Public Services and Informal Profits: Governing Township Health Centres in a Context of Misfit Regulatory Institutions

2018 ◽  
Vol 237 ◽  
pp. 108-130
Author(s):  
Armin Müller
Keyword(s):  
Healthcare System ◽  
Local Governments ◽  
Capital Investment ◽  
Service Providers ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Care Services ◽  
Curative Care ◽  
Health Centres ◽  
Informal Practices

AbstractChina's healthcare system is governed by institutions that are mutually incompatible. Although healthcare providers are supposed to offer affordable curative care services and engage in public health and administrative work, they receive insufficient financial support from the state and rely on generating informal profits and grey income. The “institutional misfit” between this public welfare mandate and medical service providers’ market orientation is particularly pronounced in the case of township health centres (THCs), a generalist type of healthcare provider with a key role in China's healthcare system. Based on fieldwork in four county-level jurisdictions, this study explores how local governments and THCs interact to cope with institutional misfit. It sheds light on a large variety of informal practices pertaining to human resources, healthcare services, drug procurement, health insurance and capital investment. Local governments deliberately neglect regulatory enforcement and collude with THCs to generate informal profits, behaviour which undermines service quality and increases healthcare costs. The study also shows that while the New Healthcare Reform altered the informal and collusive practices, it has failed to harmonize the underlying institutional misfit. To date, we see only a reconfiguration rather than an abandoning of informal practices resulting from recent healthcare reforms.

Does Public Health System Provide Adequate Financial Protection to Its Clients Through RSBY? An Exploratory Study of Tribal Odisha

2019 ◽  
Vol 21 (4) ◽  
pp. 497-509
Author(s):  
Babita Panda ◽  
Himanshu Sekhar Rout
Keyword(s):  
Service Providers ◽  
Public Health System ◽  
Healthcare Providers ◽  
Simple Random Sampling ◽  
Hospital Staff ◽  
Healthcare Services ◽  
Long Distance ◽  
Help Desk ◽  
Care Services ◽  
Health Service Providers

This study estimates whether Rashtriya Swasthya Bima Yojana (RSBY) protects beneficiaries from out-of-pocket health expenditure arising at the time of illness and points out obstacles that the beneficiaries face. This article uses data of 100 beneficiaries selected through simple random sampling from the beneficiaries list that were collected from the district headquarter hospital of Mayurbhanj District, Odisha, India. This study highlights that only 8.4 per cent beneficiaries access their full healthcare services from the scheme. More than 50 per cent are forced to spend from their own pocket even though they have sum assured. The beneficiaries face problems like lack of awareness, no proper enrolment procedure, no cooperative hospital staff, limited assured money sanctioned per day, only inpatient care services, an unhygienic atmosphere in the hospital, long distance to the empanelled hospital and exploitation among health service providers. Awareness may be created among insured. The behaviour of healthcare providers may be turned friendly. Immediate attention may be provided by help desk counters to the beneficiaries. The sum assured amount may be increased. The detailed receipt of hospital expenditure may be supplied to the insured at the time of discharge.

Healthcare under the Panchayati Raj Institutions (PRIs) in a decentralised health system

2016 ◽  
Vol 29 (2) ◽  
pp. 151-167
Author(s):  
Virendra Kumar ◽  
Anindya Jayanta Mishra
Keyword(s):  
Health System ◽  
Primary Healthcare ◽  
Service Providers ◽  
Health Planning ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Structured Interviews ◽  
Content Type ◽  
Health Centres ◽  
Panchayati Raj

Purpose This paper aims to explore the challenges and benefits arising from the involvement of Panchayati Raj Institutions (PRIs) in the provisioning of primary healthcare in a decentralised health system of India. Design/methodology/approach A qualitative study design was used in this study. Data were collected through semi-structured interviews from 89 respondents selected from nine primary health centres across the district. A thematic analytical framework approach was used to analyse the data. Findings The research results indicate that there are several challenges resulting from PRIs involvement, including prioritisation of service providers and users, coercive unethical work and lack of communication. However, there are some benefits associated with the involvement of the PRIs in service provisioning, including improved availability and regularity of healthcare providers at the health centres. Research limitations/implications The implications of the findings suggest that the PRIs play an important role in healthcare provisioning; however, their involvement is ineffective due to their partial capabilities and approach, which creates a non-conducive environment. Practical implications Health issues are among the most important human concerns, and recognising and addressing the grassroot challenges help to locate, and overcome the challenges that hinder the smooth healthcare provisioning process. Originality/value National Rural Health Mission has recognised the PRIs as a platform to promote decentralised health planning and for achieving its goals in India. The PRIs are significantly involved in planning, monitoring and provisioning of primary healthcare services at grassroot level. This paper addresses the challenges and benefits that emerged due to their involvement.

Health Care Services and EU Competition Law

2020 ◽  
Author(s):  
Okeoghene Odudu
Keyword(s):  
Market Power ◽  
Healthcare Service ◽  
Health Care Services ◽  
Service Providers ◽  
Competition Law ◽  
Healthcare Services ◽  
System Matrix ◽  
Member States ◽  
Eu Member States ◽  
Care Services

This chapter investigates how, within a number of European Union (EU) Member States, competition law has been used to address problems of market power in the healthcare services sector. It summarizes the relevant EU and national competition laws and considers the experience of applying those laws to providers of healthcare services. The chapter is chiefly concerned with healthcare services in England, although examples are drawn for other EU Member States. Examination of the English experience provides a view of the use of competition law to address market power problems in most elements of the health system matrix. The chapter then considers three challenges that emerge from that experience of using competition law to address problems of market power in healthcare service markets. The first challenges the applicability of competition law to healthcare service providers operating in each or every element of the healthcare system matrix. The second, accepting applicability, questions the appropriateness of the substantive rules to healthcare services. The third, a battle of authority and autonomy, considers whether decisions made by healthcare service providers should be subject to external review and the type of review that competition law offers.

scholarly journals Modelling improved efficiency in healthcare referral systems for the urban poor using a geo-referenced health facility data: the case of Sylhet City Corporation, Bangladesh

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Alayne M. Adams ◽  
Rushdia Ahmed ◽  
Shakil Ahmed ◽  
Sifat Shahana Yusuf ◽  
Rubana Islam ◽  
...  
Keyword(s):  
Critical Care ◽  
Urban Poor ◽  
Emergency Services ◽  
Census Data ◽  
Service Providers ◽  
Healthcare Services ◽  
Tertiary Hospital ◽  
Care Services ◽  
Referral Systems ◽  
Alternative Scenarios

Abstract Background An effective referral system is critical to ensuring access to appropriate and timely healthcare services. In pluralistic healthcare systems such as Bangladesh, referral inefficiencies due to distance, diversion to inappropriate facilities and unsuitable hours of service are common, particularly for the urban poor. This study explores the reported referral networks of urban facilities and models alternative scenarios that increase referral efficiency in terms of distance and service hours. Methods Road network and geo-referenced facility census data from Sylhet City Corporation were used to examine referral linkages between public, private and NGO facilities for maternal and emergency/critical care services, respectively. Geographic distances were calculated using ArcGIS Network Analyst extension through a “distance matrix” which was imported into a relational database. For each reported referral linkage, an alternative referral destination was identified that provided the same service at a closer distance as indicated by facility geo-location and distance analysis. Independent sample t-tests with unequal variances were performed to analyze differences in distance for each alternate scenario modelled. Results The large majority of reported referrals were received by public facilities. Taking into account distance, cost and hours of service, alternative scenarios for emergency services can augment referral efficiencies by 1.5–1.9 km (p < 0.05) compared to 2.5–2.7 km in the current scenario. For maternal health services, modeled alternate referrals enabled greater referral efficiency if directed to private and NGO-managed facilities, while still ensuring availability after working-hours. These referral alternatives also decreased the burden on Sylhet City’s major public tertiary hospital, where most referrals were directed. Nevertheless, associated costs may be disadvantageous for the urban poor. Conclusions For both maternal and emergency/critical care services, significant distance reductions can be achieved for public, NGO and private facilities that avert burden on Sylhet City’s largest public tertiary hospital. GIS-informed analyses can help strengthen coordination between service providers and contribute to more effective and equitable referral systems in Bangladesh and similar countries.

IOT-Based Smart Healthcare System: A Review on Constituent Technologies

2021 ◽  
pp. 2130008
Author(s):  
Manju Lata Sahu ◽  
Mithilesh Atulkar ◽  
Mitul Kumar Ahirwal
Keyword(s):  
Healthcare System ◽  
Service Providers ◽  
Data Communication ◽  
Healthcare Services ◽  
Vital Role ◽  
Medical Practitioners ◽  
Smart Healthcare ◽  
Rural And Remote Areas ◽  
Medical Infrastructure ◽  
Physiological Sensing

The revolution in the Internet of Things (IoT) is redesigning and reshaping the healthcare system technologically, economically and socially. The emerging and rapidly growing IoT-based Smart Healthcare System (SHCS) is seen as a sustainable solution to reduce the burden on the existing healthcare system due to increasing diseases and limited medical infrastructure. IoT-based SHCS plays a vital role in delivery of healthcare services in rural and remote areas where the essential medical amenities, necessary infrastructures and qualified medical practitioners are not available. Therefore, in this paper, a comprehensive investigation of futuristic IoT-based SHCS and its constituents is presented. This paper provides exhaustive review on different techniques and technologies dealing with smart healthcare framework, physiological sensing, signal processing, data communication, cloud computing and data analytics used in IoT-based SHCS. A comparative analysis of existing literature has been carried out to identify the recent trends and advancements in this very dynamic field of global importance. In addition to this, it highlights different issues and challenges, along with the recommendation for further research in the field. The prime objective of this paper is to deliver the state-of-the-art understanding and update about IoT-based SHCS and its constituents by providing a good source of information to the researchers, service providers, technologists, medical practitioners and the general population.

scholarly journals Do community scorecards improve utilisation of health services in community clinics: experience from a rural area of Bangladesh

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
S. M. A. Hanifi ◽  
Aazia Hossain ◽  
Asiful Haidar Chowdhury ◽  
Shahidul Hoque ◽  
Mohammad Abdus Selim ◽  
...  
Keyword(s):  
Health Services ◽  
Rural Area ◽  
Service Providers ◽  
Healthcare Providers ◽  
Community Support ◽  
Healthcare Services ◽  
Public Health Services ◽  
Community Clinics ◽  
Community Awareness ◽  
The Government

Abstract Background The government of Bangladesh initiated community clinics (CC) to extend the reach of public health services and these facilities were planned to be run through community participation. However, utilisation of CC services is still very low. Evidence indicates community score card is an effective tool to increase utilisation of services from health facility through regular interface meeting between service providers and beneficiary. We investigated whether community scorecards (CSC) improve utilisation of health services provided by CCs in rural area of Bangladesh. Methods This study was conducted from December 2017 to November 2018. Three intervention and three control CCs were selected from Chakaria, a rural sub-district of Bangladesh. CSC was introduced with the Community Groups and Community Support Groups in intervention CCs between January to October 2018. Data were collected through observation of CCs during operational hours, key informant interviews, focus group discussions, and from DHIS2. Utilisation of CC services was compared between intervention and control areas, pre and post CSC intervention. Results Post CSC intervention, community awareness about CC services, utilisation of clinic operational hours, and accountability of healthcare providers have increased in the intervention CCs. Utilisation of primary healthcare services including family planning services, antenatal care, postnatal care and basic health services have significantly improved in intervention CCs. Conclusion CSC is an effective tool to increase the service utilization provided by CCs by ensuring community awareness and participation, and service providers’ accountability. Policy makers and concerned authorities may take necessary steps to integrate community scorecard in the health system by incorporating it in CCs.

Monitoring Quality in a Federal State with Shared Powers in Healthcare: The Case of Belgium

2011 ◽  
Vol 18 (4) ◽  
pp. 413-422 ◽  
Author(s):  
Diego Fornaciari ◽  
Arthur Vleugels ◽  
Stefaan Callens ◽  
Kristof Eeckloo
Keyword(s):  
Healthcare System ◽  
Healthcare Providers ◽  
Quality Of Healthcare ◽  
Healthcare Services ◽  
Federal State ◽  
Flemish Community ◽  
The Government ◽  
Regulatory Powers ◽  
Monitoring Quality

AbstractThe Belgian healthcare system consists of a complex of more or less autonomous groups of healthcare providers. It is the responsibility of the government to ensure that the fundamental right to qualitative healthcare is secured through the services they provide. In Belgium, the regulatory powers in healthcare are divided between the federal state and the three communities. Both levels, within their area of competence, monitor the quality of healthcare services. Unique to the Belgian healthcare system is that the government that providers are accountable to is not always the same as the government that is competent to set the criteria. The goal of this article is to provide an overview of the main mechanisms that are used by the federal government and the government of the Flemish community to monitor healthcare quality in hospitals. The Flemish community is Belgian’s largest community (6.2 million inhabitants). The overview is followed by a critical analysis of the dual system of quality monitoring.

scholarly journals The Intersection of Education and Healthcare: Supporting Children with Chronic Health Conditions

2021 ◽  
Vol 8 (2) ◽  
pp. 184-193
Author(s):  
Arnold Olszewski ◽  
◽  
Donna Scarborough ◽  
Gregory Szumlas
Keyword(s):  
Chronic Illness ◽  
Service Providers ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Individual Variability ◽  
Chronic Health Conditions ◽  
Health Conditions ◽  
Chronic Health ◽  
Related Service ◽  
Diagnostic Approaches

Objective: Chronic health conditions in childhood have been negatively associated with linguistic, academic, and occupational outcomes. Traditionally, categorical diagnostic approaches relying on exclusionary criteria are used in healthcare services. Methods: This literature review examines research from various fields to evaluate the effects of chronic illness in cognitive-linguistic development in children. We explore the implications for different conceptualizations of the term “chronic illness.” We compare categorical and non-categorical diagnostic approaches, specifically in relation to children’s academic performance. Results: We provide recommendations for bridging the gap between healthcare and education to provide children with chronic conditions the best chance of thriving medically and academically. Definitions of chronic illness that rely on inclusive criteria and acknowledge individual variability seem best suited for clinical practice and research. Conclusions: Effective supports for children with chronic illness require evidence-based treatment approaches that are tailored to the unique needs of each individual child. Educators, healthcare providers, families, and related service providers must have open lines of communication to serve children with chronic health conditions. Early identification and intervention is crucial.

scholarly journals Mobile Health Technology and Healthcare Providers: Systemic Barriers to Adoption

2021 ◽  
Vol 27 (4) ◽  
pp. 267-278
Author(s):  
Somayyeh Zakerabasali ◽  
Seyed Mohammad Ayyoubzadeh ◽  
Tayebeh Baniasadi ◽  
Azita Yazdani ◽  
Shahabeddin Abhari
Keyword(s):  
Systematic Review ◽  
Healthcare System ◽  
Mobile Health ◽  
Group Discussion ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Security And Privacy ◽  
Adoption Process ◽  
Barriers To Adoption ◽  
Privacy Concerns

Objectives: Despite the growing use of mobile health (mHealth), certain barriers seem to be hindering the use of mHealth applications in healthcare. This article presents a systematic review of the literature on barriers associated with mHealth reported by healthcare professionals.Methods: This systematic review was carried out to identify studies published from January 2015 to December 2019 by searching four electronic databases (PubMed/MEDLINE, Web of Science, Embase, and Google Scholar). Studies were included if they reported perceived barriers to the adoption of mHealth from healthcare providers’ perspectives. Content analysis and categorization of barriers were performed based on a focus group discussion that explored researchers’ knowledge and experiences.Results: Among the 273 papers retrieved through the search strategy, 18 works were selected and 18 barriers were identified. The relevant barriers were categorized into three main groups: technical, individual, and healthcare system. Security and privacy concerns from the category of technical barriers, knowledge and limited literacy from the category of individual barriers, and economic and financial factors from the category of healthcare system barriers were chosen as three of the most important challenges related to the adoption of mHealth described in the included publications.Conclusions: mHealth adoption is a complex and multi-dimensional process that is widely implemented to increase access to healthcare services. However, it is influenced by various factors and barriers. Understanding the barriers to adoption of mHealth applications among providers, and engaging them in the adoption process will be important for the successful deployment of these applications.

scholarly journals Public health consequences after ten years of the Syrian crisis: a literature review

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
M. H. D. Bahaa Aldin Alhaffar ◽  
Sandor Janos
Keyword(s):  
Public Health ◽  
Health Status ◽  
Healthcare System ◽  
Healthcare Providers ◽  
Health Sector ◽  
Health Indicators ◽  
Healthcare Services ◽  
Seeking Safety ◽  
Syrian Crisis ◽  
Syrian Population

AbstractTen years of the Syrian war had a devastating effect on Syrian lives, including millions of refugees and displaced people, enormous destruction in the infrastructure, and the worst economic crisis Syria has ever faced. The health sector was hit hard by this war, up to 50% of the health facilities have been destroyed and up to 70% of the healthcare providers fled the country seeking safety, which increased the workload and mental pressure for the remaining medical staff. Five databases were searched and 438 articles were included according to the inclusion criteria, the articles were divided into categories according to the topic of the article.Through this review, the current health status of the Syrian population living inside Syria, whether under governmental or opposition control, was reviewed, and also, the health status of the Syrian refugees was examined according to each host country. Public health indicators were used to summarize and categorize the information. This research reviewed mental health, children and maternal health, oral health, non-communicable diseases, infectious diseases, occupational health, and the effect of the COVID − 19 pandemic on the Syrian healthcare system. The results of the review are irritating, as still after ten years of war and millions of refugees there is an enormous need for healthcare services, and international organization has failed to respond to those needs. The review ended with the current and future challenges facing the healthcare system, and suggestions about rebuilding the healthcare system.Through this review, the major consequences of the Syrian war on the health of the Syrian population have been reviewed and highlighted. Considerable challenges will face the future of health in Syria which require the collaboration of the health authorities to respond to the growing needs of the Syrian population. This article draws an overview about how the Syrian war affected health sector for Syrian population inside and outside Syria after ten years of war which makes it an important reference for future researchers to get the main highlight of the health sector during the Syrian crisis.

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