scholarly journals Long Term Effectiveness of Elderly Health Care Voucher Scheme Strategies: A System Dynamics Simulation Analysis

2020 ◽  
Author(s):  
Ka Chun Chong ◽  
Hong Fung ◽  
Carrie Yam ◽  
Patsy Chau ◽  
Tsz Yu Chow ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Public Sector ◽  
System Dynamics ◽  
The Elderly ◽  
Healthcare Services ◽  
Dynamics Simulation ◽  
Public And Private ◽  
The Public

Abstract Background: The elderly healthcare voucher (EHCV) scheme is expected to increase the number of elders choosing private primary healthcare services and, on the other hand, to reduce reliance on the public sector in Hong Kong. Unfortunately, the scheme was not satisfactorily as reported in the literature to date. In this study, we examined the changes in the ratio of visits between public and private doctors in primary care (as a metric of reliance on the public sector) for different strategic scenarios in the scheme.Methods: Based on the comments from the expertise discussion, a system dynamics model was formulated to simulate the impact of different enhanced strategy in the scheme: Increasing voucher amounts, lowering the age eligibility, and designating vouchers for chronic conditions follow-up. Data and statistics for model calibration were collected from different sources.Results: The simulation results showed that the current EHCV scheme was unable to reduce the utilization of public healthcare services as well as the ratio of visits between public and private when the local population aging was taken into account. When comparing the 3 different tested scenarios, even if the increase of annual voucher amount could be kept with a current pace or the age eligibility could be lowered to 60 years old, the impacts on the shifts from public to private utilization were not apparent in which the public-to-private ratio could only drop slightly from 0.74 to 0.64 in the first several years. Nevertheless, introducing a chronic disease-oriented voucher could result in an apparent drop of public-to-private ratio to 0.50 in the early implementation phase but the effect could not be maintained for a period of time. Conclusions: Our findings assist officials to further improve the design of EHCV scheme, within the bigger context of promoting primary care among the elderly. We suggested an additional chronic disease-oriented voucher could be an alternative strategy but the enhancement on the voucher amount should be considered if a long term planning was required. For not substantially rising the government expenditure for refining the scheme, health promotion works for encouraging co-payment from elderly for is recommended.

scholarly journals Long-term effectiveness of elderly health care voucher scheme strategies: a system dynamics simulation analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ka Chun Chong ◽  
Hong Fung ◽  
Carrie Ho Kwan Yam ◽  
Patsy Yuen Kwan Chau ◽  
Tsz Yu Chow ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Public Sector ◽  
System Dynamics ◽  
The Elderly ◽  
Healthcare Services ◽  
Dynamics Simulation ◽  
Public And Private ◽  
The Public ◽  
The Impact

Abstract Background The elderly healthcare voucher (EHCV) scheme is expected to lead to an increase in the number of elderly people selecting private primary healthcare services and reduce reliance on the public sector in Hong Kong. However, studies thus far have reported that this scheme has not received satisfactory responses. In this study, we examined changes in the ratio of visits between public and private doctors in primary care (to measure reliance on the public sector) for different strategic scenarios in the EHCV scheme. Methods Based on comments from an expert panel, a system dynamics model was formulated to simulate the impact of various enhanced strategies in the scheme: increasing voucher amounts, lowering the age eligibility, and designating vouchers for chronic conditions follow-up. Data and statistics for the model calibration were collected from various sources. Results The simulation results show that the current EHCV scheme is unable to reduce the utilization of public healthcare services, as well as the ratio of visits between public and private primary care among the local aging population. When comparing three different tested scenarios, even if the increase in the annual voucher amount could be maintained at the current pace or the age eligibility can be lowered to include those aged 60 years, the impact on shifts from public-to-private utilization were insignificant. The public-to-private ratio could only be marginally reduced from 0.74 to 0.64 in the first several years. Nevertheless, introducing a chronic disease-oriented voucher could result in a significant drop of 0.50 in the public-to-private ratio during the early implementation phase. However, the effect could not be maintained for an extended period. Conclusions Our findings will assist officials in improving the design of the EHCV scheme, within the wider context of promoting primary care among the elderly. We suggest that an additional chronic disease-oriented voucher can serve as an alternative strategy. The scheme must be redesigned to address more specific objectives or provide a separate voucher that promotes under-utilized healthcare services (e.g., preventive care), instead of services designed for unspecified reasons, which may lead to concerns regarding exploitation.

Transport and Logistics in Dubai

2012 ◽  
pp. 36-53
Author(s):  
Michael Thorpe ◽  
Sumit Mitra
Keyword(s):  
Public Sector ◽  
Global Market ◽  
Business Strategies ◽  
Market Place ◽  
Public And Private ◽  
The Public ◽  
Future Success ◽  
Government Project ◽  
Phased Development

The phased development of Dubai’s transport and logistics sector over the past several decades has culminated in the establishment of a major regional commercial hub, a so-called “aerotropolis”. Although a work-in-progress, several stages of this long-term project are already operational, and construction remains ongoing. The future success of this government project is unclear. In the public sector, there exist major challenges, some reflective of the need to efficiently manage and coordinate such a huge undertaking while others stem from the uncertainties of a competitive global market-place. For individual companies and industries (public and private) looking to participate and commit to the venture, a number of issues need to be addressed in the formulation of business strategies.

The quality of care in outpatient primary care in public and private sectors in Malaysia

2019 ◽  
Author(s):  
May Chien Chin ◽  
Sheamini Sivasampu ◽  
Nilmini Wijemunige ◽  
Ravindra P Rannan-Eliya ◽  
Rifat Atun
Keyword(s):  
Primary Care ◽  
Public Sector ◽  
Private Sector ◽  
Clinical Care ◽  
Developed Countries ◽  
Prescribing Practices ◽  
Public And Private ◽  
The Public ◽  
The Usa

Abstract In Malaysia, first-contact, primary care is provided by parallel public and private sectors, which are completely separate in organization, financing and governance. As the country considers new approaches to financing, including using public schemes to pay for private care, it is crucial to examine the quality of clinical care in the two sectors to make informed decisions on public policy. This study intends to measure and compare the quality of clinical care between public and private primary care services in Malaysia and, to the extent possible, assess quality with the developed economies that Malaysia aspires to join. We carried out a retrospective analysis of the National Medical Care Survey 2014, a nationally representative survey of doctor–patient encounters in Malaysia. We assessed clinical quality for 27 587 patient encounters using data on 66 internationally validated quality indicators. Aggregate scores were constructed, and comparisons made between the public and private sectors. Overall, patients received the recommended care just over half the time (56.5%). The public sector performed better than the private sector, especially in the treatment of acute conditions, chronic conditions and in prescribing practices. Both sectors performed poorly in the indicators that are most resource intensive, suggesting that resource constraints limit overall quality. A comparison with 2003 data from the USA, suggests that performance in Malaysia was similar to that a decade earlier in the USA for common indicators. The public sector showed better performance in clinical care than the private sector, contrary to common perceptions in Malaysia and despite providing worse consumer quality. The overall quality of outpatient clinical care in Malaysia appears comparable to other developed countries, yet there are gaps in quality, such as in the management of hypertension, which should be tackled to improve overall health outcomes.

Public and Private Healthcare in Slovenia in Relation to Choice and Accessibility of Services

2013 ◽  
Vol 3 (3) ◽  
pp. 1-14 ◽  
Author(s):  
Matic Kavčič ◽  
Majda Pahor
Keyword(s):  
Public Sector ◽  
Evolutionary Process ◽  
Secondary Data ◽  
Healthcare Services ◽  
Background Information ◽  
Structured Interviews ◽  
Healthcare Provision ◽  
Public And Private ◽  
The Public ◽  
Private Healthcare

This article starts with background information on the Slovenian healthcare system and the description of the evolutionary process and privatisation reforms that bring a mix of public and private healthcare services. The authors' aim is to conceptualise existing modes of public and private healthcare provision and discuss possible implications for user choice and accessibility of services. A descriptive and exploratory case study approach was employed. Literature and document analysis was complemented by secondary data and semi-structured interviews. The results demonstrate four modes of healthcare services in relation to public-private delivery. The ‘public non-profit' type refers to publicly financed and delivered services. The ‘private within public' type addresses services provided within and by the public sector for patients who pay out-of-pocket. The ‘private for public' type deals with services provided by private entities with concessions. The ‘private for-profit' type refers to completely private provision (without concession) of self-pay services. The strengths and weaknesses of each mode with respect to choice, space-time accessibility, financial accessibility and quality of services are critically discussed. The results of the study show that private healthcare services significantly complement and compete with public sector. In addition, there is a risk that uncontrolled mixing of public and private modes of practice may bring about unethical behaviour and corruption.

scholarly journals Artificial intelligence for the public sector: opportunities and challenges of cross-sector collaboration

2018 ◽  
Vol 376 (2128) ◽  
pp. 20170357 ◽  
Author(s):  
Slava Jankin Mikhaylov ◽  
Marc Esteve ◽  
Averill Campion
Keyword(s):  
Artificial Intelligence ◽  
Public Sector ◽  
Data Science ◽  
Grand Challenge ◽  
Public And Private ◽  
The Public ◽  
Using Data ◽  
The Uk ◽  
High Uncertainty

Public sector organizations are increasingly interested in using data science and artificial intelligence capabilities to deliver policy and generate efficiencies in high-uncertainty environments. The long-term success of data science and artificial intelligence (AI) in the public sector relies on effectively embedding it into delivery solutions for policy implementation. However, governments cannot do this integration of AI into public service delivery on their own. The UK Government Industrial Strategy is clear that delivering on the AI grand challenge requires collaboration between universities and the public and private sectors. This cross-sectoral collaborative approach is the norm in applied AI centres of excellence around the world. Despite their popularity, cross-sector collaborations entail serious management challenges that hinder their success. In this article we discuss the opportunities for and challenges of AI for the public sector. Finally, we propose a series of strategies to successfully manage these cross-sectoral collaborations.This article is part of a discussion meeting issue ‘The growing ubiquity of algorithms in society: implications, impacts and innovations’.

scholarly journals What is the long term impact of voucher scheme on primary care? Findings from a repeated cross sectional study using propensity score matching

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Carrie H. K. Yam ◽  
Eliza L. Y. Wong ◽  
Valerie L. H. Fung ◽  
Sian M. Griffiths ◽  
Eng-Kiong Yeoh
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Voucher Scheme ◽  
Cross Sectional ◽  
Public And Private ◽  
Care Services ◽  
Long Term Impact

Abstract Background Vouchers are increasingly used as a demand-side subsidy to reduce financial hardship and improve quality of services. Elderly Healthcare Voucher Scheme has been introduced by the Hong Kong Government since 2009 to provide subsidy to elderly aged 65 and above to visit ten different types of private primary care providers for curative, preventive and chronic disease management. Several enhancements have been made over the past few years. This paper (as part of an evaluation study of this unique healthcare voucher scheme) aims to assess the long term impact of the voucher scheme in encouraging the use of primary care services. Methods Two rounds of cross-sectional survey among elderly in Hong Kong were conducted in 2010 and 2016. Propensity score matching and analysis were used to compare changes in perception and usage of vouchers over time. Results 61.5% of respondents in 2016 agreed “the scheme encourages me to use more private primary care services”, a significant increase from 36.2% in 2010. Among those who agreed in 2016, the majority thought the voucher scheme would encourage them to use acute services (90.3%) in the private sector, rather than preventive care (40.3%) and chronic disease management (12.2%). Respondents also reported that their current usual choice of care was visiting “both public and private doctors” (61.9%), representing a significant increase (up from 48.4%) prior to their use of voucher. Conclusions The voucher scheme has encouraged the use of more private care services, particularly acute services rather than disease prevention or management of chronic disease. However, there needs to be caution that the untargeted and open-ended nature of voucher scheme could result in supply-induced demand which would affect long term financial sustainability. The dual utilization of health services in both the public and private sector may also compromise continuity and quality of care. The design of the voucher needs to be more specific, targeting prevention and chronic disease management rather than unspecified care which is mainly acute and episodic in order to maximize service delivery capacity as a whole for equitable access in universal health coverage and to contribute to a sustainable financing system.

Relationship between CSR motivations and corporate social performance: a study in the power industry in India

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Moumita Acharyya ◽  
Tanuja Agarwala
Keyword(s):  
Public Sector ◽  
Private Sector ◽  
Corporate Social Performance ◽  
Social Performance ◽  
Power Sector ◽  
Public And Private ◽  
Content Type ◽  
The Public ◽  
Self Interest ◽  
Public And Private Sector

PurposeThe paper aims to understand the different motivations / reasons for engaging in CSR initiatives by the organizations. In addition, the study also examines the relationship between CSR motivations and corporate social performance (CSP).Design/methodology/approachThe data were collected from two power sector organizations: one was a private sector firm and the other was a public sector firm. A comparative analysis of the variables with respect to private and public sector organizations was conducted. A questionnaire survey was administered among 370 employees working in the power sector, with 199 executives from public sector and 171 from private sector.Findings“Philanthropic” motivation emerged as the most dominant CSR motivation among both the public and private sector firms. The private sector firm was found to be significantly higher with respect to “philanthropic”, “enlightened self-interest” and “normative” CSR motivations when compared with the public sector firms. Findings suggest that public and private sector firms differed significantly on four CSR motivations, namely, “philanthropic”, “enlightened self-interest”, “normative” and “coercive”. The CSP score was significantly different among the two power sector firms of public and private sectors. The private sector firm had a higher CSP level than the public sector undertaking.Research limitations/implicationsFurther studies in the domain need to address differences in CSR motivations and CSP across other sectors to understand the role of industry characteristics in influencing social development targets of organizations. Research also needs to focus on demonstrating the relationship between CSP and financial performance of the firms. Further, the HR outcomes of CSR initiatives and measurement of CSP indicators, such as attracting and retaining talent, employee commitment and organizational climate factors, need to be assessed.Originality/valueThe social issues are now directly linked with the business model to ensure consistency and community development. The results reveal a need for “enlightened self-interest” which is the second dominant CSR motivation among the organizations. The study makes a novel contribution by determining that competitive and coercive motivations are not functional as part of organizational CSR strategy. CSR can never be forced as the very idea is to do social good. Eventually, the CSR approach demands a commitment from within. The organizations need to emphasize more voluntary engagement of employees and go beyond statutory requirements for realizing the true CSR benefits.

Mapping public value processes

2014 ◽  
Vol 27 (4) ◽  
pp. 334-352 ◽  
Author(s):  
John Alford ◽  
Sophie Yates
Keyword(s):  
Public Sector ◽  
Child Nutrition ◽  
Process Mapping ◽  
Public Value ◽  
Public And Private ◽  
Content Type ◽  
The Public ◽  
Public Managers ◽  
Big Picture ◽  
Comprehensive Framework

Purpose – The purpose of this paper is to add to the analytic toolkit of public sector practitioners by outlining a framework called Public Value Process Mapping (PVPM). This approach is designed to be more comprehensive than extant frameworks in either the private or public sectors, encapsulating multiple dimensions of productive processes. Design/methodology/approach – This paper explores the public administration and management literature to identify the major frameworks for visualising complex systems or processes, and a series of dimensions against which they can be compared. It then puts forward a more comprehensive framework – PVPM – and demonstrates its possible use with the example of Indigenous child nutrition in remote Australia. The benefits and limitations of the technique are then considered. Findings – First, extant process mapping frameworks each have some but not all of the features necessary to encompass certain dimensions of generic or public sector processes, such as: service-dominant logic; external as well internal providers; public and private value; and state coercive power. Second, PVPM can encompass the various dimensions more comprehensively, enabling visualisation of both the big picture and the fine detail of public value-creating processes. Third, PVPM has benefits – such as helping unearth opportunities or culprits affecting processes – as well as limitations – such as demonstrating causation and delineating the boundaries of maps. Practical implications – PVPM has a number of uses for policy analysts and public managers: it keeps the focus on outcomes; it can unearth a variety of processes and actors, some of them not immediately obvious; it can help to identify key processes and actors; it can help to identify the “real” culprits behind negative outcomes; and it highlights situations where multiple causes are at work. Originality/value – This approach, which draws on a number of precursors but constitutes a novel technique in the public sector context, enables the identification and to some extent the comprehension of a broader range of causal factors and actors. This heightens the possibility of imagining innovative solutions to difficult public policy issues, and alternative ways of delivering public services.

COVID’s Effect on India’s Health Services: A Commentary

Social Change ◽  
2021 ◽  
Vol 51 (4) ◽  
pp. 483-492
Author(s):  
Imrana Qadeer
Keyword(s):  
Public Sector ◽  
Health Services ◽  
Healthcare Services ◽  
The Public ◽  
State Authority ◽  
Comprehensive Framework ◽  
The Impact ◽  
Second Wave

Using a comprehensive framework (the state’s will to deliver, its institutional strength and its legitimacy), this article assesses the impact of the COVID-19 pandemic on public sector healthcare services in India. The power to deliver was explicit when the interventions were harsh, increasing the burden of death and disease on health services. But when it came to healthcare by the public sector we find a worsening of achievements of non-COVID ailments during the pandemic and an inability to tackle the second wave due to gaps in the nation's infrastructure, a centralised control undermining state authority; and visible results of a flawed policy that pushed further the agenda of making healthcare a profitable business.

Baseline assessment of therapeutic injection practices in Pakistan in 2020: a cross-sectional study

2021 ◽  
pp. 16-21
Author(s):  
Syed Sharaf Ali Shah ◽  
Safdar Pasha ◽  
Nikhat Iftikar ◽  
Altaf Ahmed Soomro ◽  
Nazia Farrukh ◽  
...  
Keyword(s):  
Public Sector ◽  
Healthcare Providers ◽  
Cross Sectional Study ◽  
Health Facilities ◽  
Cross Sectional ◽  
Injection Equipment ◽  
Public And Private ◽  
Healthcare Facilities ◽  
The Public ◽  
Injection Safety

Objective: To assess the magnitude of the problem of injection safety in public and private health facilities in two districts of Sindh and Punjab provinces of Pakistan. Methods: A cross-sectional observational study was conducted between October and December 2020 among public and private health facilities of two districts of Pakistan: Gujarat in Punjab and Larkana in Sindh provinces. A convenient sample size of 60 healthcare facilities (30 from each district) was taken due to time and resource constraint. Six data collection tools were used which included structured observations and interviews with injection prescribers and providers based on WHO Revised Tool C, which were finalised after piloting. Results: Reuse of injection equipment was not observed in any of the 60 health facilities. In exit interviews of 120 patients, it was found that 27 (22.5%) patients reported receiving an injection, while 11 (9.2%) were prescribed intravenous (IV) drips. More injections and drips were prescribed in the private sector (n=15; 25.0%) in comparison with the public sector (n=12; 20.0%). Slightly higher proportion of IV drips were prescribed by the private providers when compared to public sector healthcare providers: 6 (10.0%) vs 5 (8.3%) respectively. Most of the prescribers (n=58; 96.7%) reported that patients who attended public and private health facilities demanded injectable medicines. Used syringes and drips were noted to be visible in open containers and buckets for final disposal in 20 (33.3%) assessed health facilities. Continuou...

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