scholarly journals Making sense of the French public hospital system: a network-based approach to hospital clustering using unsupervised learning methods

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jan Chrusciel ◽  
Adrien Le Guillou ◽  
Eric Daoud ◽  
David Laplanche ◽  
Sandra Steunou ◽  
...  
Keyword(s):  
Clustering Algorithm ◽  
Patient Flow ◽  
Interquartile Range ◽  
Public Hospitals ◽  
Reverse Direction ◽  
Public And Private ◽  
Hospital System ◽  
Group 2 ◽  
French Hospital ◽  
Public Hospital System

Abstract Background Hospitals in the public and private sectors tend to join larger organizations to form hospital groups. This increasingly frequent mode of functioning raises the question of how countries should organize their health system, according to the interactions already present between their hospitals. The objective of this study was to identify distinctive profiles of French hospitals according to their characteristics and their role in the French hospital network. Methods Data were extracted from the national hospital database for year 2016. The database was restricted to public hospitals that practiced medicine, surgery or obstetrics. Hospitals profiles were determined using the k-means method. The variables entered in the clustering algorithm were: the number of stays, the effective diversity of hospital activity, and a network-based mobility indicator (proportion of stays followed by another stay in a different hospital of the same Regional Hospital Group within 90 days). Results Three hospital groups were identified by the clustering algorithm. The first group was constituted of 34 large hospitals (median 82,100 annual stays, interquartile range 69,004 – 117,774) with a very diverse activity. The second group contained medium-sized hospitals (with a median of 258 beds, interquartile range 164 - 377). The third group featured less diversity regarding the type of stay (with a mean of 8 effective activity domains, standard deviation 2.73), a smaller size and a higher proportion of patients that subsequently visited other hospitals (11%). The most frequent type of patient mobility occurred from the hospitals in group 2 to the hospitals in group 1 (29%). The reverse direction was less frequent (19%). Conclusions The French hospital network is organized around three categories of public hospitals, with an unbalanced and disassortative patient flow. This type of organization has implications for hospital planning and infectious diseases control.

scholarly journals Dentists’ entrepreneurial intention and associated factors in public hospitals in major cities in Guangdong (South China): a cross-sectional study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jiabi Wang ◽  
Bin Peng ◽  
Hongzhi Zhou ◽  
Jing Hua Zhang
Keyword(s):  
Family Background ◽  
Entrepreneurial Intention ◽  
Cross Sectional Study ◽  
Individual Characteristics ◽  
Public Hospitals ◽  
Snowball Sampling ◽  
Cross Sectional ◽  
Hospital System ◽  
Knowledge Intensive ◽  
Public Hospital System

Abstract Background A rapid growth in private dentistry in China has been observed during recent years. Promoting the entrepreneurship of dentists has increasingly received attention in both dentistry and dental education worldwide. However, understanding about the unique features of entrepreneurial behaviors of dentists remains inadequate. Methods This study examines dentist’s entrepreneurial intention (EI), which was represented by his/her intention of leaving the public hospital system to be engaged in the private sector. Through a snowball sampling method, a total of 336 questionnaires from public hospitals in five major cities in Guangdong Province (China) were collected. The association between the dentists’ EI and their individual characteristics were analyzed using a logistic regression model. Results In the sample studied, 35.7% of the respondents reported to have EI. Female dentists are less likely to report EI (OR = 0.365, p = 0.001). Dentists in the age group of 36 to 45 years (OR = 14.205, p = 0.012) and those aged over 45 years (OR = 8.45, p = 0.066) reported respectively a much stronger EI than those in their 20s. Compared with intern dentists, attending dentists (OR = 7.812, p = 0.016) and associate/chief dentists (OR = 9.857, p = 0.021) were significantly more likely to report EI. Those with master level (OR = 0.221, p = 0.021) or doctorate degrees (OR = 0.118, p = 0.005) are much less likely to report EI. Meanwhile, those in mid-large hospitals (with 101–200 employees) (OR = 3.554, p = 0.036) and small hospitals (with < 50 employees) (OR = 2.398, p = 0.044) reported a stronger EI than those in large hospitals. Additionally, dentists’ entrepreneurial behaviors, risk aversion attitudes and their family background all have significant associations. Conclusions Since dentistry is a knowledge-intensive industry, dentists’ entrepreneurial behaviors have their own features. The findings by this study suggest that, accumulation of practical skills in a dental career, as implied by age, professional qualifications and leadership skills, help to promote EI, whereas an academic oriented education degree per se does not. Dentists in mid-large and small hospitals, rather than in top large hospitals in China, have higher EI. Additionally, female dentists may need more social supports to develop a higher EI. These findings have practical implications for the promotion of EI among dentists.

scholarly journals Right care, right place, right time: improving the timeliness of health care in New South Wales through a public–private hospital partnership

2017 ◽  
Vol 41 (5) ◽  
pp. 511 ◽  
Author(s):  
Carla Saunders ◽  
David J. Carter
Keyword(s):  
Public Hospital ◽  
Private Hospital ◽  
Elective Surgery ◽  
New South ◽  
Public And Private ◽  
Hospital System ◽  
South Wales ◽  
Public Hospital System ◽  
The Right ◽  
Hospital Partnership

Objective The overall aim of the study was to investigate and assess the feasibility of improving the timeliness of public hospital care through a New South Wales (NSW)-wide public–private hospital partnership. Methods The study reviewed the academic and professional grey literature, and undertook exploratory analyses of secondary data acquired from two national health data repositories informing in-patient access and utilisation across NSW public and private hospitals. Results In 2014–15, the NSW public hospital system was unable to deliver care within the medically recommended time frame for over 27 400 people who were awaiting elective surgery. Available information indicates that the annual commissioning of 15% of public in-patient rehabilitation bed days to the private hospital system would potentially free up enough capacity in the NSW public hospital system to enable elective surgery for all public patients within recommended time frames. Conclusions The findings of the study justify a strategic whole-of-health system approach to reducing public patient wait times in NSW and highlight the need for research efforts aimed at securing a better understanding of available hospital capacity across the public and private hospital systems, and identifying and testing workable models that improve the timeliness of public hospital care. What is known about the topic? There are very few studies available to inform public–private hospital service partnerships and the opportunities available to improve timely health care access through such partnerships. What does this paper add? This paper has the potential to open and prompt timely discussion and debate, and generate further fundamental investigation, on public–private hospital service partnerships in Australia where opportunity is available to address elective surgery wait times in a reliable and effective manner. What are the implications for practitioners? The NSW Ministry of Health and its Local Health Districts have the potential to realise a key objective, namely to deliver the ‘right care, in the right place, at the right time’, through the core value of collaboration, using available infrastructure.

Resource Constraints and Strategic Change in a Public Hospital System

1997 ◽  
Vol 10 (3) ◽  
pp. 146-162 ◽  
Author(s):  
F. Champagne ◽  
A. Langley ◽  
J-L. Denis ◽  
A-P. Contandriopoulos ◽  
L. Cazale ◽  
...  
Keyword(s):  
Strategic Management ◽  
Resource Constraints ◽  
Strategic Change ◽  
Public Hospitals ◽  
Product Complexity ◽  
Hospital System ◽  
Financial Difficulties ◽  
Diversity Product ◽  
Public Hospital System ◽  
The Relationship

It has been suggested that strategic management in public services tends to be oriented towards preserving and perpetuating current patterns of service provision, rather than changing priorities. However, faced with severe resource constraints combined with growing demand and rapidly developing technology, public hospitals in Canada have come under increasing pressure. Based on an empirical study of strategic management and change in 32 Montreal hospitals, this paper examines the relationship between financial adversity and the extent and nature of strategic change in these organizations. Strategic change indicators considered in the study include overall product mix, product diversity, product complexity, market demographics, efficiency, and revenue diversification. Results suggest that resource constraints have indeed stimulated changes within these organizations. In particular, hospitals suffering more severe financial difficulties have reduced their size and focused on a narrower range of services. Moreover, there is evidence that greater complementarity has been achieved among the entire sample of hospitals.

scholarly journals Budgetary bias in the Finnish public hospital system

2019 ◽  
Vol 33 (4) ◽  
pp. 401-418
Author(s):  
Alpo Karila ◽  
Jarmo Vakkuri ◽  
Juhani Lehto
Keyword(s):  
Health Care ◽  
Qualitative Content Analysis ◽  
Health Care Systems ◽  
Public Hospitals ◽  
Research Knowledge ◽  
Hospital System ◽  
Content Type ◽  
Care Systems ◽  
Public Hospital System ◽  
Practical Implications

Purpose The purpose of this paper is to analyze the dynamics of budgetary biasing in the context of public hospitals. Design/methodology/approach The study applies theories of accounting and budgeting behaviors in the specific institutional context of health care systems. Based on the theoretical framework, data from interviews with hospital budget officers were analyzed using qualitative content analysis. Findings A typology of biases is provided. It proved to be useful and highlighted the central empirical assumptions and preliminary results of biasing dynamics. Practical implications Understanding the logic of budgeting actors and the drivers of bias may help explain why bias so often appears in health care budgeting. It further contributes to understanding whether the bias is functional or dysfunctional. Originality/value The concepts of budgetary bias are rarely used in the context of health care budgeting, so the study fills a gap in research knowledge.

Health Policy in Asia

2021 ◽  
Author(s):  
M. Ramesh ◽  
Azad S. Bali
Keyword(s):  
Public Hospital ◽  
Policy Design ◽  
Public Hospitals ◽  
Large Share ◽  
Hospital System ◽  
Private Providers ◽  
Efficient Management ◽  
Design Perspective ◽  
Public Hospital System ◽  
Core Issues

The book assesses the policy actions of select Asian governments (China, India, Hong Kong, South Korea, Singapore and Thailand) to address critical health system functions from a policy design perspective. The findings show that all governments in the region have made tremendous strides in focussing their attention on the core issues and, especially, the interactions among them. However, there is still insufficient appreciation of the usefulness of public hospitals and their efficient management. Similarly, some governments have not made sufficient efforts to establish an effective regulatory framework which is especially vital in systems with a large share of private providers and payers. A well-run public hospital system and an effective framework for regulating private providers are essential tools to support the governance, financing, and payment reforms underway in the six health systems studied in this book.

scholarly journals Dentists’ Entrepreneurial Intention and Associated Factors in Public Hospitals in Southeastern China: A Cross-sectional Study

2020 ◽  
Author(s):  
Jiabi Wang ◽  
Bin Peng ◽  
Hongzhi Zhou ◽  
Jing Hua Zhang
Keyword(s):  
Public Hospital ◽  
Entrepreneurial Intention ◽  
Individual Characteristics ◽  
Public Hospitals ◽  
Snowball Sampling ◽  
Southeastern China ◽  
Cross Sectional ◽  
Hospital System ◽  
The Public ◽  
Public Hospital System

Abstract Background: Due to the rising demand and fast growth opportunities, the private dental care sector in China tried to attracted experienced dentists from the public hospital system, which hence are faced with challenges of talents outflow and shortage.Methods：A dentist’s entrepreneurial intention (EI) was represented by his/her intention of leaving the public hospital system to be engaged in the private sector..Dentists from public hospitals in 9 major cities of 5 provinces in Southeastern China were surveyed in this study. Through a snowball sampling method, a total of 336 questionnaires were collected. The association between the dentists’ EI and their individual characteristics (basic demographic and professional characteristics, entrepreneurial behaviors) were analyzed using logistic regression analysis.Results: In the public hospitals in China studied, female dentists are consistently less likely to report entrepreneurial intention (EI) (OR=0.365, p=0.001). Dentists in the age group of 36 to 45 and those aged over 45 reported much stronger EI (OR=14.205, p=0.012; OR=8.45, p=0.066) than those in 20’s did. Compared with intern dentists, Attending Dentists (OR=7.812, p=0.016) and Associate/Chief Dentists (OR=9.857, p=0.021) were significantly more likely to report EI. Those with master level (OR=0.221, p=0.021) or Doctorate degrees (OR=0.118, p=0.005) are much less likely to report EI. Meanwhile, those in small hospitals ( with employee numbers < 50) reported much stronger EI than those in large hospitals (OR=2.398, p=0.044). Additionally, dentists’ entrepreneurial behaviors, risk aversion attitudes and their family background all have significant associations.Conclusions: The small public hospitals in China especially face a high risk of talented dentist outflow. As an offsetting strategy, these hospitals may consider more active recruiting policy for female dentists or those holding post-graduate degrees due to their good possibility of long term career path in the public hospital system.

scholarly journals Costs Related to Skin Cancer Prevention in Victoria and Australia

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 9s-9s
Author(s):  
S. Shih ◽  
R. Carter ◽  
S. Heward ◽  
C. Sinclair
Keyword(s):  
Skin Cancer ◽  
Cancer Treatment ◽  
Cancer Prevention ◽  
Public Hospital ◽  
Public Hospitals ◽  
Skin Cancer Prevention ◽  
Hospital System ◽  
Investment Return ◽  
Public Hospital System ◽  
The Cost

Background: The aim of this presentation is to provide an update on the economic evaluation of the Australian SunSmart program as well as outline the cost of skin cancer treatment to the Victorian public hospital system. This follows the publication of two recently released published economic evaluations that discusses the potential effects of skin cancer prevention inventions. Aim: 1. To highlight the cost effectiveness of skin cancer prevention in Australia 2. To highlight the costs of skin cancer treatment in the Victorian public hospital system 3. To provide strong evidence to inform governments of the value of skin cancer prevention to reduce the costs of treatment in future years. Methods: Program cost was compared with cost savings to determine the investment return of the program. In a separate study, a prevalence-based cost approach was undertaken in public hospitals in Victoria. Costs were estimated for inpatient admissions, using state service statistics, and outpatient services based on attendance at three hospitals in 2012-13. Cost-effectiveness for prevention was estimated from 'observed vs expected' analysis, together with program expenditure data. Results: With additional $AUD 0.16 ($USD 0.12) per capita investment into skin cancer prevention across Australia from 2011 to 2030, an upgraded SunSmart Program would prevent 45,000 melanoma and 95,000 NMSC cases. Potential savings in future healthcare costs were estimated at $200 million, while productivity gains were significant. A future upgraded SunSmart Program was predicted to be cost-saving from the funder perspective, with an investment return of $3.20 for every additional dollar the Australian governments/funding bodies invested into the program. In relation to the costs to the Victorian public hospital system, total annual costs were $48 million to $56 million. Skin cancer treatment in public hospitals ($9.20∼$10.39 per head/year) was 30-times current public funding in skin cancer prevention ($0.37 per head/year). Conclusion: The study demonstrates the strong economic credentials of the SunSmart Program, with a strong economic rationale for increased investment. Increased funding for skin cancer prevention must be kept high on the public health agenda. This would also have the dual benefit of enabling hospitals to redirect resources to nonpreventable conditions.

scholarly journals Dentists’ entrepreneurial intention and associated factors in public hospitals in major cities in Guangdong (South China): a cross-sectional study

2020 ◽  
Author(s):  
Jiabi Wang ◽  
Bin Peng ◽  
Hongzhi Zhou ◽  
Jing Hua Zhang
Keyword(s):  
Family Background ◽  
Entrepreneurial Intention ◽  
Cross Sectional Study ◽  
Individual Characteristics ◽  
Public Hospitals ◽  
Snowball Sampling ◽  
Cross Sectional ◽  
Hospital System ◽  
Knowledge Intensive ◽  
Public Hospital System

Abstract Background: A rapid growth in private dentistry in China has been observed during recent years. Promoting the entrepreneurship of dentists has increasingly received attention in both dentistry and dental education worldwide. However, understanding about the unique features of entrepreneurial behaviors of dentists remains inadequate.Methods: This study examines dentist’s entrepreneurial intention (EI), which was represented by his/her intention of leaving the public hospital system to be engaged in the private sector. Through a snowball sampling method, a total of 336 questionnaires from public hospitals in five major cities in Guangdong Province (China) were collected. The association between the dentists’ EI and their individual characteristics were analyzed using a logistic regression model.Results: In the sample studied, 35.7% of the respondents reported to have EI. Female dentists are less likely to report EI (OR=0.365, p =0.001). Dentists in the age group of 36 to 45 years (OR=14.205, p =0.012) and those aged over 45 years (OR=8.45, p =0.066) reported respectively a much stronger EI than those in their 20s. Compared with intern dentists, attending dentists (OR=7.812, p =0.016) and associate/chief dentists (OR=9.857, p =0.021) were significantly more likely to report EI. Those with master level (OR=0.221, p =0.021) or doctorate degrees (OR=0.118, p =0.005) are much less likely to report EI. Meanwhile, those in mid-large hospitals (with 101-200 employees) (OR=3.554, p =0.036) and small hospitals (with < 50 employees) (OR=2.398, p =0.044) reported a stronger EI than those in large hospitals. Additionally, dentists’ entrepreneurial behaviors, risk aversion attitudes and their family background all have significant associations.Conclusions: Since dentistry is a knowledge-intensive industry, dentists’ entrepreneurial behaviors have their own features. The findings by this study suggest that, accumulation of practical skills in a dental career, as implied by age, professional qualifications and leadership skills, help to promote EI, whereas an academic oriented education degree per se does not. Dentists in mid-large and small hospitals, rather than in top large hospitals in China, have higher EI. Additionally, female dentists may need more social supports to develop a higher EI. These findings have practical implications for the promotion of EI among dentists.

scholarly journals Eliciting Patients’ Health Concerns in Consulting Rooms and Wards in Vietnamese Public Hospitals

2018 ◽  
Vol 7 (2) ◽  
pp. 121
Author(s):  
Huong Thi Linh Nguyen ◽  
Gavin Austin ◽  
Dung Duc Chau ◽  
Hien Quang Nguyen ◽  
Khanh Hoang Bao Nguyen ◽  
...  
Keyword(s):  
Public Hospital ◽  
Public Hospitals ◽  
Health Concern ◽  
General Level ◽  
Clinical Settings ◽  
Hospital System ◽  
Doctor Patient Communication ◽  
Epistemic Stance ◽  
Public Hospital System

This article examines the doctor’s elicitation of the patient’s presenting health concern in two clinical settings in the Vietnamese public hospital system: the consulting room and the ward. The data were taken from 66 audio-recorded consultations. Our analysis shows that the elicitors used by the doctor in the consulting room often communicate a weak epistemic stance towards the patient’s health issue, while those used in the ward tend to signal a strong epistemic stance. In addition, this contrast between the elicitors employed in the consulting room and the ward is evident in our data regardless of whether the consultation is a first visit or a same follow-up (in which the doctor is the same one that treated the patient on their last visit), though the contrast is less clear for different follow-ups (in which the doctor has not treated the patient before). An additional finding is that the clinical setting has some bearing on the use of inappropriate elicitation formats (in which the doctor opens the visit with an elicitor which is more appropriate for another type of visit). The precise way in which each of the consulting room and the ward operates is, of course, a feature of the Vietnamese public hospital system itself. Hence, the overall contrast between the elicitors and elicitation formats used in these two settings illustrates how, on a more general level, the institutional context can have an impact on doctor-patient communication.

scholarly journals The Role of Place of Delivery in Preventing Neonatal and Infant Mortality Rate in India

Geographies ◽  
2021 ◽  
Vol 1 (1) ◽  
pp. 47-62
Author(s):  
Ujjwal Das ◽  
Barkha Chaplot ◽  
Hazi Mohammad Azamathulla
Keyword(s):  
Mortality Rate ◽  
Infant Mortality ◽  
Neonatal Mortality ◽  
Public Hospitals ◽  
Infant Mortality Rate ◽  
Private Institutions ◽  
Public And Private ◽  
Place Of Delivery ◽  
At Home

Skilled birth attendance and institutional delivery have been advocated for reducing maternal, neonatal mortality and infant mortality (NMR and IMR). This paper examines the role of place of delivery with respect to neo-natal and infant mortality in India using four rounds of the Indian National Family Health Survey conducted in 2015–2016. The place of birth has been categorized as “at home” or “public and private institution.” The role of place of delivery on neo-natal and infant mortality was examined by using multivariate hazard regression models adjusted for clus-tering and relevant maternal, socio-economic, pregnancy and new-born characteristics. There were 141,028 deliveries recorded in public institutions and 54,338 in private institutions. The esti-mated neonatal mortality rate in public and private institutions during this period was 27 and 26 per 1000 live births respectively. The study shows that when the mother delivers child at home, the chances of neonatal mortality risks are higher than the mortality among children born at the health facility centers. Regression analysis also indicates that a professionally qualified provider′s antenatal treatment and assistance greatly decreases the risks of neonatal mortality. The results of the study illustrate the importance of the provision of institutional facilities and proper pregnancy in the prevention of neonatal and infant deaths. To improve the quality of care during and imme-diately after delivery in health facilities, particularly in public hospitals and in rural areas, accel-erated strengthening is required.

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