Private Health Services Research Articles

Educational program to promote the self-care of people with diabetes mellitus

Objective: to evaluate the effect of an intervention program on the capacity and action for the self-care of people with diabetes mellitus.Method: this is an intervention study with the implementation of a problem-solving educational program in diabetes in a private health service. Capacity and action scales were applied for the self-care, in the initial moment and after the intervention with analysis of the outcome by the metabolic control. Differences were identified by the Student t test and the comparison of the scales variability calculated by Cronbach's alpha, with a 95 % confidence interval.Results: participated in the study 23 people, with significant improvement in the values of glycated hemoglobin, glycemic and diastolic blood pressure variability after the educationalprogram. The educational strategy in diabetes provided improvement in both capacity and action for self-care,respectively (p ≤ 0.0 %), Cronbach’s alpha initial 0.895 and final 0.938 Conclusion: education programs using participatory methodologies are essential to enable the person with diabetes to manage and monitor the disease.

Evaluación de estándares de intensidad de unidades de curado tugsteno-halógenas y leds.

Current evidence indicates that the minimum light intensity of photo curing units required to polymerize in a reliable way a composite resin, in increments of 2mm, is 300mW/cm2. The recent introduction of new generations of composite resin materials for large volume increments, partially contrasts with ISO 4049 (2009), calling for the use of light intensity of 1,000mW/cm2. Therefore, it is considered relevant to carry out periodic measurements of the emission intensity of light-curing units of clinical use. The aim of this study was to test the intensity [mW/cm2] of a representative sample of tungsten-halogen and LED photopolymerization units used in private and public health service in different areas of the Valparaíso Region in Chile. This was achieved through the use of dental radiometers, without considering the variables of intensity modification over time (either spontaneously, by undesirable inherent characteristics of the device, or by programs of intensity modification in time), or the density of accumulated power needed. This in vitro diagnostic test, evaluated a sample of 507 units, 107 halogen and 400 LED, for a period of around one month, using two radiometers as measuring instruments. For LED units the Bluephase Meter® radiometer, from Ivoclar-VivadentTM was used, and for halogen units we used the Coltolux® from ColténeTM. As a result, 85% of the LED and halogen units achieved the minimum requirements of intensity needed for the polymerization of conventional dental biomaterials. However, only 25% from the tested units achieved a power density of 1,000mW/cm2.

Forensic Staff Attitudes Toward Men Who Have Sexually Offended: A General Public Comparison.

The aim of this study was to explore the attitudes toward men who have sexually offended (MSO) between the general public and professionals and paraprofessionals in forensic settings. Existing research shows a number of different factors that appear to be important in the development, maintenance, and deterioration of attitudes toward MSO. The exploration of such factors requires further exploration. A convenience sample was used for the cross-sectional study. Five hundred fifty-three participants were recruited from the general public and forensic hospitals, both private and National Health Service. An online version of the Attitudes Towards Sex Offenders scale (Hogue, 1993) was distributed via email and social media. Gender was not found to have any impact on the attitudes individuals held toward MSO. The general public was found to have significantly more negative attitudes when compared with those exposed to MSO at work (professional and paraprofessional staff). Duration of employment did not make attitudes any more or less positive. The clinical and societal implications of the research are important for MSO to reduce risk within forensic establishments and be supported to reintegrate successfully into the community. Without the support from both staff and the general public at each stage of rehabilitation, desistance is less likely to be maintained. Research continues to provide varying results regarding the factors that influence the nature of attitudes toward MSO.

Status of public-private partnership recognition and willingness to pay for private health care in China.

The Chinese government has been increasingly engaging and interacting with the private sectors to initiate public-private partnerships (PPPs) to enhance the capacity of the health care system. Thus, the availability of private health services and copays are increasing. However, Chinese residents appear to be more accustomed to public health care because it has long been the dominant health service provider in China. Therefore, learning how the Chinese recognize PPPs, whether they would like to use private health services and how much they are willing to pay out of pocket are important for policymakers. A bibliographical search was performed through PubMed in Medline, the Chinese National Knowledge Infrastructure and key government websites using a combination of keywords from seminal papers on PPPs and then sequentially added "willingness to pay (WTP), health, and private." The papers selected were closely related to PPPs and WTP for health care in China, and then, over 100 peer-reviewed literature, opinion, or commentary papers and postgraduate theses on the particular topics were carefully reviewed. Out of 139 papers closely related to WTP for private health care, 37 were extensively reviewed and substantially analyzed. The results corroborate that Chinese residents are generally willing to pay for high-risk disease screening, improved therapies, and health insurance, although the WTP intentions and the amounts they are willing to pay are different among distinct populations for the various types of health services. The results also present conditions that the responders are not explicitly willing to pay for or are willing to pay additional fees for their health promotion. Education level, family per capita income, self-reported health status, and dwelling districts (such as urban or rural residents) are the main factors that affect cost-sharing intention. PPPs are increasingly recognized as an effective means to mobilize resources in the private sector to relieve the pressure/burden placed on the public system during medical reform in China. Responders in China are generally willing to pay reasonable fees out of pocket for primary health care services or for improved therapies; however, cost-sharing intentions are affected by multiple factors. Health-related policymakers should learn the general health concerns/demands of the residents and their WTP status to perfect the design of PPPs for the benefit of the majority population in China.

Clinical pathways of breast cancer patients treated in the Federal District, Brazil.

ABSTRACTOBJECTIVE:To identify the clinical pathways of women with breast cancer treated in public hospitals, and to analyze the factors that influence the time interval between the first appointment and the start of therapy.METHODS:A cross-sectional study was conducted with 600 women with breast cancer treated in nine public hospitals in the Brazilian Federal District. Patients were interviewed between September 2012 and September 2014. Simple and multiple logistic regression models were adjusted to evaluate the variables associated with the time interval studied. The most frequent pathway was the one that started in primary care with following care in the therapy service (28.9%). In the multiple adjustment, factors associated to a longer time interval between the first appointment and therapy were: lower family income (OR = 1.89; 95%CI 1.32–2.68), the first appointment in public services (OR = 1.78; 95%CI 1.20–2.64), care in more than two health services in the clinical pathway (OR = 1.71; 95%CI 1.19–2.44); and obtaining the anatomopathological analysis of the biopsy in public services instead of private health services (OR = 1.87; 95%CI 1.29–2.71). Independently, the implementation of specialist appointment scheduling, with care regulation, was associated with a shorter time interval between first appointment and therapy (OR = 0.33; 95%CI 0.16–0.65).CONCLUSIONS:We observed that multiple pathways were covered by women with breast cancer treated in public services of the Federal District. Socioeconomic iniquities and several aspectos of the pathways covered were associated with a longer time interval between the first appointment and the start of breast cancer therapy.

A community based cross-sectional study on the health system responsiveness in the urban field practicing area of tertiary health care centre, Hyderabad

Background: According to WHO, responsiveness is an important goal of the health system, in addition to the two predominant goals of improving health and fairness of financing. Responsiveness includes non-medical aspects of health care. As the progress to universal health coverage is gaining pace, the present study has attempted to study the domains of responsiveness in the government and private health services and health care providers.Methods: A community based cross-sectional study for a period of 3 months in the households of the urban field practising area. Sampling technique was simple random sampling. Assuming the prevalence of 50% and allowable error of 5%, 400 households were surveyed. KISH table method was used at household level. Study tool was World Health Survey responsiveness module questionnaire for the eight responsiveness domains-prompt attention, dignity, communication, autonomy, confidentiality, choice, quality of basic facilities and social support (for inpatients).Results: The mean age (yrs) of the study subjects is 46.078±13.998. 68.25% (273) were males.31.75% (127) were females. 46.25% (185) were using government services and 53.75% (215) were using private services. The mean waiting time (min) in the public health facilities was 135.2±111.2 which was more than private facilities, 62.4±40.8.Conclusions: All the responsiveness domains (except confidentiality) were found to be positively associated (p<0.05) with the government health services. Proportion of people rating the responsiveness domains from most important to the least important showed prompt attention (52%) and dignity (30%) as the most important domains.

Factors associated with the quality of life of elderly caregivers of other elderly persons

Abstract Objective : To evaluate the association between the double vulnerability of being elderly and a caregiver and quality of life assessed by Control, Autonomy, Self-realization and Pleasure factors (CASP-19). Method : 148 elderly caregivers participated in the present study. They were selected for convenience from Brazilian public and private health services - a sample from the study “The Psychological Well-Being of Elderly Persons Caring for Other Elderly Persons in a Family Context”. The variables: caregiver’s state of health, care demands, perception of burden, self-rated health, and quality of life were selected. Descriptive analyses, chi-squared tests, Fisher’s exact test, the Kruskal-Wallis test and analysis of multivariate hierarchical logistics were carried out, with theStepwisecriteria applied for selection of variables. Results : The hierarchical multivariate analyses found that number of symptoms and total burden were significantly associated with a poorer quality of life. Elderly persons with three or more symptoms and those with a high burden level were at a higher risk of poor quality of life. The variables number of diseases, burden, and self-rated health compared with the past, were significantly associated with a poorer quality of life. Conclusion : It can be concluded that for the elderly caregiver, physical aspects (signs and symptoms, chronic diseases and a perception of health deterioration) combined with burden are the aspects that most influence quality of life.

Telemedicine Trajectory in Healthcare

Telemedicine has been implemented in both public and private health services and has shown a potential to improve healthcare industry. Many governments are boosting telemedicine applications through regulations to reap the benefits. The purpose of this article is to investigate the current situation revolving around telehealth and more precisely, telemedicine. This is accomplished by supplying a brief history of the technology as it has evolved. Then, an analysis of the benefits of telemedicine and its opportunities for growth. Next, the current issues and limitations of telemedicine will be examined. Finally, there is a final discussion on the future of telemedicine with some currently developing applications and conclusion.

The Factors Making the Law Protection for the Patients of Esthetic Beauty Clinic in Indonesia not fulfilling Citizen's Constitutional Right

Considering Article 28 H of the fourth amendment to the Republic of Indonesia's 1945 Constitution, there is citizen's constitutional right, the right to health and to get healthcare service. Therefore, all healthcare services should fulfill right and obligation of service provider and patient, and medical service standard. Esthetic beauty clinic as a private health service should fulfill it compulsorily. This article studied the factors making the law protection for the patients of esthetic beauty clinic in Indonesia not fulfilling yet the citizen's constitutional right. This study was conducted on stakeholders of esthetic beauty clinic in five provinces in ten cities of Indonesia, using empirical qualitative method. The result of research showed that the factors the law protection for the patients of esthetic beauty clinic in Indonesia not fulfilling yet the citizen's constitutional right.

Community-Based Health Insurance Enrollment and Determinants in Addis Ababa: Insights from Behavioral Economics and Discrete Choice Experiments

Community-based health insurance target those employed in the rural and informal sector in urban by pooling risks and protect households from out-of-pocket expenditures when receiving health facility services. However, Ethiopian community-based health insurance is schemes characterized by low enrollment. The aim of this study is to analyze the determinants of community-based health insurance enrollment in Addis Ababa from behavioral economics and discrete choice experiment insights. A total of 222 households from ten pilot woredas were selected for the study using a simple random sampling technique. A simple social experiment is used to examine the significance of behavioral biases. A discrete choice experiment conducted across three attributes and conditional logit model used to determine the relative importance of the selected attributes and willingness-to-pay for those attributes. In addition, the binary logit regression model is used to estimate the probability of households enrollment in community-based health insurance. The study result indicates that households have the highest willingness to pay for only private health service providers (Birr 1849.6/year) compared to status-quo level. Non-member households’ willingness to pay for comprehensive health service package Birr 2271.7/year. Moreover, this study revealed loss-aversion bias, over-optimistic bias, and herding bias had significantly affected the household decision on community-based health insurance enrollment. The study suggests that behavioral biases affect Community-based health insurance enrollment. The study finding also reveals that respondent households are willingness to pay more for comprehensive health service package and for health insurance scheme that includes private health service providers. In addition, the study concludes eligible household enrollment decision varied based on their socio-demographic and household characteristic. This study recommends the need to consider mandatory community-based health insurance schemes and apply targeting intervention (coverage) to the particular group.

HIV testing coverage among female sex workers, Brazil, 2016

Knowing the factors associated with periodic HIV testing among female sex workers (FSW) is essential to expand testing coverage and to broaden programs of treatment as prevention. We used data from 4,328 FSWs recruited by the respondent-driven sampling (RDS) method in 12 Brazilian cities in 2016. Data analysis considered the complex sampling design. The prevalence of HIV testing in the last year and periodic HIV test were estimated. Factors associated with regular HIV testing were identified through logistic regression models. The testing coverage in the last year was 39.3%. Only 13.5% of FSW reported having performed a periodic HIV test in the last year. Among the factors associated with the higher probability of HIV testing in the last year were a better level of education, living with a partner, working indoors, consistent use of condoms, and regular use of public and private health services stood out. Periodic HIV testing allows early diagnosis and immediate treatment of cases, reducing the chances of spreading the infection to the population. However, factors such as stigma and discrimination hinder the use of regular health services. It is necessary to expand awareness campaigns, especially among FSWs with low educational level and greater vulnerability, in order to broaden the perception of risk and the importance of periodic testing, in addition to encouraging regular health care.

Profile and Professional Practices of Health Psychologists of the Federal District

Abstract The study aimed to describe the profile of psychologists from public and private health services of the Federal District, Brazil; to describe the professional practices, the theoretical-methodological frameworks adopted, expectations and perceptions of health work, as well as aspects that facilitate and hinder team integration. The instrument was a self-administered online questionnaire. The data analysis included descriptive and inferential statistical techniques and content analysis of the qualitative data. The participants were 96 psychologists (91.6% women). The ages ranged from 24 to 54 years (M=35.5) and the majority (88.4%) were working in public health services. Individual psychological consultations and guidance for relatives/caregivers were the practices highlighted as being frequent in the professional quotidian. Diversified psychological practices were observed among the participants who were researchers, had graduate degrees and supervised undergraduate students and/or residents. Regarding aspects that facilitated team integration, the most frequent categories were: activities or care in multi/interdisciplinary team and regular team meetings. Regarding hindering aspects, work overload and personal and interpersonal characteristics of the professionals prevailed. The study highlights the strengthening of health psychology in the Federal District, especially in the services of the Brazilian National Health System, being incipient in private establishments.

Poor Health Literacy, Dilapidated Referral System, Step-Wise Commission Business and Huge Out of Pocket Expense: The Hardcore Challenges of Private Health Services in Bangladesh

Poor Health Literacy, Dilapidated Referral System, Step-Wise Commission Business and Huge Out of Pocket Expense: The Hardcore Challenges of Private Health Services in Bangladesh

Socio-Cultural Determinants of Child Marriages and Teenage Pregnancies among Adolescent Girls and Young Women: A Case Study of District Sanghar and Karachi

Child marriages and early age pregnancy are an alarming issue among adolescent girls and young females in South Asian region. This research was carried out to understand the knowledge, attitude, and practices towards child marriages and early age pregnancies. For this purpose an exploratory research design was employed and data was gathered through using qualitative and quantitative research techniques. The research found that the respondents were lacking authentic knowledge about sexual and reproductive health rights. Most of the respondents were having access to public and private health service providers and this channel can be a source for the quality information about sexual and reproduce health and rights. An integrated approach through combing all the channels and stakeholders of the society can be vital for the desired social change to counter child marriages and early age pregnancies.

Exploring the relationship between life expectancy at birth and economic growth in 56 developing countries

# Background Higher income per capita (IPC) means better access to public and private health services those are provided by public or private sectors in a country. Good health service which lowers mortality rates in a country promotes to reach a long living population level with a higher life expectancy at birth (LEB) and healthy labour force enhancing productivity. People feel themselves more productive with a good health care hence increasing productivity and working hours will cause an increase in IPC (economic growth) incessantly. In traditional economic growth theory, labour force which is one of the factors of production function has got an important effect on the country's economic growth. This study aims to investigate the relationship between LEB and IPC data and vice versa for 56 developing countries in North Africa, Middle-East and South-East Asia where most of them are Islamic countries and members of The Organisation of Islamic Cooperation (OIC). # Methods Cross-section data analysis and panel data analysis consisting random and fixed effects estimations were used in the study to investigate the relationship. # Results According to the random and fixed effects estimation models with panel data analysis and cross-section data analysis in the study, LEB is found as one of the determinants of IPC and IPC as a main determinant of LEB in 56 developing countries. Granger causality test is also applied to test the direction of causality between LEB and national IPC for 56 developing countries and it is seen that IPC Granger causes LEB increase and vice versa for panel data. For cross-section data analysis there is no proved correlation between two variables. # Conclusions In the manuscript 56 developing countries were analysed together. LEB and IPC promote each other not at once but in a time period. In the study our results show that economic growth Granger causes LEB increase and vice versa only for panel data not for cross-section data. The case or IPC not increasing to a higher level is called in literature as \Middle Income Trap\. So benchmarking emerging countries is important to show the guidelines avoiding the \Middle Income Trap\.

Impact of organisational change for leaders in mental health

PurposeThe purpose of this paper is to examine the impact of organisational and structural change on the evolution of quality and safety in health organisations, specifically in mental health services.Design/methodology/approachData were gathered through semi-structured interviews. In total, 25 executive management team members in both public and private mental health services were interviewed and data were analysed using Burnard’s framework.FindingsThree overarching themes emerged: organisational characteristics, leadership and accountability; sustaining collaboration and engagement with stakeholders; and challenges to and facilitators of quality and safety. Taken together, the findings speak to the disruptive and disorienting impact of on-going organisational change and restructuring on leaders’ ability to focus on, and advance, the quality and safety agenda.Research limitations/implicationsTypical with qualitative research of this nature, the potentially limited generalisability of the findings must be acknowledged.Practical implicationsThere is a need for strategies to implement change that are informed by evidence and theory and informed by decades of research on this topic, rather than introduced ad hoc. Change agents must pair effective change management and implementation science strategies to specific contexts, depending on what is being implemented and ensure appropriate evaluation of organisational change to bolster the evidence base around quality and safety and inform future decision-making.Originality/valueThe study explores an identified gap in the literature on the impact of on-going organisational re-structuring and transformation on the evolution of quality and safety in mental health services.

Principal-agent problems in implementation of Ghana’s health insurance scheme

Principal-agent relationship exists between health service providers and their authority and clients. It asserts that health service providers as ‘imperfect agents’ of the authority and clients will take actions that aim to maximise profits at the expense of authority and clients (principal). The situation is possible when reimbursement is based on fee-for-service or a diagnosis-related groups. It looks at relationships between health service providers as agents and health insurance authority, and clients as principals in areas of provision of health services, supply of drugs, medicines and reimbursement. Results showed the private health service providers prescribed more drugs and medicines for clients towards profit maximisation (agency) than their public counterparts. Also, it was found that the public health service providers continued to provide health services and drugs despite health insurance authority indebtedness to them exhibiting more stewardship towards health insurance authority. It recommends strict regulations in tariffs/vetting claims and prompt reimbursement.

Quality of working life for dentists in Antioquia 2011-2012

To analyze the Quality of Life at Work (QOL) of dentists in Antioquia, Colombia, based on objective and subjective components. A sample of 323 dentists was used for a descriptive study using a structured survey. Data were processed using in SPSS 17.0 and Epidat 3.1 software. Significant trends (p<0.05) were found for the decrease of male, home-based and postgraduate professionals. Fewer and fewer professionals earn more than five times the legal monthly minimum wage, have access to private health services, and enjoy more than 15 vacation days per year. On the other hand, the number of dentists that cover their social security expenses and updating courses costs by themselves Increased, as well as the number of professionals that moved to different municipalities to work (p<0.05). Working conditions and the distance between dreams and reality have meaningful differences for the periods observed. Findings ratify the incidence of health and education reforms over the practice of dentistry, revealing significant supply and demand conflicts that exacerbate the deterioration of working conditions and push professionals to merely accommodate, more and more, distancing from the once dreamed profession. The QOL for dentists in Antioquia has deteriorated due to negative tendencies on working conditions derived from the complexity and crisis of the working environment. In addition, professionals do not attempt to associate to face and transform this reality.

Population-based approach and integration of services: their relationship to the territory in the context of Québec's integrative reforms

Context: Two major reforms 2004 and 2015 have transformed Quebec's health and social care system over the last twenty years. In 2004, the reform was based on a coordination model of integration in order to promote the implementation of the principle of population-based responsibility. The population-based approach emphasises planning and delivery of services aimed at improving the health and well-being of a geographically defined population. Concretely, this principle was manifested in 2004 by the implementation of Local Health Networks LHNs, which promote inter-organisational consultations between public, community and private health services of a given territory. On the other hand, the 2015 reform instead pushed in a fully integrated model that breaks down organizational and geographical boundaries over vast territories; effectively abandoning consultations. Aims: To analyze how Quebec’s health and social services system has succeeded in embodying and combining the principles that underlie the integration of services and the population-based approach. Methods: This research is part of an international research program implementing community based integrated care for older adults with complex health ICOACH. This presentation is based on data collected in Quebec from 44 semi-structured interviews with policy makers n = 11 and managers n = 33. The thematic analysis of interviews was based on the principles of the population-based approach Couturier, Bonin and Belzile, 2016, Roy, Litvak and Paccaud, 2010. Results: The population-based approach remained a core principle in the design and structuring of both reforms, but its operationalization weakened over time. For instance, an important operational indicator such as the presence of intersectoral consultation mechanisms, were undermined during the transition from the first to the second reform, thus favoring a managerial rather than participatory conception of governance. The LHNs which were the consultation sites, were intended, in principle, to enable integrated organizations to respond to the needs of the population under their responsibility, and to produce health upstream of traditional curative strategies alone. These LHNs were abandoned by the second reform, in favor of the creation of large centralized organizations, implanted over large geographical areas. Their essentially top-down governance is centralized, making consultation venues irrelevant, characterised by a curtailment of organizations towards their own internal priorities rather than the needs of the population. However, the population-based approach has recently re-emerged as a potential solution to the excesses of the second reform. The populational-based approach makes it possible to revisit the concerns about the relationship between the health system and the dynamics of local populations in their territories, which are small by nature. Conclusion: The population-based approach seems useful to positively conceive integrative reforms at the systemic level of healthcare systems. But its capacity to be durably translated into practices is limited by the implementation of such reforms. They primarily respond to political and managerial imperatives, hence, producing a more service-driven managerial logic rather than a population needs driven logic.

Organizational policies and diversity management in Saudi Arabia

PurposeThe purpose of this paper is to report empirical research conducted in Saudi Arabia on the impacts of organizational policies and practices on the diversity management of the Saudi private sector. To this end, the Saudization policy and views of key respondents have been tested and discussed.Design/methodology/approachPrimary data were collected through questionnaire surveys from the largest 11 private sector organizations listed on the Saudi Stock Market in the financial/banking, oil and gas, petrochemical, private higher education and private health service sectors. Statistical tools such as means and standard deviations and one-sample t-tests were used for analysis.FindingsThe findings suggest that Saudization, retention, pay with benefits and health insurance policies significantly affect the diversity management in the Saudi private sector. Therefore, there is a need to develop organizational policies that support the existence of foreign employees for private businesses in Saudi Arabia. Considering differences as strengths that can be utilized to enhance performance, a diverse workforce might better be able to serve diverse markets.Research limitations/implicationsCollecting data from a closed environment such as Saudi Arabia is constrained by access difficulties, as well as inadequate literature on relevant diversity issues. However, the convenience sampling method and snowballing approach adopted in this study generated reliable data. As a result, this study has implications for both the multinational corporations operating in Saudi Arabia and Saudi owned companies operating in the West and intending to adopt and implement diversity management initiatives for branches in different countries. As such, further research on the gulf countries’ diversity management issues would be critical.Originality/valueThe current study is a first survey-based research endeavor on the topic of diversity management in the Saudi context. The findings contribute to the limited knowledge base on middle eastern countries, thus presenting new empirical evidence on the organizational policies and practices of Saudization, retention, pay and benefits and health insurance policies. The study of the Saudi case, thus adds value to the existing knowledge on diversity management.