Poor Quality Health Care Research Articles

Health Coaching Effective for Obesity in Severe Mental Illness

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessHealth Coaching Effective for Obesity in Severe Mental IllnessMark MoranMark MoranSearch for more papers by this authorPublished Online:6 Feb 2015https://doi.org/10.1176/appi.pn.2015.1b10AbstractHaving a health-promotion coach is associated with greatly increased fitness-club attendance, which in turn was linked with greater weight loss and improved cardiac fitness in those with serious mental illness.A health-coaching intervention for obesity appears to be effective in achieving and sustaining clinically significant reductions in cardiovascular risk for overweight and obese individuals with serious mental illness.That’s the finding of a replication trial of the In SHAPE program, the results of which were published December 12, 2014, in AJP in Advance.The report is “the first replication study confirming the effectiveness of a health-coaching intervention in achieving clinically significant reductions in cardiovascular risk for overweight and obese persons with serious mental illness and the first study to demonstrate persistent reduction in cardiovascular risk after the active intervention has been withdrawn,” said lead author Stephen Bartels, M.D., of the Department of Psychiatry and the Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth and colleagues.In SHAPE is a 12-month program consisting of individual weekly meetings in the community with a health-promotion coach, a fitness-club (YMCA) membership, and nutrition education adapted for people with serious mental illness that was found in a previous study to contribute to clinically significant reduction in cardiovascular risk in overweight or obese adults with serious mental illness. In the new study, Bartels and colleagues randomly assigned 210 individuals with serious mental illness and a body-mass index greater than 25 receiving services in one of three community mental health organizations either to the 12-month In SHAPE program or to fitness-club membership alone. The primary outcome measures were weight and cardiorespiratory fitness (as measured with the six-minute walk test) assessed at baseline and at three-month intervals for 18 months.At 12 months, the In SHAPE group had greater reduction in weight and improved fitness compared with the fitness-club membership group. Primary outcomes were maintained at 18 months (see chart). Approximately half of the In SHAPE group achieved clinically significant cardiovascular risk reduction, defined by a weight loss greater than 5 percent or an increase of greater than 50 meters on the six-minute walk test.“By comparing In SHAPE to an active comparison condition (a fitness-club membership), we were able to test the specific contribution of having a health-promotion coach,” the researchers stated. “Having a health-promotion coach was associated with more than two-and-a-half times the mean amount of fitness-club attendance, which in turn was associated with greater weight loss and improved fitness.”They added that current efforts to increase life expectancy for people with serious mental illness are focused on improving the quality and delivery of primary health care by integrating “health homes” within mental health care. “These initiatives address the inadequate access to and poor quality of health care experienced by persons with mental illness,” they said. “However, only 10 percent to 15 percent of preventable mortality is estimated to be due to health care access and quality factors, in contrast to health behaviors, which are estimated to account for the majority (57 percent) of a population’s health status and 40 percent of early deaths. By also providing health promotion as a core service, it may be possible to further reduce early mortality while improving both the psychological and physical wellness of the whole person.” ■“Pragmatic Replication Trial of Health Promotion Coaching for Obesity in Serious Mental Illness and Maintenance of Outcomes” can be accessed here. ISSUES NewArchived

Choosing wisely: prevalence and correlates of low-value health care services in the United States.

Specialty societies in the United States identified low-value tests and procedures that contribute to waste and poor health care quality via implementation of the American Board of Internal Medicine Foundation's Choosing Wisely initiative. To develop claims-based algorithms, to use them to estimate the prevalence of select Choosing Wisely services and to examine the demographic, health and health care system correlates of low-value care at a regional level. Using Medicare data from 2006 to 2011, we created claims-based algorithms to measure the prevalence of 11 Choosing Wisely-identified low-value services and examined geographic variation across hospital referral regions (HRRs). We created a composite low-value care score for each HRR and used linear regression to identify regional characteristics associated with more intense use of low-value services. Fee-for-service Medicare beneficiaries over age 65. Prevalence of selected Choosing Wisely low-value services. The national average annual prevalence of the selected Choosing Wisely low-value services ranged from 1.2% (upper urinary tract imaging in men with benign prostatic hyperplasia) to 46.5% (preoperative cardiac testing for low-risk, non-cardiac procedures). Prevalence across HRRs varied significantly. Regional characteristics associated with higher use of low-value services included greater overall per capita spending, a higher specialist to primary care ratio and higher proportion of minority beneficiaries. Identifying and measuring low-value health services is a prerequisite for improving quality and eliminating waste. Our findings suggest that the delivery of wasteful and potentially harmful services may be a fruitful area for further research and policy intervention for HRRs with higher per-capita spending. These findings should inform action by physicians, health systems, policymakers, payers and consumer educators to improve the value of health care by targeting services and areas with greater use of potentially inappropriate care.

Involving people with intellectual disabilities in the assessment of healthcare professionals

Purpose – It is widely recognised that people with intellectual disabilities receive a poorer quality of healthcare than their non-disabled counterparts. Training for healthcare professionals in intellectual disability is often scant or non-existent. The purpose of this paper is to explore the usefulness of employing actors with intellectual disabilities as simulated patients in the assessment of trainee psychiatrists. Design/methodology/approach – The development of a structured clinical exam “station” designed to assess the ability of trainee psychiatrists to communicate with a simulated patient played by an actor with an intellectual disability is described. The paper also assesses the potential benefits of this kind of assessment and the experience of actors and examiners taking part in this process. Findings – The station was found to perform well in discriminating between candidates of various abilities and was well received by actors, examiners and observers. The station is now routinely used in the formal assessment of trainee psychiatrists. Practical implications – The use of people with intellectual disabilities in training and assessment appears to be advantageous in terms of improving knowledge, attitudes and skills amongst healthcare professionals and gives increased opportunities for people with intellectual disabilities to undertake valued social roles. Originality/value – Few institutions currently employ actors with intellectual disabilities as simulated patients as part of their training programmes and as a result there is little in the way of literature on this subject. This paper describes an alternative approach to teaching and assessment which falls in line with recommendations from the Department of Health to involve service users in the training of healthcare professionals.

Workers' compensation: poor quality health care and the growing disability problem in the United States.

The proportion of working age citizens permanently removed from the workforce has dramatically increased over the past 30 years, straining both Federal and State disability systems designed as a safety net to protect them. Almost one-third of these rapidly emerging disabilities are related to musculoskeletal disorders, and three of the top five diagnoses associated with the longest Years Lived with Disability are back, neck and other musculoskeletal disorders. The failure of Federal and state workers' compensation systems to provide effective health care to treat non-catastrophic injuries has been largely overlooked as a principal source of permanent disablement and corresponding reduced labor force participation. Innovations in workers' compensation health care delivery, and in use of evidence-based coverage methods such as prospective utilization review, are effective secondary prevention efforts that, if more widely adopted, could substantially prevent avoidable disability and provide more financial stability for disability safety net programs.

Readmissions following umbilical cord blood stem cell transplantation.

272 Background: Readmission within 30 days of discharge has been perceived by the Centers for Medicare and Medicaid Services to be an indicator of poor healthcare quality, however it is unclear how accurately this applies to oncology patients. Patients treated with allogeneic hematopoietic stem cell transplantation (HSCT) have high rates of readmission, but the incidence following umbilical cord blood transplantation (UCBT) is poorly described. The goal of this study was to identify the incidence, reasons, and risk factors for readmission following UCBT. Methods: A retrospective review of patients receiving an UCBT at Dana-Farber/Brigham and Women’s Hospital between January 1, 2004 and December 31, 2013 was performed. The 30-day and the day +100, a traditional assessment point in transplantation, readmission rates were examined. Reasons for readmission, as well as sociodemographic and disease and stem cell transplant related variables were evaluated. Predictors of readmission were identified using multivariate regression analysis. Results: 33.6% (42/125) of patients were readmitted within 30 days of discharge. Of patients who survived until day +100, 46.7% (57/122) were readmitted within 100 days of UCBT. The most common cause for readmission was infection (38.3%), followed by fever without a source (14.8%) and graft vs. host disease (GVHD) (8.6%) (Table). A multivariate logistic regression model of the probability of being readmitted within 30 days and by day +100 suggested that infection during transplant admission was a significant risk factor for readmission (OR: 5.1, p=0.003 and OR: 2.9, p=0.014, respectively). Conclusions: There is a high rate of readmission within 30 days and by day +100 following UCBT. The most common causes of readmission were infection and fever without a source. Infection during the transplant admission predicted a higher risk of readmission, suggesting a possible group to target for interventions aimed at reducing readmissions and improving quality of care. [Table: see text]

Family Impacts Among Children With Autism Spectrum Disorder: The Role of Health Care Quality

ObjectiveTo compare health care quality and family employment and financial impacts among children with special health care needs (CSHCN) with autism spectrum disorder (CSHCN + ASD), CSHCN with functional limitations (CSHCN + FL), and CSHCN lacking these conditions (other CSHCN); to test whether high health care quality was associated with reduced family impacts among CSHCN + ASD. MethodsData from the 2009–2010 National Survey of CSHCN were used to compare 3025 CSHCN + ASD, 6505 CSHCN + FL, and 28,296 other CSHCN. Weighted multivariate logistic regression analyses examined 6 age-relevant, federally defined health care quality indicators and 5 family financial and employment impact indicators. Two composite measures were additionally used: 1) receipt of care that met all age-relevant quality indicators; and 2) had ≥2 of the 5 adverse family impacts. ResultsAcross all health care quality indicators, CSHCN + ASD fared poorly, with only 7.4% meeting all age-relevant indicators. CSHCN + ASD had worse health care quality than other CSHCN, including CSHCN + FL. CSHCN + ASD also had high rates of adverse family impact, with over half experiencing ≥2 adverse impacts. Rates of adverse family impact were higher in CSHCN + ASD than other CSHCN, including CSHCN + FL. Among CSHCN + ASD, those whose health care that met federal quality standards were less likely to have multiple adverse family impacts than CSHCN + ASD whose health care did not meet federal quality standards. ConclusionsCSHCN + ASD are more prone to experience poor health care quality and family impacts than other CSHCN, even CSHCN + FL. Receipt of care meeting federal quality standards may potentially lessen adverse family impacts for CSHCN + ASD.

The effect of health-facility admission and skilled birth attendant coverage on maternal survival in India: a case-control analysis.

BackgroundResearch in areas of low skilled attendant coverage found that maternal mortality is paradoxically higher in women who seek obstetric care. We estimated the effect of health-facility admission on maternal survival, and how this effect varies with skilled attendant coverage across India.Methods/FindingsUsing unmatched population-based case-control analysis of national datasets, we compared the effect of health-facility admission at any time (antenatal, intrapartum, postpartum) on maternal deaths (cases) to women reporting pregnancies (controls). Probability of maternal death decreased with increasing skilled attendant coverage, among both women who were and were not admitted to a health-facility, however, the risk of death among women who were admitted was higher (at 50% coverage, OR = 2.32, 95% confidence interval 1.85–2.92) than among those women who were not; while at higher levels of coverage, the effect of health-facility admission was attenuated. In a secondary analysis, the probability of maternal death decreased with increasing coverage among both women admitted for delivery or delivered at home but there was no effect of admission for delivery on mortality risk (50% coverage, OR = 1.0, 0.80–1.25), suggesting that poor quality of obstetric care may have attenuated the benefits of facility-based care. Subpopulation analysis of obstetric hemorrhage cases and report of ‘excessive bleeding’ in controls showed that the probability of maternal death decreased with increasing skilled attendant coverage; but the effect of health-facility admission was attenuated (at 50% coverage, OR = 1.47, 0.95–1.79), suggesting that some of the effect in the main model can be explained by women arriving at facility with complications underway. Finally, highest risk associated with health-facility admission was clustered in women with education 8 years.ConclusionsThe effect of health-facility admission did vary by skilled attendant coverage, and this effect appears to be driven partially by reverse causality; however, inequitable access to and possibly poor quality of healthcare for primary and emergency services appears to play a role in maternal survival as well.

Cultural competence education for health professionals.

Cultural competence education for health professionals.

Correcting Past Health Policy Mistakes

China's health policy in the 1980s followed its economic policy of marketization. China shifted health financing from public to private and commercialized the country's public health services. Unwittingly, the Chinese government did not grasp the serious market failures in health care, which resulted in a profit-driven public health service in which patients pay directly for services. China's health policy created three major unintended consequences: disparity between rural and urban residents, poor quality of health care, and rapid inflation in health expenditures. Since 2003, China has tried to correct its policy mistakes through public financing and by establishing social health insurance. However, strong profit motives have become embedded within the culture of medical professionals and have eroded the professional ethics that prioritize medical practices for patients' benefits. Restoring medical ethics is a formidable challenge. This paper analyzes the transformation of the Chinese health system and its ongoing challenges.

Child and Adolescent Health Care Quality and Disparities: Are We Making Progress?

ObjectiveChildren and adolescents are known to experience poor health care quality; some groups of children have poorer health care than others. We sought to examine trends over time in health care quality and disparities by race, Hispanic ethnicity, income, insurance, gender, rurality, and special health care needs. MethodsSource data were extracted from the 2011 National Healthcare Quality Report (NHQR) and National Healthcare Disparities Report (NHDR) database, which contains aggregated data from many government and private sources for the years 2000 through 2009. The NHQR and NHDR approaches to calculating disparities and trends in quality and disparities were used. Within each quality measure with available data, results for demographic subgroups of children characterized by race/ethnicity, income, insurance, residence, special health care need, and gender were compared to those of a reference group to determine whether disparities existed and whether disparities had changed over time. ResultsOf 68 measures with data for calculating potential disparities, 50 showed disparities in quality for at least 1 comparison subgroup in the most recent year of data available, while 18 measures showed no such disparities. Of the 50 measures with current disparities, 39 measures had sufficient data to calculate trends. Among the 137 comparisons made within these 39 measures, there was no change in disparities over time for 126 comparisons, 3 comparisons worsened, and 8 comparisons improved. ConclusionsThere was some progress in health care quality and reducing disparities in children's health care quality from 2000 to 2009; opportunities for targeting improvement strategies remain.

Speeding the Translation of Research into Evidence‐Based Practice and Conducting Projects That Impact Healthcare Quality, Patient Outcomes and Costs: The “So What” Outcome Factors

Speeding the Translation of Research into Evidence‐Based Practice and Conducting Projects That Impact Healthcare Quality, Patient Outcomes and Costs: The “So What” Outcome Factors

Ekonomska dimenzija zdravstvenih sistema u Indiji i Kini

The main objective of this work is the understanding of the health system structure of two major world powers China and India, the members of the BRIKS states, as their economies in recent decades represent the paradigm of rapid development. The research is primarily focused on the similarities and differences that characterize the two health systems, and treats the problems they are confronting and the environment in which they are operating. If they are observed together, the economies of India and China act as powerful engine which pulls forward the world's economy. This paper is only a modest attempt to determinate the uniform mantra by using the available conceived material according to which the two very different health care systems in the future could effectively operate. Among the present academic authorities there is no consensus that in the near future these two systems will be developing in the same direction, with the same dynamics and success. However, this possibility should not be neglected. The paper will be composed in a way to explain a paradox that, despite the full economic momentum of India and China, their health systems are having increasingly difficulties to cope with financial issues, inaccessible and poor quality health care, the continual growth of health care spending, growing needs of the population and dissatisfied health care workers, especially these working in the rural areas. India and China are both struggling for decades with frustrated doctors, because they could not, and do not want, to accept so much differences between the rich poor and urban rural counterparts. Health care workers (especially doctors) have started to ignore the work in rural health facilities, or to modify it for the better paid jobs in traffic, services, agriculture or construction.

6.2 Prevalence and Factors Associated With Hospital Re-Admissions Among Elderly Medicare Beneficiaries With Type 2 Diabetes Mellitus (262-OR)

Health care policy makers and payors are adopting hospital readmissions as a marker of poor health care quality. However, few studies have focused on the factors associated with readmissions in the elderly with T2DM.

Multiple Chronic Diseases and Co-Morbidities Among Older Adults in India: New Insights from Lasi Pilot, 2010

Objectives: Older adults in India face increased health risks due to socioeconomic and cultural characteristics found in India, including one of the highest out-of-pocket health expenditure in the world, poor quality healthcare and poor nutritional intake. In the backdrop of very little scientific data on elderly, this paper aims to provide fresh insights on the experience of multiple chronic diseases, co-morbidities and their co-variates.Study design: Cross-sectional survey studyMethods: Data from the Longitudinal Aging Study in India(LASI), Pilot survey, 2010 conducted in the four states of Karnataka, Kerala, Punjab and Rajasthan are used. Based on self reports of major chronic diseases, bi-variate analysis explores prevalence of multiple chronic disease and co-morbidities. Zero inflated Poisson regression model is estimated to assess the effects of social determinants on multiple chronic diseases. Results: Analysis reveals hypertension and diabetes as mutually critical co-morbidities of each other while heart and lung diseases are other important co-morbidities. Zero-inflated Poisson regression model estimates reveal age, education, economic status and physical activities as significant determinants of multiple chronic diseases. Conclusion: Age and social determinants show strong positive gradients of multiple chronic diseases and; considerable state variations are observed.

Molecular epidemiology and population dynamics of hepatitis B virus in Dianjiang County, Chongqing, China

Hepatitis B virus infection is highly endemic in China, especially in rural areas such as Dianjiang County with poor-quality health care and little local HBV information. Therefore, for the first time, the present study was carried out to investigate the molecular epidemiology, phylogeny and population dynamics of HBV based on 146 HBV-infected patients. A 435-bp portion of the HBV S region was sequenced, and the phylogeny was reconstructed, indicating that three genotypes, B, C and D of HBV were distributed in Dianjiang County. The predominant genotype is B (67.12%), followed by C (32.19%) and D (0.68%). Patient demographic information and clinical outcomes were examined by genotypes, and no significant association was found. Population dynamics analysis suggested that both genotype B and C have experienced a tenfold expansion during the last five years for reasons that are unclear. Thus, a thorough molecular epidemiology investigation is strongly recommended in the future.

Left behind: widening disparities for males and females in US county life expectancy, 1985-2010.

BackgroundThe United States spends more than any other country on health care. The poor relative performance of the US compared to other high-income countries has attracted attention and raised questions about the performance of the US health system. An important dimension to poor national performance is the large disparities in life expectancy.MethodsWe applied a mixed effects Poisson statistical model and Gaussian Process Regression to estimate age-specific mortality rates for US counties from 1985 to 2010. We generated uncertainty distributions for life expectancy at each age using standard simulation methods.ResultsFemale life expectancy in the United States increased from 78.0 years in 1985 to 80.9 years in 2010, while male life expectancy increased from 71.0 years in 1985 to 76.3 years in 2010. The gap between female and male life expectancy in the United States was 7.0 years in 1985, narrowing to 4.6 years in 2010. For males at the county level, the highest life expectancy steadily increased from 75.5 in 1985 to 81.7 in 2010, while the lowest life expectancy remained under 65. For females at the county level, the highest life expectancy increased from 81.1 to 85.0, and the lowest life expectancy remained around 73. For male life expectancy at the county level, there have been three phases in the evolution of inequality: a period of rising inequality from 1985 to 1993, a period of stable inequality from 1993 to 2002, and rising inequality from 2002 to 2010. For females, in contrast, inequality has steadily increased during the 25-year period. Compared to only 154 counties where male life expectancy remained stagnant or declined, 1,405 out of 3,143 counties (45%) have seen no significant change or a significant decline in female life expectancy from 1985 to 2010. In all time periods, the lowest county-level life expectancies are seen in the South, the Mississippi basin, West Virginia, Kentucky, and selected counties with large Native American populations.ConclusionsThe reduction in the number of counties where female life expectancy at birth is declining in the most recent period is welcome news. However, the widening disparities between counties and the slow rate of increase compared to other countries should be viewed as a call for action. An increased focus on factors affecting health outcomes, morbidity, and mortality such as socioeconomic factors, difficulty of access to and poor quality of health care, and behavioral, environmental, and metabolic risk factors is urgently required.

Developing a tool to measure satisfaction among health professionals in sub-Saharan Africa

BackgroundIn sub-Saharan Africa, lack of motivation and job dissatisfaction have been cited as causes of poor healthcare quality and outcomes. Measurement of health workers’ satisfaction adapted to sub-Saharan African working conditions and cultures is a challenge. The objective of this study was to develop a valid and reliable instrument to measure satisfaction among health professionals in the sub-Saharan African context.MethodsA survey was conducted in Senegal and Mali in 2011 among 962 care providers (doctors, midwives, nurses and technicians) practicing in 46 hospitals (capital, regional and district). The participation rate was very high: 97% (937/962). After exploratory factor analysis (EFA), construct validity was assessed through confirmatory factor analysis (CFA). The discriminant validity of our subscales was evaluated by comparing the average variance extracted (AVE) for each of the constructs with the squared interconstruct correlation (SIC), and finally for criterion validity, each subscale was tested with two hypotheses. Two dimensions of reliability were assessed: internal consistency with Cronbach’s alpha subscales and stability over time using a test-retest process.ResultsEight dimensions of satisfaction encompassing 24 items were identified and validated using a process that combined psychometric analyses and expert opinions: continuing education, salary and benefits, management style, tasks, work environment, workload, moral satisfaction and job stability. All eight dimensions demonstrated significant discriminant validity. The final model showed good performance, with a root mean square error of approximation (RMSEA) of 0.0508 (90% CI: 0.0448 to 0.0569) and a comparative fit index (CFI) of 0.9415. The concurrent criterion validity of the eight dimensions was good. Reliability was assessed based on internal consistency, which was good for all dimensions but one (moral satisfaction < 0.70). Test-retest showed satisfactory temporal stability (intra class coefficient range: 0.60 to 0.91).ConclusionsJob satisfaction is a complex construct; this study provides a multidimensional instrument whose content, construct and criterion validities were verified to ensure its suitability for the sub-Saharan African context. When using these subscales in further studies, the variability of the reliability of the subscales should be taken in to account for calculating the sample sizes. The instrument will be useful in evaluative studies which will help guide interventions aimed at improving both the quality of care and its effectiveness.

Harnessing the cloud of patient experience: using social media to detect poor quality healthcare

Recent years have seen increasing interest in patient-centred care and calls to focus on improving the patient experience. At the same time, a growing number of patients are using the...

A mixed methods study to develop and pilot a competency assessment tool to support midwifery care of women with intellectual disabilities

Recent reports have highlighted the poor quality of health care received by people with intellectual disabilities (otherwise known as 'learning disabilities') in the United Kingdom (UK). UK Confidential Enquiries into maternal deaths have highlighted adverse pregnancy outcomes for women with intellectual disabilities and need for timely and appropriate clinical care. To develop and test a competency assessment tool to support midwifery care of women with intellectual disabilities. A mixed methods study. Large inner city maternity unit. Midwives and key experts in intellectual disabilities, maternity policy and midwifery education. Phase one comprised a systematic narrative review of the literature. Evidence identified informed phase two which included focus groups and interviews. Emergent themes informed the development of a competency assessment tool which was piloted in phase three. Phase one: Four primary research papers and two systematic reviews met the review inclusion criteria. Support to develop parenting skills of women with intellectual disabilities was highlighted as was the need to optimise organisation of maternity services. No studies specifically considered midwifery competencies to support women with intellectual disabilities. Phase two: 23 midwives attended three focus groups and individual interviews were conducted with national leaders in intellectual disability (n=6) and midwifery policy and education (n=7). Themes identified included need for individualised care provided by a known midwife, the importance of effective communication skills and need for clear knowledge and understanding of the legislative framework relevant to intellectual disability. Phase three: A convenience sample of 60 midwives was asked to participate in a pilot study to test the tool, 46 (77%) of whom responded. Thirty midwives (65%) felt competent in their ability to recognise intellectual disability and 37 (80%) competent or expert in understanding women have the right to be offered choice and make informed decisions. A high proportion (n=40, 87%) reported little or no knowledge regarding consent issues. Work to inform timely and appropriate care of women with intellectual disability has been neglected in the UK maternity services. Use of a tool could aid assessment of midwifery competencies to support women with intellectual disability and highlight where further midwifery education and development are needed. Evidence of optimal care for women with intellectual disabilities and their families across the continuum of pregnancy and birth is required.

Health Worker Satisfaction and Motivation: An Empirical Study of Incomes, Allowances and Working Conditions in Zambia

Health worker salaries in Zambia are low by any standard. In recent times there have been real reductions in thesalaries of health workers. This has resulted in significant attrition in the public sector as health workers areattracted to the private sector or leave Zambia entirely, leaving a large deficit in public sector health workers. Inthis study we examine the relationship between health worker incomes and their satisfaction and motivation.Cross-sectional data collection was undertaken using both quantitative and qualitative methods. A refined surveyinstrument was used for the quantitative data method. Document review (past and current records) was employedfor the qualitative method. Data was collected in three regions that represent extremes in overall remunerationand benefits. Lusaka represented the favourable area while Monze and Nyimba represented less favourable areasfor study in Zambia.There are hefty disparities between different health workers. There are also enormous salary differentials for thesame workers between the public and private sectors. These salary differentials explain the experience of publicto private “traffic” of health workers as well as casual private sector work by public sector health workers. Inaddition, there are negligible efforts by government to reduce the benefits gaps among key public health cadres.The low incomes received by public health workers in Zambia have many negative implications: it begetsabsenteeism, results in low output, poor quality health care, and the departure of health workers to the privatesector and overseas.