Where Do Internal Markets Come from and Can They Work?

1996 ◽  
Vol 1 (1) ◽  
pp. 56-59 ◽  
Author(s):  
Alistair McGuire
Keyword(s):  
Health Care ◽  
Exchange Process ◽  
Health Sector ◽  
Internal Market ◽  
Internal Markets ◽  
Bilateral Agreements ◽  
Pricing Rules ◽  
Market Allocation ◽  
Central Argument ◽  
The Uk

The basis for the argument in favour of the internal market as a means of allocating resources within the health care sector has never been made fully explicit. In particular, the link between the economic theory of market allocation and the specific pricing rules adopted by a number of health care sectors to allocate resources is rarely a focus of attention. Health sector objectives are rarely specified. The mechanisms which remedy failure in the exchange process are not explicitly defined. In short, the optimal structural conditions for the operation of internal markets are not known. The central argument pursued here is that, as this is the case, and using the UK as an example, there are no criteria to which purchasers or providers can turn to assess the operation of exchange within the internal market. Not surprisingly, the internal market dissolves into a number of individual bilateral agreements between purchasers and providers which may or may not increase efficiency in allocating health sector resources.

IS Implementation in the UK Health Sector

2011 ◽  
pp. 1232-1236
Author(s):  
Stuart J. Barnes
Keyword(s):  
Health Care ◽  
Health Service ◽  
Health Expenditure ◽  
Health Sector ◽  
Private Industry ◽  
Is Implementation ◽  
Department Of Health ◽  
The Subject ◽  
The Uk

Since the mid-1980s, the UK public sector has been the subject of wide-ranging reforms involving the introduction of IS and IT. Change has been sought in the ways that services are managed and delivered, the evaluation of the quality of aforesaid services, and in accountability and costing. One of the most predominant of such changes has been the introduction of competition for services, the motivation of which has been to invite efficiency, effectiveness, and related benefits ensuing from the accrual of economies. Pivotal to such change has been an explosion in the introduction of a variety of information systems to meet such challenges. Focusing on health care, a large part of the work of the health service involves collecting and handling information, from lists of people in the population to medical records (including images such as X-ray pictures), to prescriptions, letters, staffing rosters and huge numbers of administrative forms. Yet until recently, the health service has been woefully backward in its use of the technology to handle information by the standards of private industry. This has been quickly changing in recent years and by 2003 the National Health Service (NHS) spent £2.8 billion annually on capital in hospitals (Department of Health, 2003a), around 10% of which was for IT. In the last 20 years, IT has added 2% to overall health expenditure (Wanless, 2001). This investment is still small by the standards of the private sector, but is all the more significant when we consider that health care is an industry which has been slow to adopt IT and one which presents some of the biggest IT opportunities (Department of Health, 2002).

scholarly journals Networked innovation in the health sector: comparative qualitative study of the role of Collaborations for Leadership in Applied Health Research and Care in translating research into practice

2014 ◽  
Vol 2 (13) ◽  
pp. 1-128 ◽  
Author(s):  
Harry Scarbrough ◽  
Daniela D’Andreta ◽  
Sarah Evans ◽  
Marco Marabelli ◽  
Sue Newell ◽  
...  
Keyword(s):  
Health Care ◽  
Social Networks ◽  
Social Network ◽  
Research Methods ◽  
Health Research ◽  
Health Sector ◽  
Network Structures ◽  
The Uk ◽  
Applied Health Research ◽  
Over Time

BackgroundCollaborations for Leadership in Applied Health Research and Care (CLAHRCs) were an initiative of the National Institute for Health Research in response to a new research and development strategy in the NHS: ‘Best Research for Best Health’. They were designed to address the ‘second gap in translation’ identified by the Cooksey review; namely, the need to improve health care in the UK by translating clinical research into practice more effectively. Nine CLAHRCs, each encompassing a university in partnership with local NHS bodies, were funded over the period 2008–13.AimsThe aim of this report is to provide an independent and theory-based evaluation of CLAHRCs as a new form of networked innovation in the health sector. This evaluation is based on an intensive research study involving three CLAHRCs in the UK and three international organisations (one in the USA and two in Canada). This study was carried out over two overlapping time phases so as to capture changes in the CLAHRCs over time. Networked innovation in the health sector is conceptualised as involving the translation of knowledge via informal social networks.MethodsA mix of research methods was used to help ensure the validity and generalisability of the study. These methods addressed the development of each CLAHRC over time, over multiple levels of analysis, and with particular reference to the translation of knowledge across the groups involved, and the quality of the informal underpinning network ties that supported such translation. Research methods, therefore, included a qualitative enquiry based on case studies and case analysis, cognitive mapping methods, and social network analysis.FindingsThrough our study, we found that each one of our samples of CLAHRCs appropriated the CLAHRC idea in a particular way, depending on their different interpretations or ‘visions’ of the CLAHRC’s role in knowledge translation (KT), and different operating models of how such visions could be achieved. These helped to shape the development of social networks (centralised vs. decentralised) and each CLAHRC’s approach to KT activity (‘bridging’ vs. ‘blurring’ the boundaries between professional groups). Through a comparative analysis, we develop an analytical model of the resultant capabilities which each case, including our international sites, developed for undertaking innovation, encompassing a combination of both ‘integrative capability’ (the ability to move back and forth between scientific evidence and practical application) and ‘relational capability’ (the ability of groups and organisations to work together). This extends previous models of KT by highlighting the effects of leadership and management, and the emergence of social network structures. We further highlight the implications of this analysis for policy and practice by discussing how network structures and boundary-spanning roles and activities can be tailored to different KT objectives.ConclusionsDifferent interpretations and enactments of the CLAHRC mission ultimately led to differing capabilities for KT among our studied initiatives. Further research could usefully explore how these different capabilities are produced, and how they may be more or less appropriate for particular national health-care settings, with a view to improving the design blueprint for future KT initiatives.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Social Logics in Reproduction Health

2018 ◽  
Vol 3 (6) ◽  
Keyword(s):  
Health Care ◽  
Child Health ◽  
Reproductive Health ◽  
Health Sector ◽  
Cultural Representations ◽  
Reproductive Health Care ◽  
Social Actors ◽  
Efficient Management ◽  
Social Logic ◽  
And Child Health

The issue that underlies a worrying question of maternal and child health in Côte d'Ivoire is that of social logic. Social logic is perceived as "cultural constructions of actors with regard to morbidity that cause to adopt reproductive health care". Based on this understanding, the concept of social logic in reproductive health is similar to a paradigm that highlights the various factors that structure and organise sociological resistance to mothers' openness to healthy reproductive behaviours; that is, openness to change for sustainable reproductive health. Far from becoming and remaining a prisoner of blind culturalism with the social logic that generates the health of mothers, new-borns and children, practically-relevant questions are raised. Issues of "bad governance", socio-cultural representations and behaviours in conflict with modern epidemiological standards are addressed in a culturally-sensitive manner, an important issue for the provision of care focused on the needs of mothers seeking answers to health problems. Developing these original community characteristics helps to orient a reading list in a socioanthropological perspective with a view to explaining and understanding different problems encountered, experiences acquired by social actors during the implementation of antenatal, postnatal and family planning care. This context of building logic with regard to reproductive health care is key to identifying real bottlenecks in maternity services and achieving efficient management of maternal, new-born and child health care for the benefit of populations and actors in the public health sector.

Beveridge, Bismarck and Southern European Health Care Systems: Can We Decide Which is the Best in EU-15? A Statistical Analysis

2017 ◽  
Vol 1 (1) ◽  
pp. 41
Author(s):  
Angeliki Moisidou
Keyword(s):  
Health Care ◽  
Statistical Analysis ◽  
Empirical Analysis ◽  
Access To Health Care ◽  
High Performance ◽  
Social Protection ◽  
Health Care Systems ◽  
Health Sector ◽  
Economic Cost ◽  
Care Systems

A statistical analysis has been conducted with the aim to elucidate the effect of health care systems (HSs) on health inequalities assessed in terms of (a) differential access to health care services and (b) varying health outcomes among different models of HSs in EU-15 ((Beveridge: UK, IE, SE, FI, DK), (Bismarck: DE, FR, BE, LU, AT, NL), (Southern European model: GR, IT, ES, PT)). In the effort to interpret the results of the empirical analysis, we have ascertained systematic differences among the HSs in EU-15. Specifically, it is concluded that countries with Beveridge HS can be characterized more efficient (than average) in the most examined correlations, showing particularly high performance in the health sector. Similarly, countries with Bismarck HS record fairly satisfactory performance, but simultaneously they display more structural weaknesses compared with the Beveridge model. In addition, our empirical analysis has shown that adopting Bismarck model requires higher economic cost, compared with the Beveridge model, which is directly financed by taxation. On the contrary, in the countries with Southern European HS, the lowest performances are generally identified, which can be attributed to the residual social protection that characterizes these countries. The paper concludes with a synthesis of the empirical findings of our research. It proposes some directions for further research and presents a set of implications for policymakers regarding the planning and implementation of appropriate policies in order to tackle health inequality within HSs.

scholarly journals SAT0640-HPR RHEUMATOLOGY CARE OF MIGRANTS FROM SUB-SAHARAN AFRICA; A QUALITATIVE PILOT STUDY OF PATIENTS’ PERSPECTIVES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1279.1-1279
Author(s):  
Z. Rutter-Locher ◽  
J. Galloway ◽  
H. Lempp
Keyword(s):  
Rheumatoid Arthritis ◽  
Health Care ◽  
Health Care Providers ◽  
Unmet Need ◽  
Primary Care Providers ◽  
Sub Saharan Africa ◽  
Care Providers ◽  
Specialist Care ◽  
Sub Saharan ◽  
The Uk

Background:Rheumatological diseases are common in Sub-Saharan Africa [1] but specialist healthcare is limited and there are less than 150 rheumatologists currently serving 1 billion people in Sub-Saharan Africa [2]. Rheumatologists practising in the UK NHS are likely to be exposed to migrant patients. There is therefore, an unmet need for health care providers to understand the differences in rheumatology healthcare provision between Sub-Saharan Africa and the UK and the barriers which migrants face in their transition of rheumatology care.Objectives:To gain an understanding of the experiences of patients with rheumatological conditions, about their past healthcare in Sub-Saharan Africa and their transition of care to the UK.Methods:A qualitative study using semi-structured interviews was conducted. Participants were recruited from two rheumatology outpatient clinics in London. Thematic analysis was applied to identify key themes.Results:Seven participants were recruited. Five had rheumatoid arthritis, one had ankylosing spondylitis and one had undifferentiated inflammatory arthritis. Participants described the significant impact their rheumatological conditions had on their physical and emotional wellbeing, including their social and financial implications. Compared to the UK, rheumatology healthcare in Sub-Saharan Africa was characterised by higher costs, limited access to specialists, lack of investigations and treatments, the use of traditional medicines and poor communication by clinicians. Barriers to transition of rheumatology care to the UK were: poor understanding of rheumatological conditions by the public and primary care providers, lack of understanding of NHS entitlements by migrants, fear of data sharing with immigration services and delayed referral to specialist care. Patient, doctor and public education were identified by participants as important ways to improve access to healthcare.Conclusion:This study has described, for the first time, patients’ perspectives of rheumatology health care in Sub-Saharan Africa and the transition of their care to the UK. These initial findings allow healthcare providers in the UK to tailor management for this migrant population and suggests that migrants need more information about their NHS entitlements and specific explanations on what non-clinical data will be shared with immigration services. To increase access to appropriate care, a concerted effort by clinicians and public health authorities is necessary to raise awareness and provide better education to patients and migrant populations about rheumatological conditions.References:[1]G. Mody, “Rheumatology in Africa-challenges and opportunities,” Arthritis Res. Ther., vol. 19, no. 1, p. 49, 2017.[2]M. A. M. Elagib et al., “Sudan and Sweden Active Rheumatoid Arthritis in Central Africa: A Comparative Study Between,” J. Rheumatol. J. Rheumatol. January, vol. 43, no. 10, pp. 1777–1786, 2016.Acknowledgments:We are grateful to the patients involved in this study for their time and involvement.Disclosure of Interests:None declared

scholarly journals “At Least until the Second Wave Comes…”: A Twitter Analysis of the NHS and COVID-19 between March and June 2020

2021 ◽  
Vol 18 (8) ◽  
pp. 3943
Author(s):  
Kathy McKay ◽  
Sarah Wayland ◽  
David Ferguson ◽  
Jane Petty ◽  
Eilis Kennedy
Keyword(s):  
Health Care ◽  
Social Media ◽  
Content Analysis ◽  
Well Being ◽  
Profound Impact ◽  
Time Period ◽  
Twitter Analysis ◽  
The Uk ◽  
Media Narratives ◽  
Second Wave

In the UK, tweets around COVID-19 and health care have primarily focused on the NHS. Recent research has identified that the psychological well-being of NHS staff has been adversely impacted as a result of the COVID-19 pandemic. The aim of this study was to investigate narratives relating to the NHS and COVID-19 during the first lockdown (26 March–4 July 2020). A total of 123,880 tweets were collated and downloaded bound to the time period of the first lockdown in order to analyse the real-time discourse around COVID-19 and the NHS. Content analysis was undertaken and tweets were coded to positive and negative sentiments. Five main themes were identified: (1) the dichotomies of ‘clap for carers’; (2) problems with PPE and testing; (3) peaks of anger; (4) issues around hero worship; and (5) hints of a normality. Further research exploring and documenting social media narratives around COVID-19 and the NHS, in this and subsequent lockdowns, should help in tailoring suitable support for staff in the future and acknowledging the profound impact that the pandemic has had.

scholarly journals Southern social world-regionalisms: The place of health in nine African regional economic communities

2020 ◽  
pp. 146801812096185
Author(s):  
Nicola Yeates ◽  
Rebecca Surender
Keyword(s):  
Health Care ◽  
Public Policy ◽  
Social Policy ◽  
Health Systems ◽  
Regional Integration ◽  
Regional Cooperation ◽  
Health Sector ◽  
World Health ◽  
Regional Health ◽  
Regional Economic

This article presents key results from a comparative qualitative Social Policy study of nine African regional economic communities’ (RECs) regional health policies. The article asks to what extent has health been incorporated into RECs’ public policy functions and actions, and what similarities and differences are evident among the RECs. Utilising a World Health Organization (WHO) framework for conceptualising health systems, the research evidence routes the article’s arguments towards the following principal conclusions. First, the health sector is a key component of the public policy functions of most of the RECs. In these RECs, innovations in health sector organisation are notable; there is considerable regulatory, organisational, resourcing and programmatic diversity among the RECs alongside under-resourcing and fragmentation within each of them. Second, there are indications of important tangible benefits of regional cooperation and coordination in health, and growing interest by international donors in regional mechanisms through which to disburse health and -related Official Development Assistance (ODA). Third, content analysis of RECs’ regional health strategies suggests fairly minimal strategic ambitions as well as significant limitations of current approaches to advancing effective and progressive health reform. The lack of emphasis on universal health care and reliance on piecemeal donor funding are out of step with approaches and recommendations increasingly emphasising health systems development, sector-wide approaches (SWAPs) and primary health care as the bedrock of health services expansion. Overall, the health component of RECs’ development priorities is consistent with an instrumentalist social policy approach. The development of a more comprehensive sustainable world-regional health policy is unlikely to come from the African Continental Free-Trade Area, which lacks requisite social and health clauses to underpin ‘positive’ forms of regional integration.

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