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China’s Healthcare Reform And Resources Redistribution: Lessons For Emerging Nations
Jia CUI,Shaomin HUANG,Gerald RAMEY
Review of Economic and Business Studies (REBS) , 2009,
Abstract: Following China’s recent economic growth and healthcare reform, medical services quickly merged into the market economy. The burden of healthcare expense on the Chinese people has become a serious political issue. This research project reviews the changes in health expenditures made during the last two decades. This paper explores the cause of this rapid change in the healthcare sector and analyzes the corresponding statistics during the entire economic reform period. In addition, the paper articulates that the lack of healthcare coverage existed even before the healthcare reform formally started. As a direct result of this reform, medical resources were quickly concentrated in urban hospitals and the individual out-of pocket expense as the share of total health expenditures sharply increased. Recommendations are made for further healthcare reform.
Choice of healthcare provider following reform in Vietnam
Nguyen Thuan, Curt Lofgren, Lars Lindholm, Nguyen Chuc
BMC Health Services Research , 2008, DOI: 10.1186/1472-6963-8-162
Abstract: The study consisted of twelve monthly follow-up interviews of 621 randomly selected households. The households are part of the FilaBavi project sample – Health System Research Project. The heads of household were interviewed at monthly intervals from July 2001 to June 2002.The use of private health providers and self-treatment are quite common for both episodes (60% and 23% of all illness episodes) and expenditure (60% and 12.8% of healthcare expenditure) The poor tend to use self-treatment more frequently than wealthier members of the community (31% vs. 14.5% of illness episodes respectively). All patients in this study often use private services before public ones. The poor use less public care and less care at higher levels than the rich do (8% vs.13% of total illness episodes, which decomposes into 3% vs. 7% at district level, and 1% vs. 3% at the provincial or central level, respectively). The education of the patients significantly affects healthcare decisions. Those with higher education tend to choose healthcare providers rather than self-treatment. Women tend to use drugs or healthcare services more often than men do. Patients in two highest quintiles use health services more than in the lowest quintile. Moreover, seriously ill patients frequently use more drugs, healthcare services, public care than those with less severe illness.The results are useful for policy makers and healthcare professionals to (i) formulate healthcare policies-of foremost importance are methods used to reduce self-treatment and no treatment; (ii) the management of private practices and maintaining public healthcare providers at all levels, particularly at the basic levels (district, commune) where the poor more easily can access healthcare services, is also important, as is the management of private practices and (iii) provide a background for further studies on both short and long-term health service strategies.Access to healthcare providers is a significant factor in improving pu
Networks and social capital: a relational approach to primary healthcare reform
Catherine Scott, Anne Hofmeyer
Health Research Policy and Systems , 2007, DOI: 10.1186/1478-4505-5-9
Abstract: Partnerships, collaboratives, interdisciplinary teams, and networks have all been presented as relational strategies to redesign traditional practices, to improve healthcare services and to enhance knowledge exchange between people in healthcare systems [1-8]. The importance of social relationships between people in families, communities, teams, organizations, and other collectives has been well established [9-12] and "identifying the nature and extent of the impact of social relationships is generally referred to as 'social capital' " [10]. For decades, people working in primary healthcare have been encouraged to work in teams, to collaborate with other professionals, to form partnerships with other service providers and other sectors in order to improve health services and health outcomes [13]. More recently, the notion of networks as an important mechanism in and across organizations has made its way into this discourse [14]. As with ideas of collaboration and partnership, there is no consensus within the health services on what is meant by adopting a network approach, and no empirical consensus about the nature of networks [15]. Thus, despite changes in the collaborative rhetoric, little has changed in the way professionals work within and across professional boundaries.In this paper, we review the rationale for collaboration within healthcare systems; provide an overview and synthesis of key concepts; dispel some common misconceptions of networks; and then finally apply theory to an example of primary healthcare network reform in Alberta (Canada). Our central thesis is that a relational approach to systems change, one based on a synthesis of network theory and social capital can provide the foundation for a multi-focal approach to primary healthcare reform. In the absence of such an approach, collaborative talk alone (e.g., working "in partnership" or "through networks") will do little to enhance practice and bring about real change. It is increasingly apparent
Dutch healthcare reform: did it result in better patient experiences in hospitals? a comparison of the consumer quality index over time
David E Ikkersheim, Xander Koolman
BMC Health Services Research , 2012, DOI: 10.1186/1472-6963-12-76
Abstract: We analyzed 8,311 respondents covering 31 hospitals in 2006, 22,333 respondents covering 78 hospitals in 2007 and 24,246 respondents covering 94 hospitals in 2009. We describe CQI trends over the period 2006-2009. In addition we compare hospitals that varied in the level of competition they faced and hospitals that were forced to publish CQI results publicly and those that were not. We corrected for observable covariates between hospital respondents using a multi level linear regression. We used the Herfindahl Hirschman Index to indicate the level of competition.Between 2006 and 2009 hospitals showed a CQI improvement of 0.034 (p < 0.05) to 0.060 (p < 0.01) points on a scale between one and four. Hospitals that were forced to publish their scores showed a further improvement of 0.027 (p < 0.01) to 0.030 (p < 0.05). Furthermore, hospitals that faced more competition from geographically close competitors showed a more pronounced improvement of CQI-scores 0.004 to 0.05 than other hospitals (p < 0.001).Our results show that patients reported improved experiences measured by the CQI between 2006 and 2009. CQI levels improve at a faster rate in areas with higher levels of competition. Hospitals confronted with forced public publication of their CQI responded by enhancing the experiences of their patients.In the last two decades, several Western countries introduced some form of managed competition in their health care system [1,2]. Common goal of these reforms is creating a demand driven system that provides more patient centered care [3]. To achieve this goal the quality of health care providers needs to be assessed and publicly reported [4,5]. Patients and health plans may then use quality information to make informed choices between health care providers.The public reporting of provider quality can stimulate quality improvement through informed patient choice, quality contracting of providers by health plans and/or by intrinsic motivation of health care providers [6].
Improving health outcomes with better patient understanding and education  [cached]
Robert John Adams
Risk Management and Healthcare Policy , 2010,
Abstract: Robert John AdamsThe Health Observatory, The Queen Elizabeth Hospital Campus, The University of Adelaide, Woodville, South Australia, AustraliaAbstract: A central plank of health care reform is an expanded role for educated consumers interacting with responsive health care teams. However, for individuals to realize the benefits of health education also requires a high level of engagement. Population studies have documented a gap between expectations and the actual performance of behaviours related to participation in health care and prevention. Interventions to improve self-care have shown improvements in self-efficacy, patient satisfaction, coping skills, and perceptions of social support. Significant clinical benefits have been seen from trials of self-management or lifestyle interventions across conditions such as diabetes, coronary heart disease, heart failure and rheumatoid arthritis. However, the focus of many studies has been on short-term outcomes rather that long term effects. There is also some evidence that participation in patient education programs is not spread evenly across socio economic groups. This review considers three other issues that may be important in increasing the public health impact of patient education. The first is health literacy, which is the capacity to seek, understand and act on health information. Although health literacy involves an individual’s competencies, the health system has a primary responsibility in setting the parameters of the health interaction and the style, content and mode of information. Secondly, much patient education work has focused on factors such as attitudes and beliefs. That small changes in physical environments can have large effects on behavior and can be utilized in self-management and chronic disease research. Choice architecture involves reconfiguring the context or physical environment in a way that makes it more likely that people will choose certain behaviours. Thirdly, better means of evaluating the impact of programs on public health is needed. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework has been promoted as one such potential approach.Keywords: self-management, health literacy, patient education, behavioral economics, program evaluation
Improving health outcomes with better patient understanding and education
Robert John Adams
Risk Management and Healthcare Policy , 2010, DOI: http://dx.doi.org/10.2147/RMHP.S7500
Abstract: oving health outcomes with better patient understanding and education Review (7661) Total Article Views Authors: Robert John Adams Published Date October 2010 Volume 2010:3 Pages 61 - 72 DOI: http://dx.doi.org/10.2147/RMHP.S7500 Robert John Adams The Health Observatory, The Queen Elizabeth Hospital Campus, The University of Adelaide, Woodville, South Australia, Australia Abstract: A central plank of health care reform is an expanded role for educated consumers interacting with responsive health care teams. However, for individuals to realize the benefits of health education also requires a high level of engagement. Population studies have documented a gap between expectations and the actual performance of behaviours related to participation in health care and prevention. Interventions to improve self-care have shown improvements in self-efficacy, patient satisfaction, coping skills, and perceptions of social support. Significant clinical benefits have been seen from trials of self-management or lifestyle interventions across conditions such as diabetes, coronary heart disease, heart failure and rheumatoid arthritis. However, the focus of many studies has been on short-term outcomes rather that long term effects. There is also some evidence that participation in patient education programs is not spread evenly across socio economic groups. This review considers three other issues that may be important in increasing the public health impact of patient education. The first is health literacy, which is the capacity to seek, understand and act on health information. Although health literacy involves an individual’s competencies, the health system has a primary responsibility in setting the parameters of the health interaction and the style, content and mode of information. Secondly, much patient education work has focused on factors such as attitudes and beliefs. That small changes in physical environments can have large effects on behavior and can be utilized in self-management and chronic disease research. Choice architecture involves reconfiguring the context or physical environment in a way that makes it more likely that people will choose certain behaviours. Thirdly, better means of evaluating the impact of programs on public health is needed. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework has been promoted as one such potential approach.
Determination of the Impacts of the Existence of Public/Private Clinics (Mix) in the Delivery of Healthcare and Safety Services to the Employees in Nigeria and Malaysia under Healthcare and Safety Reform
Yahya Saleh Ibrahim,Mohamad Khan Jamal Khan
Global Journal of Health Science , 2011, DOI: 10.5539/gjhs.v3n2p175
Abstract: Based on the assumption of most health expert, paramedics, health economist, reformists and labor/safety proponents is that, the healthcare and safety services can only be available to common man when the process is partially or fully mixed (public-private). That is to them, the private sector participation in healthcare and safety sect oral service provision is eminent. In the payment for healthcare and safety services it was concluded that, the relative efficiency of payments through private insurance scheme or its impacts on the efficiency of public sector is not debatable. It is also postulated that the private/public mix may evolve the possibility of reduction in administrative bottle necks, improve access at an affordable price, and ensure equity through the use of government control mechanisms. The target respondents were medical doctors, nurses, paramedics, human resource personnel and healthcare and safety beneficiaries in Nigeria and Malaysian higher institution as well as both public and private clinics. A random sampling technique was used. A log-linear and chi-square test was used for the analysis of the750 sample respondents in both Nigeria and Malaysia. The study revealed the following results/relationship between Nigeria and Malaysian National Healthcare Scheme and Safety under reform which show r=0.257 with p=0.000 which is less than 0.05, therefore significant, relationship between public control health and healthcare service delivery for safety under reform revealed r=0.164 and p=0.008 and 0.005 which is significant, so also as reform ensures efficiency in healthcare delivery services to employees it in turn ensures equity and safety of employees with r=201, p=0.006 and 0.005 therefore significant and finally control mechanism instituted by the government ensures access and equity improvement in healthcare and safety services to employees under reform.
Healthcare Reform and the Next Generation: United States Medical Student Attitudes toward the Patient Protection and Affordable Care Act  [PDF]
Kristin M. Huntoon, Colin J. McCluney, Christopher A. Scannell, Elizabeth A. Wiley, Richard Bruno, Allen Andrews, Paul Gorman
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0023557
Abstract: Context Over one year after passage of the Patient Protection and Affordable Care Act (PPACA), legislators, healthcare experts, physicians, and the general public continue to debate the implications of the law and its repeal. The PPACA will have a significant impact on future physicians, yet medical student perspectives on the legislation have not been well documented. Objective To evaluate medical students' understanding of and attitudes toward healthcare reform and the PPACA including issues of quality, access and cost. Design, Setting, and Participants An anonymous electronic survey was sent to medical students at 10 medical schools (total of 6982 students) between October–December 2010, with 1232 students responding and a response rate of 18%. Main Outcome Measures Medical students' views and attitudes regarding the PPACA and related topics, measured with Likert scale and open response items. Results Of medical students surveyed, 94.8% agreed that the existing United States healthcare system needs to be reformed, 31.4% believed the PPACA will improve healthcare quality, while 20.9% disagreed and almost half (47.7%) were unsure if quality will be improved. Two thirds (67.6%) believed that the PPACA will increase access, 6.5% disagreed and the remaining 25.9% were unsure. With regard to containing healthcare costs, 45.4% of participants indicated that they are unsure if the provisions of the PPACA will do so. Overall, 80.1% of respondents indicated that they support the PPACA, and 78.3% also indicated that they did not feel that reform efforts had gone far enough. A majority of respondents (58.8%) opposed repeal of the PPACA, while 15.0% supported repeal, and 26.1% were undecided. Conclusion The overwhelming majority of medical students recognized healthcare reform is needed and expressed support for the PPACA but echoed concerns about whether it will address issues of quality or cost containment.
HEALTH CARE SECTOR REFORM IN NIGERIA: ISSUES ON EQUITY, ACCESS AND DEMOGRAPHIC DEFINITION IN HEALTHCARE SERVICE PROVISION
Yahya Saleh Ibrahim,Mohamad Khan Jamal Khan
Economics and Finance Review , 2011,
Abstract: The purpose of this article is to make contribution in the area of debate on whether reform is ultimately the solution to an ailing healthcare provision, and to at the same time aggregate the fact on whether same reform will succeed in bridging the gap in the differentiation in demographic characterization that suffered deprivationof access and equity to healthcare services to those defined categories such as age, gender, marital status,ethnic group, and occupation type. The authors draw some inferences from statistics available in the literature that has to do with Nigeria healthcare as presented by professionals in the field and official documents. Theyalso gather data through the use of questionnaire as pilot tests to acquire the data used in this research. The questionnaires distributed were about 60 but 50 were returned and 43 were found to be eligible for this research. A chi-square method of analysis was used to process the results on spss version 15; two hypotheseswere tested to find out on whether or not healthcare equity and accessibility is to all citizens with the above defined demographic characteristics. The research was able to conclude that despite the massive advertisementby the National Health Insurance Scheme the reform was only able to achieve a segmental success, with the federal public sector with permanent income benefitting. The research was also able to obtain a result on age,equity and access ,the results is apparently encouraging, with this we accepted that equity and access is to all age classification, while as for gender we rejected the assertion that healthcare by the reform is to all gender definition, on the other hand a close look at marital status, ethnic group and occupation with the chi-square results the research accepted , that health provision by the reform has successfully provided care to the above classification. There is a number of implications for practice and choice of reform system that will carter for all manner of citizens. One of the implication should be on recognizing the difficulty the women gender faces, as depicted from the record, they have high number of clinical attendance than men (Tan, 2010), yet has less means of livelihood or wholly dependent on men, who may decides to be unconcerned about their situation( Tan, 2010). Secondly, the lopsided application of the policy to only those in formal sector contradicted the fundamental right of the citizens to having access to free medical service (Law of Nigeria, 1999). Thirdly even in the formal sector only 4 million people benefitted as from 2005 to
Reasons behind non-adherence of healthcare practitioners to pediatric asthma guidelines in an emergency department in Saudi Arabia  [cached]
Wahabi Hayfaa A,Alziedan Rasmieh A
BMC Health Services Research , 2012, DOI: 10.1186/1472-6963-12-226
Abstract: Background The prevalence of childhood bronchial asthma in Saudi Arabia has increased in less than a decade from 8% to 23%. Innovations in the management of asthma led to the development of evidence based clinical practice guidelines and protocols to improve the patients’ outcomes. The objectives of this study are to examine the compliance of the healthcare providers in the Pediatrics Emergency Department, in King Khalid University Hospital, with the recommendations of the Pediatrics Asthma Management Protocol (PAMP), and to explore the reasons behind non-adherence. Methods This study is designed in 2 parts, a patients’ chart review and a focus group interview. The medical records of all the children who presented to the Pediatric Emergency Department (PED) and were diagnosed as asthmatic, during the period from the 1st of January 2009 to the 31st of March 2009, were reviewed to investigate the compliance of healthcare providers (physicians and nurses) with 8 recommendations of the PAMP which are considered to be frequently encountered evidence-practice gaps, and these are 1) documentation of asthma severity grading by the treating physician and nurse 2) limiting the prescription of Ipratropium for children with severe asthma 3) administration of Salbutamol through an inhaler and a spacer 4) documentation of parental education 5) prescription of systemic corticosteroids to all cases of acute asthma 6) limiting chest x-ray requisition for children with suspected chest infection 7) management of all cases of asthma as outpatients, unless diagnosed as severe or life threatening asthma 8) limiting prescription of antibiotics to children with chest infection. The second part of this study is a focus group interview designed to elicit the reasons behind non- adherence to the recommendations detected by the chart review. Two separate focus group interviews were conducted for 10 physicians and 10 nurses. The focus group interviews were tape-recorded and transcribed verbatim. Theory-based content analysis was used to analyze interviews into themes and sub-themes. Results and discussion A total of 657 charts were reviewed. The percentage of adherence by the healthcare providers to the 8 previously mentioned recommendations was established. There was non-adherence to the first 5 of the 8 aforementioned recommendations. Analysis of the focus group interview revealed 3 main themes as reasons behind non-compliance to the 5 recommendations mentioned above and those are 1) factors related to the organization, 2) factors related to the asthma management protoco
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