Changes In Health Care System Research Articles

Perception and Acceptance of Telemedicine Use in Health Care Among the General Public in China: Web-Based Cross-Sectional Survey.

The COVID-19 pandemic is bringing about substantial changes in health care systems, leading to a significant shift toward telemedicine for the delivery of health care services. This study aims to examine the relationship between perceived usefulness and ease of use of telemedicine services and their association with the behavioral intention to use telemedicine. An anonymous cross-sectional survey was conducted in China. Partial least squares structural equation modeling was used to determine significant predictors of intention to use telemedicine consultation. Types of illnesses that favored seeking telemedicine consultation, as well as the most preferred platform for conducting telemedicine consultations, were also investigated. In total, 1006 participants completed the survey. A total of 44.3% (n=446) reported being very likely and 49.3% (n=496) reported being likely to seek telemedicine consultation. Overall, the majority of participants expressed strong agreement or agreement regarding the perceived usefulness of telemedicine. Likewise, the majority indicated strong agreement or agreement when it came to their perception of the ease of using telemedicine. In the partial least squares structural equation modeling, perceived usefulness (β=0.322; P<.001) and perceived ease of use (β=0.118; P=.01) were significantly associated with a higher likelihood of seeking telemedicine consultation. A considerable number of participants expressed willingness to use telemedicine services for various medical conditions, particularly respiratory (n=340, 33.8%), skin (n=316, 31.4%), and musculoskeletal issues (n=316, 31.4%) while showing less interest in seeking telemedicine consultations for reproductive health (n=44, 4.4%) and cancer (n=64, 6.4%). The majority preferred video chat (n=443, 44%) and text chat (n=317, 31.5%) as their most preferred platforms for telemedicine consultation, while a smaller proportion preferred telephone (n=193, 19.2%) and email (n=53, 5.3%). Telemedicine has the potential to play a larger role in China's health care system. The preferences for certain platforms over others may influence service design and implementation.

The Use of COVID-19 Mobile Apps in Connecting Patients with Primary Healthcare in 30 Countries: Eurodata Study

Background: The COVID-19 pandemic has necessitated changes in European healthcare systems, with a significant proportion of COVID-19 cases being managed on an outpatient basis in primary healthcare (PHC). To alleviate the burden on healthcare facilities, many European countries developed contact-tracing apps and symptom checkers to identify potential cases. As the pandemic evolved, the European Union introduced the Digital COVID-19 Certificate for travel, which relies on vaccination, recent recovery, or negative test results. However, the integration between these apps and PHC has not been thoroughly explored in Europe. Objective: To describe if governmental COVID-19 apps allowed COVID-19 patients to connect with PHC through their apps in Europe and to examine how the Digital COVID-19 Certificate was obtained. Methodology: Design and setting: Retrospective descriptive study in PHC in 30 European countries. An ad hoc, semi-structured questionnaire was developed to collect country-specific data on primary healthcare activity during the COVID-19 pandemic and the use of information technology tools to support medical care from 15 March 2020 to 31 August 2021. Key informants belong to the WONCA Europe network (World Organization of Family Doctors). The data were collected from relevant and reliable official sources, such as governmental websites and guidelines. Main outcome measures: Patient’s first contact with health system, governmental COVID-19 app (name and function), Digital COVID-19 Certification, COVID-19 app connection with PHC. Results: Primary care was the first point of care for suspected COVID-19 patients in 28 countries, and 24 countries developed apps to complement classical medical care. The most frequently developed app was for tracing COVID-19 cases (24 countries), followed by the Digital COVID-19 Certificate app (17 countries). Bulgaria, Italy, Serbia, North Macedonia, and Romania had interoperability between PHC and COVID-19 apps, and Poland and Romania’s apps considered social needs. Conclusions: COVID-19 apps were widely created during the first pandemic year. Contact tracing was the most frequent function found in the registered apps. Connection with PHC was scarcely developed. In future pandemics, connections between health system levels should be guaranteed to develop and implement effective strategies for managing diseases.

Paramedics’ experiences of barriers to, and enablers of, responding to suspected or confirmed COVID-19 cases: a qualitative study

BackgroundParamedics’ work, even pre-pandemic, can be confronting and dangerous. As pandemics add extra stressors, the study explored paramedics’ lived experience of the barriers to, and enablers of, responding to suspected or confirmed Coronavirus Disease 2019 (COVID-19) cases.MethodsThis exploratory-descriptive qualitative study used semi-structured interviews to investigate Queensland metropolitan paramedics’ experiences of responding to cases during the COVID-19 pandemic. Interview transcripts were analysed using thematic analysis. Registered Paramedics were recruited by criterion sampling of staff who experienced the COVID-19 pandemic as active officers.ResultsNine registered paramedics participated. Five themes emerged: communication, fear and risk, work-related protective factors, leadership, and change. Unique barriers included impacts on effective communication due to the mobile nature of paramedicine, inconsistent policies/procedures between different healthcare facilities, dispatch of incorrect information to paramedics, assisting people to navigate the changing healthcare system, and wearing personal protective equipment in hot, humid environments. A lower perceived risk from COVID-19, and increased empathy after recovering from COVID-19 were unique enablers.ConclusionsThis study uncovered barriers and enablers to attending suspected or confirmed COVID-19 cases unique to paramedicine, often stemming from the mobile nature of prehospital care, and identifies the need for further research in paramedicine post-pandemic to better understand how paramedics can be supported during public health emergencies to ensure uninterrupted ambulance service delivery.

The changing health-care system in Ghana: forms of care within residential aged care facilities in urban Accra

Purpose The emergence of residential aged care facilities (RACFs) within the Ghanaian health-care system has raised eyebrows because, hitherto, the concept of nursing homes had largely been perceived as an anomaly. The purpose of this study is to understand this emerging phenomenon and the activities of care provided within two facilities in the nation’s capital, Accra. Design/methodology/approach The study draws on participant observations and in-depth interviews with purposively sampled 15 residents in the two facilities and eight caregivers. The data were analysed using thematic approach. Findings The study found that the daily forms of care mostly performed for the elderly were intimate and non-intimate physical, medical, emotional and spiritual and end-of-life care. The bulk of activities of care were performed in the morning. Originality/value The study reveals that the changing landscape of health-care facilities in Ghana to include RACFs indicates RACFs have come to stay to provide different forms of care to older persons who otherwise were cared for by the family.

Perception gaps of patient engagement for patient safety between healthcare professionals and the public in Korea

Background To ensure effective patient engagement, patients’ efforts, partnerships with healthcare professionals, and the organisation’s role in providing safe healthcare settings must be emphasised. Perception gaps regarding patient engagement between the public and healthcare professionals could prevent healthy partnerships from forming and hinder patient engagement activities. This study examined healthcare professionals’ perception of patient engagement and compared the findings with that determined for the public in a previous study. Methods An anonymous online survey was conducted in February 2020 among 1,007 healthcare professionals (physicians, nurses). The questionnaire comprised five parts regarding the perception of patient engagement. Descriptive analysis and Chi-squared/Fisher’s exact tests determined the frequency and significant differences among the public from previous study and healthcare professionals in this study. Results The perception of the importance of patient safety was high among healthcare professionals and the public. However, statistically significant differences in perceptions were observed among the public and healthcare professionals in all categories. The perception gaps were substantial between the groups in sub-categories of engagement for patient safety during medical treatment; 86% of physicians and 90% of nurses agreed that patients participate in the decision-making for the treatment process. Conversely, 58% of the public agreed. Only 22% of the public agreed with confirming healthcare professionals’ hand washing to prevent infection, versus 57% of physicians and 65% of nurses. More than 89% of healthcare professionals positively perceived medical dispute mediation versus only half of the public. In certain areas such as “medical dispute mediation and arbitration programs”, “fall prevention”, and “infection prevention”, there was a statistically significant difference in the perception of patient involvement among healthcare professionals, with nurses’ perception being particularly more positive than that of physicians. Conclusions The healthcare professionals’ perception of patient engagement was more positive than that of the public. To narrow the perception gaps and enhance the public’s perception, strategies involving changes in healthcare systems, promotional efforts, and educational initiatives should be developed. Additionally, strategies should be formulated for healthcare professionals to better engage as partners in patient care.

Nationwide epidemiology and health resource use among children with COVID-19 in Japan

BackgroundThe COVID-19 pandemic posed substantial challenges to healthcare systems. Understanding the responses of pediatric health services is crucial for future pandemic planning and preparedness, yet such data remains limited. MethodsIn this retrospective cohort study, we analyzed data from administrative databases developed by Japan Medical Data Center and DeSC Healthcare Inc. The dataset comprised records of 2,612,511 children, totaling 60,224,888 person-months, from January 2020 to May 2022. Multivariate generalized estimation equations were used to examine the incidence rates of COVID-19 and associated health resource use. ResultsOur analysis revealed that the incidence rates of COVID-19 gradually increased from Wave I (2.2 cases per 100,000 person-months) to Wave V (177.8cases per 100,000 person-months), with a notable elevation during Wave VI (2367.7 cases per 100,000 person-months). While nucleic acid amplification tests were primarily used during Waves I–V, the use of rapid antigen tests markedly increased in Wave VI. The hospitalization rates increased gradually from 0.2 in Wave I to 10.2 events per 100,000 person-months in Wave VI, and the case-hospitalization risk decreased from 14.9% in Wave II to 0.7% in Wave VI. Additionally, we observed decreasing trends in the use of antibiotics (Wave I, 31.8%; Wave VI, 9.0%), whereas antipyretic use rose from Wave I (56.1%) to Wave VI (86.6%). ConclusionsOur study highlighted essential changes in the nationwide pediatric healthcare system's response to the COVID-19 pandemic. These findings provide valuable insights into the future pandemic planning and preparedness.

From computing science to intelligent computing: A review of artificial and computational intelligence in data and information analysis

Artificial intelligence put forward using human intelligence index by use of advanced algorithms and models that transform computational principles of AI. Deep learning is a category of Artificial intelligence that shows the best problem-solving techniques and ways across different domains. Also, Computational Intelligence (CI) enhances conventional computing strategies through processes such as fuzzy logic, evolutionary algorithms, and neural networks that enables smarter decision-making among vague variables. Intelligent computing's impact is expanded over technological domains, that shows transformative changes in healthcare systems, finance industry, and other industrial processes. Having access to these technologies through collective platforms and open-source initiatives look after innovation. This review shatter perspectives from research scholars, industrial persons, and research communities, highlighting the current landscape and future prospects of A.I. and computational intelligence. Interdisciplinary applications and cross-cutting research initiatives represent the transformative potential of integrating intelligent computing techniques into expanded strategies. This wide scattering of A.I. and computational intelligence gives rise to the ethical concerns that majorly includes algorithmic biases and privacy issues to the end user. Meaningful dialogues and ethical practices are imperative to harnessing A.I. for social good in our interconnected world. This article represents the interdependent relationship between A.I., computational intelligence, and data science, offering deep knowledges into their synergistic applications and societal implications. It highlights the need for responsible A.I. deployment and ethical considerations to ensure the beneficial use of intelligent computing technologies.

Necessary, burdensome, or threatening? Awareness of Black-White disparities in health care access and self-rated health for Black and White Americans.

Awareness of racial health care inequities is one prerequisite to eliminating them. Although extant research has described awareness of racial health care inequities in the United States, the health impacts of such awareness on communities that are most impacted by these inequities remains unknown. Therefore, we examined associations between awareness of Black-White racial health care inequities and self-rated health for Black and White adults in the United States. We used survey data from non-Hispanic Black and White participants (N = 6,449) who responded to the national American Health Values Survey (2015-2016) to test associations between awareness of Black-White inequities in health care and self-rated health. Accurate awareness of health care inequities was associated with 47% higher odds of poorer self-rated health for Black individuals. Inaccurate awareness was associated with 36% higher odds of poorer self-rated health for White individuals. Accurate awareness may be adaptive, yet place an additional burden on Black individuals. Inaccurate awareness may harm White individuals' health. Health care system changes and alleviation of racism-related stress may be preventive supports for the health of Black individuals. Accurate awareness should be a goal for White individuals, not only to prevent health risks, but to also facilitate structural change for racial equity. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Effects of metacognitions, self-compassion, and difficulties in emotion regulation on psychological resilience in oncology nurses

PurposeProviding care to individuals with cancer requires oncology nurses to have superior skills related to physical care and adaptation to the changing healthcare system, as well as witnessing and supporting the psychosocial difficulties experienced by patients and families in this process. It requires oncology nurses to be psychologically resilient. Therefore, it is crucial to determine the factors affecting the psychological resilience of oncology nurses. This study aimed to determine the effect of self-compassion, metacognitions, and difficulties in emotion regulation on psychological resilience in oncology nurses. MethodsThis is a cross-sectional correlational study. The study was conducted with 121 oncology nurses providing active oncologic care and who volunteered to participate. The Difficulties in Emotion Regulation Scale-Short Form, the Self-Compassion Scale, and the Metacognitions Questionnaire-30 were used to collect data. Data were analyzed using descriptive statistics, Pearson correlation coefficient, and multiple linear regression analysis. ResultsThe regression model established to determine the effect of self-compassion, metacognitions, and difficulties in emotion regulation on psychological resilience was statistically significant (F(3,117) = 24.086 p < 0.001) and explained 36.6% of the change in resilience. Among the independent variables, only self-compassion had a significant contribution to the model (p = 0.001). According to the model, 1-unit change in self-compassion caused 0.571-unit change in psychological resilience. ConclusionSelf-compassion, metacognitions, and difficulties in emotion regulation were significantly related to psychological resilience, but only self-compassion significantly affected psychological resilience.

Health care use experiences of ethnoculturally diverse immigrant older adults: a meta-ethnography

PurposeCurrent and predicted continued dramatic increases in international migration and ethnocultural diversity of older adult cohorts pose challenges for health care services. Review studies on ethnoculturally diverse older adults and health care show a lack of focus on their service use experiences. This study aims to report a meta-ethnography that addresses this knowledge gap through answering the review question: How do ethnoculturally diverse older adults who are immigrants experience health careservices?Design/methodology/approachThe authors applied a seven-phase method of meta-ethnography to guide the review. The authors conducted two literature searches (April 2018 and June 2020) in MEDLINE, CINAHL, Embase, Sociological s and s in Social Gerontology that yielded 17 papers eligible for review.Findings“There’s always something positive and something negative” is the overarching metaphor for answering the review question. Findings highlight positive and negative tensions within ethnoculturally diverse older adults’ health care use experiences of understanding and being understood, having trust in providers and the health care system, having needs, preferences and resources met and desire for self-care over dependency. The majority of experiences were negative. Tipping points towards negative experiences included language, fear, provider attitudes and behaviours, service flexibility, attitudes towards Western and traditional health care and having knowledge and resources.Originality/valueThe authors propose concrete actions to mitigate the tipping points. The authors discuss policy recommendations for health care system changes at the micro, meso and macro service levels to promote positive experiences and address mainstream service policy inequities.

Special issue Innovation development and digital technologies for sustainable healthcare ecosystems

The use of information and communication technologies (ICT) is a twenty-first-century approach that is patient-centered and protects patients, physicians, and others. Where key actors are more interested in social value creation than in value capture (Santos, 2012), health services ecosystems can generate strongly positive externalities and be sustainable. Digital ICT technologies spanning robotics, artificial intelligence, remote patient monitoring, and telemedicine have improved equitable access to care and participated in the sustainable agenda, nurturing an ecosystem of caregiving interaction. Therefore, framing research on information systems in healthcare related to the SDGs can be helpful in the innovation of healthcare organizations in dealing with the pandemic and the post-pandemic. The primary purpose of this special issue is to identify the role and relevance of ICT in healthcare ecosystems while promoting sustainability. Various topics emerge within this special issue, such as Governance models, institutional relations, and social capital; the role of ICT in the healthcare system changes and finally, the use of digital innovations and ICT in pandemics and post-pandemics. In this special issue, we build on this knowledge base and expand the research direction on developing innovation and digital technologies for sustainable health ecosystems.

Providers' Experiences and Perspectives in Treating Patients With Co-Occurring Opioid and Stimulant Use Disorders in the Hospital.

The overdose crisis is increasingly characterized by opioid and stimulant co-use. Despite effective pharmacologic treatment for both opioid use disorder (OUD) and contingency management for stimulant use disorders, most individuals with these co-occurring conditions are not engaged in treatment. Hospitalization is an important opportunity to engage patients and initiate treatment, however existing hospital addiction care is not tailored for patients with co-use and may not meet the needs of this population. Semi-structured interviews were conducted with hospital providers about their experiences and perspectives treating patients with opioid and stimulant co-use. We used directed content analysis to identify common experiences and opportunities to improve hospital-based treatment for patients with co-use. From qualitative interviews with 20 providers, we identified 4 themes describing how co-use complicated hospital-based substance use treatment: (1) patients' unstable circumstances impacting the treatment plan, (2) co-occurring withdrawals are difficult to identify and treat, (3) providers holding more stigmatizing views of patients with co-use, and (4) stimulant use is often "ignored" in the treatment plans. Participants also described a range of potential opportunities to improve hospital-based treatment of co-use that fall into 3 categories: (1) provider practice changes, (2) healthcare system changes, and (3) development and validation of clinical tools and treatment approaches. We identified unique challenges providing hospital addiction medicine care to patients who use both opioids and stimulants. These findings inform the development, implementation, and testing of hospital-based interventions for patients with co-use.

Digital technology and mental health during the COVID-19 pandemic: a narrative review with a focus on depression, anxiety, stress, and trauma.

The sudden appearance and devastating effects of the COVID-19 pandemic resulted in the need for multiple adaptive changes in societies, business operations and healthcare systems across the world. This review describes the development and increased use of digital technologies such as chat bots, electronic diaries, online questionnaires and even video gameplay to maintain effective treatment standards for individuals with mental health conditions such as depression, anxiety and post-traumatic stress syndrome. We describe how these approaches have been applied to help meet the challenges of the pandemic in delivering mental healthcare solutions. The main focus of this narrative review is on describing how these digital platforms have been used in diagnostics, patient monitoring and as a treatment option for the general public, as well as for frontline medical staff suffering with mental health issues.

How should the healthcare system support cancer survivors? Survivors’ and health professionals’ expectations and perception on comprehensive cancer survivorship care in Korea: a qualitative study

BackgroundQualitative research on cancer survivors’ need for comprehensive cancer survivorship care within the health care system is limited. Our study aimed to understand cancer survivors' and health professionals' expectations and perceptions for developing a comprehensive cancer survivorship care system in South Korea.MethodsAn exploratory qualitative study was conducted. A total of 16 subjects (11 cancer survivors and 5 health professionals) were purposively sampled from Regional Cancer Survivorship Centers or Cancer Survivor Clinics in Korea. In-depth semi-structured online or face-to-face interviews were conducted. Six steps of thematic analysis were used to analyze data.ResultsThe following four primary themes emerged from the interviews: 1) introducing a customized follow-up care system to improve continuity of survivorship care, 2) implementing educational strategies for both survivors and health professionals to manage changed health, and 3) accepting cancer survivors as companions. These three themes included a total of nine subthemes. As a result, the comprehensive survivorship model identified needs in terms of 1) changes in the medical healthcare system and core services that can accommodate the cancer survivors’ condition and 2) necessary care services and social support for cancer survivors.ConclusionsThis study identified the existing gaps in Korea’s current healthcare system regarding comprehensive cancer survivorship care for cancer survivors. Further research on eHealth-based counseling and educational support, the payment models of cancer survivorship care within universal health coverage, and changing social perceptions to strengthen the biopsychosocial needs of cancer survivors is needed.

Comparing characteristics and perspectives of U.S. anesthesiology fellows in training and anesthesiologists in their first year of practice

BackgroundThe purpose of this study was to evaluate relationships between demographics, professional characteristics, and perceived challenges facing the specialty of anesthesiology among physicians who entered a fellowship and those who started independent practice immediately after finishing a U.S. anesthesiology residency.MethodsAnesthesiologists in the year after their residency graduation were invited to take an online survey during the academic years of 2016–2017, 2017–2018, and 2018–2019, with questions about their personal characteristics, the nature of their professional lives, and their perceptions of the greatest challenge facing the profession of anesthesiology.ResultsA total of 884 fellows-in-training and 735 anesthesiologists starting independent practice right after the completion of their residency responded. Fellows were slightly younger (mean = 33.2 vs. 34.0 years old, p < 0.001), were more likely to have a spouse who works outside the home (63.9% vs. 57.0%, p = 0.002), had fewer children (mean = 0.69 vs. 0.88, p < 0.001), worked more hours per week (mean = 56.2 vs. 52.4, p < 0.001), and were less likely to report a personal and professional life balance (66.4% vs. 72.3% positive, p = 0.005) than direct-entry anesthesiologists. Fellows and direct-entry anesthesiologists identified similar challenges in three broad themes – workforce competition (80.3% and 71.8%), healthcare system changes (30.0% and 37.9%), and personal challenges (6.4% and 8.8%). Employment security issues posed by non-physician anesthesia providers and perceived lack of appreciation of anesthesiologists’ value were commonly cited. Relative weighting of challenge concerns varied between fellows and direct-entry physicians, as well as within these groups based on gender, fellowship subspecialty, location or size of practice, and frequency of supervisory roles.ConclusionsAnesthesiology fellows and direct-entry anesthesiologists had largely similar demographics and perspectives on the challenges facing anesthesiology in the United States. Group differences found in some demographics and perspectives may reflect different motivations for choosing their professional paths and their diverse professional experiences.

Providing Home Healthcare Services for Patients during Pandemics: Applicability in Developing Countries

The need for a systematic way to provide routine healthcare services for patients during pandemics is one of the priorities of the healthcare sector, especially when the country is in lockdown. In this article, we study the possibility of providing healthcare services for patients at their homes during pandemics in developing countries where such a system is not available. We present a technology-based solution and examine the possibility of its adaptation through a number of theoretical perspectives that examine changes in healthcare systems in general. Examining the theories of change revealed that providing healthcare services at home is a must during pandemics, and it has a significant role in improving the healthcare sector and in providing valuable services to patients, especially when the county is on lockdown. However, a number of challenges do exist for 0its adaptation in developing countries. These challenges are concerned with the costs of developing and maintaining the new system, as well as ensuring a precise and accurate healthcare service to be delivered on time and without any faults or errors. Having a well-studied plan by the health sector, an efficient scheduling mechanism for the healthcare services’ requests, and a service monitoring system can overcome all challenges and ensure a better quality of life for patients.

Geriatric Interprofessional Team Transformation for Primary Care overview.

The Geriatric Interprofessional Team Transformation for Primary Care (GITT-PC) is a model developed to deliver optimal care to older adults in primary care. GITT-PC is an expansion of the John A. Hartford Foundation Geriatric Interdisciplinary Team Training (GITT) program developed at New York University and funded from 1995 to 2002 (Fulmer et al., 2004). GITT was designed to create training models that reflect the needs of the changing health care system and the challenge of caring for older adults with complex conditions (Fulmer et al., 2005). The GITT-PC model builds on the lessons learned from GITT and the development of curricula and training materials based on best practices. Implementation of GITT-PC is accomplished through systems and practices that meet the needs and preferences of patients and their families and that are implemented by teams of health professionals and community service providers. GITT-PC is focused on four core components of high-quality geriatric care: (1) health promotion and prevention, (2) chronic disease management, (3) advanced care planning, and (4) transitional care management, each component corresponding to a Medicare-reimbursable visit. Implementation of these reimbursable services enables practices to provide evidence-based geriatric care while realizing a potential significant return on investment. The GITT-PC model has evolved from an academic training program to a financially sustainable model that serves to improve the care of older adults through a systematic team transformation process that makes a clear business case for primary care (Tabbush et al., 2021). The GITT-PC training program can be implemented in primary care practices with a focus on improving or expanding delivery of annual wellness visits (AWVs) and, potentially, registered RN-led AWVs.

Egyptian community pharmacies and self-care: Context, challenges and opportunities

Community pharmacists are ideally positioned to play a key role in promoting self-care behaviors through judicious use of self-care interventions. As highlighted by the International Pharmaceutical Federation, supporting effective self-care is a key strategy for pharmacists to contribute to the sustainability of healthcare systems. Despite recent positive developments in national health policies, Egypt does not have a clear self-care strategy and policy. It also has no national programs focusing on community pharmacists and self-care, important components that future health policy initiatives should tackle. This commentary explores self-care policies, strategies, and developments in the Egyptian community pharmacy practice context. It describes national research, roles, and challenges within the current model of community pharmacy practice and education concerning self-care. It addresses opportunities that Egyptian community pharmacy has to support self-care in light of the anticipated changes in the Egyptian healthcare system. Noting that success in the delivery of self-care interventions within community pharmacies is associated with key factors, recommendations are suggested for community pharmacy stakeholders to address such factors guided by the World Health Organization's implementation considerations for individuals' health needs and self-care-related health system challenges (agency, availability, quality, cost, information, accessibility, utilization, social support, acceptability, and efficiency).

Impact of vertical integration in a referral-based healthcare system

Vertical integration has been growing steadily in healthcare and several studies have explored the impact of this phenomenon on prices, consumers, etc. In this work, motivated by changes in healthcare systems in China, we provide an operational perspective by investigating how vertical integration influences the referral behavior in primary care and the corresponding service provision at hospitals or specialists. We present an optimization model to explore the effect of different levels of vertical integration on generalists and specialists. We find that the healthcare system efficiency can indeed be improved with a moderate level of integration. However, when the level of integration increases beyond a certain threshold, healthcare costs may actually increase with more integration especially when generalists or primary care providers are inadequately trained and specialists are highly utilized. We find that full integration is not optimal. Moreover, aiming for a moderate level of integration is especially appropriate if the generalist’s ability to treat complex patients is limited and/or timely access to treatment is important. Our work also shows that physicians get higher payment without necessarily improving service quality when the integration level is higher. We discuss the implications of our results in the context of the Chinese healthcare system, although some insights may apply more broadly.

Diabetes Education Linked to Improved Patient Outcomes and Healthcare System Change.

Diabetes Education Linked to Improved Patient Outcomes and Healthcare System Change.