Distribution Of Health Care Resources Research Articles

The Assessment of Inequality in the Geographical Distribution of Burn Beds in Iran.

IntroductionIn recent years, the World Health Organization (WHO) has emphasized the importance of determining the equality of the distribution of healthcare resources. Inequalities in the healthcare system are one of the world’s most important developmental challenges, and the inefficiencies that exist in healthcare systems are the most important reason for these challenges. Thermal burns are one of the common injuries worldwide, and their effects are a significant reason for the mortality and morbidity rates throughout the world. Considering the importance of burns as one of the 30 leading causes of death in Iran, this study was aimed to compare the distribution of burn beds with its disability-adjusted life years (DALY) in Iran.MethodsThis applied analytic-descriptive study was conducted in order to determine the distribution of burn beds in Iran using the Lorenz curve. In this way, the distribution of burn beds was analyzed in relation to the population of each province and lost DALY caused by burns in Iran. For each province, the number of burn beds in 2012 was collected from credible and authoritative sources at the Ministry of Health, and the population of each province was obtained using data from the National Center of Statistics. The data were analyzed and presented using Microsoft Office Excel.ResultsIsfahan and Khorasan Razavi Provinces had approximately 11 and 10.4% of the country’s burn beds, respectively. The Provinces that had the most DALY were Sistan Baluchestan, Fars, and Kerman with 10.75%, 10.34%, and 9.54%, respectively. The Gini coefficients of burn beds in relation to population and DALY were calculated as 0.09 and 0.16, respectively.ConclusionThe Gini coefficients in relation to population and DALY were less than 0.2. Although the Gini coefficient of the burn beds in relation to DALY was more than that for the population, the difference was not significant, and the distributions of beds regarding the two calculated coefficients were equal. It is recommended that healthcare policymakers distribute burn beds in proportion to the populations of the provinces.

Analysis of progress and problems in coordinated care delivery

Authors described the patterns, core measures and mechanisms of coordinated care delivery in the localities and analyzed initial outcomes of this practice. It is found that such practice has optimized distribution of regional healthcare resources, implemented first visit to primary institutions, and the care delivery to separate emergency from outpatient service. In addition, the paper analyzed problems found in localities in terms of policy, public hospitals and primary institutions, and proposed elements required for coordinated care delivery system to succeed, such as enhanced policy support, enhanced multi-departmental coordination, and public hospital reform to explore feasible approaches. Key words: Coordinated care; Public hospital reform

Urban-rural difference in patients utilizing the service of telehealthcare

There are concerns about the unbalanced distribution of healthcare resources between rural and urban areas. There have been attempts to use existing healthcare resources more effectively through telehealthcare. Usability is an important indicator for evaluating patient behavior and determining service improvements. Nevertheless, usability has not been studied extensively enough. This study analyzed the usability differences between urban and rural areas in Taiwan for a web portal used in a telehealthcare program. Data were collected for two years. Usability data includes the frequency of web portal patient logins, the frequency of glucose measurements, whether the records were transmitted to the system through 3G networks automatically or were manually inputted, and the correlation of the mean 3-month daily glucose levels and HbA1c results. Patients in urban areas logged into the web portal more frequently (p < .001) and recorded glucose levels more frequently (p = .003). More patients in the rural area transmitted their daily glucose levels using devices (p < .001). Mean 3-month daily glucose levels and HbA1c results appear to be highly consistent. Patients in urban areas did not readily change glucometer habits but were willing to log in to web portal and record daily glucose levels manually. Patients in rural areas were willing to use the 3G glucometer to transmit data more frequently. For patients in urban areas, web portals should provide more information and smart applications. For patients in rural areas, the application should be simple and easy to use.

Quality use of medicine in a developing economy: Measures to overcome challenges in the Malaysian healthcare system.

Malaysia inherits a highly subsidized tax-based public healthcare system complemented by a fee-for-service private sector. Population health in Malaysia has considerably improved since independence using a relatively small amount of gross domestic product (~4%). Brain drain of highly specialized personnel, growth in healthcare spending, demographic and disease pattern changes and increase in patients’ demands and expectations towards better medical care are exerting pressure on the sustainability of the system to continuously provide efficient and effective services at relatively low cost. Malaysia has adopted and implemented some of the quality use of medicine concepts such as National Essential Medicine List, health technology assessment and promotion of generic medicines in their health policy, but so far the results may not be optimal. Activities to further promote these strategies are needed for successful implementation to achieve more positive and sustained beneficial outcomes. Better strategic planning, management and collaboration between various stakeholders, considering the needs and barriers of the strategies, are important to ensure effective implementation of the strategies. More emphasis should be placed upon more equitable and rational distribution of healthcare resources to cater for rapid urbanization. Additionally, a sustainable health financing structure that is more progressive and does not encourage moral hazard should be established. In conclusion, Malaysia has achieved good outcomes in population health with relatively low financial inputs since independence. However, changes in the overall environment have created issues which would threaten the long-term viability of the healthcare system if not tackled properly. The numbers of internationally trialled strategies could be used to deal with these challenges. In addition, coordinated implementation of these strategies and effective engagement and communication between various stakeholders are necessary to further strengthen the Malaysian healthcare system effectively.

Does it matter whose opinion we seek regarding the allocation of healthcare resources? - a case study.

BackgroundSocietal preferences have to be taken into consideration to ensure difficult healthcare decisions are legitimate and acceptable. It has been interesting to ascertain whether attitudes towards the principles of public healthcare resources allocation are homogenous. In particular, it has been thought provoking to ask whether advancement in medical technologies, and growing accessibility issues due to scarcity of healthcare resources, have influenced the beliefs of the general public with regard to allocative principles in recent years. The objective of this study was to compare preferences towards the distribution of healthcare resources between younger and older members of society.MethodsDiscrete choice experiments using the equivalence of numbers technique and the social welfare function were conducted in Poland. Public preferences towards disease severity, and potential to benefit, as well as aversion to inequity, were elicited. In order to ensure full understanding of questions by the older respondents, a pilot study with ten respondents aged 65+ was conducted.ResultsIn total, 52 adult respondents (seniors) and 45 students (juniors) were interviewed. While the first were unwilling to trade between different patients, the latter chose a higher number of individuals to compensate for the loss of ten patients with a more severe disease and a higher potential to treat everything else being equal. Juniors were more inequality averse compared to seniors as well.ConclusionsWhile the revealed preferences of seniors were egalitarian, juniors were more willing to differentiate between disease severity and potential to benefit. Differences in opinion between juniors and seniors should be considered in open dialogue regarding healthcare rationing. Insight into the preferences towards health maximization of the former group and the egalitarian beliefs of the latter group could be useful for decision makers in the search for public acceptance of allocation of scarce healthcare resources.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-1210-8) contains supplementary material, which is available to authorized users.

Constitutions of justice in genetic medicine: distributing diagnostics for familial hypercholesterolemia in three European countries

While developments in genetic medicine are widely considered to bring forward pressing policy challenges, the question how genetic diagnostics are integrated into and distributed within existing health-care infrastructures has virtually been ignored. This paper addresses the distribution of genetic diagnostics through the framework of bioconstitutionalism, which suggests that basic categories for the allocation of rights and duties in law and policymaking are redefined together with and through specific scientific and technological ways of understanding and intervening in life. The paper thus analyzes the coproduction of diagnostic and distributive approaches to familial hypercholesterolemia (FH), a hereditary form of high cholesterol, in the Netherlands, the United Kingdom and Germany. It describes how a commitment to a genetically narrow screening program in the Netherlands reflects a commitment to providing care to specific subcommunities of people at risk; how a broad and predominantly phenotypic understanding of FH in the United Kingdom can be understood in terms of an emphasis on comprehensive population coverage and how the framing of high cholesterol as a regular risk factor in Germany expresses a rule-bound notion of justice. The paper thus suggests that particular culturally situated imaginations of distributive justice in the distribution of health-care resources underwrite the formation of diagnostic and distributive arrangements. The paper thereby proposes that bioconstitutionalism can provide a valuable contribution to (comparative) health policy analysis by lying bare how policies affect individual access to medical care.

Sociocultural and structural factors contributing to delays in treatment for children with severe malaria: a qualitative study in southwestern Uganda.

Malaria is a leading cause of pediatric mortality, and Uganda has among the highest incidences in the world. Increased morbidity and mortality are associated with delays to care. This qualitative study sought to characterize barriers to prompt allopathic care for children hospitalized with severe malaria in the endemic region of southwestern Uganda. Minimally structured, qualitative interviews were conducted with guardians of children admitted to a regional hospital with severe malaria. Using an inductive and content analytic approach, transcripts were analyzed to identify and define categories that explain delayed care. These categories represented two broad themes: sociocultural and structural factors. Sociocultural factors were 1) interviewee's distinctions of “traditional” versus “hospital” illnesses, which were mutually exclusive and 2) generational conflict, where deference to one's elders, who recommended traditional medicine, was expected. Structural factors were 1) inadequate distribution of health-care resources, 2) impoverishment limiting escalation of care, and 3) financial impact of illness on household economies. These factors perpetuate a cycle of illness, debt, and poverty consistent with a model of structural violence. Our findings inform a number of potential interventions that could alleviate the burden of this preventable, but often fatal, illness. Such interventions could be beneficial in similarly endemic, low-resource settings.

Canadian perspectives on the clinical actionability of neuroimaging in disorders of consciousness.

Acquired brain injury is a critical public health and socioeconomic problem in Canada, leaving many patients in vegetative, minimally conscious, or locked-in states, unresponsive and unable to communicate. Recent advances in neuroimaging research have demonstrated residual consciousness in a few exemplary patients with acquired brain injury, suggesting potential misdiagnosis and changes in prognosis. Such progress, in parallel with research using multimodal brain imaging technologies in recent years, has promising implications for clinical translation, notwithstanding the many challenges that impact health care and policy development. This study explored the perspectives of Canadian professionals with expertise either in neuroimaging research, disorders of consciousness, or both, on the potential clinical applications and implications of imaging technology. Twenty-two professionals from designated communities of neuroimaging researchers, ethicists, lawyers, and practitioners participated in semistructured interviews. Data were analyzed for emergent themes. The five most dominant themes were: (1) validation and calibration of the methods; (2) informed consent; (3) burdens on the health care system; (4) implications for the Canadian health care system; and (5) possibilities for improved prognosis. Movement of neuroimaging from research into clinical care for acquired brain injury will require careful consideration of legal and ethical issues alongside research reliability, responsible distribution of health care resources, and the interaction of technological capabilities with patient outcome.

Current small cell lung cancer treatment in China.

BackgroundThe treatment status of small cell lung cancer (SCLC) in Mainland China has never been reported; therefore, this study is the first multicenter survey investigating the status of epidemiology and treatment options of SCLC in Mainland China.MethodsTwo questionnaires were designed to obtain information in 12 medical centers in five major Chinese cities. The hospital information questionnaire was designed to outline SCLC patients' characteristics and treatment preferences in each medical institution, and the patient information questionnaire collected detailed treatment information of 298 SCLC cases in these hospitals.ResultsSCLC represented 13.7% and 18.3% of all lung cancer patients in 2005 and 2010, respectively. Clinical management of SCLC follows mainstream clinical guidelines in general. The most widely applied first-line treatment mode for limited-stage patients was combined chemoradiotherapy (66.2%), while 77.0% of the extensive-stage patients received chemotherapy alone as initial treatment. Etoposide with cisplatin or carboplatin were the most accepted first-line chemotherapy regimens. The objective response rate was 58.3% after first-line chemotherapy and 23% of the patients who responded well to first-line treatment received prophylactic cranial irradiation. As for second-line chemotherapy, single regimen topotecan or a combined regimen containing topotecan were preferred (53.0%).ConclusionsThe treatment options indicated in our study are in accordance with the international clinical guidelines, which is valuable for the improvement of future guidelines, health care standard, and even the better distribution of health care resources in China.

Providing optimal regional care for ST-segment elevation myocardial infarction: a prospective cohort study of patients in the Hamilton Niagara Haldimand Brant Local Health Integration Network.

Although considered the evidence-based best therapy for ST-segment elevation myocardial infarction (STEMI), many patients do not receive primary percutaneous coronary intervention (PCI) because of health care resource distribution and constraints. This study describes the clinical management and outcomes of all patients identified with STEMI within a region, including those who did not receive primary PCI. This study used a prospective cohort design. Patients presenting with STEMI to PCI- and non-PCI-capable hospitals in one integrated health region in Ontario were included in the study. The primary objective was to examine use of reperfusion strategies and timeliness of care. Secondary objectives included determining (through regression models) which variables were associated with mortality within 90 days, and describing patient uptake of risk-reducing therapies and activities post-STEMI. Between Apr. 1, 2010, and Mar. 31, 2013, data were collected on 2247 consecutive patients presenting with STEMI. Patients presenting to the PCI-capable hospital were more likely to receive primary PCI (82.5% v. 65.2%, p < 0.001) and be treated within optimal treatment times. However, there was no appreciable difference in mortality at 90 days post-STEMI between patients presenting to PCI- and non-PCI-capable hospitals (7.8% v. 7.5%, p = 0.82), even after adjustment for acuity on presentation. Despite recognized risk factors, many patients were not taking evidence-based medications for risk factor modification before STEMI. A systematic approach to regional STEMI care focusing on timely access to the best available therapies, rather than the type of reperfusion provided alone, can yield favourable outcomes.

The future of simulation in medical education

The future of simulation in medical education

Economic growth and the geographic maldistribution of health care resources: Evidence from China, 1949-2010

The geographic maldistribution of health care resources is one of the most persistent characteristics of health care systems around the world. Based on China’s provincial-level panel data in 1949-2010, this paper empirically investigates whether the geographic distribution of health care resources is convergent or divergent in the long run and whether the rapid economic growth contributes to reducing the regional disparity in health care resources in China. Using a dynamic convergence model that controls unobserved provincial heterogeneity and spatial dependence, the empirical results provide much support for β-convergence in that the provinces with lower initial values of health care resources, including the densities of physicians and hospital beds, are seen to grow faster and to catch up with the provinces with higher initial stocks. In addition, we find that GDP per capita has a significant and non-linear impact on the convergence rate of health care resources, providing support for a Kuznets curve in China’s health sector. That is, the inequality in the distribution of health care resources follows an inverted “U” shape as income increases over time. An important implication of our study is that economic growth per se provides a built-in stabilizer to mitigate health inequality through the convergence of health care resources across regions in the long run.

Development of Measurement Model for the Value of QOL as an Influential Factor of Metabolic Syndrome

The quality of life (QOL) has been underscored by the increase in chronic diseases like metabolic syndrome and expanded life expectancy. Studies on QOL fundamentally aims to determine what is important in every individual, and to assess the concept of subjective QOL. For these reasons, QOL has been an important factor to oneself`s needs to be objectively measured by respondents from the various aspects of life wherein these measurements are required in evaluating the value of the QOL. In this study, a measurement model was developed to assesses health-related quality of life (HRQL) objectively using basic data, instead of indicators obtained from the subjective evaluation of patients. Data used are based on EQ-5D, which is a widely used assessment tool in measuring HRQL. The proposed tool has a very high accuracy of 90.4 %,which will contribute to improving QOL by promoting the distribution of healthcare management resources as an indicator to assess QOL uniformly based on objective information.

Suggestions to ameliorate the inequity in urban/rural allocation of healthcare resources in China.

The imbalance in the allocation in healthcare resources between urban and rural areas has become a main focus of the recent medical reforms adopted in China. However, systematic analysis has identified wide differences in the allocation of healthcare resources between urban and rural areas, including healthcare expenditures and the number of healthcare facilities, available beds, and personnel. Therefore, the aim of this report was to identify ethical considerations in current governmental policies to rectify existing problems in the distribution of healthcare resources. Our findings indicate that the inequality in the distribution of healthcare resources does not adhere to ethical standards and the policies are flawed because they give rise to differences in the availability of medical care to urban and rural communities. To optimize the allocation of medical healthcare resources, countermeasures are proposed to formulate policies to urge the flow of public healthcare resources to rural areas, strengthen the responsibilities of both governmental and public financial investments, increase the construction of public healthcare facilities in rural areas, promote the quality of healthcare resources, adjust resource allocations to rural public healthcare facilities, and improve resource utilization efficiency by establishing two-way referral mechanisms.

PHP73 - Transparency In Medical Devices Pricing: Information That Helps Different Stakeholders In Decision Making

The Brazilian Health Surveillance Agency (Anvisa) approved in October 2006 a specific legislation, the Resolution RDC 185/2006, which obliges the suppliers of medical devices to send economic information of their products to Anvisa. In order to reduce the information asymmetry in this market, the Economic Regulation Office (NUREM/ANVISA) has developed the database of economic information of medical devices and has published on Anvisa’s website a list of prices of some cardiologic and orthopedic devices. The list compares the supplier economic information to the data provided by different sources, such as specific medical devices journals, marketing authorization and research on international and Brazilian market. The aim of this study is to present an assessment of economic information of medical devices based on the ANVISA database. The data of medical devices were collected from Anvisa’s database of economic information from 2007 to 2013. The price from different regions (Brazilian, American and European) and the classes of medical devices (cardiologic and orthopedic devices) were compared. The prices in Brazil are far superior to American and European countries. In 2013, considering different regions of Brazil, the prices can vary about 15%; the most expensive cardiologic product identified was Implantable Cardioverter/Defibrillator, whilst the most expensive orthopedic one was the Intervertebral Prosthesis (Cage). These analyses allow the health care professionals and payers know the medical device pricing behavior regarding to the internal and international market. In summary, the free access of economic data of medical devices can increase the transparency, which can be helpful to support decisions of different stakeholders, who can distribute health care resources more efficiently in order to improve the health care conditions and to develop health public policies.

Intergenerational justice and health care: A case for interdependence

Among the myriad longstanding political, socioeconomic, and moral debates focused on the fair distribution of health-care resources within the United States, those addressing intergenerational justice tend to produce the most heat and, often, the least amount of light. The familiar narratives tend to be binary ones of opposing generational stakeholders. While a great number of proposed solutions focus on reconfiguring rationing priorities, this paper will instead shift the discourse to intergenerational interdependence, suggesting that these conflict-born moral dilemmas are in important ways false. The alternative view of intergenerational relations defended here is grounded in an interdependent, rather an oppositional, model of human relationships. I argue that this interdependence can best be realized through a deliberate movement toward intergenerational narrative understandings, as well as through physical proximities. I conclude by considering several ongoing intergenerational projects directed at just such a goal.

Distribution of selected healthcare resources for influenza pandemic response in Cambodia

IntroductionHuman influenza infection poses a serious public health threat in Cambodia, a country at risk for the emergence and spread of novel influenza viruses with pandemic potential. Prior pandemics demonstrated the adverse impact of influenza on poor communities in developing countries. Investigation of healthcare resource distribution can inform decisions regarding resource mobilization and investment for pandemic mitigation.MethodsA health facility survey performed across Cambodia obtained data on availability of healthcare resources important for pandemic influenza response. Focusing on five key resources considered most necessary for treating severe influenza (inpatient beds, doctors, nurses, oseltamivir, and ventilators), resource distributions were analyzed at the Operational District (OD) and Province levels, refining data analysis from earlier studies. Resources were stratified by respondent type (hospital vs. District Health Office [DHO]). A summary index of distribution inequality was calculated using the Gini coefficient. Indices for local spatial autocorrelation were measured at the OD level using geographical information system (GIS) analysis. Finally, a potential link between socioeconomic status and resource distribution was explored by mapping resource densities against poverty rates.ResultsGini coefficient calculation revealed variable inequality in distribution of the five key resources at the Province and OD levels. A greater percentage of the population resides in areas of relative under-supply (28.5%) than over-supply (21.3%). Areas with more resources per capita showed significant clustering in central Cambodia while areas with fewer resources clustered in the northern and western provinces. Hospital-based inpatient beds, doctors, and nurses were most heavily concentrated in areas of the country with the lowest poverty rates; however, beds and nurses in Non-Hospital Medical Facilities (NHMF) showed increasing concentrations at higher levels of poverty.ConclusionsThere is considerable heterogeneity in healthcare resource distribution across Cambodia. Distribution mapping at the local level can inform policy decisions on where to stockpile resources in advance of and for reallocation in the event of a pandemic. These findings will be useful in determining future health resource investment, both for pandemic preparedness and for general health system strengthening, and provide a foundation for future analyses of equity in health services provision for pandemic mitigation planning in Cambodia.

Quality of Life in Chronic Disease Patients.

During the past decades there was an increasing predominance of chronic disorders, with a large number of people living with chronic diseases that can adversely affect their quality of life. The aim of the present paper is to study quality of life and especially Health-related quality of life (HRQoL) in chronic diseases. HRQOL is a multidimensional construct that consists of at least three broad domains – physical, psychological, and social functioning – that are affected by one’s disease and/or treatment. HRQoL is usually measured in chronic conditions and is frequently impaired to a great extent. In addition, factors that are associated with good and poor HRQoL, as well as HRQoL assessment will be discussed. The estimation of the relative impact of chronic diseases on HRQoL is necessary in order to better plan and distribute health care resources aiming at a better HRQoL.[«All the people perceive the concept of living good or being well, that is the same as being happy». (Aristotle. 384-322 BC. Ethica Nichomachea)]

Quality of life in chronic disease patients

&lt;p&gt;During the past decades there was an increasing predominance of chronic disorders, with a large number of people living with chronic diseases that can adversely affect their quality of life. The aim of the present paper is to study quality of life and especially Health-related quality of life (HRQoL) in chronic diseases. HRQOL is a multidimensional construct that consists of at least three broad domains &amp;minus; physical, psychological, and social functioning &amp;minus; that are affected by one&amp;rsquo;s disease and/or treatment. HRQoL is usually measured in chronic conditions and is frequently impaired to a great extent. In addition, factors that are associated with good and poor HRQoL, as well as HRQoL assessment will be discussed. The estimation of the relative impact of chronic diseases on HRQoL is necessary in order to better plan and distribute health care resources aiming at a better HRQoL.&lt;/p&gt;&lt;p&gt;[&amp;laquo;&lt;em&gt;All the people perceive the concept of living good or being well, that is the same as being happy&lt;/em&gt;&amp;raquo;. (Aristotle. 384-322 BC. Ethica Nichomachea)]&lt;/p&gt;

The diverse issues of Healthcare in Low-resource Settings

Not available.