Need For Inpatient Services Research Articles

Large scale public health system transformation: Germany

Abstract The COVID-19 pandemic was a stress test for public health services in Germany. Decision making was complex (party lengthy and inconsistent) due to the divided responsibilities within the federal system. Some improvements on the public health system were already enacted during the pandemic. A “pandemic radar” was established to bundle up relevant infectious disease indicators with indicators of health services use. The national electronic notification and information system for infectious diseases was extended. Digital improvements were made in the public health offices. Laboratory capacity was strengthened, so was inter-science modelling to forecast pathogen spread. A nation-wide collaborative mechanism, the cloverleaf system, was introduced between regions to avoid the overburdening of hospitals. It is now established for times of excess need for inpatient services. In 2020, a 4 billion euros investment program, the “Pact of Public Health Services”, was adopted to strengthen and modernize the German public health service institutions. The pact is implemented until 2026. The human resources component is the largest. Further priorities include digitalization, improvement of the infrastructure (of designated ports and airports) for the implementation of the International Health Regulations, research and the creation of agile and resilient public health structures. Outputs so far include the establishment of more than 4800 new public health positions, the appointment of new professorships for public health services, the initiation of several research projects, and the roll-out of more than 300 digitalization projects. A new federal institute for prevention is planned. It aims to foster networking between public health services, strengthen health communication, data use, and evidence for public health services. In this process, WHO advised the federal ministry e.g. on behavioral insights; heat health action; prevention on noncommunicable diseases and others. Many public health actors have provided opinions. However, consensus building on how Germany can overcome fragmentation in public health is ongoing.

11 Experiences of Inpatient Healthcare Services among Children with Medical Complexity: A Scoping Review

Abstract Background Children with medical complexity (CMC) have among the highest need for inpatient services in paediatrics. In addition to effectiveness and safety, experience of care (EoC) is a crucial pillar of health care quality, encompassing all interactions that shape a patient/family’s perception of care. Current evidence suggests that CMC have lower EoC compared to other populations. Collating the existing cross-disciplinary evidence will identify critical aspects of their EoC, both positive and negative, that could inform the development and evaluation of health services interventions for CMC in the hospital setting. Objectives The objectives of this scoping review were to map the existing literature related to the experience of inpatient health services for CMC and their families, describe research methods, and categorize key concepts of EoC while simultaneously identifying knowledge gaps. Design/Methods The Joanna Briggs Institute (JBI) methodology for scoping reviews was used. Articles related to CMC and the inpatient setting were identified through EMBASE, CINAHL, Web of Science, MEDLINE and PsychoInfo. Reference lists were also searched for relevant articles. Screening of titles, abstracts, and full-text articles was conducted by two independent researchers, resolving discrepancies by discussion and consensus. Data extraction and critical appraisal for included papers were likewise conducted by two separate researchers. Abstracted data included authors, participants, objectives, methodology, and key findings. Critical appraisal was conducted using the Mixed Methods Appraisal Tool and the JBI critical appraisal tool for systemic reviews. Results A total of 4463 separate articles underwent title/abstract review and 513 went on to full text review. After applying inclusion and exclusion criteria, a total of 48 articles was included in the review. There were 26 qualitative studies, 8 quantitative studies, 7 mixed methods studies, and 7 review papers. Quantitative studies used a variety of instruments to measure EoC, with the most common being the Measures of Processes of Care. The primary concepts related to EoC to be identified include partnerships (including continuity, building a therapeutic alliance), communication (particularly parent-nurse), decision-making and goal setting, and psychological distress and symptoms that occur during a hospitalization. Conclusion This review synthesizes the existing evidence on inpatient EoC for CMC. Although a diverse set of elements related to EoC are described, there are few interventional studies that include these as outcome measures. These EoC elements could be mapped to existing instruments or form the basis for the development of new tools that would allow the incorporation of EoC into evaluation of inpatient interventions.

Socioeconomic inequity in inpatient service utilization based on need among internal migrants: evidence from 2014 national cross-sectional survey in China

BackgroundProviding equal treatment for those who have the same need for healthcare, regardless of their socioeconomic and cultural background, has become a shared goal among policymakers who strive to improve healthcare. This study aims to identify the socioeconomic status (SES) inequities in inpatient service utilization based on need among migrants by using a nationally representative study in China.MethodsThe data used in this study was derived from the 2014 National Internal Migrant Population Dynamic Monitoring Survey collected by the National Health Commission of China. The sampling frame for this study was taken using the stratified multistage random sampling method. All provincial urban belt and key cities were stratified, and 119 strata were finally determined. We used logistic regression method and Blinder-Oaxaca decomposition and calculated the concentration index to measure inequities of SES in inpatient service utilization based on need. Sample weights provided in the survey were applied in all the analysis and all standard errors in this study were clustered at the strata level.ResultsOf the total internal migrants, 18.75% unmet the inpatient service need. Results showed that inpatient service utilization concentrated among high-SES migrants (Concentration Index: 0.036, p < 0.001) and the decomposition results suggested that about 44.16% of the total SES gap in inpatient service utilization could be attributed to the gradient effect. After adjusting for other confounding variables, those had high school degree and university degree were more likely to meet the inpatient services need, and the OR values were 1.48 (95% CI 1.07, 2.03, p = 0.017) and 2.04 (95% CI 1.45, 2.88, p = 0.001), respectively. The OR values for Quartile 3 and Quartile 4 income groups was 1.28 (95% CI 1.01, 1.62, p = 0.044) and 1.37 (95% CI 1.02, 1.83, p = 0.035), respectively.ConclusionThis study observed an inequity in inpatient service utilization where the utilization concentrates among high SES migrants. It is important for policy makers to be aware of them and more intervention should be conducted.

Measuring the equity of inpatient utilization in Chinese rural areas

BackgroundAs an important outcome of the health system, equity in health service utilization has attracted an increasing amount of attention in the literature on health reform in China in recent years. The poor, who frequently require more services, are often the least able to pay, while the wealthy utilize disproportionately more services although they have less need. Whereas equity in health service utilization between richer and poorer populations has been studied in urban areas, the equity in health service utilization in rural areas has received little attention. With improving levels of economic development, the introduction of health insurance and increasing costs of health services, health service utilization patterns have changed dramatically in rural areas in recent years. However, previous studies have shown neither the extent of utilization inequity, nor which factors are associated with utilization inequity in rural China.MethodsThis paper uses previously unavailable country-wide data and focuses on income-related inequity of inpatient utilization and its determinants in Chinese rural areas. The data for this study come from the Chinese National Health Services Surveys (NHSS) conducted in 2003 and 2008. To measure the level of inequity in inpatient utilization over time, the concentration index, decomposition of the concentration index, and decomposition of change in the concentration index are employed.ResultsThis study finds that even with the same need for inpatient services, richer individuals utilize more inpatient services than poorer individuals. Income is the principal determinant of this pro-rich inpatient utilization inequity- wealthier individuals are able to pay for more services and therefore use more services regardless of need. However, rising income and increased health insurance coverage have reduced the inequity in inpatient utilization in spite of increasing inpatient prices.ConclusionsThere remains a strong pro-rich inequity of inpatient utilization in rural China. However, a narrowing income gap between the rich and poor and greater access to health insurance has effectively reduced income inequality, equalizing access to care. This suggests that the most effective way to reduce the inequity is to narrow the gap of income between the rich and poor while adopting social risk protection.

Fundholding in general practice and financial risk.

To estimate the financial effect of random yearly variations in need for services on fundholding practices with various list sizes. A simulation model was derived using historical data on general practitioner referrals for the 113 surgical procedures covered by the general practitioner fund, combined with data on the hospital prices for those procedures. Resident population of Central Birmingham Health Authority. Expected expenditure on the relevant surgical procedures for the whole district and for practices with list sizes of 9000, 12,000, 15,000, 18,000, 21,000, or 24,000 for each of 100 simulated years. By using average hospital prices for the West Midlands region the mean (SD) annual expenditure for the 179,400 residents was 4,832,471 pounds (87,149 pounds); the random variation between the 5th and 95th most expensive years was 5.7% of the mean cost. For a practice with a list size of 9000 the values were 244,891 pounds (18,349 pounds), with a variation of 27.5%. With a list size of 24,000 the values were 652,762 pounds (32,512 pounds), with a variation of 15.3%. Random variations in need for inpatient services will have a significant financial impact on the practice fund. The problem will be particularly great for smaller practices. Additional measures are required to ensure that the scheme is not undermined and that the potential benefits are secured.