Effects of Perceived Control upon Role Performances among Healthcare Service Customers

With the implementation of the Nation Health Insurance in 1995, all levels of medical institutes were influenced by the constraint of government budget that resulted in a high degree market orientation. Also, medical cosmetology had grown up very fast during these years. Because medical cosmetology is mostly consumer's initiative, the importance of medical service experience must be particularly emphasized. The purposes of this research include: (1) to discuss the relationships among consumer experiences, experiential value and experiential behavior; (2) to build Medical Service Experience Model (MSEM) for medical cosmetology. We used purposed sampling to interview 1040 samples with medical cosmetology experience and used structural equation modeling to analyze data. The results showed that Medical Service Experience Model (MSEM) could explain the relationships among consumer experiences, experiential value and experiential behavior more completely. In practice, this study can help medical institutions with medical cosmetology services understanding consumers' whole feels and use appropriate marketing tools to enhance consumer experiences.

Community pharmacies around the world are redefining their roles by experimenting to provide medical services directly to consumers. The aim of this study was to investigate the medical services provided by community pharmacies and consumers’ usage of these medical services. This study was carried out through semi-structured interviews with both community pharmacists and their consumers in New York, Macao and Zhuhai. Community pharmacists reported information about provision of medical services, and consumers provided information about their usage of medical services at community pharmacies accordingly. Through analysis of interview materials it showed that community pharmacies mainly provided free medical examination, reference books and booklet of drug information. Some community pharmacies provided health care lecture and founded own website for medicine information. But touch-screen computer querying system and telephone health care service had not been provided. Additionally the consumers’ usage of medical services at community pharmacy is obviously lower than provision by community pharmacy. The provision level of medical services by community pharmacy was relatively low and the types of medical services were relatively narrow. There was an obvious gap between provision of medical services by community pharmacies and usage of such services by consumers. The position of community pharmacy in national health system and capability of community pharmacy have impact on the medical services of community pharmacies. Key words: Community pharmacy; Medical services; Comparative study; New York; Macao; Zhuhai (China)

This study aims to investigate the factors influencing residents' healthcare utilization behavior and provide a scientific basis for enhancing the overall efficiency of healthcare utilization. A comprehensive analysis was conducted using data from the China General Social Survey (CGSS) project. Exploratory Factor Analysis (EFA) and Structural Equation Modeling (SEM) were utilized to examine the influences and interrelationships of the three core factors of the Andersen Healthcare Utilization Model (Predisposing Factors, Enabling Resources, and Need), as well as the two extended factors (health behaviors and Medical-service Experience), on residents' decisions regarding the utilization of healthcare services. A total of 2,230 participants were enrolled in this study. Most were male (55.74%), were married (85.38%), and had junior- and senior-high school educations (45.29%). Mean age was 52.39 years, and 56.32% of participants reported an annual income of <30,000 RMB. EFA distilled influencing factors into four domains: Predisposing and Enabling, Need, Health Behaviors, and Medical-service Experience. The results of the revised SEM indicated that the influence coefficients of Predisposing and Enabling, Need, and Medical-service Experience on Decision to Utilize Health Services (DUHS) were 0.095, -0.104, and 0.093 respectively. Mediation effect test results demonstrated that the indirect effects of Predisposing and Enabling, Need, and Health Behaviors on DUHS were -0.098, 0.024, and -0.017, respectively, all of which were statistically significant. Finally, the fit indices of the modified model indicated an acceptable model fit. This study showed that unmarried individuals with lower income and job instability exhibit reduced healthcare utilization due to economic barriers and lack of social support. Furthermore, medical service experience is another crucial factor affecting health service utilization. Notably, our findings suggest the need for targeted interventions, including enhanced insurance coverage, improving the quality of medical services and health education campaigns to mitigate disparities in access to health services.

To construct a satisfaction evaluation indicator system based on patients' experiences of medical services. A questionnaire was designed by expert interview and literature review and 400 copies were randomly handed out to inpatients and outpatients from five 3A-public hospitals in Shanghai. The patient's evaluation of importance of various factors in medical services was analyzed and the mean and weight of indicators in terms of recognition, importance and evaluation were determined to establish a satisfaction evaluation indicator system. A total of 396 valid questionnaires were retrieved, with an effective response rate of 99%. By analyzing survey data, the patient satisfaction evaluation indicator system was constructed with 5 primary indicators (hospital environment, medical procedures, attitude, and quality of care and patient rights) and 25 secondary indicators (convenient hospital environment, auxiliary facilities, reasonable arrangement, clearly mark, convenient appointment, simple procedures, short time, the attitude of medical staff, solutions of medical dispute, medical technology, treatment, medical equipment, medical expenses, respect, patient privacy, etc.). A patient satisfaction evaluation indicator system has been established based on patients' experience of medical services in the study, which may be applicable to measure patients' satisfaction and to improve medical services in hospitals.

Israel has become a destination for asylum seekers. Asylum seekers often experience emotional distress, but have limited access to health services and rarely use psychiatric services. This study sought to understand and characterize the use of psychiatric versus medical services by asylum seekers in Israel. We compared the emotional distress, stressful life events and previous treatment consultations of 21 psychiatric service users (PSU) and 55 medical service users (MSU) at the Open Clinic of Physicians for Human Rights in Tel-Aviv. Participants completed a socio-demographic questionnaire, the General Health Questionnaire (GHQ-12), the Stressful Life Events Scale and the Health Care Utilization Questionnaire. PSU and MSU did not have significantly different levels of emotional distress. PSU reported significantly more stressful life events during the past year than MSU ( M = 5.81, SD 3.47 vs. M = 3.8, SD 2.35, p < 0.01). In comparison to MSU, PSU utilized more medical ( M = 4.33, SD 2.28) and non-medical ( M = 2.38, SD 1.92) services ( p < 0.001) than MSU. Asylum seekers who consulted multiple treatment agencies in the last year were 1.55 times more likely to seek psychiatric treatment than those who had consulted only a few treatment agencies. Emotional distress in asylum seekers appears to be under-diagnosed in the Open Clinic and under-treated by mental health professionals. To better detect this distress, a thorough screening is recommended at assessment. Collaboration with mental health professionals and community and religious leaders consulted in the past is important and can contribute to good health care outcomes in this population.

In this study we exploit a regulation in Colombia that exogenously changes health insurance coverage of young adult dependents, specifically those turning 18 years old, to analyze the effects of losing health insurance coverage on their health service usage and health status. We assess this effect using a regression discontinuity design (RDD) and data from the Encuesta Nacional de Calidad de Vida Survey for Colombia from 2010 to 2013. Losing coverage implies an increase in the cost of some medical services which may reduce their consumption (i.e. preventive services). Additionally, since under Colombian regulations, emergency department (ED) visits cannot be denied to anyone, regardless of health insurance status, uninsured young adults tend to use this service more instead of regular medical services (such as preventive healthcare or visits to physicians or specialists). We find, consistent with the change in relative prices, that losing health insurance when turning 18 years old increases the visits to the ED, reduces preventive care visits with a physician, and reduces the usage of other medical services. These results imply a substitution of cheaper medical services for more expensive ones when individuals turn 18 years old in Colombia.

Based on data from the five sites of the National Institute of Mental Health-sponsored Epidemiologic Catchment Area (ECA) Program, this paper examines the prevalence of psychiatric disorder among recent medical service users versus nonusers, with a particular focus on affective disorders, substance abuse/dependence, and phobias. The rate of current Diagnostic Interview Schedule (DIS) disorders among medical users in all five ECA sites is 21.7 per cent (slightly higher than general population rates) versus 16.7 per cent among nonusers; there is generally no difference between users and nonusers with past DIS diagnoses. Affective disorders were among the most common mental disorders of medical service users, especially among females, with little variation between sites: females: users: 6.9 per cent to 9.3 per cent, nonusers: 3.4 per cent to 6.4 per cent, and males: users: 3.3 per cent to 6.5 per cent, nonusers: 1.2 per cent to 4.1 per cent. Rates of phobias among persons using medical services are also higher than among nonusers. Substance abuse disorders are at least as common among persons who use medical services (8 per cent to 14 per cent of male users) as among those who do not (9 per cent to 11 per cent of male nonusers). The high rates of affective disorders among women and of substance abuse among male medical service users underscore the need to increase the ability of general medical practitioners to recognize and manage or refer these conditions.

The paper aims to explore theoretically and empirically the reciprocity of expressed emotion (EE) in the interaction of medical service users with chronic gastrointestinal diseases, their relatives and healthcare staff. The key research question was whether the objective emotions expresses by relatives and healthcare staff coincided with subjective EE experienced by medical service users. The study applied methods of theoretical analysis, as well as measures, represented by scales and questionnaires for empirical research, including the Health-Related Quality of Life Questionnaire (EQ-5D-3L), the Level of Expressed Emotion Scale (LEE), the Family Attitude Scale (FAS), the perceived Expressed Emotion in Staff Scale (pEESS). According with the goal, the study aimed to solve the following research questions: Are there any correlations (as markers of EE reciprocity) between EE as the family's objective attitude to a diseased medical service user and the user's subjective experience of such family's and healthcare staff's attitude to him/her? Can the family attitudes towards a medical service user with chronic gastrointestinal diseases, the subjective experience of this attitude by the medical service user (perceived emotions expressed by the relatives), the user's subjective experience of the healthcare staff's EE and the user's health condition become predictors of disease-related quality of life? Are there any differences in health condition and disease-related quality of life according to the status of a family member (a partner/other relative)? The study results indicate that there were significant correlations between the perceived EE as a marker of subjective experiences of relatives' EE and objective family attitude towards medical service users. The findings also indicate correlations between family member's and healthcare staff's EE as it was perceived by medical service users. These results showed the reciprocal character of EE as a marker of a diseased individual's family environment. The results of the linear multiple regression showed that FAS as a marker of the family's attitude towards medical service users and users' health condition were significant predictors of life quality related to gastrointestinal diseases. There were significant differences between the objective family attitudes towards medical service users depending on caregivers' family status, in particular, FAS was higher in partners compared to other caregivers.

The purpose of this study is to investigate the structural causality between constructive concepts such as cognitive experience, affective experience, behavioral experience, service trust, service commitment, and service loyalty in Mongolian medical services setting, and then explains the causal role of affective commitment. To this end, the research hypothesis was verified using by structural equation modeling through SPSS 23.0 and AMOS 20.0 statistical packages. Result revealed that first, cognitive experience had a positive influence on service commitment, but service trust did not affect service commitment. Second, behavioral experience had a positive influence on service trust but not on service commitment. Third, affective experience had a positive effect on all relationship quality factors such as service trust and service commitment. Fourth, service trust had a positive effect on service commitment but did not affect service loyalty. Finally, service commitment has a positive effect on service loyalty. Therefore, medical service providers or marketers of Mongolian hospitals’ can increase the level of trust in medical services by providing users with emotional and behaviorally superior services and experience cognitive and emotional superior services. The relationship quality between the service provider and the consumer should be strengthened. In addition, it is necessary to plan and execute marketing strategies and tactics to increase service loyalty by motivating customers who have high confidence in medical service to be immersed in service.

Childhood conduct problems are associated with high medical service use in adolescence, though the mechanisms are unclear. The current study examined whether sleep and internalizing problems mediate the association between childhood conduct problems and adolescent medical service usage. Participants were drawn from a longitudinal study (N = 744; 53% boys) evaluating the development of conduct problems among girls and boys (6.3-9.9years at baseline; Mage = 8.43). Conduct problems, sleep, and internalizing problems were assessed by parents, teachers, and youth. Service use data was collected from public medical records. Significant indirect effects between childhood conduct problems and medical service usage via parent-reported sleep and internalizing problems were observed. Histories of conduct problems were associated with higher levels of sleep and internalizing difficulties which were subsequently linked to higher service usage. Findings support the importance of addressing sleep and internalizing problems in mitigating future health consequences for youth with conduct problems.

BackgroundInternational students have a lower utilization rate of the local medical service system for studying abroad, and it has been found that there may be multiple reasons behind this phenomenon. This study explores the usage of medical service systems by international students and the underlying logical factors through a study of the usage of National Health Service (NHS) of Chinese students in the UK. MethodsTo address the research questions, this study employed an online survey methodology that ran between 1st May and August 20, 2019 facing the Chinese students in the UK. A total of 1,050 questionnaires were distributed and 1,001 questionnaires were recovered, of which 977 contained valid responses (questionnaire response rate was 95.3 % and validity rate was 97.6 %). Before the questionnaire was designed and after it was issued, two focus group interviews were conducted to provide reliable and detailed information to inform the questionnaire design and to supplement the questionnaire survey data with more profound psychological qualitative data. The two focus groups consisted of 10 and 12 Chinese students studying in the UK and each lasted more than 3 h. ResultsThe survey data showed that the medical services utilization rate of Chinese students in the UK is relatively low compared to UK residents and domestic Chinese students. Their decisions and behaviours around medical services usage in the UK are not significantly related to age, gender, and monthly income, but are instead related to their current education status, types of disease suffered, and information acquisition about the UK medical services before coming to the UK. When getting sick, in addition to seeking help from official medical services, Chinese students studying in the UK tend to self-diagnose and self-medicate; seeking help from social networks based on friendship and domestic relatives are also alternatives to accessing medical services. ConclusionCombining the theories of ‘sick role’ and ‘illness experience’, the decisions and behaviours related to medical services usage by Chinese students in the UK are significantly influenced by their understanding of medical services, which is socially and culturally learned in China. Understanding the perspective of the ‘sick role’ and the ‘illness experience’ of Chinese students may help to better think about how improvements can be made to their utilization rate of medical services and their health status during their studies in the UK. This study not only provides us with specific information and understanding on the usage of medical services for Chinese students in the UK, but the research results may also provide a reference for other similar research on the health and medical service use of other international students studying in the cross-cultural contexts.

BackgroundIn rebuilding devastated health services, the government of Afghanistan has provided access to basic services mainly by contracting with non-government organisations (NGOs), and more recently the Strengthening Mechanism (SM) of contracting with Provincial Health Offices. Community-based information about the public's views and experience of health services is scarce.MethodsField teams visited households in a stratified random sample of 30 communities in two districts in Kabul province, with health services mainly provided either by an NGO or through the SM and administered a questionnaire about household views, use, and experience of health services, including payments for services and corruption. They later discussed the findings with separate community focus groups of men and women. We calculated weighted frequencies of views and experience of services and multivariate analysis examined the related factors.ResultsThe survey covered 3283 households including 2845 recent health service users. Some 42% of households in the SM district and 57% in the NGO district rated available health services as good. Some 63% of households in the SM district (adjacent to Kabul) and 93% in the NGO district ordinarily used government health facilities. Service users rated private facilities more positively than government facilities. Government service users were more satisfied in urban facilities, if the household head was not educated, if they had enough food in the last week, and if they waited less than 30 minutes. Many households were unwilling to comment on corruption in health services; 15% in the SM district and 26% in the NGO district reported having been asked for an unofficial payment. Despite a policy of free services, one in seven users paid for treatment in government facilities, and three in four paid for medicine outside the facilities. Focus groups confirmed people knew payments were unofficial; they were afraid to talk about corruption.ConclusionsHouseholds used government health services but preferred private services. The experience of service users was similar in the SM and NGO districts. People made unofficial payments in government facilities, whether SM or NGO run. Tackling corruption in health services is an important part of anti-corruption measures in Afghanistan.

A number of studies have highlighted issues around the relationship between service users and providers. The recovery model is predominant in mental health as is the recognition of the importance of person-centred practice. The authors completed an in-depth search of the literature to answer the question: What are service users' experiences of the mental health service? Three key themes emerged: acknowledging a mental health problem and seeking help; building relationships through participation in care; and working towards continuity of care. The review adds to the current body of knowledge by providing greater detail into the importance of relationships between service users and providers and how these may impact on the delivery of care in the mental health service. The overarching theme that emerged was the importance of the relationship between the service user and provider as a basis for interaction and support. This review has specific implications for mental health nursing. Despite the recognition made in policy documents for change, issues with stigma, poor attitudes and communication persist. There is a need for a fundamental shift in the provider-service user relationship to facilitate true service-user engagement in their care. The aim of this integrative literature review was to identify mental health service users' experiences of services. The rationale for this review was based on the growing emphasis and requirements for health services to deliver care and support, which recognizes the preferences of individuals. Contemporary models of mental health care strive to promote inclusion and empowerment. This review seeks to add to our current understanding of how service users experience care and support in order to determine to what extent the principles of contemporary models of mental health care are embedded in practice. A robust search of Web of Science, the Cochrane Database, Science Direct, EBSCO host (Academic Search Complete, MEDLINE, CINAHL Plus Full-Text), PsycINFO, PsycARTICLES, Social Sciences Full Text and the United Kingdom and Ireland Reference Centre for data published between 1 January 2008 and 31 December 2012 was completed. The initial search retrieved 272 609 papers. The authors used a staged approach and the application of predetermined inclusion/exclusion criteria, thus the numbers of papers for inclusion were reduced to 34. Data extraction, quality assessment and thematic analysis were completed for the included studies. Satisfaction with the mental health service was moderately good. However, accessing services could be difficult because of a lack of knowledge and the stigma surrounding mental health. Large surveys document moderate satisfaction ratings; however, feelings of fear regarding how services function and the lack of treatment choice remain. The main finding from this review is while people may express satisfaction with mental health services, there are still issues around three main themes: acknowledging a mental health problem and seeking help; building relationship through participation and care; and working towards continuity of care. Elements of the recovery model appear to be lacking in relation to user involvement, empowerment and decision making. There is a need for a fundamental shift in the context of the provider-service user relationship to fully facilitate service users' engagement in their care.

In order to improve the users’ medical service experience and the efficiency of medical treatment, a model for mobile health application has made, including one target layer, 10 principal layers and 46 index layers through the reviewing literature and questionnaire. And to get the importance of index, the biggest mobile health application in China named Chunyuyisheng has been calculated by AHP-fuzzy comprehensive evaluation. As is shown, most people had a positive effect on the Chunyuyisheng. But it needs to make more effort in marketing strategy, use of special groups, information auditing and the accessibility of other device. If the mobile health application wants to develop further, it should make more progress in these areas so as to improve the quality of e-health services more effectively and the health condition of the users.

Purpose – The purpose of this study is to identify the predictive factors of medical tourism in Vietnam by analyzing the variables that lead to the annual visitor number. Design/methodology/approach – This study collected data from Vietnamese with experience in domestic and international medical tourism, and focused on Hanoi, Vietnam. In this study, the variable of medical tourism preferences was applied independently. Factors that impacted the number of annual visitors were estimated by the truncated Poisson model. Findings – The results of the TP model analysis of demand for medical tourism are as follows. Among the variables related to socio-economic characteristics, age, marital status, and occupation had a significantly positive effect on the number of annual medical visits. These results imply that it is important to understand socio-economic characteristics to expand demand for medical tourism in Vietnam, which shows high growth potential. The top three variables that gave a significant positive effect on the number of annual medical visitors are the level of medical technology, waiting time, and price, as well as medical service experience. Research implications – The results indicate the need to develop medical tourism products tailored to consumer tastes by subdividing medical technology levels, waiting for time and price, medical experience services, and so on. Thus, the results presented by this study create a starting point for the development of demand forecasting models for the domestic, international, and Vietnamese medical tourism markets in the future.