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Exploring the responsiveness of public and private hospitals in Lagos, Nigeria  [cached]
Tomilola Adesanya,Olayinka Gbolahan,Obadah Ghannam,Marisa Miraldo
Journal of Public Health Research , 2012, DOI: 10.4081/jphr.2012.e2
Abstract: According to the World Health Report 2000, health system responsiveness is proposed as one of the three key objectives of any health system. This multi-domain concept describes how well a health system responds to the expectations of their users concerning the non-health enhancing aspects of care. In this study we aim to compare the levels of responsiveness experienced by users of private and publicly managed hospitals in Nigeria, and through these insights, to propose recommendations on how to improve performance on this measure. This quantitative, cross-sectional study uses a questionnaire that is adapted from two responsiveness surveys designed by the World Health Organization (WHO). Researchers collected responses from 520 respondents from four hospitals in Lagos, Nigeria. Analysis of the data using statistical techniques found that significant differences exist between the performance of public and private hospitals on certain domains of responsiveness, with privately operated hospitals performing better where differences exist. Users of private hospitals also reported a higher level of overall satisfaction. Private hospitals were found to perform particularly better on the domains of dignity, waiting times, and travel times. These findings have implications for the management of public hospitals in focusing their efforts on improving their performance in low scoring domains. Performance in these hospitals can be improved by emphasis on staff training and demand management.
An Analysis of Motivation and WelfareEffects of Vertical Integration of Public Hospitals in China:a Perspective of Modified Salop Circle Model  [cached]
Xia Liu,Yingsheng Cheng
International Journal of Business and Management , 2009,
Abstract: Objective: To introduce the current condition of China’s medical and health industry, analyze the policy background of vertical integration of public hospitals and the classification of integration modes, and try to answer the following questions: What is the motivation for vertical integration of public hospitals in China? Has vertical integration realized the goal of optimizing medical resource allocation and conducting regional medical planning? Has vertical integration improved social welfare? Method: We adopt modified Salop circle model and complete information dynamic game model to analyze the motivation and welfare effects of vertical integration. Results: The research has the following findings: 1) vertical integration of hospitals eases the pressure of tertiary hospitals, disperses some of the patients to secondary hospitals and as a result optimizes the allocation of hygienic resources; 2) compared with before integration, patients’ demand for integrated multi-hospital systems has increased; 3) the utility of the integrated hospitals has been enhanced; 4) the utility of the non-integrated hospitals has been worsened; 5) the utility of the integrated hospitals is greater than that of the non-integrated; 6) hospital administrators are motivated to precede in carrying out vertical integration; 7) each tertiary hospital is likely to fulfill vertical integration activities several times;8) vertical integration of public hospitals improves the standard of social welfare. Conclusions: Tertiary hospital presidents have the motivation to conduct vertical integration activities; Vertical integration realized the goal of optimizing medical resource allocation and conducting regional medical planning; Vertical integration improves social welfare.
The Cost Efficiency of Regional Public Hospitals in South Korea  [PDF]
Sang-Mok Kang, Moon-Hwee Kim
Modern Economy (ME) , 2014, DOI: 10.4236/me.2014.59091
Abstract:

This paper investigates the cost efficiency (CE), technical efficiency (TE), allocative efficiency (AE), and scale efficiency (SE) over 34 regional public hospitals in South Korea from 2007 to 2010 using Data Envelopment Analysis (DEA). The CE, AE, and TE of these hospitals during the period are 0.52, 0.71, and 0.74, on average, respectively, indicating that there is a possibility to reduce their inefficiency of 48%, 29%, and 26% by reallocating the input mix or scaling input back. SE of these hospitals during the same period is 0.85, suggesting that most of the regional public hospitals do not operate under the optimal scale which is efficient relative to both constant returns to scale (CRS) and variable returns to scale (VRS) technologies. The empirical result implies that even though half of the regional public hospitals are comparatively efficient allocatively and technically, they have not been good at selecting the cost-minimal input mix. It also indicates that some hospitals have suffered losses from not having the most optimal scale.

Selection of medicines in Chilean public hospitals: an exploratory study
Collao Juan F,Smith Felicity,Barber Nick
BMC Health Services Research , 2013, DOI: 10.1186/1472-6963-13-10
Abstract: Background There is a growing interest in high income countries to control expenditure on medicines by improving the rationale for their selection. However, in middle income countries with differing priorities and needs, little attention has been paid to this issue. In this paper we explore the policies and processes for the selection and use of medicines in a group of hospitals in Chile, a middle income country which has recently joined the OECD. Methods A combination of qualitative and quantitative methods was used. A national survey questionnaire was distributed to investigate the role and operation of PTCs (Pharmacy and Therapeutics Committees). Interviews were conducted with key actors in the selection of medicines in large urban public hospitals. Results The national survey had an overall response rate of 42% (83 out of 196), whilst 7 out of 14 hospitals participated in the qualitative study. High complexity hospitals are large urban hospitals; all of which claim to have a working PTC. The pharmacy offices are mainly involved in dispensing medicines with little involvement in clinical duties. The interviews conducted suggest that the formulary of all the hospitals visited is no more than a stock list. PTCs are unable to influence the prescribing practices of doctors. Members do not feel prepared to challenge the opinions of specialists requesting a certain drug, and decisions are based primarily on costs. The inclusion of medicines in the clinical practice of hospitals is as a result of doctors bypassing the PTC and requesting the purchase of exceptional items, some of which are included in the formulary if they are widely used. Conclusions There is an urgent need to develop medicine policies in hospitals in Chile. The procedures used to purchase medicines need to be revised. Central guidance for PTCs could help ensure a more rational use of medicines. PTCs need to be empowered to design formularies which cover all the clinical needs of doctors, training members in the analysis of scientific evidence beyond their own specialities. An influential PTC can take the appropriate measures and design workable policies to enforce a cost effective-use of resources.
The current situation in the public and private hospitals in Greece
Maria Maniou,E Iakovidou
To Vima tou Asklipiou , 2009,
Abstract: The fundamental concept of the policy of the health-care sector, is the creation of a modern System of Health, in which the protection of health and not only the management of illness will come first and it will be ensured that all the citizens will have the same access in the health serviced of high quality.Aim: The purpose of the present study was to evaluate the public and private hospitals in Greece.Conclusively: There is necessity and it is important to evaluate proposals and solutions for the improvement of the health services.
The Adaptive Capabilities of Organizations. Case of Polish Public Hospitals
Mariola Ciszewska-Mlinaric
Contemporary Economics , 2009,
Abstract: Information gathering and analysis, reaction design and implementation, and activities correction and learning are three types of adaptive capabilities connected to three phases of organizational adaptation to the environment. The primary objective of this article is to present how adaptive capabilities of high and low performers differ. In the second part of the article the key factors influencing the adaptive capabilities of Polish public hospitals will be identified and examined.
Modeling population access to New Zealand public hospitals
Lars Brabyn, Chris Skelly
International Journal of Health Geographics , 2002, DOI: 10.1186/1476-072x-1-3
Abstract: The retention of 'local' hospital services has been a contentious issue in most countries including New Zealand [1]. Local retention of services is a geographical access issue, and the major tension is between the cost of providing hospital services from small relatively isolated facilities and the advantages in providing fewer large facilities with the capacity for providing more complex services. Locating health services, particularly hospitals, is always going to be contentious because facilities are visible symbols of local empowerment. Spatial modeling allows planning and policy development to consider a range of factors in the decision-making process, including where disadvantaged subpopulations may be under-serviced and/or whether there is identifiable inequities in geographical access.Recent improvements in computer power and the availability of Geographical Information Systems (GIS) data layers has opened up new opportunities for modeling accessibility. Even though least-cost path algorithms, such as those applied here, have been available in commercial GIS since the late 1980s, the application of these algorithms to large national data sets has only recently become feasible. This paper demonstrates how GIS can be used to model travel distance and time to public hospitals in New Zealand using 63 hospitals and approximately 38,000 enumeration census district centroids in New Zealand. These enumeration districts are call "Meshblocks" in New Zealand and are the most detailed census information that is available to the public. The approximate travel time and distance, based on using a private car, from each census centroid to the closest public hospital will be calculated. This paper will describe a GIS process to do this, comment on experiences, and demonstrate applications of such a result.The benefit of having travel time and distance to the closest hospital for each census centroid is that by multiplying the travel distance or travel time by the population
Comparing public and private hospitals in China: Evidence from Guangdong
Karen Eggleston, Mingshan Lu, Congdong Li, Jian Wang, Zhe Yang, Jing Zhang, Hude Quan
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-76
Abstract: We analyze survey data collected from 362 government-owned and private hospitals in Guangdong Province in 2005, combining mandatorily reported administrative data with a survey instrument designed for this study. We use univariate and multi-variate regression analyses to compare hospital characteristics and to identify factors associated with simple measures of structural quality and patient outcomes.Compared to private hospitals, government hospitals have a higher average value of total assets, more pieces of expensive medical equipment, more employees, and more physicians (controlling for hospital beds, urban location, insurance network, and university affiliation). Government and for-profit private hospitals do not statistically differ in total staffing, although for-profits have proportionally more support staff and fewer medical professionals. Mortality rates for non-government non-profit and for-profit hospitals do not statistically differ from those of government hospitals of similar size, accreditation level, and patient mix.In combination with other evidence on health service delivery in China, our results suggest that changes in ownership type alone are unlikely to dramatically improve or harm overall quality. System incentives need to be designed to reward desired hospital performance and protect vulnerable patients, regardless of hospital ownership type.The roles of the government and the private sector in health service delivery are controversial, especially in developing and transitional economies. Some authors argue for a dominant if not exclusive government role in health service delivery in developing countries [1]; others call for broad and expanding engagement with the private sector [2]. The relatively extensive literature comparing the performance of private not-for-profit, for-profit, and government providers mostly relies on empirical evidence from hospitals in high-income and established market economies [3-6]. Evidence from developing and tr
Perception of Accreditation on Human Resource Development and Management in Hospitals Accredited by CCHSA, JCI and NABH: A Comparative Studyc
Syed Jaleeluddin Hyder,Bimal Kumar Mishra,Manju Bhagat
Journal of Economics Theory , 2012, DOI: 10.3923/jeth.2010.20.24
Abstract: Accreditation is being used as one of the tool by the hospitals in ensuring and enhancing quality of service as well as its professionals. Accreditation also ensures the development, growth and satisfaction of its employees thereby enabling retention and stability to the organization which is very much essential in the present era of intensive competitive market. Present study compares the implementation of human resource development and management standards in Hospitals accredited by three different agencies namely JCI, CCHSA and NABH. In other words, the study assesses the perception of quality of work life and human resource processes through the lens of its leaders and managers. The results are then analyzed using statistical techniques and it s observed that there is a significant difference in the implementation of standards in the hospitals considered.
Payments and quality of care in private for-profit and public hospitals in Greece
Elias Kondilis, Magda Gavana, Stathis Giannakopoulos, Emmanouil Smyrnakis, Nikolaos Dombros, Alexis Benos
BMC Health Services Research , 2011, DOI: 10.1186/1472-6963-11-234
Abstract: Five different datasets were prepared and analyzed, two of which were derived from information provided by the National Statistical Service (NSS) of Greece and the other three from data held by the three largest SHI schemes in the country. All data referred to the 3-year period from 2001 to 2003.PFP hospitals in Greece are smaller than public hospitals, with lower patient occupancy, and have lower staffing rates of all types of nurses and highly qualified nurses compared with public hospitals. Calculation of ALoS using NSS data yielded mixed results, whereas calculations of ALoS and SHI payments using SHI data gave results clearly favoring the public hospital sector in terms of cost-efficiency; in all years examined, over all specialties and all SHI schemes included in our study, unweighted ALoS and SHI payments for hospital care per discharge were higher for PFP facilities.In a mixed healthcare system, such as that in Greece, significant performance differences were observed between PFP and public hospitals. Close monitoring of healthcare provision by hospital ownership type will be essential to permit evidence-based decisions on the future of the public/private mix in terms of healthcare provision.Debate on the effects of hospital ownership type on the quality and costs of medical care has continued for years [1,2]. Pro-private-care advocates argue that involvement of the private sector in healthcare provision affords a fast and innovative response [3], aggressive and creative fulfillment of customer demands [4,5], and a high quality of care [3-6] at competitive prices [4], whereas public health services are inequitable and inefficient towing to bureaucracy, politicization, lack of health worker incentives [7], and resource limitations [1], especially in times of fiscal austerity [8].Conversely, some claim that, in modern society, some aspects of life are off-limits to commerce and, of these, "healthcare is too precious, intimate and corruptible to entrust to the
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