Diverging trends in health care use between 2010 and 2016: Evidence from three groups of transition countries

This paper investigates changes in health care use in 28 transition countries using data on more than 60,000 households from the “Life in Transition” surveys II and III conducted in 2010 and 2016. Following the literature, the transition countries are divided into three groups – Eastern Europe, Southern Europe and the non-Baltic states of the former Soviet Union with Mongolia – based on the speed of their transformation. Regressions based on Andersen’s conceptual framework show no difference in public health care use between the three groups in 2010. By 2016, however, the share of households using the public health care system dropped by remarkable 17.1–22.2% points in Southern Europe and 13.5–27.1% points in the former Soviet Union with Mongolia compared to Eastern Europe. Moreover, by 2016, the probability of a household using the private health care system (with no use of public health care) in Southern Europe and the former Soviet Union was 7.5–18.7% points higher than in Eastern Europe, whereas it was 2.9–6.8% points lower than in Eastern Europe back in 2010. The analyses indicate that differences in household characteristics, as well as perceived corruption and quality of public health care, help to understand these diverging trends in health care use in the three groups of transition countries between 2010 and 2016.     

Coordination Mechanisms for Implementing Complex Innovations in the Health Care Sector

Abstract

Coordination is a central element in the public sector, especially for introducing complex innovations. In health care, this issue takes on great importance since many stakeholders are involved, pursuing multiple interests, and influencing the outputs and outcomes of the health care system. This paper discusses the introduction of a specific health care innovation (i.e. electronic patient records) in two Italian regions, and it aims to contribute to the debate on coordination in health care, depicting the coordination mechanisms that took place in two different contexts in order to introduce the same kind of innovation, and highlighting any potential enabling conditions.     

责任制护理为契入点推进“优质护理服务示范工程”在产科的应用

全国卫生系统开展"优质护理服务示范工程"活动,我院领导高度重视,加强组织领导,护理部真抓实干,以责任制护理为切入点,在产科开展优质护理服务示范病房,多措并举,扎实推进优质护理示范工程活动,实现了患者、护士的双满意。     

Development of an integrated medical supply information system

The integrated medical supply inventory control system introduced in this study is a hybrid system that is shaped by the nature of medical supply, usage and storage capacity limitations of health care facilities. The system links demand, service provided at the clinic, health care service provider's information, inventory storage data and decision support tools into an integrated information system. ABC analysis method, economic order quantity model, two-bin method and safety stock concept are applied as decision support models to tackle inventory management issues at health care facilities. In the decision support module, each medical item and storage location has been scrutinised to determine the best-fit inventory control policy. The pilot case study demonstrates that the integrated medical supply information system holds several advantages for inventory managers, since it entails benefits of deploying enterprise information systems to manage medical supply and better patient services.     

An examination of anti-violence human resource management practices in the context of health care and aged care

Although accumulated research has demonstrated the negative impacts of workplace violence and called for effective solutions from a human resource management (HRM) perspective, a valid measure of anti-violence HRM practices is missing. In this paper, we develop a scale of anti-violence HRM practices that is critical for both theoretical advancement and managerial practices in health care and aged care contexts. Through an inductive approach in Study 1, we generated items for the scale to be used in health care and aged care contexts, which we then subjected to a content validity test in Study 2. Using the newly developed scale, we further demonstrated in Study 3 that anti-violence HRM practices that are implemented in aged care facilities reduce workers' experienced violence, improve workers' emotional wellbeing, and enhance workers' organisational and career commitment.     

Promoting shared health care decision making using the analytic hierarchy process

Recent developments in medical technology and bioethics have led to a shift in the traditional framework of physician–patient responsibility in health care decision making. Patients are increasingly participating in serious health care decisions, resulting in a “shared decision-making model“ that both patients and their doctors agree is a significant improvement over the traditional system in which a doctor served as the primary decision maker. However, patients are finding they need to develop strategies that allow them to understand and evaluate their health care options in a clear manner. T.L. Saaty’s “Analytic Hierarchy Process” (AHP) is a decision methodology that has been successfully applied to a wide variety of situations and has great potential as a methodology for improved shared health care decision making. This paper reports the results of an experimental use of AHP as a tool to facilitate shared decision making for two specific health care populations. Both groups of patients were deciding amongst their options in terms of two important elective health care procedures: estrogen replacement therapy and cosmetic eyelid surgery. After using AHP, the majority of both patients and physicians agreed that this technique improved physician–patient communication, thus greatly assisting shared health care decisions. When considering other criteria in addition to physician–patient communication, including the entire physician–patient relationship, the patients felt that AHP was preferable to the conventional doctor-patient mode of decision making.     

南京市老年人养老服务需求研究

本文通过对南京市老年人口养老服务需求的调查研究,发现:在健康状况和生活自理能力弱化的预期下,选择机构养老的老年人口比例增加;高收入老年人的机构养老的意愿明显高于低收入或没有收入的老年人;市区老人在各项居家养老服务的知晓率上明显高于郊区老人;空巢老年人的居家养老服务需求率明显高于非空巢老人;老年人对水电气维修服务、医疗咨询和保健服务、精神慰藉等居家养老服务的需求比例较高。最后,针对上述结论提出完善南京市养老服务体系建设的对策。     

Hospital efficiency and equity in health care delivery: A study based in China

Hospital efficiency and equity in health care delivery are two enduring research topics. Yet little research has been done to examine the relationship between them. This paper studies the impact of hospital efficiency on equity in health care delivery based on a proprietary dataset of hospital characteristics and 630,000 inpatient records from 149 public hospitals in a representative Chinese city. To measure the hospitals' efficiencies, this study takes the hospitals' operational features and case-mix indexes into account, and computes the efficiency levels using data envelopment analysis with bootstrapping. Through regressions that control for a variety of the patients’ personal characteristics (e.g., age, disease, residence, hospital visit frequency), this study shows that the gap between hospitalization expenses of urban and rural inpatients in more efficient hospitals is smaller than those in less efficient hospitals. Thus efficiency enhances equity in expenditure between urban and rural patients. But the dwindling urban-rural gap in expenditure is achieved by raising the spending of rural patients, thereby undermining their access to health care. This pattern is more conspicuous in large and sophisticated high-tier hospitals. Further analysis shows that hospital efficiency impacts equity of health care delivery by inducing different lengths of stay and uncovered parts of total expenditure for urban and rural groups. The findings imply that an efficiency-oriented health care policy may lead to social benefit loss.     

促进医药卫生改革的税收政策研究

我国医药卫生领域现行税收政策与新一轮医药卫生体制改革目标存在一定冲突。现行税收政策不利于医疗行业公益性目标的实现,不利于吸引民营资本进入,不利于营利性民营医疗机构的发展,不利于鼓励商业健康保险的发展。我国应建立和完善能够与医药卫生体制改革目标相适应的税收政策体系,包括医疗服务营业税及税收优惠制度、医疗机构所得税税收优惠制度、药品增值税及税收优惠制度、商业健康保险税收优惠制度等。     

中国医疗卫生事业效益分析之系列研究——全国各地区孕产妇保健情况的社会效益分析

研究全国各地区孕产妇保健情况,孕保健开展好的地区有江苏、宁夏、北京和浙江。加强对西藏、青海两地区孕保健基础工作,加速培养本地区医疗卫生人员,降低孕产妇死亡率。     

When health care workers perceive high-commitment HRM will they be motivated to continue working in health care? It may depend on their supervisor and intrinsic motivation

In this health care field study, we examined the link between human resource management (HRM), transformational leadership, intrinsic motivation and motivation to continue to work. Based on the social exchange theory, we proposed a mediation model linking HRM to motivation to continue to work in health care, via respectively transformational leadership and intrinsic motivation. Results from data collected from 171 employees revealed that transformational leadership and intrinsic motivation mediate the relationship between perceptions of high-commitment HRM and workers’ motivation to continue to work. Practical implications for organizations in health care are discussed.     

Developing collaborative professionalism: an investigation of status differentiation in academic organizations in knowledge transfer partnerships

In recent years, there has been a significant growth in knowledge transfer partnerships to improve the quality and timeliness of health care. These activities require an increasing level of interdependence between academic and health care professionals, with important implications for human resource management. To understand these knowledge transfer partnerships, we conducted an in-depth longitudinal study based on 99 interviews and 5 focus group workshops across academic and health care professionals in nine university-based knowledge transfer partnerships in England. We explore how academic professionals of lower and higher status organizations develop a new form of professional work, based on the principles of collaborative professionalism, during their involvement in partnerships with health care professionals. We illuminate how the interdependent work between academic professionals and health care professionals in the development of a new academic specialization is shaped by the status of their organizations.     

Public–Private Partnerships in the Health Care Sector: A systematic review of the literature

Public–private partnerships (PPPs) have become popular worldwide as a way of improving health care service delivery. In order to enhance our knowledge of PPPs in the health care sector, we conduct a systematic review of forty-six articles published in peer-reviewed journals for the period of 1990–2011. Six lines of research in the PPP domain are identified: effectiveness, benefits, public interest, country overview, efficiency and partners. The main findings suggest that although PPPs are used to address internationally emerging public health issues, questions as to their actual effectiveness, efficiency and convenience, still remain unanswered. We propose viable recommendations and ideas for future research.     

Nursing,bedside care,and the organization of expert knowledge: Professional work as agencement

Professional work such as nursing has traditionally been examined as being localized in the individual’s body where professional know-how and skills are residing in the cognitive faculties and in embodied action. Contrary to such a view, the concept of agencement, recently used in the social study of finance, underlines that agency is in the contemporary technoscientifically determined times of necessity distributed and includes a variety of tempospatially distributed resources. Reporting a study nursing work in a leukemia ward in a Swedish regional hospital, it is demonstrated that the conventional view of nursing as primarily being bedside care is only accommodating a subset of the totality of the nurses’ work. In addition to face-to-face care and patient interaction, nursing work is the mobilization of a great number of actors with different domains of expertise to safeguard the health care status of the patient. Speaking of nursing work as agencement is opening up for alternative and more accurate understandings of nursing work in an increasingly technologically determined health care system.     

‘Why Partnership Working Doesn't Work’

Abstract

English public services in general (and health and social care in particular) have become increasingly dominated by the notion of partnership working. Despite this, more recent years have seen something of a reaction against partnerships. This article reviews lessons learned from a case study of a forensic mental health partnership, arguing that the service in question reveals a number of common pitfalls in terms of the way that partnerships are established and put into practice. In many ways, this was not the fault of the case study partnership, but the product of the wider institutional context in which health and social care partnerships have been developed and promoted. Ultimately, the article suggests some additions to the partnership theoretical literature, before concluding that the current concept of partnership working may lose credibility without additional work to clarify its meaning and contribution.     

The interplay between regulation and efficiency: Evidence from the Austrian hospital inpatient sector

The Austrian health policy aims to maintain and even expand high-quality health care. The implementation of an integrated master plan, which contains input and output target values for the overall health care system, is an important regulatory intervention. To support the regulatory authorities, efficiency studies that simultaneously reveal input and output improvement potential can be promising. To serve this purpose, we computed bootstrapped non-oriented super-efficiency measures to identify any improvement potential in inputs and outputs for the Austrian hospital inpatient sector for four years. Variations in hospital efficiency were investigated using non-parametric post-efficiency analyses.     

A hands-on hands-off approach: governance of managed long-term care services in a context of rapid policy change

Amidst state-level budgetary pressures and growing elderly populations, many US states have adopted managed care for home-based services funded through the Medicaid program. New York State’s managed care mandate is part of a Medicaid ‘Redesign’ targeting health outcomes, cost control, and administrative efficiency, reflecting features emphasized by both governance and New Public Management frameworks, but neither adequately captures this case. Incorporating a Polanyian perspective can elucidate this market expansion and related reactions and re-regulation. Drawing from interviews with staff of service-providing agencies, this case study reveals outcomes contrary to goals: administrative complexity, containment of care, and unexpected costs.     

The Financial Implications of Using Decision Tree Analysis for Publicly Funded Health Care Screening in Canada

This article demonstrates that decision trees have several applications in screening for incidences of various cancers in the publicly funded health care system of Canada. This article reviews previous research on the design of various types of decision trees to identify the relevant decision-making parameters that should be incorporated into enhanced usage of decision trees. This article proposes a methodology for screening breast and prostate cancers. While an accounting is made for various financial costs and benefits, comments are made on the limitations of the modeling exercise through identification of problems in assigning probabilities, the use of samples in ascertaining population parameters, ethical concerns, and measuring a cost per life year. This article concludes with prospects for future research including private sector versus public sector financing and the incorporation of opportunity costs into the decision-making process.     

Concordat or contract

The New Labour Government in England is seeking to promote public/private partnerships in health and social care as a key component of its political project. This article reports the findings from the first phase of an ongoing qualitative research study exploring the relationship between a private sector company and their public sector partners at four study sites. These findings indicate that organizations within the NHS do not view the development of public/private partnerships as a priority and furthermore currently have a limited ability to engage in strategic planning with the private sector. The findings are explored in the broader context of the evolution of ‘managed competition’ in health care systems and the role of partnership in that process.