Health and Care Bill fails to tackle workforce problems and risks outsourcing to private providers, BMA warns

BMJ ◽  
2021 ◽  
pp. n2876
Author(s):  
Elisabeth Mahase
Keyword(s):  
Private Providers

scholarly journals As predicted by theory: choice and competition in a publicly funded and regulated regional health system yield improved access and cost control

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jonas Wohlin ◽  
Clara Fischer ◽  
Karin Solberg Carlsson ◽  
Sara Korlén ◽  
Pamela Mazzocato ◽  
...  
Keyword(s):  
Cost Control ◽  
Care Quality ◽  
Patient Choice ◽  
Public Healthcare ◽  
Successful Implementation ◽  
Publicly Funded ◽  
Public And Private ◽  
Bundled Payment ◽  
Private Providers ◽  
Number Of Patients

Abstract Background New Public Management (NPM) has been widely used to introduce competition into public healthcare. Results have been mixed, and there has been much controversy about the appropriateness of a private sector-mimicking governance model in a public service. One voice in the debate suggested that rather than discussing whether competition is “good” or “bad” the emphasis should be on exploring the conditions for a successful implementation. Methods We report a longitudinal case study of the introduction of patient choice and allowing private providers to enter a publicly funded market. Patients in need of hip or knee replacement surgery are allowed to choose provider, and those are paid a fixed reimbursement for the full care episode (bundled payment). Providers are financially accountable for complications. Data on number of patients, waiting lists and times, costs to the public purchaser, and complications were collected from public registries. Providers were interviewed at three points in time during a nine-year follow-up period. Time-series of the quantitative data were exhibited and the views of actors involved were explored in a thematic analysis of the interviews. Results The policy goals of improving access to care and care quality while controlling total costs were achieved in a sustained way. Six themes were identified among actors interviewed and those were consistent over time. The design of the patient choice model was accepted, although all providers were discontent with the level of reimbursement. Providers felt that quality, timeliness of service and staff satisfaction had improved. Public and private providers differed in terms of patient-mix and developed different strategies to adjust to the reimbursement system. Private providers were more active in marketing and improving operation room efficiency. All providers intensified cooperation with referring physicians. Close attention was paid to following the rules set by the purchaser. Discussion and conclusions The sustained cost control was an effect of bundled payment. What this study shows is that both public and private providers adhere long-term to regulations by a public purchaser that also controls entrance to the market. The compensation was fixed and led to competition on quality, as predicted by theory.

scholarly journals Connected diagnostics to improve accurate diagnosis, treatment, and conditional payment of malaria services in Kenya

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shannen M. C. van Duijn ◽  
Angela K. Siteyi ◽  
Sherzel Smith ◽  
Emmanuel Milimo ◽  
Leon Stijvers ◽  
...  
Keyword(s):  
Clinical Performance ◽  
Healthcare Providers ◽  
Malaria Treatment ◽  
Sub Saharan Africa ◽  
Structured Interviews ◽  
National Guidelines ◽  
Private Providers ◽  
Provider Perspectives ◽  
Treatment Data ◽  
Sub Saharan

Abstract Background In sub-Saharan Africa, the material and human capacity to diagnose patients reporting with fever to healthcare providers is largely insufficient. Febrile patients are typically treated presumptively with antimalarials and/or antibiotics. Such over-prescription can lead to drug resistance and involves unnecessary costs to the health system. International funding for malaria is currently not sufficient to control malaria. Transition to domestic funding is challenged by UHC efforts and recent COVID-19 outbreak. Herewith we present a digital approach to improve efficiencies in diagnosis and treatment of malaria in endemic Kisumu, Kenya: Connected Diagnostics. The objective of this study is to evaluate the feasibility, user experience and clinical performance of this approach in Kisumu. Methods Our intervention was performed Oct 2017–Dec 2018 across five private providers in Kisumu. Patients were enrolled on M-TIBA platform, diagnostic test results digitized, and only positive patients were digitally entitled to malaria treatment. Data on socio-demographics, healthcare transactions and medical outcomes were analysed using standard descriptive quantitative statistics. Provider perspectives were gathered by 19 semi-structured interviews. Results In total 11,689 febrile patients were digitally tested through five private providers. Malaria positivity ranged from 7.4 to 30.2% between providers, significantly more amongst the poor (p < 0.05). Prescription of antimalarials was substantially aberrant from National Guidelines, with 28% over-prescription (4.6–63.3% per provider) and prescription of branded versus generic antimalarials differing amongst facilities and correlating with the socioeconomic status of clients. Challenges were encountered transitioning from microscopy to RDT. Conclusion We provide full proof-of-concept of innovative Connected Diagnostics to use digitized malaria diagnostics to earmark digital entitlements for correct malaria treatment of patients. This approach has large cost-saving and quality improvement potential.

scholarly journals Running up a Down-Escalator in the Middle of a Class Structure Gone Pear-Shaped

2013 ◽  
Vol 18 (1) ◽  
pp. 171-178 ◽  
Author(s):  
Patrick Ainley ◽  
Martin Allen
Keyword(s):  
Higher Education ◽  
Middle Class ◽  
Widening Participation ◽  
Class Structure ◽  
Private Providers

Whilst widening participation to higher education was approaching New Labour's target of 50% of 18-30s (for women at least), it was presented as a professionalisation of the proletariat but in reality and in hindsight it can be seen to have disguised a proletarianisation of the professions - for which HE supposedly prepares its graduates - with many reduced to para-professions at best. It is argued therefore that education as a whole faces a credibility crunch. However, many have nowhere else to go since without qualifications they face falling into the so-called ‘underclass’ which was widely seen to have manifested itself in the riots of summer 2011. Like other commentators, we point out that the majority of youth did not riot and focus instead upon the children of the new working-middle class who are running up a down-escalator of devalued qualifications. This only intensifies national hysteria about education as the Coalition's reception of Browne's Review restricts competitive academic HE entry to those who can afford tripled fees, while relegating those who cannot to ‘Apprenticeships Without Jobs’ (cf. Finn 1987 ) in FE and private providers. With reference to Allen and Ainley (2011) , this paper speculates as to the likely outcome of this generational crisis.

scholarly journals Management of childhood diarrhea among private providers in Uttar Pradesh, India

2016 ◽  
Vol 6 (1) ◽  
Author(s):  
Christa L Fisher Walker ◽  
Sunita Taneja ◽  
Laura M. Lamberti ◽  
Amnesty Lefevre ◽  
Robert Black ◽  
...  
Keyword(s):  
Uttar Pradesh ◽  
Childhood Diarrhea ◽  
Private Providers

scholarly journals Competing for Recognition through Public Good Provision

2008 ◽  
Vol 8 (1) ◽  
Author(s):  
Mattias K Polborn
Keyword(s):  
Public Good ◽  
Open Source Software ◽  
Public Good Provision ◽  
Competition Effect ◽  
Software Projects ◽  
The Public ◽  
Context Recognition ◽  
Private Providers ◽  
Common Interests ◽  
Good Provision

We consider a setting in which several groups of individuals with common interests (``clubs") compete with each other for recognition by other individuals. Depending on the context, recognition may be expressed by these other individuals joining a club, or choosing one club to admire. Clubs compete by providing a public good. Competition between clubs increases the public good provision level, and a sufficiently strong competition effect may even lead to overprovision. The model thus limits the argument for subsidies to the private providers of public goods. We discuss implications of the model for open-source software projects, university fundraising and infrastructure competition between cities.

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