Effects of purchaser competition in the Dutch health system: is the glass half full or half empty?

2011 ◽  
Vol 6 (1) ◽  
pp. 109-123 ◽  
Author(s):  
Frederik T. Schut ◽  
Wynand P. M. M. van de Ven
Keyword(s):  
Health Services ◽  
Health System ◽  
Performance Indicators ◽  
Hospital Care ◽  
Care Provision ◽  
Health Insurance System ◽  
Improve Performance ◽  
Dutch Health ◽  
Product Classification

AbstractIn 2006, the Dutch health insurance system was radically reformed to strengthen competition among health insurers as purchasers of health services. This article considers whether purchaser competition has improved efficiency in health-care provision. Although supply and price regulation still dominates the allocation of health services, purchaser competition has already significantly affected the provision of hospital care, pharmaceuticals and primary care, as well as efforts to gather and disseminate information about quality of care. From this perspective, the glass is half full. However, based on the crude performance indicators available, the reforms have not yet demonstrated significant effects on the performance of the Dutch health system. From this perspective the glass is half empty. The article concludes that the effectiveness of purchaser competition depends crucially on the success of ongoing efforts to improve performance indicators, product classification and the risk equalisation scheme.

scholarly journals Improving maternal health services through social accountability interventions in Nepal: an analytical review of existing literature

2020 ◽  
Vol 41 (1) ◽  
Author(s):  
Adweeti Nepal ◽  
Santa Kumar Dangol ◽  
Anke van der Kwaak
Keyword(s):  
Maternal Health ◽  
Health Services ◽  
Health System ◽  
Maternal Health Services ◽  
Policy Formulation ◽  
Social Accountability ◽  
The Social ◽  
The Government ◽  
The Impact

Abstract Background The persistent quality gap in maternal health services in Nepal has resulted in poor maternal health outcomes. Accordingly, the Government of Nepal (GoN) has placed emphasis on responsive and accountable maternal health services and initiated social accountability interventions as a strategical approach simultaneously. This review critically explores the social accountability interventions in maternal health services in Nepal and its outcomes by analyzing existing evidence to contribute to the informed policy formulation process. Methods A literature review and desk study undertaken between December 2018 and May 2019. An adapted framework of social accountability by Lodenstein et al. was used for critical analysis of the existing literature between January 2000 and May 2019 from Nepal and other low-and-middle-income countries (LMICs) that have similar operational context to Nepal. The literature was searched and extracted from database such as PubMed and ScienceDirect, and web search engines such as Google Scholar using defined keywords. Results The study found various social accountability interventions that have been initiated by GoN and external development partners in maternal health services in Nepal. Evidence from Nepal and other LMICs showed that the social accountability interventions improved the quality of maternal health services by improving health system responsiveness, enhancing community ownership, addressing inequalities and enabling the community to influence the policy decision-making process. Strong gender norms, caste-hierarchy system, socio-political and economic context and weak enforceability mechanism in the health system are found to be the major contextual factors influencing community engagement in social accountability interventions in Nepal. Conclusions Social accountability interventions have potential to improve the quality of maternal health services in Nepal. The critical factor for successful outcomes in maternal health services is quality implementation of interventions. Similarly, continuous effort is needed from policymakers to strengthen monitoring and regulatory mechanism of the health system and decentralization process, to improve access to the information and to establish proper complaints and feedback system from the community to ensure the effectiveness and sustainability of the interventions. Furthermore, more study needs to be conducted to evaluate the impact of the existing social accountability interventions in improving maternal health services in Nepal.

Allied health: integral to transforming health

2016 ◽  
Vol 40 (2) ◽  
pp. 194 ◽  
Author(s):  
Lucylynn Lizarondo ◽  
Catherine Turnbull ◽  
Tracey Kroon ◽  
Karen Grimmer ◽  
Alison Bell ◽  
...  
Keyword(s):  
Health Services ◽  
Health System ◽  
Patient Outcomes ◽  
Allied Health ◽  
Systems Of Care ◽  
Healthcare Services ◽  
Supporting Evidence ◽  
Allied Health Professionals ◽  
Health Practitioners

Objective South Australia is taking an innovative step in transforming the way its healthcare is organised and delivered to better manage current and future demands on the health system. In an environment of transforming health services, there are clear opportunities for allied health to assist in determining solutions to various healthcare challenges. A recent opinion piece proposed 10 clinician-driven strategies to assist in maximising value and sustainability of healthcare in Australia. The present study aimed to seek the perspectives of allied health clinicians, educators, researchers, policy makers and managers on these strategies and their relevance to allied health. Methods A survey of allied health practitioners was undertaken to capture their perspectives on the 10 clinician-driven strategies for maximising value and sustainability of healthcare in Australia. Survey findings were then layered with evidence from the literature. Results Highly relevant across allied health are the strategies of discontinuation of low value practices, targeting clinical interventions to those getting greatest benefit, active involvement of patients in shared decision making and self-management and advocating for integrated systems of care. Conclusions Allied health professionals have been involved in the South Australian healthcare system for a prolonged period, but their services are poorly recognised, often overlooked and not greatly supported in existing traditional practices. The results of the present study highlight ways in which healthcare services can implement strategies not only to improve the quality of patient outcomes, but also to offer innovative solutions for future, sustainable healthcare. The findings call for concerted efforts to increase the utilisation of allied health services to ensure the ‘maximum value for spend’ of the increasingly scarce health dollar. What is known about the topic? In medicine, clinician-driven strategies have been proposed to minimise inappropriate and costly care and maximise highly appropriate and less expensive care. These strategies were developed based on clinical experiences and with supporting evidence from scientific studies. What does this paper add? Major changes to the health system are required to slow down the growth in healthcare expenditure. This paper describes opportunities in which allied health practitioners can implement similar strategies not only to improve the quality of patient outcomes, but also to offer cost-effective solutions for a sustainable healthcare. What are the implications for practitioners? Allied health practitioners can provide solutions to healthcare challenges and assist in the transformation of healthcare in Australia. However, for this to happen, there should be concerted efforts to increase recognition of and support for the use of allied health services.

Quality

2020 ◽  
pp. 166-183
Author(s):  
Julie Sin
Keyword(s):  
Health Services ◽  
Health System ◽  
Services Quality ◽  
Quality Care ◽  
System Level ◽  
Quality Of Services ◽  
Provider Perspective ◽  
Multidimensional Concept

This chapter looks at the topic of health services quality from a commissioning and whole population perspective. Quality is noted to be a multidimensional concept and dimensions of quality are considered. The role of the commissioner in maintaining and improving quality of services is explored, and this is seen within a wider backdrop of a health system with commissioner and provider functions (if there are such distinctions in the system). Commissioners need to know whether they are securing quality care for their population for the money spent. They also need an understanding of how this dovetails with the provider perspective on this topic. Commissioners also need to be able to articulate what they wish to assess in practice under the guise of quality. Finally, at a system level there are also bearings on how to compile and interpret a picture of a population’s health if needed.

scholarly journals Development of an integrated computational tool to improve performance of irrigation districts

2012 ◽  
Vol 14 (3) ◽  
pp. 716-730 ◽  
Author(s):  
L. Pérez Urrestarazu ◽  
J. A. Rodríguez Díaz ◽  
E. Camacho Poyato ◽  
R. López Luque ◽  
F. M. Borrego Jaraba
Keyword(s):  
Performance Indicators ◽  
Network Performance ◽  
Hydraulic Modeling ◽  
Hydraulic Model ◽  
Irrigation District ◽  
Improve Performance ◽  
Computer Tool ◽  
Calculation Module ◽  
And Performance

Nowadays irrigation district managers require several tools to assess irrigation networks' performance such as hydraulic models, geographic information systems (GIS) or decision support systems (DSS) which are available but as independent elements. Thus, simplifying the use of these tools by means of applications that integrate all these components would be helpful for irrigation district managers. In this paper, a computer tool combining a GIS, a hydraulic model and performance indicators (PIs) has been developed creating a database to deal with most information required in an irritation district. MapObjects Java Edition was used for the GIS integration and EPANET calculation module for the hydraulic modeling. This tool enables the study of the network performance, taking into account real measures (data from the remote control system) and simulated measures (obtained when running the hydraulic model) which are stored in a database and used to calculate different indicators that can be represented in the GIS. The PIs calculated with this tool give important information regarding the network response to different conditions, malfunction problems and failures in supply. Therefore, this tool is also useful to study the effects of improvements and the quality of service provided to farmers.

scholarly journals Improving People’s Self-Reported Experience with the Health Services: The Role of Non-Clinical Factors

2019 ◽  
Vol 17 (1) ◽  
pp. 178
Author(s):  
Ángel Fernández-Pérez ◽  
Ángeles Sánchez
Keyword(s):  
Health Services ◽  
Health System ◽  
Waiting Time ◽  
Hospital Care ◽  
Well Being ◽  
Ordinary Least Squares ◽  
Public Healthcare ◽  
Health Staff ◽  
Clinical Factors ◽  
Care Services

The main aim of this study was to analyse the association between non-clinical factors and the self-reported experience of people with the main health services of the Spanish public healthcare system. Specifically, we analysed whether factors such as the treatment received from health staff, the confidence transmitted to the patient by the doctor, or waiting time for a diagnostic test had an influence on people reporting a more satisfactory experience with primary, specialised, and hospital care services. We used cross-sectional microdata from the Spanish Healthcare Barometer survey of 2015 comprising a sample of 7800 individuals. We applied a probit-adapted ordinary least squares estimation, which is one of the most widely used methods in recent studies on subjective well-being. Our findings suggest that individuals’ interaction with non-clinical factors was positively correlated with the overall health services experience. Treatment received from health staff was one of the most relevant factors to ensure that individuals report a more satisfactory experience with primary care. Time devoted by physicians to each patient and waiting time for a non-emergency admission were the most correlated factors in specialised and hospital care services, respectively. This study could have implications for public policies. First, it shows policy-makers the influence of non-clinical factors when individuals rate their overall experience with the main health services in Spain. Second, it identifies the key factors where the health system could reallocate more public resources to improve people’s experience and thus the health system responsiveness.

scholarly journals Regulation of health care professionals as a quality strategy

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
D Panteli ◽  
A Kreutzberg ◽  
C Reichebner ◽  
C Maier ◽  
F Destrebecq
Keyword(s):  
Health Services ◽  
Health System ◽  
Health Professionals ◽  
Health Care Professionals ◽  
Professional Competence ◽  
Continuing Professional Development ◽  
Cost Effective ◽  
Patient Centered ◽  
System Input

Abstract Health professionals are both a health system input and an active component of the functions that the health system performs. As such, the performance of the health workforce is directly linked to the quality of health services. Regulation is essential to define a clear framework within which health professionals acquire and maintain the competence needed to provide health services that are of high quality, i.e. that are safe, effective and patient-centered. This presentation discusses the evidence on a sequence of strategies that regulate health professionals, looking at how they are currently deployed in Europe, how (cost-)effective they are, and what can be done to optimize their implementation. Adopting a comprehensive perspective ranging from the entry into training to life-long maintenance and demonstration of competence, the presentation brings together a) strategies to develop professional competence (including training structure and contents, curriculum development and the accreditation of institutions for health education); b) strategies that regulate the entry of physicians and nurses into their professions (e.g. licensing and registration); c) mechanisms to maintain competence (e.g. continuing professional development); and d) levers to address instances when fitness to practice comes into question.

Sign in / Sign up

Export Citation Format

Share Document