Health Service Supply Research Articles

Patient Preferences, Concerns, and Satisfaction with Providers before the Chinese Urban Health System Reform: A Social Groups Analysis

Many Chinese express dissatisfaction with their healthcare system with the popular phrase Kan bing nan, kan bing gui (“medical treatment is difficult to access and expensive”). Critics have cited inefficiencies in delivery and poor quality of services. Determining the pattern of patient satisfaction with health services in China — and the causes of patient dissatisfaction — may help to improve health care not only in China but in countries in similar predicaments throughout the world.Using data from a sample of 5,036 residents from 17 provinces collected in a 2008 household survey by the National Bureau of Statistics of China, we analyze the patterns of patient preferences, concerns, and satisfaction among six social groups, classified by socioeconomic status including education level, income, and type of employment.From regression results we conclude that the gap between what patients predict their service will entail and what they perceive the service actually did entail is the key determinant of lower satisfaction, especially for patients who care most about the quality of service and patients with higher social positions. Patients from lower social groups are more concerned with price and the attitudes of medical professionals, and generally express higher satisfaction with their health care experiences than their wealthier peers, despite receiving lower-level services. Patients with higher social positions are more concerned with the technical competence and quality of providers, and struggle with what they perceive as a lack of freedom to purchase and receive their desired services, as well as long waiting times and poor physician-patient interactions. These patterns of patient satisfaction appear to be the consequence of China’s unreliable basic delivery system, lack of advanced health service supply, and distorted health market. We discuss how what we have learned about patients’ dissatisfaction can be used to restructure the delivery system to better meet and shape patients’ needs.

Equilibrium replenishment in a supply chain with a single distributor and multiple retailers

This paper addresses a problem encountered by a large-scale health service supply chain operating in a periodic review mode. Due to the vital nature of the products it provides, the number and timing of urgent orders are not limited. As a result, increasingly high transportation costs are incurred and the problem is to select an inventory replenishment (review) period that minimizes the transportation cost. Moreover, the supply chain involves multiple retailers which inevitably and independently respond to any change in replenishment policy since it may affect their inventory costs. Such a relationship results in a game between a distribution centre and retailers. Since the problem is intractable due to its scale and stochastic nature, we combine a game theoretic approach with an empirical analysis. We show that this system is predictable using equilibria and that the current replenishment equilibrium of the health service supply chain is close to the Nash solution. Numerical analysis shows that the transportation costs are cut if the distribution centre implements in reality its formal (Stackelberg) leadership by reducing the replenishment period. However, this does not coordinate the supply chain and greater system-wide savings are possible by increasing the replenishment period if the supply chain is vertically integrated or the parties cooperate.

Reflections on longitudinal action research with the English National Health Service

This paper reflects on a longitudinal collaborative action research programme between the Centre for Research in Strategic Purchasing and Supply and the UK National Health Service Purchasing and Supply Agency that has operated since 1995. During the collaboration, research has changed practice and practice has changed research. A framework for analysing change is introduced as a means of examining how supply strategy has changed during the course of the research. The framework is applied to three supply strategy cases of prosthetics, clinical waste and cardiology, illustrating how practice and research have changed and influenced the production of knowledge over time. The methodological, theoretical and managerial implications of such longitudinal action research programmes are reflected on.

The relationship between physician supply, cardiovascular health service use and cardiac disease burden in Ontario: Supply-need mismatch

While health service use appears to be positively correlated with resource availability, no study has explored the interactions among health service supply, cardiovascular disease burden and health service use. The objective of the present study was to examine the relationship among cardiovascular evaluation and management intensity, physician supply and cardiovascular disease burden in the Canadian population. The present cross-sectional, population-based study consisted of adult residents in Ontario in 2001. Cardiac evaluation and management intensity, the main outcome measure, was measured at the individual level, and consisted of receiving one or more of the following services: noninvasive cardiac testing, coronary angiography and statin use (the latter among individuals 65 years of age and older). Mortality was the secondary outcome measure. Cardiovascular disease burden, and cardiologist and primary care physician supply were measured at the regional (ie, county) level. Analyses were adjusted for age and sex using Poisson regression, accounting for regional clustering. Regional per capita cardiologist supply varied more than twofold across regions, but was inversely related to the regional cardiovascular disease burden (r=-0.34, P=0.01). Primary care physician supply was relatively evenly distributed across regions. Residents in areas with more cardiologists were more likely to receive some form of cardiac intervention (RR=1.074, 95% CI 1.066 to 1.082 per additional cardiologist per 100,000). Those in areas with more primary care physicians were also more likely to receive noninvasive cardiac testing (RR=1.056, 95% CI 1.051 to 1.061 per six additional primary care physicians per 100,000). However, the intensity of provision of cardiac health services was unrelated to regional cardiovascular disease burden and was not associated with improved survival. The mismatch between physician supply and cardiac disease burden may explain why cardiovascular health service use is neither concordant with the cardiovascular disease burden nor associated with mortality in the population. These results underscore the importance of physician service maldistribution and supply-sensitive care on the appropriateness of cardiac health service use.

A model of user engagement in medical device development

The purpose of this paper is to address three topical themes: user involvement in health services research; determining the value of new medical technologies in patient care pathways, furthering knowledge related to quality in health and social care; and knowledge exchange between manufacturers, health service supply chain networks and device users. The model is being validated in a case study in progress. The latter is a "proving ground" study for a translational research company. Medical devices play a pivotal role in the management of chronic diseases, across all care settings. Failure to engage users in device development inevitably affects the quality of clinical outcomes. A model of user engagement is presented, turning unmet needs for medical devices into viable commercial propositions. A case study investigating the perceptions of individuals with Epidermolysis Bullosa (EB), their lay and professional carers into unmet needs. EB is an inherited condition affecting the skin and mucosal linings that leads to blistering and wounds. Qualitative data are being collected to generate understanding of unmet needs and wound care products. These needs are being translated into new design concepts and prototypes. Prototypes will be evaluated in an n = 1 experimental design, generating quantitative outcomes data. There are generalisations from the case study, and the model outlined. New products for managing EB wounds can logically benefit other groups. The model is transferable to other clinical problems, which can benefit from research and technological advances that are integral to clinical needs and care.

Neue Versorgungsmodelle in der Psychosebehandlung

It is generally accepted that modern mental health care gives community treatment priority over partial or full inpatient treatment. The requirements for community treatment of severely ill and chronic psychiatric patients are complex and, together with financing by the different social insurance providers, may lead to a rather problematic fragmentation of health service supply. Schizophrenia is considered the most expensive mental illness in Germany. It is estimated that indirect costs (expressed in financial terms) are five times higher than the direct costs of treatment and care. Innovative concepts of psychosocial intervention show that case management and assertive community treatment reduce the hospitalisation rate and duration of inpatient treatment, enhance social integration, and find the approval of most patients. However, there is no empirical evidence supporting this "psychiatry with no beds". Consideration should be given to psychosocial interventions as an alternative to inpatient hospital treatment such as day hospital care, crisis houses, or acute home treatment.

Implementing an electronic records management system

PurposeThis article seeks to consider the practical implementation of an electronic records management system in the National Health Service Purchasing and Supply Agency, a UK government agency.Design/methodology/approachIt examines the four main stages from specifying and selecting the system through to post‐implementation evaluation and identifies the lessons learned within the context of the specific organisation and its record‐keeping culture.FindingsThe implementation of an ERM system causes a massive cultural shift that can be made easier with the backing of senior management. However, the desired results can also be achieved with a strong team if senior management empowers the project but does not get personally involved.Originality/valueThis article will give insight to those organisations that are thinking of implementing an ERM system.

Does the lack of availability of information represent a bottleneck for research and evaluation in health policy?

This article describes the difficulties encountered in obtaining information about health services, sanitation and health insurance coverage supply, use and coverage regarding a sample of Colombian municipalities during 1991-2000. The availability of information is also analysed in terms of decentralisation and municipal development. This was a cross-sectional study of a random stratified sample of 495 Colombian municipalities; information regarding the variables of interest was requested at municipal and departmental level and from national sources. A scale was constructed for measuring the availability of information at local level. Non-parametric statistics were used for testing differences in availability of information in terms of certification and municipal category. Applying the scale revealed 51% availability of data regarding health service supply, 39% for data regarding service use and 45% for both types of information (supply and demand taken together). No information was available in 32% of the municipalities. Information was more readily available in non-certified and less developed municipalities. Study findings provided indirect evidence of difficulty in obtaining information regarding health systems at both municipal and departmental levels; this represents an important obstacle for health system management and evaluating performance, as well as for research and widening knowledge (and availability to such knowledge) in this area.

Choosing where to deliver: decision criteria among women with low-risk pregnancies in France

As in the rest of Europe, the supply of maternity hospitals has progressively decreased over the past few decades in France. An understanding of user choice criteria is important to help health planners reorganize obstetrical services and to predict changes in utilization patterns in response to supply changes. The objectives were to understand the criteria that women use to select their maternity hospital in France and to analyse the relation to individual and community characteristics. A survey of 536 recently delivered women with low-risk pregnancies explored the factors motivating user choice in three territories with distinct geographical and health service supply characteristics: four districts in Burgundy, two districts in Pays de la Loire, and the district of Seine-Saint-Denis in Ile-de-France. Women were asked to select a principal choice criterion. Their responses were grouped into categories: Accessibility/proximity, reputation of the establishment among users, advice of treating physician, technical quality and cost. Accessibility and proximity were the most selected criteria (33%), followed by the reputation of the maternity (29%), technical quality (15%) and advice of treating physician (13%). Age, parity and education influenced choice criteria. After controlling for individual determinants, region of residence was highly related to choice criteria; women living in Burgundy were more likely to select an establishment based on proximity, in Seine-Saint-Denis women were more likely to follow the advice of their physician, and in Pays de la Loire, more likely to base their decisions on the reputation of the establishment. The association between choice criteria and community characteristics could explain the failure of previous models to predict behaviour in different contexts. It is important to carry out local surveys of user perceptions before restructuring in order to take into consideration women's opinions on their future places of delivery and to refine geographic models.

지역 보건서비스의 산출에 영향을 미치는 요인

This study focuses on the determinants of the community health service utilization. Theories suggest seven models for community health service utilization, which are divided largely into two groups such as Health Service Supply Model and Health Service Demand Model: Supply Model includes Medical Implements Model, Personnel and Budget Model, Management System Model, Staffs' Behavior Model, Service Quality Model; Demand Model includes Area Model and Clients' Characteristics Model. This paper tests how the above models influence on the community health service utilization. After interviewing some administrative staffs of the Community Health Service Center at Pusan, questionnaires were made and mailed to the staffs of 198 Korean Community Health Service Center as a universe, among which from 98 centers we got response. Analyzing the data from the questionnaires, we found "the number of personnels in the health service center" and "demands for medical service" as important variables to affect the utilization of the community health service center. These two variables are typical factors representing Supply Model and Demand Model each. However, the variables selected from Management System Model, Administrative Behavior Model, Service Quality Model and Area model are not significant in a statistical sense. The paper suggests that to recruit the personnels, especially nurses, and to make out the demands of the clients for health service be the precedent conditions to increase the utilization of the Community Health Service Centers in Korea.ce Centers in Korea.

Geographic barriers to child health services in rural northern New England: 1980 to 1989.

Despite substantial recent increases in the number of rural physicians, it is unknown whether rural children still face significant barriers to medical care. To address this question, we determined travel times in 1980 and in 1989 to child health services for the rural pediatric population of northern New England--the area with the highest per-capita primary care physician supply of any non-metropolitan region in the United States. The study population in 1989 included 363,443 children living in 936 nonmetropolitan towns. The study revealed important spatial relationships in health service supply and demand not identified using other methods of assessing physician availability. Although travel times to physicians decreased slightly during the decade, we found that 15.5 percent of the children in our population were more than 30 minutes from pediatricians in 1989, and travel time to emergency rooms was more than 30 minutes for 9.9 percent of the children. In contrast, only 1.8 percent of children faced excessive travel times to family/general practitioners. While towns with pediatricians were likely to also have a family physician or an emergency room, the majority of towns with family physicians had neither a pediatrician nor an emergency room. Towns with poor geographic access to pediatricians and emergency rooms had low population densities and were distant from metropolitan areas. The analysis indicates that even in rural areas of high physician supply, access to pediatricians and emergency rooms for many children remains limited, and family physicians are the dominant medical providers for children.(ABSTRACT TRUNCATED AT 250 WORDS)

Debate: Overcoming trade union resistance to local change; Government and the right to know; Health service supply council

Debate: Overcoming trade union resistance to local change; Government and the right to know; Health service supply council

The Health Service Supply Council

The establishment by the British Parliament in July 1980 of the Supply Council as a special Health Authority is a unique decision to create a health authority for a particular function, and is the first such statutory body for supplies ever constituted in the United Kingdom. It effectively predetermines change in the National Health Service (NHS) for a function which has, during the life of the NHS, been the subject of six organizational reports. None of which, in the view of various governments and indeed of professional supplies officers and others within the NHS, achieved the efficiency required to obtain best value for the financial resource employed in the acquisition of goods, which for 1981 and 1982 is valued at approximately $1600 million per annum.

Factors influencing choice of hospitals: A case study of the Northern part of Oyo State, Nigeria

A total number of 859 patients were interviewed in the four hospitals that served Oyo Health Zone, Nigeria in 1979 on why they chose particular hospitals for treatment. The following factors in descending order of magnitude were identified as influencing their choice: nerness, quality of service, relative living in hospital town, finance, ease of transport, religion and connections with hospital staff. Although nearness was the leading factor, it accounted for only 31.8% of the total responses. In effect, about 70% of patients' behaviour are explained by other factors. This study points to the inappropriateness of the emphasis usually placed on linear distance as determining attractiveness of health service supply centres. In reality, a maze of interactions among spatial and non-spatial variables is at work in the choice of hospitals. Policy decisions should take cognizance of this if satisfactory health service to a majority of patients is to be achieved.

Health equipment information

Two recent issues of this publication, which we have reviewed,1 are likely to interest many general practitioners and hospital doctors. Issue No. 100 (April 1982) on ECG recorders updates a previous review (No. 91, March 1981): it reports on 4 recorders and reviews all 8 models which have so far been evaluated. Issue No. 101 (April 1982) deals with 9 portable defibrillators updating issue No. 87 (July 1980). Details of the contents of other issues can be obtained from The Editor, Health Equipment Information, DHSS, Health Service Supply Branch, 14 Russell Square, London WC1B 5EP: tel 01-636 6811 ext 3381.