Exploring quality perceptions of health care operations: a study of public hospitals of Mauritius

Patient care has become increasingly important in the health care environment of Mauritius. Patients' satisfaction and their expectations of health care are valid indicators of quality health care. The present paper reports the results of a survey of patient satisfaction with heath care, administered by face-to-face interview to 300 in-patient adults discharged from five main regional hospitals based in Mauritius. It examines the predictors and level of patients' satisfaction across the five regional hospitals of Mauritius. In this study, a modified version of HEALTHQUAL scale was used for determining patient satisfaction with health care in the regional public hospitals. Multiple regression analysis was conducted to understand the relationships among patients' perceptions of in-patient services and their overall perceptions of health care quality, and also satisfaction with their care and willingness to return or recommend the same hospital's services to others. The dimensions labelled as "Patients' perceptions of ward/hospital environment" and "Patients' perceptions of medical and nursing staff" served a significant impact on nearly all measures of patient satisfaction in the regional public hospitals of Mauritius.     

The competitive solution and the health care problems of today

Mark Pauly claims that a "competitive" health care system will solve the health care cost crisis. This article examines how well the competitive solution deals with the five central problems of the health care system: (1) almost universal lack of adequate health insurance for nursing homes and home care; (2) Medicaid's penurious approach to payment for health services for the poor; (3) the emergence of a dual health care system, especially for children; (4) the entrenched waste and inefficiency of the health care system; and (5) consumers' inability to judge the quality of health care. The competitive solution does not eliminate any of these problems--and may not even improve some of them.     

养老护理人员胜任素质指标体系构建与应用——基于396名养老护理人员的调查

随着我国人口老龄化步伐的加快,如何完善养老服务体系,提供社会化、多层次养老服务成为我国当前亟待解决的社会热点问题。提高养老护理人员素质和保障服务水平,是推进我国养老服务体系发展的关键。构建养老护理人员胜任素质指标体系,能够为政府部门制定养老护理人员培育政策及其职业生涯发展提供指导、为加强养老服务人力资源开发与管理提供科学的依据。以胜任素质模型为理论依据,运用文献回顾、行为事件访谈法编制养老护理人员调查量表,针对济南、青岛6家养老机构396名养老护理人员的问卷调查数据,采用探索性因子分析和结构方程模型,构建并检验了养老护理人员的胜任素质指标体系。研究结果表明:养老护理人员胜任素质指标体系主要由护理基本知识、照护技能、个人特质、职业道德与认同感4个维度的26项胜任素质特征构成。从每个维度的影响效应分析,影响最大的是照护技能,其后依次为护理基本知识、个人特质、职业道德与认同感。基于该指标体系,分别从完善养老护理人员的招聘选拔机制、培训机制、考核激励机制三方面提出了拓宽招聘渠道扩大招聘群体、设置合理选拨标准、加强培训内容开发、增设培训可选择方案及实景模拟评价方式等养老护理人员胜任素质提升路径。     

A dynamic forecasting model for nursing manpower requirements in the medical service industry

Today there is an increasing demand for quality health care throughout the world. Such demand requires the medical service industry to equip with high technologies and high caliber professionals (e.g., doctors and nurses), to contain cost and improve quality of care. Since the medical service industry constantly suffers from the shortage of nursing manpower, forecasting the supply and demand of nursing manpower is an important issue. This study proposes a forecasting model for nursing manpower requirement using system dynamics. Data were collected from authorized institutions in Korea and were used as inputs of the model. The results show that the demand for nursing manpower exceeded the supply during the forecasting period (2006–2020), which requires both national and the medical service industry attention for sustained quality health care.     

Fracture incidence among elderly people in institutional care: linking injury surveillance data with a postal code-based register of residential and nursing homes

Fracture prevention strategies will be most cost-effective if targeted at groups of frail elderly people who are at particularly high risk of falls and fractures. Elderly people living in residential and nursing homes are one potential target population, but fracture incidence in this setting remains poorly defined in many countries. We have used the All Wales Injury Surveillance System (AWISS) in a population-based study of people aged over 65 living in the city of Cardiff. We linked a postal code-based register of all care homes in the city with injury data from Cardiff’s only Accident and Emergency department. Cardiff has 47,520 residents aged over 65, and 1,874 (3.9%) live in residential or nursing homes. Fracture incidence was 25/1,000/year overall, and 5/1,000/year for hip fracture. During 1997, the care home residents suffered 162 fractures, 82 of which were of the hip; an incidence of 86/1,000/year overall, 44/1,000/year for hip fracture. Even after adjustment for the age and sex profile of the care home population, fracture incidence remained 2.3 times higher and hip fracture incidence 3.6 times higher than in the general elderly population. Such figures support the potential cost-effectiveness of strategies that prevent fractures in care homes, and are of special interest to those planning intervention studies in this setting.     

Consumer Preferences for Health Care Reform Options

This study uses the 1992 Health and Retirement Study to examine consumer preferences for four health care reform options: tax-financed national health insurance, personally subsidized Medicare extensions, publicly subsidized nursing home insurance, and tax credits for health insurance purchases. Males, non-Caucasians, the self-employed, those in excellent health, and those who reside in the Northeast favor national health insurance, while those with high levels of liquid and non-liquid assets tend to disfavor it. Males and those with higher expectations of living in nursing homes tend to favor personally subsidized Medicare extensions to cover nursing homes and home health care. Those with higher expectations of living in nursing homes also favor publicly subsidized nursing home insurance. Relatively little support for subsidized nursing home insurance is found among males and those with high levels of liquid and non-liquid assets. The self-employed tend to support tax credits for health insurance premiums.     

Reconstructing consumer participation in evidence‐based health care: a polemic

Consumer participation in the evidence‐based health‐care movement is largely seen as important by those who promote evidence‐based health care but is surrounded by a range of competing discourses that variously critique medicine, nursing or health‐care systems; situate consumers as powerless players within systems characterized by controlling health professionals; or politicize the role of the consumer as activist and defender of patient rights. This paper explores these competing discourses and develops an argument that asserts that the social construction of the evidence‐based movement has rendered previously accepted terminology regarding the user or receiver of health services relatively meaningless. The result has been the ‘politicisation’ and ‘professionalisation’ of consumer participation and the time has come to reconstruct consumer participation in evidence‐based health care – from the generation of evidence to guideline development.     

Ethics and politics of resource allocation: The role of nursing

The use of ethics in everyday nursing practice will become increasingly important to the individual nurse, and nursing as a profession, as technology has a greater impact on health status and the provision of health care. Resource allocation is only one example of an ethical issue in which nursing must have input. Nursing can expand its contribution to society by ensuring that it plays a major role in shaping public policy and legislation. If nursing is to continue to serve the public, the involvement of nurses within the political process must be accepted as an ethical necessity.Margaret Keatings, RN, MHSc, is the Director, Nursing Practice in the Department of Medicine at Toronto General Hospital. She combines this role with a strong interest in biomedical ethics to serve as co-chair of the hospital's clinical ethics committee. Keatings is also an assistant professor in the University of Toronto Faculty of Nursing. In spring 1988, she participated in an exchange program between Toronto General Hospital and a teaching hospital in Cambridge, England.Diana Dick, RN, BScN, MEd, co-ordinated a national campaign of the Canadian Nurses Association resulting in two significant amendments to the Canada Health Act (1984). As Project Manager with the Registered Nurses' Association of Ontario, she initiated the Association's involvement in the Grange Inquiry. She has taught at Seneca College, practised nursing in special care units, and written and spoken both nationally and internationally on resource allocation. Currently she works in a branch of Ontario's Pay Equity Commission.     

南通民办养老机构创新模式研究

通过对南通市30家养老机构的调查研究显示,随着人口老龄化程度的加剧,老年人对医疗护理的需求与日俱增,而目前南通民办养老机构与医疗机构互不衔接,南通市可通过在较大规模民办养老机构中设立医疗机构、将普通民办养老机构和区域内医疗机构相互衔接等方式来实现"养医结合"模式的发展;政府应加快完善相关政策和管理机制,加大照护队伍的专业化建设,并依据不同需求设定相应服务内容,以提高医疗和养老资源利用效率,有效推进该模式的实施。     

Lookism in the Chinese Nursing Industry: A Content Analysis of Online Recruitment Advertisements

This study investigated the prevalence of lookism through a content analysis of nursing recruitment advertisements in China. Lookism or physical appearance-based discrimination is prevalent in roles predominantly occupied by women. This attributive bias assumes greater significance in the context of a patriarchal society like China within industries such as nursing that are highly feminized. Nevertheless, few studies explore the existence of lookism within the nursing industry in China. Reporting on the intent of Chinese health care employers to discriminate based on physical appearance, this article argues for awareness of and sensitivity toward the implications of workplace lookism in China.     

New directions in injury surveillance: Development of a model for continuous monitoring of direct medical costs

Information on the costs of injuries is an important additional instrument in setting priorities for injury prevention. The importance of this instrument is increasingly being recognized by health policy makers. The objective of this study was to develop a model which continuously monitors the direct medical costs of injuries in The Netherlands. This model should provide information on the direct medical costs of injuries at any time and for any selection of injury categories. It is an incidence-based model according to the ‘bottom up’ principle. Homogeneous patient groupings with respect to health care use are defined. The groupings are based on existing classifications from the literature and the experience of medical experts, and are defined by means of seven criteria: nature of care provided, body region of the injury, type of injury, severity of injury, age, complications, and sex of the patient. Several cost elements are distinguished (e.g., general practitioner help, hospital care, nursing home care). For each cost element, relevant patient groupings are determined. The new Dutch Injury Surveillance System (LIS) for injuries treated in an A&E department is an important source for incidence data. This article presents the design of the model as adopted by the Working Group on the Costs of Injuries of the European Consumer Safety Association (ECOSA).     

Out-of-Pocket Home Care Expenditures for Disabled Elderly

Levels and predictors of out-of-pocket home care expenditures for the disabled elderly are examined using a sample of users of home care with out-of-pocket expenditures from the 1984 National Long Term Care Survey (N = 856). Multiple regression results indicate need, specifically functional ability, adds the most explanation to out-of-pocket home care expenditures. Education, marital status, asset availability, prior nursing home use, and population density, while significant, add relatively little explanation to the total variance. Implications for prevention education and long-term care policy are discussed.     

Resource Allocation through Negotiation and Compromise: A Database Approach

In this paper, a resource allocation system is modeled with relational database technology. To allocate resources through a negotiation-based system, two steps of pre-allocation and negotiated allocation have been modeled with a join procedure for two relations. These relations represent the requirements for experiential nursing practice and the availability of such experience at hospitals, respectively.The first step was implemented through a new join operation called -Distance Join. After the first step, some nursing departments and some hospitals have fully satisfied requirements or fully utilized availability. Other nursing department and hospitals have partial or no satisfaction of requirements or availability, respectively.The second step was implemented through a custom-designed implementation of a user-interface that provides coordinated negotiation among the nodes involved in the system. With the customized interface and join operation, an off-the-shelf or packaged database management system is used. Through this interface, nursing departments and hospitals negotiate until potentially all demands and availability are totally satisfied. This negotiation takes place without face-to-face meetings but with complete knowledge of the entire situation by all parties. This provides the potential for complete fulfillment of nursing experience requirements and total utilization of hospital experience availability.     

Information Management in Aged Care: Cases of Confidentiality and Elder Abuse

Typically seniors like others choose to avoid institutional care. However, when age-related infirmity requires it, they not only enter into the care of others, but they also do so as vulnerable members of society. As their frailty increases with age, so does their dependence on the professionals who care for them and on the enforcement of policies concerning their care. A qualitative case study involving seniors and their carers revealed that breaches of confidentiality, unprofessional behaviour and the non-enforcement of policy, continue to hide the physical and emotional abuse perpetrated by nursing and other staff on vulnerable consumers. Professional ethics, including at a corporate level, enforcing policy, protecting whistleblowers and creating reporting mechanisms for aged care researchers, are amongst the recommendations arising from this study.     

Quality choice in Medicaid markets. The case of nursing homes.

This article examines whether private patients, who typically pay a price higher than the Medicaid reimbursement rate, receive the same or higher quality services than Medicaid patients in the same health care facility. Because the mix of patients will affect the firm's cost only when Medicaid and private patients receive different levels of quality, the cost function can be used to test for the presence of quality differences. Estimates of a cost function for Texas nursing home in 1983 indicate that the mix of patients does not affect the firm's cost. Thus, private and Medicaid patients in the same nursing home receive the same level of quality.     

Mature Consumer Awareness and Attitudes Toward Retirement Housing and Long-Term Care Alternatives

The retirement housing and long-term care industries have been responding to the needs of aging consumers by developing a wide range of housing facilities and personal care services. The increasing variety of long-term care options is expected to better satisfy the heterogeneous needs of older consumers. Results of a national study and qualitative research suggest that many present and potential consumers of supportive housing and long-term care services do not have a good understanding of these offerings. Many are unaware of the alternatives available. Mature consumers often perceive all long-term care negatively as nursing homes. The proliferation in the variety of housing and long-term care services and the lack of standardization in labeling products may be contributing to the misunderstanding of various options. This misunderstanding leads to consumers not obtaining the housing and long-term care services best suited to their needs. Government agencies, consumer interest groups, and housing and long-term care providers can help to differentiate products and educate consumers to better serve their needs.     

整合照料视角下的老年家庭照护床位政策研究

作为嵌入式养老的创新模式，家庭照护床位是解决当前养老服务困境，推动养老服务体系高质量发展、精细化治理的重要举措。然而，当前的试点仍存在需求不足、供给乏力的双重困境。究其原因，主要在于对家庭照护床位认识不清、理解错位；政策实施中尚未有效解决社区居家养老服务资源碎片化问题，资源整合定位不准、整合层次低。基于此，本文提出回归家庭照护床位政策本色，强调其准市场化服务属性，明确其补充、协调、整合的功能定位，探索以街镇-社区为基点、以“养老管家”为媒介、以智能科技为支撑、以老年人住所为场域、以老年人个体为中心的服务终端功能性整合路径，完善配套激励相容机制、支付保障机制，推动实现 “医-养-康-护”一体化居家养老。     

医疗护理服务可及性对居家老人照料服务选择的影响研究——基于北京市的实证研究

利用课题组2018年在北京市的抽样调查数据,运用Logistic回归方法考察医疗护理服务可及性对居家老人照料服务选择的影响。结果发现,医疗护理服务的便捷性、可支付性与老人照料服务的选择显著相关。住所附近有医疗卫生机构、有提供上门护理服务的机构或是与家庭医生签约的老人,更倾向于选择社会照料服务;支付能力对照料服务的选择呈现"U"型效应:家庭支付能力较强或者经济自评相对不足的老人更倾向于选择社会照料服务。应通过优化医疗护理资源布局、建立并完善社会照料服务的价格机制等措施,推进高效、可持续的社会照料服务体系的构建。     

居家养老服务体系财税政策空间及顶层设计--基于上海市的实证研究

财税政策是养老服务财政责任的重要工具变量;政策路径与财力支持能力是核心,直接关系服务体系建设与发展。上海是中国老龄化最突出的地区。本文以问题为导向,基于实际调查与老龄人口服务需求预测;通过居家养老服务财税政策空间及财政支持能力关联分析,从“财税、社保、民政福利”财力统筹及“养、医、康、护、住”服务融合的全局,设计与经济社会发展相适应、满足老年服务需求以及发挥财税政策效能三者相协调的财税支持政策顶层框架,并进行政策效果模拟,制定财税政策分步实施路线。     

城市中年人非正式养老准备问题初探——对南京市白下区的调查

学术界对"中年人"群体的养老研究相对薄弱。提出了"非正式养老准备"的概念。通过对南京市白下区的抽样调查,从个人、家庭与制度等方面探讨了城市中年人非正式养老准备的状况。结果表明:非正式养老准备普遍缺乏;非正式养老准备在各群体间呈现多样化;城市中年人非正式养老准备的途径单一。