Medical and social characteristics of patients receiving medical care in outpatient settings in the public and private healthcare sectors of a large metropolis

BackgroundIn Korea, the actual distribution of cardiac rehabilitation (CR) to the clinical field is insufficient due to the many barriers for cardiovascular patients to participate in CR. Community-based CR is a useful alternative to overcome these obstacles. Through a nationwide survey, we investigated the possibility of regional medical and public health management institutes which can be in charge of community-based CR in Korea.MethodsThe questionnaires on recognition of CR and current available resources in health-related institutions were developed with reference to the CR evaluation tools of York University and the International Council of Cardiovascular Prevention and Rehabilitation. The questionnaires were sent to regional public and private medical institutions and public health management institutions.ResultsIn total, 2,267 questionnaires were sent to 1,186 institutions. There were 241 and 242 responses from 173 and 179 regional private and public medical institutions, respectively. And a total of 244 responses were gathered from 180 public health management institutions. Although many institutions were equipped with the necessary facilities for exercise training, there were few patient-monitoring systems during exercise. Most institutions were aware of the need for CR, but were burdened with the cost of establishing personnel and facilities to operate CR.ConclusionMost regional medical, and public health management institutions in Korea are unprepared for the implementation of community-based CR programs. To encourage the utilization of such, there should be efforts to establish a national consensus.

The growth of healthcare expenditure provokes constant comments and discussions, as countries battle the issues on cost containment and cost effectiveness. Prior to 1978, medical institutions in China were either state-owned or were collective public hospitals. Since 1978, China has been trying to rebuild its healthcare system, which was destroyed during the 'cultural revolution', allowing private medical institutions to deliver healthcare services. As a result, private medical institutions have grown from 0% to 28.57% between 1978 and 2010. In this context, we compare outpatient healthcare expenditures between public and private medical institutions. The central problem of this comparison is that the choice of medical institution is endogenous. So we apply an instrumental variable (IV) framework utilizing geographic information (whether the closest medical institution is private) as the instrument while controlling for severity of health and other relevant confounding factors. Using China's Urban Resident Basic Medical Insurance Survey 2008-2010, we found that there is no difference in expenditure between public and private medical institutions when IV framework is used. Our econometric tests suggest that our IV model is specified appropriately. However, the ordinary least square model, which is inconsistent in the presence of endogenous regressor(s), reveals that public medical institutions are more expensive.

This article summarizes the arguments and counterarguments within the scientific discussion on improving the marketing policy of the clinic. The purpose of the study is to improve the marketing policy of the clinic. The urgency of solving the scientific problem lies in need to promote medical services, where marketing activities contribute to establishing relations between providers and consumers of medical services. The authors noted that patients have a low level of awareness in medical services, making it difficult to understand the market of medical services. In turn, public and municipal health care facilities have a passive marketing policy that is not competitive enough with private health care facilities. In most cases, state and municipal medical institutions do not use marketing tools to acquaint consumers with the list of available services, do not inform consumers about the expansion of medical services and the benefits of their medical institution. The object of the study was selected health care management. According to the results of empirical analysis of ways to improve the marketing policy of the clinic, it is established that the reform of the medical sector of Ukraine intensifies the processes of competition in the market. The marketing system of Ukrainian health care has no concept of medical care. Instead of that, there is a market element as medical service or health care service provided to the patient by a health care institution or an individual registered according to the law and possessing the medical business license. Besides, the medical services are paid for by the customer, such as patients, various organizations, local authorities, and the government. Thus, public medical institutions faced the need to fight (particularly with private medical institutions) for the consumer and state funding for the package of primary medical services. The study empirically confirms and theoretically proves the existence of competition between private and public medical institutions in the market of medical services. The results of this study can help improve the marketing policy of public and municipal clinics.

(1) Background: The discussion on how to reduce the health costs of chronic disease patients has become an important public health issue. Limited research has been conducted on how chronic disease patients’ medical choice of public and private medical institutions affect health costs. (2) Methods: This study used the panel data composed of the China Health and Retirement Longitudinal Survey (CHARLS) from 2011 to 2018, adopted the quasi-natural experimental research method, and set up a control group and an experimental group that chose public medical institutions and private medical institutions, to analyze the association between the medical choice and health costs of chronic disease patients. (3) Results: Compared with chronic disease patients who chose private medical institutions, patients who chose public medical institutions increased their total cost by 44.9%, total out-of-pocket cost by 22.9%, and decreased the total out-of-pocket ratio by 0.117%, total drug cost out-of-pocket ratio by 0.075%, and drug cost ratio by 0.102%. (4) Conclusions: According to the triple principal-agent relationships, the resource advantages given by the government to public medical institutions, the salary incentive system of medical institutions, and the information asymmetry advantage held by physicians may be important factors for the increase in health costs for chronic disease patients.

The purpose of this study is to analyze the publicness of medical services in public and private medical institutions, with a focus on treatment performance using National Health Insurance data. Data from the National Health Insurance Service were used to compare the publicness of medical services in public and private medical institutions. Beta regression analysis was conducted after adjusting for the relevant characteristics to identify the impact on the public treatment performance of medical institutions. The public case rate of public health institutions was higher than that of private medical institutions. According to the type of medical care institution, the public case rate was higher in general hospitals and tertiary hospitals than in hospitals. Recently, it has often highlighted that increasing emphasis of profitability in the evaluation of public health institutions is damaging the publicness of medical services. Even in this study, it can be evaluated that the public case rate of public health institutions is not higher than that of private medical institutions.

Barriers to expanding primary care roles for chiropractors: the role of chiropractic as primary care gatekeeper

Based on available statistical data, the key characteristics of the medical personnel of the Moscow area – both Moscow and the Moscow region – are described. The analysis of the labor market in the healthcare sector of the Moscow area is carried out through the prism of “forms of ownership of a medical institution” (public and private) and “type of medical institution” (outpatient and hospital). Based on the data of content analysis of job advertisements posted by employers on the hh.ru resource, the authors reveal requirements that are announced to doctors by employers and the conditions offered to potential employees in public and private medical institutions. Private clinics focus on more comfortable working conditions, additional benefits and guarantees, career opportunities, however, the requirements that they present to doctors are much higher than at public medical institutions. That, in turn, allows a private employer to be in a more advantageous position in the labor market, competitive in the fight for highly qualified medical workers. Employers in the healthcare sector react very quickly to the changes taking place, trying to be adaptive and to reduce all kinds of risks, both for doctors and for patients. According to that, employers influence changes in the labor market: they declare new requirements for doctors and offer special working conditions.

To measure the readiness for self-directed learning among medical undergraduates of private and public medical colleges, and to evaluate their performance and strategies. The cross-sectional study was conducted in Lahore, Pakistan from February to July 2023, and comprised medical undergraduate students of either gender from 1 private and 1 public academic institution. Data was collected using a prevalidated structured questionnaire having self-management, desire for learning, and self-control domains to explore self-directed learning readiness. Data was analysed using SPSS 26. Of the 330 subjects, 166(50.3%) were females and 164(49.7%) males, while 166(50.3%) were from the private institution and 164(49.7%) were from the public institution. There were 183(55.4%) students in the 3rd year, 89(27.0%) in the 4th year and 58(17.6%) in the final year of their coursework. Self-directed learning readiness was significantly higher in students from the private institution (p<0.05). There was a significant correlation between self-directed learning readiness in private and public medical education institutions, with readiness being higher in the private sector.

Objective: The aim of this study was to analyze the public and private sector medical and dental institutions’ management of online education amidst the COVID-19 pandemic in Pakistan and to understand whether their respective modes derived satisfaction of e-learning from students. Methods: We conducted a survey of 371 students of various public and private sector medical and dental institutions across Pakistan, investigating their experience, confidence, and satisfaction regarding e-learning. The survey was carried out using ‘Google Forms’, which was sent via email to students. Results: In total, 371 responses were received. Despite the differences in resources and facilities, students of both sectors had not been confident in taking professional exams after the shift to online education: public (81.3%) and private (74.4%); very few students felt confident about their knowledge of basic medical sciences without labs/ practical work: public (10.8%) and private (10.3%); and more than 80% from both sectors also held the belief that e-learning is not sufficient to support academics. Conclusion: Private medical and dental institutes in Pakistan have better funding but students still felt under-confident. Public sector institutes lacked a developed IT department and had an irregular and erratic schedule of online lectures with limited engagement from professors. Many felt that online and traditional learning can be blended to bring forth a form of learning known as "blended learning". Keywords: Blended Learning; E-Learning; Medical Education; Pandemic.

The purpose of this study was to find out medical librarians' perceptions towards the importance of information literacy (IL) skills. A structured questionnaire, consisting of eight IL skills, was administered to the head librarians of all academic medical institutions in Pakistan. The respondents were asked to rate the importance of IL skills for their users on a 5-point Likert scale (1- Least important to 5-Most important). A total of 69 (60.5 %) usable questionnaires were returned out of 114 disseminated to the respondents. The IL skills about “accessing the needed information effectively and efficiently”, “identifying relevant, authoritative and reliable information sources”, “recognizing the need for information”, "verifying the relevance and quality of information sources” and “using information ethically and legally” got mean scores exceeding four from head librarians of both public and private sector medical institutions. However, IL skill "evaluating the information critically” received mean score less than four i.e., 3.94 from public sector medical librarians and IL skills "organizing information collected or generated in a logical way" and "using the selected information effectively to accomplish a specific task" although considered important but got lower mean scores (3.97 each) from private sector medical librarians. Respondents from both public and private sector medical institutions had considered all the eight IL skills important for their library users, meaning that library users must be adequately equipped with information competencies.

The digitalization of the healthcare sector highlights the necessity for modern medical institutions to integrate digital technologies into all aspects of their operations, including marketing. Digital marketing technologies in the medical services market encompass a range of advanced online tools, digital platforms, and networks used by healthcare providers to promote medical services in the digital environment, attract new patients, ensure patient loyalty, and build and manage the brand of a medical institution. Implementing these technologies in healthcare facilities improves overall operational efficiency, enhances the quality and accessibility of medical services, facilitates patient acquisition, and strengthens retention strategies. This article aims to examine the variety of existing digital marketing technologies in the medical services market, highlight their advantages and potential risks, and propose an algorithm for their integration into the operations of healthcare institutions. The study utilizes materials from monographs and scientific articles by domestic researchers and analytical methods such as analysis, synthesis, induction, deduction, generalization, comparison, and systematization. The article analyzes the impact of digitalization on the medical services market’s marketing system. It explores the specific use of digital marketing technologies in public and private medical institutions, identifying key differences related to sources and volumes of marketing funding, objectives and strategies, the use of digital platforms and technologies, the implementation of reputation management strategies, and the handling of patient reviews. Additionally, the study identifies the most widely used and effective digital marketing technologies for healthcare institutions, including SEO (Search Engine Optimization), SMM (Social Media Marketing), SERM (Search Engine Reputation Management), content marketing, contextual and targeted advertising, telemarketing, video marketing, email and SMS marketing, Big Data, mobile applications, and chatbots. The article also presents a five-stage algorithm for implementing digital marketing tools in healthcare institutions. Keywords: healthcare system, medical services, medical services market, marketing activities, marketing, digital marketing, content marketing, reputation marketing.

Significance. Commercial medicine is a rather young branch of the Russian national economy. In our days its development forms a wide interdisciplinary discussion environment for scientists and practitioners. The basic areas for research include dynamics in commercial medicine development under the Russian economic and social conditions, factors and type of demand for paid medical services, correlation between budget and commercial medicine, as well as a social aspect of healthcare commercialization, manifested through quality of life, access to medical care, etc. A comprehensive and objective analysis of the development trends and demand for commercial medical services is especially relevant in view of meeting the national strategic objectives for healthcare development and social well-being assurance. Purpose of the study is to identify development trends and substantiate main demand factors for commercial medical services in Russia in 2005-2021. Material and methods: data from the Russian Federal State Statistics Service, data from some medical institutions, materials from specialized media publications. The study used methods of logical and statistical analysis. Results. The authors have studied dynamics and structure of medical organizations by ownership; analyzed social statistics related to paid medical services, demographic statistics of commercial enterprises in healthcare; examined basic performance characteristics of the largest private medical institutions in Russia; identified and analyzed the most important demand factors for commercial medicine. Conclusion. Russia is currently witnessing an active development of commercial medicine as an individual area of activity, which is characterized by sustainable positive dynamics in a number of indicators, by significant structural changes, capital accumulation, strengthening of market positions, and increased influence on the social sphere. The above-mentioned suggests a growing demand for paid medical services, the main factor of which, according to the authors’ opinion, is increased legal and institutional opportunities for paid service delivery by both private and public medical institutions, their active focus on non-gratuitous nature of care delivery.

The legal position of institutions in the field of health care and rehabilitation was studied. The main trends of reforming the sphere of functioning of health care institutions are defined, their main types, organizational and legal forms and forms of ownership are characterized. The peculiarities of the activity of state health care institutions, which are business entities belonging to the state sector of the economy and the management of such institutions is carried out exclusively by the state in accordance with the principles of domestic and foreign policy, are considered. The procedure for the formation and operation of communal enterprises that carry out their activities on a non-commercial basis is analyzed, that is, medical institutions that work as communal non-commercial enterprises independently carry out their economic activities, which are aimed at achieving relevant economic, social and other results and without the goal of making a profit. It is noted that the network of state and communal health care institutions is formed taking into account the development plans of hospital districts, the needs of the population in medical care, the need to ensure the proper quality of such care, timeliness, accessibility for citizens, effective use of material, labor and financial resources. It was noted that private health care institutions are not limited in the choice of organizational and legal form. Key words: medical institution, rehabilitation care institution, hospital district, state medical institution, communal medical institution, private medical institution, state medical institution.

The aim of this study was to identify the changes in the development of primary health care in 2002-2006 and to predict its potential results in 2008, based on various criteria (indicators). Data from the compulsory health insurance system "Sveidra" have been used for the analysis. A share of the private primary health care institutions, the persons enrolled with them, and visits in such institutions from all primary health care institutions during the study period have significantly statistically increased (average annual changes were 6.9%, 22.2%, and 27.2%, respectively). In 2008, this part would make up 61.0%, 30.6%, and 27.2%, respectively. The proportion of persons registered with family doctors and the number of visits to family doctors were significantly increasing (average annual changes were 22.5% and 27.2%, respectively). It is predicted that this part would make up 27.8% and 35.2% in 2008. More detailed analysis has shown that relatively more young and working-age persons (aged 18-44 years) were enrolled in private primary health care institutions. It is in particular evident in Vilnius and Kaunas where the choice of such institutions is high. The number of persons registered with family doctors was increasing in both private and public institutions (average annual changes were 22.5% and 8.3%, respectively; P<0.05). In private institutions, the proportion of persons registered with local district pediatricians was also significantly increasing. The study results have shown significant differences in the developments of primary health care in 2002-2006 by various indicators. The objective defined in the strategy of restructuring will be achieved in 2008 only in respect of the number of institutions. Assessing by the aspect of services, the results achieved will be approximately two times lower. The practice of the institution of the family doctor is becoming more intensive in both private and public institutions.

BackgroundThe EUprimecare project-team assessed the perception of primary health care (PHC) professionals and patients on quality of organization of PHC systems in the participating countries: Estonia, Finland, Germany, Hungary, Italy, Lithuania and Spain. This article presents the aggregated opinions, expectations and priorities of patients and professionals along some main dimensions of quality in primary health care, such as access, equity, appropriateness and patient- centeredness.MethodsThe focus group technique was applied in the study as a qualitative research method for exploration of attitudes regarding the health care system and health service. Discussions were addressing the topics of: general aspects of quality in primary health care; possibilities to receive/provide PHC services based on both parties needs; determinant factors of accessibility to PHC services; patient centeredness. The data sets collected during the focus group discussions were evaluated using the method of thematic analysis.ResultsThere were 14 focus groups in total: a professional and a patient group in each of the seven partner countries. Findings of the thematic analysis were summarized along the following dimensions: access and equity, appropriateness (coordination, continuity, competency and comprehensiveness) and patient centeredness.ConclusionsThis study shows perceptions and views of patients in interaction with PHC and opinion of professionals working in PHC. It serves as source of criteria with relevance to everyday practice and experience. The criteria mentioned by patients and by health care professionals which were considered determining factors of the quality in primary care were quite similar among the investigated countries. However, the perception and the level of tolerance regarding some of the criteria differed among EUprimecare countries. Among these dissimilar criteria we especially note the gate-keeping role of GPs, the importance of nurses' competency and the acceptance of waiting times. The impact of waiting time on patient satisfaction is obvious; the influence of equity and access to PHC services are more dependent on the equal distribution of settings and doctors in urban and rural area. Foreseen shortage of doctors is expected to have a substantial influence on patient satisfaction in the near future.