Private Health Care Providers Research Articles

The cost of cosmetic surgery tourism complications to the NHS: A retrospective analysis

IntroductionMedical tourism refers to the process of patients travelling outside of their native country to undergo elective surgical procedures and is a rapidly expanding healthcare phenomenon [1–3]. Whilst a multitude of established Private Healthcare Providers (PHPs) offer cosmetic surgical procedures within the United Kingdom (UK), a growing number of patients are opting to travel outside of the UK to undergo cosmetic surgery. AimTo assess the number of patients presenting to the Canniesburn Plastic Surgery Unit, with cosmetic surgery tourism complications, from outside of the UK, and the associated costs to NHS Scotland over a five-year period. MethodsA retrospective case review of a prospectively maintained trauma database, which records all acute referrals, was undertaken analysing patients referred from January 1st 2019 to December 31st 2023 inclusive. Results81 patients presented over five years with complications of cosmetic surgery tourism. The most common presenting complaints were wound dehiscence (49.4%) or wound infection (24.7%). The total cost to NHS Scotland was £755,559.68 with an average of £9327.90 per patient. ConclusionThis is the largest single centre cohort of cosmetic surgery tourism complications reported within the NHS to date; with rates on the rise, demand grows for increased patient information regarding healthcare tourism risks, a national consensus on the extent of NHS management and urgent international collaboration with policymakers is required to address this issue across borders.

Reasons and extent of delay in the diagnosis of pulmonary tuberculosis after the appearance of symptoms.

Delay in the diagnosis of tuberculosis (TB) is a significant problem at both individual and community levels. Delayed diagnosis of TB contributes to more severe disease manifestations, higher risk of death, and higher disease transmission in the community. We conducted this study to assess the extent and associated reasons for delay in diagnosis of pulmonary TB. This study was conducted in the Department of TB and Respiratory Diseases, J. N. Medical College, Aligarh, from June 2020 to May 2022. A total of 2053 new pulmonary TB patients, who first consulted any private healthcare provider (HCP) for treatment, were enrolled in the study. The required information was collected by interview technique using a predesigned questionnaire. A total of 2053 patients were enrolled in the study. There was a significant delay of more than 2 weeks in the diagnosis of pulmonary TB after the onset of symptoms in 94% of patients. The extent of delay ranged from 8 days to 240 days with a mean of 36.33 days. The delay in visiting the HCPs by the patient was not significant. Only 5.85% of patients had a significant delay of more than 2 weeks in seeking any health care after the appearance of symptoms. A delay by HCP contributed to a greater portion of the total delay, with a mean of 31.77 days. The main reason for the delay by HCPs was not investigating TB. The hospital delay was not significant. The mean hospital delay was 5.82 days. The delay in the diagnosis of TB in India is very high. A delay by HCPs contributes to a greater portion of the total delay. Information, Education and Communication (IEC) activities will play an important role in reducing the delay. All HCPs should be actively involved in subjecting the suspects to TB diagnosis at the earliest possible as per National Tuberculosis Elimination Programme (NTEP) guidelines.

Factors influencing fever care-seeking for children under five years of age in The Gambia: a secondary analysis of 2019–20 DHS data

BackgroundMalaria contributes to excess child mortality in The Gambia. Children under five are at risk of severe malaria and death if not treated promptly and appropriately. It is crucial that a child with fever receive appropriate care from a trained provider. The aim was to identify influences on child fever care-seeking in The Gambia to inform malaria control strategies.MethodsThis cross-sectional analysis of The Gambia 2019–20 Demographic and Health Survey used logistic regression analysis to identify associations between source of care for a child with fever (public or private healthcare provider, other, or no treatment) and mother, child, and household characteristics.ResultsOnly 52.0% of mothers sought care from a trained healthcare provider for a child with fever—45.1% from a public facility and 7.0% from the private sector. 35.2% of mothers did not seek treatment. Mothers in urban households were 2.67 times as likely (aOR, 95% CI 1.504–4.736) as mothers in rural households to seek care from an informal source (e.g., pharmacy) versus not seeking treatment, and 0.29 times as likely (aOR, 95% CI 0.165–0.515) as mothers in rural households to seek care from a public provider versus informal source. Mothers in wealthier households were 2.30 times as likely (aOR, 95% CI 1.274–4.164) as mothers in poorer households to seek care from an informal source versus no treatment and half as likely as mothers in poorer households to seek care from a public provider versus informal source (aOR 0.53, 95% CI 0.291–0.959).ConclusionsMaintaining The Gambia’s malaria control achievements will require the active engagement and oversight of private pharmacies along with continued integrated community case management to reach mothers who do not seek care for a child with fever, and remove challenges to seeking appropriate care from trained providers. Whether influenced by convenience, costs, perceived urgency, or other factors, given the likelihood of urban mothers and mothers in wealthier households to seek care from private pharmacies, it will be necessary to incorporate private pharmacies into malaria control strategies while building public sector capacity and workforce, and initiating more effective attitude and behavioural change among mothers and households.

The Role of Trust as a Driver of Private-Provider Participation in Disease Surveillance: Cross-Sectional Survey From Nigeria.

Recognition of the importance of valid, real-time knowledge of infectious disease risk has renewed scrutiny into private providers' intentions, motives, and obstacles to comply with an Integrated Disease Surveillance Response (IDSR) framework. Appreciation of how private providers' attitudes shape their tuberculosis (TB) notification behaviors can yield lessons for the surveillance of emerging pathogens, antibiotic stewardship, and other crucial public health functions. Reciprocal trust among actors and institutions is an understudied part of the "software" of surveillance. We aimed to assess the self-reported knowledge, motivation, barriers, and TB case notification behavior of private health care providers to public health authorities in Lagos, Nigeria. We measured the concordance between self-reported notification, TB cases found in facility records, and actual notifications received. A representative, stratified sample of 278 private health care workers was surveyed on TB notification attitudes, behavior, and perceptions of public health authorities using validated scales. Record reviews were conducted to identify the TB treatment provided and facility case counts were abstracted from the records. Self-reports were triangulated against actual notification behavior for 2016. The complex health system framework was used to identify potential predictors of notification behavior. Noncompliance with the legal obligations to notify infectious diseases was not attributable to a lack of knowledge. Private providers who were uncomfortable notifying TB cases via the IDSR system scored lower on the perceived benevolence subscale of trust. Health care workers who affirmed "always" notifying via IDSR monthly reported higher median trust in the state's public disease control capacity. Although self-reported notification behavior was predicted by age, gender, and positive interaction with public health bodies, the self-report numbers did not tally with actual TB notifications. Providers perceived both risks and benefits to recording and reporting TB cases. To improve private providers' public health behaviors, policy makers need to transcend instrumental and transactional approaches to surveillance to include building trust in public health, simplifying the task, and enhancing the link to improved health. Renewed attention to the "software" of health systems (eg, norms, values, and relationships) is vital to address pandemic threats. Surveys with private providers may overestimate their actual participation in public health surveillance.

Management of groin hernia repair in Sweden: A register-based comparative analysis of public and private healthcare providers.

Swedish healthcare is in a period of transition with an expanding private sector. This study compares quality of outcome after groin hernia repair performed in a public or private healthcare setting. A cohort study based on data from the Swedish National Hernia Register combined with Patient-Reported Outcome Measures (PROMs) 1 year after groin hernia repair. Between September 2012 and December 2018, a questionnaire was sent to all patients registered in the hernia register 1 year after surgery. Endpoints were reoperation for recurrence, chronic pain, and patient satisfaction. From a total of 87,650 patients with unilateral groin hernia repair, 61,337 PROM answers (70%) were received from 71 public and 28 private healthcare providers. More females, acute and recurrent cases, and patients with high American Society of Anesthesiology (ASA) scores were operated under the national healthcare system. The private sector had more experience surgeons with higher annual volume per surgeon, shorter time on waiting lists, and shorter operation times. No difference was seen in patient satisfaction. Groin hernia repair performed in a private clinic was associated with less postoperative chronic pain (OR 0.85, 95% CI 0.8-0.91) but a higher recurrence rate (HR 1.41; 95% CI 1.26-1.59) in a multivariable logistic regression analysis. Despite private clinics having a higher proportion of experienced surgeons and fewer complex cases, the recurrence rate was higher, whereas the risk for chronic postoperative pain was higher among patients treated in the public sector.

An Examination of Inter-State Variation in Utilization of Healthcare Services, Associated Financial Burden and Inequality: Evidence from Nationally Representative Survey in India.

This study examines the health care utilization pattern, associated financial catastrophes, and inequality across Indian states to understand the subnational variations and aid the policy makers in this regard. Data from recent National Sample Survey (2017-2018), titled, "Household Social Consumption: Health," covering 113,823 households, was employed in the study. Descriptive statistics, Erreygers concentration index (CI), and recentered influence function decomposition were applied in the study. We found that, in India, 7 percent of households experienced catastrophic health expenditure (CHE) and 1.9 percent of households were pushed below poverty line due to out-of-pocket expenditure on hospitalization. Notably, outpatient care was more burdensome (CHE: 12.1%; impoverishment: 4%). Substantial interstate variations were observed, with high financial burden in poorer states. Utilization of health care services from private health care providers was pro-rich (hospitalization CI 0.31; outpatient CI 0.10), while the occurrence of CHE incidence was pro-poor (hospitalization CI -0.10; outpatient CI -0.14). Education level, economic status, health insurance, and area of residence contributed significantly to inequalities in utilization of health care services from private providers and financial burden. The high financial burden of seeking health care necessitates the need to increase public health spending and strengthen public health infrastructure. Also, concerted efforts directed towards increasing awareness about health insurance and introducing comprehensive health insurance products (covering both inpatient and outpatient services) are imperative to augment financial risk protection in India.

Knowledge and practices of private healthcare providers regarding tuberculosis case notification in Rural Maharashtra

India carries the highest share of active and missing tuberculosis (TB) cases globally. The Government of India is prioritizing private sector engagement (PSE) in TB elimination activities, as most healthcare-seeking in the country happens in this sector. This study aimed to understand the knowledge and practices of private healthcare providers (PHP) on various aspects of TB case notification through the National TB Elimination Programme (NTEP). This cross-sectional study was carried out between Oct 2020 to April 2021 amongst PHPs in the Junnar Tuberculosis Unit (TU), Pune District, Maharashtra. Junnar Block has 299 PHPs who assess, diagnose, and/or treat TB cases. A total of 97 participants were enrolled in the study. About 89 (91.8%) PHPs are aware that TB case notifications are mandatory by law. However, 80.4% are unaware of the Ni-kshay portal (web-based case surveillance system) by NTEP. Similarly, 74 (76.3%) must be aware of incentives for PHPs to collaborate with the government healthcare delivery system. 82.8% of total Ayurveda, Unani, Naturopathy, Siddha, and Homeopathy (AYUSH) practitioners and 46.2% of Allopathic practitioners have poor knowledge about TB case notification, with a Chi-square value of 14.36 (p<0.01). Our study shows that the active engagement of private providers (PPs), especially AYUSH practitioners in rural areas, is a need of the hour in achieving TB elimination.

Interoperability of Botswana’s healthcare systems using semantic prescription ontologies

<p>The developing country of Botswana’s health information system faces interoperability challenges mainly due to the lack of shared patient medical data and histories between private and public healthcare providers, which leads to increased medical errors, increased healthcare costs, and potentially fatal outcomes. This research proposes an intelligent electronic prescription ontology (IEPO) framework to share Botswana’s patient electronic health records (EHRs) between private and public healthcare systems for a standardized and semantically rich data exchange. IEPO was evaluated for interoperability using the recall metric for completeness to capture the degree of all relevant information for exchange and the precision metric for accuracy performance to gauge the degree of error minimization during interoperability. The harmonic means of precision and recall called the F1- score, offered the overall interoperability performance. IEPO outperformed related works by 75% in recall, 54% in precision, and 76% in F1-score, demonstrating improved interoperability performance. Furthermore, IEPO was evaluated for correctness and expressiveness through competency questions via queries, results confirming correct and expressive responses.</p>

Assessment of Private Hospitals’ Acceptability to Introduce Human Immunodeficiency Virus Provider Initiated Counseling and Testing (PICT) Policy in Khartoum State, Sudan: A Cross Sectional Survey

Introduction: Sudan shows low coverage and utilization of HIV testing services among general population, according to the WHO indicators 1% of women and men aged 15-49 years old received HIV test and know their result. To increase coverage and utilization of HIV testing services among general population many strategic interventions are introduced in Sudan HIV strategic plan 2019-2025 and one of them is introducing the HIV PITC in private hospitals. Till now no data base available for acceptability of private hospitals to introduce HIV PICT policy. Aims: to study the private hospitals acceptability to introduce HIV provider-initiated counseling and testing policy in Khartoum state. Methods: A mixed qualitative- quantitative analytical cross-sectional study was done. The study was conducted in federal ministry of health, state ministry of health and private hospitals within Khartoum state. The study population was composed of HIV focal person at FMoH, HIV program director at SMoH, private hospitals general directors and health care providers within private hospitals. The study used thematic analysis for the qualitative part and descriptive analysis for the quantitative part. Results: FMoH didn’t start to implement PICT policy in private hospitals to increase the coverage. SMoH believe private hospital adoption of HIV PICT is a major addition and will also increase the coverage. private hospitals admins accepted the PICT policy implementation after training for their health cadre. 77% of the health care providers are willing to be trained in implementation of PICT. Conclusion: This study showed that private hospitals will accept the PICT policy implementation to increase coverage and utilization of HIV testing services among general population.

Examining the nexus of relationship marketing and patient loyalty: The mediation and moderation analysis

Studies on association amongst relationship marketing and loyalty of patients are still trying to establish its presence in the healthcare management. Also, the variables impacting this association are still in exploratory phases. The research is being carried out for determining the nature of that relationship and also examining mediating and moderating effect of different variables. Data collected through various Scopus and other online databases have been used for this study. Literature review has been carried out by dividing it into three parts, relationship marketing, patient loyalty and variables like patient satisfaction, age, gender, family size, health insurance, etc. Primary data was collected from 938 patients of private healthcare providers by administering questionnaire online as well as in person. PLS-SEM was applied to analyze the data, which was used after testing the instrument for reliability and validity. After Covid-19 pandemic everyone felt need of a good health insurance but in actual many people were not having a simple health insurance cover also. Hospitals will have a major role in promoting health insurance and in turn providing quality service, but their role is currently limited to processing of health insurance and nothing more. Model from the study will help understand organizations the strength and direction of relationship between patient loyalty and efforts taken for marketing along with impact of moderating and mediating variable on the same. Future research can look into the other variables that will moderate or mediate the relationship in turn will help not only healthcare organizations but insurance companies also to develop product or service according to requirement of relationship. Research focuses on impact of moderating effect of health insurance on association amongst marketing efforts taken for relationship marketing and loyalty of patients through patient satisfactions’ mediation which was not studied before this. The study aims to test the conceptual model of moderating impact of health insurance on association between relationship marketing, patient loyalty and patient satisfaction using SEM.

The shifting landscape of private healthcare providers before and during the COVID-19 pandemic: Lessons to strengthen the private sectors engagement for future pandemic and tuberculosis care.

COVID-19 pandemic changed many aspects of healthcare services and deliveries, including among private healthcare providers (i.e., private healthcare facilities [HCFs] and private practitioners [PPs]). We aimed to compare the spatial distribution of private providers and describe changes in characteristics and services offered during and before the COVID-19 pandemic, and explore the tuberculosis (TB) and COVID-19-related services offered by the private sector in Bandung, Indonesia. A cross-sectional study with historical comparison was conducted in 36 randomly selected community health centers areas (locally referred to as Puskesmas) in Bandung, Indonesia, during the COVID-19 pandemic from 5th April 2021 - 27th December 2021. Data pertaining to before the COVID-19 pandemic was abstracted from a similar survey conducted in 2017 (i.e., INSTEP study). We obtained latitude and longitude coordinates of private healthcare providers and then compared the geographical spread with data collected for INSTEP study. We also compared characteristics of, and services provided by private healthcare providers interviewed during the COVID-19 pandemic with those previously interviewed for INSTEP study. Differences were summarized using descriptive and bivariate analyses. From April-December 2021, we surveyed 367 private HCFs and interviewed 637 PPs. Compared to INSTEP study data, the number of operating HCFs was reduced by 3% during the COVID-19 pandemic (401 vs. 412 before COVID-19), although we observed increases in laboratory service (37.8% increase), x-ray service (66.7% increase), and pharmacy (18.1% increase). Among a subset of private HCFs managing patients with respiratory tract infection symptoms, a quarter (60/235, 25.3%) indicated that they had to close their facilities in response to the emerging situation during the COVID-19 pandemic. For PPs, the number of practicing PPs was reduced by 7% during the COVID-19 pandemic (872 vs. 936 before COVID-19). Interestingly, the number of practicing PPs encountering patients with TB disease increased during the COVID-19 pandemic (42.9% vs. 35.7% before COVID-19, p = 0.008). This study confirmed that the COVID-19 pandemic adversely impacted health care service deliveries in private sectors, largely marked by closures and shortened business hours. However, the increased service capacities (laboratory and pharmacy), as well as significant increase in the number of patients cared for TB disease by PPs during the COVID-19 pandemic, made a more compelling case to further the implementation of public-private mix model for TB care in Indonesia.

District health information system 2 data utilization among health professionals in Amara region private hospitals, Ethiopia.

Globally, health information systems have been improved by District Health Information System Version 2 (DHIS2), which promotes consistency and integrity in collecting data, processing, and utilization. This success has been attributed to its user-friendly interface and incorporation of advanced data analysis and validation features. This study aimed to assess DHIS2 data utilization among health professionals working at private hospitals in the Amara region. An Institution-based cross-sectional study design was conducted from 9 May to 30 June 2022. A simple random sampling technique was used to select participants, with a total of 395 health professionals participating. Data was collected using a self-administered paper-based questionnaire. Data entry was performed using the Kobo Collect tool, and data analysis was conducted using STATA version 14.0. Bivariable and multivariable logistic regression analyses were used and p < .05 with a 95% CI was considered to measure statistically significant variables. Out of 395 participants, about 37.72% of the participants had good DHIS2 data utilization. Had good data analysis skills (adjusted odds ratio (AOR) = 6.5, 95% CI [3.1-13.8]), regular supportive supervision and feedback (AOR = 5.2, 95% CI [2.8-9.5]), monthly salary > 5000 ETB (AOR = 2.0, 95% CI [1.1-3.7]), ease of use (AOR = 5.4, 95% CI [2.8-10.2]), and district health information system training (AOR = 4.2, 95% CI [2.2-7.3]) were enabling factors for utilization of DHIS2 data. Private healthcare providers had limited utilization of DHIS2 data. It is highly recommended to provide DHIS2 training, supervision, and feedback focused on private health facilities. Additionally, enhancing data analysis skills and prioritizing ease of use are crucial to improving DHIS2 data utilization.

The financialization of healthcare

In contemporary capitalism, finance has extended its reach to encompass a growing array of economic sectors traditionally associated with public provisioning or social policy, with healthcare emerging as a prominent domain where fictitious capital has flourished. Financialization exerts a direct influence on the delivery of public health services while also reshaping the behavior and operations of private healthcare providers and health insurance firms. This paper aims to characterize the process of financialization of healthcare in Brazil by analyzing the behavior of firms in the private health insurance market from 2007 to 2019. These firms provide healthcare coverage alongside the functioning of the Unified Health System (SUS), constituting an avenue for the accumulation of capital. The paper analyzes how the strategies for managing assets, liabilities, and the equity of leader firms operating in the market of private healthcare plans firms, as expressed by the movements recorded in their balance sheets, inform us on their process of financialization. A set of financialization indexes is developed, addressing: (i) asset financialization; (ii) liability financialization; and (iii) the maximization of shareholder value. Economic-financial data and financial statements made available by the Brazilian Regulatory Agency for Private Health Insurance (ANS) are used to build such indexes. The results show a greater engagement of leader firms in the allocation of their resources in financial assets, but the weight of financial gains in total profits is small. Regarding indebtedness, results do not show an increase in leverage and financial burden, and does not confirm the hypothesis of increased susceptibility to creditor influence. Finally, changes in the equity structure and initial public offerings suggest a greater alignment of management practices with the standards of corporate governance established in capital markets. We conclude that those firms are increasingly serving as platforms for the financial accumulation of other economic agents and set a research agenda on this topic.

Exploring social media adoption for marketing purpose among healthcare professionals in Gondar town, central Gondar zone: A facility-based cross-sectional survey

Background Social media has become an integral platform for global information exchange and business interactions, emerging as a crucial tool for promoting products and services in the digital age. Despite its worldwide significance, local businesses, especially in Ethiopia, lag behind in leveraging social media for healthcare marketing. The scarcity of studies on social media adoption among healthcare providers in Ethiopia highlights the imperative for comprehensive research. Objective This study, conducted in Gondar Town, focused on private healthcare professionals, aiming to identify the determinants of their behavioral intention and usage behavior in adopting social media marketing. Method A facility-based cross-sectional survey involving 238 health professionals from private healthcare facilities in Gondar Town was conducted between March and June 2023. The study analyzed data using SPSS Version 26 and AMOS Structural Equation Modeling Version 23. Results All participants reported using social media platforms, with Facebook, Telegram, and YouTube being popular choices. Performance expectancy, social influence, facilitation condition, and behavioral intention significantly influenced healthcare professionals’ adoption of social media marketing. Performance expectancy and social influence exhibited the strongest impact on behavioral intention, acting as mediators influencing usage behavior. However, effort expectancy did not significantly influence behavioral intention. Age, gender, experience, and voluntariness showed no significant moderating effects. Conclusion This study contributes valuable insights into social media marketing adoption in the healthcare sector, emphasizing the critical role of various factors in shaping behavioral intention and usage behavior. The findings offer practical implications for private healthcare providers, policymakers, and marketers, guiding strategies to enhance patient communication and engagement through social media in Gondar Town.

Structural reforms in action - Singapore's population health journey and the structural changes at the national and local level

Summary: This workshop explores the challenges and opportunities for health systems in transition using Singapore as a case study to explore:&#x0D; &#x0D; a) How the health system is shifting towards a population approach&#x0D; b) Change management and implementation approaches required at the macro, meso and micro level&#x0D; &#x0D; Background: Confronted with the challenges of an ageing population, rising prevalence of chronic diseases, and increasing healthcare costs – Singapore’s Ministry of Health has embarked on “Healthier SG”, an ambitious health transformation strategy which aims to shift the system to a population health approach and place a stronger focus on preventive health. Healthier SG is a multi-year healthcare transformation journey which will be launched in the second half of 2023, with the commencement of a national enrolment programme for residents, to a primary care physician of their choice. Key enablers such as financing shift towards capitation will also be implemented gradually, along the with building of a strong digital data background and relevant supporting IT architecture. &#x0D; Objectives:&#x0D; 1.Introduce Singapore’s “Healthier SG” strategy, a primary care and community-centric movement to bring key stakeholders across public and private healthcare providers, and community care partners, to better enable Singaporeans to take charge of their health. &#x0D; 2.Share on a range of Singapore’s population health strategies, including child and maternal health, promoting a healthy lifestyle, enhancing personal mental health, and supporting well-being and care planning for our elderly population. &#x0D; 3.Through the sharing, understand the process and journey for countries and health systems undergoing similar transformation journeys, and be able to describe and discuss the structural changes that are happening at the national and local levels.&#x0D; 4.Discuss and explore the enablers, challenges and opportunities for structural reforms in this case study, using the selected Pillars of Integrated Care as a reference&#x0D; &#x0D; Target Audience: Policy makers, health sector decision makers, health managers, health authorities, health and social care professionals, researchers, academia, health experts, and the staff working on implementation, digitalization and/or evaluation of integrated care.&#x0D; Session Format:&#x0D; Time&#x0D; 10 minsIntroduce Singapore’s “Healthier SG” population health strategy and plans&#x0D; 15 minsHighlight the opportunities, challenges and structural changes happening at (a) national, (b) local, and (c) primary care levels&#x0D; 40 minsModerated group discussion, using the selected Pillars of Integrated Care as reference, for 4 groups&#x0D; 10 minsRead back on group discussion and insightsPlenary style read-back by groups, facilitated by group leads&#x0D; 15 minsDiscussion and Round Up, facilitated by workshop lead&#x0D; Group discussions will be guided and facilitated by the workshop speakers, and attendees will be encouraged to contribute and participate actively in the group discussions. Flipcharts and post-its will be used to facilitate the group discussions.&#x0D; Key Learnings / Takeaways&#x0D; 1.Gain knowledge about how other countries are progressing with their integrated care, people-centred care and population health journeys&#x0D; 2.Understand and appreciate the importance of the local context and cultural considerations for countries and health systems undergoing transformation and structural changes&#x0D; &#x0D;

Antecedents of patient health engagement in the radiotherapy service (evidence from Indonesia).

Private radiotherapy (RT) facilities in emerging countries are growing with cancer incidence. Private healthcare providers must provide better care based on patient perspectives to reach more patients. This study investigated the relationship between antecedents of patient health engagement (PHE) with revisit intention (RVI) and intent to recommend (ITR) in private RT facilities. The survey was conducted in a private hospital with a RT service in Central Java province, Indonesia. A quantitative, cross-sectional design with a purposive sampling method was used. Patient questionnaire survey modified from validated self-administered radiotherapy experience (RTEQ) and PHE questionnaire were used to collect data. Partial least squares-structural equation modelling was used to analyse the data. In this study, 173 respondents consented to participate, which demonstrated that seven of the eight experience antecedents of PHE measured by reliable and valid RTEQ and were significantly related to PHE (p-value <0.05). At the same time, the degree of PHE has a significant relationship with RVI and ITR (p-value <0.05). Patient informational needs elements from the patient experience, followed by situational repose, were shown to have a prominent relation to PHE. The management of private RT facilities needs to focus more on these elements to encourage PHE to establish hospital performance. The findings denote that six elements of RTEQ relate to PHE and further hospital outcomes. Hospital management could utilise this approach to improve the quality of care in RT facilities, specifically in private hospitals in emerging countries.

Implementation and evaluation of an oncological case management system among public and private healthcare providers in Chile

This article presented the implementation, results, and usability evaluation of a software solution designed to manage oncological cases between healthcare centers. The software was developed to facilitate the exchange of clinical and administrative data for patients referred to the Arturo López Peréz Foundation (FALP) through a charitable program. The software underwent iterative development and included features such as user roles, patient list, progress tracking, document upload and viewer, chat, DICOM viewer, sharing, download, and API integration. The usability of the software was evaluated using the System Usability Scale (SUS) questionnaire, which showed high levels of usability and user satisfaction. The software proved successful in facilitating the coordination and continuity of care for patients referred to FALP and received positive feedback from users. The results of this study highlight the effectiveness and value of the software solution in improving case management and information exchange in the Chilean healthcare system. Future plans include expanding the software for internal patient management at FALP and extending its use to other institutions

‘COVID-19 is just another way to die…’: a qualitative longitudinal study of frontline COVID-19 response governance across Syria

IntroductionGovernance of COVID-19 responses has been challenging for all countries. Syria has been particularly challenged due to protracted multiparty conflict and debilitated health systems fragmented across different areas of control....

Determining Marketing and Communication Dimensions of Healthcare Providers in Hungary

Abstract While the actors of the developed world are deeply concerned with the complex interpretation of health, studying the path leading to that is a less investigated area, although, among the global Sustainable Development Goals (SDGs), a prominent role is given to the complex experience of health and its quality improvement. Regarding the V4 countries, many indicators of health need to be improved, while the quality of online marketing and communication, as well as the social media activities of private healthcare providers, largely determines the intensity and efficiency of using the service they provide. The focus of the online survey, with the involvement of almost 2,000 respondents, was to assess whether the marketing activities of healthcare services and their activities on social media platforms meet the expectations of Hungarian female consumers. Due to the results, social media platforms proved to be extremely critical, although older respondents trust advertisements about marketing services less. In the selection of service providers, patients base their decisions to a decisive extent on the expressions of the community of acquaintances, which assumes the management of a multi-level marketing, and communication tool park, and the emphatic and controlled education of brand ambassadors.

Universal and Equitable Access to High-Cost Drugs in Uruguay. Results of 15 Years of Treatment of Non-Hodgkin Difusse Large B Cell Lymphoma (DLBCL) with Ritiximab in First Line Treatment in Uruguay

Introduction The Integrated National Health System (INHS) allows the worker or retiree and their families to have universal health coverage through a contribution proportional to their income, with the option of a public or private healthcare provider. This determines universal and equitable care coverage for the entire population. In 2004, with the arrival of the first high-cost drugs, rituximab and imatinib, healthcare providers had difficulties financially covering them. The National Resource Fund is a non-state public Entity created in 1980 to provide coverage for highly specialized medical techniques. It currently provides universal financial coverage to all residents linked to the INHS and encompasses almost all the coverage of patients nationwide. On January 1, 2005, financial coverage for high-cost drugs began with rituximab and imatinib under regulations that required strict diagnosis, treatment, and follow-up criteria. Non Hodgkin Lymphoma incidence in Uruguay is 11,53 cases per 100,000 men/year, and 7,9 cases per 100.000 women/year. Uruguay's population is estimated in 3,400,000. This study shows the results obtained with rituximab in DLBCL. Methods Analytical retrospective study of a historical cohort of consecutive patients with DLBCL who started first line treatment with chemo-immunotherapy with rituximab between January 1, 2005 and December 31, 2019. Follow-up was conducted until March 8, 2021. All patients signed informed consent. Results In the period considered, 1699 requests for rituximab treatment for patients with DLBCL were received, 1597 (94%) treatments were authorized. The results of the 1413 (89%) patients with onset of the disease are analyzed, 51,1% were from the capital city, Montevideo and 48,9% from other cities, 21% from public hospitals and 79% from private health system. Median age was 61 years (9-90), 4 patients &amp;lt; 18 years. Male patients 751 (53.2%) Regarding the characteristics of the disease, Ann Arbor stage was I in 223 (16.01%), II in 370 (26.56%), III in 326 (23.40%) and IV in 474 (34.03%) of the patients. IPI Score from 0 to 5 were 168 (12.03%), 390 (27.94%), 306 (21.92%), 412 (29.51%), 104 (7.45%), 16 (1.15%) respectively. The most frequent components of the IPI score were age &amp;gt;=60 (54.92%), elevated LDH (46.35%), and Ann Arbor stage III-IV (55.87%). B symptoms were present in 38.19% of the patients and Bulky disease in 479 patients (36%). HIV diagnosis was recorded in 2.05% of patients (n=29). CHOP with Rituximab was the treatment in 83.79% of the patients. With a median follow-up of 84.8 months, the median overall survival (OS) for the study population was 126.9 months (95% CI 102.6 - 138.3). The OS rate at 2 years was 72.75% (95%CI 70.37 - 75.01), at 3 years 69.14% (95%CI 66.69 - 71.50) and at 5 years 64.76% (95%CI 62.22 - 67.20) In the IPI univariate analysis, age &amp;gt; 60, Ann Arbor Stage III-IV, elevated LDH, and PS&amp;gt;=2 were associated with shorter survival time, but extra-nodal involvement greater than or equal to 2 was not. These prognostic associations were maintained when performing a multivariate analysis. Median OS according to the IPI for low-, low-intermediate, high-intermediate, and high-risk patients was 190.8, 138.2, 45.5, and 27.9 months, respectively. (p=0.00001). The 2 years OS for patients &amp;lt; 60 years was 77.86% (95% CI 74.48 - 80.92) while in those &amp;gt; 60 years was 68.56% (95% CI 65.21 - 71.73) (P&amp;lt;0.00001). Median OS was 114 months and 129 months for patients from public and private health system respectively (p=0.7) Discussion The results of OS and its relationship with the factors that make up the IPI are those expected according to the studies that determined that the use of rituximab associated with CHOP was the standard in DLBCL. Access to the medication was universal for the entire population of Uruguay, we found a lower-than-expected number of patients from the public health system. Conclusions The regulations provided the possibility of universal use of rituximab in DLBCL; the diagnosis, treatment and follow-up of these patients was standardized throughout the country. This is reflected in results comparable with international standards in the public and private health system. The survival results found in this study are those expected according to the reference works used in the design of the rituximab coverage regulations. Said regulation was the beginning of financial coverage by the National Resources Fund for other high-cost medicines.