scholarly journals Establishing Appropriate Agency Relationships for Providers in China

2019 ◽  
Vol 56 ◽  
pp. 004695801987234
Author(s):  
Yu Liu ◽  
Richard B. Saltman
Keyword(s):  
Health Care ◽  
Health Care Reform ◽  
Financial Incentives ◽  
Health Care Facilities ◽  
Public Hospitals ◽  
Multiple Roles ◽  
Chinese Patients ◽  
Chinese Government ◽  
Physician Agency

Physicians play multiple roles in a health system. They typically serve simultaneously as the agent for patients, for insurers, for their own medical practices, and for the hospital facilities where they practice. Theoretical and empirical results have demonstrated that financial relations among these different stakeholders can affect clinical outcomes as well as the efficiency and quality of care. What are the physicians’ roles as the agents of Chinese patients? The marketization approach of China’s economic reforms since 1978 has made hospitals and physicians profit-driven. Such profit-driven behavior and the financial tie between hospitals and physicians have in turn made physicians more the agents of hospitals rather than of their patients. While this commentary acknowledges physicians’ ethics and their dedication to their patients, it argues that the current physician agency relation in China has created barriers to achieving some of the central goals of current provider-side health care reform efforts. In addition to eliminating existing perverse financial incentives for both hospitals and physicians, the need for which is already agreed upon by numerous scholars, we argue that the success of the ongoing Chinese public hospital reform and of overall health care reform also relies on establishing appropriate physician-hospital agency relations. This commentary proposes 2 essential steps to establish such physician-hospital agency relations: (1) minimize financial ties between senior physicians and tertiary-level public hospitals by establishing a separate reimbursement system for senior physicians, and (2) establishing a comprehensive physician professionalism system underwritten by the Chinese government, professional physician associations, and major health care facilities as well as by physician leadership representatives. Neither of these suggestions is addressed adequately in current health care reform activities.

Public Hospitals in China

2015 ◽  
Vol 4 (1) ◽  
pp. 53-72
Author(s):  
Donghai Wei ◽  
Louis Rubino
Keyword(s):  
Health Care ◽  
Health Care Reform ◽  
Essential Medicine ◽  
Universal Coverage ◽  
Health Care Facilities ◽  
Public Hospitals ◽  
The Public ◽  
Reform Plan ◽  
Health Care Leaders ◽  
Primary Health Care Facilities

China has had some initial success in its current health care reform efforts. Five areas of reform have been targeted and include providing universal coverage, equitable access to basic health insurance, establishing an essential medicine system, and improving primary health care facilities. The last area, the reform of the public hospitals, remains the most difficult to reform. General guidelines have been established by the national government and movement is being taken to delegate authority to local units for implementation. The aim of this paper is to compare China's formal government sponsored health care reform plan for public hospitals to the acknowledgement and acceptance by a sample of health care leaders in Guangzhou. Challenges are strong and include cost accountability, doctor training, employee empowerment, improprieties, and the influence of private hospitals. Based on this qualitative research, conclusions and recommendations are made by the authors as to what is necessary to have effective pubic hospital reform in China.

Public Hospitals in China

2016 ◽  
pp. 1296-1315
Author(s):  
Donghai Wei ◽  
Louis Rubino
Keyword(s):  
Health Care ◽  
Health Care Reform ◽  
Essential Medicine ◽  
Universal Coverage ◽  
Health Care Facilities ◽  
Public Hospitals ◽  
Private Hospitals ◽  
The Public ◽  
Reform Plan ◽  
Health Care Leaders

China has had some initial success in its current health care reform efforts. Five areas of reform have been targeted and include providing universal coverage, equitable access to basic health insurance, establishing an essential medicine system, and improving primary health care facilities. The last area, the reform of the public hospitals, remains the most difficult to reform. General guidelines have been established by the national government and movement is being taken to delegate authority to local units for implementation. The aim of this paper is to compare China's formal government sponsored health care reform plan for public hospitals to the acknowledgement and acceptance by a sample of health care leaders in Guangzhou. Challenges are strong and include cost accountability, doctor training, employee empowerment, improprieties, and the influence of private hospitals. Based on this qualitative research, conclusions and recommendations are made by the authors as to what is necessary to have effective pubic hospital reform in China.

scholarly journals Conundrum of bureaucratic processes and healthcare service delivery in government hospitals in Nigeria

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Owolabi Lateef Kuye ◽  
Olusegun Emmanuel Akinwale
Keyword(s):  
Health Care ◽  
Quality Of Service ◽  
Service Delivery ◽  
Healthcare Service ◽  
Health Care Facilities ◽  
Public Hospitals ◽  
Quality Service ◽  
Content Type ◽  
Government Hospitals

Purpose Bureaucracy to a large extent entrenches orderliness and productive means of achieving goals in both public and private organisations across the world. However, bureaucracy is not suitable in the management of hospitals due to its peculiar nature of operations. This study investigates the conundrum of bureaucratic processes and health-care service delivery in government hospitals in Nigeria. Design/methodology/approach The study surveyed 600 outpatients and attendees visiting tertiary and government hospitals in Nigeria using descriptive design to obtained data from the respondents. A research instrument, questionnaire, was used to gather data. Out of the 600 outpatients visiting the 20 hospitals in government and tertiary hospitals, 494 responses were returned from the attendees. The study employed random sampling strategy to collect the information. Findings The findings of this study were that service delivery in government hospitals were in adverse position on all the four constructs of bureaucratic dimensions as against quality of service delivery in hospitals in Nigeria. It discovered that bureaucratic impersonality cannot impact on the quality of service delivery in government hospitals in Nigeria. Separation and division of labour among health workers have no significant effect on quality service delivery in government hospitals. Formal rules and regulations (administrative procedure, rules, and policies) prevent quality service delivery in government hospitals in Nigeria. Also, patient’s waiting time was not significant to the quality of service delivery in government hospitals. Research limitations/implications The results are constrained with dimensions of bureaucratic processes. Thus, the implication of this study is that bureaucracy in the Nigerian public hospitals is an unnecessary marriage which should be carefully separated and de-emphasised for quality service delivery in the hospitals to thrive. Practical implications Largely, this study is practical essential as it unearths the irrelevant operations procedure that hinder progress in Nigerian hospitals. Originality/value The study accomplishes recognised importance to survey how bureaucracy impedes quality service delivery in government hospitals. This study has provided a vital clue to elements that will bring rapid attention to patients’outcome in Nigerian hospitals and health-care facilities which hitherto has not been emphasised. The study has contributed to the existing body of knowledge associated to healthcare service quality in developing country.

scholarly journals Implementing an Integrated Large-Scale Clinical Information System for ISSSTE’s Hospital Network in Mexico

2021 ◽  
Vol 3 (2) ◽  
pp. 444-453
Author(s):  
Arturo Cervantes Trejo ◽  
Sophie Domenge Treuille ◽  
Isaac Castañeda Alcántara
Keyword(s):  
Health Care ◽  
Information System ◽  
Health Care Services ◽  
Large Scale ◽  
Clinical Information System ◽  
Clinical Information ◽  
Public Hospitals ◽  
Care Services ◽  
Cost Reductions

AbstractThe Institute for Security and Social Services for State Workers (ISSSTE) is a large public provider of health care services that serve around 13.2 million Mexican government workers and their families. To attain process efficiencies, cost reductions, and improvement of the quality of diagnostic and imaging services, ISSSTE was set out in 2019 to create a digital filmless medical image and report management system. A large-scale clinical information system (CIS), including radiology information system (RIS), picture archiving and communication system (PACS), and clinical data warehouse (CDW) components, was implemented at ISSSTE’s network of forty secondary- and tertiary-level public hospitals, applying global HL-7 and Digital Imaging and Communications in Medicine (DICOM) standards. In just 5 months, 40 hospitals had their endoscopy, radiology, and pathology services functionally interconnected within a national CIS and RIS/PACS on secure private local area networks (LANs) and a secure national wide area network (WAN). More than 2 million yearly studies and reports are now in digital form in a CDW, securely stored and always available. Benefits include increased productivity, reduced turnaround times, reduced need for duplicate exams, and reduced costs. Functional IT solutions allow ISSSTE hospitals to leave behind the use of radiographic film and printed medical reports with important cost reductions, as well as social and environmental impacts, leading to direct improvement in the quality of health care services rendered.

Patient satisfaction with the quality of care in Ghana’s health-care institutions

2019 ◽  
Vol 13 (2) ◽  
pp. 160-170 ◽  
Author(s):  
Aaron Asibi Abuosi ◽  
Mahama Braimah
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Quality Of Care ◽  
Service Delivery ◽  
National Survey ◽  
Health Care Facilities ◽  
Health Facilities ◽  
Content Type ◽  
Care Facilities

Purpose The purpose of this study was to examine patient satisfaction with the quality of care in Ghana’s health-care facilities using a disaggregated approach. Design/methodology/approach The study was a cross-sectional national survey. A sample of 4,079 males and females in the age group of 15-49 years were interviewed. Descriptive statistics, principal component analysis and t-tests were used in statistical analysis. Findings About 70 per cent of patients were satisfied with the quality of care provided in health-care facilities in Ghana, whereas about 30 per cent of patients were fairly satisfied. Females and insured patients were more likely to be satisfied with the quality of care, compared with males and uninsured patients. Research limitations/implications Because data were obtained from a national survey, the questionnaire did not include the type of facility patients attended to find out whether satisfaction with the quality of care varied by the type of health facility. Future studies may, therefore, include this. Practical implications The study contributes to the literature on patient satisfaction with the quality of care. It highlights that long waiting time remains an intractable problem at various service delivery units of health facilities and constitutes a major source of patient dissatisfaction with the quality of care. Innovative measures must, therefore, be adopted to address the problem. Originality/value There is a paucity of research that uses a disaggregated approach to examine patient satisfaction with the quality of care at various service delivery units of health facilities. This study is a modest contribution to this research gap.

Healthcare Cost and Patient Satisfaction: A Comparative Analysis Between Public and Private Hospitals in Bangladesh

2021 ◽  
Author(s):  
Farhana Begum ◽  
Jamaliah Said ◽  
Syed Zabid Hossain ◽  
Mohammad Jahid Hasan ◽  
Normah Binti
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Comparative Analysis ◽  
Healthcare Cost ◽  
Health Care Facilities ◽  
Public Hospitals ◽  
Satisfaction Level ◽  
Private Hospitals ◽  
Public And Private ◽  
Female Ratio

Abstract Background and objective: Patient satisfaction and its relation with healthcare cost in Bangladesh remains unknown. The objective of the study was to perform a comparative analysis of satisfaction of patients in relation with healthcare cost in public and private healthcare settings in Bangladesh.Methods: This cross-sectional study was conducted at two public and two private hospitals in Dhaka city, Bangladesh. A total of 1120 respondents were included by purposive sampling. Data collection was performed with a semi-structured questionnaire. The level of satisfaction was assessed by a 5-point Likert scale. Expenditure details during hospital stay were also recorded. Informed consent was obtained, and study procedures were conducted according to the Declaration of Helsinki. SPSS 23 was used for statical test. Results: The mean age of the respondents was 50.10±21.13 (SD) years, with a male-female ratio of 1.14:1. The majority were from urban areas. The average health-care cost of patients in both the conservative and operative groups was statistically significantly higher in private hospitals than in public hospitals (p<0.001). The overall satisfaction level was higher among the patients who received care from private settings than the public (p<0.001). However, taking health care in private hospitals rather than public hospitals was independently associated with patient satisfaction when adjusted for other factors (age, sex, economic status, treatment type, duration of hospital stays, treatment outcome, and total expense).Conclusion: Despite higher expenses, the overall satisfaction level was significantly better in private health-care facilities. These findings need to be explored in further large multicenter studies.

scholarly journals Quality of Counselling Services for Pregnant Women in Community Clinics

2022 ◽  
Vol 02 (01) ◽  
Author(s):  
Shahzadi Mahmuda ◽  
Keyword(s):  
Health Care ◽  
Pregnant Women ◽  
Health Care Provider ◽  
Care Provider ◽  
Service Providers ◽  
Critical Role ◽  
Health Care Facilities ◽  
Maternal Health Service ◽  
Community Clinics

Maternal health service had a potentially critical role in the improvement of reproductive health. This descriptive study was carried out in Tangail district, from 1st January to 31st December, 2019 to find out the quality of counselling of services for pregnant women in community clinics during pregnancy period. Data were collected among 289 respondents by face to face interview who had delivered within last 24 months and respondents were selected purposively. The majority (97.6%) of the respondents were housewife and maximum (72%) of the respondent were below SSC in this study monthly family income mean was taka 16124.00± 10065.480. Majority of the respondents (99.2%) had received antenatal check-up from different health care facilities and highest (87.2%) had received from the community clinic other hands (6.0%) pregnant women got antenatal care from non-government hospital among 250 respondents (94.0%) pregnant women received ANC from CHCP also (4%) pregnant women received ANC from HA. Out of 250 pregnant women (70%) of the respondents were problem suffer during pregnancy. Here majority (59.6%) pregnant women were suffer from nausea and vomiting and only (6.3%) were suffering from constipation. Majority (89.2%) of the respondents had preparation about danger sign during pregnancy. Most 245 (98%) of the respondents of pregnant women had information about ANC and most (85.7%) got information from CHCF on other hand ride got information (2.9%) from neighbour. half (4.8%) of the respondents choice of conduct delivery at upazila health complex followed by (48.8%) only choice of conduct clinics. Most (98%) of the respondents had received TT vaccine and maximum (95.1%) of the respondents had completed TT vaccine. Enough skilled manpower for patient care (98.4%). Health care provider perform ANC check-up (96.8%). Health care provider counselling during pregnancy (96.4%) physical examination (98.0%) explanation of health. (99.2%) health care provider give any advice before departure (70.4%). Continue to follow-up health status over phone (99.2%). Service providers in health care shows that 33.3% was BSc/BA, 42.9% of service providers were masters and above their professional training more than one third (38.1%) of the providers has basic training, 47.6% had basic & CSBA and rest 14.3% had ECT and nutritional training. Majority 100% of the provider’s designation had CHCP, number of staff in two health care had more than half (57.1%) providers.

scholarly journals Identifikasi Kompetensi Bidan: Data Riset Pendidikan Tenaga Kesehatan Tahun 2017

2020 ◽  
pp. 142-151
Author(s):  
Sefrina Werni ◽  
Rosita Rosita ◽  
Nita Prihartini ◽  
Mieska Despitasari
Keyword(s):  
Health Care ◽  
Professional Education ◽  
Health Workers ◽  
Health Care Facilities ◽  
Child Health Services ◽  
Prospective Students ◽  
Average Value ◽  
Midwifery Education ◽  
Depth Interviews

Abstrak Bidan sebagai tenaga kesehatan strategis yang berperan dalam pelayanan kesehatan ibu dan anak dituntut memiliki kompetensi tinggi untuk dapat menjalankan fungsinya dengan baik. Kompetensi yang tinggi dapat tercapai bila penyelenggara pendidikan profesi bidan memenuhi standar penyelenggaraan pendidikan. Berdasarkan data Majelis Tenaga Kesehatan Indonesia (MTKI) tahun 2016, nilai rata-rata uji kompetensi DIII kebidanan hanya 41,08. Peserta uji kompetensi yang belum lulus sebanyak 46,5%. Hasil yang masih jauh dari harapan juga ditunjukkan dari rerata try out uji kompetensi tenaga kesehatan tahun 2012 hingga tahun 2015 yang cenderung menurun. Kajian ini bertujuan untuk mendapatkan informasi identifikasi kompetensi bidan berdasarkan Kepmenkes 369/MENKES/SK/III/2007 tentang standar profesi bidan pada hasil Risdiknakes tahun 2017. Kajian dilakukan menggunakan observasi, wawancara mendalam dan literatur review. Informan adalah bidan di puskesmas dan pakar kebidanan. Hasil kajian menunjukkan bahwa kompetensi bidan di fasilitas pelayanan kesehatan masih belum sesuai standar. Beberapa faktor dalam penyelenggaraan pendidikan kebidanan turut membentuk kompetensi bidan yang dihasilkan. Proses rekrutmen calon peserta didik, kualitas dosen, dan proses penyelenggaraan pendidikan kebidanan secara keseluruhan merupakan komponen yang harus menjadi fokus untuk menghasilkan bidan yang sesuai dengan standar kompetensi seperti tercantum dalam Kepmenkes Nomor 369/MENKES/SK/III/2007. Kata kunci: kompetensi bidan, kajian kebidanan, pendidikan bidan, kurikulum kebidanan Abstract Midwives are strategic health workers who play an important role in maternal and child health services. They are required to have well competencies to run their tasks properly. Well, competencies can be achieved if the midwife's professional education providers meet the standards. Based on the Indonesian Health Workers' Assembly (MTKI) data in 2016, the average value of the DIII midwifery-competency test was only 41.08. Participants who failed the competency test were as much as 46.5%. It is still far from the expectation as the average value of health workers’ competency tests try out between 2012 to 2015 tends to decline. This study aims to identify midwife competencies based on Minister of Health's decree No. 369/MENKES/SK/III/2007 on midwives' profession standards and the results of the 2017 Research on Health Workers’ Education (Risdiknakes). The study was conducted using observation, in-depth interviews, and literature review. Informants are midwives at primary health care and midwifery experts. The results of the study indicate that midwife competencies in health care facilities are still not up to standard. Several factors in the administration of midwifery education also shape the competence of the midwives produced. The process of recruiting prospective students, the quality of lecturers, and the process of conducting midwifery education as a whole are components that must be the focus to produce midwives that comply with the competency standards in Minister of Health's decree No. 369/MENKES/SK/III/ 2007. Keywords: midwife competencies, midwifery studies, midwife education

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