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.     

Health provider choice and implicit rationing in healthcare: Evidence from Mozambique

An analysis of health provider choice together with a model of implicit rationing in healthcare is presented using Mozambique as a case study. We make use of the Mozambican Household Surveys on Living Conditions 2002/3 and 2008/9. Updated and sometimes contrasting results with respect to similar analyses on older Mozambican data are obtained. In particular, we find that the role of income is more important in 2002/3 and in 2008/9 than it was in 1996/7. In consequence, we further expand the analysis by studying how socioeconomic disparities among other factors influence implicit rationing in healthcare. When using the 2008/9 survey only, moderate evidence that some sort of implicit healthcare rationing is in place is found; that is, some people do not seek care because they foresee they will not be granted quality healthcare access or treatment.     

Community health service centers in China, not always trusted by the populations they serve?

Based on the idea that healthcare needs to be managed by individuals and that basic health services should be provided by the community, this paper examines the factors that impact urban outpatients' preferences for particular community health service centers (CHSCs) and hospitals. Rational consumption of healthcare is influenced by a patient's beliefs, beyond simple demographics and social structure. Ignorance of basic health issues leads to non-rational patient behavior, which also explains the confusion in Chinese health reform regarding people's mistrust of CHSCs. Health education in the form of self-managed care may increase personal health knowledge and encourage individuals to make use of the basic health services that are supplied by CHSCs.     

Richard Y.Lee：Act today to Presume Tomorrow

Like many other entrepreneurs, Richard Lee＇s road to success is full of adventures and difficulties.     

市场竞争性和我国的医疗体制改革——经济学视角下的医疗体制改革模式

市场的竞争性不仅取决于市场结构,还取决于价格信息在消费者之间的传播速度。由于医疗服务的价格信息在患者之间的传播是一个缓慢的时间过程,所以医疗服务市场看似有竞争而实际上竞争程度远比一般商品和服务市场低得多。在说明医疗服务市场的高价格水平形成机制的同时,指出政府只要能够改变医疗服务价格信息的传播机制,就能够建立一个以市场机制为基础的高效率的医疗卫生体制。     

A conceptual framework to analyse hospital competitiveness

This article proposes a conceptual framework to analyse hospital competitiveness at the organisational level. Hospital competitiveness, defined as the capacity a hospital has to develop a superior performance that leads it to a position of competitive advantage, may be analysed in three dimensions: organisation, strategic behaviour, and performance. Based on previous studies and on the current structural adjustment in the Portuguese public hospital sector, this article suggests the following categories: legal status, organisational complexity, and resources for the organisation dimension; stakeholders, services and inter-organisational relationships for the strategic behaviour dimension; and type of indicators, efficiency and effectiveness, and benchmarking for the performance dimension. This framework seems to be particularly useful in evaluating Portuguese hospital competitiveness and providing insights for hospitals' managers and public decision makers both from Portugal and other countries.     

Healthier for whom? Technological service improvement in the healthcare industry

This study tackles the dilemma of a technology-based service improvement wherein an organization performs a technology change to improve its service process, while its customers do not necessarily perceive the new service as an improvement. The empirical research follows a healthcare provider that changed its primary care provider appointment scheduling using a new call centre technology. The methodology involves three processes reflecting the entire change: personal interviews, focus groups, and surveys. To facilitate adoption of a technology-based service, it is recommended that there be a focus on customers’ experience with similar service industries’ image, and organizational policies on contracting service representatives.     

A New Internet Driven Internationalisation Framework

This paper aims to offer a new Internet driven theoretical framework that explains how a successful internationalisation process may be developed and identifies the strategic dimensions that influence the key decisions in an interrelated, performance-associated way. The extant literature is examined in international marketing, international entrepreneurship and Internet marketing and a comprehensive strategic analysis is conducted of a successful individual services business: ING Direct. It is shown how strategic constructs and risk constructs drive the internationalisation process in an interrelated and performance-associated way. In the framework, the firm's target is to take advantage of an opportunity by obtaining a sustainable competitive advantage while attenuating international risk. Entry mode and country selection are strategic decisions interrelated mutually and with other strategic choices and with performance; this is why an analysis with ceteris paribus statements or episodic analysis may lead to the wrong conclusions.     

Examining Public Hospital Service Failure: The Influence of Service Failure Type,Service Expectations,and Attribution on Consumer Response

This study investigates three independent variables; types of service failure, service expectations, and attribution on postfailure responses in healthcare. A between-subjects 3?×?2?×?2 experimental design using written scenarios was used. The findings demonstrate that customer responses to service failures in hospitals are extensively influenced by the type of service failure, the level of service expectation of the provider, and, to a lesser extent, the controllability of the cause of the failure. Core service failures lead to greater increases in negative responses for satisfaction, emotional, and behavioral responses than supplementary service failure with high service expectations protecting the provider against overall dissatisfaction, negative word-of-mouth, and switching behaviors. Interestingly, perceived high controllability leads to greater dissatisfaction but not to increased negative emotional or behavioral responses. The study applies attribution theory to explain the results. The article concludes with managerial implications.     

Measuring the Perceived Quality of Professional Business Services

Professional firms serving business clients are recognizing the need for improved quality services. Unfortunately, measures of professional service quality have proven difficult to develop. This paper reports on the use of SERVQUAL, an instrument commonly used to assess consumer perceptions of service quality. This instrument was employed with a sample of business owners who were asked to rate the quality of service received from their accounting firm. Although several dimensions of the scale proved useful, additional quality related factors emerged from the analysis.