Pairing assistance (PA) of health professionals between county hospitals and township health centers is one of the key components of the reform of medical alliances in China to strengthen the development of health workforce in primary health care (PHC). This study aims to examine the effect of PA on healthcare utilization for patients with chronic diseases in rural areas. Two waves of National Health Services Survey (2013 and 2018) were used. A total of 13893 and 22725 rural residents with chronic diseases were included in the 2013 and 2018 waves, respectively. Multiple logistic regressions were used to examine the associations between PA and outpatient and inpatient service utilization in PHC. Chow test was used to examine the difference between PA in two models. Among rural patients with chronic diseases, two-week outpatient visits increased from 22.69% to 27.54%, and annual hospitalization admission increased from 20.72% in 2013 to 25.44%. PA was associated with a significant decrease in outpatient visits (p<0.001) in 2018 after controlling for individual and county characteristics. Patients in PA counties were 1.45 times (95% CI 1.10-1.90) more likely to use PHC outpatient care in 2013, but the difference disappeared in 2018 (OR=0.85, 95% CI 0.71-1.01). PA did not reverse the downward trend in the share of PHC outpatient visits. PA under medical alliances in China provides a potential model for building integrated people-centered health systems for other low- and middle-income countries.
The objective of this study was to explore the dynamics of efficiency and productivity of Greek public hospitals during the crisis, as well as to review the effect of implemented policies on hospital efficiency before and the implementation of the claw-back for hospital pharmaceutical expenditure. We implemented Data Envelopment Analysis and decomposed the Malmquist productivity index (MPI) to investigate the fluctuations of the Greek public hospital productivity frontier and therefore their technical efficiency between 2009 and 2019. The MPI components allowed us to capture the frontier shift, as well as pure efficiency changes and scale efficiency changes. Through the period 2009-2019 hospital inputs were reduced drastically. Doctors were reduced by 54% while beds were reduced by 15%. Hospital expenditure was decreasing between 2009 and 2015 but increased by 23% since due to fixed hospital budgets and the “claw-back”. Moreover, output seems to have increased. Patient discharges increased by 14% while diagnostic procedures were reduced by 10% between 2009 and 2016 but have been continuously rising since. Nonetheless, under variable returns to scale (VRS) average hospital efficiency was stable (~75%) for most of the period under study while declining since 2016. Policymakers in Greece have always chosen to implement cost- or input-oriented policies, instead of opting to improve outputs and quality of services. Our analysis indicated that fixed-budget-oriented reforms have impacted hospital efficiency negatively by creating a counterincentive to adopting best practices and improving hospital efficiency. Highlights Technical Efficiency under CRS was stable in Greece (0.70) over the period 2012-2016, and declined to 0.51 in 2019. Hospital Fixed Budget reforms had a negative impact on hospital efficiency. During the economic crisis 2009-2019 hospital inputs were reduced drastically Memorandum Policies introduced by Troika focused exclusively in reducing cost and not improving efficiency.
With the development of medical treatment partnership and “internet + medical service” in China, this study proposes a remote patient perceived value satisfaction model (RPPVSM) with online medical service for specialties from the perspective of patient perceived value. Taking Shanghai Pulmonary Hospital Specialist Alliance (SPHSA) as the research subject, RPPVSM was constructed based on ACSI and TAM. Structural Equation Modeling (SEM) was modified to have a better degree of fitness and validation outcomes of the hypothesis as follows: Perceived ease of use has a significantly positive impact on perceived value with coefficient being 0.248; perceived usefulness has a significantly positive impact on the satisfaction with coefficient being 0.577; perceived value has a significantly positive impact on satisfaction with coefficient being 0.163. Perceived synergy has a significantly positive impact on perceived value with coefficient of 0.547; perceived ease of use will have a significantly positive impact on satisfaction through the perceived value variable with coefficient of mediation being 0.094; perceived synergy has a significant impact on satisfaction through perceived value with mediation coefficient being 0.196. The results suggest that the inclusion of the patient’s perception value index in the medical information platform is conducive to the construction of RPPVSM.
Abstract Objective This study aims to explore the spatiotemporal disparities in the equalization of basic medical and health services in China, in order to provide reference and guidance for promoting the equalization process of basic medical and health services and ensuring the fair enjoyment of citizens’ right to life and health. Methods Based on the theory of Structure-Process-Outcome(SPO), a comprehensive evaluation index system of equalization level was constructed with 22 core indicators of basic medical and health services, from the three dimensions of medical and health investment, health service utilization, and medical service effectiveness. The Generalized Principal Component Analysis (GPCA) model was used to calculate the equalization level of basic medical and health services in 31 provinces, municipalities, and autonomous regions from 2011 to 2021. Furthermore, the kernel density estimation and Moran’s I model was employed to analyze the correlation and disparity at the spatial level. Results 1. From a national perspective, the level of equalization of basic medical and health services in China has significantly improved from 2011 to 2021. The mean score of national equalization level increased from -0.605 to 0.174, with an increase of 128.75%.
As the Universal Health Insurance Plan (RAMU) is being implemented in Mali, community-based health insurance (CBHI) — one of the pillars— must innovate to meet the challenge of universal health coverage. An experimental CBHI was tested in central Mali between 2017 and 2021. This innovative CBHI professionalizes and organizes risk sharing on a larger scale, moving from municipalities to circles (department). A mixed-method study was carried out to assess the acceptability of this innovation among elected representatives of CBHI offices. In April 2021, 118 questionnaires were administered, followed by 43 qualitative interviews from the same sample in October 2021. Sekhon el al. (2017) seven dimensions of acceptability was used as the conceptual model. More than half of individuals (58%) reported above-average acceptability. Elected officials feel well supported in their activities by the Technical Union of Malian Mutuality (UTM), the umbrella organization of CBHI. They show some confidence in their ability to perform their duties effectively despite varying levels of commitment that often fall short of expectations and needs, which they justify by their volunteer status. Elected officials note that the system is very effective despite the nonoptimal conditions linked to the prevailing insecurity. Professionalization appears to be an unavoidable condition for the performance of the innovation, as well as the new community assembly. However, elected officials are concerned about the sustainability. The UTM will play an important role in continuing its support and fulfilling its functions as a delegated management organization within the framework of the RAMU.
Even when the SARS-CoV-2 pandemic recedes, evidence-based researches regarding the effectiveness of pharmaceutical and non-pharmaceutical government interventions (NPIs) remain important. In this study, SARS-CoV-2 data of 30 European countries from early 2020 up to mid 2022 are analyzed using Bayesian machine learning. Four data sources containing each country’s daily NPIs (consisting of 66 government measures, virus variant distributions of 31 virus types, the vaccinated population percentages by the first five doses as well as the reported daily infections in each country) are brought together to undertake a comprehensive assessment of the impact of SARS-CoV-2 influential factors on the spread of the virus. First, a Bayesian deep learning model is constructed with a set of input factors to predict the growth rate of the virus one month ahead of the time from each day. Based on this, the importance and the marginal effect of each relevant influencing input factor on the predicted outcome of the neural network model is computed by applying the relevant algorithms. Subsequently, in order to examine the performed deep learning analysis, a Bayesian statistical inference analysis is performed within each country’s data. For each influencing input factor, the distribution of pandemic growth rates, in the days where the selected explanatory factor has been active, is compared with the distribution of the pandemic growth rates, in the days where the selected explanatory variable has not been active. The results of the statistical inference confirm the predictions of the deep learning model to a significant extent. Similar conclusions from the SARS-CoV-2 experiences of the thirty studied European countries have been drawn.
This paper explores the relationship between the reliance on different information sources and infodemic exposure in the early phases of the pandemic. The aim is to identify the sources that create less infodemic. We analyze high-quality secondary data from two studies using a 10-country sample: the US, UK, Canada, Brazil, France, Germany, Italy, Japan, South Africa, and South Korea. Study 1 analyzes infodemic exposure through an analysis of 3,723,920 COVID-19 tweets. Likewise, study 2 analyzes reliance on COVID-19 information sources by surveying 10,000 respondents. This research provides perspectives and implications for the infodemic debunking to the government departments, public health organizations, and media industries by analyzing the correlations between these two studies. We found that people who rely on national government information sources about COVID-19 tend to be less exposed to the infodemic. Findings also suggest a correlation between the countries with higher COVID-19 confirmed cases and people’s reliance on the national government information sources. We found that people from countries with more unverified bots tweeting about COVID-19 tend to rely less on family and friends and social media as sources. Evidence also suggests that the most trusted spokespeople are scientists and health professionals rather than politicians. Finally, we observed 70% of the sample´s countries slightly reduced their risk of exposure to the infodemic within 12 months of the pandemic’s start.
The 35 member states (MS) of the Pan American Health Organization (PAHO) have been committed to training physicians in leadership competencies since 2008. However, four reviews on teaching leadership using competency-based education (CBE) in undergraduate medical education (UME) identified only two MS: Canada and the USA that worked on identifying gaps in teaching leadership in UME. Previous reviews did not focus on factors influencing leadership education and did not use qualitative methodology to support their findings. Therefore, this review aims to identify facilitating and inhibiting factors in teaching leadership in UME using a scoping review and thematic analysis. Six databases containing grey and indexed literature in English, Spanish, and Portuguese were searched including hand search and authors’ consultations. Forty-eight documents out of 7849 were selected based on eligibility criteria. Braun and Clarke’s thematic analysis guide was used, resulting in seven themes: curriculum, intended learning outcomes, teaching methods, assessment, addressing barriers, supporting organizational change, and building networks. Considering these themes, the authors propose a critical route for teaching leadership in UME in the Americas. First, institutional design should consider governance gaps, such as having national and international policies for leadership in UME with an inter-professional, trans-professional, and citizen-focused approach. This means that there is a pressing need to equip physicians and other professionals from the government, academia, non-governmental organizations, hospitals, and national and international organizations whose missions are related to health or education with leadership competencies. Networking among actors for leadership education and teacher training is also essential. Second, instructional design reveals knowledge-do gaps in MS when incorporating leadership into the medical curriculum. This includes using leadership frameworks, defining learning outcomes, and employing assessment and monitoring tools for leadership education. Mechanisms to reduce these gaps in MS include the Equator Network and Evidence-Informed Policy Networks which foster knowledge translation and governance.
Purpose: The provision of accessible eye care services can help reduce the prevalence of avoidable blindness within a population by providing timely high-quality interventions to those in need. Our aim was to identify and quantify barriers to accessing eye care for the elderly population in Pakistan, which prevent effective eye care delivery to this group. Patients’ experiences with the Sehat Sahulat (health insurance) programme (SSP) in relation to eye care were also explored. Methods: Using an exploratory sequential mixed methods design, an initial qualitative phase explored participant experiences and identified specific barriers. The qualitative study provided the basis for the development of a customised survey tool. The survey tool was used in a second phase to obtain quantitative data of barriers and costs associated with accessing eye care. Results: Numerous considerable barriers were identified, including illiteracy, long travel times, female gender, old age, mobility issues, and costs, all of which limited access to eye care in Pakistan. Awareness surrounding the use of the SSP was poor, with the programme seldom used for eye care costs. Conclusions: This study provides valuable evidence on patient experience with eye care services in urban and rural areas of Pakistan, including expenditure, patient priorities, and enablers and barriers to accessing eye care. Areas for improvement should focus on educating the public on eye health, increasing the availability of secondary eye care services in rural areas, improving accessibility within eye care facilities, addressing gender disparities, and reducing costs associated with eye care treatments, potentially through advancement of the SSP.
Objective: To integrate the qualitative research on self-management experience of breast cancer patients, and conduct a systematic review on their self-management experience. Methods: Using a computer to search a series of databases such as CNKI, Wanfang, VIP, and China Biomedical Database, systematically collect and integrate qualitative research on the self-management experience of breast cancer patients, and the search time is limited to 2010 January to December 2022. The qualitative research quality evaluation standard of the Joanna Briggs Institute (JBI) Center for Evidence-Based Health Care in Australia was used as the evaluation standard of this project to complete the accurate evaluation of the literature; Meta-analysis was used to complete the effective integration of the results. Results: A total of 17 literatures were included in this project, and 37 research results with strong integrity were extracted accordingly. On this basis, 7 different categories were summarized, and 3 integrated results were obtained, which were experience of maintaining self-management, symptom recognition, and self-management. Conclusion: In the different stages of self-management of breast cancer patients, medical staff should give targeted guidance to help patients obtain good prognosis. Patient or Public Contribution： Patients, service users, care-givers, people with lived experience or members of the public were involved at several stages of the trial, including the design, management and conduct of the trial, but all the information was collected from public database. The statement is not applicable.
Background. Attention to the healthcare workforce has increased, yet comprehensive information on migrant healthcare workers is missing. This study focuses on migrant healthcare workers’ experiences and mobility patterns in the middle of a global health crisis, aiming to explore the capacity for circular migration and support effective and equitable healthcare workforce policy. Material and methods. Romanian physicians working in Germany during the COVID-19 pandemic served as an empirical case study. We applied a qualitative explorative approach; interviews (n=21) were collected from mid of September to early November 2022 and content analysis was performed. Results and discussion. Migrant physicians showed strong resilience during the COVID-19 crisis and rarely complained. Commitment to high professional standards and career development were major pull factors towards Germany, while perceptions of limited career choices, nepotism and corruption in Romania caused strong push mechanisms. We identified two major mobility patterns that may support circular migration policies: well-integrated physicians with a wish to give something back to their home country, and mobile cosmopolitan physicians who flexibly balance career opportunities and personal/family interests. Health policy must establish systematic monitoring of the migrant healthcare workforce including actor-centred approaches, support integration in destination countries as well as health system development in sending countries, and invest in evidence-based circular migration policy.
Background. Discharge against medical advice (DAMA) is used in healthcare facilities in a situation where patients refuse care or decide to leave the hospital before the treating physician recommends discharge. Previous studies have found DAMA to be prevalent among patients with various chronic conditions. The study had four objectives. The study aimed to investigate: 1) the prevalence of DAMA during COVID-19 (2020-2021) among Jordanian patients with chronic diseases, 2) the association between DAMA and sociodemographic and clinical characteristics of patients with chronic diseases, 3) the predictors of DAMA, and 4) the reasons behind DAMA at the patient, hospital, and environmental levels. Methods. A descriptive cross-sectional correlational design was used in the study. A convenience sampling approach was used to collect data from 1576 patients with chronic diseases from 3 private hospitals. Results. The study found that the prevalence rate of DAMA was 33.3%. There was a significant association between the sociodemographic and clinical characteristics of patients with chronic diseases and DAMA. Health insurance found to be the strongest predictor of DAMA. Finally, the study found that patient, hospital, and environmental- related factors had a low impact on DAMA. Conclusions: DAMA is prevalent among patients with chronic diseases in Jordan during COVID-19 pandemic. The current study’s findings can serve as an empirical basis for planning and implementing DAMA prevention programs and/or establishing or revising policies for the target population.
Private health insurance is an important part of China’s multilevel medical security system, which is conducive to improving the medical security level of insured households. Based on Chinese General Social Survey (CGSS) data, this study uses a logit model to estimate the impact of private health insurance on household catastrophic health expenditure. Our research results show that private health insurance can significantly reduce the incidence of catastrophic household health expenditure. Using the instrumental variable method to weaken the endogenous problem and the propensity score matching method to control the self-selection problem, the research conclusion is still valid. In terms of heterogeneity, private health insurance has a greater impact on reducing the incidence of catastrophic health expenditure in rural and non-elderly households. The mechanism test shows that health performance plays an intermediary role between private health insurance and catastrophic household health expenditure. This study suggests that the Chinese government should accelerate the development of private health insurance, expand its coverage of private health insurance, and reduce the incidence of catastrophic health expenditure in households.
Abstract Background: There has been a decline in childhood vaccination uptake, with reports indicating that 25 million children missed out on one or more doses in 2021 . There is a need to understand the socio-behavioural drivers of vaccination uptake and to identify contextual and emerging factors that can inform demand-creation interventions. Objective: This review examined the social and behavioural factors influencing childhood vaccination intentions and uptake globally. Methods: A comprehensive search was carried out for published studies that presented data on patterns of association between socio-behavioural factors and vaccination intentions and uptake in children under five years. Studies were screened for eligibility by two reviewers, and information was collected using a standard data abstraction form. Findings: Out of 4462 records identified in the search, 82 studies were included. Emerging factors influencing vaccination uptake included gender-based factors like the mother’s financial autonomy, the number of social and formal messengers recommending vaccination, the proportion of non-conforming social network members, and the role of decisional balance and conflict as a moderator of the vaccination intention and action pathway. Conclusion: The review identified multiple behavioural and social constructs influencing vaccination intentions and uptake. The diversity of influences underscores the complexity of relationships between social-behavioural factors and vaccination uptake, which may be contributing to low vaccination uptake. More context-specific research is required to extend the geographical base and depth of evidence and to evaluate highly localised socio-behavioural interventions.
Objective: To analyze the spatial patterns of distribution of Specialized Rehabilitation Centers(CERs). Methods: An ecological-level study design, descriptive and Bayesian spatial regression analyses was carried out using the 438 Brazilian Health Regions. Main outcome is the “presence or absence of CER” and as covariates the rate of PWD, health funding and socioeconomic indicators. Modeling considered a binomial probability distribution and spatial randomness in the Besag-York-Mollié model. Neighborhood relationships between Health Regions were constructed using Queen-type contiguity matrix. Results:Considering four types of disability(hearing, intellectual, physical and visual) alone, the rate of PWD and transfers of financial resources increase the chances of implementing an CER. In joint analysis of disabilities, implementation of CERs doesn’t correspond to regions with higher rates of PWD. Conclusions:Prioritize the CER implementation according to territorial distribution of needs is essential to improve equitable access. Use of qualified data to identify PWD is essential for the creation of public policies.
Executive Summary This policy brief provides lessons learned from development of Botswana Christian Health & AIDS Intervention Program (BOCHAIP) 2022-2026 strategy. In this strategy development paper, we outline the process of strategy development in a community health service providing non-governmental organization, six months of strategy implementation and make recommendations for strategic planning. The findings from this community-based organisation’s strategic plan development process extends scholarship on non-governmental organization strategy planning and development scholarship The findings from this paper could be utilised by other civil society organisation that experience similar strategy development process realities while taking into consideration the uniqueness of each organisation.
While the estimate of hospital costs concerns the past, its planning focus on the future. However, many public hospitals in low and middle-income countries don’t have robust accounting health systems to evaluate and project their expenses. In Brazil, public hospitals are funded based on government estimates of available hospital infrastructure, historical expenditures and population needs. However, these pieces of information are not always readily available for all hospitals. To solve this challenge, we propose a flexible simulation-based optimisation algorithm that integrates this dual task: estimating and planning hospital costs. The method was applied to a network of 17 public hospitals in Brazil to produce the estimates. Setting the model parameters for population needs and future hospital infrastructure can be used as a cost-projection tool for divestment, maintenance, or investment. Results show that the method can aid health managers in hospitals’ global budgeting and policymakers in improving fairness in hospitals’ financing.
The rise of AI is viewed as the next important technology in human history that would serve as a driver for sustainable development. Accordingly, several organizations have incorporated AI into their operations – including healthcare, hence, attracting extant literature to AI discussions. However, AI literature in healthcare has focused on medical diagnosis, operations, and prescriptions – to the neglect of supply chain (SC). This study bridges this knowledge gap by exploring the drivers and success factors of AI-enabled medical drones’ adoption in public healthcare SC. Drawing on data from the world’s largest medical drone programme in Ghana, we find that the need to make the public healthcare SC efficient with the aim of improving the socio-economic life of the citizens is the main driver of the policy adoption. Several success factors are identified and categorized into three phases – policy, project, and operation. Long-term policy and operating sustainability are delineated.