Could Patient Engagement Promote a Health System Free From Malpractice Litigation Risk?

In recent decades, medical malpractice litigation experienced a large-scale expansion in the United States as well as in Europe, involving both medical and surgical specialties. Previous studies have investigated the reasons why patients decide to sue doctors for malpractice and highlighted that adverse outcome, negative communication with doctors and seeking compensation are among the major reasons for malpractice litigation. In this chapter, patient engagement is discussed as a possible method for reducing the risks of doctors being sued for medical malpractice. The results of a first qualitative study underline how an active role for patients and their engagement in the treatment definition and execution could be a way to limit the occurrence of malpractice litigations. However, a second study noted that in Italy, many patients are still struggling to become involved in the process of their care. The authors discuss the role of professional education in promoting patient engagement in Italy.

The Administrative Policy Quandary in Canada's Health Service Organizations

This chapter examines the process for administrative health service policy development with respect to information sharing and decision-making as well as the relationship of policy to decision making. The challenges experienced by health service managers are identified. The administrative health policy experience in Nova Scotia is described. There is a need for integrated policy at multiple levels (public, clinical, and administrative). The quandary is that while working to share health information systems, most Canadian health service organizations continue to individually develop administrative health policy, expending more resources on policy writing than on translation/education, monitoring, or evaluation. By exploring the importance and nature of administrative policy as a foundation for quality improvement in healthcare delivery, a case is made for greater use of health informatics tools and processes.

From the Margins to the Mainstream

Healthcare system performance needs information on cost and revenue of care because of the rising healthcare costs. Empowering clinicians with clinical costing information is central to the success of containing costs. This information holds clinical data linkage unifying clinical, financial and administrative datasets, and seems to facilitate the spending of scarce health care resources in a way that produces the biggest difference in clinical outcomes. This chapter looks at the methodology and processes of clinical costing and its potential applications to facilitate the delivery of value-based healthcare, which confers quality care at lowest unit cost. Policy implications would be purchasing value-based healthcare, based mostly on quality of care after removing avoidable costs for inefficiency and poor quality. Clinician participation in the clinical costing is the key to success, because clinicians will be informed of the options available to choose the most value-based healthcare, which will, in turn, take care of the tight healthcare budget. Yet, this method of clinical costing is still at the margins.

Linking Cost Control to Cost Management in Healthcare Services

The issue of healthcare costs has become increasingly problematic over the years. This chapter summarizes the problems faced by hospitals when measuring the costs of healthcare treatments, explaining how an Activity-Based Costing (ABC) framework can be successfully adopted in healthcare settings. After describing the theoretical foundations of cost control and cost management, the chapter continues with the analysis of three real-life applications of ABC in a hospital, drawn from the process analysis and activity-based costing experience developed at the Azienda Ospedaliero-Universitaria “Ospedali Riuniti” (Joint Hospitals) of Trieste, Italy. In particular, the cases are about cost measurement in cardiology, odontostomatology, and radiology, and describe the technical solutions applied for computing the costs of selected therapeutic and diagnostic treatments. A particular emphasis is placed on how these measures have been subsequently used by hospital managers and medical personnel in order to gain insights and to improve the efficiency of the processes developed within the organization.

The Impact of the New Rural Cooperative Medical Scheme on Township Hospitals' Utilization and Income Structure in Weifang Prefecture, China

The New Rural Cooperative Medical Scheme was gradually introduced from 2003 in China. This paper is based on a representative survey of 24 randomly selected township hospitals in Weifang prefecture over the period 2000-2008. Using a generalized form of differences-in-differences model, it aims to assess the effect of the reform on the utilization and income structure of the township hospitals. The estimations provide three main results linked to the effects of the New Rural Cooperative Medical Scheme on the behavior of the key stakeholders (households, health care providers and Health Bureau). Firstly, the reform had positive impacts on the utilization of township hospitals, particularly on the inpatient activity, but no significant impact on their income structure. Secondly, a decrease in the burden of hospitalization costs for households is suggested by the higher positive impact of the reform on the volume of inpatients in poor areas than in the other ones. Lastly, the marginal impact of the reform decreases over time.

Customer Value Dimensions in E-Healthcare Services

Healthcare services have been extensively researched for customer value creation activities. There has been, however, limited attention on the dimensions of customer value, as reported by customers themselves, in e-healthcare services. The purpose of this paper is to investigate customer value dimensions in which customers experience e-healthcare services. Narrative techniques were used to investigate customer experiences of e-healthcare services offered by eight private Finnish providers. The findings show that customers evaluate e-healthcare services in four value dimensions: 1) The outcome of e-healthcare service (‘What'), 2) The process of e-healthcare service (‘How'), 3) The responsiveness and temporal aspect of e-healthcare service (‘When'), and, 4) The location of e-healthcare service provision (‘Where'). The value dimensions reflect customer expectations that service providers can fulfill for improved customer value creation. To the best of the authors' knowledge, this study is one of the first researches to investigate customer value dimensions in e-healthcare services in Finland.

Telemedicine and Electronic Health

This chapter reveals the overview of telemedicine; telemedicine in developing countries; Electronic Health Record (EHR); and mobile health technologies. Telemedicine and Electronic Health (e-health) are modern technologies toward improving quality of care and increasing patient safety in developing countries. Telemedicine and e-health are the utilization of medical information exchanged from one site to another site via electronic communications. Telemedicine and e-health help health care organizations share data contained in the largely proprietary EHR systems in developing countries. Telemedicine and e-health help reduce the cost of health care and increases the efficiency through better management of chronic diseases, shared health professional staffing, reduced travel times, and shorter hospital stays. The chapter argues that utilizing telemedicine and e-health has the potential to enhance health care performance and reach strategic goals in developing countries.

A Simulation Framework for Evaluating the Effectiveness of Chronic Disease Management Interventions

The treatment and management of chronic diseases currently comprise a major fraction of the United States' healthcare expenditures. These expenses are projected to increase as the US population ages. Utilization of the ambulatory healthcare system stemming from chronic conditions has been seen as contributory factor in the rising expenditures. Efforts to better manage chronic conditions ought to result in better health outcomes and, by extension, savings through lower utilization of ambulatory services. The longer-term financial consequences of such interventions, however, are more uncertain. This study offers a System Dynamics simulation framework that identifies and models the critical relationships associated with health outcomes and longer-term financial consequences. This framework is demonstrated through a comparison between groups with a similar generic chronic condition, but one group is subjected to a management intervention and the other group is not. The framework provides constructive insights into how the initial intervention cost estimates, the resulting savings, and the health status may change depending on uncertainties, feedback effects, and cost structures.

Demand for Health Care in Kenya

Although studies on health care demand have previously been conducted in Kenya and elsewhere in Africa, it has hitherto not been shown how health seeking behavior conditional on illness is affected by information on health care quality and by quality variation conditional on that information. This study develops and tests the hypothesis that the information available on service quality at a health facility significantly affects demand for health care, and therefore, parameter estimates that ignore information available to patients about service quality might be biased. The authors highlight the need for public provision of such information. They also draw attention to a potential limitation of demand analysis in the design and implementation of health care financing policies.

The Determinants of Health Expenditures in Tunisia

This article examines the determinants of health expenditures in Tunisia during the period 1961-2008, using the Autoregressive Distributed Lag (ARDL) approach by Pesaran et al. (2001). The results of the bounds test show that there is a stable long-run relationship between per capita health expenditure, GDP, population ageing, medical density and environmental quality. In fact, on the one hand there are the short-run and long-run results which reveal that health care is a necessity, not a luxury good. On the other hand, results of the causality test show that there is a bidirectional causal flow from health expenditures to income, both in the short and in the long run.