Market-Based Governance in Public Healthcare Delivery

This chapter analyses the market-based reforms introduced in the UK. From 1979 onwards, it is clear that market governance has been central in the delivery of public healthcare services in the UK. The move towards using private sector techniques to run public health services has been reinforced over the last few decades, and New Public Management (NPM) reforms have often been more pronounced than in many other European countries. The chapter considers how public health services have been reconfigured within the changing boundaries between the state and its citizens. The government still continues to play a major role in the running of health services and decision making, even in the new configuration of public health services and the extension of informal networks, but health policy is also now formulated through a variety of different actors. This chapter will finish by presenting how healthcare is organised today in the UK following these reforms.

2014 ◽  
Vol 1 (2) ◽  
Author(s):  
Hiral Sheth

The new challenges of globalisation have made it essential to achieve and sustain a high level of efficiency in the provision of healthcare. Even though the Government of Maharashtra clearly views assuring efficiency and providing public health services to the people as an important policy objective, data reveals that the amount of resources spent on public healthcare especially public hospitals is very meagre as compared to the needs of the population. This study attempts to understand the shift from public to the private health sector by the users of health services in the city of Mumbai. This changing trend towards increasing use of private hospitals for healthcare services was analysed to understand the specific reasons behind the privatisation of health services in this metropolitan city. Using primary survey, the analysis revealed that majority of the users preferred private hospital services due to various reasons like cleanliness, better infrastructure, efficient and competent doctors and other staff. The results also indicated significant inefficiencies in the functioning of the public hospitals as noted from the responses of the users.


2020 ◽  
Vol 14 (1) ◽  
pp. 17-28
Author(s):  
Ditha Prasanti ◽  
Ikhsan Fuady ◽  
Sri Seti Indriani

The "one data" policy driven by the government through the Ministry of Health is believed to be able to innovate and give a new face to health services. Of course, the improvement of health services starts from the smallest and lowest layers, namely Polindes. Starting from this policy and the finding of relatively low public health service problems, the authors see a health service in Polindes, which contributes positively to improving the quality of public health services. The health service is the author's view of the communication perspective through the study of Communication in the Synergy of Public Health Services Polindes (Village Maternity Post) in Tarumajaya Village, Kertasari District, Bandung Regency. The method used in this research is a case study. The results of the study revealed that public health services in Polindes are inseparable from the communication process that exists in the village. The verbal communication process includes positive synergy between the communicator and the communicant. In this case, the communicators are village midwives, village officials, namely the village head and his staff, the sub-district health center, and the active role of the village cadres involved. In contrast, the communicant that was targeted was the community in the village of Tarumajaya. This positive synergy results in a marked increase in public services, namely by providing new facilities in the village, RTK (Birth Waiting Home).   Kebijakan “one data” yang dimotori oleh pemerintah melalui Kementerian kesehatan diyakini mampu membuat inovasi dan memberikan wajah baru terhadap layanan kesehatan. Tentunya, perbaikan layanan kesehatan tersebut dimulai dari lapisan terkecil dan terbawah yakni Polindes. Berawal dari kebijakan tersebut dan masih ditemukannya masalah pelayanan kesehatan publik yang relatif rendah, penulis melihat sebuah layanan kesehatan di Polindes, yang memberikan kontribusi positif dalam peningkatan kualitas layanan kesehatan masyarakat. Pelayanan kesahatan tersebut penulis lihat dari perpektif komunikasi melaui penelitian Komunikasi dalam Sinergi Pelayanan Kesehatan Publik Polindes (Pos Bersalin Desa) di Desa Tarumajaya, Kecamatan Kertasari, Kabupaten Bandung ini dilakukan. Metode yang digunakan dalam penelitian ini adalah studi kasus. Hasil penelitian mengungkapkan bahwa pelayanan kesehatan publik di Polindes, tidak terlepas dari adanya proses komunikasi yang terjalin di desa tersebut. Proses komunikasi verbal tersebut meliputi sinergitas positif antara pihak komunikator dan komunikan. Dalam hal ini, komunikator tersebut adalah Bidan Desa, Aparat Desa yakni Kepala Desa beserta staffnya, Puskesmas tingkat kecamatan, serta peran aktif dari para kader desa yang terlibat. Sedangkan komunikan yang menjadi target adalah masyarakat di desa Tarumajaya. Sinergitas positif tersebut menghasilkan peningkatan pelayanan publik yang nyata, yaitu dengan adanya penyediaan fasilitas baru di desa, RTK (Rumah Tunggu Kelahiran).


Author(s):  
Raymond K. H. Chan

Hong Kong's public health services gradually developed since the 1950s. They are mainly funded by taxes, supplemented by minimal user fees. In the late 1980s, the government recognized the limitations of this financing model and has subsequently proposed alternative methods of funding. Their proposals have been rejected by various stakeholders, who represent different, and even conflicting, values and interests; and eventually can only end up with a limited voluntary health insurance scheme. This chapter describes the development of health services and the debates that have surrounded health financing since the late 1980s. It shows that the health finance debate in Hong Kong is not a simple issue that can be tackled by rational planning; instead, it is a complex consequence of welfare politics in an increasingly mobilized society.


Author(s):  
S. M. A. Hanifi ◽  
Aazia Hossain ◽  
Asiful Haidar Chowdhury ◽  
Shahidul Hoque ◽  
Mohammad Abdus Selim ◽  
...  

Abstract Background The government of Bangladesh initiated community clinics (CC) to extend the reach of public health services and these facilities were planned to be run through community participation. However, utilisation of CC services is still very low. Evidence indicates community score card is an effective tool to increase utilisation of services from health facility through regular interface meeting between service providers and beneficiary. We investigated whether community scorecards (CSC) improve utilisation of health services provided by CCs in rural area of Bangladesh. Methods This study was conducted from December 2017 to November 2018. Three intervention and three control CCs were selected from Chakaria, a rural sub-district of Bangladesh. CSC was introduced with the Community Groups and Community Support Groups in intervention CCs between January to October 2018. Data were collected through observation of CCs during operational hours, key informant interviews, focus group discussions, and from DHIS2. Utilisation of CC services was compared between intervention and control areas, pre and post CSC intervention. Results Post CSC intervention, community awareness about CC services, utilisation of clinic operational hours, and accountability of healthcare providers have increased in the intervention CCs. Utilisation of primary healthcare services including family planning services, antenatal care, postnatal care and basic health services have significantly improved in intervention CCs. Conclusion CSC is an effective tool to increase the service utilization provided by CCs by ensuring community awareness and participation, and service providers’ accountability. Policy makers and concerned authorities may take necessary steps to integrate community scorecard in the health system by incorporating it in CCs.


Author(s):  
Raymond K. H. Chan

Hong Kong's public health services gradually developed since the 1950s. They are mainly funded by taxes, supplemented by minimal user fees. In the late 1980s, the government recognized the limitations of this financing model and has subsequently proposed alternative methods of funding. Their proposals have been rejected by various stakeholders, who represent different, and even conflicting, values and interests; and eventually can only end up with a limited voluntary health insurance scheme. This chapter describes the development of health services and the debates that have surrounded health financing since the late 1980s. It shows that the health finance debate in Hong Kong is not a simple issue that can be tackled by rational planning; instead, it is a complex consequence of welfare politics in an increasingly mobilized society.


2016 ◽  
Vol 20 (1) ◽  
pp. 121
Author(s):  
Débora Holanda Leite Menezes ◽  
Janete Luzia Leite

Este texto discute as mudanças na gestão dos serviços públicos de saúde no Brasil a partir de 1990. Objetiva analisar como, ao longo dos últimos 30 anos, estes serviços perdem seu caráter público e universal, assumindo um cariz privatista. A metodologia conta com uma revisão bibliográfica e um estudo sobre o funcionamento da rede pública de saúde do Rio de Janeiro – locus privilegiado devido ao grande número de unidades de saúde, e pela rápida adesão de seus governantes aos novos modelos de gestão. Conclui que os maiores prejuízos da adoção destes modelos recairão sobre a população pobre, que depende dos serviços públicos de saúde. Ademais, a precarização das condições de trabalho e salário dos profissionais de saúde também deriva sobremaneira de um modelo que desconhece o valor da vida e da saúde, posto que este bem comum representa só mais uma mercadoria. Quem não paga, não tem. Palavras-chave: Serviços de saúde, Privatização, Novos modelos de gestão, Rio de Janeiro.THE NEW CONFIGURATION OF HEALTH POLICY IN BRAZIL: Rio de Janeiro as a Laboratory Abstract: This text discusses the changes in the management of public health services in Brazil since 1990. It aims to analyze how, over the last 30 years, these services lose their public and universal character, assuming a privatized nature. The methodology includes a literature review and a study on the functioning of the public healthcare system of Rio de Janeiro - privileged locus because of the number of health facilities, and the rapid accession of their rulers to new management models. It concludes that the biggest losses of the adoption of these models will fall on the poor, who depend on public health services. Furthermore, the precarious working conditions and salaries of health professionals also comes on way to a model that ignores the value of life and health, since this common good is just another commodity. Who does not pay, do not have. Key word: Health services, Privatization, New management models, Rio de Janeiro.


2021 ◽  
Author(s):  
Ben Kasstan ◽  
Sandra Mounier-Jack ◽  
Louise Letley ◽  
Katherine M Gaskell ◽  
Chrissy H Roberts ◽  
...  

AbstractEthnic and religious minorities have been disproportionately affected by the SARS-CoV-2 pandemic and are less likely to accept coronavirus vaccinations. Orthodox (Haredi) Jewish neighbourhoods in England experienced high incidences of SARS-CoV-2 in 2020-21 and measles outbreaks (2018-19) due to suboptimal childhood vaccination coverage. The objective of our study was to explore how the coronavirus vaccination programme (CVP) was co-delivered between public health services and an Orthodox Jewish health organisation.Methods included 28 semi-structured interviews conducted virtually with public health professionals, community welfare and religious representatives, and household members. We examined CVP delivery from the perspectives of those involved in organising services and vaccine beneficiaries. Interview data was contextualised within debates of the CVP in Orthodox (Haredi) Jewish print and social media. Thematic analysis generated five considerations: i) Prior immunisation-related collaboration with public health services carved a role for Jewish health organisations to host and promote coronavirus vaccination sessions, distribute appointments, and administer vaccines ii) Public health services maintained responsibility for training, logistics, and maintaining vaccination records; iii) The localised approach to service delivery promoted vaccination in a minority with historically suboptimal levels of coverage; iv) Co-delivery promoted trust in the CVP, though a minority of participants maintained concerns around safety; v) Provision of CVP information and stakeholders’ response to situated (context-specific) challenges and concerns.Drawing on this example of CVP co-delivery, we propose that a localised approach to delivering immunisation programmes could address service provision gaps in ways that involve trusted community organisations. Localisation of vaccination services can include communication or implementation strategies, but both approaches involve consideration of investment, engagement and coordination, which are not cost-neutral. Localising vaccination services in collaboration with welfare groups raises opportunities for the on-going CVP and other immunisation programmes, and constitutes an opportunity for ethnic and religious minorities to collaborate in safeguarding community health.


2019 ◽  
Author(s):  
Katie Wright-Bevans ◽  
Alison Stephanie Walker ◽  
Emma Vosper

In order to be age-friendly, communities need adequate public health support. Community consultation is increasingly favoured as a means of ensuring public health services adequately meet the needs of the populations they serve yet research has highlighted the frequency of inadequate and tokenistic consultation. Our aim was to address the gap in understanding of the subjective benefits of community consultation by being the first study to examine these events in a disadvantaged British city. A naturalistic world café study was co-designed with a community engagement service in the UK. Adults aged 68 to 91 years (n=103) participated in one of two world cafés which aimed to investigate the subjective benefits of consultation forums. Qualitative findings demonstrated how consultation through forums can support age-friendly communities in a variety of expected and unexpected ways. Understanding of the added value of consultation forums may incentivise service providers to facilitate more meaningful consultation.


Author(s):  
Louise Dalingwater

This chapter differs somewhat in its approach to governance issues compared with the previous chapters as it goes beyond the national framework. In essence, the national and sub-national issues at stake do not quite capture the full picture when considering the future challenges of the provision of public healthcare services in the UK. This chapter looks at healthcare service exchanges across borders. Indeed, there has been a significant expansion of services trade, and in particular health services, which have grown not only thanks to a number of institutional frameworks but also to the support of the British government and health stakeholders. However, there are also a number of risks involved in the international exchange of health services, which can have a significant impact on public healthcare systems.


2019 ◽  
Vol 4 (3) ◽  
pp. e001162 ◽  
Author(s):  
Gunjan Taneja ◽  
Vegamadagu Suryanarayana-Rao Sridhar ◽  
Jaya Swarup Mohanty ◽  
Anurag Joshi ◽  
Pranav Bhushan ◽  
...  

Building on the gains of the National Health Mission, India’s Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) Strategy, launched in 2013, was a milestone in the country’s health planning. The strategy recognised the interdependence of RMNCH+A Interventions across the life stages and adopted a comprehensive approach to address inequitable distribution of healthcare services for the vulnerable population groups and in poor-performing geographies of the country. Based on innovative approaches and management reforms, like selection of poor-performing districts, prioritisation of high-impact RMNCH+A healthcare interventions, engagement of development partners and institutionalising a concurrent monitoring system the strategy strived to improve efficiency and effectiveness within the public healthcare delivery system of the country. 184 High Priority Districts were identified across the country on a defined set of indicators for implementation of critical RMNCH+A Interventions and a dedicated institutional framework comprising National and State RMNCH+A Units and District Level Monitors supported by the development partners was established to provide technical support to the state and district health departments. Health facilities based on case load and available services across the High Priority Districts were prioritised for strengthening and were monitored by an RMNCH+A Supportive Supervision mechanism to track progress and generate evidence to facilitate actions for strengthening ongoing interventions. The strategy helped develop an integrated systems-based approach to address public health challenges through a comprehensive framework, defined priorities and robust partnerships with the partner agencies. However, lack of a robust monitoring and evaluation framework and sub-optimal focus on social determinants of health possibly limited its overall impact and ability to sustain improvements. Guided by the learnings and limitations, the Government of India has now designed the ‘Aspirational Districts Program’ to holistically address health challenges in poor-performing districts within the overall sociocultural domain to ensure inclusive and sustained improvements.


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