Improving hospital-based processes for effective implementation of Government funded health insurance schemes: evidence from early implementation of PM-JAY in India

Background Government-sponsored health insurance schemes (GSHIS) aim to improve access to and utilization of healthcare services and offer financial protection to the population. India’s Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY) is one such GSHIS. This paper aims to understand how the processes put in place to manage hospital-based transactions, from the time a beneficiary arrives at the hospital to discharge are being implemented in PM-JAY and how to improve them to strengthen the scheme’s operation. Methods Guidelines were reviewed for the processes associated with hospital-based transactions, namely, beneficiary authentication, treatment package selection, preauthorization, discharge, and claims payments. Across 14 hospitals in Gujarat and Madhya Pradesh states, the above-mentioned processes were observed, and using a semi-structured interview guide fifty-three respondents were interviewed. The study was carried out from March 2019 to August 2019. Results Average turn-around time for claim reimbursement is two to six times higher than that proposed in guidelines and tender. As opposed to the guidelines, beneficiaries are incurring out-of-pocket expenditure while availing healthcare services. The training provided to the front-line workers is software-centric. Hospital-based processes are relatively more efficient in hospitals where frontline workers have a medical/paramedical/managerial background. Conclusions There is a need to broaden capacity-building efforts from enabling frontline staff to operate the scheme’s IT platform to developing the technical, managerial, and leadership skills required for them. At the hospital level, an empowered frontline worker is the key to efficient hospital-based processes. There is a need to streamline back-end processes to eliminate the causes for delay in the processing of claim payment requests. For policymakers, the most important and urgent need is to reduce out-of-pocket expenses. To that end, there is a need to both revisit and streamline the existing guidelines and ensure adherence to the guidelines.

Launching an Online Business Program at Scale: A Retrospective Case Study of Disruptive Innovation Before the Pandemic

How does an online graduate business program become the fastest growing program in a short span of 5 years, in a category that has been showing constant decline in the last decade? This article takes a retrospective look at the journey from conception to launch and early implementation of an innovative online program at a large public university about half a decade before the pandemic. Extant research about online learning focuses on educational strategies, the changing roles of faculty in a new environment, or students’ satisfaction and performance in online learning programs or courses. This article takes a broad-based view to discuss details on the strategy, design, and development of a disruptive online graduate program built for scale. Given the accelerated transition into remote learning during the COVID-19 pandemic, our journey also has important implications from the forward-looking approach of half a decade ago for how higher education should navigate the digital future.

Design and Technology in Malaysian Secondary Schools: A Perspective on Challenges

Design and Technology (D&T) is a relatively new curriculum in Malaysian secondary schools. The basic idea of a design-based curriculum is to facilitate deeper learning for learners to design and develop knowledge and application. However, knowing how design-based education is employed in schools is crucially essential. Therefore, this study aimed to obtain insights into the D&T curriculum implementation from students and teachers’ viewpoints. The study involved semi-structured interviews with four teachers and five secondary school students. Interviews were transcribed verbatim, while conclusions were drawn based on theme analysis. The findings indicated that students and teachers recognised the purpose and direction of the D&T curriculum. Nevertheless, challenges exist in various aspects, as the subject is still in the early implementation stages. Challenges such as teachers’ knowledge and skills, students’ lack of understanding in abstract topics and insufficient facilities, equipment, and resources offer opportunities for researchers to explore relevant approaches to assist teachers and students in teaching and learning. Previous studies demonstrated the effectiveness of technology-assisted interventions to ease and overcome problems involving cost and time constraints. Thus, suitable technology-assisted strategies should be developed and utilised to facilitate the students’ abstract details visualisation in technological application topics.

Aripiprazole in young people with early psychosis: a systematic review and meta-analysis of weight gain

Objective: Aripiprazole is often prescribed to young people, although there remain unanswered questions about its effects on weight gain. This study undertook a meta-analysis of weight gain occurring in young people with early psychosis who were prescribed aripiprazole. Method: A systematic search was conducted for studies reporting on aripiprazole and weight change in young people with a psychotic disorder. A meta-analysis integrated the data into an estimate of effect size. Results: Eleven studies met the inclusion criteria amounting to 886 participants (mean age 18 years). The results showed significant weight gain averaging 2.7 kg. These increases were associated with a longer duration of exposure to aripiprazole but not a higher dosage. Conclusions: The results highlight the importance of regular patient monitoring and the early implementation of interventions to manage antipsychotic-related weight gain.

Combining a Being Imitated Strategy With IBT Improves Basic Joint Attention Behaviors in Young Children With ASD

In the present study, we examined how an initial being imitated (BIm) strategy affected the development of initiating joint attention (IJA) among a group of children newly diagnosed with autism spectrum disorder (ASD). One group received 3 months of BIm followed by 12 months of intensive behavior treatment (IBT) which equaled treatment as usual whereas a second group received IBT for the entire 15-month study period. We utilized two measures of IJA: an eye gaze and a gesture score (point and show). IJA did not change during the first 3 months of treatment, nor were any significant between-group differences noted. However, at the end of the 15-month-long intervention period, the BIm group used eye gaze significantly more often to initiate joint attention. No significant change was noted for the gesture score. These results suggest that an early implementation of a being imitated strategy might be useful as less resource intensive but beneficial “start-up” intervention when combined with IBT treatment as a follow-up.

Epidemiological waves - types, drivers and modulators in the COVID-19 pandemic

Introduction: A discussion of 'waves' of the COVID-19 epidemic in different countries is a part of the national conversation for many, but there is no hard and fast means of delineating these waves in the available data and their connection to waves in the sense of mathematical epidemiology is only tenuous. Methods: We present an algorithm which processes a general time series to identify substantial, significant and sustained periods of increase in the value of the time series, which could reasonably be described as 'observed waves'. This provides an objective means of describing observed waves in time series. Results: The output of the algorithm as applied to epidemiological time series related to COVID-19 corresponds to visual intuition and expert opinion. Inspecting the results of individual countries shows how consecutive observed waves can differ greatly with respect to the case fatality ratio. Furthermore, in large countries, a more detailed analysis shows that consecutive observed waves have different geographical ranges. We also show how waves can be modulated by government interventions and find that early implementation of non-pharmaceutical interventions correlates with a reduced number of observed waves and reduced mortality burden in those waves. Conclusion: It is possible to identify observed waves of disease by algorithmic methods and the results can be fruitfully used to analyse the progression of the epidemic.

Expert Views on COVAX and Equitable Global Access to COVID-19 Vaccines

Objectives: We face the impossibility of having enough COVID-19 vaccines for everyone in the near future. This study aims to contribute to the debate on equitable global access to COVID-19 vaccines, tackling key ethical discussions and policy challenges regarding early phases of COVAX, the global cooperation mechanism for supporting fair vaccine allocation.Methods: We conducted in-depth interviews with twelve experts and a literature research on academic articles, media sources and public statements. We built a data analysis matrix and conducted a thematic analysis.Results: Our findings show, first, that interviewed experts who hold different views on vaccine allocation, including moderate nationalist perspectives, agree on joining a global cooperation mechanism. Second, incentives to join COVAX vary greatly among countries. Third, specific barriers to COVAX emerged in the early implementation phase. And fourth, countries might be trapped in a zero-sum game regarding the global vaccine supply.Conclusion: We present findings that enrich analyses of early phases of COVAX (April 2020–21), we introduce three ethical discussions that provide a common ground for equitable access to COVID-19 vaccines, and we highlight policy challenges.

Evaluating Implementation of the Behavioral Recovery Outreach (BRO) Team: One Year of Implementation

We present evaluation results after one year of implementation by nine BRO Teams. Monthly checklists documented consistent composition across teams: a psychologist, social worker and nurse. Social workers were recognized as having a critical role in implementation, serving as a referral source and liaison between the CLC, Veteran/family, and community facility. Early implementation focused on team and program development with barriers including unprotected time for Team members. In the first year, the nine teams enrolled 70 Veterans, discharging 86% to community facilities. Characteristics of the Veterans suggest Teams are reaching the complex Veteran targeted by the model. Barriers to successful discharge include community facility inexperience/training and confidence to manage complex residents. COVID emerged as the leading barrier to outreach to internal and external partners and providing transitional support to the Veteran after discharge. We discuss the impact of these preliminary findings on future implementation and dissemination of the model.