Public and private healthcare services: What drives the choice?

This paper has explored patients' propensity to consume private healthcare services. We based our analysis on the typical tangible and intangible (for instance, responsiveness, reliability, assurance and staff empathy) domains of the SERVQUAL and SERVPERF methods. These variables may influence patients' decision-making when they choose between the public and private sectors. We combined factor analysis (to obtain a set of latent factors related to perceived quality) and a partial proportional ordered logit model to estimate the probability that a patient would access private healthcare services. To test the main hypotheses, we used data from a stratified sample in Sardinia, a peripheral region of Italy. Findings revealed that private and public healthcare are substitutes, especially for primary/specialised services. Patients who used public healthcare frequently and had a low income were unlikely to change to private healthcare or to recommend private services. ‘Responsiveness’ and perceptions on ‘tangibles’ were key in determining the probability that a patient would choose and recommend private services. This paper offers a multifaceted framework that can be used in future research to generalise these findings, especially in insular regions that are constrained by mobility.     

Metafrontier efficiency analysis for hospital pharmacy services using dynamic network DEA framework

Medication management is a complex but critical process within the healthcare delivery system. The pharmacy department in healthcare facilities is responsible for acquisition, distribution and dispensing of medication to patients that involves a series of network process. This process can be categorized into two main subprocesses: i) pharmacy store and ii) patient services (i.e., ambulatory and inpatient pharmacy). The objective of this study was to investigate the relative efficiency level of the two subprocesses of pharmacy services in Malaysia's public hospitals. We used a nonconvex metafrontier technology to estimate technical efficiency of hospital pharmacies between specialist and nonspecialist hospital categories under the dynamic network data envelopment analysis (DNDEA) framework. For overall efficiency, both specialist and nonspecialist categories had similar mean efficiency scores. However, when measuring the efficiency level according to pharmacy store and patient services separately, the nonspecialist category had a higher mean efficiency score in pharmacy store, whereas for patient service efficiency, both categories had similar results. The patient service efficiency level was lower consistently over time, suggesting that the overall inefficiency of hospital pharmacy is greatly influenced by the inefficiency of the patient service. This suggests that systematic improvements in patient service efficiency should be a higher priority than pharmacy store efficiency to further increase the overall efficiency level. We believe that our findings will provide valuable information to policymakers towards achieving an efficient public healthcare service.     

The effect of management commitment to service quality on frontline employees' affective and performance outcomes: an empirical investigation of the New Zealand public healthcare sector

• Very little attention has been given to understand the antecedents of service recovery performance in a public healthcare setting. In this study, a cross-sectional survey investigates a model of service recovery performance. Frontline hospital employees completed a self-administered questionnaire on how factors characterising management commitment to service quality (MCSQ) affect their service recovery efforts. The results suggest the influence of MCSQ is mediated by frontline employees' affective commitment to their hospital. The research advances understanding of frontline service recovery performance in a public healthcare setting and the findings indicate that public healthcare managers can take actions on a number of fronts to assist progress towards the achievement of frontline service recovery excellence.

Copyright © 2006 John Wiley & Sons, Ltd.     

The adoption,character and impact of strategic human resource management: a case study of two large metropolitan Vietnamese public hospitals

In this paper the researchers set out to explore the adoption, character and impact of strategic human resource management (SHRM) in two large metropolitan Vietnamese public hospitals using a multi-level qualitative research design. Data are analyzed from 21 interviews and 5 focus groups with key players from the hospitals and government authorities. Findings show that the State controls many of the core day-to-day HR functions of public hospitals, curtailing local autonomy and management innovation. This is compacted by inadequate government funding, poor training of medical staff, and inadequate management and business skills of hospital managers. Inhibiting greater experimentation with SHRM is the fear of developing management initiatives out of sync with the State. Consequently, many managers and clinicians held negative views of the HR department and their relevance for the day-to-day management of healthcare services. Respondents reported that they perceived these factors had a negative impact on the well-being of medical staff and the quality of patient care. The paper concludes with a discussion on the necessity for continued State reforms that can enable greater autonomy of the hospitals' HRM functions and greater investment in local HR capabilities to materialize the link between SHRM, employee well-being and quality of patient care.     

A model for dual health care market with congestion differentiation

The French market for specialist physician care has a dual legal structure: physicians must exclusively work in sector 1 and charge regulated fees or in sector 2, where they can freely set their fees. Patient out-of-pocket payments in sector 2 are partially covered by private insurance. The primary differentiating factor between both sectors is the number of patients per specialist, which in turn directly affects the overall quality of the service provided. We built an equilibrium model to analyze both specialists' decisions about which sector to work in, and patients' choice of physician and therefore sector. More specifically, the model allowed us to study the effect of changes in prices and economy-wide patient-to-specialist ratios on profits and patients' utility associated with the services provided in each sector.     

Implementing the third way

This article examines the transfer of NPM strategies by comparing Service Charter initiatives in the United Kingdom, United States and Australia. These three countries, together with Canada and New Zealand,are partofwhathas beendescribedas the ‘core’ new public management (NPM) policy community (Common 1998). Service Charters are an NPM strategy intended to change the culture of public service delivery to focus on the needs of the users, identified as ‘clients’ or ‘customers’. The objectives are to make service providers more responsive to users by guaranteeing specific standards for service delivery, providing a substitute for competition and a benchmark for measuring service quality. The first section examines the historical and political context of the development of the Citizen's Charter and Service First programmes in the UK, customer service plans in the USA and Government Service Charters in Australia. The second section explores the similarities and differences between these charter initiatives based on analysis of public documents. There is evidence of convergence at the ideological level as managerial values underpin the service charter frameworks in all three jurisdictions (Walsh 1994; Pollitt 1995; Kettl 1997). Despite drawing from a similar toolkit influenced by private sector techniques, significant differences between the country contextshaveresultedindivergent strategies. Timing in the three countries examined suggests that national politics rather than global policy convergence is more significant in explaining the development of service charters. This case study provides evidence of policy transfer rather than policy convergence (Common 1998). The final section considers the limitations of the customer service model. Monitoring quality iscentral to theprogrammes in all three countries. Performance monitoring is essentially a quantitative methodology that requires criteria and indicators for measuring the quality of service delivery and programme outcomes. Two problems are considered. The first is the difficulty of specifying and measuring service quality. The second is that quality indicators derived from services marketing and management research do not take into account the characteristics of public services.     

A multiple criteria sorting method for supporting the maintenance management of medical ventilators: The case of Hospital da Luz Lisboa

Medical equipment is characterized by a constant flow of innovations, which is transforming the delivery of healthcare. This creates the need for healthcare organizations to incorporate methodologies to support the maintenance management of these equipment. Within this context, Luz Saúde, the holding company of one of the largest healthcare groups in Portugal, intends to complement the medical equipment maintenance management program of the biggest hospital in its network, Hospital da Luz Lisboa. To this aim, we develop a decision aiding tool for assessing the maintenance condition of medical ventilators and recommend a plan of action. For that, we apply a multicriteria decision aiding methodology, utilizing the Electre Tri-nC method. In interaction with the decision makers, we construct a model using twelve criteria for assigning ventilators to one of the five ordered categories representing the current condition (excellent, very good, good, adequate, and poor). Most of the medical ventilators in the analysis were considered in adequate or good maintenance conditions, which was consistent with the decision makers’ expectations. A detailed analysis of the results evidenced the robustness of the model. This study constitutes the first step toward the use of multicriteria methodologies for supporting decision processes in Hospital da Luz Lisboa.     

基于DEA方法的物流服务质量评价研究

对物流企业来说,物流服务质量是其不被市场淘汰,获得良好的信誉并赢得利润的关键因素。为合理评价物流服务质量,文中选择了物流服务水平等评价指标,并运用DEA对广州市16家物流公司进行服务质量评价。结果显示,人力资源成本投入、管理资源、物质资源投入过大,而服务质量和无形资源投入偏小。最后针对上述存在的问题,提出了改进的建议。     

基于服务科学构建旅游服务质量评价模型的研究

本研究旨在为旅游业提供可靠的服务水平测量工具,帮助旅游管理者找寻服务质量的改进方向,提高服务水平。根据服务科学管理与工程(SSME)的研究方法,界定出旅游服务质量的5个维度,22项指标,在进行了信度、效度检验的基础上建立服务质量评价模型,分析评价了松潘旅游服务质量。     

在线旅行服务企业战略绩效评价体系研究

本研究采用深度访谈法搜集数据,利用内容分析法构建了在线旅行服务企业战略绩效评价维度和指标,运用层次分析法和模糊综合评价法构建了在线旅行服务企业战略绩效综合评价体系。首先,将在线旅行服务企业战略绩效评价体系分为6个一级指标、16个二级指标和34个三级指标,财务状况、市场地位、产品质量、服务质量、员工关系和社会责任6个维度为一级指标;其次,运用层次分析法确定了各一级和二级评价指标的权重系数,其中财务状况的权重最高,随后依次是市场地位、产品质量、服务质量、员工关系和社会责任;最后,利用模糊综合评价法构建了在线旅行服务企业战略绩效综合评价体系模型。本研究在理论上丰富了在线旅行服务企业战略绩效管理的研究内容和理论,也为未来的实证研究提供了可靠和操作性强的战略绩效评价工具。     

QaaS (quality as a service) model for web services using big data technologies

Quality of service (QoS) determines the service usability and utility and both of which influence the service selection process. The QoS varies from one service provider to other. Each web service has its own methodology for evaluating QoS. The lack of transparent QoS evaluation model makes the service selection challenging. Moreover, most QoS evaluation processes do not consider their historical data which not only helps in getting more accurate QoS but also helps for future prediction, recommendation and knowledge discovery. QoS driven service selection demands a model where QoS can be provided as a service to end users. This paper proposes a layered QaaS (quality as a service) model in the same line as PaaS and software as a service, where users can provide QoS attributes as inputs and the model returns services satisfying the user’s QoS expectation. This paper covers all the key aspects in this context, like selection of data sources, its transformation, evaluation, classification and storage of QoS. The paper uses server log as the source for evaluating QoS values, common methodology for its evaluation and big data technologies for its transformation and analysis. This paper also establishes the fact that Spark outperforms the Pig with respect to evaluation of QoS from logs.     

A gap model of purchasing's internal service quality: Concept,case study and internal survey

Traditionally, the monitoring of a purchasing department's performance is primarily focused on cost analysis and the evaluation of suppliers rather than on internal service aspects. Therefore, the main objective of this paper is to develop an instrument for the measurement of the internal service quality of purchasing departments. Based on the SERVQUAL and the general gap model of service quality, a specific gap model regarding purchasing's internal service quality was developed. Similar to previous research, both the perceptions of the actual service and the internal customers’ expectations of the service quality were included. In addition, the model contains a self-evaluation by contrasting the views (expectations and perceptions) of the internal customer with those of the purchaser. The application of this instrument in a large company demonstrates the general usefulness of this instrument. Statements of 145 internal customers and 36 purchasers were available for statistical analysis. The results of this analysis can be helpful in detecting weak points and sources of internal customers’ dissatisfaction.     

基于顾客导向的物流服务质量评价研究

从客户角度出发,参照SERVQUAL质量评价体系,建立基于顾客导向的物流服务质量评价体系,运用动态模糊综合评价方法对物流服务质量进行综合评价,结果显示动态模糊综合评价方法能够准确地反映出第物流服务失误之所在,并用实例论证了该评价方法的可行性。     

国外两种网站信息服务管理质量评价体系的分析与综合

网站信息服务管理质量的评价对于现代化信息服务管理来说意义重大。文章首先对网站信息服务管理质量评价的内涵进行了说明;其次,分析了基于ITIL的网站信息服务管理质量评价体系,指出了该评价体系的局限性以及缺陷;然后,分析了基于用户满意度的网站信息服务管理质量评价体系,讨论了该评价体系的导人原因以及优点;最后,将两者进行了综合,建立了更加全面系统、面向用户的网站信息服务质量综合评价指标体系。该综合评价指标体系能更加有效地对网站信息服务管理的质量做出评价,从而使网站信息服务管理的质量得到不断的改进和提高。     

Screening the impacts of municipal service policy changes

The planning of municipal service delivery systems requires accurate forecasts of demand, and particularly of the effects the quality of service delivery has on demand. A metholology for this problem should meet three criteria, if it is to be useful for municipal planning: it must be low-cost and use generally available data; it must be based on user behavior, so that the effects of policy changes can be correctly attributed; and it must allow testing of the transferability of the results, since this is required for general forecasting use. This paper develops such a methodology, based on econometric analysis of data from a number of service areas within a number of regions, forming a double cross-section. Empirical tests of the methodology were performed for two local government services where the effect of service quality on demand is important: sewer and highway construction, which have been hypothesized to affect the patterns of development within regions; and solid waste collection, where the level of service provided affects how much waste enters the collection system and how much is littered, burned or recycled. The two case studies and other analyses suggest that the methodology is a useful tool for testing whether policy changes have an effect on the demand for service, but not for accurate demand forecasting. Thus, these simple models are relevant for the role of screening the effect of policy changes, but more detailed and localized approaches are necessary for system design.     

谈病案窗口服务的价值

随着病案作为法律依据的广泛应用,病案窗口服务也成为医院对外服务的一个重要环节,提高病案窗口服务质量,比如良好的环境、较强的法律意识与解惑能力、人性化的服务,不仅可以和谐医患关系还可以提升医疗质量与管理水平。     

Supply chain planning of vaccine and pharmaceutical clusters under uncertainty: The case of COVID-19

As an abrupt epidemic occurs, healthcare systems are shocked by the surge in the number of susceptible patients' demands, and decision-makers mostly rely on their frame of reference for urgent decision-making. Many reports have declared the COVID-19 impediments to trading and global economic growth. This study aims to provide a mathematical model to support pharmaceutical supply chain planning during the COVID-19 epidemic. Additionally, it aims to offer new insights into hospital supply chain problems by unifying cold and non-cold chains and considering a wide range of pharmaceuticals and vaccines. This approach is unprecedented and includes an analysis of various pharmaceutical features such as temperature, shelf life, priority, and clustering. To propose a model for planning the pharmaceutical supply chains, a mixed-integer linear programming (MILP) model is used for a four-echelon supply chain design. This model aims to minimize the costs involved in the pharmaceutical supply chain by maintaining an acceptable service level. Also, this paper considers uncertainty as an intrinsic part of the problem and addresses it through the wait-and-see method. Furthermore, an unexplored unsupervised learning method in the realm of supply chain planning has been used to cluster the pharmaceuticals and the vaccines and its merits and drawbacks are proposed. A case of Tehran hospitals with real data has been used to show the model's capabilities, as well. Based on the obtained results, the proposed approach is able to reach the optimum service level in the COVID conditions while maintaining a reduced cost. The experiment illustrates that the hospitals' adjacency and emergency orders alleviated the service level significantly. The proposed MILP model has proven to be efficient in providing a practical intuition for decision-makers. The clustering technique reduced the size of the problem and the time required to solve the model considerably.     

加拿大与我国大学图书馆管理的比较及对策

本文通过对加拿大大学图书馆管理特点总结,比较分析了我国大学图书馆管理存在的问题,并从健全管理体系与制度,提高员工素质,实行多元化服务,加强网络资源建设,完善图书馆质量管理与员工绩效评价制度,持续改进工作质量方面提出我国大学图书馆管理对策。     

Restructuring materiel management functions: a method for prioritizing changes and reducing costs

The success of any manager depends highly on the ability to seize on opportunities that will achieve the organization's goals. Hospitals are currently searching for ways to reduce costs while maintaining or enhancing the quality of services. Quality services are increasingly being defined as those that are most responsive to customer needs. It is important, as hospital management restructures materiel systems or methods of operation for reduced costs, to focus on the user departments as the customers. The consolidation of materiel management activity should not be seen as a loss of control at the user department level. Instead it can be seen as a new way of providing service with higher quality. User departments should see concrete benefits on a weekly basis, including reduced time spent on materiel management functions; increased planning of purchasing, inventory, and distribution functions; and assistance in meeting restricted supply budgets.     

Effects of healthcare quality and reimbursement rate in a hospital association

Tackling the mismatch between the supply of and demand for care service is an especially important issue among many healthcare providers and regulators. To entice patient demand distribution to become more equilibrated among different regions, some countries' governments have proposed to establish a hospital association with different levels of hospitals to implement patient mobility. However, the sustainable operation and management of the hospital association have not been formally analyzed. In this paper, we develop a Salop model to analyze the strategic behavior of patient welfare and hospital utility maximizations in a hospital association comprised of three hospitals in different income regions. For the former objective, we find that the higher quality provisions may harm patient welfare, and especially there are unique quality thresholds of the hospitals such that the higher quality provisions lead to higher patient welfare only when the quality provisions exceed the thresholds. For the latter objective, we capture the optimal equilibrium quality provisions of the overall hospital association. We consider both the case when the taxation rates are regulated (TRR) and exogenous to the hospitals and the case when taxation rates are adjusted (TRA) and constrained by hospital reimbursement rates. Under the TRA case, we find that a higher reimbursement rate of the local hospital causes a higher and lower quality threshold of the hospital in the local and neighboring regions, respectively; and we also show that with the utility maximization objective, the reimbursement rate's impact depends on regulator's altruism towards patient welfare. For a relatively low altruistic behavior, a TRA could improve the quality provision but lower the number of outflowing patients in the case of a high (and low) hospital's reimbursement rate in the local (and neighboring) region. When the regulator cares more about patient welfare, the findings in the quality provision and patient mobility are just contrary. Our analytical results lead to some important policy implications for facilitating the further deployment of hospital association delivery in the hospitals' quality provision associated with patient mobility.