Whether Public Hospital Reform Affects the Hospital Choices of Patients in Urban Areas: New Evidence from Smart Card Data

The effects of public hospital reforms on spatial and temporal patterns of health-seeking behavior have received little attention due to small sample sizes and low spatiotemporal resolution of survey data. Without such information, however, health planners might be unable to adjust interventions in a timely manner, and they devise less-effective interventions. Recently, massive electronic trip records have been widely used to infer people’s health-seeking trips. With health-seeking trips inferred from smart card data, this paper mainly answers two questions: (i) how do public hospital reforms affect the hospital choices of patients? (ii) What are the spatial differences of the effects of public hospital reforms? To achieve these goals, tertiary hospital preferences, hospital bypass, and the efficiency of the health-seeking behaviors of patients, before and after Beijing’s public hospital reform in 2017, were compared. The results demonstrate that the effects of this reform on the hospital choices of patients were spatially different. In subdistricts with (or near) hospitals, the reform exerted the opposite impact on tertiary hospital preference compared with core and periphery areas. However, the reform had no significant effect on the tertiary hospital preference and hospital bypass in subdistricts without (or far away from) hospitals. Regarding the efficiency of the health-seeking behaviors of patients, the reform positively affected patient travel time, time of stay at hospitals, and arrival time. This study presents a time-efficient method to evaluate the effects of the recent public hospital reform in Beijing on a fine scale.

Forecasting daily confirmed COVID-19 cases in Algeria using ARIMA models

ABSTRACTCoronavirus disease has become a worldwide threat affecting almost every country in the world. The aim of this study is to identify the COVID-19 cases (positive, recovery and death) in Algeria using the Double Exponential Smoothing Method and an Autoregressive Integrated Moving Average (ARIMA) model for forecasting the COVID-19 cases.The data for this study were obtained from March 21st, 2020 to November 26th, 2020. The daily Algerian COVID-19 confirmed cases were sourced from The Ministry of Health, Population and Hospital Reform of Algeria. Based on the results of PACF, ACF, and estimated parameters of the ARIMA model in the COVID-19 case in Algeria following the ARIMA model (0,1,1). Observed cases during the forecast period were accurately predicted and were placed within the prediction intervals generated by the fitted model. This study shows that ARIMA models with optimally selected covariates are useful tools for monitoring and predicting trends of COVID-19 cases in Algeria.

The Effects of County Public Hospital Reform on the Consumption and Costs of Antibiotics: Evidence from a Quasinatural Experiment in Jiangsu, China

Background. Overuse of antibiotics is a major driver for rapid spread of antimicrobial resistance worldwide, particularly common in China. The close linkage between hospital revenue and sales of drugs has become the key incentive for overprescription of antibiotics. Since 2009, the Chinese government implemented a series of measures to cut off the link, including removing the markup of drugs, increasing financial subsidies, and adjusting charges for medical service. Objective. To evaluate the impacts of county public hospital reform on the consumption and costs of procured antibiotics in Jiangsu province. Methods. A quasiexperiment design was conducted in Jiangsu province where 99 county public hospitals implemented the reform successively in different periods. Of these, 37 county public hospitals implemented the reform since January 2013, which were regarded as the intervention group, and the remaining 62 hospitals were included in the control group. A difference-in-differences (DID) analysis with generalized linear regressions was used on the procurement records of antibiotics from January 2012 to December 2013. Modified Park test was used for family distribution and Box–Cox test for log link. Placebo tests were employed to test the common-trend hypothesis of two groups. Results. For the intervention group, the average volume of procured restricted antibiotics and injectable antibiotics increased by 24.12% and 2.75% while the costs increased by 19.01% and 9.09%, respectively. The average costs per DDD of restricted and injectable antibiotics were much higher than unrestricted and oral antibiotics. The DID results showed that the reform had a positive impact on the average volume ( p = 0.005 ) and costs ( p = 0.001 ) of nonrestricted antibiotics. In addition, the implementation of the reform was associated with a reduction in volume ( p = 0.031 ) and costs ( p = 0.043 ) of procured oral antibiotics. The reform also contributed to an increase in average costs per DDD of total antibiotics ( p = 0.049 ). Conclusions. The reform is effective in reducing the consumption and costs of unrestricted and oral antibiotics, but it has failed to reduce the consumption and costs of expensive restricted and injectable antibiotics, leading to increased burden of diseases. It is critical that the health policy initiatives can deincentivize overuse of antibiotics at both hospital and individual physician’s levels. The reform should enforce government financial support, improve hospital governance, optimize performance evaluation, and establish specialized management approach for antibiotic use.

Analysis of the political process of Denmark’s hospital reform

Background The German hospital landscape is characterized by a decentralization of the range of services provided, low levels of specialization and significant overcapacity. This leads to over-, under- and misuse of hospital care, which is not least evidenced by wide variation in quality in the system. In Denmark, since the early 2000s, a continuous restructuring of the hospital landscape has been undertaken. Among other things, hospitals have been rebuilt, many smaller hospitals have closed and the number of emergency rooms has been halved. The aim of the project K:IDD (Hospital: Impulses for Germany from Denmark) is to examine the conditions that have to be created to be able to incorporate parts of the Danish reform into German hospital care, and to leverage these for improved patient care. To learn from the case of Denmark, it is important to understand which circumstances facilitated the reform. Methods To analyse the political process behind Denmark's hospital reform using two different sources will be used: (1) A qualitative content analysis of 17 semi-structured expert interviews with political scientists, journalists, politicians, among others and (2) an analysis of the literature about the reform. Kingdon's (1994) multiple stream framework as well as Tsebelis' (1995) Veto-player theory will be used. Results The key success factors encouraging to the reform will be presented. In addition potential Veto-Players and institutional settings enabling or hindering the reform will be described. The final assessment of the policy process and comparison to the German context will lead to implementation guidance and recommendations for the German context. Further, alternative courses of action will be presented. Conclusions The findings from this analysis can provide important and practical recommendations for the necessary reform of the hospital landscape in Germany, thereby improving hospital care in the long term. Key messages The hospital reform in Denmark was possible due to the interaction of different social currents, which ultimately opened a window of opportunity. This could be used as role model for decision-makers, professionals and researchers strive for change in other countries.

The Question of Francia (400–816)

The consistency of the character of hospitals in law, as observed in Chapter 2, suggests a customary legal inheritance that preceded classical canon law. Part II turns now to the early middle ages to discover that inheritance. This chapter begins that process by unpicking the long-held model of the early medieval hospital. It surveys the many hypotheses for the origins of hospital law in the West, which claim that hospital law adopted from the East and accommodated via Frankish councils. The chapter confronts the latter of these claims and re-examines its twin pillars: a legal formula of ‘murderers of the poor’ (necator pauperum) and a hospital reform at Aachen (816). The first hinges on the council of Orléans (549), whose efforts were aimed at one royal foundation, King Childebert and Queen Ultrogotha’s xenodochium at Lyons. The council of Aachen’s (816) rules for canons and canonesses prescribed a way of common life for these religious, with different facilities for each for the poor. The chapter argues that the efforts of both councils were singular, and carefully circumscribed. Frankish councils were not to take an interest in xenodochia until c.850. Legal initiatives regarding hospitals began elsewhere.

Robert de Courson and the Northern Reformers

This chapter, the first study of hospital reform under papal legate Robert de Courson, offers a new picture of the legation in preparation for Lateran IV. Courson’s hospital decree is well-known from his councils of Paris (1213) and Rouen (1214). The chapter begins by exploring the origins of the decree, finding that it did not emerge from Courson’s own moral theology, nor from the Parisian theological circle of which he was a leading member. Documentary evidence reveals an earlier iteration of the same decree and unearths a lost first council under Courson, at Reims (1213). Further investigation reveals that the legation was not launched at Paris, as has always been assumed, but with a preaching tour of Flanders and Brabant in June 1213, followed by the council at Reims. The new geography offers a new source for the hospital reform, which is explored through the spread of hospital rules, westward out of Brabant, in the late twelfth and early thirteenth century. It argues, finally, that the reform was closely tied to the beguine movement and, especially, to Jacques de Vitry. After Courson’s council at Rouen (1214), it was not adopted at any other council, including Lateran IV.

Psychiatric hospital reform in low-income and middle-income countries Structured Individualised inTervention And Recovery (SITAR): a two-arm pragmatic randomised controlled trial study protocol

IntroductionLow-income and middle-income settings like India have large treatment gaps in mental healthcare. People with severe mental disorders face impediments to their clinical and functional recovery, and have large unmet needs. The infrastructure and standards of care are poor in colonial period psychiatric hospitals, with no clear pathways to discharge and successfully integrate recovered individuals into the community. Our aim is to study the impact of psychiatric hospital reform on individual patient outcomes in a psychiatric hospital in India.Methods and analysisStructured Individualised inTervention And Recovery (SITAR) is a two-arm pragmatic randomised controlled trial, focusing on patients aged 18–60 years with a hospital stay of 12–120 months and a primary diagnosis of psychosis. It tests the effectiveness of structural and process reform with and without an individually tailored recovery plan on patient outcomes of disability (primary outcome WHO Disability Assessment Scale), symptom severity, social and occupational functioning and quality of life. A computer-generated permuted block randomisation schedule will allocate recruited subjects to the two study arms. We aim to recruit 100 people into each trial arm. Baseline and outcome measures will be undertaken by trained researchers independent to the case managers providing the individual intervention. A health economic analysis will determine the costing of implementing the individually tailored recovery plan.Ethics and disseminationThe study will provide answers to important questions around the nature and process of reforms in institutional care that promote recovery while being cognizant of protecting human rights, and dignity. Ethical approval for SITAR was obtained from a registered ethics committee in India (Institutional Ethics Committee VikasAnvesh Foundation, VAF/2018-19/012 dated 6 December 2018) and the University of Warwick’s Biomedical and Scientific Research Ethics Committee (REGO-2019–2332, dated 21 March 2019), and registered on the Central Trial Registry of India (CTRI/2019/01/017267). Trial results will be published in accordance to CONSORT guidelines.