different workflows is adopted for patient management, whereas the Scheduled Workflow (SWF), the Laboratory Testing Workflow (LTW), and the Ambulatory Testing Workflow (ATW) are adopted for order management. At present, the system manages 4,700,000 pharmacological e-prescriptions, and 1,700,000 e-prescriptions for laboratory exams per month. It produces, monthly, 490,000 laboratory medical reports, 180,000 radiology medical reports, 180

  17. Semantic Web Service Delivery in Healthcare Based on Functional and Non-Functional Properties.

    Science.gov (United States)

    Schweitzer, Marco; Gorfer, Thilo; Hörbst, Alexander

    2017-01-01

    In the past decades, a lot of endeavor has been made on the trans-institutional exchange of healthcare data through electronic health records (EHR) in order to obtain a lifelong, shared accessible health record of a patient. Besides basic information exchange, there is a growing need for Information and Communication Technology (ICT) to support the use of the collected health data in an individual, case-specific workflow-based manner. This paper presents the results on how workflows can be used to process data from electronic health records, following a semantic web service approach that enables automatic discovery, composition and invocation of suitable web services. Based on this solution, the user (physician) can define its needs from a domain-specific perspective, whereas the ICT-system fulfills those needs with modular web services. By involving also non-functional properties for the service selection, this approach is even more suitable for the dynamic medical domain.

  18. Work load and management in the delivery room: changing the direction of healthcare policy.

    Science.gov (United States)

    Sfregola, Gianfranco; Laganà, Antonio Simone; Granese, Roberta; Sfregola, Pamela; Lopinto, Angela; Triolo, Onofrio

    2017-02-01

    Nurse staffing, increased workload and unstable nursing unit environments are linked to negative patient outcomes including falls and medication errors on medical/surgical units. Considering this evidence, the aim of our study was to overview midwives' workload and work setting. We created a questionnaire and performed an online survey. We obtained information about the type and level of hospital, workload, the use of standardised procedures, reporting of sentinel and 'near-miss' events. We reported a severe understaffing in midwives' work settings and important underuse of standard protocols according to the international guidelines, especially in the South of Italy. Based on our results, we strongly suggest a change of direction of healthcare policy, oriented to increase the number of employed midwives, in order to let them fulfil their duties according to the international guidelines (especially one-to-one care). On the other hand, we encourage the adoption of standardised protocols in each work setting.

  19. Buprenorphine Maintenance for Opioid Dependence in Public Sector Healthcare: Benefits and Barriers.

    Science.gov (United States)

    Duncan, Laura G; Mendoza, Sonia; Hansen, Helena

    Since its U.S. FDA approval in 2002, buprenorphine has been available for maintenance treatment of opiate dependence in primary care physicians' offices. Though buprenorphine was intended to facilitate access to treatment, disparities in utilization have emerged; while buprenorphine treatment is widely used in private care setting, public healthcare integration of buprenorphine lags behind. Through a review of the literature, we found that U.S. disparities are partly due to a shortage of certified prescribers, concern of patient diversion, as well as economic and institutional barriers. Disparity of buprenorphine treatment dissemination is concerning since buprenorphine treatment has specific characteristics that are especially suited for low-income patient population in public sector healthcare such as flexible dosing schedules, ease of concurrently treating co-morbidities such as HIV and hepatitis C, positive patient attitudes towards treatment, and the potential of reducing addiction treatment stigma. As the gap between buprenorphine treatment in public sector settings and private sector settings persists in the U.S., current research suggests ways to facilitate its dissemination.

  20. Operationalising emergency care delivery in sub-Saharan Africa: consensus-based recommendations for healthcare facilities.

    Science.gov (United States)

    Calvello, Emilie J B; Tenner, Andrea G; Broccoli, Morgan C; Skog, Alexander P; Muck, Andrew E; Tupesis, Janis P; Brysiewicz, Petra; Teklu, Sisay; Wallis, Lee; Reynolds, Teri

    2016-08-01

    A major barrier to successful integration of acute care into health systems is the lack of consensus on the essential components of emergency care within resource-limited environments. The 2013 African Federation of Emergency Medicine Consensus Conference was convened to address the growing need for practical solutions to further implementation of emergency care in sub-Saharan Africa. Over 40 participants from 15 countries participated in the working group that focused on emergency care delivery at health facilities. Using the well-established approach developed in the WHO's Monitoring Emergency Obstetric Care, the workgroup identified the essential services delivered-signal functions-associated with each emergency care sentinel condition. Levels of emergency care were assigned based on the expected capacity of the facility to perform signal functions, and the necessary human, equipment and infrastructure resources identified. These consensus-based recommendations provide the foundation for objective facility capacity assessment in developing emergency health systems that can bolster strategic planning as well as facilitate monitoring and evaluation of service delivery. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  1. A web-based information system for a regional public mental healthcare service network in Brazil.

    Science.gov (United States)

    Yoshiura, Vinicius Tohoru; de Azevedo-Marques, João Mazzoncini; Rzewuska, Magdalena; Vinci, André Luiz Teixeira; Sasso, Ariane Morassi; Miyoshi, Newton Shydeo Brandão; Furegato, Antonia Regina Ferreira; Rijo, Rui Pedro Charters Lopes; Del-Ben, Cristina Marta; Alves, Domingos

    2017-01-01

    Regional networking between services that provide mental health care in Brazil's decentralized public health system is challenging, partly due to the simultaneous existence of services managed by municipal and state authorities and a lack of efficient and transparent mechanisms for continuous and updated communication between them. Since 2011, the Ribeirao Preto Medical School and the XIII Regional Health Department of the Sao Paulo state, Brazil, have been developing and implementing a web-based information system to facilitate an integrated care throughout a public regional mental health care network. After a profound on-site analysis, the structure of the network was identified and a web-based information system for psychiatric admissions and discharges was developed and implemented using a socio-technical approach. An information technology team liaised with mental health professionals, health-service managers, municipal and state health secretariats and judicial authorities. Primary care, specialized community services, general emergency and psychiatric wards services, that comprise the regional mental healthcare network, were identified and the system flow was delineated. The web-based system overcame the fragmentation of the healthcare system and addressed service specific needs, enabling: detailed patient information sharing; active coordination of the processes of psychiatric admissions and discharges; real-time monitoring; the patients' status reports; the evaluation of the performance of each service and the whole network. During a 2-year period of operation, it registered 137 services, 480 health care professionals and 4271 patients, with a mean number of 2835 accesses per month. To date the system is successfully operating and further expanding. We have successfully developed and implemented an acceptable, useful and transparent web-based information system for a regional mental healthcare service network in a medium-income country with a decentralized

  2. Emerging role of human factors and ergonomics in healthcare delivery – A new field of application and influence for the IEA

    Science.gov (United States)

    Carayon, Pascale

    2014-01-01

    Recent developments of research and application of Human Factors and Ergonomics (HFE) are described, in particular the domain of healthcare delivery. HFE activities in this domain are highlighted and challenges for the discipline and the International Ergonomics Association are presented. PMID:22317500

  3. The utilization of mobile devices for telemedicine services in a South African public healthcare system.

    Science.gov (United States)

    Hartmann, André; Van Dyk, Liezl

    2014-01-01

    The purpose of this study is to develop an understanding in the use of mobile devices in administering telemedicine services within the public health care sector of South Africa. An online questionnaire was developed and distributed amongst medical officers, specialists, students and medical staff of one of the health districts of South Africa. This paper describes the design of the questionnaire as well as the most significant outcomes. Results are presented in terms of reasons why healthcare workers use mobile devices, as well as perceptions in terms of transmission security and quality of transmitted information.

  4. Will forensic use of medical biobanks decrease public trust in healthcare services? Some empirical observations.

    Science.gov (United States)

    Bexelius, Christin; Hoeyer, Klaus; Lynöe, Niels

    2007-01-01

    The authors tested the prevalent hypothesis that forensic use of medical biobanks has a negative impact on public trust in healthcare services. A questionnaire was sent to 1,184 inhabitant in the age group 20-80 years in Stockholm County, Sweden, in November 2005. With a response rate of 68.4%, the results showed that a majority (88.1%) of the respondents thought that it would be acceptable for the police to gain access to genetic samples stored in relation to healthcare; 5.6% said no and 6.3% were uncertain. In the case of police access to medical biobanks, a minority (6.3%) indicated that this would have a negative impact on their trust, a larger proportion (37.8%) that it would influence their trust in the healthcare services positively, and 56% stated that it would not affect their trust at all. The hypothesis tested appears to be unfounded. This should cause us to reconsider prevalent assumptions and current policies on the interface of medical and forensic genetics.

  5. Public engagement in setting healthcare priorities: a ranking exercise in Cyprus.

    Science.gov (United States)

    Farmakas, Antonis; Theodorou, Mamas; Galanis, Petros; Karayiannis, Georgios; Ghobrial, Stefanos; Polyzos, Nikos; Papastavrou, Evridiki; Agapidaki, Eirini; Souliotis, Kyriakos

    2017-01-01

    In countries such as Cyprus the financial crisis and the recession have severely affected the funding and priority setting of the health care system. There is evidence highlighting the importance of population' preferences in designing priorities for health care settings. Although public preferences have been thorough analysed in many countries, there is a research gap in terms of simultaneously investigating the relative importance and the weight of differing and competing criteria for determining healthcare priority settings. The main objective of the study was tο investigate public preferences for the relative utility and weight of differing and competing criteria for health care priority setting in Cyprus. The 'conjoint analysis' technique was applied to develop a ranking exercise. The aim of the study was to identify the preferences of the participants for alternative options. Participants were asked to grade in a priority order 16 hypothetical case scenarios of patients with different disease and of diverse socio-economic characteristics awaiting treatment. The sample was purposive and consisted of 100 Cypriots, selected from public locations all over the country. It was revealed that the "severity of the disease" and the " age of the patient" were the key prioritization criteria. Participants assigned the smallest relative value to the criterion " healthy lifestyle" . More precisely, participants older than 35 years old assigned higher relative importance to " age" , while younger participants to the " severity of the disease". The " healthy lifestyle" criterion was assigned to the lowest relative importance to by all participants. In Cyprus, public participation in health care priority setting is almost inexistent. Nonetheless, it seems that the public's participation in this process could lead to a wider acceptance of the healthcare system especially as a result of the financial crisis and the upcoming reforms implemented such as the establishment of the

  6. Preference of Chinese general public and healthcare providers for a good death.

    Science.gov (United States)

    Haishan, Huang; Hongjuan, Liu; Tieying, Zeng; Xuemei, Pu

    2015-03-01

    The aim of this study is to find and compare the current situation between common people and healthcare providers' preferences for a good death in the context of Chinese culture. A cross-sectional anonymous questionnaire survey covering 190 ordinary Chinese people and 323 healthcare providers was conducted. An inventory of the good death was translated and the subjects were surveyed about their attitude toward it. Permission to conduct the study was granted by department chiefs, nurse managers and the participants themselves. The participants were informed that they took part on a voluntary and anonymous basis, that they could withdraw at any time, that they had the right to ignore questions they did not wish to answer, and that whatever they chose to do would not jeopardize their employment conditions. The attributes that were perceived as important by major respondents for a good death were maintaining hope and pleasure, good relationship with medical staff, good relationship with family, independence, environment comfort, being respected as an individual, preparation for death, physical and psychological comfort, dying in a favorite place, and not being a burden to others. And some relatively less important characteristics were life completion, receiving enough treatment, natural death, controlling over the future, unawareness of death, pride and beauty, feeling that one's life is worth living, and religious and spiritual comfort. We also found that healthcare providers were more likely than general out-patients to perceive "physical and psychological comfort," "dying in a favorite place," "good relationship with medical staff," and "natural death" as important for a good death. This study offers healthcare providers in China a fundamental understanding of the normal expectations of the general public for a good death. It is believed that these findings in our study are valuable to improve palliative care in China. We compared the attitudes of Chinese and

  7. Nanotechnology based approaches for detection and delivery of microRNA in healthcare and crop protection.

    Science.gov (United States)

    Chaudhary, Vrantika; Jangra, Sumit; Yadav, Neelam R

    2018-04-13

    Nanobiotechnology has the potential to revolutionize diverse sectors including medicine, agriculture, food, textile and pharmaceuticals. Disease diagnostics, therapeutics and crop protection strategies are fast emerging using nanomaterials preferably nanobiomaterials. It has potential for development of novel nanobiomolecules which offer several advantages over conventional treatment methods. RNA nanoparticles with many unique features are promising candidates in disease treatment. The miRNAs are involved in many biochemical and developmental pathways and their regulation in plants and animals. These appear to be a powerful tool for controlling various pathological diseases in human, plants and animals, however there are challenges associated with miRNA based nanotechnology. Several advancements made in the field of miRNA therapeutics make it an attractive approach, but a lot more has to be explored in nanotechnology assisted miRNA therapy. The miRNA based technologies can be employed for detection and combating crop diseases as well. Despite these potential advantages, nanobiotechnology applications in the agricultural sector are still in its infancy and have not yet made its mark in comparison with healthcare sector. The review provides a platform to discuss nature, role and use of miRNAs in nanobiotechnology applications.

  8. Beyond medical pluralism: characterising health-care delivery of biomedicine and traditional medicine in rural Guatemala.

    Science.gov (United States)

    Hoyler, Elizabeth; Martinez, Roxana; Mehta, Kurren; Nisonoff, Hunter; Boyd, David

    2018-04-01

    Although approximately one half of Guatemalans are indigenous, the Guatemalan Maya account for 72% of the extremely poor within the country. While some biomedical services are available in these communities, many Maya utilise traditional medicine as a significant, if not primary, source of health care. While existing medical anthropological research characterises these modes of medicine as medically dichotomous or pluralistic, our research in a Maya community of the Western Highlands, Concepción Huista, builds on previous studies and finds instead a syncretistic, imbricated local health system. We find significant overlap and interpenetration of the biomedical and traditional medical models that are described best as a framework where practitioners in both settings employ elements of the other in order to best meet community needs. By focusing on the practitioner's perspective, we demonstrate that in addition to patients' willingness to seek care across health systems, practitioners converse across seemingly distinct systems via incorporation of certain elements of the 'other'. Interventions to date have not accounted for this imbrication. Guatemalan governmental policies to support local healers have led to little practical change in the health-care landscape of the country. Therefore, understanding this complex imbrication is crucial for interventions and policy changes.

  9. Organizational structure for addressing the attributes of the ideal healthcare delivery system.

    Science.gov (United States)

    Cowen, Mark; Halasyamani, Lakshmi K; McMurtrie, Daniel; Hoffman, Denise; Polley, Theodore; Alexander, Jeffrey A

    2008-01-01

    The Institute of Medicine's (IOM) report Crossing the Quality Chasm described the aims, characteristics, and components of the ideal healthcare system but did not provide the templates of organizational structures needed to achieve this vision. In this article, we review three principles of effective organizations to inform the design of a facilitative clinical care structure: a focus on the patient and caregiving team, the use of information, and connectivity with executive and operational leadership. These concepts can be realized in an organizational chart that is inverted to place patients and their care providers on top, flat with few degrees of separation between patients and executive leadership, and webbed to reflect connections to the professional and ancillary departments. An example of a recently implemented clinical care infrastructure follows this discussion. This model divides the patient population into nonexclusive subgroups, each with an interdisciplinary collaborative practice team that oversees and advocates the subgroup's clinical care activities. The organization's interdisciplinary practice council, in conjunction with its physician and nursing practice councils, backs these teams, providing a second layer of support. The council layer is connected to the health system board through the clinical oversight group, whose core membership consists of council chairs, the chief executive officer, and the chief medical and nursing officers. Clinical information for planning and evaluation is available at all levels. This model provides a framework for identifying the individuals and processes necessary to achieve IOM's vision.

  10. Access to, and the delivery of, free healthcare in Kanakantapa, rural ...

    African Journals Online (AJOL)

    This study determines the proportion of people experiencing health needs in rural ... African Journal of Health Sciences Vol. ... The Director of Public Health and Research at the ... The questionnaire was devised following a literature review. Themes were identified ..... taken to travel to the clinic, as this would take mode of.

  11. Outpatient parenteral antimicrobial therapy for orthopedic infections – a successful public healthcare experience in Brazil

    Directory of Open Access Journals (Sweden)

    Priscila Rosalba Oliveira

    2016-05-01

    Full Text Available Treatment of orthopedic infections usually requires prolonged antimicrobial therapy, ranging from 14 days up to 6 months. Nowadays, rising levels of antimicrobial resistance demands parenteral therapy for many patients. Outpatient parenteral antimicrobial therapy (OPAT is a modality that allows treatment out of hospital in these situations. In Brazil, where a public universal healthcare system allows full coverage for all citizens, implantation and dissemination of OPAT programs would be beneficial for patients and for the system, because it would allow a better allocation of health resources. The Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da USP (IOT started, in July 2013, a partnership with municipal health authorities in Sao Paulo, Brazil, in order to initiate an OPAT program in which patients discharged from that hospital would be able to continue antimicrobial therapy at primary care facilities. When necessary, patients could also receive their therapy at the day-hospital located at IOT. Primary care nursing and physician staff were trained about antimicrobial infusion and peripherally inserted central catheter manipulation. An OPAT specific antimicrobial protocol was designed and a special reference and counter-reference organized. As a result, 450 primary healthcare professionals were trained. In the first year of this program, 116 patients were discharged for OPAT. Chronic and acute osteomyelitis were most frequent diagnosis. Teicoplanin, ertapenem and tigecycline were the most used drugs. Duration of treatment varied from 10 to 180 days (average 101, median 42. Total sum of days in OPAT regimen was 11,698. Only 3 patients presented adverse effects. Partnership between services of different levels of complexity allowed implantation of a safe and effective public healthcare OPAT program for treatment of orthopedic infections. This program can serve as a model for developing similar strategies

  12. [Ophthalmological service quality offered to outpatients of the Public Healthcare System].

    Science.gov (United States)

    Santos Hercos, Benigno Vicente; Berezovsky, Adriana

    2006-01-01

    To identify the perception of the ophthalmic service quality provided for outpatients of the public healthcare system as well as to detect which actions should be considered necessary and priority in order to improve its quality. A quantitative descriptive study was carried out on 100 outpatients of the public healthcare system which were submitted to ophthalmic tests at Fundação Hilton Rocha--Belo Horizonte-MG, from July 1st-July 30th 2004. Individual interviews were carried out by giving the interviewees two structured questionnaires adapted from the modified SERVQUAL. This scale is in agreement with the reality of the studied institute. The adapted SERVQUAL scale was submitted to statistical validation and it showed a suitable internal consistency index. In general terms, a slight general dissatisfaction was detected regarding ophthalmological service quality. The interviewees cared more about safety and reliability. A higher degree of dissatisfaction was detected mainly concerning fulfillment of procedures at scheduled appointments related to the execution of services within due time-limits. The institute is supposed to plan as well as carry out actions which lead to a general improvement in the patient's satisfaction regarding service quality and mainly reliability. Service quality monitoring through periodic use of the SERVQUAL scale will not only make it possible to plan highly precise and effective intervention strategies in these and in other healthcare services but it will also allow monitoring the responses to these actions. All these actions will contribute to the improvement of the service in the system as a whole.

  13. Protecting Public Health: Plug-In Electric Vehicle Charging and the Healthcare Industry

    Energy Technology Data Exchange (ETDEWEB)

    Ryder, Carrie; Lommele, Stephen

    2016-10-01

    In 2014, the U.S. transportation sector consumed more than 13 million barrels of petroleum a day, approximately 70% of all domestic petroleum consumption. Internal combustion engine vehicles are major sources of greenhouse gases (GHGs), smog-forming compounds, particulate matter, and other air pollutants. Widespread use of alternative fuels and advanced vehicles, including plug-in electric vehicles (PEVs), can reduce our national dependence on petroleum and decrease the emissions that impact our air quality and public health. Healthcare organizations are major employers and community leaders that are committed to public well-being and are often early adopters of employer best practices. A growing number of hospitals are offering PEV charging stations for employees to help promote driving electric vehicles, reduce their carbon footprint, and improve local air quality.

  14. Innovation in Public Service Delivery: Civic Participation in Slovakia

    Directory of Open Access Journals (Sweden)

    Beata M. Merickova

    2016-06-01

    Full Text Available Participation as such is connected with political, social and civic dimensions. Through participation, citizens can directly or indirectly help to make the public process become more transparent and more efficient. It allows citizens “to see" into a decision-making process, to understand it, as well as contribute and be able to control it. In practice, civic participation has various forms; it includes both formal civic associations and informal groups of citizens that develop activities in order to solve local problems. In this paper we focus on civic participation in the innovation in the provision of public services, i.e. co-creation. Our objective is to map the best practices of co-creation in social innovations at the local government level in Slovakia. The main findings of our analysis are that co-created innovations are mostly initiated by non-governmental actors. Our study uses a qualitative approach and is based on original survey data from our own research, conducted mainly within the LIPSE research project.

  15. Accumulation of Domain-Specific Physical Inactivity and Presence of Hypertension in Brazilian Public Healthcare System.

    Science.gov (United States)

    Turi, Bruna Camilo; Codogno, Jamile S; Fernandes, Romulo A; Sui, Xuemei; Lavie, Carl J; Blair, Steven N; Monteiro, Henrique Luiz

    2015-11-01

    Hypertension is one of the most common noncommunicable diseases worldwide, and physical inactivity is a risk factor predisposing to its occurrence and complications. However, it is still unclear the association between physical inactivity domains and hypertension, especially in public healthcare systems. Thus, this study aimed to investigate the association between physical inactivity aggregation in different domains and prevalence of hypertension among users of Brazilian public health system. 963 participants composed the sample. Subjects were divided into quartiles groups according to 3 different domains of physical activity (occupational; physical exercises; and leisure-time and transportation). Hypertension was based on physician diagnosis. Physical inactivity in occupational domain was significantly associated with higher prevalence of hypertension (OR = 1.52 [1.05 to 2.21]). The same pattern occurred for physical inactivity in leisure-time (OR = 1.63 [1.11 to 2.39]) and aggregation of physical inactivity in 3 domains (OR = 2.46 [1.14 to 5.32]). However, the multivariate-adjusted model showed significant association between hypertension and physical inactivity in 3 domains (OR = 2.57 [1.14 to 5.79]). The results suggest an unequal prevalence of hypertension according to physical inactivity across different domains and increasing the promotion of physical activity in the healthcare system is needed.

  16. A systematic review of stated preference studies reporting public preferences for healthcare priority setting.

    Science.gov (United States)

    Whitty, Jennifer A; Lancsar, Emily; Rixon, Kylie; Golenko, Xanthe; Ratcliffe, Julie

    2014-01-01

    There is current interest in incorporating weights based on public preferences for health and healthcare into priority-setting decisions. The aim of this systematic review was to explore the extent to which public preferences and trade-offs for priority-setting criteria have been quantified, and to describe the study contexts and preference elicitation methods employed. A systematic review was performed in April 2013 to identify empirical studies eliciting the stated preferences of the public for the provision of healthcare in a priority-setting context. Studies are described in terms of (i) the stated preference approaches used, (ii) the priority-setting levels and contexts, and (iii) the criteria identified as important and their relative importance. Thirty-nine studies applying 40 elicitation methods reported in 41 papers met the inclusion criteria. The discrete choice experiment method was most commonly applied (n = 18, 45.0 %), but other approaches, including contingent valuation and the person trade-off, were also used. Studies prioritised health systems (n = 4, 10.2 %), policies/programmes/services/interventions (n = 16, 41.0 %), or patient groups (n = 19, 48.7 %). Studies generally confirmed the importance of a wide range of process, non-health and patient-related characteristics in priority setting in selected contexts, alongside health outcomes. However, inconsistencies were observed for the relative importance of some prioritisation criteria, suggesting context and/or elicitation approach matter. Overall, findings suggest caution in directly incorporating public preferences as weights for priority setting unless the methods used to elicit the weights can be shown to be appropriate and robust in the priority-setting context.

  17. Telerehabilitation: enabling the remote delivery of healthcare, rehabilitation, and self management.

    Science.gov (United States)

    Brennan, David M; Mawson, Sue; Brownsell, Simon

    2009-01-01

    Telerehabilitation refers to the use of Information and Communication Technologies (ICT) to provide rehabilitation services to people remotely in their homes or other environments. By using ICT, client access to care can be improved and the reach of clinicians can extend beyond the physical walls of a traditional healthcare facility, thus expanding continuity of care to persons with disabling conditions. The concept of telecare, when telerehabilitation is used to deliver services to clients in their homes or other living environments, empowers and enables individuals to take control of the management of their medical needs and interventions by enabling personalized care, choice and personal control. A wide variety of assessment and treatment interventions can be delivered to clients using remote monitoring systems, robotic and virtual reality technologies, and synchronized collaboration with online material. This chapter will present a brief history of telerehabilitation and telecare and offer an overview of the technology used to provide remote rehabilitation services. Emphasis will be given to the importance of human factors and user-centered design in the planning, development, and implementation of telerehabilitation systems and programs. The issue of self-care in rehabilitation and self-management will be discussed along with the rationale for how telerehabilitation can be used to promote client self-care and self-management. Two case studies of real-world telerehabilitation systems will be given, with a focus on how they were planned and implemented so as to maximize their potential benefits. The chapter will close with a discussion of obstacles and challenges facing telerehabilitation and suggestions for ways to promote its growth in use and acceptance.

  18. Energy-efficient Public Procurement: Best Practice in Program Delivery

    Energy Technology Data Exchange (ETDEWEB)

    Payne, Christopher [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division; Weber, Andrew [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States). Environmental Energy Technologies Division; Semple, Abby [Public Procurement Analysis, London (United Kingdom)

    2013-02-15

    This document illustrates the key issues and considerations involved in implementing energy-efficient public procurement. Our primary sources of information have been our partners in the Super Efficient Equipment and Appliance Deployment (SEAD) Initiative Procurement Working Group. Where applicable, we have highlighted specific ways in which working group participants have successfully overcome barriers to delivering effective programs. The following key points emerge from this analysis of programs for energy-efficient public procurement. Lessons for both developed and developing programs are highlighted throughout the guide. 1. Policy: Policy provides the initiative to begin a transition from first cost to life-cycle cost based purchasing methods and culture. Effective policy is well-communicated, establishes accountability from top to bottom of organizations and simplifies the processes necessary to comply. Flexibility and responsiveness are essential in policy development and implementation. Mandatory and voluntary policies may complement one another. 2. Procurement Criteria: Procurement staff must be confident that energy-efficient procurement criteria offer the best long-term value for their organization’s money and represent real environmental gains. Involving multiple stakeholders at the early stages of the criteria creation process can result in greater levels of cooperation from private industry. Criteria should make comparison of products easy for purchasers and require minimal additional calculations. Criteria will need to be regularly updated to reflect market developments. 3. Training: Resources for the creation of training programs are usually very limited, but well-targeted training is necessary in order for a program to be effective. Training must emphasize a process that is efficient for purchasers and simplifies compliance. Purchaser resources and policy must be well designed for training to be effective. Training program development is an

  19. Regulation for delivery of subsidies for public relations and safety

    International Nuclear Information System (INIS)

    1984-01-01

    The regulations provide for subsidies for the public relations activities and safety operations carried out by a local government for the local inhabitants in the vicinity of a nuclear power generation, etc. facility. This type of activity includes the dissemination of information on nuclear power, studies on securing the safety of the inhabitants and communication concerning the facility safety. The contents are as follows: limits of the subsidies, terms of subsidy allocations, the application for subsidies, determination of subsidy allocations, withdrawal of applications, the conditions to the allocations, a report on the work proceedings, a report on the results, confirmation on the sum of subsidies, withdrawal of the decision for subsidies, limitations for disposal of the properties, etc. (Mori, K.)

  20. Regulation for delivery of subsidies for public relations and safety

    International Nuclear Information System (INIS)

    1985-01-01

    The regulations provide for subsidies for the public relations activities and safety operations carried out by a local government for the local inhabitants in the vicinity of a nuclear power generation, etc. facility. This type of activity includes the dissemination of information on nuclear power, studies on securing the safety of the inhabitants and communication concerning the facility safety. The contents are as follows : limits of the subsidies, terms of subsidy allocations, the application for subsidies, determination of subsidy allocations, withdrawal of applications, the conditions to the allocations, a report on the work proceedings, a report on the results, confirmation on the sum of subsidies, withdrawal of the decision for subsidies, limitations for disposal of the properties, etc. (Kubozono, M.)

  1. Fiscal Decentralization and Delivery of Public Services: Evidence from Education Sector in Pakistan

    Directory of Open Access Journals (Sweden)

    Rauf Abdur

    2017-04-01

    Full Text Available Fiscal Decentralization is the devolution of fiscal assignments to lower governments for high growth and better delivery of public services. The current study covering the period from 1972 to 2009 is an attempt to find out the impacts of fiscal decentralization on public services deliveries in Pakistan. Public services are proxy by Gross enrollment at primary school level while fiscal decentralization by fiscal transfer and expenditure sides of devolution. Using time series data, it is found that the individual impacts of fiscal transfer are although insignificant but still support the theoretical proposition regarding fiscal decentralization and public services relationship while delegation of expenditure responsibilities helps in improving the gross enrollment at primary school level. Furthermore the study evident that complete delegation of fiscal responsibilities to lower governments enhance enrollment ratio in Pakistan.

  2. Developing a conceptual model for the application of patient and public involvement in the healthcare system in Iran.

    Science.gov (United States)

    Azmal, Mohammad; Sari, Ali Akbari; Foroushani, Abbas Rahimi; Ahmadi, Batoul

    2016-06-01

    Patient and public involvement is engaging patients, providers, community representatives, and the public in healthcare planning and decision-making. The purpose of this study was to develop a model for the application of patient and public involvement in decision making in the Iranian healthcare system. A mixed qualitative-quantitative approach was used to develop a conceptual model. Thirty three key informants were purposely recruited in the qualitative stage, and 420 people (patients and their companions) were included in a protocol study that was implemented in five steps: 1) Identifying antecedents, consequences, and variables associated with the patient and the publics' involvement in healthcare decision making through a comprehensive literature review; 2) Determining the main variables in the context of Iran's health system using conceptual framework analysis; 3) Prioritizing and weighting variables by Shannon entropy; 4) designing and validating a tool for patient and public involvement in healthcare decision making; and 5) Providing a conceptual model of patient and the public involvement in planning and developing healthcare using structural equation modeling. We used various software programs, including SPSS (17), Max QDA (10), EXCEL, and LISREL. Content analysis, Shannon entropy, and descriptive and analytic statistics were used to analyze the data. In this study, seven antecedents variable, five dimensions of involvement, and six consequences were identified. These variables were used to design a valid tool. A logical model was derived that explained the logical relationships between antecedent and consequent variables and the dimensions of patient and public involvement as well. Given the specific context of the political, social, and innovative environments in Iran, it was necessary to design a model that would be compatible with these features. It can improve the quality of care and promote the patient and the public satisfaction with healthcare and

  3. Health care and ideology: a reconsideration of political determinants of public healthcare funding in the OECD.

    Science.gov (United States)

    Herwartz, Helmut; Theilen, Bernd

    2014-02-01

    In this article, we examined if partisan ideology and electoral motives influence public healthcare expenditure (HCE) in countries of the Organization for Economic Cooperation and Development. We distinguished between the effects on the growth of the expenditures and its adjustment to violations of a long-run equilibrium linking HCE with macroeconomic and demographic trends. Regarding the influence of partisan ideology, we found that if governments are sufficiently long in power, right-wing governments spend less on public health than their left-wing counterparts. Furthermore, if a right-wing party governs without coalition partners, it responds more strongly to deviations from the long-run HCE equilibrium than left-wing governments. With regard to electoral motives, we found that health expenditure increases in years of elections. Independent of their partisan ideology, single-party (minority) governments induce higher (lower) growth of public HCE. Each of these political factors by its own may increase (decrease) HCE growth by approximately one percentage point. Given an average annual growth of HCE of approximately 4.1%, political factors turn out to be important determinants of trends in public HCE. Copyright © 2013 John Wiley & Sons, Ltd.

  4. A decentralised model of psychiatric care: Profile, length of stay and outcome of mental healthcare users admitted to a district-level public hospital in the Western Cape

    Directory of Open Access Journals (Sweden)

    Eileen Thomas

    2015-02-01

    Full Text Available Background. There is a lack of studies assessing the profile and outcome of psychiatric patients at entry-level public hospitals that are prescribed by the Mental Health Care Act to provide a decentralised model of psychiatric care. Objective. To assess the demographic and clinical profile as well as length of stay and outcomes of mental healthcare users admitted to a district-level public hospital in the Western Cape.  Method. Demographic data, clinical diagnosis, length of stay, referral profile and outcomes of patients (N=487 admitted to Helderberg Hospital during the period 1 January 2011 - 31 December 2011 were collected.  Results. Psychotic disorders were the most prevalent (n=287, 59% diagnoses, while 228 (47% of admission episodes had comorbid/secondary diagnoses. Substance use disorders were present in 184 (38% of admission episodes, 37 (57% of readmissions and 19 (61% of abscondments. Most admission episodes (n=372, 76% were discharged without referral to specialist/tertiary care.  Conclusion. Methamphetamine use places a significant burden on the provision of mental healthcare services at entry-level care. Recommendations for improving service delivery at this district-level public hospital are provided.

  5. How do we want to grow old? Anti-ageing-medicine and the scope of public healthcare in liberal democracies.

    Science.gov (United States)

    Schweda, Mark; Marckmann, Georg

    2013-09-01

    Healthcare counts as a morally relevant good whose distribution should neither be left to the free market nor be simply imposed by governmental decisions without further justification. This problem is particularly prevalent in the current boom of anti-ageing medicine. While the public demand for medical interventions which promise a longer, healthier and more active and attractive life has been increasing, public healthcare systems usually do not cover these products and services, thus leaving their allocation to the mechanisms of supply and demand on the free market. This situation raises the question on which basis the underlying preferences for and claims to a longer, healthier life should be evaluated. What makes anti-ageing medicine eligible for public funding? In this article, we discuss the role of anti-ageing medicine with regard to the scope and limits of public healthcare. We will first briefly sketch the basic problem of justifying a particular healthcare scheme within the framework of a modern liberal democracy, focusing on the challenge anti-ageing interventions pose in this regard. In the next section, we will present and discuss three possible solutions to the problem, essentialistic, transcendental, and procedural strategies of defining the scope of public healthcare. We will suggest a procedural solution adopting essentialistic and transcendental elements and discuss its theoretical and practical implications with regard to anti-ageing medicine. © 2012 John Wiley & Sons Ltd.

  6. Governance and Public Sector Transformation in South Africa: Reporting and Providing Assurance on Service Delivery Information

    OpenAIRE

    Mariaan Roos

    2012-01-01

    Reporting on performance was legislatively established in South Africa in terms of the Public Finance Management Act, Act 1 of 1999, section 40 (3)(a). The auditing of the reported information was legislated in the Public Audit Act, Act 25 of 2004, section 20(2) (c). The objectives of the article are firstly to provide an overview of the development and application of the reporting and secondly providing assurance on service delivery information and thirdly to reflect on challenges to the imp...

  7. Improving interpretation of publically reported statistics on health and healthcare: the Figure Interpretation Assessment Tool (FIAT-Health).

    Science.gov (United States)

    Gerrits, Reinie G; Kringos, Dionne S; van den Berg, Michael J; Klazinga, Niek S

    2018-03-07

    Policy-makers, managers, scientists, patients and the general public are confronted daily with figures on health and healthcare through public reporting in newspapers, webpages and press releases. However, information on the key characteristics of these figures necessary for their correct interpretation is often not adequately communicated, which can lead to misinterpretation and misinformed decision-making. The objective of this research was to map the key characteristics relevant to the interpretation of figures on health and healthcare, and to develop a Figure Interpretation Assessment Tool-Health (FIAT-Health) through which figures on health and healthcare can be systematically assessed, allowing for a better interpretation of these figures. The abovementioned key characteristics of figures on health and healthcare were identified through systematic expert consultations in the Netherlands on four topic categories of figures, namely morbidity, healthcare expenditure, healthcare outcomes and lifestyle. The identified characteristics were used as a frame for the development of the FIAT-Health. Development of the tool and its content was supported and validated through regular review by a sounding board of potential users. Identified characteristics relevant for the interpretation of figures in the four categories relate to the figures' origin, credibility, expression, subject matter, population and geographical focus, time period, and underlying data collection methods. The characteristics were translated into a set of 13 dichotomous and 4-point Likert scale questions constituting the FIAT-Health, and two final assessment statements. Users of the FIAT-Health were provided with a summary overview of their answers to support a final assessment of the correctness of a figure and the appropriateness of its reporting. FIAT-Health can support policy-makers, managers, scientists, patients and the general public to systematically assess the quality of publicly reported

  8. Comparing patient and healthcare worker experiences during a dengue outbreak in Singapore: understanding the patient journey and the introduction of a point-of-care test (POCT) toward better care delivery.

    Science.gov (United States)

    Tan, Qinghui; Hildon, Zoe J-L; Singh, Shweta; Jing, Jin; Thein, Tun Linn; Coker, Richard; Vrijhoef, Hubertus J M; Leo, Yee Sin

    2017-07-19

    In the aftermath of an upsurge in the number of dengue cases in 2013 and 2014, the SD BIOLINE Dengue Duo rapid diagnostic Point-of-Care Test (POCT) kit was introduced in Tan Tock Seng Hospital, Singapore in June 2013. It is known that the success of POCT usage is contingent on its implementation within the health system. We evaluated health services delivery and the Dengue Duo rapid diagnostic test kit application in Singapore from healthcare workers' perspectives and patient experiences of dengue at surge times. Focus group discussions were conducted with dengue patients, from before and after the POCT implementation period. In-depth interviews with semi-structured components with healthcare workers were carried out. A patient centred process mapping technique was used for evaluation, which mapped the patient's journey and was mirrored from the healthcare worker's perspective. Patients and healthcare workers confirmed a wide range of symptoms in adults, making it challenging to determine diagnosis. There were multiple routes to help seeking, and no 'typical patient journey', with patients either presenting directly to the hospital emergency department, or being referred there by a primary care provider. Patients groups diagnosed before and after POCT implementation expressed some differences between speed of diagnoses and attitudes of doctors, yet shared negative feelings about waiting times and a lack of communication and poor information delivery. However, the POCT did not in its current implementation do much to help waiting times. Healthcare workers expressed that public perceptions of dengue in recent years was a major factor in changing patient management, and that the POCT kit was helpful in improving the speed and accuracy of diagnoses. Health service delivery for dengue patients in Singapore was overall perceived to be of an acceptable clinical standard, which was enhanced by the introduction of the POCT. However, improvements can be focused on Adapting

  9. Decision making at the frontline: Exploring coping with moral conflicts during public service delivery

    NARCIS (Netherlands)

    Vink, E.; Tummers, L.G.; Bekkers, V.J.J.M.; Musheno, M.

    2015-01-01

    Moral conflicts, where a person is confronted with two or more clashing values, norms or responsibilities, are common in public service delivery. Choosing one is realized at the cost of the other(s). Frontline professionals, such as physicians and police officers, often experience clashes over the

  10. Cultural and Linguistic Imperatives in Public Health Delivery in Developing Countries.

    Science.gov (United States)

    Goke-Pariola, Abiodun

    Some cultural realities and linguistic considerations are discussed that public health providers can use to make preventive health care delivery more effective and acceptable in several developing countries. The case of the Yoruba people of southwestern Nigeria is used as an example. Two points are addressed: the question of the usefulness of…

  11. The challenges of government use of cloud services for public service delivery

    NARCIS (Netherlands)

    Irion, K.

    2014-01-01

    Cloud services hold the promise of rendering public service delivery and back-office operations more effective and efficient, by providing ubiquitous, on-demand access to computing resources. Beyond the compelling cost economies, cloud technology is also a promising platform for open government,

  12. Where to go in the near future: diverging perspectives on online public service delivery

    NARCIS (Netherlands)

    van Deursen, Alexander Johannes Aloysius Maria; Wimmer, Maria A.; Scholl, Jochen; Grönlund, Åke

    2007-01-01

    Although the electronic government is under heavy development, a clear vision doesn’t seem to exist. In this study 20 interviews among leaders in the field of e-government in the Netherlands resulted in different perspectives on the future of electronic public service delivery. The interviews

  13. Does co-creation impact public service delivery? The importance of state and governance traditions

    NARCIS (Netherlands)

    Voorberg, Willem; Bekkers, Victor; Flemig, Sophie; Timeus, Krista; Tõnurist, Piret; Tummers, L.G.

    2017-01-01

    Co-creation in public service delivery requires partnerships between citizens and civil servants. The authors argue that whether or not these partnerships will be successful depends on state and governance traditions (for example a tradition of authority sharing or consultation). These traditions

  14. Perceptions of International Students on Service Quality Delivery in a Malaysian Public University

    Science.gov (United States)

    Njie, Baboucarr; Asimiran, Soaib; Baki, Roselan

    2012-01-01

    Purpose: The purpose of this study is to explore the perceptions of international students of service quality delivery (SQD) in a Malaysian public university. Design/methodology/approach: The study was limited to the University's immediate physical environment and its associated human and systems-based services. The physical environment in this…

  15. From PACS to Web-based ePR system with image distribution for enterprise-level filmless healthcare delivery.

    Science.gov (United States)

    Huang, H K

    2011-07-01

    The concept of PACS (picture archiving and communication system) was initiated in 1982 during the SPIE medical imaging conference in New Port Beach, CA. Since then PACS has been matured to become an everyday clinical tool for image archiving, communication, display, and review. This paper follows the continuous development of PACS technology including Web-based PACS, PACS and ePR (electronic patient record), enterprise PACS to ePR with image distribution (ID). The concept of large-scale Web-based enterprise PACS and ePR with image distribution is presented along with its implementation, clinical deployment, and operation. The Hong Kong Hospital Authority's (HKHA) integration of its home-grown clinical management system (CMS) with PACS and ePR with image distribution is used as a case study. The current concept and design criteria of the HKHA enterprise integration of the CMS, PACS, and ePR-ID for filmless healthcare delivery are discussed, followed by its work-in-progress and current status.

  16. Income, egalitarianism and attitudes towards healthcare policy: a study on public attitudes in 29 countries.

    Science.gov (United States)

    Azar, A; Maldonado, L; Castillo, J C; Atria, J

    2018-01-01

    To evaluate the relationship between income and egalitarian values and attitudes towards healthcare policy. Cross-sectional and cross-national study. Data for 29 countries from the International Social Survey Programme (ISSP) 2011 were used. The dependent variables are a general attitude towards government involvement in healthcare provision and two attitudes regarding specific policies (taxes and public funding). Income and egalitarianism were also measured by using ISSP. Data were analysed using regression models that account for individual and country-level characteristics, and country-fixed effects. The effect of income is small and non-significant for attitudes towards government involvement and public funding. For willingness to pay (WTP) taxes to improve healthcare services, we find a positive association with income. Results for egalitarianism suggest a positive association with government involvement in healthcare provision and significant interactions with WTP taxes. The distinction of dimensions and mechanisms underlying policy attitudes appears as relevant. Citizens across socioeconomic groups are motivated to support state-funded healthcare, favouring the design of non-selfish policies. These findings suggest that there is space for policymakers who seek to increase healthcare spending encouraging either policies for specific groups or broader institutional changes. Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  17. Integrating social justice concerns into economic evaluation for healthcare and public health: A systematic review.

    Science.gov (United States)

    Dukhanin, Vadim; Searle, Alexandra; Zwerling, Alice; Dowdy, David W; Taylor, Holly A; Merritt, Maria W

    2018-02-01

    Social justice is the moral imperative to avoid and remediate unfair distributions of societal disadvantage. In priority setting in healthcare and public health, social justice reaches beyond fairness in the distribution of health outcomes and economic impacts to encompass fairness in the distribution of policy impacts upon other dimensions of well-being. There is an emerging awareness of the need for economic evaluation to integrate all such concerns. We performed a systematic review (1) to describe methodological solutions suitable for integrating social justice concerns into economic evaluation, and (2) to describe the challenges that those solutions face. To be included, publications must have captured fairness considerations that (a) involve cross-dimensional subjective personal life experience and (b) can be manifested at the level of subpopulations. We identified relevant publications using an electronic search in EMBASE, PubMed, EconLit, PsycInfo, Philosopher's Index, and Scopus, including publications available in English in the past 20 years. Two reviewers independently appraised candidate publications, extracted data, and synthesized findings in narrative form. Out of 2388 publications reviewed, 26 were included. Solutions sought either to incorporate relevant fairness considerations directly into economic evaluation or to report them alongside cost-effectiveness measures. The majority of reviewed solutions, if adapted to integrate social justice concerns, would require their explicit quantification. Four broad challenges related to the implementation of these solutions were identified: clarifying the normative basis; measuring and determining the relative importance of criteria representing that basis; combining the criteria; and evaluating trade-offs. All included solutions must grapple with an inherent tension: they must either face the normative and operational challenges of quantifying social justice concerns or accede to offering incomplete policy

  18. Autopsy on the AMA: An Analysis of Healthcare Delivery Systems in America [1970

    Directory of Open Access Journals (Sweden)

    Joe Woodard

    2009-02-01

    Full Text Available Prepared by: Cy Schoenfield, Janet Brown, Joe Woodard, Jeff Brown, Martin Brown, Charles Turner, Jill Hill Published in 1970 by Student Research Facility, Berkeley, California Reproduced from the US Heath Activism History Collection Rare Book and Manuscript Library, University of Pennsylvania "The United States (has a quality of medical care unsurpassed anywhere," said Dr. Milford O. Rouse, President of the American Medical Association (the AMA in 1967. His position at the pinnacle of the most powerful country's most powerful medical organization certainly gave him the authority to say that with confidence. "People respect doctors. In fact, 92% of the public feels most doctors can be trusted. People in the medical therapy professions are admired and the communities they serve reward them well for their work. Doctors averaged $31,400 a year in 1967 and their median income was $32,170 in 1968. These figures are approximately five times the average and median incomes for the general population. "Medically speaking, things seem to be going well. The drama of headlines about organ transplants and new medical advances in the laboratory also serve to indicate that the System that provides health care for Americans does its job splendidly. But does it, really?"

  19. [Production chain supply management for public hospitals: a logistical approach to healthcare].

    Science.gov (United States)

    Infante, Maria; dos Santos, Maria Angélica Borges

    2007-01-01

    Despite their importance for hospital operations, discussions of healthcare organization logistics and supply and materials management are notably lacking in Brazilian literature. This paper describes a methodology for organizing the supply of medical materials in public hospitals, based on an action-research approach. Interventions were based on the assumption that a significant portion of problems in Brazil's National Health System (SUS) facilities derive from the fact that their clinical and administrative departments do not see themselves as belonging to the same production chain - neither the hospital nor the supply department is aware of what the other produces. The development of the methodology and its main steps are presented and discussed, against a background of recent literature and total quality and supply chain management concepts.

  20. Migration and access to maternal healthcare: determinants of adequate antenatal care and institutional delivery among socio-economically disadvantaged migrants in Delhi, India.

    Science.gov (United States)

    Kusuma, Yadlapalli S; Kumari, Rita; Kaushal, Sonia

    2013-10-01

    To identify the determinants of adequate antenatal care (ANC) utilisation and institutional deliveries among socio-economically disadvantaged migrants living in Delhi, India. In a cross-sectional survey, 809 rural-urban migrant mothers with a child aged below 2 years were interviewed with a pretested questionnaire. Data on receiving antenatal, delivery and post-natal services, migration history and other social, demographic and income were collected. Recent migrants used the services significantly less than settled migrants. ANC was adequate only among 37% (35% of recent migrant women and 39% of settled migrants). Multinomial regression revealed that being a recent migrant, multiparous, illiterate and married to an unskilled worker were significant risk factors for receiving inadequate ANC. Around 53% of deliveries took place at home. ANC seeking has a strong influence on place of delivery: 70% of births to women who received inadequate ANC were at home. Women who are educated, had their first delivery after the age of 20 years and received adequate ANC were more likely to deliver their child in hospital. Post-natal care is grossly neglected among these groups. Migrant women, particularly recent migrants, are at the risk of not receiving adequate maternal healthcare. Because migration is a continuing phenomenon, measures to mitigate disadvantage due to migration need to be taken in the healthcare system. © 2013 John Wiley & Sons Ltd.

  1. [Involving patients, the insured and the general public in healthcare decision making].

    Science.gov (United States)

    Mühlbacher, Axel C; Juhnke, Christin

    2016-01-01

    No doubt, the public should be involved in healthcare decision making, especially when decision makers from politics and self-government agencies are faced with the difficult task of setting priorities. There is a general consensus on the need for a stronger patient centeredness, even in HTA processes, and internationally different ways of public participation are discussed and tested in decision making processes. This paper describes how the public can be involved in different decision situations, and it shows how preference measurement methods are currently being used in an international context to support decision making. It distinguishes between different levels of decision making on health technologies: approval, assessment, pricing, and finally utilization. The range of participation efforts extends from qualitative surveys of patients' needs (Citizen Councils of NICE in the UK) to science-based documentation of quantitative patient preferences, such as in the current pilot projects of the FDA in the US and the EMA at the European level. Possible approaches for the elicitation and documentation of preference structures and trade-offs in relation to alternate health technologies are decision aids, such as multi-criteria decision analysis (MCDA), that provide the necessary information for weighting and prioritizing decision criteria. Copyright © 2015. Published by Elsevier GmbH.

  2. Building energy efficiency for public hospitals and healthcare facilities in China: Barriers and drivers

    International Nuclear Information System (INIS)

    Wang, Tao; Li, Xiaodong; Liao, Pin-Chao; Fang, Dongping

    2016-01-01

    Maximizing energy efficiency within HHFs (hospitals and healthcare facilities) is a major challenge in the field of energy conservation. This paper studies the key barriers to the implementation of energy-efficient technologies in China's public HHFs. For this purpose, a preliminary survey was conducted at the Beijing Municipal Health Bureau in order to assess the energy conservation efforts being made at 20 public HHFs. In the survey, a list of specific barriers to energy efficiency was created and HHF staffs were asked to rank these barriers in the order of importance. The results show that the economic incentives, appropriate technology, as well as enforceable laws and regulations are insufficiently supported by the government, have become the most significant obstacles to the improvement of energy efficiency. To remedy this, policymakers should take a multipronged approach which addresses the hospitals, projects, and technical and operating procedures in order to encourage the full participation and support of all stakeholders involved. Specifically, the government should offer multilevel economic incentives and reward policies; establish practical mandatory targets for building energy efficiency; provide demonstrable best practices in terms of the project, techniques, and operating procedures; and promote awareness of the importance of property risk management. - Highlights: • We developed a checklist of building energy efficiency barriers of HHFs in China. • We took a survey to prioritize the barriers by the staff from 20 public HHFs. • Policy makers should provide multiple-level solutions to all the stakeholders. • Economic incentives, mandatory target, technique supports are critical drivers.

  3. Techno-Bureaucratic Governance and Public Service Delivery: Indonesia and Nigeria in Perspectives

    Directory of Open Access Journals (Sweden)

    Jacob Olufemi Fatile

    2015-09-01

    Full Text Available Techno-bureaucratic governance is fundamental to contemporary public service. This is because the roles of the bureaucrats and technocrats become more relevant in policy formulation and implementation when the government had to (reinvent its institutions to move from routine administration to that of development planning and management. Utilizing a qualitative approach, the paper notes that techno-bureaucratic ideology values technical expertise itself and its technical experts, efficiency, economic development and effective public service delivery. Adopting comparative perspective, the paper examines techno-bureaucratic governance and public service delivery in Indonesia and Nigeria. The paper takes a cursory look at the similarities and differences between the two countries. The paper notes that the technocracy nurtured by the New Order in Indonesia was cohesive and effective because of its technical expertise and has helped Indonesia to turn oil income into productive investments,whereas in Nigeria the oil income was used for prestigious projects to the detriment of productive investments. The paper therefore recommend among others that developing societies need a new strategy in delivery services in their public service, and this can be achieved through skilled professionals, technocrats and knowledge based actors. It concludes that for public service to deliver effective services, an efficient bureaucracy and technocracy remain invaluable.

  4. Measurement and evaluation of the public administration performance through delivery of electronic services

    Directory of Open Access Journals (Sweden)

    Mirlinda Batalli

    2015-07-01

    Full Text Available The purpose of this paper concerns the relation between delivery of electronic services (e-services and evaluation of public administration performance. Public sector organizations should pay attention and determine the strategies to be followed in order to increase the satisfaction of citizens and businesses in relation to delivery of electronic services. The study aims to review the demands toward progress to the competitiveness, the sustainability, efficiency and effectives in public administration that have rapidly enforced the wide reforms in the public sector, in order to modernize the initiatives to offer better electronic services for the citizens. The article aims to present that the transformation process toward providing electronic services to the citizens should be assessed continuously, in light with challenges, demands and process of globalization, in order to strengthen the capacities of public administration and make it more efficient. In this regard, the regular evaluation and measurement of the public administration performance leads toward the promotion of enhanced public services and higher level of accountability. Through receiving the e-services, citizens can save their time, can reduce the expenses and create an easier access of communication with all levels of the government.

  5. Healthcare in Equatorial Guinea, West Africa: obstacles and barriers to care.

    Science.gov (United States)

    Reuter, Kim Eleanor; Geysimonyan, Aurora; Molina, Gabriela; Reuter, Peter Robert

    2014-01-01

    The provision of healthcare services in developing countries has received increasing attention, but inequalities persist. One nation with potential inequalities in healthcare services is Equatorial Guinea (Central-West Africa). Mitigating these inequalities is difficult, as the Equatoguinean healthcare system remains relatively understudied. In this study, we interviewed members of the healthcare community in order to: 1) learn which diseases are most common and the most common cause of death from the perspective of healthcare workers; and 2) gain an understanding of the healthcare community in Equatorial Guinea by describing how: a) healthcare workers gain their professional knowledge; b) summarizing ongoing healthcare programs aimed at the general public; c) discussing conflicts within the healthcare community and between the public and healthcare providers; d) and addressing opportunities to improve healthcare delivery. We found that some causes of death, such as serious injuries, may not be currently treatable in country, potentially due to a lack of resources and trauma care facilities. In addition, training and informational programs for both healthcare workers and the general public may not be effectively transmitting information to the intended recipients. This presents hurdles to the healthcare community, both in terms of having professional competence in healthcare delivery and in having a community that is receptive to medical care. Our data also highlight government-facility communication as an opportunity for improvement. Our research is an important first step in understanding the context of healthcare delivery in Equatorial Guinea, a country that is relatively data poor.

  6. Perceptions of registered nurses regarding factors influencing service delivery in expanding programmes in a primary healthcare setting

    Directory of Open Access Journals (Sweden)

    Nnoi. A. Xaba

    2012-11-01

    Full Text Available The aim of this study was to explore and describe the perceptions of registered nurses regarding factors influencing service delivery regarding expansion programmes in a primary healthcare setting, using a qualitative approach. The registered nurses, who have been working in the clinics for more than two years and have been exposed to the expansion programmes there, were purposively sampled. Two focus group interviews were conducted in a neutral place and the data collected by the researcher Nnoi A. Xaba (N.A.X.. Data were analysed by the researcher and an independent co-coder using the Tesch method. Categories, subcategories and themes were identified; those that formed the basis of discussion were disabling factors, enabling factors, client-related factors, service-related factors and solutions to problems. It is recommended that integration of programmes and coordination be done at a provincial level and planned together with the training centres in order to alleviate problems in service delivery. Training on expansion programmes in the form of in-service education should be carried out continually in the region.Die doel van die studie was om die persepsie van geregistreerde verpleegkundiges met betrekking tot die faktore wat dienslewering van die uitbreidingsprogramme in ‘n primêre gesondheid opset beinvloed; te eksploreer en te beskryf. ‘n Kwalitatiewe benadering is gevolg in die iutvoering van die studie. ‘n Doelgerigte steekproef is uitgevoer vanuit geregistreerde verpleegkundiges wat vir langer as twee jaar in die klinieke werksaam was en blootgestel is aan die uitbreiding programme. Twee fokus groep onderhoude is deur die navorser Nnoi A. Xaba (N.A.X. in ‘n neutrale opset uitgevoer. Data is deur die navorser en ʼn onafhanklike kodeerder ontleed volgens Tesch se metode van analise. Kategorieë, sub-kategorieë en temas was geidentifiseer. Die kategorieë fundamenteel tot die bespreking behels: remmende faktore, bydraende faktore

  7. Women's preferences and mode of delivery in public and private hospitals: a prospective cohort study.

    Science.gov (United States)

    Mazzoni, Agustina; Althabe, Fernando; Gutierrez, Laura; Gibbons, Luz; Liu, Nancy H; Bonotti, Ana María; Izbizky, Gustavo H; Ferrary, Marta; Viergue, Nora; Vigil, Silvia I; Zalazar Denett, Gabriela; Belizán, José M

    2016-02-08

    Rates of caesarean section have steadily increased in most middle- and high-income countries over the last few decades without medical justification. Maternal request is one of the frequently cited non-medical factors contributing to this trend. The objectives of this study were to assess pregnant women's preferences regarding mode of delivery and to compare actual caesarean section rates in the public and private sectors. A prospective cohort study was conducted in two public and three private hospitals in Buenos Aires, Argentina. 382 nulliparous pregnant women (183 from the private sector and 199 from the public sector) aged 18 to 35 years, with single pregnancies over 32 weeks of gestational age were enrolled during antenatal care visits between October 2010 and September 2011. We excluded women with pregnancies resulting from assisted fertility, women with known pre-existing major diseases or, with pregnancy complications, or with a medical indication of elective cesarean section. We used two different approaches to assess women's preferences: a survey using a tailored questionnaire, and a discrete choice experiment. Only 8 and 6% of the healthy nulliparous women in the public and private sectors, respectively, expressed a preference for caesarean section. Fear of pain and safety were the most frequently expressed reasons for preferring caesarean section. When reasons for delivery mode were assessed by a discrete choice experiment, women placed the most emphasis on sex after childbirth. Of women who expressed their preference for vaginal delivery, 34 and 40% ended their pregnancies by caesarean section in public and private hospitals, respectively. The preference for caesarean section is low among healthy nulliparous women in Buenos Aires. The reasons why these women had a rate of more than 35% caesarean sections are unlikely related to their preferences for mode of delivery.

  8. Documentation of e-cigarette use and associations with smoking from 2012 to 2015 in an integrated healthcare delivery system.

    Science.gov (United States)

    Young-Wolff, Kelly C; Klebaner, Daniella; Folck, Bruce; Tan, Andy S L; Fogelberg, Renee; Sarovar, Varada; Prochaska, Judith J

    2018-04-01

    It is unclear whether use of electronic nicotine delivery systems (ENDS) precedes cigarette smoking initiation, relapse, and/or quitting. Healthcare systems with electronic health records (EHRs) provide unique data to examine ENDS use and changes in smoking. We examined the incidence of ENDS use (2012-2015) based on clinician documentation and tested whether EHR documented ENDS use is associated with twelve-month changes in patient smoking status using a matched retrospective cohort design. The sample was Kaiser Permanente Northern California (KPNC) patients aged ≥12 with documented ENDS use (N = 7926); 57% were current smokers, 35% former smokers, and 8% never-smokers. ENDS documentation incidence peaked in 2014 for current and former smokers and in 2015 for never-smokers. We matched patients with documented ENDS use to KPNC patients without documented ENDS use (N = 7926) on age, sex, race/ethnicity, and smoking status. Documented ENDS use predicted the likelihood of smoking in the following year. Among current smokers, ENDS use was associated with greater odds of quitting smoking (OR = 1.17, 95%CI = 1.05-1.31). Among former smokers, ENDS use was associated with greater odds of smoking relapse (OR = 1.53, 95%CI = 1.22-1.92). Among never-smokers, ENDS use was associated with greater odds of initiating smoking (OR = 7.41, 95%CI = 3.14-17.5). The overall number of current smokers at 12 months was slightly higher among patients with (N = 3931) versus without (N = 3850) documented ENDS use. Results support both potential harm reduction of ENDS use (quitting combustibles among current smokers) and potential for harm (relapse to combustibles among former smokers, initiation for never-smokers). Copyright © 2018 Elsevier Inc. All rights reserved.

  9. Incorporating financial protection into decision rules for publicly financed healthcare treatments.

    Science.gov (United States)

    Smith, Peter C

    2013-02-01

    Almost all health systems seek to offer some form of publicly financed healthcare insurance, and governments must therefore choose the size of the benefit package and the types of treatments to cover. Conventionally, the usual approach of economists has been to recommend choices on the basis of cost effectiveness of treatments, using metrics such as the 'cost per quality adjusted life year'. However, this approach is based on the assumption of health maximization subject to a budget constraint and ignores the potential impact of any additional concern with protecting individuals from the financial consequences of a health shock. Furthermore, it does not take account of the possible availability of complementary privately funded health care. This paper develops a model in which risk-averse individuals care about health but also place a value on protection from the financial consequences of rare but costly events. The paper shows how conventional cost-effectiveness analysis can readily be augmented to take account of financial protection objectives. The results depend on whether or not there exists a market in complementary privately funded health care. They have important implications for the methodology adopted by health technology assessment agencies and for the broader design of publicly funded health systems. Copyright © 2012 John Wiley & Sons, Ltd.

  10. Approaches to the international standards application in healthcare and public health in different countries

    Directory of Open Access Journals (Sweden)

    Vitaliy Sarancha

    2017-06-01

    Full Text Available As a result of consequent development, and guided by an increasing demand of different types of the organizations regarding structured management, the system of standardization has been established. The idea behind standardization is adjusting the characteristics of a product, process or a production cycle to make them consistent and in line with the rules regarding what is proper and acceptable. The “standard” is a document that specifies such established set of criteria covering a broad range of topics and applicable to commissioners of health, specialists in primary care, public health staff, and social care providers, as well as the local authorities and service users. Health products, ranging from medical devices and health informatics to traditional medicines and unconventional healing tools are all in the focus of standards’ application. Different countries have their own quality management traditions based on their history, mentality, socio-economic environment and the local regulations. Taking into consideration that community social system organization and the quality of social infrastructure are the main foundations of social relations and future prosperity, here we review the existing standardization environment in the health sector in different countries, both developed and those on a convergence path. We focused on standardization environment in the United States of America, Great Britain, Germany, Ukraine, Russian Federation, Croatia and Albania. In order to simplify comprehension, we also demonstrate the algorithm of standardization, as well as the opportunities for application of the international standards in healthcare and public health.

  11. Growth surveillance in the context of the Primary Public Healthcare Service Network in Brazil: literature review

    Directory of Open Access Journals (Sweden)

    Dixis Figueroa Pedraza

    2016-03-01

    Full Text Available Abstract Objectives: to identify and analyze the scientific literature on child growth monitoring in the context of the primary public healthcare service network in Brazil, focusing on the main problems detected in studies. Methods: the review was based on searches ofSciELO, Lilacs and PubMed databases to identify articles published between 2006 and 2014. The articles were categorized according to the analytical categories of structure (items needed to carry out primary activities or work processes (set of activities and procedures used in the management of resources. Results: of the 16 articles included in this review, only six dealt with structure and, in these, thetraining of professionals and availability of protocols were the most frequently identified problems. Processes, addressed in 15 articles, highlighted the underutilization of Child Health Handbook to record growth measurements and the adoption of guidelines on the basis of notes taken. Conclusions: the difficulties found demonstrate the everyday circumstances of the public health service which have a detrimental effect on growth surveillance.

  12. The role of transformational leadership and organizational culture in service delivery within a public service organization

    Directory of Open Access Journals (Sweden)

    Ophillia Ledimo

    2014-08-01

    Full Text Available Continuous changes in the external environment deriving from legislative, economic and technological factors, puts pressure not only to corporate organizations, but also to public service organizations. These changes have increased pressure on service delivery and calls for accountability in public service organizations. With this increased pressure comes the need for public service organizations to discover how to most effectively enhance their organizational performance. Two of the most effective ways to improve performance are through the organizational leadership and culture. Although many studies were conducted on transformational leadership and organizational culture, there is still a need to investigate the link between these constructs in public service organizations. Hence the objective of this study was to explore the relationship between transformational leadership and organizational culture for service delivery practices. The Leadership Practice Inventory (LPI and Organizational Culture Inventory (OCI were administered to a random sample size of N=238, from a population of 4350 employees working within the public service organization. Descriptive statistics and Pearson’s correlation were conducted to analyse the data. The results of this study indicated a significant positive relationship between transformational leadership and the constructive dimension of organizational culture within a public service organization. In terms of contributions and practical implications, insight gained from the findings may be used in proposing leadership and organizational development interventions and future research

  13. SU-B-BRF-01: Professional Council Symposium: The Evolving US Healthcare Delivery Model, How Will the Medical Physics Profession Be Impacted and How Should We Respond?

    International Nuclear Information System (INIS)

    Halvorsen, P; Shine, K; White, G

    2014-01-01

    The United States' healthcare delivery model is undergoing significant change. Insurance and reimbursement models are rapidly evolving, federal allocations are shifting from specialty services to preventive and generalpractice services, and Accountable Care Organizations are gaining in prominence. One area of focus is on the perceived over-utilization of expensive services such as advanced imaging and, in some cases, radiation therapy. Reimbursement incentives are increasingly aimed at quality metrics, leading to an increased interest in the core concepts of High Reliability Organizations. With the shift in federal resources away from specialty services and the increasing prominence of Accountable Care Organizations, we will likely be challenged to re-assess our traditional model for delivering medical physics services. Medical physicists have a unique combination of education and training in physics principles, radiation physics applications in medicine, human anatomy, as well as safety analysis and quality control methods. An effective medical physicist recognizes that to advance the institution's mission, the medical physicist must join other professional leaders within the institution to provide clear direction and perspective for the entire team. To do that, we must first recognize the macro changes in our healthcare delivery system and candidly assess how the medical physics practice model can evolve in a prudent way to support the institution's objectives while maintaining the traditionally high level of quality and safety. This year's Professional Council Symposium will explore the many facets of the changing healthcare system and its potential impact on medical physics. Dr. Shine will provide an overview of the developing healthcare delivery and reimbursement models, with a focus on how the physician community has adapted to the changing objectives. Mr. White will describe recent changes in the reimbursement patterns for both imaging

  14. SU-B-BRF-01: Professional Council Symposium: The Evolving US Healthcare Delivery Model, How Will the Medical Physics Profession Be Impacted and How Should We Respond?

    Energy Technology Data Exchange (ETDEWEB)

    Halvorsen, P [Lahey Clinic, Burlington, MA (United States); Shine, K [Austin, TX (United States); White, G [Colorado Associates in Medical Phys, Colorado Springs, CO (United States)

    2014-06-15

    The United States' healthcare delivery model is undergoing significant change. Insurance and reimbursement models are rapidly evolving, federal allocations are shifting from specialty services to preventive and generalpractice services, and Accountable Care Organizations are gaining in prominence. One area of focus is on the perceived over-utilization of expensive services such as advanced imaging and, in some cases, radiation therapy. Reimbursement incentives are increasingly aimed at quality metrics, leading to an increased interest in the core concepts of High Reliability Organizations. With the shift in federal resources away from specialty services and the increasing prominence of Accountable Care Organizations, we will likely be challenged to re-assess our traditional model for delivering medical physics services. Medical physicists have a unique combination of education and training in physics principles, radiation physics applications in medicine, human anatomy, as well as safety analysis and quality control methods. An effective medical physicist recognizes that to advance the institution's mission, the medical physicist must join other professional leaders within the institution to provide clear direction and perspective for the entire team. To do that, we must first recognize the macro changes in our healthcare delivery system and candidly assess how the medical physics practice model can evolve in a prudent way to support the institution's objectives while maintaining the traditionally high level of quality and safety. This year's Professional Council Symposium will explore the many facets of the changing healthcare system and its potential impact on medical physics. Dr. Shine will provide an overview of the developing healthcare delivery and reimbursement models, with a focus on how the physician community has adapted to the changing objectives. Mr. White will describe recent changes in the reimbursement patterns for both imaging

  15. Individual responsibility for what? : A conceptual framework for exploring the suitability of private financing in a publicly funded health-care system

    OpenAIRE

    Tinghög, Gustav; Carlsson, Per; Lyttkens, Carl H.

    2010-01-01

    Policymakers in publicly funded health-care systems are frequently required to make intricate decisions on which health-care services to include or exclude from the basic health-care package. Although it seems likely that the concept of individual responsibility is an essential feature of such decisions, it is rarely explicitly articulated or evaluated in health policy. This paper presents a tentative conceptual framwork for exploring when health-care services contain characteristics that fac...

  16. Knowledge and Attitude about Multidrug-Resistant Tuberculosis among Healthcare Workers in Public Health Centres

    Directory of Open Access Journals (Sweden)

    Bony Wiem Lestari

    2016-12-01

    Full Text Available Background: Multidrug-resistant Tuberculosis (MDR-TB is a significant public health problem and poses a threat to global tuberculosis (TB control. In 2015, at least 504 new MDR-TB cases were identified in Indonesia. Treating MDR-TB patients is very challenging. It may take more than two years for MDR-TB treatment. Therefore, it is crucial healthcare workers (HCWs are knowledgeable about MDR-TB. The aim of this study was to measure level of knowledge and attitude regarding MDR-TB among HCWs in public health centres. Methods: A cross-sectional study was conducted at 73 Public Health Centres in Bandung the capital of West Java Province from August until November 2015. The samples were 73 TB nurses and 32 laboratory staff. A self-administered questionnaire was given comprising 27 knowledge questions and 29 attitude questions. Correlation between knowledge and attitude scores was calculated by Pearson correlation test. Results: The majority of study participants were women (82.9%, married (92.4%, nursing staff (65.7% with history of TB training (98.1%. Most of the participants were 40-59 years old (69.5% with working experience in TB programme < 10 years (69.5%. Less than half (38.1% of study participants had good knowledge. In terms of attitude, more than half (53.3% of study participants had a positive attitude towards MDR-TB. Conclusions: The level of knowledge among HCWs about MDR-TB is still at an unacceptable level. Certain educational interventions aim to ensure prompt diagnosis, implement infection control and accurate treatment should be established among those HCWs.

  17. How Multi-Levels of Individual and Team Learning Interact in a Public Healthcare Organisation: A Conceptual Framework

    Science.gov (United States)

    Doyle, Louise; Kelliher, Felicity; Harrington, Denis

    2016-01-01

    The aim of this paper is to review the relevant literature on organisational learning and offer a preliminary conceptual framework as a basis to explore how the multi-levels of individual learning and team learning interact in a public healthcare organisation. The organisational learning literature highlights a need for further understanding of…

  18. Public assessment of key performance indicators of healthcare in a Canadian province: the effect of age and chronic health problems.

    Science.gov (United States)

    Nurullah, Abu Sadat; Northcott, Herbert C; Harvey, Michael D

    2014-01-15

    This study explores the effect of age and chronic conditions on public perceptions of the health system, as measured by the Key Performance Indicators (KPIs) of healthcare, in the province of Alberta in Canada. Drawing from data collected by Government of Alberta's Department of Health and Wellness, this research examines two key questions: (1) Do people in the 65+ age group rate the KPIs of healthcare (i.e., availability, accessibility, quality, outcome, and satisfaction) more favorably compared to people in younger age groups in Alberta? (2) Does the rating of KPIs of healthcare in Alberta vary with different chronic conditions (i.e., no chronic problem, chronic illnesses without pain, and chronic pain)? The findings indicate that people in the older age group tend to rate the KPIs of healthcare more favorably compared to younger age groups in Alberta, net of socio-demographic factors, self-reported health status, and knowledge and utilization of health services. However, people experiencing chronic pain are less likely to rate the KPIs of healthcare favorably compared to people with no chronic health problem in Alberta. Discussion includes implications of the findings for the healthcare system in the province.

  19. The 2014–2015 Ebola virus disease outbreak and primary healthcare delivery in Liberia: Time-series analyses for 2010–2016

    Science.gov (United States)

    Beste, Jason; Toomay, Stephen J.; Dunbar, Nelson; Bawo, Luke; Wesseh, Chea Sanford

    2018-01-01

    Background The aim of this study is to estimate the immediate and lasting effects of the 2014–2015 Ebola virus disease (EVD) outbreak on public-sector primary healthcare delivery in Liberia using 7 years of comprehensive routine health information system data. Methods and findings We analyzed 10 key primary healthcare indicators before, during, and after the EVD outbreak using 31,836 facility-month service outputs from 1 January 2010 to 31 December 2016 across a census of 379 public-sector health facilities in Liberia (excluding Montserrado County). All indicators had statistically significant decreases during the first 4 months of the EVD outbreak, with all indicators having their lowest raw mean outputs in August 2014. Decreases in outputs comparing the end of the initial EVD period (September 2014) to May 2014 (pre-EVD) ranged in magnitude from a 67.3% decrease in measles vaccinations (95% CI: −77.9%, −56.8%, p < 0.001) and a 61.4% decrease in artemisinin-based combination therapy (ACT) treatments for malaria (95% CI: −69.0%, −53.8%, p < 0.001) to a 35.2% decrease in first antenatal care (ANC) visits (95% CI: −45.8%, −24.7%, p < 0.001) and a 38.5% decrease in medroxyprogesterone acetate doses (95% CI: −47.6%, −29.5%, p < 0.001). Following the nadir of system outputs in August 2014, all indicators showed statistically significant increases from October 2014 to December 2014. All indicators had significant positive trends during the post-EVD period, with every system output exceeding pre-Ebola forecasted trends for 3 consecutive months by November 2016. Health system outputs lost during and after the EVD outbreak were large and sustained for most indicators. Prior to exceeding pre-EVD forecasted trends for 3 months, we estimate statistically significant cumulative losses of −776,110 clinic visits (95% CI: −1,480,896, −101,357, p = 0.030); −24,449 bacille Calmette–Guérin vaccinations (95% CI: −45,947, −2,020, p = 0.032); −9

  20. [Healthcare Provider Professional Secrecy: an Issue for Public Health Democracy somewhere between Immanence and Alienation.

    Science.gov (United States)

    Pautier, Silvère

    2017-09-01

    For a long time considered as total and absolute, healthcare professional secrecy is today difficult to reconcile with care practices. Lots of paradoxes question its preservation in favour of general interest and public order against the protection of private interest within an individualistic normative society. Exploring this interrogation, the article's objective is to initiate an ethical discussion from a professional caregiver secrecy's historical and sociological evolution perspective. Thus, with the help of theoretical understandings, especially those by Michel Foucault, medical secrecy is considered a defense of rationality specific to populations' government. This conceptualization finds arguments through social collective norms attached to an alienating biopower at the expense of secrecy integrated as an individualistic and immanent social norm. However, beyond the well-known debate on the absolute necessity for change, evolution… the distance from the Socratic and Hippocratic principles engage people and society in real democratic decisions about Health. Also, health professionals, patients, usgers and society must consider the limits that would lead to medical confidentiality.

  1. Public-private delivery of insecticide-treated nets: a voucher scheme in Volta Region, Ghana

    Directory of Open Access Journals (Sweden)

    Taylor Ian

    2007-02-01

    Full Text Available Abstract Background Coverage of vulnerable groups with insecticide-treated nets (ITNs in Ghana, as in the majority of countries of sub-Saharan Africa is currently low. A voucher scheme was introduced in Volta Region as a possible sustainable delivery system for increasing this coverage through scale-up to other regions. Successful scale-up of public health interventions depends upon optimal delivery processes but operational research for delivery processes in large-scale implementation has been inadequate. Methods A simple tool was developed to monitor numbers of vouchers given to each health facility, numbers issued to pregnant women by the health staff, and numbers redeemed by the distributors back to the management agent. Three rounds of interviews were undertaken with health facility staff, retailers and pregnant women who had attended antenatal clinic (ANC. Results During the one year pilot 25,926 vouchers were issued to eligible women from clinics, which equates to 50.7% of the 51,658 ANC registrants during this time period. Of the vouchers issued 66.7% were redeemed by distributors back to the management agent. Initially, non-issuing of vouchers to pregnant women was mainly due to eligibility criteria imposed by the midwives; later in the year it was due to decisions of the pregnant women, and supply constraints. These in turn were heavily influenced by factors external to the programme: current household ownership of nets, competing ITN delivery strategies, and competition for the limited number of ITNs available in the country from major urban areas of other regions. Conclusion Both issuing and redemption of vouchers should be monitored as factors assumed to influence voucher redemption had an influence on issuing, and vice versa. More evidence is needed on how specific contextual factors influence the success of voucher schemes and other models of delivery of ITNs. Such an evidence base will facilitate optimal strategic decision making

  2. Pregnancy outcomes associated with Cesarean deliveries in Peruvian public health facilities

    Science.gov (United States)

    Gonzales, Gustavo F; Tapia, Vilma L; Fort, Alfredo L; Betran, Ana Pilar

    2013-01-01

    A continuous rise in the rate of cesarean deliveries has been reported in many countries over recent decades. This trend has prompted the emergence of a debate on the risks and benefits associated with cesarean section. The present study was designed to estimate cesarean section rates over time during the period between 2000 and 2010 in Peru and to present outcomes for each mode of delivery. This is a secondary analysis of a large database obtained from the Perinatal Information System, which includes 570,997 pregnant women and their babies from 43 Peruvian public health facilities in three geographical regions: coast, highlands, and jungle. Over 10 years, 558,901 women delivered 563,668 infants weighing at least 500 g. The cesarean section rate increased from 25.5% in 2000 to 29.9% in 2010 (26.9% average; P cesarean than vaginal deliveries (P cesarean section (P cesarean section group than in the vaginal delivery group. Data suggest that cesarean sections are associated with adverse pregnancy outcomes. PMID:24124393

  3. Attitudes of oncology healthcare practitioners towards smoking cessation: A systematic review of the facilitators, barriers and recommendations for delivery of advice and support to cancer patients

    International Nuclear Information System (INIS)

    Conlon, K.; Pattinson, L.; Hutton, D.

    2017-01-01

    Objectives: A systematic review of the literature was conducted. The review was conducted using a search of the literature for all years up to October 2016. Statements that identified facilitators, barriers or recommendations surrounding smoking cessation delivery were extracted and analogous statements aggregated to enable thematic analysis. After searching multiple databases and the application of exclusion and inclusion criteria, a total of 19 acceptable studies were identified. Key findings: Delivery of cessation by oncology professionals was impacted by their own knowledge and views, their perception of the benefits to patient health and by the workplace procedures within their institution. Conclusion: Oncology practitioners worldwide face similar issues in delivering smoking cessation advice. By improving training programs that address the attitudes and beliefs which facilitate or block delivery of smoking cessation and by implementing systemic changes within cancer centres, delivery of smoking cessation should be enabled. - Highlights: • Oncology professional attitudes towards smoking cessation are relatively ubiquitous. • Lack of training is frequently reported to be a barrier to smoking interventions. • Oncology healthcare practitioners have a desire to be trained in smoking cessation. • Required improvements to training programs to facilitate delivery are addressed. • Integration of smoking assessment and advice into workplace policy is required.

  4. Healthcare is primary

    Directory of Open Access Journals (Sweden)

    Raman Kumar

    2015-01-01

    Full Text Available India is undergoing a rapid transformation in terms of governance, administrative reforms, newer policy develoment, and social movements. India is also considered one of the most vibrant economies in the world. The current discourse in public space is dominated by issues such as economic development, security, corruption free governance, gender equity, and women safety. Healthcare though remains a pressing need of population; seems to have taken a backseat. In the era of decreasing subsidies and cautious investment in social sectors, the 2 nd National Conference on Family Medicine and Primary Care 2015 (FMPC brought a focus on "healthcare" in India. The theme of this conference was "Healthcare is Primary." The conference participants discussed on the theme of why healthcare should be a national priority and why strong primary care should remain at the center of healthcare delivery system. The experts recommended that India needs to strengthen the "general health system" instead of focusing on disease based vertical programs. Public health system should have capacity and skill pool to be able to deliver person centered comprehensive health services to the community. Proactive implementation of policies towards human resource in health is the need of the hour. As the draft National Health Policy 2015 is being debated, "family medicine" (academic primary care, the unfinished agenda of National Health Policy 2002, remains a priority area of implementation.

  5. The Utility of Rural and Underserved Designations in Geospatial Assessments of Distance Traveled to Healthcare Services: Implications for Public Health Research and Practice

    Directory of Open Access Journals (Sweden)

    Matthew Lee Smith

    2013-01-01

    Full Text Available Health disparities research in rural populations is based on several common taxonomies identified by geography and population density. However, little is known about the implications of different rurality definitions on public health outcomes. To help illuminate the meaning of different rural designations often used in research, service delivery, or policy reports, this study will (1 review the different definitions of rurality and their purposes; (2 identify the overlap of various rural designations in an eight-county Brazos Valley region in Central Texas; (3 describe participant characteristic profiles based on distances traveled to obtain healthcare services; and (4 examine common profile characteristics associated with each designation. Data were analyzed from a random sample from 1,958 Texas adults participating in a community assessment. K-means cluster analysis was used to identify natural groupings of individuals based on distance traveled to obtain three healthcare services: medical care, dental care, and prescription medication pick-up. Significant variation in cluster representation and resident characteristics was observed by rural designation. Given widely used taxonomies for designating areas as rural (or provider shortage in health-related research, this study highlights differences that could influence research results and subsequent program and policy development based on rural designation.

  6. The utility of rural and underserved designations in geospatial assessments of distance traveled to healthcare services: implications for public health research and practice.

    Science.gov (United States)

    Smith, Matthew Lee; Dickerson, Justin B; Wendel, Monica L; Ahn, Sangnam; Pulczinski, Jairus C; Drake, Kelly N; Ory, Marcia G

    2013-01-01

    Health disparities research in rural populations is based on several common taxonomies identified by geography and population density. However, little is known about the implications of different rurality definitions on public health outcomes. To help illuminate the meaning of different rural designations often used in research, service delivery, or policy reports, this study will (1) review the different definitions of rurality and their purposes; (2) identify the overlap of various rural designations in an eight-county Brazos Valley region in Central Texas; (3) describe participant characteristic profiles based on distances traveled to obtain healthcare services; and (4) examine common profile characteristics associated with each designation. Data were analyzed from a random sample from 1,958 Texas adults participating in a community assessment. K-means cluster analysis was used to identify natural groupings of individuals based on distance traveled to obtain three healthcare services: medical care, dental care, and prescription medication pick-up. Significant variation in cluster representation and resident characteristics was observed by rural designation. Given widely used taxonomies for designating areas as rural (or provider shortage) in health-related research, this study highlights differences that could influence research results and subsequent program and policy development based on rural designation.

  7. [Art, mental health, and public healthcare: profile of a care culture in the history of São Paulo city].

    Science.gov (United States)

    Galvanese, Ana Tereza Costa; D'Oliveira, Ana Flávia Pires Lucas; Lima, Elizabeth Maria Freire de Araújo; Pereira, Lygia Maria de França; Nascimento, Ana Paula; Nascimento, Andréia de Fátima

    2016-01-01

    By studying the inclusion of artistic and cultural activities in the care provided throughout the history of public mental healthcare in greater São Paulo, Brazil, we can better understand and characterize the practices adopted in the Psychosocial Care Centers in the city today. Experiments carried out between the 1920s and 1990s are investigated, based on bibliographic research. The contemporary data were obtained from research undertaken at 126 workshops at 21 Psychosocial Care Centers in the same city between April 2007 and April 2008. The findings indicate that the current trend in mental healthcare, whose clinical perspective spans the realms of art and mental health and has territorial ramifications, has maintained some of the features encountered in earlier mental healthcare experiments.

  8. Strategies for healthcare information systems

    NARCIS (Netherlands)

    Stegwee, R.A.; Spil, Antonius A.M.

    2001-01-01

    Information technologies of the past two decades have created significant fundamental changes in the delivery of healthcare services by healthcare provider organizations. Many healthcare organizations have been in search of ways and strategies to keep up with continuously emerging information

  9. Caesarean section deliveries: Experiences of mothers of midwifery care at a public hospital in Nelson Mandela Bay

    Directory of Open Access Journals (Sweden)

    Thobeka P. Jikijela

    2018-01-01

    Conclusion: Experiences of mothers following a caesarean section delivery with midwifery services at a public hospital in Nelson Mandela Bay were explored and described as diverse. A need for adequate pain management as well as assistance and breastfeeding support to mothers following caesarean delivery was identified as crucial to promote a good mother-to-child relationship.

  10. The Delivery of Health Promotion and Environmental Health Services; Public Health or Primary Care Settings?

    Directory of Open Access Journals (Sweden)

    Lene Bjørn Jensen

    2018-05-01

    Full Text Available The WHO Regional Office for Europe developed a set of public health functions resulting in the ten Essential Public Health Operations (EPHO. Public health or primary care settings seem to be favorable to embrace all actions included into EPHOs. The presented paper aims to guide readers on how to assign individual health promotion and environmental health services to public health or primary care settings. Survey tools were developed based on EPHO 2, 3 and 4; there were six key informant surveys out of 18 contacted completed via e-mails by informants working in Denmark on health promotion and five face-to-face interviews were conducted in Australia (Melbourne and Victoria state with experts from environmental health, public health and a physician. Based on interviews, we developed a set of indicators to support the assignment process. Population or individual focus, a system approach or one-to-one approach, dealing with hazards or dealing with effects, being proactive or reactive were identified as main element of the decision tool. Assignment of public health services to one of two settings proved to be possible in some cases, whereas in many there is no clear distinction between the two settings. National context might be the one which guides delivery of public health services.

  11. The Delivery of Health Promotion and Environmental Health Services; Public Health or Primary Care Settings?

    Science.gov (United States)

    Bjørn Jensen, Lene; Lukic, Irena; Gulis, Gabriel

    2018-05-07

    The WHO Regional Office for Europe developed a set of public health functions resulting in the ten Essential Public Health Operations (EPHO). Public health or primary care settings seem to be favorable to embrace all actions included into EPHOs. The presented paper aims to guide readers on how to assign individual health promotion and environmental health services to public health or primary care settings. Survey tools were developed based on EPHO 2, 3 and 4; there were six key informant surveys out of 18 contacted completed via e-mails by informants working in Denmark on health promotion and five face-to-face interviews were conducted in Australia (Melbourne and Victoria state) with experts from environmental health, public health and a physician. Based on interviews, we developed a set of indicators to support the assignment process. Population or individual focus, a system approach or one-to-one approach, dealing with hazards or dealing with effects, being proactive or reactive were identified as main element of the decision tool. Assignment of public health services to one of two settings proved to be possible in some cases, whereas in many there is no clear distinction between the two settings. National context might be the one which guides delivery of public health services.

  12. Firms’ reshaping of commercialization practices to overcome the ‘not invented here’ phenomenon in public healthcare organizations

    DEFF Research Database (Denmark)

    Nissen, Helle Aarøe; Evald, Majbritt Rostgaard; Clarke, Ann Højbjerg

    2015-01-01

    The present study is rooted in Public Private Innovation (PPI) projects where public hospitals and private firms engage in cross-sector collaboration with a view to developing new welfare solutions targeting public sector needs. Research into PPI is mainly focused on public management of innovation...... processes. Consequently, PPI is rarely examined from a private sector perspective, including how private firms seek to commercialize new innovations after co-creating these innovations in collaboration with public organizations. However, commercialization is a critical aspect of innovation because...... by elucidating how private firms commercialize co-created welfare solutions. The empirical setting is a multiple case study consisting of four PPI projects conducted in public Danish healthcare. The findings reveal that PPI firms experience the ‘not invented here’ (NIH) phenomenon across Danish hospitals...

  13. Decoupling the use and meaning of strategic plans in public healthcare.

    Science.gov (United States)

    Lega, Federico; Longo, Francesco; Rotolo, Andrea

    2013-01-04

    The culture of New Public Management has promoted the diffusion of strategic management tools throughout Public Healthcare Organisations (PHOs). There is consensus that better strategic planning tools are required to achieve higher levels of organisational performance. This paper provides evidence and understanding of the emergent uses and scope of strategic planning in PHOs, in order to answer three research questions: (i) has the New Public Management approach changed the organisational culture of PHOs in terms of how they adopt, diffuse, and use strategic planning documents? (ii) how coherent are strategic planning documents in PHOs? and (iii) what are the main purposes of strategic documents in PHOs? An analysis was carried out in three Italian Local Health Authorities. We analysed the number and types of formal strategic documents adopted between 2004 and 2012, evaluating their degree of coherence and coordination, their hierarchy, their degree of disclosure, and the consistency of their strategic goals. A content analysis was performed to investigate overlap in terms of content and focus, and a qualitative analysis was carried out to study and represent the relationships between documents. The analysis showed that a rich set of strategic documents were adopted by each PHO. However, these are often uncoordinated and overlap in terms of content. They adopt different language and formats for various stakeholders. The presence of diverse external drivers may explain the divergent focus, priorities and inconsistent goals in the strategic documents. This planning complexity makes it difficult to determine how the overall goals and mission of an organisation are defined and made visible. The evidence suggests that PHOs use a considerable number of strategic documents. However, they employ no clear or explicit overarching strategy currently, and strategic planning appears to be externally oriented. All the documents communicate similar topics to different

  14. Decoupling the use and meaning of strategic plans in public healthcare

    Science.gov (United States)

    2013-01-01

    Background The culture of New Public Management has promoted the diffusion of strategic management tools throughout Public Healthcare Organisations (PHOs). There is consensus that better strategic planning tools are required to achieve higher levels of organisational performance. This paper provides evidence and understanding of the emergent uses and scope of strategic planning in PHOs, in order to answer three research questions: (i) has the New Public Management approach changed the organisational culture of PHOs in terms of how they adopt, diffuse, and use strategic planning documents? (ii) how coherent are strategic planning documents in PHOs? and (iii) what are the main purposes of strategic documents in PHOs? Methods An analysis was carried out in three Italian Local Health Authorities. We analysed the number and types of formal strategic documents adopted between 2004 and 2012, evaluating their degree of coherence and coordination, their hierarchy, their degree of disclosure, and the consistency of their strategic goals. A content analysis was performed to investigate overlap in terms of content and focus, and a qualitative analysis was carried out to study and represent the relationships between documents. Results The analysis showed that a rich set of strategic documents were adopted by each PHO. However, these are often uncoordinated and overlap in terms of content. They adopt different language and formats for various stakeholders. The presence of diverse external drivers may explain the divergent focus, priorities and inconsistent goals in the strategic documents. This planning complexity makes it difficult to determine how the overall goals and mission of an organisation are defined and made visible. Conclusions The evidence suggests that PHOs use a considerable number of strategic documents. However, they employ no clear or explicit overarching strategy currently, and strategic planning appears to be externally oriented. All the documents communicate

  15. Telemedicine and its transformation of emergency care: a case study of one of the largest US integrated healthcare delivery systems.

    Science.gov (United States)

    Sharma, Rahul; Fleischut, Peter; Barchi, Daniel

    2017-12-01

    Innovative methods for delivering healthcare via the use of technology are rapidly growing. Despite the passage of the Affordable Care Act, emergency department visits have continued to rise nationally. Healthcare systems must devise solutions to face these increasing volumes and also deliver high quality care. In response to the changing healthcare landscape, New York Presbyterian Hospital has implemented a comprehensive enterprise wide digital health portfolio which includes the first mobile stroke treatment unit on the east coast and the first emergency department-based digital emergency care program in New York City.

  16. Graduate public health training in healthcare of refugee asylum seekers and clinical human rights: evaluation of an innovative curriculum.

    Science.gov (United States)

    Asgary, Ramin

    2016-04-01

    An innovative curriculum was developed to equip public health students with appropriate attitude and skills to address healthcare of asylum seekers. Implemented in 2005 the curriculum included: (1) didactic sessions covering epidemiology and health sequelae of torture, asylum laws, and approaches to identify survivors' healthcare needs; (2) panel discussions with survivors and advocates; and (3) participating in medico-legal process of asylum seeking. Complementary mixed methods evaluations included pre- and post-curriculum questionnaires, formal curriculum evaluations, final papers and oral presentations. 125 students participated. Students showed improved knowledge regrading sequelae of abuse and survivors' healthcare needs (P health and human rights careers. As an advocacy and cultural competency training in public health practice addressing healthcare of refugees domestically, this curriculum was well received and effective, and will also help students better serve other similar populations. Population case-based domestic opportunities to teach global health and health and human rights should be effectively utilized to develop a well-equipped global health corps.

  17. Explaining public satisfaction with health-care systems: findings from a nationwide survey in China.

    Science.gov (United States)

    Munro, Neil; Duckett, Jane

    2016-06-01

    To identify factors associated with health-care system satisfaction in China. Recent research suggests that socio-demographic characteristics, self-reported health, income and insurance, ideological beliefs, health-care utilization, media use and perceptions of services may affect health-care system satisfaction, but the relative importance of these factors is poorly understood. New data from China offer the opportunity to test theories about the sources of health-care system satisfaction. Stratified nationwide survey sample analysed using multilevel logistic regression. 3680 Chinese adults residing in family dwellings between 1 November 2012 and 17 January 2013. Satisfaction with the way the health-care system in China is run. We find only weak associations between satisfaction and socio-demographic characteristics, self-reported health and income. We do, however, find that satisfaction is strongly associated with having insurance and belief in personal responsibility for meeting health-care costs. We also find it is negatively associated with utilization, social media use, perceptions of access as unequal and perceptions of service providers as unethical. To improve satisfaction, Chinese policymakers - and their counterparts in countries with similar health-care system characteristics - should improve insurance coverage and the quality of health services, and tackle unethical medical practices. © 2015 The Authors. Health Expectations published by John Wiley & Sons Ltd.

  18. Public Private Partnerships: A possible alternative for delivery of infrastructure projects in Africa

    Directory of Open Access Journals (Sweden)

    Salim Bwanali

    2017-12-01

    Full Text Available It is estimated that Africa needs $93 billion annually until 2020 in order to bridge its infrastructure deficit. It is through significant investment in infrastructure development that economic growth and poverty alleviation can be enhanced. However central to all construction projects is an effective and sustainable procurement system. There is a notable shift by some African governments to turn to the private sector to design, build, finance and operate infrastructure facilities previously provided by the public sector in the form of Public Private Partnerships (PPP’s. As an innovative financing model, PPPs present an opportunity to governments to improve service delivery. Accordingly, this paper focuses on assessing international best practices as to how some developing nations tap into the resources of the private sector in implementing their infrastructure projects. The study is a result of critical review, synthesis and contextualization of relevant academic literature, conference and journal publications. A thorough document review method was employed to assess how some developing countries have institutionalized PPP as part of their development strategy. The paper will be of significant value to senior government officials as understanding the concept and dynamics of PPP will result in accelerated and effective service delivery.

  19. Does social trust increase willingness to pay taxes to improve public healthcare? Cross-sectional cross-country instrumental variable analysis.

    Science.gov (United States)

    Habibov, Nazim; Cheung, Alex; Auchynnikava, Alena

    2017-09-01

    The purpose of this paper is to investigate the effect of social trust on the willingness to pay more taxes to improve public healthcare in post-communist countries. The well-documented association between higher levels of social trust and better health has traditionally been assumed to reflect the notion that social trust is positively associated with support for public healthcare system through its encouragement of cooperative behaviour, social cohesion, social solidarity, and collective action. Hence, in this paper, we have explicitly tested the notion that social trust contributes to an increase in willingness to financially support public healthcare. We use micro data from the 2010 Life-in-Transition survey (N = 29,526). Classic binomial probit and instrumental variables ivprobit regressions are estimated to model the relationship between social trust and paying more taxes to improve public healthcare. We found that an increase in social trust is associated with a greater willingness to pay more taxes to improve public healthcare. From the perspective of policy-making, healthcare administrators, policy-makers, and international donors should be aware that social trust is an important factor in determining the willingness of the population to provide much-needed financial resources to supporting public healthcare. From a theoretical perspective, we found that estimating the effect of trust on support for healthcare without taking confounding and measurement error problems into consideration will likely lead to an underestimation of the true effect of trust. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Interactions: trade policy and healthcare reform after Chaoulli v. Quebec: is it time for Canada to acknowledge the fragile boundary between health and trade policies and strengthen the separation between private and public health insurance?

    Science.gov (United States)

    Crawford, Mark

    2006-01-01

    The insulation of Canada's healthcare system from trade treaty obligations is crucial to the legitimacy of Canada's trade policy. Legal analysis has suggested, however, that competitive and for-profit delivery of the kind contemplated by the Kirby Report and some provinces may make healthcare more vulnerable to challenges under NAFTA and GATS. The Government of Canada has tried to counter this interpretation by stressing the importance of public financing as the principal criterion for exemption of healthcare from trade treaties, but now the potential for private financing of essential medical services indicated by the Supreme Court's decision in Chaoulli v. Quebec has made that line of argument look risky as well. It is apparent that Canada failed to anticipate the possible interactions of domestic, international and constitutional law when it made commitments in the area of private health insurance at the WTO in 1997. Accordingly, the time has come to acknowledge the fragility of the boundary between health and trade policies, to take the risks and costs associated with trade treaty obligations fully into account when undertaking healthcare reform and to strengthen the separation between private and public health insurance.

  1. Pregnancy outcomes associated with Cesarean deliveries in Peruvian public health facilities

    Directory of Open Access Journals (Sweden)

    Gonzales GF

    2013-10-01

    Full Text Available Gustavo F Gonzales,1–2 Vilma L Tapia,2 Alfredo L Fort,3 Ana Pilar Betran31Department of Biological and Physiological Sciences, Faculty of Sciences and Philosophy, 2Instituto de Investigaciones de la Altura, Universidad Peruana Cayetano Heredia, Lima, Peru; 3Department of Reproductive Health and Research, World Health Organization, Geneva, SwitzerlandAbstract: A continuous rise in the rate of cesarean deliveries has been reported in many countries over recent decades. This trend has prompted the emergence of a debate on the risks and benefits associated with cesarean section. The present study was designed to estimate cesarean section rates over time during the period between 2000 and 2010 in Peru and to present outcomes for each mode of delivery. This is a secondary analysis of a large database obtained from the Perinatal Information System, which includes 570,997 pregnant women and their babies from 43 Peruvian public health facilities in three geographical regions: coast, highlands, and jungle. Over 10 years, 558,901 women delivered 563,668 infants weighing at least 500 g. The cesarean section rate increased from 25.5% in 2000 to 29.9% in 2010 (26.9% average; P < 0.01. The rate of stillbirths was lower with cesarean than vaginal deliveries (P < 0.01. On the other hand, and as expected, the rates for preterm births, twin pregnancies, and preeclampsia were higher in women who delivered by cesarean section (P < 0.01. More importantly, the rate of maternal mortality was 5.5 times higher in the cesarean section group than in the vaginal delivery group. Data suggest that cesarean sections are associated with adverse pregnancy outcomes.Keywords: elective cesarean, emergency cesarean, geographical regions, cesarean rates over time, adverse outcomes, developing country

  2. Estimating the unit costs of public hospitals and primary healthcare centers.

    Science.gov (United States)

    Younis, Mustafa Z; Jaber, Samer; Mawson, Anthony R; Hartmann, Michael

    2013-01-01

    Many factors have affected the rise of health expenditures, such as high-cost medical technologies, changes in disease patterns and increasing demand for health services. All countries allocate a significant portion of resources to the health sector. In 2008, the gross domestic product of Palestine was estimated to be at $6.108bn (current price) or about $1697 per capita. Health expenditures are estimated at 15.6% of the gross domestic product, almost as much as those of Germany, Japan and other developed countries. The numbers of hospitals, hospital beds and primary healthcare centers in the country have all increased. The Ministry of Health (MOH) currently operates 27 of 76 hospitals, with a total of 3074 beds, which represent 61% of total beds of all hospitals in the Palestinian Authorities area. Also, the MOH is operating 453 of 706 Primary Health Care facilities. By 2007, about 40 000 people were employed in different sectors of the health system, with 33% employed by the MOH. This purpose of this study was to develop a financing strategy to help cover some or all of the costs involved in operating such institutions and to estimate the unit cost of primary and secondary programs and departments. A retrospective study was carried out on data from government hospitals and primary healthcare centers to identify and analyze the costs and output (patient-related services) and to estimate the unit cost of health services provided by hospitals and PHCs during the year 2008. All operating costs are assigned and allocated to the departments at MOH hospitals and primary health care centers (PPHCs) and are identified as overhead departments, intermediate-service and final-service departments. Intermediate-service departments provide procedures and services to patients in the final-service departments. The costs of the overhead departments are distributed to the intermediate-service and final-service departments through a step-down method, according to allocation

  3. Is healthcare a 'Necessity' or 'Luxury'? an empirical evidence from public and private sector analyses of South-East Asian countries?

    Science.gov (United States)

    Khan, Jahangir Am; Mahumud, Rashidul Alam

    2015-01-01

    South-East Asian Regional (SEAR) countries range from low- to middle-income countries and have considerable differences in mix of public and private sector expenditure on health. This study intends to estimate the income-elasticities of healthcare expenditure in public and private sectors separately for investigating whether healthcare is a 'necessity' or 'luxury' for citizens of these countries. Panel data from 9 SEAR countries over 16 years (1995-2010) were employed. Fixed- and random-effect models were fitted to estimate income-elasticity of public, private and total healthcare expenditure. Results showed that one percent point increase in GDP per capita increased private expenditure on healthcare by 1.128%, while public expenditure increased by only 0.412%. Inclusion of three-year lagged variables of GDP per capita in the models did not have remarkable influence on the findings. The citizens of SEAR countries consider healthcare as a necessity while provided through public sector and a luxury when delivered by private sector. By increasing the public provisions of healthcare, more redistribution of healthcare resources can be ensured, which can accelerate the journey of SEAR countries towards universal health coverage.

  4. Trends in treatment of anterior cruciate ligament injuries of the knee in the public and private healthcare systems of Brazil

    Directory of Open Access Journals (Sweden)

    Diego Costa Astur

    Full Text Available CONTEXT AND OBJECTIVE Orthopedic surgery implies high costs for both public and private healthcare. The aim of this study was to better understand the differences between the public and private sectors regarding treatment of a damaged anterior cruciate ligament, which is a common knee injury. DESIGN AND SETTING Descriptive cross-sectional study conducted during the Brazilian Orthopedics Congress in Brasília. METHODS We applied questionnaires during the 2010 Brazilian Orthopedics Congress, with participation by 241 knee surgeons from 24 Brazilian states. This was followed by statistical analysis on the data that were obtained. RESULTS The orthopedic surgeons who were evaluated used different approaches and treatment options in different Brazilian states, comparing between the public and private systems. CONCLUSION Both in the public and in the private systems in Brazil, because of non-medical issues surrounding the treatment, the best medical decision is not always made. This may be harmful both to patients and to physicians.

  5. Toward a Learning Health-care System – Knowledge Delivery at the Point of Care Empowered by Big Data and NLP

    Science.gov (United States)

    Kaggal, Vinod C.; Elayavilli, Ravikumar Komandur; Mehrabi, Saeed; Pankratz, Joshua J.; Sohn, Sunghwan; Wang, Yanshan; Li, Dingcheng; Rastegar, Majid Mojarad; Murphy, Sean P.; Ross, Jason L.; Chaudhry, Rajeev; Buntrock, James D.; Liu, Hongfang

    2016-01-01

    The concept of optimizing health care by understanding and generating knowledge from previous evidence, ie, the Learning Health-care System (LHS), has gained momentum and now has national prominence. Meanwhile, the rapid adoption of electronic health records (EHRs) enables the data collection required to form the basis for facilitating LHS. A prerequisite for using EHR data within the LHS is an infrastructure that enables access to EHR data longitudinally for health-care analytics and real time for knowledge delivery. Additionally, significant clinical information is embedded in the free text, making natural language processing (NLP) an essential component in implementing an LHS. Herein, we share our institutional implementation of a big data-empowered clinical NLP infrastructure, which not only enables health-care analytics but also has real-time NLP processing capability. The infrastructure has been utilized for multiple institutional projects including the MayoExpertAdvisor, an individualized care recommendation solution for clinical care. We compared the advantages of big data over two other environments. Big data infrastructure significantly outperformed other infrastructure in terms of computing speed, demonstrating its value in making the LHS a possibility in the near future. PMID:27385912

  6. An Investigation of the Amount of Emphasis Placed on Content and Delivery by Instructors of Public Speaking.

    Science.gov (United States)

    Siddens, Paul J., III

    A study examined how much emphasis instructors of public speaking place on content and delivery when teaching and delivering oral and written critiques. The study sought to determine whether when teaching a hybrid introduction to communication course, or public speaking course, instructors are challenged with teaching their students about issues…

  7. Factors influencing the delivery of the fundamentals of care: Perceptions of nurses, nursing leaders and healthcare consumers.

    Science.gov (United States)

    Conroy, Tiffany

    2017-11-17

    To explore the factors described by nurses and consumer representatives influencing the delivery of the fundamentals of care. An ongoing challenge facing nursing is ensuring the "basics" or fundamentals of care are delivered optimally. The way nurses and patients perceive the delivery of the fundamentals of care had not been explored. Once identified, the factors that promote the delivery of the fundamentals of care may be facilitated. Inductive content analysis of scenario based focus groups. A qualitative approach was taken using three stages, including direct observation, focus groups and interviews. This paper reports the second stage. Focus groups discussed four patient care scenarios derived from the observational data. Focus groups were conducted separately for registered nurses, nurses in leadership roles and consumer representatives. Content analysis was used. The analysis of the focus group data resulted in three themes: Organisational factors; Individual nurse or patient factors; and Interpersonal factors. Organisational factors include nursing leadership, the context of care delivery and the availability of time. Individual nurse and patient factors include the specific care needs of the patient and the individual nurse and patient characteristics. Interpersonal factors include the nurse-patient relationship; involving the patient in their care, ensuring understanding and respecting choices; communication; and setting care priorities. Seeking the perspective of the people involved in delivering and receiving the fundamentals of care showed a shared understanding of the factors influencing the delivery of the fundamentals of care. The influence of nursing leadership and the quality of the nurse-patient relationship were perceived as important factors. Nurses and consumers share a common perspective of the factors influencing the delivery of the fundamentals of care and both value a therapeutic nurse-patient relationship. Clinical nursing leaders must

  8. Reliable in their failure: an analysis of healthcare reform policies in public systems.

    Science.gov (United States)

    Contandriopoulos, Damien; Brousselle, Astrid

    2010-05-01

    In this paper, we analyze recommendations of past governmental commissions and their implementation in Quebec as a case to discuss the obstacles that litter the road to healthcare system reform. Our analysis shows that the obstacles to tackling the healthcare system's main problems may have less to do with programmatic (what to do) than with political and governance (how to do it) questions. We then draw on neo-institutional theory to discuss the causes and effects of this situation. Copyright (c) 2009 Elsevier Ireland Ltd. All rights reserved.

  9. Outcomes of treatment of drug-susceptible tuberculosis at public sector primary healthcare clinics in Johannesburg, South Africa: A retrospective cohort study.

    Science.gov (United States)

    Budgell, E P; Evans, D; Schnippel, K; Ive, P; Long, L; Rosen, S

    2016-09-05

    Despite the large number of tuberculosis (TB) patients treated in South Africa (SA), there are few descriptions in the published literature of drug-susceptible TB patient characteristics, mode of diagnosis or treatment outcomes in routine public sector treatment programmes. To enhance the evidence base for public sector TB treatment service delivery, we reported the characteristics of and outcomes for a retrospective cohort of adult TB patients at public sector clinics in the Johannesburg Metropolitan Municipality (JHB), SA. We collected medical record data for a retrospective cohort of adult (≥18 years) TB patients registered between 1 April 2011 and 31 March 2012 at three public sector clinics in JHB. Data were abstracted from National TB Programme clinic cards and the TB case registers routinely maintained at study sites. We report patient characteristics, mode of diagnosis, mode of treatment supervision, treatment characteristics, HIV status and treatment outcomes for this cohort. A total of 544 patients were enrolled in the cohort. Most (86%) were new TB cases, 81% had pulmonary TB, 58% were smear-positive at treatment initiation and 71% were HIV co-infected. Among 495 patients with treatment outcomes reported, 80% (n=394) had successful outcomes, 11% (n=55) were lost to follow-up, 8% (n=40) died and 1% (n=6) failed treatment. Primary healthcare clinics in JHB are achieving relatively high rates of success in treating drug-susceptible TB. Missing laboratory results were common, including follow-up smears, cultures and drug susceptibility tests, making it difficult to assess adherence to guidelines and leaving scope for substantial improvements in record-keeping at the clinics involved.

  10. The Relationship of Repeated Technical Assistance Support Visits to the Delivery of Positive Health, Dignity, and Prevention (PHDP) Messages by Healthcare Providers in Mozambique: A Longitudinal Multilevel Analysis.

    Science.gov (United States)

    Gutin, Sarah A; Amico, K Rivet; Hunguana, Elsa; Munguambe, António Orlando; Rose, Carol Dawson

    Positive health, dignity, and prevention (PHDP) is Mozambique's strategy to engage clinicians in the delivery of prevention messages to their HIV-positive clients. This national implementation strategy uses provider trainings on offering key messages and focuses on intervening on 9 evidence-based risk reduction areas. We investigated the impact of longitudinal technical assistance (TA) as an addition to this basic training. We followed 153 healthcare providers in 5 Mozambican provinces over 6 months to evaluate the impact of on-site, observation-based TA on PHDP implementation. Longitudinal multilevel models were estimated to model change in PHDP message delivery over time among individual providers. With each additional TA visit, providers delivered about 1 additional PHDP message ( P < .001); clinicians and nonclinicians started at about the same baseline level, but clinicians improved more quickly ( P = .004). Message delivery varied by practice sector; maternal and child health sectors outperformed other sectors. Longitudinal TA helped reach the programmatic goals of the PHDP program in Mozambique.

  11. Evaluation of Patient and Medical Staff Satisfaction regarding Healthcare Services in Wuhan Public Hospitals.

    Science.gov (United States)

    Meng, Runtang; Li, Jingjing; Zhang, Yunquan; Yu, Yong; Luo, Yi; Liu, Xiaohan; Zhao, Yanxia; Hao, Yuantao; Hu, Ying; Yu, Chuanhua

    2018-04-17

    Satisfaction evaluation is widely used in healthcare systems to improve healthcare service quality to obtain better health outcomes. The aim of this study was to measure employee work satisfaction and patient satisfaction status in Wuhan, China. A cross-sectional study was conducted in 14 medical institutions. The final valid sample comprised a total of 696 medical staff and 668 patients. The overall satisfaction levels of medical staff and patients were 58.28 ± 14.60 (10.47–100.00) and 65.82 ± 14.66 (8.62–100.00), respectively. The factors affecting medical staff satisfaction, ranking in sequence from most to least satisfied, were: the work itself, working environment and atmosphere, hospital management, practicing environment, and job rewards. Patient satisfaction factors, from most to least affecting, were ranked as follows: physician-patient relationship and communication, service organization and facilities, continuity and collaboration of medical care, access to relevant information and support, and healthcare and related services, respectively. The overall satisfaction evaluation of medical staff was average. Healthcare policy makers and medical institution management staff should focus on job rewards and working environment. This would allow them to increase their work happiness and sense of belonging, which in turn would allow them to provide better medical services to patients. The overall patient evaluation was satisfactory, with patients satisfied at all levels of the satisfaction evaluation.

  12. Mind the gap! A comparison of oral health knowledge between dental, healthcare professionals and the public.

    Science.gov (United States)

    Richards, W; Filipponi, T; Roberts-Burt, V

    2014-02-01

    The importance of consistent, accurate and unambiguous messages are well documented in oral health promotion literature. Whether the reality of delivering messages in the field fulfils these principle is questionable. This paper explores the perceptions of dental professionals, healthcare professionals and lay community members with regard to key oral health messages in order to highlight any inconsistencies and knowledge gaps between and within groups for disease risk factors. A questionnaire was administered to individuals who belonged to three groups: dental professionals, healthcare professionals and lay community members. The questionnaire established knowledge regarding risk factors for caries, periodontal disease and erosion. Thirty-five (57.4%) of the dental group answered the whole questionnaire correctly, with 22 (27.8%) and 9 (5.1%) of the healthcare and lay community group answering the whole questionnaire correctly, respectively. The question of fluoride levels in children's toothpaste was the main reason for incorrect answers in the dental group. The results of this survey demonstrate a knowledge gradient from dental professionals through to healthcare professionals and then to lay members of the community. The knowledge base observed in the dental group is reflected in the other two groups as would be expected albeit with a significant gap between each group. As expected the dental professionals are generally well informed, but not as well informed as could be expected.

  13. Evaluation of Patient and Medical Staff Satisfaction regarding Healthcare Services in Wuhan Public Hospitals

    Science.gov (United States)

    Li, Jingjing; Yu, Yong; Liu, Xiaohan; Zhao, Yanxia; Hao, Yuantao; Hu, Ying

    2018-01-01

    Satisfaction evaluation is widely used in healthcare systems to improve healthcare service quality to obtain better health outcomes. The aim of this study was to measure employee work satisfaction and patient satisfaction status in Wuhan, China. A cross-sectional study was conducted in 14 medical institutions. The final valid sample comprised a total of 696 medical staff and 668 patients. The overall satisfaction levels of medical staff and patients were 58.28 ± 14.60 (10.47–100.00) and 65.82 ± 14.66 (8.62–100.00), respectively. The factors affecting medical staff satisfaction, ranking in sequence from most to least satisfied, were: the work itself, working environment and atmosphere, hospital management, practicing environment, and job rewards. Patient satisfaction factors, from most to least affecting, were ranked as follows: physician-patient relationship and communication, service organization and facilities, continuity and collaboration of medical care, access to relevant information and support, and healthcare and related services, respectively. The overall satisfaction evaluation of medical staff was average. Healthcare policy makers and medical institution management staff should focus on job rewards and working environment. This would allow them to increase their work happiness and sense of belonging, which in turn would allow them to provide better medical services to patients. The overall patient evaluation was satisfactory, with patients satisfied at all levels of the satisfaction evaluation. PMID:29673134

  14. A comparison of social accounting between local public healthcare services:An empirical research

    Directory of Open Access Journals (Sweden)

    Paolo Ursillo

    2010-03-01

    Full Text Available

    Introduction: Social accounting in healthcare is a quantitative–qualitative accounting tool which marks the bond between the business and its social background. It displays healthcare business results and information to the stakeholder. Actually, its use is not widespread in Italy, but often published in United States and other Countries.

    Methods: This work is based upon an empirical research, studying social accounting from Local Health Units (LHU, Italian ASL of Adria, Brindisi, Firenze and Umbria region published between 2006 and 2008. These documents have been analyzed, studying the business’ structure, healthcare services, social and economical conditions, financial status, performance indexes and much more data about most company activities.

    Results: Accountability in Italy has been studied carefully through longitudinal and cross sectional analysis, observing models and contents, elaborating a concrete proposal for social accounting.

    Discussion: Social accounting in healthcare can guarantee important information for non-expert users and expert technicians, allowing the former to take more conscious decisions, and the latter to study its business aspects more deeply. This is made possible by the consideration of extended economical data available in other accountability forms (like annual financial statement, and other performance indexes which give valuable data about social impact, efficiency and effectiveness to the end user.

  15. Survey of patient and public perceptions of electronic health records for healthcare, policy and research: Study protocol

    Directory of Open Access Journals (Sweden)

    Luchenski Serena

    2012-05-01

    Full Text Available Abstract Background Immediate access to patients’ complete health records via electronic databases could improve healthcare and facilitate health research. However, the possible benefits of a national electronic health records (EHR system must be balanced against public concerns about data security and personal privacy. Successful development of EHR requires better understanding of the views of the public and those most affected by EHR: users of the National Health Service. This study aims to explore the correlation between personal healthcare experience (including number of healthcare contacts and number and type of longer term conditions and views relating to development of EHR for healthcare, health services planning and policy and health research. Methods/design A multi-site cross-sectional self-complete questionnaire designed and piloted for use in waiting rooms was administered to patients from randomly selected outpatients’ clinics at a university teaching hospital (431 beds and general practice surgeries from the four primary care trusts within the catchment area of the hospital. All patients entering the selected outpatients clinics and general practice surgeries were invited to take part in the survey during August-September 2011. Statistical analyses will be conducted using descriptive techniques to present respondents’ overall views about electronic health records and logistic regression to explore associations between these views and participants’ personal circumstances, experiences, sociodemographics and more specific views about electronic health records. Discussion The study design and implementation were successful, resulting in unusually high response rates and overall recruitment (85.5%, 5336 responses. Rates for face-to-face recruitment in previous work are variable, but typically lower (mean 76.7%, SD 20. We discuss details of how we collected the data to provide insight into how we obtained this unusually high

  16. The effect of service delivery in public ‘community service centres’: A case of an emerging economy

    OpenAIRE

    Ndabazinhle Ngobese; Roger B. Mason; Mandusha Maharaj

    2017-01-01

    This study investigated public perceptions of the service delivery provided by the Community Service Centres (CSC) of the South African Police Service (SAPS) Durban, South Africa. The study focuses on measuring service quality and service delivery. SERVQUAL was used to compare clients’ perceptions against expectations of service quality. Four hundred respondents were surveyed at three community service centres (previously known as ‘police stations’), with expectations and perceptions being as...

  17. Multiple sclerosis in Germany: data analysis of administrative prevalence and healthcare delivery in the statutory health system.

    Science.gov (United States)

    Höer, Ariane; Schiffhorst, Guido; Zimmermann, Anne; Fischaleck, Johann; Gehrmann, Luise; Ahrens, Henrik; Carl, Gunther; Sigel, Karl-Otto; Osowski, Ulrike; Klein, Maria; Bleß, Hans-Holger

    2014-09-10

    Healthcare-utilization data for multiple sclerosis (MS) are scarce in Germany. The Purpose of the study was to analyse administrative prevalence of MS, medication use and type of specialists involved in MS treatment in the outpatient setting in Bavaria. Pseudonymized claims data from Bavarian Statutory Health Insurance (SHI)-accredited physicians were used. Administrative prevalence of MS was defined as having ≥1 MS diagnosis (International Classification of Diseases, 10th edition, code G35) documented by a neurologist or psychiatrist, or ≥1 prescription for disease-modifying drugs (DMDs)). The administrative prevalence calculated for Bavaria was projected to Germany. DMD prescription and involvement of different specialities in health care service for MS patients was analysed. Administrative prevalence of MS in Bavaria increased from 0.123% to 0.175% of insured persons between 2005 and 2009; when projected, this yielded ~102,000-143,000 patients with MS in the German population. The percentage of patients receiving ≥1 DMD prescription increased from 45.5% to 50.5%. Patients with MS were mainly treated by neurologists in the ambulatory care setting. These results provide important information on the administrative prevalence of MS in Bavaria and on healthcare provision for patients, which is relevant for resource planning in the healthcare sector.

  18. Social marketing in healthcare.

    Science.gov (United States)

    Aras, Radha

    2011-01-01

    Social marketing is an important tool in the delivery of healthcare services. For any healthcare programme or project to be successful, community/consumer participation is required. The four principles of social marketing can guide policymakers and healthcare providers to successfully plan and implement health programmes. To review the existing literature in order to project the benefits of social marketing in healthcare. A search of periodical literature by the author involving social marketing and marketing concepts in health was carried out. Items were identified initially through health-oriented indexing services such as Medline, Health STAR and Cinahl, using the identifiers "social marketing" and "marketing in health". An extensive search was also carried out on educational database ERIC. A literature review of various studies on social marketing indicated that the selection of the right product (according to the community need) at the right place, with the right strategy for promotion and at the right price yields good results. However, along with technical sustainability (product, price, promotion and place), financial sustainability, institutional sustainability and market sustainability are conducive factors for the success of social marketing. The purpose of this literature review was to ascertain the likely effectiveness of social marketing principles and approaches and behaviour change communication towards health promotion. It is important for all healthcare workers to understand and respond to the public's desires and needs and routinely use consumer research to determine how best to help the public to solve problems and realise aspirations. Social marketing can optimise public health by facilitating relationship-building with consumers and making their lives healthier.

  19. Inequity in ecosystem service delivery: Socioeconomic gaps in the public-private conservation network

    Science.gov (United States)

    Villamagna, Amy M.; Mogollón, Beatriz; Angermeier, Paul L.

    2017-01-01

    private conservation lands included beneficiaries of significantly greater household income than benefit zones of other types of conservation areas. Our analysis of ES flows revealed significant socioeconomic gaps in how the current public-private conservation network benefits the public. These gaps warrant consideration in regional conservation plans and suggest that private conservation initiatives may be best suited for responding to the equity challenge. Enhancing the ecosystem benefits and the equity of benefit delivery from private conservation networks could build public and political support for long-term conservation strategies and ultimately enhance conservation efficacy.

  20. Governance and Public Sector Transformation in South Africa: Reporting and Providing Assurance on Service Delivery Information

    Directory of Open Access Journals (Sweden)

    Mariaan Roos

    2012-12-01

    Full Text Available Reporting on performance was legislatively established in South Africa in terms of the Public Finance Management Act, Act 1 of 1999, section 40 (3(a. The auditing of the reported information was legislated in the Public Audit Act, Act 25 of 2004, section 20(2 (c. The objectives of the article are firstly to provide an overview of the development and application of the reporting and secondly providing assurance on service delivery information and thirdly to reflect on challenges to the implementation thereof in South Africa. The aim through deploying these set objectives is to formulate possible future considerations for improved governance. As central part of the methodology, review of literature on reporting and audit of non-financialwas conducted. The research included scrutiny of the different philosophies and approaches adopted by different countries to the reporting and providing assurance on service delivery information. In this respect, the research reflects a comparative element. In South Africa the Auditor-General adopted a phasing-in approach. The development of the audit approach and audit procedures has reached a stable stage, nine years after the initial process started. The audit of performance information now forms an integral part of the regularity audit process. The analysis of audit findings of the period under study indicates a considerable improvement once initiated, but stagnation persists in subsequent years. Numerous challenges remain around the application of performance reporting in South Africa including non-compliance, the lack of sufficient and appropriate audit evidence, inconsistencies between the various strategic documents and the need to improve the usefulness of performance information. In conclusion the article proposes some steps to address the challenges.

  1. Value-Based Health Care Delivery, Preventive Medicine and the Medicalization of Public Health

    Science.gov (United States)

    2017-01-01

    The real paradigm shift for healthcare is often stated to include a transition from accentuating health care production and instead emphasize patient value by moving to a ‘value-based health care delivery’. In this transition, personalized medicine is sometimes referred to as almost a panacea in solving the current and future health challenges. In theory, the progress of precision medicine sounds uncontroversial and most welcomed with its promise of a better healthcare for all, with real benefits for the individual patient provided a tailored and optimized treatment plan suitable for his or her genetic makeup. And maybe, therefore, the assumptions underpinning personalized medicine have largely escaped questioning. The use of personalized medicine and the use of digital technologies is reshaping our health care system and how we think of health interventions and our individual responsibility. However, encouraging individuals to engage in preventive health activities possibly avoids one form of medicalization (clinical), but on the other hand, it takes up another form (preventive medicine and ‘self-care’) that moves medical and health concerns into every corner of everyday life. This ought to be of little value to the individual patient and public health. We ought to instead demand proof of these value ideas and the lacking research. Before this is in place critical appraisal and cynicism are requisite skills for the future. Otherwise, we are just listening to visionaries when we put our future health into their hands and let personalized solutions reach into people's everyday life regardless of patient safety and integrity. PMID:28409064

  2. Is cost-effective healthcare compatible with publicly financed academic medical centres?

    Science.gov (United States)

    Chia, Whay Kuang; Toh, Han Chong

    2013-01-01

    Probably more than any country, Singapore has made significant investment into the biomedical enterprise as a proportion of its economy and size. This focus recently witnessed a shift towards a greater emphasis on translational and clinical development. Key to the realisation of this strategy will be Academic Medical Centres (AMCs), as a principal tool to developing and applying useful products for the market and further improving health outcomes. Here, we explore the principal value proposition of the AMC to Singapore society and its healthcare system. We question if the values inherent within academic medicine--that of inquiry, innovation, pedagogy and clinical exceptionalism--can be compatible with the seemingly paradoxical mandate of providing cost-effective or rationed healthcare.

  3. In science communication, why does the idea of a public deficit always return? How do the shifting information flows in healthcare affect the deficit model of science communication?

    Science.gov (United States)

    Ko, Henry

    2016-05-01

    The healthcare field contains a multitude of opportunities for science communication. Given the many stakeholders dancing together in a multidirectional tango of communication, we need to ask how much does the deficit model apply to the health field? History dictates that healthcare professionals are the holders of all knowledge, and the patients and other stakeholders are the ones that need the scientific information communicated to them. This essay argues otherwise, in part due to the rise of shared decision-making and patients and other stakeholders acting as partners in healthcare. The traditional deficit model in health held that: (1) doctors were experts and patients were consumers, (2) it is impossible for the public to grasp the many disciplines of knowledge in medicine, (3) if experts have trouble keeping up with medical research then the public surely can't keep up, and (4) it is safer for healthcare professionals to communicate to the public using a deficit model. However, with the rise of partnerships with patients in healthcare decision-making, the deficit model might be weakening. Examples of public participation in healthcare decision-making include: (1) crowd-sourcing public participation in systematic reviews, (2) public participation in health policy, (3) public collaboration in health research, and (4) health consumer groups acting as producers of health information. With the challenges to the deficit model in science communication in health, caution is needed with the increasing role of technology and social media, and how these may affect the legitimacy of healthcare information flows away from the healthcare professional. © The Author(s) 2016.

  4. Applying a Total Market Lens: Increased IUD Service Delivery Through Complementary Public- and Private-Sector Interventions in 4 Countries

    Science.gov (United States)

    White, Julia N; Corker, Jamaica

    2016-01-01

    ABSTRACT Increasing access to the intrauterine device (IUD), as part of a comprehensive method mix, is a key strategy for reducing unintended pregnancy and maternal mortality in low-income countries. To expand access to IUDs within the framework of informed choice, Population Services International (PSI) has historically supported increased IUD service delivery through private providers. In applying a total market lens to better understand the family planning market and address major market gaps, PSI identified a lack of high-quality public provision of IUDs. In 2013, PSI started a pilot in 4 countries (Guatemala, Laos, Mali, and Uganda) to grow public-provider IUD service delivery through increased public-sector engagement while maintaining its ongoing focus on private providers. In collaboration with country governments, PSI affiliates carried out family planning market analyses in the 4 pilot countries to identify gaps in IUD service delivery and create sustainable strategies for scaling up IUD services in the public sector. Country-specific interventions to increase service delivery were implemented across all levels of the public health system, including targeted advocacy at the national level to promote government ownership and program sustainability. Mechanisms to ensure government ownership were built into the program design, including a proof-of-concept approach to convince governments of the feasibility and value of taking over and scaling up interventions. In the first 2 years of the pilot (2013–2014), 102,055 IUD services were provided to women at 417 targeted public-sector facilities. These preliminary results suggest that there is untapped demand for IUD service delivery in the public sector that can be met in part through greater participation of the public sector in family planning and IUD provision. PMID:27540122

  5. Applying a Total Market Lens: Increased IUD Service Delivery Through Complementary Public- and Private-Sector Interventions in 4 Countries.

    Science.gov (United States)

    White, Julia N; Corker, Jamaica

    2016-08-11

    Increasing access to the intrauterine device (IUD), as part of a comprehensive method mix, is a key strategy for reducing unintended pregnancy and maternal mortality in low-income countries. To expand access to IUDs within the framework of informed choice, Population Services International (PSI) has historically supported increased IUD service delivery through private providers. In applying a total market lens to better understand the family planning market and address major market gaps, PSI identified a lack of high-quality public provision of IUDs. In 2013, PSI started a pilot in 4 countries (Guatemala, Laos, Mali, and Uganda) to grow public-provider IUD service delivery through increased public-sector engagement while maintaining its ongoing focus on private providers. In collaboration with country governments, PSI affiliates carried out family planning market analyses in the 4 pilot countries to identify gaps in IUD service delivery and create sustainable strategies for scaling up IUD services in the public sector. Country-specific interventions to increase service delivery were implemented across all levels of the public health system, including targeted advocacy at the national level to promote government ownership and program sustainability. Mechanisms to ensure government ownership were built into the program design, including a proof-of-concept approach to convince governments of the feasibility and value of taking over and scaling up interventions. In the first 2 years of the pilot (2013-2014), 102,055 IUD services were provided to women at 417 targeted public-sector facilities. These preliminary results suggest that there is untapped demand for IUD service delivery in the public sector that can be met in part through greater participation of the public sector in family planning and IUD provision. © White et al.

  6. The Impact of Healthscape on Customer Satisfaction and Loyalty in Public and Private Healthcare Institutions

    OpenAIRE

    Akmaz, Arif Emre; Ozansoy Çadırcı, Tuğçe

    2018-01-01

    The evaluation of services is highly dependable on consumers’ experiences and emotions toward the service encounter. The service environment (the servicescape) has an influential aspect on customers’ satisfaction and behavioral intentions including customer loyalty.  This study aims to define the possible effects of the healthcare service environment (healthscape) on consumer experience, satisfaction and loyalty. The data was collected from patients that has visited an outpatient clinic, ER, ...

  7. Are undocumented migrants’ entitlements and barriers to healthcare a public health challenge for the European Union?

    OpenAIRE

    De Vito, Elisabetta; de Waure, Chiara; Specchia, Maria Lucia; Parente, Paolo; Azzolini, Elena; Frisicale, Emanuela Maria; Favale, Marcella; Teleman, Adele Anna; Ricciardi, Walter

    2016-01-01

    Undocumented migrants (UMs) are at higher risk for health problems because of their irregular status and the consequences of economic and social marginalization. Moreover, the emergent reality of undocumented migration in Europe calls for action in the field of management of UM’s health demands as their access to health services has become a sensitive political and social issue. In this light, this paper aims to address UMs’ entitlement and barriers to healthcare and related policies citing e...

  8. Third degree waiting time discrimination: optimal allocation of a public sector healthcare treatment under rationing by waiting.

    Science.gov (United States)

    Gravelle, Hugh; Siciliani, Luigi

    2009-08-01

    In many public healthcare systems treatments are rationed by waiting time. We examine the optimal allocation of a fixed supply of a given treatment between different groups of patients. Even in the absence of any distributional aims, welfare is increased by third degree waiting time discrimination: setting different waiting times for different groups waiting for the same treatment. Because waiting time imposes dead weight losses on patients, lower waiting times should be offered to groups with higher marginal waiting time costs and with less elastic demand for the treatment.

  9. 77 FR 26281 - National Advisory Council for Healthcare Research and Quality: Request for Nominations for Public...

    Science.gov (United States)

    2012-05-03

    ... delivery systems; (6) in the fields of health care economics, information systems, law, ethics, business... U.S.C. 299c(c)(2). Individuals are particularly sought with experience and success in activities... groups; minority groups; women; children; the elderly; and individuals with special health care needs...

  10. 76 FR 18765 - National Advisory Council for Healthcare Research and Quality: Request for Nominations for Public...

    Science.gov (United States)

    2011-04-05

    ... delivery systems; (6) in the fields of health care economics, information systems, law, ethics, business... U.S.C. 299c(c)(2). Individuals are particularly sought with experience and success in activities... priority populations, which include: low-income groups; minority groups; women; children; the elderly; and...

  11. 78 FR 26638 - National Advisory Council for Healthcare Research and Quality: Request for Nominations for Public...

    Science.gov (United States)

    2013-05-07

    ... delivery systems; (6) in the fields of health care economics, information systems, law, ethics, business... U.S.C. 299c(c)(2). Individuals are particularly sought with experience and success in activities... groups; minority groups; women; children; the elderly; and individuals with special health care needs...

  12. Healthcare reform: the role of coordinated critical care.

    Science.gov (United States)

    Cerra, F B

    1993-03-01

    To evaluate and editorialize the evolving role of the discipline of critical care as a healthcare delivery system in the process of healthcare reform. The sources included material from the Federal Office of Management and Budget, Health Care Financing Review, President Bush's Office, Association of American Medical Colleges, and publications of the Society of Critical Care Medicine. Data were selected that the author felt was relevant to the healthcare reform process and its implications for the discipline of critical care. The data were extracted by the author to illustrate the forces behind healthcare reform, the implications for the practice of critical care, and role of critical care as a coordinated (managed) care system in the process of healthcare reform. Healthcare reform has been initiated because of a number of considerations that arise in evaluating the current healthcare delivery system: access, financing, cost, dissatisfactions with the mechanisms of delivery, and political issues. The reform process will occur with or without the involvement of critical care practitioners. Reforms may greatly alter the delivery of critical care services, education, training, and research in critical care. Critical care has evolved into a healthcare delivery system that provides services to patients who need and request them and provides these services in a coordinated (managed) care model. Critical care practitioners must become involved in the healthcare reform process, and critical care services that are effective must be preserved, as must the education, training, and research programs. Critical care as a healthcare delivery system utilizing a coordinated (managed) care model has the potential to provide services to all patients who need them and to deliver them in a manner that is cost effective and recognized as providing added value.

  13. Institutional delivery in India, 2004-14: unravelling the equity-enhancing contributions of the public sector.

    Science.gov (United States)

    Joe, William; Perkins, Jessica M; Kumar, Saroj; Rajpal, Sunil; Subramanian, S V

    2018-06-01

    To achieve faster and equitable improvements in maternal and child health outcomes, the government of India launched the National Rural Health Mission in 2005. This paper describes the equity-enhancing role of the public sector in increasing use of institutional delivery care services in India between 2004 and 2014. Information on 24 661 births from nationally representative survey data for 2004 and 2014 is analysed. Concentration index is computed to describe socioeconomic-rank-related relative inequalities in institutional delivery and decomposition is used to assess the contributions of public and private sectors in overall socioeconomic inequality. Multilevel logistic regression is applied to examine the changes in socioeconomic gradient between 2004 and 2014. The analysis finds that utilization of institutional delivery care in India increased from 43% in 2004 to 83% in 2014. The bulk of the increase was in public sector use (21% in 2004 to 53% in 2014) with a modest increase in private sector use (22% in 2004 to 30% in 2014). The shift from a pro-rich to pro-poor distribution of public sector use is confirmed. Decomposition analysis indicates that 51% of these reductions in socioeconomic inequality are associated with improved pro-poor distribution of public sector births. Multilevel logistic regressions confirm the disappearance of a wealth-based gradient in public sector births between 2004 and 2014. We conclude that public health investments in India have significantly contributed towards an equitable increase in the coverage of institutional delivery care. Sustained policy efforts are necessary, however, with an emphasis on education, sociocultural and geographical factors to ensure universal coverage of institutional delivery care services in India.

  14. Role Of E-Government In Delivery Of Public Services In Tanzania Electric Supply Company In Ruvuma Region Tanzania

    Directory of Open Access Journals (Sweden)

    Emmanuel Jackson Petro Gunda

    2015-06-01

    Full Text Available ABSTRACT E-government facilitates delivery of public services of relevant government information in electronic form to citizens in a timely manner and better service delivery to citizens. E-government is a kind of governmental administration which is based on Information Communication and Technology Services. Electronic government describes the use of technologies to facilitate the operation of government and disperse of government information and services. The scope of the work was limited to Tanzania Electric Supply Company Limited TANESCO in Ruvuma region. The population of thirty 31 were selected from a total population of 169 public servants use both purposive and stratified random sampling techniques applied. The major findings of study revealed that about 67.7 of response from respondents agree that ICT infrastructures specifically modern computer connected to internet reliable internet speed well organized organization website power availability in public operation contribute to efficient in delivery of services it also noted by respondents to faster decision making speeding up transaction processing and reduce cost. The study greatly recommends that capacity building to public servants on ICT install and strengthening ICT infrastructures to government organizational are inevitable to realise relevant role of e-government in delivery of public services.

  15. Social marketing in healthcare

    Directory of Open Access Journals (Sweden)

    Radha Aras

    2011-08-01

    Full Text Available BackgroundSocial marketing is an important tool in the delivery ofhealthcare services. For any healthcare programme orproject to be successful, community/consumer participationis required. The four principles of social marketing can guidepolicymakers and healthcare providers to successfully planand implement health programmes.AimTo review the existing literature in order to project thebenefits of social marketing in healthcare.MethodA search of periodical literature by the author involvingsocial marketing and marketing concepts in health wascarried out. Items were identified initially through healthorientedindexing services such as Medline, Health STARand Cinahl, using the identifiers “social marketing“ and“marketing in health”. An extensive search was also carriedout on educational database ERIC.ResultsA literature review of various studies on social marketingindicated that the selection of the right product (accordingto the community need at the right place, with the rightstrategy for promotion and at the right price yields goodresults. However, along with technical sustainability(product, price, promotion and place, financialsustainability, institutional sustainability and marketsustainability are conducive factors for the success of socialmarketing.ConclusionThe purpose of this literature review was to ascertain thelikely effectiveness of social marketing principles andapproaches and behaviour change communication towardshealth promotion.It is important for all healthcare workers to understand andrespond to the public’s desires and needs and routinely useconsumer research to determine how best to help thepublic to solve problems and realise aspirations. Socialmarketing can optimise public health by facilitatingrelationship-building with consumers and making their liveshealthier.

  16. Physical therapists' perception of workplace ethics in an evolving health-care delivery environment: a cross-sectional survey.

    Science.gov (United States)

    Cantu, Roberto

    2018-03-30

    Physical therapists are trained and obligated to deliver optimal health care and put patients first above all else. In the changing health-care environment, health-care organizations are grappling with controlling cost and increasing revenues. Moral distress may be created when physical therapists' desire to provide optimal care conflicts with their organization's goals to remain financially viable or profitable. Moral distress has been associated with low perception of ethical environment, professional burnout, and high turnover in organizations. This study identified groups who may be vulnerable to low perception of organizational ethical environment and identified self-reported strategies to remedy these perceptions. An ethics environment questionnaire was mailed to a random sample of 1200 physical therapists in Georgia. Respondents (n = 340) were analyzed by age, workplace setting, and position in organization. Therapists working in skilled nursing/assisted living environments scored the lowest on the questionnaire and voiced concerns regarding their ethical work environments. Owners and executives perceived their organizations to be more ethical than front-line clinicians. Respondent concerns included high productivity standards, aggressive coding/billing policies, decreased reimbursement, and increased insurance regulation. Possible solutions included more frequent communication between management and clinicians about ethics, greater professional autonomy, and increased training in business ethics and finance.

  17. Operationalization of the Ghanaian Patients’ Charter in a Peri-urban Public Hospital: Voices of Healthcare Workers and Patients

    Science.gov (United States)

    Yarney, Lily; Buabeng, Thomas; Baidoo, Diana; Bawole, Justice Nyigmah

    2016-01-01

    Background: Health is a basic human right necessary for the exercise of other human rights. Every human being is, therefore, entitled to the highest possible standard of health necessary to living a life of dignity. Establishment of patients’ Charter is a step towards protecting the rights and responsibilities of patients, but violation of patients’ rights is common in healthcare institutions, especially in the developing world. This study which was conducted between May 2013 and May 2014, assessed the operationalization of Ghana’s Patients Charter in a peri-urban public hospital. Methods: Qualitative data collection methods were used to collect data from 25 healthcare workers and patients who were purposively selected. The interview data were analyzed manually, using the principles of systematic text condensation. Results: The findings indicate that the healthcare staff of the Polyclinic are aware of the existence of the patients’ Charter and also know some of its contents. Patients have no knowledge of the existence or the contents of the Charter. Availability of the Charter, community sensitization, monitoring and orientation of staff are factors that promote the operationalization of the Charter, while institutional implementation procedures such as lack of complaint procedures and low knowledge among patients militate against operationalization of the Charter. Conclusion: Public health facilities should ensure that their patients are well-informed about their rights and responsibilities to facilitate effective implementation of the Charter. Also, patients’ rights and responsibilities can be dramatized and broadcasted on television and radio in major Ghanaian languages to enhance awareness of Ghanaians on the Charter. PMID:27694679

  18. Operationalization of the Ghanaian Patients’ Charter in a Peri-urban Public Hospital: Voices of Healthcare Workers and Patients

    Directory of Open Access Journals (Sweden)

    Lily Yarney

    2016-09-01

    Full Text Available Background Health is a basic human right necessary for the exercise of other human rights. Every human being is, therefore, entitled to the highest possible standard of health necessary to living a life of dignity. Establishment of patients’ Charter is a step towards protecting the rights and responsibilities of patients, but violation of patients’ rights is common in healthcare institutions, especially in the developing world. This study which was conducted between May 2013 and May 2014, assessed the operationalization of Ghana’s Patients Charter in a peri-urban public hospital. Methods Qualitative data collection methods were used to collect data from 25 healthcare workers and patients who were purposively selected. The interview data were analyzed manually, using the principles of systematic text condensation. Results The findings indicate that the healthcare staff of the Polyclinic are aware of the existence of the patients’ Charter and also know some of its contents. Patients have no knowledge of the existence or the contents of the Charter. Availability of the Charter, community sensitization, monitoring and orientation of staff are factors that promote the operationalization of the Charter, while institutional implementation procedures such as lack of complaint procedures and low knowledge among patients militate against operationalization of the Charter. Conclusion Public health facilities should ensure that their patients are well-informed about their rights and responsibilities to facilitate effective implementation of the Charter. Also, patients’ rights and responsibilities can be dramatized and broadcasted on television and radio in major Ghanaian languages to enhance awareness of Ghanaians on the Charter.

  19. Operationalization of the Ghanaian Patients' Charter in a Peri-urban Public Hospital: Voices of Healthcare Workers and Patients.

    Science.gov (United States)

    Yarney, Lily; Buabeng, Thomas; Baidoo, Diana; Bawole, Justice Nyigmah

    2016-04-23

    Health is a basic human right necessary for the exercise of other human rights. Every human being is, therefore, entitled to the highest possible standard of health necessary to living a life of dignity. Establishment of patients' Charter is a step towards protecting the rights and responsibilities of patients, but violation of patients' rights is common in healthcare institutions, especially in the developing world. This study which was conducted between May 2013 and May 2014, assessed the operationalization of Ghana's Patients Charter in a peri-urban public hospital. Qualitative data collection methods were used to collect data from 25 healthcare workers and patients who were purposively selected. The interview data were analyzed manually, using the principles of systematic text condensation. The findings indicate that the healthcare staff of the Polyclinic are aware of the existence of the patients' Charter and also know some of its contents. Patients have no knowledge of the existence or the contents of the Charter. Availability of the Charter, community sensitization, monitoring and orientation of staff are factors that promote the operationalization of the Charter, while institutional implementation procedures such as lack of complaint procedures and low knowledge among patients militate against operationalization of the Charter. Public health facilities should ensure that their patients are well-informed about their rights and responsibilities to facilitate effective implementation of the Charter. Also, patients' rights and responsibilities can be dramatized and broadcasted on television and radio in major Ghanaian languages to enhance awareness of Ghanaians on the Charter. © 2016 by Kerman University of Medical Sciences

  20. Management accounting use and financial performance in public health-care organisations: evidence from the Italian National Health Service.

    Science.gov (United States)

    Macinati, Manuela S; Anessi-Pessina, E

    2014-07-01

    Reforms of the public health-care sector have emphasised the role of management accounting (MA). However, there is little systematic evidence on its use and benefits. To fill this gap, we propose a contingency-based model which addresses three related issues, that is, whether: (i) MA use is influenced by contextual variables and MA design; (ii) top-management satisfaction with MA mediates the relationship between MA design and MA use; and (iii) financial performance is influenced by MA use. A questionnaire was mailed out to all Italian public health-care organisations. Structural equation modelling was performed to validate the research hypotheses. The response rate was 49%. Our findings suggest that: (i) cost-containment strategies encourage more sophisticated MA designs; (ii) MA use is directly and indirectly influenced by contingency, organisational, and behavioural variables; (iii) a weakly significant positive relationship exists between MA use and financial performance. These findings are relevant from the viewpoint of both top managers and policymakers. The former must make sure that MA is not only technically advanced, but also properly understood and appreciated by users. The latter need to be aware that MA may improve performance in ways and along dimensions that may not fully translate into better financial results. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  1. Unemployment, public-sector health-care spending and breast cancer mortality in the European Union: 1990-2009.

    Science.gov (United States)

    Maruthappu, Mahiben; Watkins, Johnathan A; Waqar, Mueez; Williams, Callum; Ali, Raghib; Atun, Rifat; Faiz, Omar; Zeltner, Thomas

    2015-04-01

    The global economic crisis has been associated with increased unemployment, reduced health-care spending and adverse health outcomes. Insights into the impact of economic variations on cancer mortality, however, remain limited. We used multivariate regression analysis to assess how changes in unemployment and public-sector expenditure on health care (PSEH) varied with female breast cancer mortality in the 27 European Union member states from 1990 to 2009. We then determined how the association with unemployment was modified by PSEH. Country-specific differences in infrastructure and demographic structure were controlled for, and 1-, 3-, 5- and 10-year lag analyses were conducted. Several robustness checks were also implemented. Unemployment was associated with an increase in breast cancer mortality [P unemployment rises (P unemployment and breast cancer mortality remained in all robustness checks. Rises in unemployment are associated with significant short- and long-term increases in breast cancer mortality, while increases in PSEH are associated with reductions in breast cancer mortality. Initiatives that bolster employment and maintain total health-care expenditure may help minimize increases in breast cancer mortality during economic crises. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  2. Behavioral and biological correlates of medicine use in type 2 diabetic patients attended by Brazilian public healthcare system

    Directory of Open Access Journals (Sweden)

    Jamile Sanches Codogno

    2013-01-01

    Full Text Available DOI: http://dx.doi.org/10.5007/1980-0037.2013v15n1p82 The relationship between physical activity and the use of medicines is not clear. The purpose of this study was to investigate this relationship between the level of physical activity and the use of medications by type 2 diabetic patients who were attended in the Brazilian public healthcare system. The sample was composed of 121 Brazilian diabetic patients, of both genders, attended by the public healthcare system. Body fat (estimated by anthropometry and bioelectrical impedance, physical activity (measured by Baecke’s questionnaire, and the participant’s use of medicines (during the 15 days before evaluation were assessed. There was a relationship between the use of medicines and: gender (r = 0.18; p = 0.045, body mass index (BMI (r = 0.22; p = 0.012, waist circumference (r = 0.19; p = 0.029, body fat percentage (r = 0.21; p = 0.016, age (r = 0.23; p = 0.009, and level of physical activity (r = -0.22; p = 0.012. Linear regression included in the multivariate model only age (β = 0.718; p = 0.057, BMI (β= 0.057; p = 0.022, and level of physical activity (β = -0.176; p = 0.044. In conclusion, physical activity decreases medicinal use independent of age or obesity.

  3. Is the public healthcare sector a more strenuous working environment than the private sector for a physician?

    Science.gov (United States)

    Heponiemi, Tarja; Kouvonen, Anne; Sinervo, Timo; Elovainio, Marko

    2013-02-01

    The present study examined the differences between physicians working in public and private health care in strenuous working environments (presence of occupational hazards, physical violence, and presenteeism) and health behaviours (alcohol consumption, body mass index, and physical activity). In addition, we examined whether gender or age moderated these potential differences. Cross-sectional survey data were compiled on 1422 female and 948 male randomly selected physicians aged 25-65 years from The Finnish Health Care Professionals Study. Logistic regression and linear regression analyses were used with adjustment for gender, age, specialisation status, working time, managerial position, and on-call duty. Occupational hazards, physical violence, and presenteeism were more commonly reported by physicians working in the public sector than by their counterparts in the private sector. Among physicians aged 50 years or younger, those who worked in the public sector consumed more alcohol than those who worked in the private sector, whereas in those aged 50 or more the reverse was true. In addition, working in the private sector was most strongly associated with lower levels of physical violence in those who were older than 50 years, and with lower levels of presenteeism among those aged 40-50 years. The present study found evidence for the public sector being a more strenuous work environment for physicians than the private sector. Our results suggest that public healthcare organisations should pay more attention to the working conditions of their employees.

  4. Disentangling patient and public involvement in healthcare decisions: why the difference matters.

    Science.gov (United States)

    Fredriksson, Mio; Tritter, Jonathan Q

    2017-01-01

    Patient and public involvement has become an integral aspect of many developed health systems and is judged to be an essential driver for reform. However, little attention has been paid to the distinctions between patients and the public, and the views of patients are often seen to encompass those of the general public. Using an ideal-type approach, we analyse crucial distinctions between patient involvement and public involvement using examples from Sweden and England. We highlight that patients have sectional interests as health service users in contrast to citizens who engage as a public policy agent reflecting societal interests. Patients draw on experiential knowledge and focus on output legitimacy and performance accountability, aim at typical representativeness, and a direct responsiveness to individual needs and preferences. In contrast, the public contributes with collective perspectives generated from diversity, centres on input legitimacy achieved through statistical representativeness, democratic accountability and indirect responsiveness to general citizen preferences. Thus, using patients as proxies for the public fails to achieve intended goals and benefits of involvement. We conclude that understanding and measuring the impact of patient and public involvement can only develop with the application of a clearer comprehension of the differences. © 2016 Foundation for the Sociology of Health & Illness.

  5. Strengthening the decentralised healthcare system in rural South Africa through improved service delivery: testing mobility, information and communication technology intervention options

    CSIR Research Space (South Africa)

    Chakwizira, J

    2010-09-01

    Full Text Available their own human resources in providing healthcare services that ultimately counteract these inequalities. Presently, what could be considered the last level of decentralised healthcare is mostly represented by home and community-based healthcare...

  6. Peer pressure and public reporting within healthcare setting: improving accountability and health care quality in hospitals.

    Science.gov (United States)

    Specchia, Maria Lucia; Veneziano, Maria Assunta; Cadeddu, Chiara; Ferriero, Anna Maria; Capizzi, Silvio; Ricciardi, Walter

    2012-01-01

    In the last few years, the need of public reporting of health outcomes has acquired a great importance. The public release of performance results could be a tool for improving health care quality and many attempts have been made in order to introduce public reporting programs within the health care context at different levels. It would be necessary to promote the introduction of a standardized set of outcome and performance measures in order to improve quality of health care services and to make health care providers aware of the importance of transparency and accountability.

  7. Osteoporosis Knowledge among future healthcare practitioners: Findings from a Malaysian public university

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    Mohamed Hassan Elnaem

    2017-01-01

    Full Text Available Background and Objectives: Students in relevant health-care academic programs are the future professionals who should play an active role in increasing community awareness regarding chronic diseases such as osteoporosis. This research aimed to evaluate the knowledge of osteoporosis, one of the growing health-care burdens in Malaysia, among students belong to three different health occupations programs in a Malaysian University. Methods: A cross-sectional study design was conducted to assess the level of knowledge on osteoporosis and to explore the potential association between the study program and osteoporosis-related knowledge among medicine, pharmacy, and allied health sciences students in a Malaysian University. A total of 348 students were approached. The data were collected using validated revised Osteoporosis Knowledge Test questionnaire. Results: The results showed variability in knowledge score between students belonging to different study programs. allied health sciences students have the highest overall total score (median = 20 and nutrition score (median = 16, but for exercise score, both students in allied health sciences and medicine programs shared a similar median score (median = 11.5. More than half of the respondents showed adequate knowledge on osteoporosis. The students from allied health sciences exhibited more knowledge on osteoporosis compared to students in other study programs. Among the Kulliyyah of Pharmacy respondents, the majority did not manage to answer correctly on the whole scale. This was evident by total percentage of 69.91% of the respondents scored below than median score. Conclusion: There is a considerable gap of knowledge regarding osteoporosis among students in various health occupations academic programs. Pharmacy students particularly need focused learning related to exercise and nutrition in preventing osteoporosis during their academic program.

  8. Osteoporosis Knowledge among Future Healthcare Practitioners: Findings from a Malaysian Public University

    Science.gov (United States)

    Elnaem, Mohamed Hassan; Jamshed, Shazia Qasim; Elkalmi, Ramadan Mohamed; Baharuddin, Muhammad Farhan; Johari, Muhammad Afif; Aziz, Nur Ashikin Binti Ab; Sabri, Siti Farhanah Binti Ahmad; Ismail, Nur Akmal Binti

    2017-01-01

    Background and Objectives: Students in relevant health-care academic programs are the future professionals who should play an active role in increasing community awareness regarding chronic diseases such as osteoporosis. This research aimed to evaluate the knowledge of osteoporosis, one of the growing health-care burdens in Malaysia, among students belong to three different health occupations programs in a Malaysian University. Methods: A cross-sectional study design was conducted to assess the level of knowledge on osteoporosis and to explore the potential association between the study program and osteoporosis-related knowledge among medicine, pharmacy, and allied health sciences students in a Malaysian University. A total of 348 students were approached. The data were collected using validated revised Osteoporosis Knowledge Test questionnaire. Results: The results showed variability in knowledge score between students belonging to different study programs. allied health sciences students have the highest overall total score (median = 20) and nutrition score (median = 16), but for exercise score, both students in allied health sciences and medicine programs shared a similar median score (median = 11.5). More than half of the respondents showed adequate knowledge on osteoporosis. The students from allied health sciences exhibited more knowledge on osteoporosis compared to students in other study programs. Among the Kulliyyah of Pharmacy respondents, the majority did not manage to answer correctly on the whole scale. This was evident by total percentage of 69.91% of the respondents scored below than median score. Conclusion: There is a considerable gap of knowledge regarding osteoporosis among students in various health occupations academic programs. Pharmacy students particularly need focused learning related to exercise and nutrition in preventing osteoporosis during their academic program. PMID:28717334

  9. Public speaking for the healthcare professional: Part I--Preparing for the program.

    Science.gov (United States)

    Baum, Neil

    2011-01-01

    It is true that most doctors do not enjoy public speaking. Most physicians, although good with one-on-one conversations with patients, are out of their comfort zone when it comes to speaking in front of other physicians, colleagues, and even lay persons. This three-part article will discuss the preparation, the presentation, and what you need to do after the program is over in order to become an effective public speaker.

  10. Public health safety and environment in inadequate hospital and healthcare settings: a review.

    Science.gov (United States)

    Baguma, D

    2017-03-01

    Public health safety and environmental management are concerns that pose challenges worldwide. This paper briefly assesses a selected impact of the environment on public health. The study used an assessment of environmental mechanism to analyse the underlying different pathways in which the health sector is affected in inadequate hospital and health care settings. We reviewed the limited available evidence of the association between the health sector and the environment, and the likely pathways through which the environment influences health. The paper also models the use of private health care as a function of costs and benefits relative to public care and no care. The need to enhancing policies to improve the administration of health services, strengthening interventions on environment using international agreements, like Rio Conventions, including measures to control hospital-related infection, planning for human resources and infrastructure construction development have linkage to improve environment care and public health. The present study findings partly also demonstrate the influence of demand for health on the environment. The list of possible interventions includes enhancing policies to improve the administration of health services, strengthening Rio Conventions implementation on environmental concerns, control of environmental hazards and public health. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  11. Assessing Continuous Quality Improvement in Public Health: Adapting Lessons from Healthcare

    Science.gov (United States)

    Schwartz, Robert; Cohen, Joanna; Manson, Heather; Scott, Fran

    2017-01-01

    Context: Evidence of the effect of continuous quality improvement (CQI) in public health and valid tools to judge that such effects are not fully formed. Objective: The objective was to adapt and apply Shortell et al.'s (1998) four dimensions of CQI in an examination of a public health accountability and performance management initiative in Ontario, Canada. Methods: In total, 24 semi-structured, in-depth interviews were conducted with informants from public health units and the Ministry of Health and Long-Term Care. A web survey of public health managers in the province was also carried out. Results: A mix of facilitators and barriers was identified. Leadership and organizational cultures, conducive to CQI success were evident. However, limitations in performance measurement and managerial discretion were key barriers. Conclusion: The four dimensions of CQI provided insight into both facilitators and barriers of CQI adoption in public health. Future research should compare the outcomes of public health CQI initiatives to the framework's stated facilitators and barriers. PMID:28277203

  12. Assessing Continuous Quality Improvement in Public Health: Adapting Lessons from Healthcare.

    Science.gov (United States)

    Price, Alex; Schwartz, Robert; Cohen, Joanna; Manson, Heather; Scott, Fran

    2017-02-01

    Evidence of the effect of continuous quality improvement (CQI) in public health and valid tools to judge that such effects are not fully formed. The objective was to adapt and apply Shortell et al.'s (1998) four dimensions of CQI in an examination of a public health accountability and performance management initiative in Ontario, Canada. In total, 24 semi-structured, in-depth interviews were conducted with informants from public health units and the Ministry of Health and Long-Term Care. A web survey of public health managers in the province was also carried out. A mix of facilitators and barriers was identified. Leadership and organizational cultures, conducive to CQI success were evident. However, limitations in performance measurement and managerial discretion were key barriers. The four dimensions of CQI provided insight into both facilitators and barriers of CQI adoption in public health. Future research should compare the outcomes of public health CQI initiatives to the framework's stated facilitators and barriers. Copyright © 2017 Longwoods Publishing.

  13. Faith, Trust and the Perinatal Healthcare Maze in Urban India

    Directory of Open Access Journals (Sweden)

    S. Raman

    2014-05-01

    Full Text Available How women access and utilise health services through pregnancy, childbirth and infancy needs to be understood if we are to improve the delivery of and access to appropriate healthcare. Drawing on ethnographic observations of clinic encounters and in-depth interviews with women in Bangalore, South India, this paper reports on the complexities of negotiating healthcare throughout the perinatal continuum in urban India. Key themes identified include faith and trust in health services, confusion over right to healthcare; and the contested nature of choice for women. What is revealed is a socially restrictive framework that results in choices that seem arbitrary, irrational and self-defeating; poor women being particularly vulnerable. Given the current policy support for public-private-partnerships in reproductive healthcare delivery in India, both public and private health services need to move substantially to achieve true partnership and provide care that is respectful and valued by women and children in urban India.

  14. The ethics of health service delivery: a challenge to public health leadership.

    Science.gov (United States)

    DeLuca, D M

    1989-01-01

    The ethical distribution of health care is a central issue now that AIDS has started to be a drain on health care resources. If the worst predictions are true, the next half century will be capitalized by a great stress of the health care delivery system in the Pacific. The critical challenges that face the current leadership are: sustaining commitment to all levels of administration to reduce social and health inequities; making sound decisions on policies, priorities and goals that are based on valid information; strengthen health infrastructure, based on the principle of primary health care, including appropriate distribution of staffing, skills, technology and resources. The goals of the Pacific Health Promotion and Development center must not focus exclusively on AIDs. Hepatitis B control measures, hypertension and diabetes, primary care in remote areas, and rehabilitation initiatives must be kept in place. Humanitarian interests for AIDs patients must be balanced with the pragmatic reality of saving children's hearing, or extending useful lives. The attributes of respect, accountability, leadership, judgement, fairness, integrity and honesty controlled by principles of social justice must be part of the administrative decision making process. The 2 major issues facing public health professional are: (1) the financial considerations involved with increasingly expensive technology, services and research, contrasted against the need to prioritize their use and development; (2) pragmatic and ideological needs must be balanced to maximize preventative and curative services and make them available to those who can benefit from them.

  15. Barriers to healthcare coordination in market-based and decentralized public health systems: a qualitative study in healthcare networks of Colombia and Brazil.

    Science.gov (United States)

    Vargas, Ingrid; Mogollón-Pérez, Amparo Susana; De Paepe, Pierre; Ferreira da Silva, Maria Rejane; Unger, Jean-Pierre; Vázquez, María-Luisa

    2016-07-01

    Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel' perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive-interpretative study was conducted, based on a case study of healthcare networks in four municipalities. Individual semi-structured interviews were conducted with a three stage theoretical sample of (a) health (112) and administrative (66) professionals of different care levels, and (b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes. The results reveal poor clinical information transfer between healthcare levels in all networks analysed, with added deficiencies in Brazil in the coordination of access and clinical management. The obstacles to care coordination are related to the organization of both the health system and the healthcare networks. In the health system, there is the existence of economic incentives to compete (exacerbated in Brazil by partisan political interests), the fragmentation and instability of networks in Colombia and weak planning and evaluation in Brazil. In the healthcare networks, there are inadequate working conditions (temporary and/or part-time contracts) which hinder the use of coordination mechanisms, and inadequate professional training for implementing a healthcare model in which primary care should act as coordinator in patient care. Reforms are needed in these health systems and networks in order to modify incentives, strengthen

  16. Integrated Delivery of Quality, Safety and Environment through Road Sector Procurement: The Case of Public Sector Agencies in Ghana

    Directory of Open Access Journals (Sweden)

    Abdul-Majeed Mahamadu

    2015-01-01

    Full Text Available Poor quality, safety and environmental (QSE performance within Ghana's road sector has been cited as a major challenge in the procurement of infrastructure. This study evaluates the applicability and level of integrated consideration of QSE in the delivery of roads through procurement by public sector agencies in Ghana. Integrated delivery is explored on the basis of theoretical and empirical evidence of an existing synergistic relationship among QSE in the management and delivery of projects. A mixed methodological design was adopted to investigate two public road agencies through a questionnaire survey and interviews of technical staff with procurement responsibilities. This was done concurrently with soliciting professional perspectives on the subject. Procurement is widely regarded as paramount to the delivery of better QSE in the Ghana road sector. However, the level of synergistic consideration is low, which is attributable to an over-reliance on traditional procurement arrangements as a result of non-supportive local procurement regulatory frameworks. It is further established that a general lack of know-how and experience in the use of modern and integrated procurement arrangements prevent effective management and realisation of QSE beyond the current focus on time and cost through procurement processes within public road sector agencies.

  17. ["Integrity" in the healthcare system : Recognize and avoid risks: on dealing with the Association of Statutory Health Insurance Physicians and the public prosecutors office].

    Science.gov (United States)

    Wohlgemuth, Martin; Heinrich, Julia

    2018-05-24

    This article describes the introduction of the law to combat corruption in the healthcare system. The effects of the introduced penal regulations on the delivery of medical services is critically scrutinized and the associated procedures as well as indications for the course of action are presented. Knowledge of the relevant regulations and types of procedure is decisive for the penal, social legislative and professional conduct risk minimization.

  18. Adapting Features from the SIOP Component: Lesson Delivery to English Lessons in a Colombian Public School

    Directory of Open Access Journals (Sweden)

    Rativa Murillo Hollman Alejandro

    2013-04-01

    Full Text Available Despite some school efforts to offer students the best second language learning, English language lessons are often taught with an overuse of the mother tongue. Hence, an action research project was conducted in order to discover how to adapt some features of the Sheltered Instruction Observation Protocol (SIOP component: Lesson delivery, for the teaching of English in sixth grade at a public school in Bogotá, Colombia. Data collection included observation checklists, field notes, surveys and artifacts. The findings demonstrated that the overuse of Spanish–the students’ mother tongue–was reduced when in addition to implementing the lesson delivery component, the teacher developed vocabulary activities. Finally, it was suggested that teachers have SIOP training for teaching content andto focus more on students needs.A pesar de algunos esfuerzos para ofrecer a los estudiantes un mejor aprendizaje de una segunda lengua, a menudo se recurre al uso excesivo de la lengua materna en las clases de inglés. Con el objetivo de hallar la forma de adaptar algunas características del componente del protocolo deobservación SIOP para la instrucción ‘Sheltered’: Desarrollo de clase, para la enseñanza de inglés en grado séptimo, se realiz�� un proyecto de investigación acción en un colegio público en Bogotá, Colombia. En la recolección de datos se emplearon formatos de observación, notas de campo,cuestionarios y evidencias documentales. Los resultados demostraron que el uso excesivo de español –la lengua materna de los estudiantes– se redujo porque además de la implementación del componente Desarrollo de clase, se llevaron a cabo actividades de vocabulario. Con esta investigación se sugiere que los profesores adquieran conocimientos acerca del citado modelo para la enseñanza de contenidos, y que se enfoquen más en las necesidades de los estudiantes.

  19. Environmental and Public Health Issues of Animal Food Products Delivery System in Imo State, Nigeria

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    Opara Maxwell Nwachukwu

    2006-05-01

    Full Text Available Information on livestock movement, animal food products processing facilities, meat inspection methods, official meat inspection records and distribution and marketing systems for processed products in Imo state, Nigeria needed for policy development interventions in the sector are not fully understood. The primary data generated with the aid of personal interviews, field observations and secondary data obtained from records accumulated by the department of veterinary services Imo state from 2001 to 2004 were used to investigate the environmental and public health issues of animal food products delivery system in state. Majority of trade animals supplied to the state originated from the northern states of the country and were brought in with trucks by road. Only two veterinary control posts served the whole state thus resulting in non-inspection and taxing of a large proportion of trade animals. Official record of trade animals supplied to the state from 2001 to 2004 ranged from 45000 – 144000 for cattle, 23000 – 96000 for goats and 11000 – 72000 for sheep per annum, with supplies increasing steadily across the years. Official slaughter points in the state were principally low-grade quality slaughter premises consisting of a thin concrete slab. Meat handling was very unhygienic with carcasses dressed beside refuse heaps of over 2 years standing. Carcasses were dragged on the ground and transported in taxi boots and open trucks. Meat inspection at these points was not thorough because of stiff resistance of butchers to carcass condemnation. Official meat inspection records for the state from 2001 to 2004 revealed that overall totals of 159,000 cattle, 101,000 goats and 67,000 sheep were slaughtered. This accounted for about 56, 57 and 57% shortfall of cattle, goat and sheep respectively supplied to the state and represents the volume of un-inspected animals during the study period. Fascioliasis and tuberculosis were the most common

  20. The Impact of Healthcare Insurance on the Utilisation of Facility-Based Delivery for Childbirth in the Philippines.

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    Hebe N Gouda

    Full Text Available In recent years, the government of the Philippines embarked upon an ambitious Universal Health Care program, underpinned by the rapid scale-up of subsidized insurance coverage for poor and vulnerable populations. With a view of reducing the stubbornly high maternal mortality rates in the country, the program has a strong focus on maternal health services and is supported by a national policy of universal facility-based delivery (FBD. In this study, we examine the impact that recent reforms expanding health insurance coverage have had on FBD.Data from the most recent Philippines 2013 Demographic Health Survey was employed. This study applies quasi-experimental methods using propensity scores along with alternative matching techniques and weighted regression to control for self-selection and investigate the impact of health insurance on the utilization of FBD.Our findings reveal that the likelihood of FBD for women who are insured is between 5 to 10 percent higher than for those without insurance. The impact of health insurance is more pronounced amongst rural and poor women for whom insurance leads to a 9 to 11 per cent higher likelihood of FBD.We conclude that increasing health insurance coverage is likely to be an effective approach to increase women's access to FBD. Our findings suggest that when such coverage is subsidized, as it is the case in the Philippines, women from poor and rural populations are likely to benefit the most.

  1. 75 FR 38819 - National Advisory Council for Healthcare Research and Quality: Request for Nominations for Public...

    Science.gov (United States)

    2010-07-06

    ..., law, ethics, business, or public policy; and (6) individuals who could represent the interests of...., Individuals are particularly sought with experience and success in activities specified in the summary above...-income groups; minority groups; women; children; the elderly; and individuals with special health care...

  2. Combating Identity Fraud in the Public Domain: Information Strategies for Healthcare and Criminal Justice

    NARCIS (Netherlands)

    Plomp, M.G.A.; Grijpink, J.H.A.M.

    2011-01-01

    Two trends are present in both the private and public domain: increasing interorganisational co-operation and increasing digitisation. Nowadays, more and more processes within and between organisations take place electronically. These developments are visible on local, national and European scale.

  3. Assessment of the rates and characteristics of the short-term supply of medication (Tider from an integrated healthcare delivery system in the United States

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    Delate T

    2017-06-01

    Full Text Available Objectives: The purpose of this study was to describe the rate of medication short-term supply dispensings (tider, patient and medication characteristics associated with a tider, and costs for tider dispensings in an integrated healthcare delivery system in Colorado, United States. Methods: This was a retrospective study conducted in an integrated healthcare delivery system’s outpatient clinics. All patients who had a prescription dispensed for a study medication at any of the system’s 28 outpatient pharmacies during the first quarter of 2016 were included. A tider was identified as a 3-day supply of a prescription medication that was dispensed at no charge to a patient. The quarterly tider rate and the per member per month (PMPM cost of tiders were estimated. Patient and medication characteristics associated with a tider were assessed. Results: A total of 444,225 study medications were dispensed for 135,907 patients during the study period. There were 3,430 (0.77%, 95%CI 0.75%:0.80% medications dispensed as a tider. The PMPM cost of tider medications and their dispensing fees was USD 0.03. There were 1,092 (0.8% and 134,815 (99.2% patients who did and did not, respectively, have at least one tider dispensed during the study period. Patient characteristics strongly associated with having had a tider dispensed included being older, male, and a Medicare beneficiary. Cardiovascular and neuromuscular medications had the highest rates of tider dispensing. Conclusions: The rate of tider dispensing was relatively low; however, approximately one out of 125 patients had at least one tider. Patients who had a tider were more likely to be older, female, a Medicare beneficiary, and having had a previous tider dispensing and a higher burden of chronic disease. The tider medication was more likely to be a cardiovascular or neuromuscular medication class and more likely to be dispensed on a weekend. The total cost of dispensing a tider appears reasonable

  4. The effect of service delivery in public ‘community service centres’: A case of an emerging economy

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    Ndabazinhle Ngobese

    2017-07-01

    Full Text Available This study investigated public perceptions of the service delivery provided by the Community Service Centres (CSC of the South African Police Service (SAPS Durban, South Africa. The study focuses on measuring service quality and service delivery. SERVQUAL was used to compare clients’ perceptions against expectations of service quality. Four hundred respondents were surveyed at three community service centres (previously known as ‘police stations’, with expectations and perceptions being assessed via the dimensions of tangibility, reliability, responsiveness, assurance and empathy. The results indicate that in all five dimensions there is a significant negative quality gap, implying that the quality of service received is below what is expected by clients. Improvements are required in all five dimensions if service delivery is to be improved. Actions needed to improve service quality include regular assessment and monitoring of clients’ experiences, as well as employees’ behaviour

  5. Unit cost of healthcare services at 200-bed public hospitals in Myanmar: what plays an important role of hospital budgeting?

    Science.gov (United States)

    Than, Thet Mon; Saw, Yu Mon; Khaing, Moe; Win, Ei Mon; Cho, Su Myat; Kariya, Tetsuyoshi; Yamamoto, Eiko; Hamajima, Nobuyuki

    2017-09-19

    Cost information is important for efficient allocation of healthcare expenditure, estimating future budget allocation, and setting user fees to start new financing systems. Myanmar is in political transition, and trying to achieve universal health coverage by 2030. This study assessed the unit cost of healthcare services at two public hospitals in the country from the provider perspective. The study also analyzed the cost structure of the hospitals to allocate and manage the budgets appropriately. A hospital-based cross-sectional study was conducted at 200-bed Magway Teaching Hospital (MTH) and Pyinmanar General Hospital (PMN GH), in Myanmar, for the financial year 2015-2016. The step-down costing method was applied to calculate unit cost per inpatient day and per outpatient visit. The costs were calculated by using Microsoft Excel 2010. The unit costs per inpatient day varied largely from unit to unit in both hospitals. At PMN GH, unit cost per inpatient day was 28,374 Kyats (27.60 USD) for pediatric unit and 1,961,806 Kyats (1908.37 USD) for ear, nose, and throat unit. At MTH, the unit costs per inpatient day were 19,704 Kyats (19.17 USD) for medicine unit and 168,835 Kyats (164.24 USD) for eye unit. The unit cost of outpatient visit was 14,882 Kyats (14.48 USD) at PMN GH, while 23,059 Kyats (22.43 USD) at MTH. Regarding cost structure, medicines and medical supplies was the largest component at MTH, and the equipment was the largest component at PMN GH. The surgery unit of MTH and the eye unit of PMN GH consumed most of the total cost of the hospitals. The unit costs were influenced by the utilization of hospital services by the patients, the efficiency of available resources, type of medical services provided, and medical practice of the physicians. The cost structures variation was also found between MTH and PMN GH. The findings provided the basic information regarding the healthcare cost of public hospitals which can apply the efficient utilization of the

  6. Patients as healthcare consumers in the public and private sectors: a qualitative study of acupuncture in the UK.

    Science.gov (United States)

    Bishop, Felicity L; Barlow, Fiona; Coghlan, Beverly; Lee, Philippa; Lewith, George T

    2011-05-27

    The aim of this study was to compare patients' experiences of public and private sector healthcare, using acupuncture as an example. In the UK, acupuncture is popular with patients, is recommended in official guidelines for low back pain, and is available in both the private sector and the public sector (NHS). Consumerism was used as a theoretical framework to explore patients' experiences. Semi-structured face-to-face interviews were conducted in 2007-8 with a purposive sample of 27 patients who had recently used acupuncture for painful conditions in the private sector and/or in the NHS. Inductive thematic analysis was used to develop themes that summarised the bulk of the data and provided insights into consumerism in NHS- and private practice-based acupuncture. Five main themes were identified: value for money and willingness to pay; free and fair access; individualised holistic care: feeling cared for; consequences of choice: empowerment and vulnerability; and "just added extras": physical environment. Patients who had received acupuncture in the private sector constructed detailed accounts of the benefits of private care. Patients who had not received acupuncture in the private sector expected minimal differences from NHS care, and those differences were seen as not integral to treatment. The private sector facilitated consumerist behaviour to a greater extent than did the NHS, but private consumers appeared to base their decisions on unreliable and incomplete information. Patients used and experienced acupuncture differently in the NHS compared to the private sector. Eight different faces of consumerist behaviour were identified, but six were dominant: consumer as chooser, consumer as pragmatist, consumer as patient, consumer as earnest explorer, consumer as victim, and consumer as citizen. The decision to use acupuncture in either the private sector or the NHS was rarely well-informed: NHS and private patients both had misconceptions about acupuncture in the

  7. Patients as healthcare consumers in the public and private sectors: a qualitative study of acupuncture in the UK

    Directory of Open Access Journals (Sweden)

    Coghlan Beverly

    2011-05-01

    Full Text Available Abstract Background The aim of this study was to compare patients' experiences of public and private sector healthcare, using acupuncture as an example. In the UK, acupuncture is popular with patients, is recommended in official guidelines for low back pain, and is available in both the private sector and the public sector (NHS. Consumerism was used as a theoretical framework to explore patients' experiences. Methods Semi-structured face-to-face interviews were conducted in 2007-8 with a purposive sample of 27 patients who had recently used acupuncture for painful conditions in the private sector and/or in the NHS. Inductive thematic analysis was used to develop themes that summarised the bulk of the data and provided insights into consumerism in NHS- and private practice-based acupuncture. Results Five main themes were identified: value for money and willingness to pay; free and fair access; individualised holistic care: feeling cared for; consequences of choice: empowerment and vulnerability; and "just added extras": physical environment. Patients who had received acupuncture in the private sector constructed detailed accounts of the benefits of private care. Patients who had not received acupuncture in the private sector expected minimal differences from NHS care, and those differences were seen as not integral to treatment. The private sector facilitated consumerist behaviour to a greater extent than did the NHS, but private consumers appeared to base their decisions on unreliable and incomplete information. Conclusions Patients used and experienced acupuncture differently in the NHS compared to the private sector. Eight different faces of consumerist behaviour were identified, but six were dominant: consumer as chooser, consumer as pragmatist, consumer as patient, consumer as earnest explorer, consumer as victim, and consumer as citizen. The decision to use acupuncture in either the private sector or the NHS was rarely well-informed: NHS

  8. Public speaking for the healthcare professional: Part III--after the program.

    Science.gov (United States)

    Baum, Neil

    2012-01-01

    Public speaking is one of life's greatest fears for many people. However, with practice, repetition, and planning, you can safely leave your comfort zone and make a presentation that will engage the members of the audience, attract their attention, and cause them to take action on your material. This third article in the series will discuss what to do after the last slide is shown.

  9. [Impact of the new system of resource allocation on French public healthcare establishments].

    Science.gov (United States)

    Accary-Bézard, Catherine

    2012-06-01

    The reform of the tarification according to activity is now in place with a "T2A" rate said to be 100%, ie the hospitals are paid based on the national tariffs for a stay in hospital. The reform will continue with a list of stays for which, each year, a single tariff between the public sector and the private sector is applied. This single tariff results from the "inter-sector tariff convergence" policy which is applied.

  10. Comparative performance of public and private sector delivery of BCG vaccination: evidence from Sub-Saharan Africa.

    Science.gov (United States)

    Wagner, Zachary; Szilagyi, Peter G; Sood, Neeraj

    2014-07-31

    The private sector is an important source of health care in the developing world. However, there is limited evidence on how private providers compare to public providers, particularly for preventive services such as immunizations. We used data from Sub-Saharan Africa (SSA) to assess public-private differences in Bacillus Calmette-Guérin (BCG) vaccine delivery. We used demographic and health surveys from 102,629 children aged 0-59 months from 29 countries across SSA to measure differences in BCG status for children born at private versus public health facilities (BCG is recommended at birth). We used a probit model to estimate public-private differences in BCG delivery, while controlling for key confounders. Next, we estimated how differences in BCG status evolved over time for children born at private versus public facilities. Finally, we estimated heterogeneity in public-private differences based on wealth and rural-urban residency. We found that children born at a private facility were 7.1 percentage points less likely to receive BCG vaccine in the same month as birth than children born at a public facility (95% CI 6.3-8.0; pprivate providers (as opposed to NGOs) where the BCG provision rate was 10.0 percentage points less than public providers (95% CI 9.0-11.2; pprivate for-profit facilities remained less likely to be vaccinated up to 59 months after birth. Finally, public-private differences were more pronounced for poorer children and children in rural areas. The for-profit private sector performed substantially worse than the public sector in providing BCG vaccine to newborns, resulting in a longer duration of vulnerability to tuberculosis. This disparity was greater for poorer children and children in rural areas. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Caesarean section deliveries: Experiences of mothers of midwifery care at a public hospital in Nelson Mandela Bay.

    Science.gov (United States)

    Jikijela, Thobeka P; James, Sindiwe; Sonti, Balandeli S I

    2018-01-30

    The rate of caesarean section deliveries has increased globally and mothers are faced with challenges of postoperative recovery and caring thereof. Midwives have a duty to assist these mothers to self-care. The objective was to explore and describe experiences of post-caesarean section delivered mothers of midwifery care at a public hospital in Nelson Mandela Bay. A qualitative, descriptive and explorative research design was used in the study. Data were collected from 11 purposively criterion-selected mothers who had a caesarean section delivery. One-on-one semi-structured interviews were conducted in the post-natal wards. Research ethics, namely autonomy, beneficence, justice and informed consent, were adopted in the study. All participants were informed of their right to withdraw from the study at any stage without penalties. Interviews were analysed using Tesch's method of data analysis. Three main themes were identified as experiences of: diverse pain, physical limitation and frustration and health care services as different. Experiences of mothers following a caesarean section delivery with midwifery services at a public hospital in Nelson Mandela Bay were explored and described as diverse. A need for adequate pain management as well as assistance and breastfeeding support to mothers following caesarean delivery was identified as crucial to promote a good mother-to-child relationship.

  12. Is Provision of Healthcare Sufficient to Ensure Better Access? An Exploration of the Scope for Public-Private Partnership in India

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    Sabitri Dutta

    2015-07-01

    Full Text Available Background India’s economic growth rate in recent years has been fairly impressive. But, it has been consistently failing to make considerable progress in achieving health related Millennium Development Goal (MDG targets. Lack of coherence between provisions and utilization becomes the face of the problem. Inadequacies in outreach, access and affordability coupled with escalating healthcare costs have aggravated the problem. Here the application of PublicPrivate Partnership (PPP model seems to have enormous potential to ease the impasse. Methods This paper tries to find the gap between the provisions and access in healthcare. The paper attempts to construct a Health Infrastructure Index (HII and Health Attainment Index (HAI for different states of India. Considering the presence of regional variations found in health infrastructure and attainment among the states, two states, viz. Maharashtra (MAH and West Bengal (WB have been chosen. Then contributions of health programs like Rashtriya Swasthya Bima Yojana (RSBY, National Rural Telemedicine Network (NRTN and Fair Price Shops (FPS, all PPP initiatives, have been assessed for both the states by carrying out comprehensive benefit-cost analysis. Results The health infrastructure for population per unit area captures the outreach/delivery issue and the health attainment reveals the true scenario about how far the infrastructure has been accessed by the people; and the gap between the two, as the paper finds, is the root of the problem. The combined effect of RSBY and NRTN will leave both MAH and WB higher benefits in terms of health attainment. The contributions of RSBY and NRTN have been assessed for both the states by carrying out comprehensive benefit-cost analysis. FPS comes up with immense benefits for WB. It is yet to be implemented in MAH. Conclusion The outreach and access problems arising from deficiencies in infrastructure, human resources and financial ability are expected to be well

  13. Costs and effects of two public sector delivery channels for long-lasting insecticidal nets in Uganda

    Directory of Open Access Journals (Sweden)

    Strachan Daniel

    2010-04-01

    Full Text Available Abstract Background In Uganda, long-lasting insecticidal nets (LLIN have been predominantly delivered through two public sector channels: targeted campaigns or routine antenatal care (ANC services. Their combination in a mixed-model strategy is being advocated to quickly increase LLIN coverage and maintain it over time, but there is little evidence on the efficiency of each system. This study evaluated the two delivery channels regarding LLIN retention and use, and estimated the associated costs, to contribute towards the evidence-base on LLIN delivery channels in Uganda. Methods Household surveys were conducted 5-7 months after LLIN distribution, combining questionnaires with visual verification of LLIN presence. Focus groups and interviews were conducted to further investigate determinants of LLIN retention and use. Campaign distribution was evaluated in Jinja and Adjumani while ANC distribution was evaluated only in the latter district. Costs were calculated from the provider perspective through retrospective analysis of expenditure data, and effects were estimated as cost per LLIN delivered and cost per treated-net-year (TNY. These effects were calculated for the total number of LLINs delivered and for those retained and used. Results After 5-7 months, over 90% of LLINs were still owned by recipients, and between 74% (Jinja and 99% (ANC Adjumani were being used. Costing results showed that delivery was cheapest for the campaign in Jinja and highest for the ANC channel, with economic delivery cost per net retained and used of USD 1.10 and USD 2.31, respectively. Financial delivery costs for the two channels were similar in the same location, USD 1.04 for campaign or USD 1.07 for ANC delivery in Adjumani, but differed between locations (USD 0.67 for campaign delivery in Jinja. Economic cost for ANC distribution were considerably higher (USD 2.27 compared to campaign costs (USD 1.23 in Adjumani. Conclusions Targeted campaigns and routine ANC

  14. Costs and effects of two public sector delivery channels for long-lasting insecticidal nets in Uganda.

    Science.gov (United States)

    Kolaczinski, Jan H; Kolaczinski, Kate; Kyabayinze, Daniel; Strachan, Daniel; Temperley, Matilda; Wijayanandana, Nayantara; Kilian, Albert

    2010-04-20

    In Uganda, long-lasting insecticidal nets (LLIN) have been predominantly delivered through two public sector channels: targeted campaigns or routine antenatal care (ANC) services. Their combination in a mixed-model strategy is being advocated to quickly increase LLIN coverage and maintain it over time, but there is little evidence on the efficiency of each system. This study evaluated the two delivery channels regarding LLIN retention and use, and estimated the associated costs, to contribute towards the evidence-base on LLIN delivery channels in Uganda. Household surveys were conducted 5-7 months after LLIN distribution, combining questionnaires with visual verification of LLIN presence. Focus groups and interviews were conducted to further investigate determinants of LLIN retention and use. Campaign distribution was evaluated in Jinja and Adjumani while ANC distribution was evaluated only in the latter district. Costs were calculated from the provider perspective through retrospective analysis of expenditure data, and effects were estimated as cost per LLIN delivered and cost per treated-net-year (TNY). These effects were calculated for the total number of LLINs delivered and for those retained and used. After 5-7 months, over 90% of LLINs were still owned by recipients, and between 74% (Jinja) and 99% (ANC Adjumani) were being used. Costing results showed that delivery was cheapest for the campaign in Jinja and highest for the ANC channel, with economic delivery cost per net retained and used of USD 1.10 and USD 2.31, respectively. Financial delivery costs for the two channels were similar in the same location, USD 1.04 for campaign or USD 1.07 for ANC delivery in Adjumani, but differed between locations (USD 0.67 for campaign delivery in Jinja). Economic cost for ANC distribution were considerably higher (USD 2.27) compared to campaign costs (USD 1.23) in Adjumani. Targeted campaigns and routine ANC services can both achieve high LLIN retention and use among

  15. Job satisfaction of primary health-care providers (public sector in urban setting

    Directory of Open Access Journals (Sweden)

    Pawan Kumar

    2013-01-01

    Full Text Available Introduction: Job satisfaction is determined by a discrepancy between what one wants in a job and what one has in a job. The core components of information necessary for what satisfies and motivates the health work force in our country are missing at policy level. Therefore present study will help us to know the factors for job satisfaction among primary health care providers in public sector. Materials and Methods: Present study is descriptive in nature conducted in public sector dispensaries/primary urban health centers in Delhi among health care providers. Pretested structured questionnaire was administered to 227 health care providers. Data was analyzed using SPSS and relevant statistical test were applied. Results: Analysis of study reveals that ANMs are more satisfied than MOs, Pharmacist and Lab assistants/Lab technicians; and the difference is significant (P < 0.01. Age and education level of health care providers don′t show any significant difference in job satisfaction. All the health care providers are dissatisfied from the training policies and practices, salaries and opportunities for career growth in the organization. Majority of variables studied for job satisfaction have low scores. Five factor were identified concerned with job satisfaction in factor analysis. Conclusion: Job satisfaction is poor for all the four groups of health care providers in dispensaries/primary urban health centers and it is not possible to assign a single factor as a sole determinant of dissatisfaction in the job. Therefore it is recommended that appropriate changes are required at the policy as well as at the dispensary/PUHC level to keep the health work force motivated under public sector in Delhi.

  16. The change in capacity and service delivery at public and private hospitals in Turkey: a closer look at regional differences.

    Science.gov (United States)

    Aksan, Hediye A D; Ergin, Işıl; Ocek, Zeliha

    2010-11-01

    Substantial regional health inequalities have been shown to exist in Turkey for major health indicators. Turkish data on hospitals deserves a closer examination with a special emphasis on the regional differences in the context of the rapid privatization of the secondary or tertiary level health services.This study aims to evaluate the change in capacity and service delivery at public and private hospitals in Turkey between 2001-2006 and to determine the regional differences. Data for this retrospective study was provided from Statistical Almanacs of Inpatient Services (2001-2006). Hospitals in each of the 81 provinces were grouped into two categories: public and private. Provinces were grouped into six regions according to a development index composed by the State Planning Organisation. The number of facilities, hospital beds, outpatient admissions, inpatient admissions (per 100 000), number of deliveries and surgical operations (per 10 000) were calculated for public and private hospitals in each province and region. Regional comparisons were based on calculation of ratios for Region 1(R1) to Region 6(R6). Public facilities had a fundamental role in service delivery. However, private sector grew rapidly in Turkey between 2001-2006 in capacity and service delivery. In public sector, there were 2.3 fold increase in the number of beds in R1 to R6 in 2001. This ratio was 69.9 fold for private sector. The substantial regional inequalities in public and private sector decreased for the private sector enormously while a little decrease was observed for the public sector. In 2001 in R1, big surgical operations were performed six times more than R6 at the public sector whereas the difference was 117.7 fold for the same operations in the same regions for the private sector. These ratios decreased to 3.6 for the public sector and 13.9 for the private sector in 2006. The private health sector has grown enormously between 2001-2006 in Turkey including the less developed

  17. The change in capacity and service delivery at public and private hospitals in Turkey: A closer look at regional differences

    Directory of Open Access Journals (Sweden)

    Ergin Işıl

    2010-11-01

    Full Text Available Abstract Background Substantial regional health inequalities have been shown to exist in Turkey for major health indicators. Turkish data on hospitals deserves a closer examination with a special emphasis on the regional differences in the context of the rapid privatization of the secondary or tertiary level health services. This study aims to evaluate the change in capacity and service delivery at public and private hospitals in Turkey between 2001-2006 and to determine the regional differences. Methods Data for this retrospective study was provided from Statistical Almanacs of Inpatient Services (2001-2006. Hospitals in each of the 81 provinces were grouped into two categories: public and private. Provinces were grouped into six regions according to a development index composed by the State Planning Organisation. The number of facilities, hospital beds, outpatient admissions, inpatient admissions (per 100 000, number of deliveries and surgical operations (per 10 000 were calculated for public and private hospitals in each province and region. Regional comparisons were based on calculation of ratios for Region 1(R1 to Region 6(R6. Results Public facilities had a fundamental role in service delivery. However, private sector grew rapidly in Turkey between 2001-2006 in capacity and service delivery. In public sector, there were 2.3 fold increase in the number of beds in R1 to R6 in 2001. This ratio was 69.9 fold for private sector. The substantial regional inequalities in public and private sector decreased for the private sector enormously while a little decrease was observed for the public sector. In 2001 in R1, big surgical operations were performed six times more than R6 at the public sector whereas the difference was 117.7 fold for the same operations in the same regions for the private sector. These ratios decreased to 3.6 for the public sector and 13.9 for the private sector in 2006. Conclusions The private health sector has grown

  18. Public-private partnerships to improve primary healthcare surgeries: clarifying assumptions about the role of private provider activities.

    Science.gov (United States)

    Mudyarabikwa, Oliver; Tobi, Patrick; Regmi, Krishna

    2017-07-01

    Aim To examine assumptions about public-private partnership (PPP) activities and their role in improving public procurement of primary healthcare surgeries. PPPs were developed to improve the quality of care and patient satisfaction. However, evidence of their effectiveness in delivering health benefits is limited. A qualitative study design was employed. A total of 25 interviews with public sector staff (n=23) and private sector managers (n=2) were conducted to understand their interpretations of assumptions in the activities of private investors and service contractors participating in Local Improvement Finance Trust (LIFT) partnerships. Realist evaluation principles were applied in the data analysis to interpret the findings. Six thematic areas of assumed health benefits were identified: (i) quality improvement; (ii) improved risk management; (iii) reduced procurement costs; (iv) increased efficiency; (v) community involvement; and (vi) sustainable investment. Primary Care Trusts that chose to procure their surgeries through LIFT were expected to support its implementation by providing an environment conducive for the private participants to achieve these benefits. Private participant activities were found to be based on a range of explicit and tacit assumptions perceived helpful in achieving government objectives for LIFT. The success of PPPs depended upon private participants' (i) capacity to assess how PPP assumptions added value to their activities, (ii) effectiveness in interpreting assumptions in their expected activities, and (iii) preparedness to align their business principles to government objectives for PPPs. They risked missing some of the expected benefits because of some factors constraining realization of the assumptions. The ways in which private participants preferred to carry out their activities also influenced the extent to which expected benefits were achieved. Giving more discretion to public than private participants over critical

  19. Public-private partnerships' contribution to quality healthcare : a case study of South Africa after 1994

    OpenAIRE

    2012-01-01

    M.Comm. PPPs have developed out of a realisation by governments that in order to improve health systems efficiency there is a need to involve the private sector. Governments throughout the world have opted for PPPs to deliver public services, share risks and attain common goals. While the idea of PPPs is not new, it nonetheless has grown in application in recent years especially in developing countries such as South Africa. The neo-liberal GEAR macro-economic policy, that seeked to reduce ...

  20. Knowledge, perceptions and media use of the Dutch general public and healthcare workers regarding Ebola, 2014.

    Science.gov (United States)

    Schol, Lianne G C; Mollers, Madelief; Swaan, Corien M; Beaujean, Desirée J M A; Wong, Albert; Timen, Aura

    2018-01-08

    The Ebola outbreak in West-Africa triggered risk communication activities to promote adequate preventive behaviour in the Netherlands. Our study investigated the level of knowledge, perceptions, and media use regarding Ebola. In December 2014, an online questionnaire was administered to the Dutch population (n = 526) and Health Care Workers (HCW) (n = 760). The mean knowledge score (range 0-15) of HCW (m = 13.3;SD = 1.4) was significantly higher than the general public (m = 10.8;SD = 2.0). No significant difference was found in perceived severity and susceptibility. Perceived fear of the general public (m = 2.5; SD = 0.8) was significantly higher than among HCW (m = 2.4; SD = 0.7). Respondents primarily used television to obtain information. While Ebola was perceived severe, it did not lead to excessive fear or perceived susceptibility for developing the disease. Nonetheless, our research showed that knowledge with respect to human-to-human transmission is low, while this is crucial to complying with preventive measures. Our study reveals priorities for improving risk communication.

  1. Healthcare decision-tools a growing Web trend: three-pronged public relations campaign heightens presence, recognition for online healthcare information provider.

    Science.gov (United States)

    2006-01-01

    Schwartz Communications, LLC, executes a successful PR campaign to position Subimo, a provider of online healthcare decision tools, as a leader in the industry that touts names such as WebMD.com and HealthGrades.com. Through a three-pronged media relations strategy, Schwartz and Subimo together branded the company as an industry thought-leader.

  2. Identifying Critical Factors Influencing the Rents of Public Rental Housing Delivery by PPPs: The Case of Nanjing

    Directory of Open Access Journals (Sweden)

    Jingfeng Yuan

    2017-02-01

    Full Text Available The occupancy rate of Public Rental Housing (PRH in China is relatively low due to the unreasonable rents. At the same time, the development of PRH using Public Private Partnerships (PPPs increases the complexity of the rents. Therefore, the critical factors influencing the rents of PRH delivery by PPPs should be identified. Based on the comprehensive literature, this article identified a conceptual model for the factors influencing the rents of PRH delivery by PPPs in China, composed of 14 factors grouped in three factor packages, and discussed the relationships among three factor packages. A survey based on Nanjing was conducted to assess the relative significance of 14 factors. According to the results, six critical factors were identified: construction costs, household income, floor area and structure, transportation, market rents in the same district and public facilities. In addition, the proposed conceptual model had a good fit. The results also supported two hypothetical relationships among three factor packages: (1 the increase of the affordability of the target tenants had a positive effect on the increase of profits of private sectors; and (2 the increase of the affordability of the target tenants had a positive effect on the increase of level of the characteristics of PRH units. For future research, six critical factors and the relationships among three factor packages can be used to determine the reasonable rents for PRH delivery by PPPs in China.

  3. Communications data delivery system analysis : public workshop read-ahead document.

    Science.gov (United States)

    2012-04-09

    This document presents an overview of work conducted to date around development and analysis of communications data delivery systems for : supporting transactions in the connected vehicle environment. It presents the results of technical analysis of ...

  4. Clinical engagement: improving healthcare together.

    Science.gov (United States)

    Riches, E; Robson, B

    2014-02-01

    Clinical engagement can achieve lasting change in the delivery of healthcare. In October 2011, Healthcare Improvement Scotland formulated a clinical engagement strategy to ensure that a progressive and sustainable approach to engaging healthcare professionals is firmly embedded in its health improvement and public assurance activities. The strategy was developed using a 90-day process, combining an evidence base of best practice and feedback from semi-structured interviews and focus groups. The strategy aims to create a culture where clinicians view working with Healthcare Improvement Scotland as a worthwhile venture, which offers a number of positive benefits such as training, career development and research opportunities. The strategy works towards developing a respectful partnership between Healthcare Improvement Scotland, the clinical community and key stakeholders whereby clinicians' contributions are recognised in a non-financial reward system. To do this, the organisation needs a sustainable infrastructure and an efficient, cost-effective approach to clinical engagement. There are a number of obstacles to achieving successful clinical engagement and these must be addressed as key drivers in its implementation. The implementation of the strategy is supported by an action and resource plan, and its impact will be monitored by a measurement plan to ensure the organisation reviews its approaches towards clinical engagement.

  5. Impact of China's Public Hospital Reform on Healthcare Expenditures and Utilization: A Case Study in ZJ Province.

    Directory of Open Access Journals (Sweden)

    Hao Zhang

    Full Text Available High drug costs due to supplier-induced demand (SID obstruct healthcare accessibility in China. Drug prescriptions can generate markup-related profits, and the low prices of other medical services can lead to labor-force underestimations; therefore, physicians are keen to prescribe drugs rather than services. Thus, in China, a public hospital reform has been instituted to cancel markups and increase service prices.A retrospective pre/post-reform study was conducted in ZJ province to assess the impact of the reform on healthcare expenditures and utilization, ultimately to inform policy development and decision-making. The main indicators are healthcare expenditures and utilization.Post-reform, drug expenditures per visit decreased by 8.2% and 15.36% in outpatient and inpatient care, respectively; service expenditures per visit increased by 23.03% and 27.69% in outpatient and inpatient care, respectively. Drug utilization per visit increased by 5.58% in outpatient care and underwent no significant change in inpatient care. Both were lower than the theoretical drug-utilization level, which may move along the demand curve because of patient-initiated demand (PID; this indicates that SID-promoted drug utilization may decrease. Finally, service utilization per visit increased by 6% in outpatient care and by 13.10% in inpatient care; both were higher than the theoretical level moving along the demand curve, and this indicates that SID-promoted service utilization may increase.The reform reduces drug-prescription profits by eliminating drug markups; additionally, it compensates for service costs by increasing service prices. Post-reform, the SID of drug prescriptions decreased, which may reduce drug-resource waste. The SID of services increased, with potentially positive and negative effects: accessibility to services may be promoted when physicians provide more services, but the risk of resource waste may also increase. This warrants further research

  6. Integrated Healthcare Delivery: A Qualitative Research Approach to Identifying and Harmonizing Perspectives of Integrated Neglected Tropical Disease Programs.

    Directory of Open Access Journals (Sweden)

    Arianna Rubin Means

    2016-10-01

    elimination programs. We highlight a set of ten recommendations that may address stakeholder concerns and perceptions regarding these key opportunities. For example, public health stakeholders should embrace a broader perspective of community-based health needs, including and beyond NTDs, and available platforms for addressing those needs.

  7. Assessment of pharmacists' delivery of public health services in rural and urban areas in Iowa and North Dakota.

    Science.gov (United States)

    Scott, David M; Strand, Mark; Undem, Teri; Anderson, Gabrielle; Clarens, Andrea; Liu, Xiyuan

    2016-01-01

    The profession of pharmacy is expanding its involvement in public health, but few studies have examined pharmacists' delivery of public health services. To assess Iowa and North Dakota pharmacists' practices, frequency of public health service delivery, level of involvement in achieving the essential services of public health, and barriers to expansion of public health services in rural and urban areas. This study implemented an on-line survey sent to all pharmacists currently practicing pharmacy in Iowa and North Dakota. Overall, 602 valid responses were analyzed, 297 in rural areas and 305 in urban areas. Three practice settings (chain stores [169, 28.2%], independent community pharmacies [162, 27.0%], and hospital pharmacies [156, 26.0%]) comprised 81.2% of the sample. Both chain and independent community pharmacists were more commonly located in rural areas than in urban areas (PDakota. These findings should be interpreted to be primarily due to differences in the role of the rural pharmacist and the quest for certain opportunities that rural pharmacists are seeking.

  8. Assessment of pharmacists’ delivery of public health services in rural and urban areas in Iowa and North Dakota

    Science.gov (United States)

    Scott, David M.; Strand, Mark; Undem, Teri; Anderson, Gabrielle; Clarens, Andrea; Liu, Xiyuan

    2016-01-01

    Background: The profession of pharmacy is expanding its involvement in public health, but few studies have examined pharmacists’ delivery of public health services. Objective: To assess Iowa and North Dakota pharmacists’ practices, frequency of public health service delivery, level of involvement in achieving the essential services of public health, and barriers to expansion of public health services in rural and urban areas. Methods: This study implemented an on-line survey sent to all pharmacists currently practicing pharmacy in Iowa and North Dakota. Results: Overall, 602 valid responses were analyzed, 297 in rural areas and 305 in urban areas. Three practice settings (chain stores [169, 28.2%], independent community pharmacies [162, 27.0%], and hospital pharmacies [156, 26.0%]) comprised 81.2% of the sample. Both chain and independent community pharmacists were more commonly located in rural areas than in urban areas (PDakota. These findings should be interpreted to be primarily due to differences in the role of the rural pharmacist and the quest for certain opportunities that rural pharmacists are seeking. PMID:28042356

  9. Impact of Publicly Financed Health Insurance Schemes on Healthcare Utilization and Financial Risk Protection in India: A Systematic Review.

    Science.gov (United States)

    Prinja, Shankar; Chauhan, Akashdeep Singh; Karan, Anup; Kaur, Gunjeet; Kumar, Rajesh

    2017-01-01

    Several publicly financed health insurance schemes have been launched in India with the aim of providing universalizing health coverage (UHC). In this paper, we report the impact of publicly financed health insurance schemes on health service utilization, out-of-pocket (OOP) expenditure, financial risk protection and health status. Empirical research studies focussing on the impact or evaluation of publicly financed health insurance schemes in India were searched on PubMed, Google scholar, Ovid, Scopus, Embase and relevant websites. The studies were selected based on two stage screening PRISMA guidelines in which two researchers independently assessed the suitability and quality of the studies. The studies included in the review were divided into two groups i.e., with and without a comparison group. To assess the impact on utilization, OOP expenditure and health indicators, only the studies with a comparison group were reviewed. Out of 1265 articles screened after initial search, 43 studies were found eligible and reviewed in full text, finally yielding 14 studies which had a comparator group in their evaluation design. All the studies (n-7) focussing on utilization showed a positive effect in terms of increase in the consumption of health services with introduction of health insurance. About 70% studies (n-5) studies with a strong design and assessing financial risk protection showed no impact in reduction of OOP expenditures, while remaining 30% of evaluations (n-2), which particularly evaluated state sponsored health insurance schemes, reported a decline in OOP expenditure among the enrolled households. One study which evaluated impact on health outcome showed reduction in mortality among enrolled as compared to non-enrolled households, from conditions covered by the insurance scheme. While utilization of healthcare did improve among those enrolled in the scheme, there is no clear evidence yet to suggest that these have resulted in reduced OOP expenditures or

  10. Can the right to health inform public health planning in developing countries? A case study for maternal healthcare from Indonesia.

    Science.gov (United States)

    D'Ambruoso, Lucia; Byass, Peter; Nurul Qomariyah, Siti

    2008-09-09

    Maternal mortality remains unacceptably high in developing countries despite international advocacy, development targets, and simple, affordable and effective interventions. In recent years, regard for maternal mortality as a human rights issue as well as one that pertains to health, has emerged. We study a case of maternal death using a theoretical framework derived from the right to health to examine access to and quality of maternal healthcare. Our objective was to explore the potential of rights-based frameworks to inform public health planning from a human rights perspective. Information was elicited as part of a verbal autopsy survey investigating maternal deaths in rural settings in Indonesia. The deceased's relatives were interviewed to collect information on medical signs, symptoms and the social, cultural and health systems circumstances surrounding the death. In this case, a prolonged, severe fever and a complicated series of referrals culminated in the death of a 19-year-old primagravida at 7 months gestation. The cause of death was acute infection. The woman encountered a range of barriers to access; behavioural, socio-cultural, geographic and economic. Several serious health system failures were also apparent. The theoretical framework derived from the right to health identified that none of the essential elements of the right were upheld. The rights-based approach could identify how and where to improve services. However, there are fundamental and inherent conflicts between the public health tradition (collective and preventative) and the right to health (individualistic and curative). As a result, and in practice, the right to health is likely to be ineffective for public health planning from a human rights perspective. Collective rights such as the right to development may provide a more suitable means to achieve equity and social justice in health planning.

  11. An Untapped Resource: Patient and Public Involvement in Implementation Comment on "Knowledge Mobilization in Healthcare Organizations: A View From the Resource-Based View of the Firm".

    Science.gov (United States)

    Burton, Christopher; Rycroft-Malone, Jo

    2015-08-07

    This commentary considers the potential role of patient and public involvement in implementation. Developing an analytical thread from the resource-based view of the Firm, we argue that this involvement may create unique resources that have the capacity to enhance the impact of implementation activity for healthcare organisations. © 2015 by Kerman University of Medical Sciences.

  12. Rotavirus vaccines contribute towards universal health coverage in a mixed public-private healthcare system.

    Science.gov (United States)

    Loganathan, Tharani; Jit, Mark; Hutubessy, Raymond; Ng, Chiu-Wan; Lee, Way-Seah; Verguet, Stéphane

    2016-11-01

    To evaluate rotavirus vaccination in Malaysia from the household's perspective. The extended cost-effectiveness analysis (ECEA) framework quantifies the broader value of universal vaccination starting with non-health benefits such as financial risk protection and equity. These dimensions better enable decision-makers to evaluate policy on the public finance of health programmes. The incidence, health service utilisation and household expenditure related to rotavirus gastroenteritis according to national income quintiles were obtained from local data sources. Multiple birth cohorts were distributed into income quintiles and followed from birth over the first five years of life in a multicohort, static model. We found that the rich pay more out of pocket (OOP) than the poor, as the rich use more expensive private care. OOP payments among the poorest although small are high as a proportion of household income. Rotavirus vaccination results in substantial reduction in rotavirus episodes and expenditure and provides financial risk protection to all income groups. Poverty reduction benefits are concentrated amongst the poorest two income quintiles. We propose that universal vaccination complements health financing reforms in strengthening Universal Health Coverage (UHC). ECEA provides an important tool to understand the implications of vaccination for UHC, beyond traditional considerations of economic efficiency. © 2016 John Wiley & Sons Ltd.

  13. Population-Wide Genetic Risk Prediction of Complex Diseases: A Pilot Feasibility Study in Macau Population for Precision Public Healthcare Planning

    OpenAIRE

    Tsui, Nancy B. Y.; Cheng, Gregory; Chung, Teresa; Lam, Christopher W. K.; Yee, Anita; Chung, Peter K. C.; Kwan, Tsz-Ki; Ko, Elaine; He, Daihai; Wong, Wing-Tak; Lau, Johnson Y. N.; Lau, Lok Ting; Fok, Manson

    2018-01-01

    The genetic bases of many common diseases have been identified through genome-wide association studies in the past decade. However, the application of this approach on public healthcare planning has not been well established. Using Macau with population of around 650,000 as a basis, we conducted a pilot study to evaluate the feasibility of population genomic research and its potential on public health decisions. By performing genome-wide SNP genotyping of over a thousand Macau individuals, we...

  14. Healthcare organisation and delivery for people with dementia and comorbidity: a qualitative study exploring the views of patients, carers and professionals.

    Science.gov (United States)

    Bunn, Frances; Burn, Anne-Marie; Robinson, Louise; Poole, Marie; Rait, Greta; Brayne, Carol; Schoeman, Johan; Norton, Sam; Goodman, Claire

    2017-01-18

    People living with dementia (PLWD) have a high prevalence of comorbidty. The aim of this study was to explore the impact of dementia on access to non-dementia services and identify ways of improving service delivery for this population. Qualitative study involving interviews and focus groups. Thematic content analysis was informed by theories of continuity of care and access to care. Primary and secondary care in the South and North East of England. PLWD who had 1 of the following comorbidities-diabetes, stroke, vision impairment, their family carers and healthcare professionals (HCPs) in the 3 conditions. We recruited 28 community-dwelling PLWD, 33 family carers and 56 HCPs. Analysis resulted in 3 overarching themes: (1) family carers facilitate access to care and continuity of care, (2) the impact of the severity and presentation of dementia on management of comorbid conditions, (3) communication and collaboration across specialities and services is not dementia aware. We found examples of good practice, but these tended to be about the behaviour of individual practitioners rather than system-based approaches; current systems may unintentionally block access to care for PLWD. This study suggests that, in order to improve access and continuity for PLWD and comorbidity, a significant change in the organisation of care is required which involves: coproduction of care where professionals, PLWD and family carers work in partnership; recognition of the way a patient's diagnosis of dementia affects the management of other long-term conditions; flexibility in services to ensure they are sensitive to the changing needs of PLWD and their family carers over time; and improved collaboration across specialities and organisations. Research is needed to develop interventions that support partnership working and tailoring of care for PLWD and comorbidity. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

  15. Deus ex machina or e-slave? Public perception of healthcare robotics in the German print media.

    Science.gov (United States)

    Laryionava, Katsiaryna; Gross, Dominik

    2012-07-01

    The news media plays a central role in providing information regarding new medical technologies and exerts an influence on their social perception, understanding, and assessments. This study, therefore, analyzes how healthcare robotics are portrayed in the German print news media. It examines whether the risks and opportunities of new medical technologies are presented in a balanced manner and investigates whether or not print media coverage of these technologies is affected by science-fiction discourse, in which robots appear mostly as a threat to humans. Ten years of German print media coverage (2000-2010) have been studied by means of systematic, standardized content analysis. Reporting focuses predominantly on beneficial advancements in medical practice and the advantages of robotics for patients, medical staff, and society. The results show that the dominant relationship between robots and humans that is transmitted in print media in medical contexts is positive, with robots mostly portrayed as assistants, colleagues, or even friends. Only a small number of articles report ethical questions and risks. In contrast to science-fiction discourse, the German print media provides a positive picture of robotics to the lay public.

  16. [Definition of medical competence. The point of view of chronically-ill patients in the Andalusian public healthcare system (Spain)].

    Science.gov (United States)

    Prieto Rodríguez, M Ángeles; Danet Danet, Alina; Escudero Carretero, María J; Ruiz Azarola, Ainhoa; Pérez Corral, Olivia; García Toyos, Noelia

    2012-01-01

    To identify the attributes used by chronically-ill patients to describe physicians' competence in the public healthcare system in Andalucia. A total of 147 chronically-ill patients and their relatives were included in this qualitative study. Focal groups and in-depth interviews were performed in health centers and outpatient centers in Granada, Malaga, Seville, Cadiz and Cordoba between 2007 and 2008. Content analysis was carried out using Nudist Vivo. The participants defined medical competence as combining elements of technical ability and knowledge (awareness of and interest in the disease, continuity of follow-up and requesting specific tests) with interpersonal skills related to communication, information (informing, listening, trust, prompting questions) and attention (courtesy, cordiality, respect, interest and approachability). Primary care was expected to provide a close relationship, personalized treatment, information, drug prescription, and referral to specialized care. Specialized care was expected to provide an accurate diagnosis and appropriate treatment, information and follow-up. Highly valued aspects of emergency care were symptom relief, accurate diagnosis, referral to specialists and courtesy. Chronically-ill patients based their evaluation of medical competence on technical and interpersonal skills. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

  17. Quality of life in the workplace for nursing staff at public healthcare institutions.

    Science.gov (United States)

    Zavala, María Olga Quintana; Klinj, Tatiana Paravic; Carrillo, Katia Lorena Saenz

    2016-08-08

    to determine the quality of life in the workplace for nursing staff at public institutions in Hermosillo, Sonora, Mexico. quantitative, correlational, cross-sectional, and comparative. We used a probabilistic sample of 345 nurses with data collected in 2013 using an instrument created by the authors to gather bio-socio-demographic data and the CVT-GOHISALO instrument with a Cronbach's alpha of 0.95. SPSS 15 was used to analyze the data. A Kolmogorov-Smirnov test was used to calculate the normality of the data; the medians were compared using the Mann-Whitney U test and Kruskal-Wallis test with the significance level set at 0.05. the average overall quality of life in the workplace for nursing staff was 207.31 (DE 41.74), indicating a moderate level. The quality of life in the workplace was higher for people with permanent contracts (p=0.007) who did not engage in other remunerative activities (p=0.046). Differences in the quality of life in the workplace were observed depending on the institution where the subjects worked (p=0.001). the nursing staff perceives itself as having a moderate-level quality of life in the workplace. This level was determined in the statistical analysis based on the type of contract, whether the person performed other remunerated activities, and the institution where the person worked. determinar el nivel de calidad de vida en el trabajo del personal de enfermería de instituciones públicas en Hermosillo, Sonora, México. cuantitativo, correlacional, transversal y comparativo. Muestreo probabilístico, de 345 enfermeras, datos recolectados en 2013, a través de instrumentos que recogen datos biososiodemográficos; creado por las autoras y CVT -GOHISALO con Alpha de Cronbach de 0.95. Para el análisis de datos se usó SPSS 15, para conocer la normalidad de los datos se utilizó Kolmogorov- Smirnov, se compararon medianas con U de Mann Whitney y Kruskal-Wallis, nivel de significancia admitido 0.05. promedio de calidad de vida en el trabajo

  18. Permeability of public and private spaces in reproductive healthcare seeking: barriers to uptake of services among low income African American women in a smaller urban setting.

    Science.gov (United States)

    Golden, Annis G

    2014-05-01

    This study was undertaken in partnership with a publicly funded reproductive healthcare organization to better understand barriers to utilization of its services as perceived by low income African American women in its community and how those barriers might be managed. The study uses a place-based, ecological perspective to theorize privacy challenges across different levels of the communication ecology. Analysis of participant observation, interviews, and focus group data identified three key public-private problematics in African American women's experience of reproductive healthcare seeking in a smaller urban setting: a public-private problematic of organizational identity, of organizational regions, and of organizational members. Potential strategies are identified for managing these problematics by the organization and community members. Copyright © 2014. Published by Elsevier Ltd.

  19. MARKET-BASED MECHANISM IN PUBLIC SERVICE DELIVERY IN LOCAL GOVERNMENT IN POLAND – A BRIEF OVERVIEW

    Directory of Open Access Journals (Sweden)

    Dawid Sześciło

    2013-12-01

    Full Text Available The reintroduction of local self-government at the level of communes (gminy in 1990 opened the way for an in-depth reform of the local governance framework in Poland. This included not only the legal, organizational and fiscal autonomisation of local communities, but also went in line with general trends concerning the transformation of the public sector. Therefore, among the core elements of the transformation we may identify the extensive privatization of the public service provision schemes. In Poland, this process was not based on the theoretical background of New Public Management, as was the case in a number of Western countries. Instead, it was natural consequence of the rebirth of a market economy with a limited public sector and the intense development of the private market. Those trends were, however, compatible with the NPM programme. The expansion of market-based mechanisms in public service delivery is one of its pillars. This article provides a historical overview of the development of market-based arrangements in public service provision at the most basic level of Polish local government. It is focused mainly on a legal framework, but also includes some observations on the practical side of this process.

  20. Brazilian scientific publications of obstetrical nurses on home delivery: systematic literature review

    OpenAIRE

    Feyer, Iara Simoni Silveira; Monticelli, Marisa; Volkmer, Cilene; Burigo, Renata Angeloni

    2013-01-01

    This review study of national journals aimed at characterizing the scientific production of Brazilian nurses regarding home delivery and identifying the results achieved. A total of 27 studies were found, of which ten studies complied with the inclusion criteria, with eight constituting the analytical corpus in accordance with the Critical Appraisal Skills Program. Data were synthesized using the meta-ethnographic approach, following the interpretation of the reciprocal translation. Three cat...

  1. Corporate municipal governance for effective and efficient public service delivery in South Africa.

    Directory of Open Access Journals (Sweden)

    Paulin Mbecke

    2014-10-01

    Full Text Available This research acknowledges the current service delivery chaos manifested through numerous protests justifying the weakness of the “Batho Pele” good governance principles to facilitate, improve and sustain service delivery by local governments. The success of corporate governance in corporate companies and state owned enterprises is recognised prompting suggestions that local governments should too adopt corporate governance principles or King III to be effective. The research reviews the King III and literature to ascertain the lack of research on corporate governance in local governments in South Africa. Considering the particular set-up of local governments, the research doubts the successful application of King III in local governments. Through critical research theory, the current service delivery crisis in local governments in South Africa is described. The success of corporate governance systems in the United Kingdom and Australian local governments justify the need for a separate corporate municipal governance system as a solution to the crisis. A specific change of legislation and corporate governance guidelines is necessary to address the uniqueness of local governments. Hence, corporate municipal governance should be compulsory and based on ten standardised good governance principles via a code of corporate governance and a corporate governance framework responding to specific prerequisites for success

  2. Compensating citizens for poor service delivery: experimental research in public and private settings

    OpenAIRE

    Thomassen, JP; Leliveld, MC; Van de Walle, Steven; Ahaus, K

    2017-01-01

    After a service failure, citizens expect a recovery strategy that restores perceived justice and places a reasonable value on their loss. Offering monetary compensation is a strategy commonly used in private settings, but less so in public settings. To date compensation effects have not been researched in public settings. To investigate citizens’ evaluations of perceived justice, negative emotions and post-recovery satisfaction we used a 2 (sector: public, private) by 2 (compensation promised...

  3. The Guatemala-Penn Partners: An Innovative Inter-Institutional Model for Scientific Capacity-Building, Healthcare Education, and Public Health

    Science.gov (United States)

    Paniagua-Avila, Maria Alejandra; Messenger, Elizabeth; Nelson, Caroline A.; Calgua, Erwin; Barg, Frances K.; Bream, Kent W.; Compher, Charlene; Dean, Anthony J.; Martinez-Siekavizza, Sergio; Puac-Polanco, Victor; Richmond, Therese S.; Roth, Rudolf R.; Branas, Charles C.

    2017-01-01

    Population health outcomes are directly related to robust public health programs, access to basic health services, and a well-trained health-care workforce. Effective health services need to systematically identify solutions, scientifically test these solutions, and share generated knowledge. The World Health Organization (WHO)’s Global Healthcare Workforce Alliance states that the capacity to perform research is an essential factor for well-functioning public health systems. Low- and middle-income countries have greater health-care worker shortages and lower research capacity than higher-income countries. International global health partnerships between higher-income countries and low-middle-income countries aim to directly address such inequalities through capacity building, a process by which human and institutional resources are strengthened and developed, allowing them to perform high-level functions, solve complex problems, and achieve important objectives. The Guatemala–Penn Partners (GPP) is a collaboration among academic centers in Guatemala and the University of Pennsylvania (Penn), in Philadelphia, Pennsylvania that echoes the vision of the WHO’s Global Healthcare Workforce Alliance. This article describes the historical development and present organization of the GPP according to its three guiding principles: university-to-university connections, dual autonomies with locally led capacity building, and mutually beneficial exchanges. It describes the GPP activities within the domains of science, health-care education, and public health, emphasizing implementation factors, such as sustainability and scalability, in relation to the guiding principles. Successes and limitations of this innovative model are also analyzed in the hope that the lessons learned may be applied to similar partnerships across the globe. PMID:28443274

  4. Modelling process integration and its management – case of a public housing delivery organization in United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Venkatachalam Senthilkumar

    2017-01-01

    Full Text Available Huge volume of project information are generated during the life cycle of an AEC projects. These project information are categorized in to technical and administrative information and managed through appropriate processes. There are many tools such as Document Management Systems, Building Information Modeling (BIM available to manage and integrate the technical information. However, the administrative information and its related processes such as the payment, status, authorization, approval etc. are not effectively managed. The current study aims to explore the administrative information management process of a local housing delivery public agency. This agency manages more than 2000 housing projects at any time of a year. The administrative processesare characterized withdelivery inconsistencies among various project participants. Though there are many commercially available process management systems, there exist limitations on the customization of the modules/ systems. Hence there is a need to develop an information management system which can integrates and manage these housing projects processes effectively. This requires the modeling of administrative processes and its interfaces among the various stakeholder processes. Hence this study aims to model the administrative processes and its related information during the life cycle of the project using IDEF0 and IDEF1X modeling. The captured processes and information interfaces are analyzed and appropriate process integration is suggested to avoid the delay in their project delivery processes. Further, the resultant model can be used for effectively managing the housing delivery projects.

  5. A Blockchain Ecosystem for Digital Identity: Improving Service Delivery in Canada’s Public and Private Sectors

    Directory of Open Access Journals (Sweden)

    Greg Wolfond

    2017-10-01

    Full Text Available Blockchain-based solutions have the potential to make government operations more efficient and improve the delivery of services in the public and private sectors. Identity verification and authentication technologies, as one of the applications of blockchain-based solutions – and the focus of our own efforts at SecureKey Technologies – have been critical components in service delivery in both sectors due to their power to increase trust between citizens and the services they access. To convert trust into solid value added, identities must be validated through highly-reliable technologies, such as blockchain, that have the capacity to reduce cost and fraud and to simplify the experience for customers while also keeping out the bad actors. With identities migrating to digital platforms, organizations and citizens need to be able to transact with reduced friction even as more counter-bound services move to online delivery. In this article, drawing on our own experiences with an ecosystem approach to digital identity, we describe the potential value of using blockchain technology to address the present and future challenges of identity verification and authentication within a Canadian context.

  6. Essays on the Microfoundations of Competition and Choice in Public Service Delivery

    NARCIS (Netherlands)

    S.R. Jilke (Sebastian)

    2015-01-01

    markdownabstract__Abstract__ The way how public services are delivered has changed fundamentally in past decades. While in the 1970s most public services such as energy, water or telecommunications were provided by state-owned monopolists, nowadays these services are delivered by a large array

  7. Service delivery and ethical conduct in the public service: the missing links

    Directory of Open Access Journals (Sweden)

    L. Lues

    2007-07-01

    Full Text Available There are a multitude of policies, strategies and programmes directed at the rendering of effective services to the citizens of South Africa by public service managers. However, in spite of the pursuit of effectiveness and the condemning of unethical behaviour by public service managers, scandals still occur and allegations are still made. So, where are the missing links? In this article, a brief description is given of some ethical concepts viewed as important in addressing the question posed. The concluding remarks are twofold: public service organisations need to provide continuous commitment, enforcement, and modelling of leadership in professional ethics by means of, among other things, policy structures; and public service managers need to realise the importance of changing their own mindset and accepting the ethical standards that are established by the public service organisation, even if these differ from their own beliefs and culture.

  8. A longitudinal study to identify the influence of quality of chronic care delivery on productive interactions between patients and (teams of) healthcare professionals within disease management programmes.

    Science.gov (United States)

    Cramm, Jane Murray; Nieboer, Anna Petra

    2014-09-19

    The chronic care model is an increasingly used approach to improve the quality of care through system changes in care delivery. While theoretically these system changes are expected to increase productive patient-professional interaction empirical evidence is lacking. This study aims to identify the influence of quality of care on productive patient-professional interaction. Longitudinal study in 18 Dutch regions. Questionnaires were sent to all 5076 patients participating in 18 Disease Management Programmes (DMPs) in 2010 (2676 (53%) respondents). One year later (T1), 4693 patients still participating in the DMPs received a questionnaire (2191 (47%) respondents) and 2 years later (in 2012; T2) 1722 patients responded (out of 4350; 40% response). DMPs Patients' perceptions of the productivity of interactions (measured as relational coordination/coproduction of care) with professionals. Patients were asked about communication dimensions (frequent, accurate, and problem-solving communication) and relationship dimensions (shared goals and mutual respect). After controlling for background characteristics these results clearly show that quality of chronic care (T0), first-year changes in quality of chronic care (T1-T0) and second-year changes in quality of chronic care (T2-T1) predicted productive interactions between patients and professionals at T2 (all at p≤0.001). Furthermore, we found a negative relationship between lower educational level and productive interactions between patients and professionals 2 years later. We can conclude that successfully dealing with the consequences of chronic illnesses requires proactive patients who are able to make productive decisions together with their healthcare providers. Since patients and professionals share responsibility for management of the chronic illness, they must also share control of interactions and decisions. The importance of patient-centeredness is growing and this study reports a first example of how quality

  9. The impact of total quality service (TQS) on healthcare and patient satisfaction: an empirical study of Turkish private and public hospitals.

    Science.gov (United States)

    Bakan, Ismail; Buyukbese, Tuba; Ersahan, Burcu

    2014-01-01

    This paper attempts to measure patients' perceptions of the quality of services in public and private healthcare centers in Turkey. The main aim was to examine the impact of the dimensions of patient-perceived total quality service (TQS) on patients' satisfaction. The research framework and hypotheses are derived from a literature review of service quality and quality in the healthcare industry. The research data were collected through questionnaires and then statistically analyzed using descriptive statistics, Pearson product moment correlation and linear regression. The results suggest that service quality perceptions positively influence patient satisfaction with overall hospital care (SOHC). The most important factors identified in the regression model regarding patient SOHC are the quality of the hospital's social responsibility, administrative processes and overall experience of medical care received. These factors explain 74% of the variance in SOHC. The findings of the study can be used to improve TQS in both private and public hospitals. Copyright © 2013 John Wiley & Sons, Ltd.

  10. The subjectively perceived quality of postgraduate medical training in integrative medicine within the public healthcare systems of Germany and Switzerland: the example of anthroposophic hospitals

    OpenAIRE

    Heusser, Peter; Eberhard, Sabine; Berger, Bettina; Weinzirl, Johannes; Orlow, Pascale

    2014-01-01

    Background Integrative medicine (IM) integrates evidence-based Complementary and Alternative Medicine (CAM) with conventional medicine (CON). Medical schools offer basic CAM electives but in postgraduate medical training (PGMT) little has been done for the integration of CAM. An exception to this is anthroposophic medicine (AM), a western form of CAM based on CON, offering an individualized holistic IM approach. AM hospitals are part of the public healthcare systems in Germany and Switzerland...

  11. A framework to expand public services to children with biomedical healthcare needs related to HIV in the Free State, South Africa.

    Science.gov (United States)

    Reid, Marianne; Botma, Yvonne

    2012-06-01

    The study undertook the development of a framework for expanding the public services available to children with biomedical healthcare needs related to HIV in South Africa. The study consisted of various component projects which were depicted as phases. The first phase was a descriptive quantitative analysis of healthcare services for children exposed to or infected by HIV, as rendered by the public health sector in the Free State Province. The second stage was informed by health policy research: a nominal group technique with stakeholders was used to identify strategies for expanding the healthcare services available to these children. The third phase consisted of workshops with stakeholders in order to devise and validate a framework for the expansion. The theory of change logic model served as the theoretical underpinning of the draft framework. Triangulated data from the literature and the preceding two phases of the study provided the empirical foundation. The problem identified was that of fragmented care delivered to children exposed to or infected with HIV, due to the 'over-verticalization' of programmes. A workshop was held during which the desired results, the possible factors that could influence the results, as well as the suggested strategies to expand and integrate the public services available to HIV-affected children were confirmed. Thus the framework was finalised during the validation workshop by the researchers in collaboration with the stakeholders.

  12. Health-care waste incineration and related dangers to public health: case study of the two teaching and referral hospitals in Kenya.

    Science.gov (United States)

    Njagi, Nkonge A; Oloo, Mayabi A; Kithinji, J; Kithinji, Magambo J

    2012-12-01

    There are practically no low cost, environmentally friendly options in practice whether incineration, autoclaving, chemical treatment or microwaving (World Health Organisation in Health-care waste management training at national level, [2006] for treatment of health-care waste. In Kenya, incineration is the most popular treatment option for hazardous health-care waste from health-care facilities. It is the choice practiced at both Kenyatta National Hospital, Nairobi and Moi Teaching and Referral Hospital, Eldoret. A study was done on the possible public health risks posed by incineration of the segregated hazardous health-care waste in one of the incinerators in each of the two hospitals. Gaseous emissions were sampled and analyzed for specific gases the equipment was designed and the incinerators Combustion efficiency (CE) established. Combustion temperatures were also recorded. A flue gas analyzer (Model-Testos-350 XL) was used to sample flue gases in an incinerator under study at Kenyatta National Hospital--Nairobi and Moi Teaching and Referral Hospital--Eldoret to assess their incineration efficiency. Flue emissions were sampled when the incinerators were fully operational. However the flue gases sampled in the study, by use of the integrated pump were, oxygen, carbon monoxide, nitrogen dioxide, nitrous oxide, sulphur dioxide and No(x). The incinerator at KNH operated at a mean stack temperature of 746 °C and achieved a CE of 48.1 %. The incinerator at MTRH operated at a mean stack temperature of 811 °C and attained a CE of 60.8 %. The two health-care waste incinerators achieved CE below the specified minimum National limit of 99 %. At the detected stack temperatures, there was a possibility that other than the emissions identified, it was possible that the two incinerators tested released dioxins, furans and antineoplastic (cytotoxic drugs) fumes should the drugs be subjected to incineration in the two units.

  13. Prevalence and compensation of academic leaders, professors, and trustees on publicly traded US healthcare company boards of directors: cross sectional study.

    Science.gov (United States)

    Anderson, Timothy S; Good, Chester B; Gellad, Walid F

    2015-09-29

    To identify the prevalence, characteristics, and compensation of members of the boards of directors of healthcare industry companies who hold academic appointments as leaders, professors, or trustees. Cross sectional study. US healthcare companies publicly traded on the NASDAQ or New York Stock Exchange in 2013. 3434 directors of pharmaceutical, biotechnology, medical equipment and supply, and healthcare provider companies. Prevalence, annual compensation, and beneficial stock ownership of directors with affiliations as leaders, professors, or trustees of academic medical and research institutions. 446 healthcare companies met the study search criteria, of which 442 (99%) had publicly accessible disclosures on boards of directors. 180 companies (41%) had one or more academically affiliated directors. Directors were affiliated with 85 geographically diverse non-profit academic institutions, including 19 of the top 20 National Institute of Health funded medical schools and all of the 17 US News honor roll hospitals. Overall, these 279 academically affiliated directors included 73 leaders, 121 professors, and 85 trustees. Leaders included 17 chief executive officers and 11 vice presidents or executive officers of health systems and hospitals; 15 university presidents, provosts, and chancellors; and eight medical school deans or presidents. The total annual compensation to academically affiliated directors for their services to companies was $54,995,786 (£35,836,000; €49,185,900) (median individual compensation $193,000) and directors beneficially owned 59,831,477 shares of company stock (median 50,699 shares). A substantial number and diversity of academic leaders, professors, and trustees hold directorships at US healthcare companies, with compensation often approaching or surpassing common academic clinical salaries. Dual obligations to for profit company shareholders and non-profit clinical and educational institutions pose considerable personal, financial, and

  14. Investigating the health care delivery system in Japan and reviewing the local public hospital reform

    Directory of Open Access Journals (Sweden)

    Zhang X

    2016-03-01

    Full Text Available Xing Zhang, Tatsuo Oyama National Graduate Institute for Policy Studies, Tokyo, Japan Abstract: Japan's health care system is considered one of the best health care systems in the world. Hospitals are one of the most important health care resources in Japan. As such, we investigate Japanese hospitals from various viewpoints, including their roles, ownership, regional distribution, and characteristics with respect to the number of beds, staff, doctors, and financial performance. Applying a multivariate analysis and regression model techniques, we show the functional differences between urban populated prefectures and remote ones; the equality gap among all prefectures with respect to the distribution of the number of beds, staff, and doctors; and managerial differences between private and public hospitals. We also review and evaluate the local public hospital reform executed in 2007 from various financial aspects related to the expenditure and revenue structure by comparing public and private hospitals. We show that the 2007 reform contributed to improving the financial situation of local public hospitals. Strategic differences between public and private hospitals with respect to their management and strategy to improve their financial situation are also quantitatively analyzed in detail. Finally, the remaining problems and the future strategy to further improve the Japanese health care system are described. Keywords: health care system, health care resource, public hospital, multivariate regression model, financial performance

  15. Institutional delivery in public and private sectors in South Asia: A comparative analysis of prospective data from four demographic surveillance sites

    NARCIS (Netherlands)

    S. Das (Sushmita); G. Alcock (Glyn); K. Azad (Kishwar); A. Kuddus (Abdul); A. Manandhar; B. Shrestha (Bhim); N. Nair (Nirmala); S. Rath (Santosh); N.S. More (Neena Shah); N. Saville (Naomi); A.J. Houweling (Tanja); D. Osrin (David)

    2016-01-01

    markdownabstract__Background:__ Maternity care in South Asia is available in both public and private sectors. Using data from demographic surveillance sites in Bangladesh, Nepal and rural and urban India, we aimed to compare institutional delivery rates and public-private share. __Methods:__ We

  16. Prevalence of post-traumatic stress symptoms and associated factors in tuberculosis (TB), TB retreatment and/or TB-HIV co-infected primary public health-care patients in three districts in South Africa.

    Science.gov (United States)

    Peltzer, Karl; Naidoo, Pamela; Matseke, Gladys; Louw, Julia; McHunu, Gugu; Tutshana, Bomkazi

    2013-01-01

    High rates of tuberculosis (TB) and TB/HIV co-infection is often linked with mental health issues such as post-traumatic stress disorder (PTSD) symptoms, which is further associated with poor health outcomes. In a country such as South Africa where rates of these infectious diseases are high, it is concerning that there is limited/no data on prevalence rates of mental disorders such as PTSD and its associated factors. Therefore, the aim of this study was to establish the prevalence of PTSD symptoms and associated factors in TB, TB retreatment and/or TB-HIV co-infected primary public health-care patients in three districts in South Africa. Brief screening self-report tools were used to measure: PTSD symptoms, psychological distress (anxiety and depression) and alcohol misuse. Other relevant measures, such as adherence to medication, stressful life events and sexual risk-taking behaviours, were obtained through structured questions. A total of 4900 public primary care adult patients from clinics in high TB burden districts from three provinces in South Africa participated. All the patients screened positive for TB (either new or retreatment cases). The prevalence of PTSD symptoms was 29.6%. Patients who screened positive for PTSD symptoms and psychological distress were more likely to be on antidepressant medication. Factors that predicted PTSD symptoms were poverty, residing in an urban area, psychological distress, suicide attempt, alcohol and/or drug use before sex, unprotected sex, TB-HIV co-infected and the number of other chronic conditions. Health-care systems should be strengthened to improve delivery of mental health care, by focusing on existing programmes and activities, such as those which address the prevention and treatment of TB and HIV.

  17. Models of public-private engagement for health services delivery and financing in Southern Africa: a systematic review.

    Science.gov (United States)

    Whyle, Eleanor Beth; Olivier, Jill

    2016-12-01

    In low- and middle-income countries (LMICs), the private sector-including international donors, non-governmental organizations, for-profit providers and traditional healers-plays a significant role in health financing and delivery. The use of the private sector in furthering public health goals is increasingly common. By working with the private sector through public -: private engagement (PPE), states can harness private sector resources to further public health goals. PPE initiatives can take a variety of forms and understanding of these models is limited. This paper presents the results of a Campbell systematic literature review conducted to establish the types and the prevalence of PPE projects for health service delivery and financing in Southern Africa. PPE initiatives identified through the review were categorized according to a PPE typology. The review reveals that the full range of PPE models, eight distinct models, are utilized in the Southern African context. The distribution of the available evidence-including significant gaps in the literature-is discussed, and key considerations for researchers, implementers, and current and potential PPE partners are presented. It was found that the literature is disproportionately representative of PPE initiatives located in South Africa, and of those that involve for-profit partners and international donors. A significant gap in the literature identified through the study is the scarcity of information regarding the relationship between international donors and national governments. This information is key to strengthening these partnerships, improving partnership outcomes and capacitating recipient countries. The need for research that disaggregates PPE models and investigates PPE functioning in context is demonstrated. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  18. Determinants of job satisfaction of healthcare professionals in public hospitals in Belgrade, Serbia--Cross-sectional analysis.

    Science.gov (United States)

    Kuburović, Nina B; Dedić, Velimir; Djuricić, Slavisa; Kuburović, Vladimir

    2016-01-01

    The quality of health care significantly depends on the satisfaction of the employees. The objective of this study was to establish the level of professional satisfaction of healthcare professionals in state hospitals in Belgrade, Serbia, and to determine and to rank the factors which impact on their satisfaction or dissatisfaction. Professional satisfaction survey was designed and conducted as a cross-sectional study in 2008. Completed questionnaires were returned by 6,595 healthcare professionals from Belgrade's hospitals. Statistical analysis was performed using the Student's t-test, χ² test and ANOVA. Factor analysis was applied in order to define determinants of professional satisfaction, i.e. dissatisfaction. This study showed that the degree of professional satisfaction of Serbian healthcare professionals was low. The main causes of professionals'dissatisfaction were wages, equipment, the possibility of continuous medical education/training and the opportunities for professional development. Healthcare professionals with university education were more satisfied with all the individual aspects of job satisfaction than those with secondary school and college education. There were significantly more healthcare professionals satisfied with their job among males, older than 60 years, in the age group 50-59 years, with managerial function, and with 30 or more years of service. Development strategy of human resources in the Serbian health care system would significantly improve the professional satisfaction and quality of the provided health care.

  19. Determinants of job satisfaction of healthcare professionals in public hospitals in Belgrade, Serbia - cross-sectional analysis

    Directory of Open Access Journals (Sweden)

    Kuburović Nina B.

    2016-01-01

    Full Text Available Introduction. The quality of health care significantly depends on the satisfaction of the employees. Objective. The objective of this study was to establish the level of professional satisfaction of healthcare professionals in state hospitals in Belgrade, Serbia, and to determine and to rank the factors which impact on their satisfaction or dissatisfaction. Method. Professional satisfaction survey was designed and conducted as a cross-sectional study in 2008. Completed questionnaires were returned by 6,595 healthcare professionals from Belgrade’s hospitals. Statistical analysis was performed using the Student’s t-test, χ2 test and ANOVA. Factor analysis was applied in order to define determinants of professional satisfaction, i.e. dissatisfaction. Results. This study showed that the degree of professional satisfaction of Serbian healthcare professionals was low. The main causes of professionals’ dissatisfaction were wages, equipment, the possibility of continuous medical education/training and the opportunities for professional development. Healthcare professionals with university education were more satisfied with all the individual aspects of job satisfaction than those with secondary school and college education. Conclusion. There were significantly more healthcare professionals satisfied with their job among males, older than 60 years, in the age group 50-59 years, with managerial function, and with 30 or more years of service. Development strategy of human resources in the Serbian health care system would significantly improve the professional satisfaction and quality of the provided health care.

  20. Carolina Care at University of North Carolina Health Care: Implementing a Theory-Driven Care Delivery Model Across a Healthcare System.

    Science.gov (United States)

    Tonges, Mary; Ray, Joel D; Herman, Suzanne; McCann, Meghan

    2018-04-01

    Patient satisfaction is a key component of healthcare organizations' performance. Providing a consistent, positive patient experience across a system can be challenging. This article describes an organization's approach to achieving this goal by implementing a successful model developed at the flagship academic healthcare center across an 8-hospital system. The Carolina Care at University of North Carolina Health Care initiative has resulted in substantive qualitative and quantitative benefits including higher patient experience scores for both overall rating and nurse communication.

  1. Integrated delivery systems: the cure for fragmentation.

    Science.gov (United States)

    Enthoven, Alain C

    2009-12-01

    Our healthcare system is fragmented, with a misalignment of incentives, or lack of coordination, that spawns inefficient allocation of resources. Fragmentation adversely impacts quality, cost, and outcomes. Eliminating waste from unnecessary, unsafe care is crucial for improving quality and reducing costs--and making the system financially sustainable. Many believe this can be achieved through greater integration of healthcare delivery, more specifically via integrated delivery systems (IDSs). An IDS is an organized, coordinated, and collaborative network that links various healthcare providers to provide a coordinated, vertical continuum of services to a particular patient population or community. It is also accountable, both clinically and fiscally, for the clinical outcomes and health status of the population or community served, and has systems in place to manage and improve them. The marketplace already contains numerous styles and degrees of integration, ranging from Kaiser Permanente-style full integration, to more loosely organized individual practice associations, to public-private partnerships. Evidence suggests that IDSs can improve healthcare quality, improve outcomes, and reduce costs--especially for patients with complex needs--if properly implemented and coordinated. No single approach or public policy will fix the fragmented healthcare system, but IDSs represent an important step in the right direction.

  2. How Do Private Sector Schools Serve the Public Good by Fostering Inclusive Service Delivery Models?

    Science.gov (United States)

    Scanlan, Martin; Tichy, Karen

    2014-01-01

    Conversations about promoting educational reforms that redress educational inequities often ignore private schools as irrelevant. Yet pursuits of inclusivity in private sector schools serve the public interest. This article focuses on how the system of Catholic schools in the Archdiocese of St. Louis has been purposefully striving for 2 decades to…

  3. Agencification of Public Service Delivery in Developing Societies: Experiences of Pakistan and Tanzania Agency Models

    Directory of Open Access Journals (Sweden)

    Friday Francis Nchukwe

    2014-09-01

    Full Text Available Agencification is not a new phenomenon in the public sector. However, since 1980s in developing societies, not only the number of new agencies has gone up but, the existing agencies have also been revitalized under the rubric of New Public Management capsulated in World Bank/IMF’s guided governance and administrative reforms. These agencies have been created in an administrative system which has weak political institutions but well entrenched bureaucracy with strong colonial bureaucratic traditions such as centralization of power exercised by a class of senior bureaucrats occupying top positions in federal ministries. The article examines agencification in developing countries with particular reference to Pakistan and Tanzania agency model. It noted that agencification in developing countries was rarely, if ever, pursued within a systemic conceptual and legal framework, but agencies are often seen as an alternative to already existing state-owned companies which are plagued with corruption. The article therefore draws some observations and remedial actions for improvement in the performance of public sector organisations in developing countries in general and Africa in particular. It concludes that while most government ministries in developing societies cannot trigger public sector transformation due to a lack of performance improvement, agencies are unlikely to do so because of the particular autonomy of the administrative systems in which they are embedded.

  4. Compensating citizens for poor service delivery : Experimental research in public and private settings

    NARCIS (Netherlands)

    Thomassen, Jean Pierre; Leliveld, Marijke C.; Van de Walle, Steven; Ahaus, Kees

    2017-01-01

    After a service failure, citizens expect a recovery strategy that restores perceived justice and places a reasonable value on their loss. Offering monetary compensation is a strategy commonly used in private settings, but less so in public settings. To date, compensation effects have not been

  5. Use of Electronic Nicotine Delivery Systems Among Adolescents: Status of the Evidence and Public Health Recommendations.

    Science.gov (United States)

    Kamat, Aarti D; Van Dyke, Alison L

    2017-02-01

    Although the prevalence of tobacco smoking has been declining in recent years, the use of electronic nicotine delivery systems (ENDS) such as of electronic cigarettes, vaporizers, and hookahs has been steadily rising, especially among adolescents. ENDS are not only advertised to children, but their sale via the Internet has made them easily accessible to youth. In general, children perceive ENDS as safe, or at least safer than smoking traditional combustible tobacco products; however, exposure to nicotine may have deleterious effects on the developing brain. Concern also persists that ENDS may be a "starter" drug that may lead to further tobacco, drug, and/or alcohol use. In contrast to this precautionary stance that is associated with calls for legislative oversight of ENDS marketing and sales, harm reductionists claim that the risks posed by ENDS are minor in comparison with those of combustible tobacco products and that ENDS may be used as a means of nicotine replacement for smoking cessation, despite no concrete evidence to support this assertion. Many medical and health-related organizations have produced position statements concerning ENDS use, including among adolescents. This article summarizes the advantages and disadvantages of using ENDS espoused in these position statements, especially as they relate to use among adolescents. [Pediatr Ann. 2017;46(2):e69-e77.]. Copyright 2017, SLACK Incorporated.

  6. No Margin, No Mission? A Field Experiment on Incentives for Public Services Delivery

    OpenAIRE

    Ashraf, Nava; Bandiera, Oriana; Jack, Kelsey

    2014-01-01

    A substantial body of research investigates the effect of pay for performance in firms, yet less is known about the effect of non-financial rewards, especially in organizations that hire individuals to perform tasks with positive social spillovers. We conduct a field experiment in which agents recruited by a public health organization to sell condoms are randomly allocated to four groups. Agents in the control group are hired as volunteers, whereas agents in the three treatment groups receive...

  7. No Margin, no Mission? A Field Experiment on Incentives for public service delivery

    OpenAIRE

    Nava Ashraf; Oriana Bandiera; Kelsey Jack

    2012-01-01

    A substantial body of research investigates the design of incentives in firms, yet less is known about incentives in organizations that hire individuals to perform tasks with positive social spillovers. We conduct a field experiment in which agents hired by a public health organization are randomly allocated to four groups. Agents in the control group receive a standard volunteer contract often offered for this type of task, whereas agents in the three treatment groups receive small financial...

  8. Perceived Efficacy and Intentions Regarding Seeking Mental Healthcare: Impact of Deepika Padukone, A Bollywood Celebrity's Public Announcement of Struggle with Depression.

    Science.gov (United States)

    Jain, Parul; Pandey, Uma Shankar; Roy, Enakshi

    2017-08-01

    The current research examines the impact of Deepika Padukone's (one of the most popular Bollywood celebrities) public announcement of struggle with depression on people's perceived efficacy and intentions to seek help for mental healthcare. A survey conducted with 206 participants from India, the country with the highest depression rates in the world, revealed that parasocial interaction with the celebrity mediated the effect of exposure on intentions and efficacy perceptions regarding seeking mental healthcare. Our study expands the research on celebrity influence on health conditions in an international realm and in a mental health context. The findings have immense practical implications and may raise awareness about mental health in India given the popularity and reach of Bollywood among audiences in India and beyond, the level of stigmatization attached to mental health issues in India, and the lack of available resources for care. Theoretically, the study explores processes and effects of involvement with a celebrity and discusses potential implications for the behaviors related to health.

  9. Summary of: Mind the gap! A comparison of oral health knowledge between dental, healthcare professionals and the public.

    Science.gov (United States)

    Levine, R S

    2014-02-01

    The importance of consistent, accurate and unambiguous messages are well documented in oral health promotion literature. Whether the reality of delivering messages in the field fulfils these principle is questionable. This paper explores the perceptions of dental professionals, healthcare professionals and lay community members with regard to key oral health messages in order to highlight any inconsistencies and knowledge gaps between and within groups for disease risk factors. A questionnaire was administered to individuals who belonged to three groups: dental professionals, healthcare professionals and lay community members. The questionnaire established knowledge regarding risk factors for caries, periodontal disease and erosion. Thirty-five (57.4%) of the dental group answered the whole questionnaire correctly, with 22 (27.8%) and 9 (5.1%) of the healthcare and lay community group answering the whole questionnaire correctly, respectively. The question of fluoride levels in children's toothpaste was the main reason for incorrect answers in the dental group. The results of this survey demonstrate a knowledge gradient from dental professionals through to healthcare professionals and then to lay members of the community. The knowledge base observed in the dental group is reflected in the other two groups as would be expected albeit with a significant gap between each group. As expected the dental professionals are generally well informed, but not as well informed as could be expected.

  10. Unemployment, public-sector healthcare expenditure and colorectal cancer mortality in the European Union: 1990-2009.

    Science.gov (United States)

    Maruthappu, Mahiben; Watson, Robert A; Watkins, Johnathan; Williams, Callum; Zeltner, Thomas; Faiz, Omar; Ali, Raghib; Atun, Rifat

    2016-01-01

    We examined the association between unemployment and government spending on healthcare with colorectal cancer mortality. Retrospective observational study using data from the World Bank and WHO. Multivariate regression analysis was used, controlling for country-specific differences in infrastructure and demographics. A 1 % increase in unemployment was associated with a significant increase in colorectal cancer mortality in both men and women [men: coefficient (R) = 0.0995, 95 % confidence interval (CI) 0.0132-0.1858, P = 0.024; women: R = 0.0742, 95 % CI 0.0160-0.1324, P = 0.013]. A 1 % increase in government spending on healthcare was associated with a statistically significant decrease in colorectal cancer mortality across both sexes (men: R = -0.4307, 95 % CI -0.6057 to -0.2557, P < 0.001; women: R = -0.2162, 95 % CI -0.3407 to -0.0917, P = 0.001). The largest changes in mortality occurred 3-4 years following changes in either economic variable. Unemployment rises are associated with a significant increase in colorectal cancer mortality, whilst government healthcare spending rises are associated with falling mortality. This is likely due, in part, to reduced access to healthcare services and has major implications for clinicians and policy makers alike.

  11. Relation of people-centered public health and person-centered healthcare management: a case study to reduce burn-out.

    Science.gov (United States)

    Stoyanov, Drozdstoj S; Cloninger, C Robert

    2012-01-01

    Healthcare management is one practical tool for mediation and implementation of public health into clinical healthcare outcomes and is taken in our case study as an exemplar arena to demonstrate the vital importance of the person-centered approach. Healthcare personnel are frequently at risk for the 'burn-out' syndrome. However, modern measures of burn-out recognize burn-out only at a late stage when it is fully developed. There are no available methods to assess the risk for vulnerability to burnout in healthcare systems. Our aim was therefore to design a complex person-centered model for detection of high risk for burn-out at an early stage, that has been termed 'flame-out'. We accept the observation that decreased personal performance is one crucial expression of burn-out. Low personal performance and negative emotions are strongly related to low self-directedness as measured by the Temperament and Character Inventory (TCI). At the same time, burn-out is characterized by decreased interest and positive emotions from work. Decreased positive emotion is directly related to low self-transcendence as measured by the TCI. Burn-out is also frequently associated with feelings of social alienation or inadequacy of support, which is in turn related to low TCI Cooperativeness. However, high Persistence and Harm Avoidance are predisposing traits for burn-out in healthcare professionals who are often overly perfectionistic and compulsive, predisposing them to anxiety, depression, suicide and burn-out. Hence, people at risk for future burn-out are often highly conscientious over-achievers with intense mixtures of positive and negative emotions. The high demand for perfection comes from both intrinsic characteristics and from features of the social milieu in their psychological climate. Letting go of the unfulfillable desire to be perfect by increasing self-transcendence allows acceptance of the imperfection of the human condition, thereby preventing burn-out and other

  12. Multiple stakeholder views on changes in delivery of public health nursing services in Ireland.

    Science.gov (United States)

    Hanafin, Sinead; Dwan O'Reilly, Emma

    2015-08-01

    In contrast with community nursing services in the UK and other parts of the world, the public health nursing service in the Republic of Ireland operates as a generalist service, providing both public health and wellbeing services in addition to clinical nursing services to a wide range of patient groups. While much discussion has taken place over the years about the benefits and challenges of a generalist service, little consensus has emerged about whether the current generalist approach should be maintained or whether a more specialised approach is required. This article presents key findings from an evaluation, using research methods, of a community nursing service that was restructured from a generalist, geographically based service, to a more specialist team-based model. The findings across multiple stakeholders show a number of positive effects in the areas of quality, safety, risk, governance, active caseload management, and finances. Some challenges were also identified, particularly with respect to continuity of services, loss of expertise, role of the team leader, and engagement in population-based activities.

  13. PERSONALIZED MEDICINE AS AN UPDATED MODEL OF NATIONAL HEALTH-CARE SYSTEM. PART 2. TOWARDS PUBLIC AND PRIVATE PARTNERSHIPS

    Directory of Open Access Journals (Sweden)

    S. V. Suchkov

    2017-01-01

    Full Text Available The article considers the key problems of the transition of the national health system to a new platform of personalized medicine and,  in particular, pediatrics. In the second part, published in this issue, the main mechanisms for building a new model are analyzed. The main  prerequisites (financial and economic, fundamental research and applied research, the emergence and construction in the structure  of global trends in the development of health care markets, actualized at the end of the last century, are presented. It is indicated  that one of the main incentives for the development of personalized medicine is a noticeable increase in individual and social demand  for preventive drugs and the corresponding tools. The development of programs for managing their own health is gaining in importance,  and new business-development models (including public and private partnerships are being developed and implemented. The evidence  is examined that a progressive scenario for the development of a model of personalized medicine will provide a significant reduction  in the cost of medical care. A large section of the article is devoted to the development of the provision that the understanding and awareness of the importance of the protection and management of one's own health by a modern state, medical audience and individual citizen  is the most important aspect of the educational and educational activities of a doctor and a nurse. The perspectives of personalized  pediatrics as a global instrument for restructuring the entire healthcare system are considered in detail.  

  14. Evaluation of patient’s satisfaction in a public-private health facility in Northeastern Brazil and the judicialization of healthcare

    Directory of Open Access Journals (Sweden)

    SILVA JUNIOR, Geraldo Bezerra

    2016-10-01

    Full Text Available This article aims to analyze the degree of satisfaction of users of a public-private healthcare service in the Northeast of Brazil, as well as their level of knowledge about their rights and about the judicial procedure used to guarantee these rights. The analysis was based on the responses to a questionnaire applied to 67 patients who are users of a healthcare assistance center that is part of the Brazilian National Public Health System, at Universidade de Fortaleza. The users showed satisfaction with the services offered, seeing them as good or excellent. The main problem highlighted was the difficulty of access to medications provided by the public health system and the lack of knowledge on health-related rights. There was a low demand for justice related to health issues; this can be explained by both the low level of knowledge on the rights related to this field and the low educational level of most respondents. The improvement of the degree of satisfaction can help reduce the judicialization, even though more knowledgeable users might become more demanding and appeal more to justice. Alternative solutions for resolving disputes, such as mediation and restorative justice, can help reduce the appeal to justice.

  15. Public Perspectives of Mobile Phones' Effects on Healthcare Quality and Medical Data Security and Privacy: A 2-Year Nationwide Survey.

    Science.gov (United States)

    Richardson, Joshua E; Ancker, Jessica S

    2015-01-01

    Given growing interest in mobile phones for health management (mHealth), we surveyed consumer perceptions of mHealth in security, privacy, and healthcare quality using national random-digit-dial telephone surveys in 2013 and 2014. In 2013, 48% thought that using a mobile phone to communicate data with a physician's electronic health record (EHR) would improve the quality of health care. By 2014, the proportion rose to 57% (p privacy concerns yet nearly two-thirds expressed privacy concerns. In 2013 alone, respondents were more likely to express privacy concerns about medical data on mobile phones than they were to endorse similar concerns with EHRs or health information exchange (HIE). Consumers increasingly believe that mHealth improves healthcare quality, but security and privacy concerns need to be addressed for quality improvement to be fully realized.

  16. Data quality maintenance of the Patient Master Index (PMI): a "snap-shot" of public healthcare facility PMI data quality and linkage activities.

    Science.gov (United States)

    Williams, Kelly; Robinson, Kerin; Toth, Alexandra

    Patient (or person) master index (PMI) data quality activities in public, acute healthcare facilities in the state of Victoria, Australia were evaluated in terms of health information management-information technology best practice including data standards and practice guidelines. The findings indicate that, whilst data quality and linkage activities are undertaken, many are limited in scope or effectiveness. In view of published evidence that: (i) duplicate patient files pose significant risks by reducing information available for clinical decision-making; and (ii) quality and clinical risk management require, as a measurable outcome, continuous monitoring of duplicate files, improvements to PMI data quality practices are recommended.

  17. Healthcare Systems and Other Applications

    NARCIS (Netherlands)

    van Kasteren, T.L.M.; Kröse, B.J.A.

    2007-01-01

    This Works in Progress department discusses eight projects related to healthcare. The first project aims to aid people with mild dementia. The second project plans to simplify the delivery of healthcare services to the elderly and cognitively disabled, while the third project is developing models

  18. Private–public partnerships: A mechanism for freight transport infrastructure delivery?

    Directory of Open Access Journals (Sweden)

    Hans W. Ittmann

    2017-02-01

    Full Text Available Background: Freight transport infrastructure is an indispensable requirement for economic growth, development and prosperity. Public–private partnerships (PPPs, as a mechanism to fund and construct freight transport infrastructure, have been suggested by many in private and public sectors. Objectives: The concept of PPPs is dealt with, and the relevance of this mechanism is expanded upon. It is clear that PPPs in the rail environment present huge challenges and complexities. The objective was to determine whether PPPs are a viable mechanism to fund freight transport infrastructure in South Africa. Method: Experiences with rail PPPs worldwide have shown that many failures occurred implementing these. The challenges and complexities of PPPs, in the freight rail environment, are highlighted together with the benefits, risks and best practices of PPPs. It is shown that suitable policies, legislation and regulations concerning PPPs are in place in South Africa. Results: A proper framework and methodology to proceed should be in place. PPPs take time and are complex. Government involvement remains essential. Firm contractual agreements between parties are essential. Risk handling, risk sharing and the magnitude of risks should be clarified with agreement on where the risks reside. Financial viability, with value for money (VfM and financial benefits for private sector role players are non-negotiable. Conclusion: Appropriate legislation for implementing PPPs must be in place while two further important elements are economic circumstances and proper project execution. Taking all these factors into consideration, the freight transport sector can only benefit from successfully negotiated and implemented PPPs.

  19. Global Fund financing of public-private mix approaches for delivery of tuberculosis care.

    Science.gov (United States)

    Lal, S S; Uplekar, Mukund; Katz, Itamar; Lonnroth, Knut; Komatsu, Ryuichi; Yesudian Dias, Hannah Monica; Atun, Rifat

    2011-06-01

    To map the extent and scope of public-private mix (PPM) interventions in tuberculosis (TB) control programmes supported by the Global Fund. We reviewed the Global Fund's official documents and data to analyse the distribution, characteristics and budgets of PPM approaches within Global Fund supported TB grants in recipient countries between 2003 and 2008. We supplemented this analysis with data on contribution of PPM to TB case notifications in 14 countries reported to World Health Organization in 2009, for the preparation of the global TB control report. Fifty-eight of 93 countries and multi-country recipients of Global Fund-supported TB grants had PPM activities in 2008. Engagement with 'for-profit' private sector was more prevalent in South Asia while involvement of prison health services has been common in Eastern Europe and central Asia. In the Middle East and North Africa, involving non-governmental organizations seemed to be the focus. Average and median spending on PPM within grants was 10% and 5% respectively, ranging from 0.03% to 69% of the total grant budget. In China, India, Nigeria and the Philippines, PPM contributed to detecting more than 25% TB cases while maintaining high treatment success rates. In spite of evidence of cost-effectiveness, PPM constitutes only a modest part of overall TB control activities. Scaling up PPM across countries could contribute to expanding access to TB care, increasing case detection, improving treatment outcomes and help achieve the global TB control targets. © 2011 Blackwell Publishing Ltd.

  20. Trends and correlates of the public's perception of healthcare systems in the European Union: a multilevel analysis of Eurobarometer survey data from 2009 to 2013.

    Science.gov (United States)

    AlSaud, AlJohara M; Taddese, Henock B; Filippidis, Filippos T

    2018-01-08

    The aim of the study is to assess trends in public perceptions of health systems in 27 European Union (EU) member states following the financial crisis (2009-2013), in order to discuss observed changes in the context of the financial crisis. Repeated cross-sectional studies. 27 EU countries. EU citizens aged 15 years and older. The study mainly uses the Eurobarometer Social Climate Survey, conducted annually between 2009 and 2013, thereby analysing 116 706 observations. A multilevel logistic regression was carried out to analyse trends over time and the factors associated with citizens' perceptions of their healthcare systems. Europeans generally exhibit positive perceptions of their national healthcare systems, 64.0% (95% CI 63.6% to 64.4%). However, we observed a significant drop in positive perceptions in the years following the crisis, especially within countries most affected by the crisis. Concerning fiscal characteristics, wealthier countries and those dedicating higher proportion of their national income to health were more likely to maintain positive perceptions. At the individual level, perceptions of healthcare systems were significantly associated with respondents' self-perceptions of their social status, financial capacity and overall satisfaction in life. Our finding confirms previous observations that citizens' perceptions of their healthcare systems may reflect their overall prospects within the broader socioeconomic systems they live in; which have in turn been affected by the financial crisis and the policy measures instituted in response. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  1. [Fact-finding survey on regional healthcare services for patients with epilepsy based on a questionnaire administered to public health centers in Japan].

    Science.gov (United States)

    Fujii, Masami; Ishimaru, Yasutaka; Takahashi, Hiroyuki; Egami, Hirofumi; Nishida, Hideki; Oka, Shinji; Shirabe, Komei

    2015-01-01

    Epilepsy is a common chronic neurological disorder characterized by recurrent unprovoked seizures. The prevalence of epilepsy is about 1%, and its incidence is increasing with the aging population. In addition to their medical problems, epilepsy patients face many social problems, including schooling, working, and maintaining their driver's licenses. However, these problems are not fully recognized by the regional healthcare centers (HCCs), and the inadequacy of collaboration between medical services, healthcare, and welfare is sometimes pointed out. Under these circumstances, this fact-finding survey was administered in the form of a questionnaire to HCCs across the nation for the purpose of improving the support system and educational activities for epilepsy in Japan. A mail-back survey on regional healthcare services for epilepsy patients was sent out to 490 HCCs across the nation. Public health nurses (PHNs) responded to the self-completed questionnaire on behalf of each HCC. The questionnaire was comprised of the presence or absence of consultations on epilepsy, content of the consultations, and holding of workshops, lectures, or conferences in the community covered by the HCC. We obtained responses from 347 HCCs (response rate 71%). Seventy-three percent of the PHNs had experience with consultations regarding the medical and healthcare issues associated with epilepsy. However, only 10% of the PHNs responded that they could provide appropriate consultation for these issues. The content of the consultations mainly included medical services, clinical symptoms of epilepsy, and anxieties about their social life and their future. Workshops, lectures, or conferences on epilepsy were held for residents or health and welfare professionals in only 8% of the communities. This percentage is lower than those (21-70%) for other intractable or mental disorders that are mainly managed by HCCs (Prestrictions. To improve these situations, regional education programs for

  2. Towards an oral healthcare framework and policy analysis for Swaziland

    OpenAIRE

    Mndzebele, Samuel

    2010-01-01

    Background and Rationale: A synopsis by the researcher suggested that caries was becoming a public health problem among the youth, hence there was a need for deeper investigations which would lead to possible oral health interventions. Purpose: The purpose of the study was to assess dental care practices and experiences among teenagers in the Northern region of Swaziland. Based on the outcomes and views from health professionals; develop a framework for oral healthcare delivery and ...

  3. Service delivery through public health care system to control sexually transmitted infections in Himachal pradesh

    Directory of Open Access Journals (Sweden)

    Sunite A Ganju

    2014-01-01

    Full Text Available Introduction: The National AIDS Control Organization has designed multiple synergistic interventions to identify and control curable sexually transmitted infections (STIs. Objective: To assess the impact of services offered at designated STI clinics in the state of Himachal Pradesh, India and the profile of the attending clients. Materials and Methods: This was a two-year prospective study, conducted from April 2011 to March 2013. Training on delivering STI/RTI services was imparted to the staff of 16 designated STI clinics including recording of data. The staff in each STI clinic comprises of one doctor, one counselor, one nurse, and one laboratory technician. The clients attending these designated clinics were offered counseling, syndromic case management (SCM, and diagnostic services wherever possible. Monthly data of STI clinic attendees was collected, compiled, and analyzed. Results: A total of 65,760 clinic visits were reported, of which 32,385 (49% visits were for index STI/RTI complaint(s. The ratio of male to female attendees was 1:2. The commonest age group accessing the STI clinics was 25-44 years (n = 38,966; 59.3%. According to SCM, 52.9% clients were managed. The commonest presenting syndrome was urethral discharge (n = 4,500; 41% in males, and vaginal discharge (n = 13,305; 56% in females. Genital ulcer disease was treated in 2099 cases. Laboratory tests were performed only in 6466 patients, and 39,597 antenatal mothers were screened for syphilis. Counseling services were provided to 51,298 (f = 34,804; 68%: m = 16,494; 32% clients and of these, 48% (n = 25,056 of the clients were referred to integrated counseling and testing centers. Forty-three clients (m = 24: f = 19 were detected positive for HIV infection. Conclusion: Uniform and standardized services delivered to clients attending public health clinics can gather reliable data to monitor trends of STI infection.

  4. Cesarean deliveries and maternal weight retention.

    Science.gov (United States)

    Kapinos, Kandice A; Yakusheva, Olga; Weiss, Marianne

    2017-10-04

    Cesarean delivery accounts for nearly one-third of all births in the U.S. and contributes to an additional $38 billion in healthcare costs each year. Although Cesarean delivery has a long record of improving maternal and neonatal mortality and morbidity, increased utilization over time has yielded public health concerns and calls for reductions. Observational evidence suggests Cesarean delivery is associated with increased maternal postpartum weight, which may have significant implications for the obesity epidemic. Previous literature, however, typically does not address selection biases stemming from correlations of pre-pregnancy weight and reproductive health with Cesarean delivery. We used fetal malpresentation as a natural experiment as it predicts Cesarean delivery but is uncorrelated with pre-pregnancy weight or maternal health. We used hospital administrative data (including fields used in vital birth record) from the state of Wisconsin from 2006 to 2013 to create a sample of mothers with at least two births. Using propensity score methods, we compared maternal weight prior to the second pregnancy of mothers who delivered via Cesarean due to fetal malpresentation to mothers who deliver vaginally. We found no evidence that Cesarean delivery in the first pregnancy causally leads to greater maternal weight, BMI, or movement to a higher BMI classification prior to the second pregnancy. After accounting for correlations between pre-pregnancy weight, gestational weight gain, and mode of delivery, there is no evidence of a causal link between Cesarean delivery and maternal weight retention.

  5. A method for defining value in healthcare using cancer care as a model.

    Science.gov (United States)

    Feeley, Thomas W; Fly, Helen Shafer; Albright, Heidi; Walters, Ronald; Burke, Thomas W

    2010-01-01

    Value-based healthcare delivery is being discussed in a variety of healthcare forums. This concept is of great importance in the reform of the US healthcare delivery system. Defining and applying the principles of value-based competition in healthcare delivery models will permit future evaluation of various delivery applications. However, there are relatively few examples of how to apply these principles to an existing care delivery system. In this article, we describe an approach for assessing the value created when treating cancer patients in a multidisciplinary care setting within a comprehensive cancer center. We describe the analysis of a multidisciplinary care center that treats head and neck cancers, and we attempt to examine how this center integrates with Porter and Teisberg's (2006) concept of value-based competition based on the results analysis. Using the relationship between outcomes and costs as the definition of value, we developed a methodology to analyze proposed outcomes for a population of patients treated using a multidisciplinary approach, and we matched those outcomes to the costs of the care provided. We present this work as a model for defining value for a subset of patients undergoing active treatment. The method can be applied not only to head and neck treatments, but to other modalities as well. Public reporting of this type of data for a variety of conditions can lead to improved competition in the healthcare marketplace and, as a result, improve outcomes and decrease health expenditures.

  6. The Integration of Two Healthcare Systems: A Common Healthcare Problem.

    Science.gov (United States)

    Cassatly, Hannah; Cassatly, Michael

    2015-01-01

    The change in reimbursement mandated by the Affordable Care Act is causing a rapid consolidation of the marketplace as well as the delivery of clinical care in a team-based model. This case report examines the successful joining of two clinical teams concurrent with the merger of two healthcare organizations and discusses some of the difficulties encountered. A subsequent discussion focuses on the resolution: the need for physicians to embrace the team concept of healthcare delivery and for healthcare systems to facilitate this transition with team and leadership coaching.

  7. Assessing spatial access to public and private hospitals in Sichuan, China: The influence of the private sector on the healthcare geography in China.

    Science.gov (United States)

    Pan, Jay; Zhao, Hanqing; Wang, Xiuli; Shi, Xun

    2016-12-01

    In 2009, the Chinese government launched a new round of healthcare reform, which encourages development of private hospitals. Meanwhile, many public hospitals in China also became increasingly profit-oriented. These trends have led to concerns about social justice and regional disparity. However, there is a lack of empirical scientific analysis to support the debate. We started to fill this gap by conducting a regional-level analysis of spatial variation in spatial access to hospitals in the Sichuan Province. Such variation is an important indication of (in) equity in healthcare resource allocation. Using data of 2012, we intended to provide a snapshot of the situation that was a few years later since the new policies had set out. We employed two methods to quantify the spatial access: the nearest-neighbor method and the enhanced two-step floating catchment area (E2SFCA) method. We recognized two sub-regions of Sichuan: the rural West Sichuan and the well-developed East Sichuan. We classified the hospitals using both ownership and level. We applied the analysis to the resulting groups of hospitals and their combinations in the two sub-regions. The two sub-regions have a high contrast in the spatial access to hospitals, in terms of both quantity and spatial pattern. Public hospitals still dominated the service in the province, especially in the West Sichuan, which had been solely relying on public hospitals. Private hospitals only occurred in the East Sichuan, and at the primary level, they had surpassed public hospitals in terms of spatial accessibility. However, the governmental health expenditures seemed to be disconnected with the actual situation of the spatial access to hospitals. The government should continue carrying on its responsibility in allocating healthcare resources, be cautious about marketizing public hospitals, and encourage private hospitals to expand into rural areas. Methodologically, the results from the two methods are concurring but not

  8. Training of professionals in post-graduation courses in public health and primary healthcare in the municipality of Rio de Janeiro, Brazil.

    Science.gov (United States)

    Engstrom, Elyne Montenegro; Motta, José Inácio; Venâncio, Sandra Aparecida

    2016-05-01

    This paper examines post-graduation professional training and qualification courses in the fields of public health and primary healthcare. Its aim is to reflect on the construction and methodological proposal of two courses given by ENSP/Fiocruz in partnership with the Municipality of Rio de Janeiro, over the years 2010 to 2014: The Professional Master's Degree in Primary Healthcare (MPAPS), and Specialization in Public Health. Systematization of academic documents of the courses, with preparation of emerging analytical categories (theoretical management-interface history, field of pedagogy). Two classes of the MPAPS course (n=24 students per group) and five of the Specialization course (average 30 per group) were held in the period, with approval rates at the 90%-80% level, with curriculum structure adjusted to the local situation. As challenges that were implemented, we highlight: 1) On the epistemological level: development of competencies for professional training that would produce results coherent with health, as social/cultural production; 2) from the learning point of view: preparation of dynamics that give value to the students, their social-cultural context and experiences; 3) work environments and relationships, bringing their structured analysis into the learning environment.

  9. [The interface of public healthcare with the health of the oceans: proliferation of disease, socio-economic impacts and beneficial relationships].

    Science.gov (United States)

    de Moura, Jailson Fulgencio; Cardozo, Marcelo; Belo, Mariana Soares da Silva Peixoto; Hacon, Sandra; Siciliano, Salvatore

    2011-08-01

    Over the past decades, human activities have had a heavy impact on the marine environment, causing alterations in ecological processes. The relationship between the health of the oceans, human activities and public healthcare is already generally accepted, though the mechanisms involved are still under scientific scrutiny. These relationships include a focus on climate change, toxic algal blooms, microbial and chemical contamination in marine waters and bioinvasion by exotic species. Moreover, there is the beneficial effect of the oceans on human health and wellbeing, such as natural products for the human diet, the development of biomedicine, or simply the satisfaction derived from human recreation, sports and other interactions of humans with oceans. The importance of appreciating the link between public healthcare and the health of the oceans is especially important due to the growing number of people living in coastal areas, mainly in tropical and subtropical regions. The backcloth to this is risk-related human activities that pose a danger to marine environmental health and the increase in the vulnerability of humans and biodiversity and socio-environmental iniquity.

  10. Service quality benchmarking via a novel approach based on fuzzy ELECTRE III and IPA: an empirical case involving the Italian public healthcare context.

    Science.gov (United States)

    La Fata, Concetta Manuela; Lupo, Toni; Piazza, Tommaso

    2017-11-21

    A novel fuzzy-based approach which combines ELECTRE III along with the Importance-Performance Analysis (IPA) is proposed in the present work to comparatively evaluate the service quality in the public healthcare context. Specifically, ELECTRE III is firstly considered to compare the service performance of examined hospitals in a noncompensatory manner. Afterwards, IPA is employed to support the service quality management to point out improvement needs and their priorities. The proposed approach also incorporates features of the Fuzzy Set Theory so as to address the possible uncertainty, subjectivity and vagueness of involved experts in evaluating the service quality. The model is applied to five major Sicilian public hospitals, and strengths and criticalities of the delivered service are finally highlighted and discussed. Although several approaches combining multi-criteria methods have already been proposed in the literature to evaluate the service performance in the healthcare field, to the best of the authors' knowledge the present work represents the first attempt at comparing service performance of alternatives in a noncompensatory manner in the investigated context.

  11. Healthcare waste management: current practices in selected healthcare facilities, Botswana.

    Science.gov (United States)

    Mbongwe, Bontle; Mmereki, Baagi T; Magashula, Andrew

    2008-01-01

    Healthcare waste management continues to present an array of challenges for developing countries, and Botswana is no exception. The possible impact of healthcare waste on public health and the environment has received a lot of attention such that Waste Management dedicated a special issue to the management of healthcare waste (Healthcare Wastes Management, 2005. Waste Management 25(6) 567-665). As the demand for more healthcare facilities increases, there is also an increase on waste generation from these facilities. This situation requires an organised system of healthcare waste management to curb public health risks as well as occupational hazards among healthcare workers as a result of poor waste management. This paper reviews current waste management practices at the healthcare facility level and proposes possible options for improvement in Botswana.

  12. Direct healthcare cost of obesity in brazil: an application of the cost-of-illness method from the perspective of the public health system in 2011.

    Science.gov (United States)

    de Oliveira, Michele Lessa; Santos, Leonor Maria Pacheco; da Silva, Everton Nunes

    2015-01-01

    Obesity is a global public health problem and a risk factor for several diseases that financially impact healthcare systems. To estimate the direct costs attributable to obesity (body mass index {BMI} ≥ 30 kg/m2) and morbid obesity (BMI ≥ 40 kg/m2) in adults aged ≥ 20 incurred by the Brazilian public health system in 2011. Public hospitals and outpatient care. A cost-of-illness method was adopted using a top-down approach based on prevalence. The proportion of the cost of each obesity-associated comorbidity was calculated and obesity prevalence was used to calculate attributable risk. Direct healthcare cost data (inpatient care, bariatric surgery, outpatient care, medications and diagnostic procedures) were extracted from the Ministry of Health information systems, available on the web. Direct costs attributable to obesity totaled US$ 269.6 million (1.86% of all expenditures on medium- and high-complexity health care). The cost of morbid obesity accounted for 23.8% (US$ 64.2 million) of all obesity-related costs despite being 18 times less prevalent than obesity. Bariatric surgery costs in Brazil totaled US$ 17.4 million in 2011. The cost of morbid obesity in women was five times higher than it was in men. The cost of morbid obesity was found to be proportionally higher than the cost of obesity. If the current epidemic were not reversed, the prevalence of obesity in Brazil will increase gradually in the coming years, as well as its costs, having serious implications for the financial sustainability of the Brazilian public health system.

  13. 45 CFR 61.9 - Reporting civil judgments related to the delivery of a health care item or service.

    Science.gov (United States)

    2010-10-01

    ... 45 Public Welfare 1 2010-10-01 2010-10-01 false Reporting civil judgments related to the delivery of a health care item or service. 61.9 Section 61.9 Public Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION HEALTHCARE INTEGRITY AND PROTECTION DATA BANK FOR FINAL ADVERSE INFORMATION...

  14. How do healthcare consumers process and evaluate comparative healthcare information? A qualitative study using cognitive interviews.

    NARCIS (Netherlands)

    Damman, O.C.; Hendriks, M.; Rademakers, J.; Delnoij, D.; Groenewegen, P.

    2009-01-01

    Background: To date, online public healthcare reports have not been effectively used by consumers. Therefore, we qualitatively examined how healthcare consumers process and evaluate comparative healthcare information on the Internet. Methods: Using semi-structured cognitive interviews, interviewees

  15. How do healthcare consumers process and evaluate comparative healthcare information? A qualitive study using cognitive interviews

    NARCIS (Netherlands)

    Damman, O.C.; Hendriks, M.; Rademakers, J.; Delnoij, D.M.J.; Groenewegen, P.P.

    2009-01-01

    Background: To date, online public healthcare reports have not been effectively used by consumers. Therefore, we qualitatively examined how healthcare consumers process and evaluate comparative healthcare information on the Internet. Methods: Using semi-structured cognitive interviews, interviewees

  16. The Effects of Public Concern for Information Privacy on the Adoption of Health Information Exchanges (HIEs) by Healthcare Entities.

    Science.gov (United States)

    Esmaeilzadeh, Pouyan

    2018-05-08

    The implementation of Health Information Exchanges (HIEs) by healthcare organizations may not achieve the desired outcomes as consumers may request that their health information remains unshared because of information privacy concerns. Drawing on the insights of concern for information privacy (CFIP) literature, this work extends the application of CFIP to the HIE domain. This study attempts to develop and test a model centered on the four dimensions of CFIP construct (collection, errors, unauthorized access, and secondary use) and their antecedents to predict consumers' opt-in behavioral intention toward HIE in the presence of the perceived health status' effects. We conducted an online survey in the United States using 826 samples. The results demonstrate that the perceived health information sensitivity and computer anxiety meaningfully contribute to information privacy concerns and CFIP construct significantly impedes consumers' opt-in decision to HIEs. Interestingly, contrary to our expectation, perceived poor health status considerably attenuates the negative effects exerted by CFIP on opt-in intention. The model proposed by this study can be used as a useful conceptual tool by both further studies and practitioners to examine the complex nature of patients' reactions to information privacy threats associated with the use of HIE technology in the healthcare industry.

  17. Ongoing Initiatives to Improve the Quality and Efficiency of Medicine Use within the Public Healthcare System in South Africa; A Preliminary Study

    Directory of Open Access Journals (Sweden)

    Johanna C. Meyer

    2017-11-01

    Full Text Available Introduction: South Africa has an appreciable burden of both communicable and non-communicable diseases as well as high maternal, neonatal, and child morbidity. In recent years there have been significant strides with improving the public health system, and addressing current inequalities, with the right to health a constitutional provision in South Africa. Initiatives include the introduction of National Health Insurance, programmes to enhance access to medicines for patients with chronic diseases, as well as activities to improve care in hospitals, including improving pharmacovigilance. Consequently, the objective of this paper is to review ongoing initiatives within the public healthcare sector in South Africa and their influence to provide future direction.Method: Principally a structured review of current and planned activities.Results: There have been a number of major activities and initiatives surrounding the availability and access to medicines in the public system in recent years in South Africa. This includes a National Surveillance Centre and an innovative early warning system for the supply of medicines as well as the development of a National Health Care Pricing Authority and initiatives to improve contracting. There have also been developments to improve the supply chain including instigating Medicine Procurement Units in the provinces and enhancing forecasting capabilities. Access to medicines is improving though the instigation of stable chronic disease management initiatives to increase the number of external pick-up points for medicines. There are also ongoing programmes to enhance adherence to medicines as well as enhance adherence to the Standard Treatment Guidelines and the Essential Medicines List with their increasing availability. In addition, there is a movement to enhance the role of health technology assessment in future decision making. Hospital initiatives include increased focus on reducing antimicrobial resistance

  18. Facilities Management Service Delivery in Public and Private High Rise Residential Buildings in Nigeria: A case study of Eko Court Complex and Niger Towers

    Directory of Open Access Journals (Sweden)

    Olanrele O. O.

    2014-01-01

    Full Text Available This study assessed and compared the delivery of Facilities Management (FM services in public and private high rise residential buildings in Lagos, Nigeria. While some facilities or services may not be available in some public estates, the efficiency of the available ones is inadequate in comparison with the adequacy and efficiency of services provided in private estates. The objectives set for the study include identification of services that are provided in the case studies, service delivery method, and an assessment of the residents’ satisfaction of the services. This study adopted questionnaire survey for collection of data. 127 questionnaires were distributed to the residents of the case studies and 93 were returned. Three of which were discarded for incompleteness, thus 90 were analysed. The study found that most but not all of the facilities services expected in high rise buildings are available in the case studies and the services are outsourced under a standard Service Level Agreement. The service delivery in private high rise residential building is better than the public residential high rise buildings as revealed by the study. The study recommends improved standardization of services, customized services and meeting customer’s expectation for improved service delivery.

  19. Supporting the delivery of cost-effective interventions in primary health-care systems in low-income and middle-income countries: an overview of systematic reviews.

    Science.gov (United States)

    Lewin, Simon; Lavis, John N; Oxman, Andrew D; Bastías, Gabriel; Chopra, Mickey; Ciapponi, Agustín; Flottorp, Signe; Martí, Sebastian García; Pantoja, Tomas; Rada, Gabriel; Souza, Nathan; Treweek, Shaun; Wiysonge, Charles S; Haines, Andy

    2008-09-13

    Strengthening health systems is a key challenge to improving the delivery of cost-effective interventions in primary health care and achieving the vision of the Alma-Ata Declaration. Effective governance, financial and delivery arrangements within health systems, and effective implementation strategies are needed urgently in low-income and middle-income countries. This overview summarises the evidence from systematic reviews of health systems arrangements and implementation strategies, with a particular focus on evidence relevant to primary health care in such settings. Although evidence is sparse, there are several promising health systems arrangements and implementation strategies for strengthening primary health care. However, their introduction must be accompanied by rigorous evaluations. The evidence base needs urgently to be strengthened, synthesised, and taken into account in policy and practice, particularly for the benefit of those who have been excluded from the health care advances of recent decades.

  20. Impact of Affirmative Action on Quality of Service Delivery in the Public Service Sector of Kenya: A Comparative Case Study of the Ministry of State in the Office of the President and Ministry of Higher Education

    Science.gov (United States)

    Kilonzo, Evans Mbuthi; Ikamari, Lawrence

    2015-01-01

    This study was carried out to determine the impact of affirmative action policy on the quality service delivery in the public service sector of Kenya. The study was carried out on the premise that there is a relationship between affirmative Action implementation and the quality of service delivery in the public service sector of Kenya. A lot of…

  1. Towards an information strategy for combating identity fraud in the public domain: Cases from healthcare and criminal justice

    NARCIS (Netherlands)

    Plomp, M.G.A.; Grijpink, J.H.A.M.

    2011-01-01

    Two trends are present in both the private and public domain: increasing interorganisational co-operation and increasing digitisation. More and more processes within and between organisations take place electronically, on local, national and European scale. The technological and organisational

  2. Balancing influence between actors in healthcare decision making.

    Science.gov (United States)

    Kaplan, Robert M; Babad, Yair M

    2011-04-19

    Healthcare costs in most developed countries are not clearly linked to better patient and public health outcomes, but are rather associated with service delivery orientation. In the U.S. this has resulted in large variation in healthcare availability and use, increased cost, reduced employer participation in health insurance programs, and reduced overall population health outcomes. Recent U.S. healthcare reform legislation addresses only some of these issues. Other countries face similar healthcare issues. A major goal of healthcare is to enhance patient health outcomes. This objective is not realized in many countries because incentives and structures are currently not aligned for maximizing population health. The misalignment occurs because of the competing interests between "actors" in healthcare. In a simplified model these are individuals motivated to enhance their own health; enterprises (including a mix of nonprofit, for profit and government providers, payers, and suppliers, etc.) motivated by profit, political, organizational and other forces; and government which often acts in the conflicting roles of a healthcare payer and provider in addition to its role as the representative and protector of the people. An imbalance exists between the actors, due to the resources and information control of the enterprise and government actors relative to the individual and the public. Failure to use effective preventive interventions is perhaps the best example of the misalignment of incentives. We consider the current Pareto efficient balance between the actors in relation to the Pareto frontier, and show that a significant change in the healthcare market requires major changes in the utilities of the enterprise and government actors. A variety of actions are necessary for maximizing population health within the constraints of available resources and the current balance between the actors. These actions include improved transparency of all aspects of medical decision

  3. Partnered research in healthcare delivery redesign for high-need, high-cost patients: development and feasibility of an Intensive Management Patient-Aligned Care Team (ImPACT).

    Science.gov (United States)

    Zulman, Donna M; Ezeji-Okoye, Stephen C; Shaw, Jonathan G; Hummel, Debra L; Holloway, Katie S; Smither, Sasha F; Breland, Jessica Y; Chardos, John F; Kirsh, Susan; Kahn, James S; Asch, Steven M

    2014-12-01

    We employed a partnered research healthcare delivery redesign process to improve care for high-need, high-cost (HNHC) patients within the Veterans Affairs (VA) healthcare system. Health services researchers partnered with VA national and Palo Alto facility leadership and clinicians to: 1) analyze characteristics and utilization patterns of HNHC patients, 2) synthesize evidence about intensive management programs for HNHC patients, 3) conduct needs-assessment interviews with HNHC patients (n = 17) across medical, access, social, and mental health domains, 4) survey providers (n = 8) about care challenges for HNHC patients, and 5) design, implement, and evaluate a pilot Intensive Management Patient-Aligned Care Team (ImPACT) for a random sample of 150 patients. HNHC patients accounted for over half (52 %) of VA facility patient costs. Most (94 %) had three or more chronic conditions, and 60 % had a mental health diagnosis. Formative data analyses and qualitative assessments revealed a need for intensive case management, care coordination, transitions navigation, and social support and services. The ImPACT multidisciplinary team developed care processes to meet these needs, including direct access to team members (including after-hours), chronic disease management protocols, case management, and rapid interventions in response to health changes or acute service use. Two-thirds of invited patients (n = 101) enrolled in ImPACT, 87 % of whom remained actively engaged at 9 months. ImPACT is now serving as a model for a national VA intensive management demonstration project. Partnered research that incorporated population data analysis, evidence synthesis, and stakeholder needs assessments led to the successful redesign and implementation of services for HNHC patients. The rigorous design process and evaluation facilitated dissemination of the intervention within the VA healthcare system. Employing partnered research to redesign care for high-need, high

  4. Communication with the public in the health-care system: a descriptive study of the use of social media in Local Health Authorities and public hospitals in Italy

    Directory of Open Access Journals (Sweden)

    Marina Vanzetta

    2014-06-01

    Full Text Available INTRODUCTION. In 2010 the Italian Ministry of Health set out recommendations for the use of social technology and Web 2.0, inviting organisations within the Italian national health service (Servizio Sanitario Nazionale, SSN to equip themselves with instruments. Objectives. 1. to ascertain how many local health authorities (Aziende Sanitarie Locali, ASL and public hospitals have a presence on the most widely used social media websites in Italy: Facebook, Twitter and YouTube; 2. to find out how well the Facebook, Twitter and YouTube pages of ASLs and public hospitals are known among the general population; 3. to find out how ASLs and public hospitals engage with the general public on social media sites. MATERIALS AND METHODS. The websites of all ASLs and public hospitals across the country were visited to look for the icons of the social media sites under examination. The data considered were publicly available upon access. RESULTS. A total of 245 websites were analysed. 7.34% ASLs and hospitals had social media accounts. 8 organisations had an account on all three of the social media sites considered in the study. CONCLUSIONS. The results show a low presence of ASLs and hospitals on social media. Other studies are needed in this field.

  5. Communication with the public in the health-care system: a descriptive study of the use of social media in local health authorities and public hospitals in Italy.

    Science.gov (United States)

    Vanzetta, Marina; Vellone, Ercole; Dal Molin, Alberto; Rocco, Gennaro; De Marinis, Maria Grazia; Rosaria, Alvaro

    2014-01-01

    In 2010 the Italian Ministry of Health set out recommendations for the use of social technology and Web 2.0, inviting organisations within the Italian national health service (Servizio Sanitario Nazionale, SSN) to equip themselves with instruments. 1. to ascertain how many local health authorities (Aziende Sanitarie Locali, ASL) and public hospitals have a presence on the most widely used social media websites in Italy: Facebook, Twitter and YouTube; 2. to find out how well the Facebook, Twitter and YouTube pages of ASLs and public hospitals are known among the general population; 3. to find out how ASLs and public hospitals engage with the general public on social media sites. The websites of all ASLs and public hospitals across the country were visited to look for the icons of the social media sites under examination. The data considered were publicly available upon access. A total of 245 websites were analysed. 7.34% ASLs and hospitals had social media accounts. 8 organisations had an account on all three of the social media sites considered in the study. The results show a low presence of ASLs and hospitals on social media. Other studies are needed in this field.

  6. Experiences of Healthcare Professionals to the Introduction in Sweden of a Public eHealth Service: Patients' Online Access to their Electronic Health Records.

    Science.gov (United States)

    Ålander, Ture; Scandurra, Isabella

    2015-01-01

    Patients' increasing demands for medical information, the digitization of health records and the fast spread of Internet access form a basis of introducing new eHealth services. An international trend is to provide access for patients to health information of various kind. In Sweden, access by patients to their proper electronic health record (EHR) has been provided in a pilot county since November 2012. This eHealth service is controversial and criticism has arised from the clinical professions, mainly physicians. Two web surveys were conducted to discover whether the opinions of healthcare professionals differ; between staff that have had experience with patients accessing their own EHR and those who have no such expericence. Experienced nurses found the EHR more important for the patients and a better reform, compared to unexperienced nurses in the rest of the country. Similarly, physicians with their own experience had a more positive attitude compared to non-experienced physicians. The conclusion of this study is that healthcare professionals must be involved in the implementation of public eHealth services such as EHRs and that real experiences of the professionals should be better disseminated to their inexperienced peers.

  7. Effect of Government-Community Healthcare Co-Financing on ...

    African Journals Online (AJOL)

    BACKGROUND: Effective maternal and child healthcare delivery requires a proper and adequate funding of the health sector. OBJECTIVE: To determine the effect of government-community healthcare co-financing on maternal and child healthcare services' delivery. METHODS: A descriptive, cross-sectional study with an ...

  8. [The use of benchmarking to manage the healthcare supply chain: effects on purchasing cost and quality].

    Science.gov (United States)

    Naranjo-Gil, David; Ruiz-Muñoz, David

    2015-01-01

    Healthcare supply expenses consume a large part of the financial resources allocated to public health. The aim of this study was to analyze the use of a benchmarking process in the management of hospital purchases, as well as its effect on product cost reduction and quality improvement. Data were collected through a survey conducted in 29 primary healthcare districts from 2010 to 2011, and through a healthcare database on the prices, quality, delivery time and supplier characteristics of 5373 products. The use of benchmarking processes reduced or eliminated products with a low quality and high price. These processes increased the quality of products by 10.57% and reduced their purchase price by 28.97%. The use of benchmarking by healthcare centers can reduce expenditure and allow more efficient management of the healthcare supply chain. It also facilitated the acquisition of products at lower prices and higher quality. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.

  9. Lean healthcare.

    Science.gov (United States)

    Weinstock, Donna

    2008-01-01

    As healthcare organizations look for new and improved ways to reduce costs and still offer quality healthcare, many are turning to the Toyota Production System of doing business. Rather than focusing on cutting personnel and assets, "lean healthcare" looks to improve patient satisfaction through improved actions and processes.

  10. Assessing the capacity of the healthcare system to use additional mechanical ventilators during a large-scale public health emergency (PHE)

    Science.gov (United States)

    Ajao, Adebola; Nystrom, Scott V.; Koonin, Lisa M.; Patel, Anita; Howell, David R.; Baccam, Prasith; Lant, Tim; Malatino, Eileen; Chamberlin, Margaret; Meltzer, Martin I.

    2015-01-01

    A large-scale Public Health Emergency (PHE), like a severe influenza pandemic can generate large numbers of critically ill patients in a short time. We modeled the number of mechanical ventilators that could be used in addition to the number of hospital-based ventilators currently in use. We identified key components of the healthcare system needed to deliver ventilation therapy, quantified the maximum number of additional ventilators that each key component could support at various capacity levels (i.e. conventional, contingency and crisis) and determined the constraining key component at each capacity level. Our study results showed that U.S. hospitals could absorb between 26,200 and 56,300 additional ventilators at the peak of a national influenza pandemic outbreak with robust pre-pandemic planning. This methodology could be adapted by emergency planners to determine stockpiling goals for critical resources or identify alternatives to manage overwhelming critical care need. PMID:26450633

  11. Gene by Environment Research to Prevent Externalizing Problem Behavior : Ethical Questions Raised from a Public Healthcare Perspective

    NARCIS (Netherlands)

    Chhangur, Rabia R.; Weeland, Joyce; Matthys, Walter; Overbeek, Geertjan

    2015-01-01

    The main public health advantages of examining gene by environment interactions (i.e., G x E) in externalizing behavior lie in the realm of personalized interventions. Nevertheless, the incorporation of genetic data in randomized controlled trials is fraught with difficulties and raises ethical

  12. Gene by environment research to prevent externalizing problem behavior: Ethical questions raised from a public healthcare perspective

    NARCIS (Netherlands)

    Chhangur, R.R.; Weeland, J.; Matthys, W.; Overbeek, G.

    2015-01-01

    The main public health advantages of examining gene by environment interactions (i.e., G × E) in externalizing behavior lie in the realm of personalized interventions. Nevertheless, the incorporation of genetic data in randomized controlled trials is fraught with difficulties and raises ethical

  13. What Surgical Education the Speciality Offers? Perception of Role of Oral and Maxillofacial Surgery by 1200 Healthcare Professionals, Students and the General Public in Hyderabad, India.

    Science.gov (United States)

    Vadepally, Ashwant Kumar; Sinha, Ramen

    2018-06-01

    To investigate the perception of Oral and maxillofacial surgery by healthcare professionals, students and general public. A questionnaire form was created that listed ten clinical situations, and given by hand to 1200 individuals, divided into six groups: group 1, medical professionals; group 2, Specialties of dentistry; group 3, general dentists; group 4, medical students; group 5, dental students; and group 6, general public, each comprising 200 individuals. Respondents were asked to indicate who they would expect to treat them if they had one of the specified conditions listed in the questionnaire. We present the results and current awareness levels of this simple questionnaire. The present study addresses the common issue raised by many authors, 'What surgical education the speciality offers?' especially to medical professionals, medical students and general public to enhance an appropriate referral. Most of the respondents in groups 2, 3 and 5 agreed that specific conditions listed in the questionnaire were within the domain of oral and maxillofacial surgery, but such response was not seen in groups 1, 4 and 6 ( p  oral and maxillofacial surgery was found to be 50.2%. The onus of creating and improving the awareness and perception of our specialty lies on oral and maxillofacial surgeon. Unified efforts at individual as well as global level will help achieve this goal.

  14. The INCENTIVE protocol: an evaluation of the organisation and delivery of NHS dental healthcare to patients—innovation in the commissioning of primary dental care service delivery and organisation in the UK

    Science.gov (United States)

    Pavitt, Sue H; Baxter, Paul D; Brunton, Paul A; Douglas, Gail; Edlin, Richard; Gibson, Barry J; Godson, Jenny; Hall, Melanie; Porritt, Jenny; Robinson, Peter G; Vinall, Karen; Hulme, Claire

    2014-01-01

    Introduction In England, in 2006, new dental contracts devolved commissioning of dental services locally to Primary Care Trusts to meet the needs of their local population. The new national General Dental Services contracts (nGDS) were based on payment for Units of Dental Activity (UDAs) awarded in three treatment bands based on complexity of care. Recently, contract currency in UK dentistry is evolving from UDAs based on volume and case complexity towards ‘blended contracts’ that include incentives linked with key performance indicators such as quality and improved health outcome. Overall, evidence of the effectiveness of incentive-driven contracting of health providers is still emerging. The INCENTIVE Study aims to evaluate a blended contract model (incentive-driven) compared to traditional nGDS contracts on dental service delivery in practices in West Yorkshire, England. Methods and analysis The INCENTIVE model uses a mixed methods approach to comprehensively evaluate a new incentive-driven model of NHS dental service delivery. The study includes 6 dental surgeries located across three newly commissioned dental practices (blended contract) and three existing traditional practices (nGDS contracts). The newly commissioned practices have been matched to traditional practices by deprivation index, age profile, ethnicity, size of practice and taking on new patients. The study consists of three interlinked work packages: a qualitative study to explore stakeholder perspectives of the new service delivery model; an effectiveness study to assess the INCENTIVE model in reducing the risk of and amount of dental disease and enhance oral health-related quality of life in patients; and an economic study to assess cost-effectiveness of the INCENTIVE model in relation to clinical status and oral health-related quality of life. Ethics and dissemination The study has been approved by NRES Committee London, Bromley. The results of this study will be disseminated at national

  15. Engaging the public in healthcare decision-making: results from a Citizens' Jury on emergency care services.

    Science.gov (United States)

    Scuffham, P A; Moretto, N; Krinks, R; Burton, P; Whitty, J A; Wilson, A; Fitzgerald, G; Littlejohns, P; Kendall, E

    2016-11-01

    Policies addressing ED crowding have failed to incorporate the public's perspectives; engaging the public in such policies is needed. This study aimed at determining the public's recommendations related to alternative models of care intended to reduce crowding, optimising access to and provision of emergency care. A Citizens' Jury was convened in Queensland, Australia, to consider priority setting and resource allocation to address ED crowding. Twenty-two jurors were recruited from the electoral roll, who were interested and available to attend the jury from 15 to 17 June 2012. Juror feedback was collected via a survey immediately following the end of the jury. The jury considered that all patients attending the ED should be assessed with a minority of cases diverted for assistance elsewhere. Jurors strongly supported enabling ambulance staff to treat patients in their homes without transporting them to the ED, and allowing non-medical staff to treat some patients without seeing a doctor. Jurors supported (in principle) patient choice over aspects of their treatment (when, where and type of health professional) with some support for patients paying towards treatment but unanimous opposition for patients paying to be prioritised. Most of the jurors were satisfied with their experience of the Citizens' Jury process, but some jurors perceived the time allocated for deliberations as insufficient. These findings suggest that the general public may be open to flexible models of emergency care. The jury provided clear recommendations for direct public input to guide health policy to tackle ED crowding. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.