Poor quality for the poor? A study of inequalities in service readiness and provider knowledge in Indonesian primary health care facilities

Abstract Background For many low and middle-income countries poor quality health care is now responsible for a greater number of deaths than insufficient access to care. This has in turn raised concerns around the distribution of quality of care in LMICs: do the poor have access to lower quality health care compared to the rich? The aim of this study is to investigate the extent of inequalities in the availability of quality health services across the Indonesian health system with a particular focus on differences between care delivered in the public and private sectors. Methods Using the Indonesian Family Life Survey (wave 5, 2015), 15,877 households in 312 communities were linked with a representative sample of both public and private health facilities available in the same communities. Quality of health facilities was assessed using both a facility service readiness score and a knowledge score constructed using clinical vignettes. Ordinary least squares regression models were used to investigate the determinants of quality in public and private health facilities. Results In both sectors, inequalities in both quality scores existed between major islands. In public facilities, inequalities in readiness scores persisted between rural and urban areas, and to a lesser extent between rich and poor communities. Conclusion In order to reach the ambitious stated goal of reaching Universal Health Coverage in Indonesia, priority should be given to redressing current inequalities in the quality of care.

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Quality Shortfalls From Health Care Waste: A Unifying Root Cause of Burnout

Mayo Clinic Strategies To Reduce Burnout ◽

10.1093/med/9780190848965.003.0005 ◽

2020 ◽

pp. 37-46

Author(s):

Stephen J. Swensen ◽

Tait D. Shanafelt

Keyword(s):

Health Care ◽

Quality Of Care ◽

Health Care Professionals ◽

Care Delivery ◽

Health Care Delivery System ◽

Poor Quality ◽

Quality Health Care ◽

Root Cause ◽

Quality Health

The current health care delivery system is perfectly designed to create high rates of professional burnout in physicians, nurses, advanced practice providers, and other health care professionals. In most organizations, a gap exists between the quality of care professionals aspire to deliver and the quality of care actually delivered, which creates burnout. Poor quality health care is fundamentally about waste, and leaders in the health care industry have primary accountability and responsibility for system waste. The following are five categories of waste in health care: Failures of care delivery and care coordination, overtreatment, administrative complexity, pricing failures, and fraud and abuse.

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Medicare Telehealth Pre and Post-COVID-19

Telehealth and Medicine Today ◽

10.30953/tmt.v6.299 ◽

2021 ◽

Author(s):

Sophia Albanese ◽

Amar Gupta ◽

Ilina Shah ◽

Joanna Mitri

Keyword(s):

Health Care ◽

Quality Of Care ◽

Literature Review ◽

Geographic Location ◽

State Agencies ◽

Fee For Service ◽

Medicare Beneficiaries ◽

Quality Health Care ◽

Quality Health

ABSTRACT The COVID-19 pandemic led to temporary relaxations for telehealth with respect to physician licensure, geographic location, and eligible sites for reimbursement. Earlier policies had impacted the rate of adoption of telehealth and retarded the ability to derive full benefits related to cost, access to care, and quality of care. This aspect is analyzed using 2018 Medicare fee-for-service codes and rates for 10 telemedicine services. Based on the analysis of these data, additional research, and literature review, this report describes how interstate practices can be better leveraged to achieve maximum potential for direct and indirect savings that can accrue through such pragmatic approaches for certain services. The interstate collaborations proposed in this report provide examples of broader telehealth policies that could foster increasing access to quality health care for Medicare beneficiaries and can potentially be used as insight to assist federal and state agencies as they review the continuation, cessation, or modifications of relaxations granted due to the COVID-19 pandemic.

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Hospital with No-class Wards Policy: An Effort to Create the Right to Access to Quality Health Care for the Poor

Journal of Health Management ◽

10.1177/0972063418822584 ◽

2019 ◽

Vol 21 (1) ◽

pp. 18-37 ◽

Cited By ~ 1

Author(s):

Budi Aji ◽

Herman Sumawan

Keyword(s):

Health Care ◽

Local Context ◽

Quality Of Services ◽

Future Research ◽

Health Coverage ◽

Quality Health Care ◽

The Poor ◽

Quality Health ◽

The Right

The purpose of the present study was to explore the experience of the patients and hospital behaviour after the implementation of the no-class wards policy and its possible impact on the poor and non-poor patients provision and quality of care. This case study was conducted at Wates Hospital and purposeful sampling was used to yield participants. This study employed in-depth interviews with health care users district health care stakeholders, and focus group discussions with hospital healthcare professionals. The no-class wards policy had clearly demonstrated on improving the right to access to quality health care for the poor. The policy had been effectively reducing the experiences of patients on discriminatory treatment and improving quality of services. The policy also had an impact on increasing hospital utilization significantly among public insurance beneficiaries for both the poor and non-poor patients which supports the success of the implementation of the universal health coverage. Moreover, the policy had improved the assurance of quality of services. Future research needs to expand on our work to compare the implementation of no-class wards policy in other hospitals in different regions in Indonesia considering different local context such as local political issues, public expectations and other technical issues.

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First experiences of accrediting district hospitals for excellence in newborn care in KwaZulu-Natal, South Africa: Successes and challenges

Journal of Hospital Administration ◽

10.5430/jha.v7n3p25 ◽

2018 ◽

Vol 7 (3) ◽

pp. 25 ◽

Cited By ~ 2

Author(s):

Lyn Haskins ◽

Dolly Nyasulu ◽

Ruth Davidge ◽

Neil McKerrow ◽

Christiane Horwood

Keyword(s):

South Africa ◽

Health Care ◽

Newborn Care ◽

Health Facilities ◽

Quality Health Care ◽

District Hospitals ◽

Kwazulu Natal ◽

Quality Health ◽

Successes And Challenges

Objective: Providing quality health care is what all health facilities seek to achieve. Accreditation of health services are used to assess and improve the quality of health care in different settings. This study describes experiences of developing and conducting accreditation for excellence in newborn care in district hospitals in KwaZulu-Natal (KZN), South Africa following a 3-year programme of support to all nurseries in KZN.Methods: A facility review was conducted in district hospitals in KZN to evaluate the quality of care provided to newborn babies to accredit hospitals in newborn care. Multiple tools were used to assess different components of care from different perspectives, including record reviews, assessment of staff skills and interviews with mothers. Awarding accreditation was based on scores achieved in various domains, which contributed to an overall score. Compliance with key priority indicators was required for accreditation to be awarded.Results: Overall scores for accreditation ranged between 57%-93%. Mothers reported high levels of satisfaction with care received. Record reviews identified shortfalls in care provided, and skills assessments showed poor resuscitation skills in labour wards in some hospitals. Of 39 district hospitals, eight were awarded silver and five were awarded gold accreditation status.Conclusions: This accreditation of newborn care provides a workable model for undertaking accreditation in district hospitals and can be used by managers to identify and address shortfalls in care. Regular accreditation would support ongoing quality improvement (QI) in neonatal care and such a process could be applied to other aspects of care in health facilities.

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Quality of health care in Nigeria: a myth or a reality

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20183621 ◽

2018 ◽

Vol 6 (9) ◽

pp. 2875

Author(s):

Benson Chukwunweike Ephraim-Emmanuel ◽

Adetutu Adigwe ◽

Roland Oyeghe ◽

Daprim S. T. Ogaji

Keyword(s):

Health Care ◽

Health Care Delivery ◽

Health Care Quality ◽

Care Delivery ◽

Care Quality ◽

Quality Systems ◽

Quality Health Care ◽

The Poor ◽

Quality Health

The delivery of high quality health care is crucial to achieving enhanced health benefits, patient safety and a positive patient experience of health care. This article provides insight on the quality of the health care delivery in Nigeria and aim to uncover if quality health care in Nigeria is a reality or a myth. Relevant information was abstracted from included articles and used to provide both descriptive and analytical discourse on the subject. Discussions and reflections were carried out along an established quality framework of treatment effectiveness, acceptability, efficiency, the appropriateness of the means of delivery as well as equity. The slow pace of development of quality systems in health service delivery in Nigeria is evidenced by the poor quality of health services as well as the poor health status of the population. The pace of developing quality systems in health care delivery in Nigeria is unsatisfactory. There is a need to galvanise the efforts of relevant stakeholders including the patient in charting a new agenda for health care quality improvement in Nigeria.

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Universal Health Coverage

10.1093/oso/9780190662455.003.0011 ◽

2017 ◽

Author(s):

Joia S. Mukherjee

Keyword(s):

Health Care ◽

Universal Health Coverage ◽

Poor Quality ◽

Theory And Practice ◽

Health Coverage ◽

Quality Health Care ◽

The Sustainable Development ◽

Quality Health ◽

The Right ◽

Universal Health

This chapter explores the seminal topic of Universal Health Coverage (UHC), an objective within the Sustainable Development goals. It reviews the theory and definitions that shape the current conversation on UHC. The movement from selective primary health care to UHC demonstrates a global commitment to the progressive realization of the right to health. However, access to UHC is limited by barriers to care, inadequate provision of care, and poor-quality services. To deliver UHC, it is critical to align inputs in the health system with the burden of disease. Quality of care must also be improved. Steady, sufficient financing is needed to achieve the laudable goal of UHC.This chapter highlights some important steps taken by countries to expand access to quality health care. Finally, the chapter investigates the theory and practice behind a morbidity-based approach to strengthening health systems and achieving UHC.

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

International Journal of Pharmaceutical and Healthcare Marketing ◽

10.1108/ijphm-08-2018-0043 ◽

2019 ◽

Vol 13 (2) ◽

pp. 160-170 ◽

Cited By ~ 2

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.

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Quality indicators of dental health care in Serbia

Stomatoloski glasnik Srbije ◽

10.2478/sdj-2019-0005 ◽

2019 ◽

Vol 66 (1) ◽

pp. 36-42

Author(s):

Svetlana Jovanović ◽

Maja Milošević ◽

Irena Aleksić-Hajduković ◽

Jelena Mandić

Keyword(s):

Health Care ◽

Quality Improvement ◽

Health System ◽

Quality Indicators ◽

Health Care Quality ◽

Care Quality ◽

System Quality ◽

Quality Health Care ◽

Quality Health

Summary Health care has witnessed considerable progresses toward quality improvement over the past two decades. More precisely, there have been global efforts aimed to improve this aspect of health care along with experts and decision-makers reaching the consensus that quality is one of the most significant dimensions and features of health system. Quality health care implies highly efficient resource use in order to meet patient’s needs in terms of prevention and treatment. Quality health care is provided in a safe way while meeting patients’ expectations and avoiding unnecessary losses. The mission of continuous improvement in quality of care is to achieve safe and reliable health care through mutual efforts of all the key supporters of health system to protect patients’ interests. A systematic approach to measuring the process of care through quality indicators (QIs) poses the greatest challenge to continuous quality improvement in health care. Quality indicators are quantitative indicators used for monitoring and evaluating quality of patient care and treatment, continuous professional development (CPD), maintaining waiting lists, patients and staff satisfaction, and patient safety.

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