scholarly journals Setting Health Care Services Tariffs in Iran: Half a Century Quest for a Window of Opportunity

2020 ◽  
Author(s):  
Leila Doshmangir ◽  
Arash Rashidian ◽  
Farhad Kouhi ◽  
Vladimir S Gordeev
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Care Services ◽  
Analysis Data ◽  
Lessons Learned ◽  
Structured Interviews ◽  
Public And Private ◽  
Middle Income ◽  
Care Services ◽  
The Right

Abstract Background: The process of medical tariffs setting in Iran remains to be a contentious issue and is heavily criticized by many stakeholders. This paper explores the experience of setting health care services tariffs in the Iranian health care system over the last five decades. Methods: We analyzed data collected through literature review and reviews of the official documents developed at the various levels of the Iranian health system using inductive and deductive content analysis. Twenty-two face-to-face semi-structured interviews supplemented the analysis. Data were analysed and interpreted using 'policy triangle' and 'garbage can' models.Results: Our comprehensive review of changes in the medical tariff setting provides valuable lessons for major stakeholders. Most changes were implemented in a sporadic, inadequate, and a non-evidence-based manner. Disparities in tariffs between public and private sectors continue to exist. Lack of clarity in tariffs setting mechanisms and its process makes negotiations between various stakeholders difficult and can potentially become a source of a corrupt income. Such clarity can be achieved by using fair and technically sound tariffs. Technical aspects of tariff setting should be separated from the political negotiations over the overall payment to the medical professionals. Transparency regarding a conflict of interest and establishing punitive measures against those violating the rules could help improving trust in the doctor-patient relationship. Conclusion: Use of evidence-informed models and methods in medical tariff setting could help to strike the right balance in the process of health care services provision to address health system objectives. A sensitive application of policy models can offer significant insights into the nature of medical tariff setting and highlight existing constraints and opportunities. This study generates lessons learned in tariffs setting, particularly for low- and middle-income countries.

scholarly journals Reactions to institutional violence: patient strategies for facing infringements of the right to health in Brazil

2013 ◽  
Vol 9 (1) ◽  
pp. 11-25
Author(s):  
Sonia Fleury ◽  
Valéria Bicudo ◽  
Gabriela Rangel
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Participant Observation ◽  
Structural Factors ◽  
Public Health Services ◽  
Structured Interviews ◽  
Institutional Violence ◽  
Care Services ◽  
Individual Solution ◽  
The Right

In this article we identify evidences of inequalities, prejudices and discrimination in the access and utilization of public health services belonging to the Brazilian Unified Health Care System, considering them to be institutional violence and a negation of rights, in order to look at the reactions of the subjects victimized by this process. This research study utilized different methodologies, articulating participant observation, semi-structured interviews, focus groups and dramatization. The results highlight the trajectory in seeking health care as the main expression of inequalities, strengthened by structural factors such as the precarious condition of health care services, which potentiate power asymmetries, and the presence of discrimination derived from stigmas and prejudices. Most patients' reactions to the situation of institutional violence seek an individual solution to the problem, often reaffirming the conditions that generate rights violations. Few patients' reactions question the systemic conditions that determine the continued discrimination.

Access to health care and Informal Patient Payments for health care in Serbia

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Buch Mejsner ◽  
S Lavasani Kjær ◽  
L Eklund Karlsson
Keyword(s):  
Health Care ◽  
Health System ◽  
Access To Health Care ◽  
Health Care Services ◽  
Local Population ◽  
Civil Servants ◽  
Care Providers ◽  
Care Services ◽  
Access To Health

Abstract Background Evidence often shows that migrants in the European region have poor access to quality health care. Having a large number of migrants seeking towards Europe, crossing through i.e. Serbia, it is crucial to improve migrants' access to health care and ensure equality in service provision Aim To investigate what are the barriers and facilitators of access to health care in Serbia, perceived by migrants, policy makers, health care providers, civil servants and experts working with migrants. Methods six migrants in an asylum center and eight civil servants in the field of migration were conducted. A complementary questionnaire to key civil servants working with migrants (N = 19) is being distributed to complement the data. The qualitative and quantitative data will be analysed through Grounded Theory and Logistic Regression respectively. Results According to preliminary findings, migrants reported that they were able to access the health care services quite easily. Migrants were mostly fully aware of their rights to access these health care services. However, the interviewed civil servants experienced that, despite the majority of migrants in camps were treated fairly, some migrants were treated inappropriately by health care professionals (being addressed inappropriately, poor or lacking treatment). The civil servants believed that local Serbs, from their own experiences, were treated poorer than migrants (I.e. paying Informal Patient Payments, poor quality of and access to health care services). The interviewed migrants were trusting towards the health system, because they felt protected by the official system that guaranteed them services. The final results will be presented at the conference. Conclusions There was a difference in quality of and access to health care services of local Serbs and migrants in the region. Migrants may be protected by the official health care system and thus have access to and do not pay additional fees for health care services. Key messages Despite comprehensive evidence on Informal Patient Payments (IPP) in Serbia, further research is needed to highlight how health system governance and prevailing policies affect IPP in migrants. There may be clear differences in quality of and access to health care services between the local population and migrants in Serbia.

Reaction of New Soviet Immigrants to Primary Health Care Services in Israel

1998 ◽  
Vol 28 (3) ◽  
pp. 555-574 ◽  
Author(s):  
Larissa I. Remennick ◽  
Naomi Ottenstein-Eisen
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
The Elderly ◽  
Medical Services ◽  
Structured Interviews ◽  
Cultural Aspects ◽  
Care Services ◽  
Israeli Population ◽  
Primary Health Care Services ◽  
Diverse Cultures

The post-1989 immigration wave from the former U.S.S.R. has increased the Israeli population by over 12 percent, seriously affecting the host health care system. This study draws on semi-structured interviews with the immigrants visiting outpatient clinics in the Tel-Aviv area in order to explore organizational and cultural aspects of their encounter with the Israeli medical services. While instrumental aspects of care were seen as an improvement over the Soviet standards, communication between providers and clients was seriously flawed, reflecting both a language barrier and diverse cultures of illness and cure. Many interviewees complained of the impersonal, “technical” attitude of Israeli physicians toward patients and the lack of holism in care, which they allegedly enjoyed before emigration. Some immigrant patients feel deprived of the paternalism of the Soviet medical system, complaining that Israeli providers “forego responsibility” for patients' health. A consumerist approach to medical services is also a novelty, and immigrants have to learn to be informed and assertive clients. Most problems are experienced by the elderly patients; overall, women seem to adjust to the new system better than men.

scholarly journals Health mediator model as a way to access to care and health information for Syrian refugees in Turkey

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
I Kayi ◽  
Z Şimşek2 ◽  
G Yıldırımkaya
Keyword(s):  
Health Care ◽  
Health System ◽  
Access To Health Care ◽  
Health Care Services ◽  
Legal Status ◽  
Healthcare Access ◽  
Syrian Refugees ◽  
Care Services ◽  
Access To Health ◽  
The City

Abstract The number of Syrian refugees residing in Turkey has increased over 200 times since 2012 reaching to 3,621,330 (April 2019). Turkey has granted temporary protection status, including access healthcare in the city of registration. Ministry of Health provides on-site health service in temporary shelters, however more than 90% of the Syrian refugees choose to stay in community settings, which along with language barriers limits their ability to access health care and information. With UNFPA we have designed a health mediator model to improve access to health care and awareness on priority concerns such as mental health, reproductive health, child health, health system in Turkey and legal status provided to Syrian refugees. This study is a participatory operational research to test the health mediator model. Operationalization took place in 3 phases: (1) selection and training of Syrian health mediators and provincial coordinators; (2) household visits and data collection; (3) evaluation and supervision. So far, we have trained 174 health mediators from 24 different Turkish cities. Training took 5 days with up to 30 participants each. UNFPA collaborated with NGOs that work with Syrian refugees for coordination purposes. Health mediators made household visits to reach out to Syrian families, gave health education and where necessary support for access to health care services, and conducted a needs assessment. Data collected has been the subject to weekly supervision meetings by local NGOs, health mediators and coordinators to set priorities for the upcoming week. Health mediator model was effective in reaching out to hard-to-reach groups among Syrian refugees, increased health system and legal awareness, contribute to improved healthcare access and prevention of negative health outcomes such as teenage marriages and pregnancies. Inclusion of refugees in decision-making and guidance during the implementation of the project was key for project success.

The making and sustaining of leaders in health care

2019 ◽  
Vol 33 (2) ◽  
pp. 241-262 ◽  
Author(s):  
Terry J. Boyle ◽  
Kieran Mervyn
Keyword(s):  
Health Care ◽  
Community Health ◽  
Health Care Services ◽  
Health Care Systems ◽  
Structured Interviews ◽  
Healthcare Provision ◽  
Triple Aim ◽  
Content Type ◽  
Care Services ◽  
Care Systems

Purpose Many nations are focussing on health care’s Triple Aim (quality, overall community health and reduced cost) with only moderate success. Traditional leadership learning programmes have been based on a taught curriculum, but the purpose of this paper is to demonstrate more modern approaches through procedures and tools. Design/methodology/approach This study evolved from grounded and activity theory foundations (using semi-structured interviews with ten senior healthcare executives and qualitative analysis) which describe obstructions to progress. The study began with the premise that quality and affordable health care are dependent upon collaborative innovation. The growth of new leaders goes from skills to procedures and tools, and from training to development. Findings This paper makes “frugal innovation” recommendations which while not costly in a financial sense, do have practical and social implications relating to the Triple Aim. The research also revealed largely externally driven health care systems under duress suffering from leadership shortages. Research limitations/implications The study centred primarily on one Canadian community health care services’ organisation. Since healthcare provision is place-based (contextual), the findings may not be universally applicable, maybe not even to an adjacent community. Practical implications The paper dismisses outdated views of the synonymity of leadership and management, while encouraging clinicians to assume leadership roles. Originality/value This paper demonstrates how health care leadership can be developed and sustained.

Assessing Low-Value Health Care Services In The Military Health System

2019 ◽  
Vol 38 (8) ◽  
pp. 1351-1357 ◽  
Author(s):  
Tracey Pérez Koehlmoos ◽  
Cathaleen King Madsen ◽  
Amanda Banaag ◽  
Adil H. Haider ◽  
Andrew J. Schoenfeld ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Care Services ◽  
Military Health System ◽  
Military Health ◽  
Care Services ◽  
The Military
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