scholarly journals How Public Trust in Health Care Can Shape Patient Overconsumption in Health Systems? The Missing Links

2021 ◽  
Vol 18 (8) ◽  
pp. 3860
Author(s):  
Katarzyna Krot ◽  
Iga Rudawska
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Health System ◽  
Health Systems ◽  
Quantitative Research ◽  
Public Trust ◽  
Complex Problem ◽  
Health Care Consumption ◽  
Mediating Role ◽  
Countries In Transition

Overconsumption of health care is an ever-present and complex problem in health systems. It is especially significant in countries in transition that assign relatively small budgets to health care. In these circumstances, trust in the health system and its institutions is of utmost importance. Many researchers have studied interpersonal trust. Relatively less attention, however, has been paid to public trust in health systems and its impact on overconsumption. Therefore, this paper seeks to identify and examine the link between public trust and the moral hazard experienced by the patient with regard to health care consumption. Moreover, it explores the mediating role of patient satisfaction and patient non-adherence. For these purposes, quantitative research was conducted based on a representative sample of patients in Poland. Interesting findings were made on the issues examined. Patients were shown not to overconsume health care if they trusted the system and were satisfied with their doctor-patient relationship. On the other hand, nonadherence to medical recommendations was shown to increase overuse of medical services. The present study contributes to the existing knowledge by identifying phenomena on the macro (public trust in health care) and micro (patient satisfaction and non-adherence) scales that modify patient behavior with regard to health care consumption. Our results also provide valuable knowledge for health system policymakers. They can be of benefit in developing communication plans at different levels of local government.

The regulation of health care in Scandinavia: professionals, the public interest and trust

2018 ◽  
pp. 61-76
Author(s):  
Karsten Vrangbæk
Keyword(s):  
Health Care ◽  
Public Policy ◽  
Health Insurance ◽  
Health System ◽  
Health Systems ◽  
Public Interest ◽  
State Level ◽  
Professional Regulation ◽  
The Public ◽  
Voluntary Health Insurance

Scandinavian health systems have traditionally been portrayed as relatively similar examples of decentralised, public integrated health systems. However, recent decades have seen significant public policy developments in the region that should lead us to modify our understanding. Several dimensions are important for understanding such developments. First, several of the countries have undergone structural reforms creating larger governance units and strengthening the state level capacity to regulate professionals and steer developments at the regional and municipal levels. Secondly, the three Nordic countries studied experienced an increase in the purchase of voluntary health insurance and the use of private providers. This introduces several issues for the equality of users and the efficiency of the system. This paper will investigate such trends and address the question: Is the Nordic health system model changing, and what are the consequences for trust, professional regulation and the public interest?

scholarly journals Emerging challenges in the health systems of Kerala, India: qualitative analysis of literature reviews

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Manesh Muraleedharan ◽  
Alaka Omprakash Chandak
Keyword(s):  
Health Care ◽  
Health Economic ◽  
Health System ◽  
Health Systems ◽  
Significant Proportion ◽  
Vital Statistics ◽  
The State ◽  
Future Research ◽  
Health Seeking ◽  
Content Type

PurposeThe substantial increase in non-communicable diseases (NCDs) is considered a major threat to developing countries. According to various international organizations and researchers, Kerala is reputed to have the best health system in India. However, many economists and health-care experts have discussed the risks embedded in the asymmetrical developmental pattern of the state, considering its high health-care and human development index and low economic growth. This study, a scoping review, aims to explore four major health economic issues related to the Kerala health system.Design/methodology/approachA systematic review of the literature was performed using PRISMA to facilitate selection, sampling and analysis. Qualitative data were collected for thematic content analysis.FindingsChronic diseases in a significant proportion of the population, low compliance with emergency medical systems, high health-care costs and poor health insurance coverage were observed in the Kerala community.Research limitations/implicationsThe present study was undertaken to determine the scope for future research on Kerala's health system. Based on the study findings, a structured health economic survey is being conducted and is scheduled to be completed by 2021. In addition, the scope for future research on Kerala's health system includes: (1) research on pathways to address root causes of NCDs in the state, (2) determine socio-economic and health system factors that shape health-seeking behavior of the Kerala community, (3) evaluation of regional differences in health system performance within the state, (4) causes of high out-of-pocket expenditure within the state.Originality/valueGiven the internationally recognized standard of Kerala's vital statistics and health system, this review paper highlights some of the challenges encountered to elicit future research that contributes to the continuous development of health systems in Kerala.

scholarly journals Improving Patient behavioral Consent through Different Service Quality Dimensions: Assessing the Mediating Role of Patient Satisfaction

2019 ◽  
Vol 16 (23) ◽  
pp. 4736 ◽  
Author(s):  
Arif Jameel ◽  
Muhammad Asif ◽  
Abid Hussain ◽  
Jinsoo Hwang ◽  
Mussawar Hussain Bukhari ◽  
...  
Keyword(s):  
Health Care ◽  
Patient Satisfaction ◽  
Service Quality ◽  
Structural Equation ◽  
Care Service ◽  
Health Care Service ◽  
Equation Modeling ◽  
Mediating Role ◽  
The Impact

This study aimed to examine the impact of the five-dimensional health care service quality (SQ) on patient behavioral consent (PBC). This study further explored the mediating role of patient satisfaction (PS) on the SQ–PBC relationship. A survey questionnaire was used to collect the data from public sector hospitals situated in Bahawalpur division, Punjab, Pakistan. We used confirmatory factor analysis (CFA) and structural equation modeling (SEM) to test the hypotheses. This study found positive and significant relationships between SQ and PBC, SQ and PS, and PS and PBC. Our results further revealed that PS partially mediates the relationship between SQ and PBC. Our study offers a comprehensive theoretical framework of several service quality attributes (SQs) affecting patient behavioral consent (PBC) and patient satisfaction (PS) in health care institutions. Testing these above relationships via a mediation approach is novel and contributed to the current study on service quality.

scholarly journals Exploring health system readiness for adopting interventions to address intimate partner violence: a case study from the occupied Palestinian Territory

2019 ◽  
Vol 35 (3) ◽  
pp. 245-256 ◽  
Author(s):  
Manuela Colombini ◽  
Abdulsalam Alkaiyat ◽  
Amira Shaheen ◽  
Claudia Garcia Moreno ◽  
Gene Feder ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Systems ◽  
Partner Violence ◽  
Scale Up ◽  
Successful Implementation ◽  
Occupied Palestinian Territory ◽  
System Readiness ◽  
Palestinian Territory

Abstract Domestic violence (DV) against women is a widespread violation of human rights. Adoption of effective interventions to address DV by health systems may fail if there is no readiness among organizations, institutions, providers and communities. There is, however, a research gap in our understanding of health systems’ readiness to respond to DV. This article describes the use of a health system’s readiness assessment to identify system obstacles to enable successful implementation of a primary health-care (PHC) intervention to address DV in the occupied Palestinian Territory (oPT). This article describes a case study where qualitative methods were used, namely 23 interviews with PHC providers and key informants, one stakeholder meeting with 19 stakeholders, two health facility observations and a document review of legal and policy materials on DV in oPT. We present data on seven dimensions of health systems. Our findings highlight the partial readiness of health systems and services to adopt a new DV intervention. Gaps were identified in: governance (no DV legislation), financial resources (no public funding and limited staff and infrastructure) and information systems (no uniform system), co-ordination (disjointed referral network) and to some extent around the values system (tension between patriarchal views on DV and more gender equal norms). Additional service-level barriers included unclear leadership structure at district level, uncertain roles for front-line staff, limited staff protection and the lack of a private space for identification and counselling. Findings also pointed to concrete actions in each system dimension that were important for effective delivery. This is the first study to use an adapted framework to assess health system readiness (HSR) for implementing an intervention to address DV in low- and middle-income countries. More research is needed on HSR to inform effective implementation and scale up of health-care-based DV interventions.

scholarly journals Mental health system governance in Nigeria: challenges, opportunities and strategies for improvement

2016 ◽  
Vol 3 ◽  
Author(s):  
J. Abdulmalik ◽  
L. Kola ◽  
O. Gureje
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Health Policy ◽  
Health System ◽  
Health Systems ◽  
Mental Health System ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health System Governance ◽  
Low And Middle Income

IntroductionA health systems approach to understanding efforts for improving health care services is gaining traction globally. A component of this approach focuses on health system governance (HSG), which can make or mar the successful implementation of health care interventions. Very few studies have explored HSG in low- and middle-income countries, including Nigeria. Studies focusing on mental health system governance, are even more of a rarity. This study evaluates the mental HSG of Nigeria with a view to understanding the challenges, opportunities and strategies for strengthening it.MethodologyThis study was conducted as part of the project, Emerging Mental Health Systems in Low and Middle Income Countries (Emerald). A multi-method study design was utilized to evaluate the mental HSG status of Nigeria. A situational analysis of the health policy and legal environment in the country was performed. Subsequently, 30 key informant interviews were conducted at national, state and district levels to explore the country's mental HSG.ResultsThe existing policy, legislative and institutional framework for HSG in Nigeria reveals a complete exclusion of mental health in key health sector documents. The revised mental health policy is however promising. Using the Siddiqi framework categories, we identified pragmatic strategies for mental health system strengthening that include a consideration of existing challenges and opportunities within the system.ConclusionThe identified strategies provide a template for the subsequent activities of the Emerald Programme (and other interventions), towards strengthening the mental health system of Nigeria.

scholarly journals Roemer 20 Years Later: When a Classical Health-System Typology Meets Market-Oriented Reforms

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Melanie Bourque ◽  
Jean-Simon Farrah
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Systems ◽  
Public Management ◽  
Health Care Services ◽  
New Public Management ◽  
Health Care Systems ◽  
Supply And Demand ◽  
Managed Competition ◽  
Care Systems

In 1990, Roemer came up with a very influential health system typology. From his vast study, emerged three types of health care systems: nationalized, mandated and entrepreneurial. Health care systems are not static; slow changes and reforms somewhat alter values and goals on which those systems were initially established. It is fair to say, then, that over the last two decades, health care reformers have adopted a market-oriented governance model that blends new public management (NPM) and managed competition reforms in the provision of health care services to transform supply- and demand-side actors into “responsibilized” customers, payers or providers. These transformations beg the question as to whether we are witnessing a radical redefinition of health care systems through the implementation of market-oriented governance. We propose to add the evolution of market-oriented health reforms in five case studies to Milton Roemer’s typology of health systems. In light of our findings, we will wrap up the analysis with an assessment of the usefulness of Roemer’s classification for social scientists to grasp the evolution of health systems over the past 20 years, and more importantly, to analyze the current state of these health care systems after years of market-oriented reforms.

scholarly journals Barriers to Creating Scalable Business Models for Digital Health Innovation in Public Systems: Qualitative Case Study (Preprint)

2020 ◽  
Author(s):  
Leah Taylor Kelley ◽  
Jamie Fujioka ◽  
Kyle Liang ◽  
Madeline Cooper ◽  
Trevor Jamieson ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Systems ◽  
Business Models ◽  
Digital Health ◽  
Digital Technologies ◽  
Economic Incentives ◽  
Barriers To Entry ◽  
Health Innovation ◽  
Health Technologies

BACKGROUND Health systems are increasingly looking toward the private sector to provide digital solutions to address health care demands. Innovation in digital health is largely driven by small- and medium-sized enterprises (SMEs), yet these companies experience significant barriers to entry, especially in public health systems. Complex and fragmented care models, alongside a myriad of relevant stakeholders (eg, purchasers, providers, and producers of health care products), make developing value propositions for digital solutions highly challenging. OBJECTIVE This study aims to identify areas for health system improvement to promote the integration of innovative digital health technologies developed by SMEs. METHODS This paper qualitatively analyzes a series of case studies to identify health system barriers faced by SMEs developing digital health technologies in Canada and proposed solutions to encourage a more innovative ecosystem. The Women’s College Hospital Institute for Health System Solutions and Virtual Care established a consultation program for SMEs to help them increase their innovation capacity and take their ideas to market. The consultation involved the SME filling out an onboarding form and review of this information by an expert advisory committee using guided considerations, leading to a recommendation report provided to the SME. This paper reports on the characteristics of 25 SMEs who completed the program and qualitatively analyzed their recommendation reports to identify common barriers to digital health innovation. RESULTS A total of 2 central themes were identified, each with 3 subthemes. First, a common barrier to system integration was the lack of formal evaluation, with SMEs having limited resources and opportunities to conduct such an evaluation. Second, the health system’s current structure does not create incentives for clinicians to use digital technologies, which threatens the sustainability of SMEs’ business models. SMEs faced significant challenges in engaging users and payers from the public system due to perverse economic incentives. Physicians are compensated by in-person visits, which actively works against the goals of many digital health solutions of keeping patients out of clinics and hospitals. CONCLUSIONS There is a significant disconnect between the economic incentives that drive clinical behaviors and the use of digital technologies that would benefit patients’ well-being. To encourage the use of digital health technologies, publicly funded health systems need to dedicate funding for the evaluation of digital solutions and streamlined pathways for clinical integration.

scholarly journals Building health system resilience in the context of primary health care revitalization for attainment of UHC: proceedings from the Fifth Health Sector Directors’ Policy and Planning Meeting for the WHO African Region

2020 ◽  
Vol 14 (S19) ◽  
Author(s):  
Prosper Tumusiime ◽  
Humphrey Karamagi ◽  
Regina Titi-Ofei ◽  
Michelle Amri ◽  
Aminata Binetou Wahebine Seydi ◽  
...  
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
Health System ◽  
Health Systems ◽  
Health Sector ◽  
Health Systems Strengthening ◽  
Health Coverage ◽  
African Region ◽  
Health Service Provision ◽  
Primary Health

Abstract Background The recent 2018 Declaration of Astana recognized primary health care (PHC) as a means to achieve universal health coverage (UHC) and the health-related Sustainable Development Goals (SDGs). Following this declaration, country progress on operationalization of the PHC agenda and attainment of UHC has been stalled by the new challenges posed by the COVID-19 pandemic. The pandemic has also disrupted the continuity of essential health service provision and tested the resilience of the region’s health systems. Methods In accordance with this, the WHO Regional Office for Africa convened the Fifth Health Sector Directors’ Planning and Policy Meeting across the 47 Member States of the Region. The two-day forum focused on building health system resilience to facilitate service continuity during health threats, PHC revitalization, and health systems strengthening towards UHC. Results The Regional Forum provided evidence on building resilient health systems in the WHO African Region and engaged participants in meaningful and critical discussion. It is from these discussions that four key themes emerged: (1) working multisectorally/intersectorally, (2) moving from fragmentation to integration, (3) ensuring implementation and knowledge exchange, and (4) rethinking resilience and embracing antifragility. These discussions and associated groupings by thematic areas lend themselves to recommendations for the WHO. Conclusions This paper details the proceedings and key findings on building resilient health systems, the four themes that emerged from participant deliberation, and the recommendations that have emerged from the meeting. Deliberations from the Regional Forum are critical, as they have the potential to directly inform policy and program design, given that the meeting convenes health sector technocrats, who are at the helm of policy design, action, and implementation.

Health Systems Simulation

2008 ◽  
pp. 646-655 ◽  
Author(s):  
David Lyell ◽  
Rosemarie Sadsad ◽  
Andrew Georgiou
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Systems ◽  
Health Care System ◽  
System Simulation ◽  
Simulation Experiments ◽  
Dynamic Complexity ◽  
Randomised Control Trials ◽  
Underlying Causes ◽  
Systems Simulation

Most problems arising from the operation of the health system are studied and addressed using conventional reductionist methods, which reduce, isolate, and freeze aspects of the system at a given time. This fails to deal with the dynamic complexity inherent in the health system and which is often the source of the problem. The result is that all too often, well intentioned interventions make the original problem worse by failing to fully understand the complexities involved in the origin of a problem (Sterman, 2000). In this article, we introduce system simulation as a means of exposing the underlying causes and systemic structures of problems within the health care system, as well as providing a tool for assessing the likely impact of new interventions. The following sections will examine the advantages of simulation, areas of application, how simulation experiments can overcome some of the limitations of randomised control trials (RCTs), and various simulation methodologies as well as the challenges of conducting simulation experiments.

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