scholarly journals The paradox of the COVID-19 pandemic: the impact on patient demand in Japanese hospitals

2021 ◽  
Author(s):  
Masako Ii ◽  
Sachiko Watanabe
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Health Care Providers ◽  
Care Providers ◽  
Payment Reform ◽  
Dramatic Decline ◽  
Hygiene Measures ◽  
Abundant Supply ◽  
The Impact ◽  
Care System

Analyzing data from a large, nationally distributed group of Japanese hospitals, we found a dramatic decline in both inpatient and outpatient volumes over the three waves of the COVID-19 pandemic in Japan from February-December 2020. We identified three key reasons for this fall in patient demand. First, COVID-19-related hygiene measures and behavioral changes significantly reduced non-COVID-19 infectious diseases. Second, consultations relating to chronic diseases fell sharply. Third, certain medical investigations and interventions were postponed or cancelled. Despite the drop in hospital attendances and admissions, COVID-19 is said to have brought the Japanese health care system to the brink of collapse. In this context, we explore longstanding systematic issues, finding that Japan's abundant supply of beds and current payment system may have introduced a perverse incentive to overprovide services, creating a mismatch between patient needs and the supply of health care resources. Poor coordination among health care providers and the highly decentralized governance of the health care system have also contributed to the crisis. In order to ensure the long-term sustainability of the Japanese health care system beyond COVID-19, it is essential to promote specialization and differentiation of medical functions among hospitals, to strengthen governance, and to introduce appropriate payment reform.

scholarly journals The Safe Resumption of Elective Plastic Surgery in Accredited Ambulatory Surgery Facilities During the COVID-19 Pandemic

2020 ◽  
Author(s):  
Mitchell Brown ◽  
Stephanie Eardley ◽  
Jamil Ahmad ◽  
Frank Lista ◽  
Scott Barr ◽  
...  
Keyword(s):  
Health Care ◽  
Plastic Surgery ◽  
Health Care System ◽  
Health Care Providers ◽  
Care Providers ◽  
Canadian Health Care System ◽  
Canadian Health ◽  
Canadian Health Care ◽  
The Impact ◽  
Care System

Abstract Background On March 11, 2020 the World Health Organization declared COVID-19 a worldwide pandemic resulting in an unprecedented shift in the Canadian health care system, where protection of an already overloaded health care system became a priority; all elective surgeries and non-essential activities were ceased. With the impact being less than predicted, on May 26, 2020, elective surgeries and non-essential activities were permitted to resume. Objectives To examine outcomes following elective aesthetic surgery and the impact on the Canadian health care system with the resumption of these services during the COVID-19 worldwide pandemic. Methods Data was collected in a prospective manner on consecutive patients undergoing elective plastic surgery procedures in six accredited ambulatory surgery facilities. Data included patient demographics, procedural characteristics, COVID-19 PCR test status, airway management and postoperative outcomes. Results 368 patients underwent elective surgical procedures requiring a general anesthetic. All 368 patients that underwent surgery were negative on pre visit screening. A COVID-19 PCR test was completed by 352 patients (95.7%) and all were negative. In the postoperative period, seven patients (1.9%) had complications, three patients (0.8%) required a hospital visit, and one patient (0.3%) required hospital admission. No patients or health care providers developed COVID-19 symptoms or had a positive test for COVID-19 within 30 days of surgery. Conclusions With appropriate screening and safety precautions, elective aesthetic plastic surgery can be performed in a manner that is safe for patients and health care providers and with a very low risk for accelerating virus transmission within the community.

scholarly journals The impact of Hurricane Maria on Puerto Rico’s health system: post-disaster perceptions and experiences of health care providers and administrators

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Sheilla L. Rodríguez-Madera ◽  
Nelson Varas-Díaz ◽  
Mark Padilla ◽  
Kevin Grove ◽  
Kariela Rivera-Bustelo ◽  
...  
Keyword(s):  
Health Care ◽  
Puerto Rico ◽  
Health Care System ◽  
Health Care Providers ◽  
Health Care Facilities ◽  
Health Needs ◽  
Care Providers ◽  
The Impact ◽  
Post Disaster ◽  
Care System

Abstract Background After its landfall in Puerto Rico in 2017, Hurricane Maria caused the longest blackout in United States history, producing cascading effects on a health care system that had already been weakened by decades of public sector austerity and neoliberal health reforms. This article addresses how health care professionals and administrators experienced the health care system’s collapse and the strategies used by them to meet their communities' health needs. Methods Data were collected between September 2018 and February 2020. Ethnographic observations in health care facilities and semi-structured qualitative interviews with representatives of the health care system were conducted. This paper focuses on data from interviews with health care providers (n = 10) and administrators (n = 10), and an ethnographic visit to a pop-up community clinic. The analysis consisted of systematic thematic coding of the interview transcripts and ethnographic field notes. Results Results provide insight on how participants, who witnessed first-hand the collapse of Puerto Rico’s health care system, responded to the crisis after Maria. The prolonged power outage and lack of a disaster management plan were partly responsible for the death of 3,052 individuals who experienced extended interruptions in access to medical care. Participants reported a sense of abandonment by the government and feelings of mistrust. They also described the health sector as chaotic and lacking clear guidelines on how to provide services or cope with personal crises while working under extreme conditions. In such circumstances, they developed resilient responses to meet communities’ health needs (e.g., itinerant acupuncture services, re-locating physicians to local pharmacies). Conclusions Participants’ narratives emphasize that the management of Hurricane Maria was fraught with political and economic constraints affecting Puerto Rico. Ineffective planning and post-Maria responses of the local and federal governments were determinants of the disaster’s impact. The findings contribute to a growing scientific literature indicating that Hurricane Maria revealed ‘the collapse before the collapse,’ alluding to the structural deficiencies that presaged the catastrophic event. In the context of governmental abandonment, the authors argue for the importance of developing alternative strategies in post-disaster health care provision among health professionals and administrators who work at the front lines of recovery.

scholarly journals “Take the treatment and be brave”: Care experiences of pregnant women with rifampicin-resistant tuberculosis

PLoS ONE ◽  
2020 ◽  
Vol 15 (12) ◽  
pp. e0242604
Author(s):  
Marian Loveday ◽  
Sindisiwe Hlangu ◽  
Jennifer Furin
Keyword(s):  
Health Care ◽  
Pregnant Women ◽  
Health Care System ◽  
Health Care Providers ◽  
Physical Symptoms ◽  
Coding System ◽  
Care Providers ◽  
Convenience Sample ◽  
Care System

Background There are few data on the on the care experiences of pregnant women with rifampicin-resistant TB. Objective To describe the treatment journeys of pregnant women with RR-TB—including how their care experiences shape their identities—and identify areas in which tailored interventions are needed. Methods In this qualitative study in-depth interviews were conducted among a convenience sample from a population of pregnant women receiving treatment for RR-TB. This paper follows COREQ guidelines. A thematic network analysis using an inductive approach was performed to analyze the interview transcripts and notes. The analysis was iterative and a coding system developed which focused on the care experiences of the women and how these experiences affected their perceptions of themselves, their children, and the health care system in which treatment was received. Results Seventeen women were interviewed. The women described multiple challenges in their treatment journeys which required them to demonstrate sustained resilience (i.e. to “be brave”). Care experiences required them to negotiate seemingly contradictory identities as both new mothers—“givers of life”—and RR-TB patients facing a complicated and potentially deadly disease. In terms of their “pregnancy identity” and “RR-TB patient identity” that emerged as part of their care experiences, four key themes were identified that appeared to have elements that were contradictory to one another (contradictory areas). These included: 1) the experience of physical symptoms or changes; 2) the experience of the “mothering” and “patient” roles; 3) the experience of the care they received for their pregnancy and their RR-TB; and 4) the experience of community engagement. There were also three areas that overlapped with both roles and during which identity was negotiated/reinforced and they included: 1) faith; 2) socioeconomic issues; and 3) long-term concerns over the child’s health. At times, the health care system exacerbated these challenges as the women were not given the support they needed by health care providers who were ill-informed or angry and treated the women in a discriminatory fashion. Left to negotiate this confusing time period, the women turned to faith, their own mothers, and the fathers of their unborn children. Conclusion The care experiences of the women who participated in this study highlight several gaps in the current health care system that must be better addressed in both TB and perinatal services in order to improve the therapeutic journeys for pregnant women with RR-TB and their children. Suggestions for optimizing care include the provision of integrated services, including specialized counseling as well as training for health care providers; engagement of peer support networks; provision of socioeconomic support; long-term medical care/follow-up for children born to women who were treated for RR-TB; and inclusion of faith-based services in the provision of care.

Outside Looking In: A Pharmacist's Personal Journey With Family Elders

2019 ◽  
Vol 34 (3) ◽  
pp. 156-167
Author(s):  
Jeannette Y. Wick
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Health Care Providers ◽  
Transitions Of Care ◽  
Clinical Inertia ◽  
Older Individuals ◽  
Care Providers ◽  
Term Care ◽  
Personal Journey ◽  
Care System

Pharmacists who work in long-term care—or in any area of health care—are exposed to the health care system on a daily basis. While most of us recognize that the health care system has problems, especially at transitions of care, few of us appreciate fully how serious these problems can be. Certifying and accrediting agencies have encouraged health care providers to step out of their silos and work more collaboratively, and educators have emphasized understanding geriatric syndromes. A description of a personal journey through the health system—for both the patient and the caregiver—with two older individuals, this narrative discusses how difficult it is for patients to understand what's happening around them. It also discusses the clinical inertia in addressing geriatric issues and offers suggestions to health care providers facing similar situations.

HIV status, trust in health care providers, and distrust in the health care system among Bronx women

AIDS Care ◽  
2007 ◽  
Vol 19 (2) ◽  
pp. 226-234 ◽  
Author(s):  
C. O. Cunningham ◽  
N. L. Sohler ◽  
L. Korin ◽  
W. Gao ◽  
K. Anastos
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Health Care Providers ◽  
Care Providers ◽  
Hiv Status ◽  
Care System

The cost burden of trastuzumab and bevacizumab monoclonal antibody therapy in solid tumors: Can we afford it?

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 6044-6044 ◽  
Author(s):  
A. Drucker ◽  
K. Virik ◽  
C. Skedgel ◽  
D. Rayson ◽  
M. Sellon ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Drug Costs ◽  
Cost Burden ◽  
Care Providers ◽  
Treatment Standard ◽  
Pharmacy Data ◽  
The Cost ◽  
The Impact ◽  
Care System

6044 Background: Monoclonal antibodies (MAb), such as trastuzumab (TZ) and bevacizumab (BZ), have become an important yet expensive component of cancer treatment. The potential cost impact on health care budgets needs to be assessed in the context of its potential utilization. An estimate of the additional costs incurred by adopting TZ and BZ therapy in breast (BRC), lung (LUC) and colorectal (CRC) cancers was undertaken. Methods: The MAb costs per patient were estimated based on treatment indications, length of treatment, standard doses / schedules and local pharmacy data. Supportive medications, diagnostics and health resources utilization only required for the MAb therapy were also examined. This analysis was performed in Canadian dollars ($), and assumes complete drug delivery and uncomplicated cycles. Drug costs were based on average 2005 wholesale prices in Canada. The analysis took a direct payer perspective. We subsequently estimated the cost of MAb therapy per patient relative to the total costs of conventional cancer management without MAb therapy. Budget impact estimates on Canada’s health care system were then derived according to constructed schema, which accounts for absolute numbers of target patients and systemic therapy utilization. Results: The average costs of TZ per treated patient were $47,278 and $26,648 for adjuvant and metastatic BRC, respectively. For BZ, these were $47,250 and $38,500 for metastatic LUC and CRC, respectively. Other costs associated with MAb therapy were in the range of 3–6%. The predicted TZ drug costs in metastatic breast cancer were within 10% of the actual costs derived from pharmacy data. The potential life-time absolute costs to Canada’s health care system were approximately $118 million for TZ, and $262 million for BZ. This corresponds to an average of approximately 21% increase in the health care expenditure for BRC, LUC, and CRC. Conclusions: MAb therapy, such as TZ and BZ, may add a significant cost burden to Canada’s publicly funded health care system. The developed schema in this analysis may be of potential use to health care providers and policy makers in assessing the impact of MAb therapy on health care budgets. No significant financial relationships to disclose.

Disclosing Gender-Based Violence During Health Care Visits: A Patient-Centered Approach

2017 ◽  
Vol 35 (23-24) ◽  
pp. 5552-5573 ◽  
Author(s):  
Jessica R. Williams ◽  
Rosa M. Gonzalez-Guarda ◽  
Valerie Halstead ◽  
Jacob Martinez ◽  
Laly Joseph
Keyword(s):  
Health Care ◽  
Human Trafficking ◽  
Health Care System ◽  
Health Care Providers ◽  
Qualitative Content Analysis ◽  
Care Providers ◽  
Gender Based Violence ◽  
Patient Centered ◽  
Gender Based ◽  
Care System

The purpose of this study was to better understand victims’ perspectives regarding decisions to disclose gender-based violence, namely, intimate partner violence (IPV) and human trafficking, to health care providers and what outcomes matter to them when discussing these issues with their provider. Twenty-five participants from racially/ethnically diverse backgrounds were recruited from a family justice center located in the southeastern United States. Two fifths had experienced human trafficking, and the remaining had experienced IPV. Upon obtaining informed consent, semistructured, in-depth interviews were conducted. Interviews were audio recorded and transcribed verbatim. Qualitative content analysis was used to examine interview data. Five primary themes emerged. Three themes focused on factors that may facilitate or impede disclosure: patient–provider connectedness, children, and social support. The fourth theme was related to ambiguity in the role of the health care system in addressing gender-based violence. The final theme focused on outcomes participants hope to achieve when discussing their experiences with health care providers. Similar themes emerged from both IPV and human trafficking victims; however, victims of human trafficking were more fearful of judgment and had a stronger desire to keep experiences private. Cultural factors also played an important role in decisions around disclosure and may interact with the general disparities racial/ethnic minority groups face within the health care system. Recognizing factors that influence patient engagement with the health care system as it relates to gender-based violence is critical. The health care system can respond to gender-based violence and its associated comorbidities in numerous ways and interventions must be driven by the patient’s goals and desired outcomes of disclosure. These interventions may be better served by taking patient-centered factors into account and viewing the effectiveness of intervention programs through a behavioral, patient-centered lens.

scholarly journals Experiences of everyday racism in Toronto’s health care system: a concept mapping study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Deb Finn Mahabir ◽  
Patricia O’Campo ◽  
Aisha Lofters ◽  
Ketan Shankardass ◽  
Christina Salmon ◽  
...  
Keyword(s):  
Health Care ◽  
Concept Mapping ◽  
Health Care System ◽  
Health Care Provider ◽  
Health Care Providers ◽  
Care Provider ◽  
Institutional Racism ◽  
Care Providers ◽  
Racial Ethnic ◽  
Care System

Abstract Background In Canada, there is longstanding evidence of health inequities for racialized groups. The purpose of this study is to understand the effect of current health care policies and practices on racial/ethnic groups and in particular racialized groups at the level of the individual in Toronto’s health care system. Methods This study used a semi-qualitative study design: concept mapping. A purposive sampling strategy was used to recruit participants. Health care users and health care providers from Toronto and the Greater Toronto Area participated in all four concept mapping activities. The sample sizes varied according to the activity. For the rating activity, 41 racialized health care users, 23 non-racialized health care users and 11 health care providers completed this activity. The data analysis was completed using the concept systems software. Results Participants generated 35 unique statements of ways in which patients feel disrespect or mistreatment when receiving health care. These statements were grouped into five clusters: ‘Racial/ethnic and class discrimination’, ‘Dehumanizing the patient’, ‘Negligent communication’, ‘Professional misconduct’, and ‘Unequal access to health and health services’. Two distinct conceptual regions were identified: ‘Viewed as inferior’ and ‘Unequal medical access’. From the rating activity, racialized health care users reported ‘race’/ethnic based discrimination or everyday racism as largely contributing to the challenges experienced when receiving health care; statements rated high for action/change include ‘when the health care provider does not complete a proper assessment’, ‘when the patient’s symptoms are ignored or not taken seriously’, ‘and ‘when the health care provider belittles or talks down to the patient’. Conclusions Our study identifies how racialized health care users experience everyday racism when receiving health care and this is important to consider in the development of future research and interventions aimed at addressing institutional racism in the health care setting. To support the elimination of institutional racism, anti-racist policies are needed to move beyond cultural competence polices and towards addressing the centrality of unequal power social relations and everyday racism in the health care system.

Health Care System in Pakistan: A review

2016 ◽  
Vol 2 (3) ◽  
pp. 211-216 ◽  
Author(s):  
Shumaila Arshad ◽  
Hira Waris ◽  
Maria Ismail ◽  
Ayesha Naseer
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Health Care Providers ◽  
Gender Discrimination ◽  
Health Care Systems ◽  
Cultural Beliefs ◽  
Care Providers ◽  
Health Seeking ◽  
Care Systems ◽  
Care System

Health systems are expected to serve the population needs in an effective, efficient and equitable manner. The factors determining the health behaviors may be seen in various contexts physical, socio-economic, cultural and political. Therefore, the utilization of a health care system, public or private, formal or non-formal, may depend on socio-demographic factors, social structures, level of education, cultural beliefs and practices, gender discrimination, status of women, economic and political systems environmental conditions, and the disease pattern and health care system itself. Policy makers need to understand the drivers of health seeking behavior of the population in an increasingly pluralistic health care system. Also a more concerted effort is required for designing behavioral health promotion campaigns through inter-sectoral collaboration focusing more on disadvantaged segments of the population. The paper reviews the health care providers, the national policies emphasizing health services as well as health care systems in Pakistan and the role of the pharmacist in health care system of Pakistan, health and economics of Pakistan and current budgeting policies and the importance of non government organizations in health care system of Pakistan.

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