Health Care Systems In Countries Research Articles

Specialty Preferences and Influential Factors among Medical Students in Sudan2021-2022

A country's healthcare system is strongly influenced by the career choices and specializations of its physicians. This is even more important in many sub-Saharan African countries, where there are acute and chronic shortages of medical professionals. This study aims to discern the predilections of final medical students regarding career specialization and the underlying factors that contribute to these preferences. A descriptive cross-sectional study was carried out between November 2021 and May 2022. The study included 218 participants, drawn from Alzaiem Alazhari University, National Ribat University, and National University.In terms of specialty preferences, it is observed that female participants exhibit a preference for obstetrics, while their male counterparts demonstrate a higher inclination towards surgery. Specifically, 20.6% of female participants chose obstetrics and gynecology compared to 6.5% of males. Conversely, 26.1% of males and 16% of all females opted for surgery as their primary choice. In the domain of internal medicine, 15.9% of females and 21.7% of males expressed interest. Pediatrics garnered the attention of 13% of female participants, while only 2.2% of males favored this option. Statistically significant factors influencing the selection of surgery and other specialties include Appraisal of own skills and aptitude" (P-value=0.019) and "Desire to provide community service" (P-value=0.0), which also pertains to internal medicine. For those opting for obstetrics and gynecology, the reasons included "Appraisal of own skills and aptitude" (P-value=0.019) and "Acceptable hours of practice" (P-value=0.971). Pediatrics was predominantly chosen based on "Appraisal of own skills and aptitude" (P-value=0.019).Evident gender disparities are observed in specialty preferences, with males showing a pronounced inclination towards surgical and internal medicine fields. While females also express interest, the percentage is notably higher among males in comparison to the total participants of each gender. The primary reasons for selecting specific specialties are rooted in "Appraisal of own skills and aptitude" and the appeal of "Acceptable hours of practice." Furthermore, an urban practice setting is favored over a rural one.

Overview and countermeasures of cancer burden in China.

Cancer is one of the leading causes of human death worldwide. Treatment of cancer exhausts significant medical resources, and the morbidity and mortality caused by cancer is a huge social burden. Cancer has therefore become a serious economic and social problem shared globally. As an increasingly prevalent disease in China, cancer is a huge challenge for the country's healthcare system. Based on recent data published in the Journal of the National Cancer Center on cancer incidence and mortality in China in 2016, we analyzed the current trends in cancer incidence and changes in cancer mortality and survival rate in China. And also, we examined several key risk factors for cancer pathogenesis and discussed potential countermeasures for cancer prevention and treatment in China.

Health needs and perception of health care quality among Asylum Seekers and Refugees in an Italian local health authority: A qualitative study.

Migrants, Asylum Seekers and Refugees (ASRs) represent a vulnerable diversified population with increased risks of developing health problems, and in the hosting countries several barriers often hamper their access to the health services. Gathering information about ASRs' experiences and perceptions of host country health care systems may contribute to improve the quality of health care provided. The aim of this study was to explore the health needs in their bio-psycho-social meaning, and the quality of health care as perceived from the ASRs' perspective. The qualitative descriptive study was conducted as part of the Project "G-START - testing a governance model of receiving and taking care of the Asylum Seekers and Refugees." Through purposeful and snowball sampling, four Focus Groups conducted in English, Italian and French were carried out between July and August 2019, involving 50 ASRs hosted by four reception centers located on the territory pertaining to an Italian Local Health Authority covering a general population of 500.000 people. The analysis of data was categorical, and was performed using N-Vivo software. The macro-categories emerged were the ASRs' bio-psycho-social health needs, including mental health, sexual and reproductive health, food and nutrition, knowledge of the health care system, need for inclusion; healthcare services access, including barriers before and after the access and the ability of the local health system to respond to existing and evolving demands; strengths of the healthcare and reception systems, and suggestions for improving them in the future. ASRs present vulnerabilities and specific health needs, and the health care system is not always able to guarantee access or to respond to these needs. Several obstacles have been highlighted, such as linguistic barriers and lack of cultural mediation, bureaucratic and administrative barriers, lack of knowledge of the Italian health care system. An effective reorganization of services driven by a more detailed output analysis of the target population needs, together with the use of cultural mediation, peer to peer education and support, and the training of health professionals are recommended to ensure a more accessible, equitable and effective health care system at local level.

Use of telehealth during COVID-19 pandemic in India: literature review

COVID-19 has provided an unprecedented opportunity to expand access and coverage to the country's healthcare system via telehealth. Because of the growing need for telemedicine by healthcare providers, the Medical Council of India issued Practice Guidelines in March 2020. Medical specialties like ophthalmology, dermatology, and neurology offered telehealth services during pandemics. Low-middle-income countries like India are highly dependent on out-of-pocket expenses for health services. Thus, there is a need to understand telehealth's accessibility, feasibility and affordability. This review aims to understand trends regarding the access and patient response to telehealth in India during the COVID-19 pandemic. We reviewed published papers to understand better accessibility and patient response to the healthcare delivery systems via telehealth in India. The results of this review showed that patients were satisfied with the use of telehealth. Healthcare providers and patients believe telehealth can be suitable for various healthcare services, including follow-up visits in clinical disciplines and minor health problems. In conclusion, for Telehealth to understand further, quality evidence must be available, and its role in developing integrated parts of the healthcare system to be defined.

Values-based healthcare (systematic review)

The current demographic situation is characterized by an increase in life expectancy and gain in the number of chronic non-communicable diseases. Healthcare is faced with the task of preserving the population health in these additional years of life, which, in turn, will lead to an increase in the shortage of resources in healthcare and, in general, negatively affect the economies of states. One of the modern concepts of optimal use of resources, evaluation of the effectiveness of health systems is value-based healthcare. In the described model, the value for the patient is the result of medical care in relation to health, which is important for the patient, the criteria for achieving which are determined by the patient himself. According to the concept of the Center, measuring the results and costs for each patient is part of the strategic program for the transition to a highly efficient healthcare system. 
 The purpose of the study is to investigate the features of value-based healthcare in different countries of the world.
 A systematic review was conducted according to the PRISMA guidelines.
 The literature search was performed in the electronic databases PubMed/MEDLINE, Scopus, eLibrary, CyberLeninka, and Yandex and Google systems among English and Russian-language reports. In the healthcare systems of countries that have implemented a value-based approach, the activities of medical institutions are evaluated according to indicators that reflect the value to the patient. To combine the available resources and coordinate the provision of medical care, multidisciplinary teams of specialists are being created and the patient is provided with a full range of services without delay at all stages. In such models, all processes in medical institutions are standardized, which makes it possible to reduce losses and costs at all stages of medical care and increase the results that are valuable for patients.

Physician-Suggested Innovative Methods for Health System Resilience amidst Workforce Emigration and Sociopolitical Unrest in Nigeria: A Survey-Based Study.

Physician emigration (the brain drain) and sociopolitical unrest significantly contribute to the instability of many low- and middle-income countries' healthcare systems. However, limited literature captures the locally driven and context specific suggestions to promote and sustain these health systems' resilience. Thus, the purpose of this study is to 1) understand the effects of physician emigration and sociopolitical unrest on Nigeria's healthcare system, and to 2) synthesize solutions suggested by Nigeria-trained physicians in the form of a resilience framework. An anonymous online survey was conducted among Nigeria-trained physicians. Respondents were recruited using convenience and snowball sampling methods via a WhatsApp group for Nigeria-trained doctors. Quantitative data were analyzed using Stata 17 and qualitative themes were coded by two independent researchers. The final sample included 49 Nigeria-trained physicians-35 physicians practicing in Nigeria and 14 emigrated physicians. All of the physicians currently practicing in Nigeria have considered emigrating, with 79% of them having concrete plans to emigrate in the next five years. Among emigrated physicians, factors such as remuneration (92%) and socioeconomic state of the country (92%) contributed to their decision to emigrate. Suggestions to enhance health system resilience fell into six broad themes: 1) policy and politics, 2) funding and resources, 3) organization and structure, 4) training and education, 5) research and primary health, and 6) health for peace initiatives. The healthcare system is currently unstable and vulnerable due to physician emigration and sociopolitical unrest. To develop and implement solutions to mitigate these issues, capturing the locally trained physicians' perspectives are critical. While each country's healthcare system is unique, countries with similar strains can adapt this model for resilience building. Future studies should focus on adapting the model in different countries with policy-level action points.

Investigation of the Group Purchasing Structure in the Field of Pharmaceuticals and Medical Devices: The Case of Public Pharmacies.

The supply chain of pharmaceuticals and medical devices takes on critical importance regarding group purchasing, given its contribution to a country's healthcare system. One of the primary loops in this chain is the pharmacy as a supplier of goods to consumers and a buyer of goods from distributors. Given the importance of proper and productive preparation, this study examined the structure of aggregated procurement of drugs and medical supplies in public pharmacies. This study used a qualitative method and interviews to collect the necessary data. Fourteen experts and specialists in the public pharmacy field were interviewed and selected using the purposive sampling method. Finally, the textual data were analyzed using efficient thematic analysis. According to experts, the organizational structure for aggregated procurement of medicines and medical supplies in Iran's public pharmacies can take the form of a headquarters structure, a virtual structure, and a semi-centralized virtual structure. The main requirements for these structures are software infrastructure, a productive workforce, and improved storage methods. According to the majority of experts, the most desirable structure for implementing aggregated procurement in hospital pharmacies is the headquarters structure. The aggregated procurement process can reduce pharmacy costs and increase financial reserves and profitability if adequately implemented and equipped with the necessary infrastructure.

Satisfaction of patients with health care services in tertiary care facilities of Riyadh, Saudi Arabia: A cross-sectional approach.

As part of Saudi Vision 2030, the country's healthcare system is undergoing a significant makeover, with accessibility and effectiveness serving as the benchmarks for measuring patient care quality. This study's goal was to ascertain the degree of patient satisfaction with the medical care and services received in Riyadh's tertiary care facilities. The PSQ-18 (Patient Satisfaction Questionnaire-18), a standardized validated questionnaire including areas of "overall satisfaction," "technical quality," "interpersonal aspect," "communication," "financial aspect," "time spent with the doctor," and "accessibility and convenience," was used in this cross-sectional study on 384 patients of two tertiary care facilities in Riyadh, Saudi Arabia, over a 6-month period. The degree to which sociodemographic characteristics and components of patient satisfaction are correlated was assessed using binary and multiple regression analysis. When the P-value was < 0.05, the results were considered significant and were presented as adjusted odds ratios (AOR). To ascertain how each PSQ-18 subscale affected other subscales, a Pearson Correlation analysis was conducted. The overall degree of satisfaction with all 18 items was 73.77%. The financial component received a rating of 81% compared to 77% for general satisfaction. Technical quality (75%) was followed by accessibility and convenience (73.5%), communication (73%), and interpersonal elements (72%). At 68%, the time spent in the doctor's domain received the lowest rating. The odds of satisfaction were increased by 3.87 times, 3.45 times, and 3.36 times among those who are employed, qualified by university education, and married compared to unemployed (P-value = 0.018), less qualified (P-value = 0.015) and singles (P-value = 0.026), respectively. The younger age group also made 1.78 times more of a difference in higher satisfaction ratings. The general satisfaction domain showed a positive association with other areas. Participants who were satisfied with the communication and accessibility and convenience domains of healthcare providers were the only ones who were typically satisfied with the domain of doctor time spent. The study's findings could act as a benchmark for Saudi Arabia's healthcare services as well as a starting point for quality assurance procedures.

Letter: Research Productivity of Physicians in the Pandemic and Post-pandemic Era: A "Productive Outbreak'".

Letter: Research Productivity of Physicians in the Pandemic and Post-pandemic Era: A "Productive Outbreak'".

Data envelopment analysis for ambulance services of different service providers in urban and rural areas in Ministry of Health Malaysia.

Ambulance services are pivotal in any country's healthcare system. An efficient ambulance service not only decreases patient mortality rate but also allows resource prioritization for better outputs. This study aims to measure the efficiency of ambulance services provided by health facilities in the Ministry of Health (MOH), Malaysia. This cross-sectional study analyzed the efficiency of 76 Decision-Making Units (DMUs) or health facilities, consisting of 62 health clinics and 14 hospitals. Data Envelopment Analysis (DEA) was used for computing efficiency scores while adopting the Variable Return to Scale (VRS) approach. The analysis was based on input orientation. The input was the cost of ambulance services, while the output for this analysis was the distance coverage (in km), the number of patients transferred, and hours of usage (in hours). Subsequent analysis was conducted to test the Overall Technical Efficiency (OTE), the Pure Technical Efficiency (PTE), the Scale Efficiency (SE), and the Return to Scale with the type of health facilities and geographical areas using a Mann-Whitney U-test and a chi-square test. The mean scores of OTE, PTE, and SE were 0.508 (±0.207), 0.721 (±0.185), and 0.700 (±0.200), respectively. Approximately, 14.47% of the total health facilities were PTE. The results showed a significant difference in OTE and SE between ambulance services in hospitals and health clinics (p < 0.05), but no significant difference in PTE between hospitals and clinics (p>0.05). There was no significant difference in efficiency scores between urban and rural health facilities in terms of ambulance services except for OTE (p < 0.05). The ambulance services provided in healthcare facilities in the MOH Malaysia operate at 72.1% PTE. The difference in OTE between hospitals and health clinics' ambulance services was mainly due to the operating size rather than PTE. This study will be beneficial in providing a guide to the policymakers in improving ambulance services through the readjustment of health resources and improvement in the outputs.

A Multi-objective Mathematical Programing Model for the Problem of P-envy Emergency Medical Service Location.

To prevent the great dangers caused by emergency situations, providing rapid and high-quality emergency aid highly depends on the location of emergency medical centers. The purpose of this research is to present a multi-objective mathematical programing model based on the minimum P-envy algorithm to locate and construct emergency medical services (EMS). Maximizing the coverage in order to increase the probability of survival of different categories of patients, minimizing the costs of constructing EMS and optimizing the ratio of regions having the right to emergency medical services is one of the fundamental challenges in the health care system of countries. In this paper, a model for maximum utilization of EMS considering budget limitations is presented. In this study, since the problem is NP-Hard, the Genetic Algorithm (GA) and Simulated Annealing (SA) algorithm were used to solve this problem. The parameters of the metaheuristic algorithms were tuned using the Taguchi method. Several instance problems were solved to compare the performance of 2 algorithms. The results demonstrate that the validity of the proposed model. Also, the mean of the solutions obtained by GA for small, medium, and large-size problems are better than the SA algorithm. Also, the GA algorithm obtained more efficient solutions than the SA algorithm.

The threat of Monkeypox in the Philippines: another problematic preparation and management for the healthcare system?

The Philippines is still in a tight battle with the coronavirus disease 2019 pandemic since many cases are detected daily. With the continuous spread of another disease worldwide-monkeypox, many Filipinos are alarmed if the country's healthcare system is prepared enough, especially with the detection of its first case. Learning from the unfortunate experiences of the country during the current pandemic is essential in facing another health crisis. With this, recommendations for a robust healthcare system are proposed centered on: a massive digital information campaign about the disease; training healthcare workers to raise awareness about the virus and its transmission, management, and treatment; an intensified surveillance and detection procedure to monitor cases and execute contact tracing properly; and a persistent procurement of vaccines and drugs for treatment, with a well-designed vaccination program.

Building an action plan to tackle palliative care inequality through multi-stakeholder platforms.

To achieve universal care and overcome existing barriers, the most effective strategy is to devise an action plan that incorporates palliative care into primary health care (PHC), as recommended by the World Health Organization's (WHO) Astana Declaration. In Colombia, a country with an upper-middle-income status, about 128,000 individuals experience severe health-related suffering (SHS) that necessitates palliative care. Although the country's healthcare system has made steady strides in the integration and development of palliative care, there is still no national plan in place for palliative care. Build up Colombia's palliative care plan through stakeholder consensus. Based on the participatory action research method and the multi-stakeholder platforms model, this study convened 142 stakeholders from different levels of the health system (patient representatives, journalists, health professionals, government entities, insurance companies, universities, and drug regulatory authorities). The national plan aims to achieve its objectives through a series of strategic actions. These include integrating and diversifying palliative care services, improving access to opioids, increasing palliative care education, promoting community-based palliative care programs, securing funding, and implementing a regulatory framework for palliative care by public policymakers. The national palliative care is an alliance that aims to reduce palliative care inequity in Colombia by 2026 by empowering stakeholders nationwide to collaborate around specific goals and objectives.

Assessing the associated medical, legal, and social issues in medical tourism and its implications for Nigeria.

Medical tourism is thriving in Nigeria among both elites and non-elites with over $1 billion annual expenditure on medical tourism. Inadequate healthcare infrastructure caused by economic problems, corruption and low budgetary allocation to the country's health sector, and lack of trust in the country's healthcare systems to handle complex medical procedures have contributed to this trend. This article discusses the trend of medical tourism in Nigeria and the associated medical, legal, and social issues in medical tourism generally, relying on relevant literature. The paper concludes that medical tourism is not inherently dangerous; however, unequal economic and power status may influence the quality of hospitals where patients receive treatment and the quality of treatment received. This unequal power and economic status may also determine justice in cases of substandard treatment in foreign hospitals. The study recommends that the Nigerian government should improve healthcare systems in the country to reverse the trend of medical tourism and to reduce the financial burden that medical tourism exerts on average Nigerians who need a high level of care but cannot access it in their country. It is also recommended that a regulatory framework that ensures protection from substandard hospitals and justice for Nigerians who fall victim to substandard care abroad must be put in place by the Nigerian government. Relevant health stakeholders should also continue to sensitize the public about the complications that may be associated with some medical procedures sought outside Nigeria especially cosmetic surgery which may result in follow-up challenges.

Rising cases of Dengue and Malaria in Flood Affected Areas of Pakistan: A Major Threat to the Country's Healthcare System.

Rising cases of Dengue and Malaria in Flood Affected Areas of Pakistan: A Major Threat to the Country's Healthcare System.

Burden and Trends of Cancer in Bangladesh: Insights into Breast, Lung, Cervical, and Liver Cancers and Implications for Public Health Interventions

Burden and Trends of Cancer in Bangladesh: Insights into Breast, Lung, Cervical, and Liver Cancers and Implications for Public Health Interventions

Your clinical pharmacist can save your life, the impact of pharmacist's intervention.

Patient safety and adverse event analysis are of paramount importance in the management of patient medication, given the significant economic burden they place on a country's healthcare system. Medication errors fall into the category of preventable adverse drug therapy events and are therefore of key importance from a patient safety perspective. Our study aims to identify the types of medication errors associated with the medication dispensing process and to determine whether automated individual medication dispensing with pharmacist intervention significantly reduces medication errors, thereby increasing patient safety, compared to traditional, ward base medication dispensing (by a nurse). A prospective, quantitative, double-blind point prevalence study was conducted in three inpatient internal medicine wards of Komló Hospital in February 2018 and 2020. We analyzed data from comparisons of prescribed and non-prescribed oral medications in 83 and 90 patients per year aged 18 years or older with different diagnoses treated for internal medicine on the same day and in the same ward. In the 2018 cohort, medication was traditionally dispensed by a ward nurse, while in the 2020 cohort, it used automated individual medication dispensing with pharmacist intervention. Transdermally administered, parenteral and patient-introduced preparations were excluded from our study. We identified the most common types of errors associated with drug dispensing. The overall error rate in the 2020 cohort was significantly lower (0.9%) than in the 2018 cohort (18.1%) (p < 0.05). Medication errors were observed in 51% of patients in the 2018 cohort, i.e. 42 patients, of which 23 had multiple errors simultaneously. In contrast, in the 2020 cohort, a medication error occurred in 2%, i.e. 2 patients (p < 0.05). When evaluating the potential clinical consequences of medication errors, in the 2018 cohort, the proportion of potentially significant errors was 76.2% and potentially serious errors 21.4%, whereas in the 2020 cohort, only three medication errors were identified in the potentially significant category due to pharmacist intervention, which was significantly lower (p < 0.05). Polypharmacy was detected in 42.2% of patients in the first study and in 12.2% (p < 0.05) in the second study. Automated individual medication dispensing with pharmacist intervention is a suitable method to increase the safety of hospital medication, reduce medication errors, and thus improve patient safety.

Perceptions of specialists in the public sector, on the role and value of family medicine.

Family medicine (FM) is often perceived to be a 'lesser' speciality compared with other disciplines, despite its importance as a generalist discipline in the healthcare system. Family physicians (FPs) provide comprehensive care at the district level and act as a gatekeeper for patient's upward referral to other specialists. This study aimed to explore the perceptions of healthcare specialists other than FPs involved in registrar training regarding FM at the University of KwaZulu-Natal, South Africa (SA). This was a qualitative study, with seven consultants, other than FPs, who worked at three public sector regional hospitals using purposive sampling. Individual semistructured interviews were conducted, audio-recorded and transcribed verbatim and analysed thematically. Four themes emerged (perception of FM as a medical speciality, role of FPs in the healthcare system and proposed National Health Insurance, FM registrars rotating in units and the scope of their training and how to improve the perceptions of FM by other specialities). Family medicine was regarded as a major and relevant specialist field with a significant contribution to make in advancing patients' care. The country's healthcare system is yet to make the best use of the FM specialist's role in improving quality of care. The perceptions of FM from other specialists were generally positive and reinforced its importance in facilitating improved healthcare in SA. These specialists have high regard for FM and emphasised the large responsibility of practitioners.

Risk Assessment of Arbaeen Mass Gathering in the Covid-19 Pandemic.

IntroductionArbaeen is a religious ceremony held annually with the participation of a large number of pilgrims. During the pandemic of Covid-19, a mass gathering of Arbaeen pilgrims can strengthen the transmission of this disease and put more pressure on the health care system of countries. The aim of the study is to evaluate the risk of Arbaeen ceremony in the Covid-19 pandemic in 2021.Materials and methodsA mixed method was performed to perform the study using qualitative and quantitative methods. A national risk assessment tool was used that consisted of hazard identification and assessment, scenario development, exposure assessment, vulnerability assessment and risk estimation. The national risk assessment tool was completed through a focused group discussion and the opinions of 20 representatives of the health system and the level of risks were estimated. Data were collected, analyzed, and integrated by the research team.ResultsBased on the results of risk matrix analysis, factors such as the increase in the number of new cases of COVID-19, the probability of exposure to a new variant of COVID-19, the probability of arrival of a new variant of COVID-19 to the country, the probability of increasing referrals to healthcare facilities (score 16), the probability of getting respiratory diseases, and the environmental contamination (score 12) occupied the red area of the matrix and were found to have the highest risk (unbearable risk), that needs immediate action.ConclusionPreparing for a mass gathering such as Arbaeen is very important in order to reduce the risk of communicable disease, and the first step in improving preparedness is risk assessment and its continuity in the various stages of the ceremony. Therefore, policy makers and planners of such events should conduct risk assessments with the participation of local and national public health authorities regularly.

Estimating the Health Effects of Expansions in Health Expenditure in Indonesia: A Dynamic Panel Data Approach.

The marginal productivity of a country's healthcare system refers to the health gains produced per unit change in the level of spending. In budget-constrained settings, this metric reflects the opportunity cost, in terms of health gains forgone, of committing additional or existing resources to alternative uses within the healthcare system. It can therefore assist in evidence-based decisions on whether different interventions represent good value for money. The aim of this paper was to estimate the marginal productivity of the Indonesian healthcare system using subnational data, and to use this to inform health opportunity costs in the country. We define a dynamic health production function to model the stream of effects of current and prior public health spending decisions on population under-five mortality. To estimate the model, we use data from the 33 Indonesian provinces for the 2004-2012 period. The estimated elasticity is then translated into gains in terms of cost per DALY (disability-adjusted life-year) averted. We use dynamic panel data methods to address potential endogeneity issues in the model. Our base-case estimates suggest that a 1% expansion in the level of health spending reduces under-five mortality by 0.38% (95% CI 0.00-0.76), which translates into a cost of averting one DALY of $235 (2019 US$). With Indonesia aiming for universal health coverage, our results support these efforts by highlighting the associated benefits resulting from increases in public health expenditure and have the potential to inform the decision-making process about a suitable locally relevant cost-effectiveness threshold.