Public Hospitals in China

China has had some initial success in its current health care reform efforts. Five areas of reform have been targeted and include providing universal coverage, equitable access to basic health insurance, establishing an essential medicine system, and improving primary health care facilities. The last area, the reform of the public hospitals, remains the most difficult to reform. General guidelines have been established by the national government and movement is being taken to delegate authority to local units for implementation. The aim of this paper is to compare China's formal government sponsored health care reform plan for public hospitals to the acknowledgement and acceptance by a sample of health care leaders in Guangzhou. Challenges are strong and include cost accountability, doctor training, employee empowerment, improprieties, and the influence of private hospitals. Based on this qualitative research, conclusions and recommendations are made by the authors as to what is necessary to have effective pubic hospital reform in China.

A Framework to Analyze Variation of the Satisfaction of Patients for Outpatient Needs

This study explored outpatient healthcare seeking behavior in India and estimated predisposing and enabling factors that influenced the satisfaction derived from the health care activity. The study assumed that if these gaps are fulfilled in the local facilities, this might invigorate lesser popular public providers within the neighborhood. The study was conducted in the state of West Bengal India. A multilevel framework was developed to incorporate factors affecting the satisfaction of the healthcare activity. Analysis revealed dependency on regional facilities and extensive traveling. Excessive traveling affected satisfaction negatively whereas in cases where respondent availed services from local primary health centers had positive impact on satisfaction. On the route to daily activity, ability to visit referred facility and visit to facility with modern amenities often triggered satisfaction. Segmented policy designed to fulfill these preferences might be indispensable to enhance local sufficiency.

A Model of European Medicine Agency (EMA)'s Decisions on Human Medicines

This paper is aimed at examining the European medicine agency decisions in the field of human medicines. Different classes of human medicines approved in the last five years have been classified. They have been analyzed considering: i) the relation between non generic drugs and generic drugs, ii) time of approval, iii) objectives of the clinical trials, iv) criteria of efficiency, efficacy, safety. By using the Summary of the European Public Assessment Report for every human medicine in the period 2010-2015, a dataset has been arranged. A Structural Equation Model analysis was carried out. The degree of efficiency, the degree of safety, the tradeoff between efficiency and safety that lead to the EMA approval decisions are conditioned by the nature of the medicines and the characteristics of their class. Different degrees of benefits and risks underpinning the decisions have been identified together with the consequent guiding principles that lead to the EMA decision process. A latent general “safety” factor at the basis of EMA decision process was assessed.

Designing Measures for Managing the Effectiveness for Integrated Service Delivery

Health and social services are increasingly produced in cooperation among several specialized organizations. This has increased the importance of service integration in the sector. While the literature acknowledges the need for performance measurement addressing outcomes and effectiveness of service integration, not enough is known about applying such measurement practices. This paper examines the design of a performance measurement system to support the effectiveness management of an integrated service delivery. The research identifies three aspects of effectiveness – community, client and network level. Empirical examination reveals that success factors for design of measures for integrated service delivery include consensus on the targets, coordination and fluent cooperation among actors in the network. The paper contributes to performance measurement literature by illustrating how the design of system level measurement is carried out in practice and analyzing the lessons learned.

Re-Balancing the Roles of Public and Private Health Sectors in Wales

In 1989 the UK implemented a form of political devolution to Wales, Scotland and Northern Ireland such that certain public policy areas, including health, became the responsibility of devolved Parliament or Assemblies and not the London based Parliament and Government. In the case of Wales, the Welsh Government is faced with a series of daunting challenges in relation to the future provision of health care but, unlike the situation in England, has rejected any significant increase in the involvement of the private sector in health care provision. The magnitude of the challenges faced in coping with the impacts of financial austerity on the Welsh health budget suggest there may be a role for the private sector to play in relation to the provision of health care in Wales. This paper explores those potential roles concerning: the supply of services to the NHS in Wales, the supply of health services to the Welsh population and the financing of Welsh health services.

Public and Private Healthcare in Slovenia in Relation to Choice and Accessibility of Services

This article starts with background information on the Slovenian healthcare system and the description of the evolutionary process and privatisation reforms that bring a mix of public and private healthcare services. The authors' aim is to conceptualise existing modes of public and private healthcare provision and discuss possible implications for user choice and accessibility of services. A descriptive and exploratory case study approach was employed. Literature and document analysis was complemented by secondary data and semi-structured interviews. The results demonstrate four modes of healthcare services in relation to public-private delivery. The ‘public non-profit' type refers to publicly financed and delivered services. The ‘private within public' type addresses services provided within and by the public sector for patients who pay out-of-pocket. The ‘private for public' type deals with services provided by private entities with concessions. The ‘private for-profit' type refers to completely private provision (without concession) of self-pay services. The strengths and weaknesses of each mode with respect to choice, space-time accessibility, financial accessibility and quality of services are critically discussed. The results of the study show that private healthcare services significantly complement and compete with public sector. In addition, there is a risk that uncontrolled mixing of public and private modes of practice may bring about unethical behaviour and corruption.

Personal Budgets, Choice and Health

Personal or individual budgets for purchasing health and social care are intended to offer more choice, control and flexibility to service users when compared with agency-directed care. They are becoming an increasingly common feature in high-income countries for purchasing personal care that often lies on the border line between health and social care. In England, they have recently been introduced explicitly for the purchasing of health care. There are some key motivations behind their introduction: they are expected to give individuals more choice about care they receive; to expand options for care; to improve outcomes; and to reduce expenditure. This paper draws from a review of the international evidence on personal budgets which identified: descriptive detail on personal budget schemes in 11 OECD countries to examine their key features and implementation processes; empirical evidence on the experiences of, and outcomes for, people using these schemes, and; empirical evidence regarding the impact of the schemes on the healthcare system, particularly with regards to resources. The paper examines the motivating factors behind personal budget schemes in light of this evidence. It concludes that there is little in the evidence to suggest that international governments' expectations for personal budget programmes are well-founded. The assumptions that they improve choice, and that more choice will in turn lead to greater autonomy and then improved outcomes at lower cost, are actually far more complex and generally unsupported by evidence.

The End of Publicness?

When Wallace Sayre declared that ‘public and private organizations are alike in all unimportant respects' a quest began to establish the truth or otherwise of this assertion. Researchers have been investigating the topic for over sixty years. They have focused on two key questions; what is meant by a public or private organization? And what constitute ‘important respects' and ‘unimportant respects' respectively? This paper reviews current evidence relating to the testing of Sayre's statement, focusing on the healthcare sector. It is concluded that research has failed to provide unequivocal evidence that particular aspects of publicness impact aspects of organizational performance in particular ways. Sayre got it wrong; public and private organizations are alike in all important respects. It is argued that it is time to call a halt to publicness studies; what matters is management and organization, and it is on these issues that public organization researchers should now concentrate.

Reputation and Legitimacy

The aim of this study is to map the principal reputation risks and threats to legitimacy in the processes of organisational change among the three cases in question. The key focus is on the core aims and dilemmas associated with transformation into a municipal enterprise form. According to the results, isomorphic forces affect the institutional process in enhancing and diminishing the isomorphism, and in simultaneously creating dilemmas that pose a risk to the organisation’s reputation and threaten its legitimacy. The findings further highlight the need to investigate strategic dilemma management as a tool for controlling reputation risks and legitimacy in the management of change in the public-healthcare sector.

Health Expenditures in Latin America 1995-2010

The authors examine the trajectory of health expenditures in Latin American countries. The authors apply standard fixed effects and dynamic models to explore the factors associated with the growth of total health expenditures as well as its main components namely, government health expenditures and out-of-pocket payments. Their results suggest that, after taking other factors into consideration, health expenditures in general do not grow faster than the Gross National Product (GNP). The authors confirm the existence of fungibility, where external aid for health reduces government health spending and out-of-pocket expenses from domestic sources. The study also finds that government health expenditure and out-of-pocket payments follow the same paths in time but vary for countries at different levels of economic development; the same is true for health expenditure growth.