Showing papers in "International Journal of Health Planning and Management in 2019"

Patients' satisfaction and public and private sectors' health care service quality in Pakistan: Application of grey decision analysis approaches.

Abstract: PURPOSE The study aims to evaluate the comprehensive relationship between patient satisfaction and five dimensions of health care service quality in Pakistani public/private health care sectors, using a novel grey relational analysis (GRA) models and the Hurwicz criteria of decision making under uncertainty DESIGN/METHODOLOGY/APPROACH Data were collected from private and public health care facilities of Pakistan through an improved SERVQUAL instrument Deng's GRA, absolute GRA, and the second synthetic GRA models were applied to address the problem under study FINDINGS Grey relational analysis models revealed that reliability and responsiveness are most strongly predicting patient satisfaction in public and private health care sectors, respectively The Hurwicz criteria showed that patients are more likely to be satisfied from private health care facilities LIMITATIONS/IMPLICATIONS Limitations of SERVQUAL model are also the limitations of the study; eg, the study suggests that because of the absence of "cost," which is a key quality indicator of Pakistani public sector health care facilities, the model was unable to comprehensively evaluate the health care situation in light of the observations of price-focused Pakistani patients The study recommends tailoring of SERVQUAL model for the resource-scant and underdeveloped countries where people's evaluation of the quality of the hospitals is likely to be influenced by the price of services ORIGINALITY/VALUE The study is a pioneer in health care evaluation of public and private sectors of Lahore and Rawalpindi while using GRA models, in general, and the second synthetic GRA model, in particular It presents an alternative method to the statistical way of analyzing data by successfully demonstrating the use of grey methods, which can make reasonable decisions even through small samples

Hospital nurse shift length, patient-centered care, and the perceived quality and patient safety

Abstract: Background There is no clear evidence that can guide decision makers regarding the appropriate shift length in the hospitals in Malaysia. Further, there is no study that explored the value of patient-centered care of nurses working longer shifts and its impact on the care outcomes. Objective The study aims to investigate the effect of the hospital nurse shift length and patient-centered care on the perceived quality and safety of nurses in the medical-surgical and multidisciplinary wards in Malaysia. Methods A cross-sectional survey has been conducted on 12 hospitals in Malaysia. Data have been collected via a questionnaire. A stratified sampling has been used. The Hayes macro regression analyses have been used to examine the mediating effects of patient-centered care between the effect of working long shifts on the perceived quality and patient safety. Results There is a significant mediation effect of patient-centered care between the effect of shift length on the perceived quality (F = 42.90, P ˂ 0.001) and patient safety (F = 25.12, P ˂ 0.001). Conclusion Patient-centered care mitigates the effect of the shift length on the care outcomes. The study provides an input for the policymakers that patient-centered care and restructuring duty hours are important to provide high-quality patient care.

Pharmacy workforce in Saudi Arabia: Challenges and opportunities: A cross-sectional study.

Abstract: Background Saudi Arabia has shown rapid growth in its pharmacy workforce and pharmacy education over the last decade. The health indicators demonstrate an increased need for medications and, thus, the accessibility of pharmacies. Since pharmacists are considered the most accessible health care professionals, the country has experienced a continuous demand to produce more pharmacists. Objectives The objectives of the study are to evaluate the pharmacy workforce in Saudi Arabia and to identify pharmaceutical manpower issues. Methods A retrospective cross-sectional approach was used. Data were obtained from the latest version of the Health Statistical Yearbook-Kingdom of Saudi Arabia, 2016; Saudi Commission for Health Specialties publications, 2018. Results In general, the exponential increase in the number of pharmacy schools has produced more pharmacists in the rural areas of the country, but inequitable distribution of the workforce still exists. The reliance on nonindigenous pharmacists, especially in the private sector, is substantial. Employed male pharmacists outnumber females, mainly due to the cultural and social factors that limit the participation of women in community pharmacy, which is the largest employment sector. The employment rate shows limited opportunities for Saudi pharmacists at MOH, as they have already Saudised almost all pharmacy positions at their health care facilities. However, the private sector needs to assume responsibility for their share of the renationalisation of the profession in order to provide jobs for local pharmacists. Conclusions Regular, more detailed profiling of the pharmacy workforce is an essential step to achieving effective pharmacy workforce planning. Currently, a large gap exists in our knowledge of the country's workforce.

An age-integrated approach to improve measurement of potential spatial accessibility to emergency medical services for urban areas.

Abstract: Objective This study aimed to develop an age-included approach to measure the potential accessibility to Emergency medical services (EMS) across urban and suburban areas of Mashhad city in Iran. Methods We used an improved version of two-step floating catchment area (2SFCA) and enhanced 2SFCA (E2SFCA) methods to measure the potential accessibility to EMS services with inclusion of age factor. This enabled us to better model accessibility of the older population to the EMS. We used 22 800 records of EMS enquiries from July to September 2018 to evaluate and assess the potential improvement in access to the EMS with incorporating age in the model. Results Suburb areas had less potential accessibility compared with central urban due to the high density of EMS stations in the city center areas. Our model showed slight improvement in potential accessibility measurement as a result of the proposed age-integrated method. Conclusion An age-integrated index of accessibility method takes into account the age distribution of the population in service area is highly associated with actual measures of accessibility to EMS services. Identifying areas with poor access to EMS will help policymakers to design better policy planning to allocate resources and improve provision of EMS services.

Health system strengthening – reflections on its meaning, assessment and our state of knowledge

Abstract: Comprehensive reviews of health system strengthening (HSS) interventions are rare, partly because of lack of clarity on definitions of the term but also the potentially huge scale of the evidence. We reflect on the process of undertaking such an evidence review recently, drawing out suggestions on definitions of HSS and approaches to assessment, as well as summarising some key conclusions from the current evidence base. The key elements of a clear definition include, in our view, consideration of scope (with effects cutting across building blocks in practice, even if not in intervention design, and also tackling more than one disease), scale (having national reach and cutting across levels of the system), sustainability (effects being sustained over time and addressing systemic blockages), and effects (impacting on health outcomes, equity, financial risk protection, and responsiveness). We also argue that agreeing a framework for design and evaluation of HSS is urgent. Most HSS interventions have theories of change relating to specific system blocks, but more work is needed on capturing their spillover effects and their contribution to meeting overarching health system process goals. We make some initial suggestions about such goals, to reflect the features that characterise a "strong health system." We highlight that current findings on "what works" are just indicative, given the limitations and biases in what has been studied and how, and argue that there is need to rethink evaluation methods for HSS beyond finite interventions and narrow outcomes. Clearer concepts, frameworks, and methods can support more coherent HSS investment.

China's policy experimentation on long-term care insurance: Implications for access.

Abstract: China's population is aging rapidly, while the traditional long-term care (LTC) system that heavily relies on families is eroding. In response, China has embarked on a journey of policy experimentation for long-term care insurance (LTCI) since 2016, launching LTCI pilots in 15 pioneer cities. These pilots have a great diversity in participation, eligibility, and provision. This paper estimates the prevalence of LTC needs and analyzes the impact of the LTCI pilots on access. Although substantial progress has been achieved, the overall coverage of LTCI is still relatively small, and a large proportion of vulnerable people needing LTC seem to be left behind because of the strict eligibility criteria. This analysis suggests that future policy experimentation on LTCI reform in China needs to address the following pressing policy issues: expanding the coverage of LTCI; narrowing rural-urban disparities in access; improving access for vulnerable subpopulations; and reducing the heavy reliance on institutional care.

What drove the health system reforms in the Kingdom of Saudi Arabia? An analysis.

Abstract: Purpose The primary objective of this article is to present the key directions taken by the Saudi health care system, following the announcement of the Saudi Vision 2030. The changing international scenario, together with reduced oil revenues, high population growth, emerging lifestyle diseases, and demands for better quality of care, has impacted the development of the Saudi health system. The government is now ardently pursuing private sector development and has initiated privatization and marketization as a core strategy of reforms in its health system. This article posits that the current economic conditions of the KSA and local and global market dynamics are the primary drivers for these reforms. Methods This study is based on a scoping literature review. Findings The intended reforms will have very limited contribution to improving the population's health, and the study remains inconclusive. Conclusion The Kingdom took a protective approach in reforming its health sector. The social values that undergird the government actions, especially, how much priority it gives to maintain status quo in the social and economic fabric vis-a-vis economic growth and development, have exerted a significant influence on whether the KSA chooses a pro-government or a pro-market approach; however, this could lead to a hybrid model of health care system.

The effect of family doctor-contracted services on noncommunicable disease self-management in Shanghai, China.

Abstract: Background Noncommunicable diseases (NCDs) are a major threat to population health worldwide. In Shanghai, China, a new pattern of NCD management-self-management-has been developed in community health service centres (CHSCs). Objective To clarify how contracting with CHSC-based family doctors (FDs) influences the engagement in and effectiveness of self-management behaviour among NCD patients. Method We conducted two waves of a questionnaire survey (in 2013 and 2016) to collect data on patients with NCDs. Separate logistic regression models and longitudinal analysis were performed to examine the effect of contracting with an FD on NCD self-management and the effectiveness of this self-management. Results Nearly all contracted patients (80.79%) had implemented NCD self-management, while only 55.57% of non-contracted patients did so. The self-management effectiveness rate was also higher among contracted patients than among non-contracted ones (86.66% vs. 54.79%). In the population-averaged models, contracted patients had 2.25 and 2.91 times greater odds of implementing self-management and reporting that the self-management was effective, respectively, after controlling for all related variables. Additionally, awareness of FD-contracted services, satisfaction with CHSCs, and experiencing first contact at CHSCs had positive impacts on the implementation and effectiveness of self-management. Conclusions FDs were important for ensuring that NCD patients engaged in self-management behaviour, the most common form of which was focus group. Participation in NCD focus groups may be key for attaining the effects of self-management, including improved health knowledge, greater health awareness, more frequent engagement in health behaviour, and, most importantly, greater practice of self-monitoring. Self-management might help to achieve greater NCD control.

A comprehensive modelling framework to forecast the demand for all hospital services

Abstract: Background Because of increasing demand, hospitals in England are currently under intense pressure resulting in shortages of beds, nurses, clinicians, and equipment. To be able to effectively cope with this demand, the management needs to accurately find out how many patients are expected to use their services in the future. This applies not just to one service but for all hospital services. Purpose A forecasting modelling framework is developed for all hospital's acute services, including all specialties within outpatient and inpatient settings and the accident and emergency (AE ie, demand was forecasted for 38 outpatient specialties (first referrals and follow-ups), 25 inpatient specialties (elective and non-elective admissions), and for AE (b) ensure necessary resources are in place (eg, beds and staff); (c) better manage budgets, ensuring enough cash is available; and (d) reduce risk.

The health care reform in Portugal: Outcomes from both the New Public Management and the economic crisis

Abstract: The Portuguese health system concentrates most of its activity in a National Health Service, created in 1979 to promote universal and general access. The National Health Service should ensure equity, efficiency, and quality of all health care delivered services. This study assesses the impact of health care policies between 2002 and 2017, focusing on 3 timeframes: the adoption and adaptation of New Public Management principles to the health care sector (2002 to 2010), the economic and financial crisis period (2011-2015), and the postcrisis recovery period (2016-2017). The current study evaluates the main policy measures in the health sector, presenting their impacts in terms of access, efficiency, accountability, and costs over those 3 economic periods. It was verified that not all the measures implemented by the successive governments obtained the desired outcomes, generating even costs increase, apart from the austerity period in which health expenditure showed a significant reduction because of the financial constraints.

Building the health workforce: Saudi Arabia's challenges in achieving Vision 2030.

Abstract: Background Saudi Arabia's Vision 2030 represents a major structural shift in all economic sectors. Health care is one of the largest sectors significantly contributing to achievement of the vision OBJECTIVES: To provide an overview of health workforce in Saudi Arabia and identify various critical issues and challenges that need to be addressed in achieving health system goals envisaged in the Vision. Methods This paper is based on extensive review of literature conducted to stimulate pertinent descriptive information on health workforce in Saudi Arabia. Findings Saudi nationals constitute 44% of all health workforce and 29.5% of all physicians employed by the health system. Among Saudi nationals, there is a significant underrepresentation of females except in the nursing profession. The health workforce is beleaguered with numerical inadequacy, skill imbalance, gender disparity, and access issues. Conclusion Health system needs to adopt a rigorous approach by investing heavily on medical, nursing, and other specialized fields of education. Planning for the health workforce needs to adopt appropriate strategies that reflect all aspects including the number, skills, and gender distribution for meeting the future health needs of population to facilitate achievement of Vision.

Patient costs of hypertension care in public health care facilities in Kenya.

Abstract: Background Hypertension in low- and middle-income countries, including Kenya, is of economic importance due to its increasing prevalence and its potential to present an economic burden to households. In this study, we examined the patient costs associated with obtaining care for hypertension in public health care facilities in Kenya. Methods We conducted a cross-sectional study among adult respondents above 18 years of age, with at least 6 months of treatment in two counties. A total of 212 patients seeking hypertension care at five public facilities were interviewed, and information on care seeking and the associated costs was obtained. We computed both annual direct and indirect costs borne by these patients. Results Overall, the mean annual direct cost to patients was US$ 304.8 (95% CI, 235.7-374.0). Medicines (mean annual cost, US$ 168.9; 95% CI, 132.5-205.4), transport (mean annual cost, US$ 126.7; 95% CI, 77.6-175.9), and user charges (mean annual cost, US$ 57.7; 95% CI, 43.7-71.6) were the highest direct cost categories. Overall mean annual indirect cost was US$ 171.7 (95% CI, 152.8-190.5). The incidence of catastrophic health care costs was 43.3% (95% CI, 36.8-50.2) and increased to 59.0% (95% CI, 52.2-65.4) when transport costs were included. Conclusions Hypertensive patients incur substantial direct and indirect costs. High rates of catastrophic costs illustrate the urgency of improving financial risk protection for these patients and strengthening primary care to ensure affordability of hypertension care.

Patient satisfaction with primary healthcare services in Lebanon

Abstract: Background Reorienting the model of care towards preventive services is integral to successfully move towards a people-centered healthcare system. Patient satisfaction is an essential component of people-centered care and an important quality of care indicator. In its efforts to strengthen primary healthcare, the Ministry of Public Health in Lebanon assessed patient satisfaction with services offered at primary healthcare centers (PHCCs) and explored the relationship between patient satisfaction and patient characteristics and accreditation. Methodology The study followed a cross-sectional design. A survey was administered through phone calls with 1313 patients receiving services as part of a benefits package provided by 59 PHCCs. The survey collected data on patients' sociodemographic characteristics, perceptions, and satisfaction. Results Overall, 96.66% of surveyed patients reported being either satisfied (60.23%) or very satisfied (36.43%) with the services provided at the PHCCs. Patients' perceptions of patient-provider communication, healthcare provider competency, and health education quality constituted strong predictors for satisfaction. However, facilities' accreditation status was not associated with satisfaction with PHC services. Conclusion Patient satisfaction with primary healthcare services in Lebanon was remarkably high. Findings highlighted the need for quality improvement particularly in health education and the alignment of accreditation standards with patient needs and expectations.

The impact of accreditation on nurses' perceptions of quality of care in Iran and its barriers and facilitators

Abstract: Background Iran national hospital accreditation was initiated as a government and mandatory program in 2012. The aim of this study was to examine the impact of accreditation on nurses' perceptions of quality of care and to determine those barriers and facilitators needed for effective implementation of accreditation. Methods A cross-sectional survey conducted in 43 tertiary public hospitals in 5 metropolises, Iran, which successfully passed national accreditation surveys. Participants included nurses with at least 5-year work experience. Overall response rate was 76%, with 1312 of 1706 valid responses included in the data analysis. A questionnaire was applied using a 5-point Likert scale ranging from 1 "strongly disagree" to 5 "strongly agree". In addition, the questionnaire included 2 open-ended questions allowing the respondent to identify barriers and facilitators to the process of for improving accreditation implementation. The relationship between the quality of results and the independent variables was tested using multiple regression analysis. Results The scales measuring benefits of accreditation had the highest mean score followed by strategic quality planning, education and training, and staff involvement. Regression analysis indicated that leadership, commitment, and support; education and training; rewards and recognition; and staff involvement were factors affecting quality results. Barriers encountered included financial and capital resources, staff, institutional, and patients. Hospital accreditation has a positive impact on quality of care. Conclusions The findings of this study provide valuable information to policymakers and hospital managers on which to base the process of accreditation and its requirements, and to help reap its benefits.

How many beds? Capacity implications of hospital care demand projections in the Irish hospital system, 2015-2030.

Abstract: Existing Irish hospital bed capacity is low by international standards while Ireland also reports the highest inpatient bed occupancy rate across OECD countries. Moreover, strong projected population growth and ageing is expected to increase demand for hospital care substantially by 2030. Reform proposals have suggested that increased investment and access to nonacute care may mitigate some increased demand for hospital care over the next number of years, and it is in this context that the Irish government has committed to increase the supply of public hospital beds by 2600 by 2027. Incorporating assumptions on the rebalancing of care to nonhospital settings, this paper analyses the capacity implications of projected demand for hospital care in Ireland to 2030. This analysis employs the HIPPOCRATES macrosimulation projection model of health care demand and expenditure developed in the ESRI to project public and private hospital bed capacity requirements in Ireland to 2030. We examine 6 alternative projection scenarios that vary assumptions related to population growth and ageing, healthy ageing, unmet demand, hospital occupancy, hospital length of stay, and avoidable hospitalisations. We project an increased need for between 4000 and 6300 beds across public and private hospitals (an increase of between 26.1% and 41.1%), of which 3200 to 5600 will be required in public hospitals. These findings suggest that government plans to increase public hospital capacity over the 10 years to 2027 by 2600 may not be sufficient to meet demand requirements to 2030, even when models of care changes are accounted for.

Factors influencing missed nursing care in public hospitals in Australia: An exploratory mixed methods study.

Abstract: Background: Missed nursing care (MNC) is a significant health care issue that impacts on the quality of health care and patient safety. It refers to delayed or omitted aspects of nursing care (totally or partially). MNC is an under-researched area in the Australian health care context. Objective: This research sought to further explore the MNC phenomenon in the context of an acute care hospital and to identify its common elements and the factors influencing its occurrence. Design: A convergent parallel mixed methods design was employed involving secondary analysis of routinely collected hospital data and a survey of 44 nursing staff using the MISSCARE survey instrument. The two sources of data were converged to address the objective. Findings: The study found that the most common elements of missed nursing care include failure of patient ambulation, emotional support for patients and/or family, and the provision of full documentation. These elements are consistent with previous international studies conducted in acute care hospital settings. This study identified that local context impacting on MNC was also important and included interruptions to workflow, “perceived” lack of management support, poor handover, and communication breakdown between the nursing team and medical staff. Conclusion: Consideration of the local health care context is foundational in understanding the MNC phenomenon. The findings of this research may help nursing managers mitigate the possible effects of MNC and therefore improve patient safety in their acute care environment. Additional multisite studies are required to further explore factors associated with MNC in both general and local contexts.

Effects of continuous care for patients with type 2 diabetes using mobile health application: A randomised controlled trial.

Abstract: BACKGROUND Type 2 diabetes is a worldwide disorder that affects millions of people and can exert negative clinical and social effects on the patients. In some previous studies, mobile health applications have been used as a means of clinical intervention. However, the therapeutic effect of continuous care through mobile phone applications for patients with type 2 diabetes remains unclear. OBJECTIVE This study aimed to explore the clinical effect of continuous care for patients with type 2 diabetes using mobile health application by comparing traditional discharge nursing. METHODS In total, 120 patients with type 2 diabetes were randomly divided into two groups: The test group received continuous care based on the mobile phone application (n = 60), and the control group received conventional care (n = 60). Primary clinical outcomes, such as Glycaemic Haemoglobin (GH) levels, blood glucose levels, self-care abilities, disease cognition abilities, and the number of readmissions, were examined in both groups. RESULTS The results showed significant improvements pertaining to disease awareness levels (81.28 vs 71.34, P < .05), self-management abilities (9.14 vs 7.81, P < .05), GH (-1.50% vs -0.76%, P < .05), fast blood glucose (-3.23 vs -1.25 mmol/L, P < .05), postprandial blood glucose levels (-4.34 vs -2.34 mmol, P < .05), and control levels in the test group. Moreover, in the test group, the frequency of rehospitalisation was reduced during the intervention period, as was the average number of rehospitalisation within 6 months after discharge (-1.19 vs P < .05). CONCLUSIONS Continuous care based on a mobile health application has potential as a management strategy for patients with type 2 diabetes.

Who experiences unmet need for mental health services and what other barriers to accessing health care do they face? Findings from Australia and Canada.

Abstract: Purpose: To examine factors associated with unmet need for mental health services and links with barriers to access to care more broadly. Methodology: The Commonwealth Fund International Health Policy Surveys from 2013 and 2016 were used to explore factors associated with unmet need for adults who experienced emotional distress for 1320 respondents in Australia and 2284 in Canada. Findings: Over one in five adults in Australia (21%) and in Canada (25%) experienced emotional distress, just over half said they received professional help (51% in Australia, 59% in Canada). The majority of those who did not get help indicated did not want to see a professional (37% in Australia, 30% in Canada). For those who did seek help, the factors associated with not receiving care included lower income, higher out‐of‐pocket health care costs, and poorer health. When compared with people with met needs, those with unmet needs for mental health services were more likely to also experience affordability, medication, and trust‐related access barriers (AOR range 2.41 to 7.49 for the two countries, P < 0.01). Conclusion: Including unmet needs for mental health services as part of regular reporting on access to care may bring attention to access barriers for people with mental health conditions.

The impact of health reform in Iran on catastrophic health expenditures: Equity and policy implications.

Abstract: Purpose In 2014, the Islamic Republic of Iran launched the Health Transformation Plan (HTP), with the goal of achieving universal health coverage (UHC) through improved financial protection and access to high-quality health services among Iranian households. We aimed to investigate the impact of the HTP on the level and pattern of out-of-pocket (OOP) payments for health care. Methods Using data from two rounds (2013 and 2016) of the Iranian Statistics Centre's Household Expenditure and Income Survey (HEIS), collected before and after implementation of the HTP, we estimate changes in the level and drivers of OOP payments, and the prevalence, intensity, and distribution of catastrophic health expenditures (CHEs) among Iranian households. Findings Our results indicate that per capita OOP payments on health remained stable during the observed period, with the largest proportion of OOP payments spent on medicines. Using thresholds of 10% and 25% of total consumption, there was a slight increase in the prevalence of CHE. The prevalence of CHE increased from 3.76% to 3.82% at threshold of 25% of total consumption. Using 40% capacity to pay threshold, prevalence diminished modestly from 2.5% to 2.37% and the intensity decreased from 13.16% to 12.32%. At all thresholds, CHE were more concentrated among wealthier households. Conclusion These results suggest that while financial protection of the poor in Iran has improved due to the HTP, more work is needed to achieve UHC in Iran. For the next phase of health reforms, more emphasis should be placed on shifting away from OOP co-payments for health financing to progressive prepayment mechanisms to facilitate better sharing of financial risks across population groups.

Impact of the doctor deficit on hospital management in Poland: A mixed-method study.

Abstract: OBJECTIVES The primary objective was to assess the scale and consequences of the doctor deficit in Poland with the main focus on hospital care providers. To provide the background for the above, an analysis of the system level responses to the problem was also conducted. DATA AND METHODS A mixed-method approach was used. We triangulated data collected using 3 methods: (1) a literature review, (2) an analysis of the national statistical databases, and (3) in-depth interviews with hospital managers. RESULTS Poland is characterized by the lowest number of physicians per 1000 population in the European Union (2.3 in 2015). Also, the age structure of the doctor working population constitutes an alarming factor (in 2015, approx. 48% of all practicing doctors and 61% of specialists were above 50). In recent years, numerous hospitals were forced to cease provision of specific services and/or close wards due to the doctor deficit. The high competition in employing doctors and pressure for wage increases puts hospital managers in situations where they must often choose between securing service provision (by offering higher wages for doctors) and maintaining the hospital's positive financial outcome (by containing costs). CONCLUSION In Poland, the long-term neglect of health workforce planning at the system level (there is neither a dedicated structure nor a formal strategy) has contributed to the current doctor deficit crisis. From the hospital managers' perspective, who are on the frontline of the problem impact, urgent solutions are needed that would at least alleviate its scale in the short term.

Financing health care in Bangladesh: Policy responses and challenges towards achieving universal health coverage

Abstract: Bangladesh has attained notable progress in most of the health indicators, but still, health system of the country is suffering badly from poor funding. Issues like burden of out-of-pocket expenditure, low per capita share in health, inadequate service facilities, and financial barriers in reducing malnutrition are being overlooked due to inadequacy and inappropriate utilization of allocated funds. We aimed to review the current status of health care spending in Bangladesh in response to national health policy (NHP) and determine the future challenges towards achieving universal health coverage (UHC). National health policy suggested a substantial increase in budgetary allocation for health care, although government health care expenditures in proportion to total public spending plummeted down from 6.2% to 4.04% in the past 8 years. Overall, 67% of the health care cost is being paid by people, whereas global standard is below 32%. Only one hospital bed is allocated per 1667 people, and 34% of total posts in health sector are vacant due to scarcity of funds. The country is experiencing demographic dividend with a concurrent rise of aged people, but there seems no financial protection schemes for the aged and working age populations. Such situation results in multiple obstacles in achieving financial risk protection as well as UHC. Policy makers must think effectively to develop and adapt systems in order to achieve UHC and ensure health for all.

Inequality trends in the demographic and geographic distribution of health care professionals in China: Data from 2002 to 2016.

Abstract: China has long been negatively affected by a shortage and maldistribution of health workers This study aimed to examine the national and regional trends in the demographic and geographic distribution inequality of health care professionals in China from 2002 to 2016 Based on data from the China Health and Family Planning Statistical and China Statistical Yearbooks, we calculated the Gini coefficient and the Theil T and Theil L indices based on the number of health care professionals per capita and per geographic area to measure the inequalities in their demographic and geographic distribution, respectively The contributions by intra-regional and inter-regional differences on total inequality were explored within and among East, Central, and West China via Theil index decomposition We found that the national demographic distribution of health care professionals maintained in an absolute equality level, and the inequality indices decreased gradually, whereas the corresponding geographic inequalities were severe and presented a worsening trend Compared with nurses, physicians not only maintained higher densities but also maintained a more equal distribution Intra-regional disparities within the east, central, and western regions were the main cause for overall demographic inequality, whereas both intra-regional and inter-regional disparities significantly contributed to overall geographic inequality To conclude, the distribution equality of health care professionals by population was satisfactory, whereas the corresponding distribution inequality by area was severe Different types of distribution inequality of health care professionals existed regionally and nationally despite their increasing quantities and densities Factors beyond population size should be considered when the government introduces health workforce allocation policies

International variations in trust in health care systems.

Abstract: Public trust in health care systems has been measured in many countries, but there have been few studies of the intercountry variability in trust, or the degree to which such variability is because of population or structural characteristics. We used data from the health care survey conducted by the International Social Survey Program from 2011 to 2013 in 31 countries to assess whether intercountry variability was significantly greater than intracountry variability using general linear models in which country was treated as a fixed factor. We also assessed the extent to which intercountry variability was because of respondent and economic circumstances (gross national income per capita). Public trust in the health care system varied significantly across countries (P < .001), even after adjustment for 8 within-country predictors and gross national income per capita. One of the strongest predictors of trust was the respondents' most recent health care experience. Higher respondent education, urban residence, and a lower country's gross national income predicted less trust in the health care system. After countries with the 10% highest health expenditures per capita (United States) and the 10% lowest health care expenditures per capita (China and the Philippines) were removed, public trust in the health care system was positively associated with the remaining countries' health care expenditures per capita (Pearson correlation coefficient, 0.490; P = .008) and gross national income per capita (Pearson correlation coefficient, 0.495; P = .007). There is significant variation in public trust in health care across the countries studied. The intercountry differences are due, in part to economic circumstances.

Is Taiwan's National Health Insurance a perfect system? Problems related to health care utilization of the aboriginal population in rural townships.

Abstract: National Health Insurance (NHI) was implemented in Taiwan in 1995, and has significantly increased coverage to 99% of the population. The implementation of NHI has had large impacts on health disparities. Despite that, the NHI faces multiple challenges, including the condition of "coverage without access" among the Taiwanese aboriginal population, mostly residing in mountainous townships and experiencing lower socioeconomic status, decreased health outcomes, and limited access to adequate high-quality health care services. This paper summarizes the persistent health gap and the differences in health care utilization and health outcomes between the aboriginal population in rural townships and urban populations in Taiwan. Mountainous townships face challenges including lack of access to high-quality health care services and limited medical resources. Further policy recommendations and current progress are highlighted and discussed.

Health system performance assessment in small countries: The case study of Latvia.

Abstract: Managing the complexity that characterizes health systems requires sophisticated performance assessment information to support the decision-making processes of healthcare stakeholders at various levels. Accordingly, in the past few decades, many countries have designed and implemented health system performance assessment (HSPA) programmes. Literature and practice agree on the key features that performance measurement in health should have, namely, multidimensionality, evidence-based data collection, systematic benchmarking of results, shared design, transparent disclosure, and timeliness. Nevertheless, the specific characteristics of different countries may pose challenges in the implementation of such programmes. In the case of small countries, many of these challenges are common and related to their inherent characteristics, eg, small populations, small volumes of activity for certain treatments, and lack of benchmarks. Through the development of the case study of Latvia, this paper aims at discussing the challenges and opportunities for assessing health system performance in a small country. As a result, for each of the performance measurement features identified by the literature, the authors discuss the issues emerging when adopting them in Latvia and set out the potential solutions that have been designed during the development of the case study.

Reforms in the Portuguese health care sector: Challenges and proposals.

Abstract: Portugal has one of the most complete public systems worldwide. Since 1979, the Portuguese National Health Service (NHS) was developed based on the integration and complementarity between different levels of care (primary, secondary, continued, and palliative care). However, in 2009, the absence of economic growth and the increased foreign debt led the country to a severe economic slowdown, reducing the public funding and weakening the decentralized model of health care administration. During the austerity period, political attention has focused primarily on reducing health care costs and consolidating the efficiency and sustainability with no structural reform. After the postcrisis period (since 2016), the recovery of the public health system begun. Since then, some proposals have required a reform of the health sector's governance structure based on the promotion of access, quality, and efficiency. This study presents several key issues involved in the current postcrisis reform of the Portuguese NHS response structure to citizens' needs. The article also discusses the implications of this Portuguese experience based on current reforms with impact on the future of citizens' health.

Factors affecting the choice of health care utilisation between private and public services among the elderly population in India.

Abstract: India is experiencing rapid population ageing in recent years. One of the most concomitant issues is the choice of health care services among the elderly, leading to its impact on the magnitude of health expenditure. Applying Andersen's Health Behavioural Model, this study identifies the predictors of the choice of inpatient health care services among the Indian elderly between private and public services. It also examines the nature of interregional disparity in the choice of health care services. Using NSSO data, the results suggest that the elderly belonging to upper caste and having higher levels of education, higher incomes, larger family size, and needing surgery are likely to choose private health care, while those experiencing higher economic dependence, chronic diseases, and higher duration of hospitalisation tend to prefer public inpatient services. The magnitude and significance of these factors, however, vary across regions. The findings of the study provide an understanding of the preferences of the India's geriatric population over hospital services, which may help policymakers better understand their health care needs.

Developing a conceptual framework for patient safety culture in emergency department: A review of the literature

Abstract: Patient safety culture is a critical component of modern health care. However, the high‐paced, unpredictable nature of the emergency department (ED) environment may impact adversely on it. The aim of this paper is to explore the concept of patient safety culture as it may apply to emergency health care, and to propose a conceptual framework that could form the basis for interventions designed to improve it. This is a systematic review of the literature. A search was undertaken of common electronic bibliographic databases using key words such as safety culture, safety climate, and Emergency Department. Articles were analysed for consistent themes with the aim to construct a conceptual framework. Ten articles met the inclusion criteria that specifically examined safety culture in the ED. Synthesis of the literature resulted in the emergence of three overarching themes of ED practice found to impact on safety culture in the ED. These were the dimensions of patient safety culture, the factors influencing it, and the interventions for improving it. A conceptual framework was constructed that identifies elements that significantly impact the patient safety culture in the ED. This framework may assist managers and researchers to take a comprehensive approach to build an effective safety culture in ED setting.

Multivariate analyses of the global acceptability rates of male intimate partner violence (IPV) against women based on World Values Survey data.

Abstract: Major international organizations like UN Women and the World Health Organization (WHO) estimate that nowadays, more than one-third of all women in the world suffer male intimate partner violence (IPV) at some point in their lives and that eliminating the societal acceptancy of that violence is a major element in combatting it. While there is consensus that IPV has disastrous public health consequences, so far, little is known about the drivers of IPV acceptability rates. This article therefore analyzes available global opinion data from the World Values Survey (WVS) project in 72 countries of the world, representing some four-fifths of the global population. Existing IPV data published prior to this study already suggested that the highest global incidence of IPV is to be found in sub-Saharan Africa, South Asia, and Andean Latin America. Neoliberal political economy in the tradition of Hayek maintained for a long time that the disrespect of property rights and traditional family values can have disastrous social and economic effects. Our study renders support for this theory: On the basis of a variety of statistical analyses, including a factor analysis of 45 key items from the WVS data, we conclude that apart from attitudes on gender equality, the disrespect of property rights and traditional family values, analyzed by Hayek, emerge as the major drivers of high acceptability rates of IPV. Mali, Serbia, Montenegro, Zambia, Burkina Faso, India, the Philippines, Rwanda, Egypt, and Algeria are on top of this list of global rates of IPV acceptability.

Opinions and evaluations of stakeholders in the implementation of the public-private partnership (PPP) model in integrated health campuses (city hospitals) in Turkey.

Abstract: Purpose This study aimed to define the public-private partnership (PPP) model, eliciting the views and assessments of stakeholders and identifying associated health policies and planning issues. Method It uses qualitative research methods to examine the extent to which PPPs promote or interfere with the provision of health services, equality, efficiency, quality, health tourism, and initiatives to strengthen the national economy. Having selected an appropriate sample, researchers approached bureaucrats and experts from the Ministry of Health, Social Security Institution, Ministry of Development, Ministry of Finance, NGOs, and other state institutions and organizations. A total of 83 people were asked to complete a semi-structured questionnaire. The qualitative research data were analyzed using a descriptive-analysis method; a content analysis was carried out using a computer-based qualitative research program, MAXQDA Versions 11. Results The majority of participants expressed positive opinions about PPPs, their applicability in Turkey, and the financial viability and scope of PPPs in the health sector. They also commented on the aims, advantages, and disadvantages of such partnerships. The majority of participants believed that a PPP was an appropriate finance model for the integrated health-campus substructure of Turkey's health sector. The most positive views were expressed by public and private sector-stakeholders, while some negative views were voiced by NGO representatives. Conclusion This study identified and assessed integrated health-campus projects to determine the aim, suitability, advantages, and disadvantages of the model in the health sector, particularly in relation to the cost, quality, and availability of health services. This study discusses the current positive and negative effects of integrated health-campus implementation.