Health Care Reform Research Articles

Assessing the maturity of integration of health and social care in Finland – findings from a pilot study

PurposeIntegrated care is the leading approach to developing health and social care services in Finland. After the national health and social care reform, the importance of assessing integration has been emphasized. The aim of this study was to pilot the SCIROCCO tool, which assesses integration maturity, in Finland. The SCIROCCO tool was translated and adapted to the Finnish health and social care context. The feasibility and utility of this tool for assessing the maturity for integration across health and social care in Finland were evaluated using empirical pilot data collected among employees of selected well-being service counties. The study also provided baseline information on the maturity of integration after the national health and social care reform.Design/methodology/approachEmployees (n = 111) of different personnel groups in health and social care services in four well-being service counties assessed the maturity of integration using a web-based survey. A pilot study design was used.FindingsThe SCIROCCO tool was found to be useful for assessing the maturity of integration in health and social care within the well-being service counties. However, the tool requires further development to be fully adapted to the Finnish health and social care system and to assess integration across sectors. The results emphasize the need to understand the perspectives of different personnel groups on integration and to consider them in the development work.Originality/valueThis was the first study conducted in Finland that provided valuable insights into the assessment of integration across the health and social care sectors. This study establishes the foundation for future research and development in the field of integration assessment.

Impact of a health system vertical integration program on patient expenditures and healthcare utilization: Evidence from county hospitals in East China

In 2009, China launched a vertical integration pilot program to promote collaboration between tertiary and county hospitals to reduce rural-urban disparities and strengthen capacity building in healthcare services delivery in county healthcare facilities. Through the program, tertiary hospitals implemented a workforce mobility program to temporarily assign selected physicians and healthcare staff to paired county hospitals. This study uses hospital-level data from 2009 to 2015 to investigate the program's impact on medical expenditures and healthcare utilization among patients visiting the paired county hospitals. A difference-in-differences method with hospital and year-fixed effects is used to address the unobservable heterogeneity of hospitals and the potential impact of national healthcare reform. We find that the average outpatient expenditure experienced a 4.0% decline after the county hospitals received paired assistance from tertiary hospitals. The decline is mainly driven by a reduced proportion of diagnostic testing expenditures. However, there is no evidence that the program affected inpatient expenditures. In addition, county hospitals had 5.1% more outpatient visits after receiving paired assistance, while the average length of stay remains stable. These results are robust when we control the effect of the Zero-Markup drug policy and conduct permutation tests of sample assignment. We conclude that the paired assistance program has successfully improved hospital healthcare services delivery and controlled patient expenditures. Vertical integration has improved healthcare system performance in East China from 2009 to 2015.

What progress has resulted since the Safeguarding Adults Review concerning the deaths of Joanna, Jon and Ben?

PurposeThe author, who is Chair of Norfolk’s Safeguarding Adults’ Board (SAB) reflects on the impact of a Safeguarding Adults Review (SAR) and the actions that resulted. The purpose of the paper is to provide an insight into a significant SAR and the resulting actions desinged to change practice.Design/methodology/approachThe actions illuminate the power of hospitals and politicians over people’s lives. It took the deaths of three young adults with learning disabilities, in a hospital, to move beyond the status quo and organise some very different service responses.Findings“Progress summits” have considered local and national actions. There have been important gains and setbacks, including the delayed reform of the Mental Health Act. Despite uncertainties, SAB can be detonators to listening and taking action.Originality/valueThis is a unique insight into the impact of a Safeguarding Adults Review and the actions that resulted from this.

Care models for older people based on a case study-Geriatrics as an active discipline

Geriatrics can enable and monitor aholistic care of older people through acomprehensive geriatric assessment in a structured way. Therefore, it must be integrated much more closely with preventive, rehabilitative and acute care units. Geriatrics are not seen in any aspects as areplacement for general practitioners or in-hospital structures but much more as asupplement to them. With its function-oriented concept, geriatrics can best coordinate the demographically necessary triage between prevention, acute treatment, rehabilitation and palliative care, thus avoiding undertreatment and overtreatment. This can only succeed in collaboration with general practitioners and specialist colleagues. The article categorizes geriatric care structures, such as preventive home visits, acute complex medical treatment, delirium prevention, outpatient and inpatient rehabilitation services based on acase example and makes proposals for structural changes that urgently need to be considered in the current healthcare reform, such as outpatient geriatric centers (AGZ).

Exploring the road to public healthcare accessibility: a qualitative study to understand healthcare utilization among hard-to-reach groups in Kerala, India

BackgroundKerala, a southern state in India, is known to be atypical due to its high literacy rate and advanced social development indicators. Facing competition from a dominant private healthcare system, recent government health system reforms have focused on providing free, high-quality universal healthcare in the public sector. We carried out an analysis to ascertain the initial impacts of these measures among ‘hard to reach groups’ as part of a larger health policy and systems research study, with a focus on public sector health service utilisation.MethodsWe conducted Focus Group Discussions (FGDs) among identified vulnerable groups across four districts of Kerala between March and August of 2022. The FGDs explored community perspectives on the use of public healthcare facilities including enablers and barriers to healthcare access. Transliterated English transcripts were coded using ATLAS.ti software and thematically analyzed using the AAAQ framework, supplemented with inductive code generation.ResultsA total of 34 FGDs were conducted. Availability and cost-effectiveness were major reasons for choosing public healthcare, with the availability of public insurance in inpatient facilities influencing this preference. However, accessibility of public sector facilities posed challenges due to long journeys and queues. Uneven roads and the non-availability of public transport further restricted access. Gaps in acceptability were also observed: participants noted the need for the availability of special treatments available, reduced waiting times for special groups like those from tribal communities or the elderly mindful of their relatively greater travel and need for prompt care. Although quality improvements resulting from health reform measures were acknowledged, participants articulated the need for further enhancements in the availability and accessibility of services so as to make public healthcare systems truly acceptable.ConclusionThe ‘Kerala Model of Development’ has been applauded internationally for its success in recent years. However, this has not inured the state from the typical barriers to public sector health care use articulated by participants in the study, which match global evidence. In order to deepen the impact of public sector reforms, the state must try to meet service user expectations– especially among those left behind. This requires attention to quality, timeliness, outreach and physical access. Longer term impacts of these reforms – as we move to a post-COVID scenario - should also be evaluated.

New Zealand Institute of Safety Management Health and Safety Reform Survey

New Zealand Institute of Safety Management Health and Safety Reform Survey

Exploring the need and potential of ambulatory pharmacy practice for empowering patient and care delivery in India.

In recent years, rapidly changing disease profile patterns, shortage & uneven utilization of healthcare professionals contributed massive burden on the Indian healthcare system, which resulted in varying, fragmented, inconsistent healthcare delivery to the patients and poor patient management. Patients often face and experience many challenges like lack of accessibility, poor patient-healthcare provider relationships, and inadequate quality of care, resulting in unnecessary economic burden in managing their health conditions. Thus Indian healthcare reform is essential in enhancing its capacity to fulfill patients' health needs that can be addressed by focusing on key sustainable strategies and initiatives meant for enhancing coordination of care, expanding services accessibility, redeveloping healthcare infrastructure, implementing workforce innovation and strong governance with the incorporation of core principles such as patient-centeredness, integrated care and collaborative care approaches. The clinical and ambulatory pharmacy practice are fragment of the healthcare delivery which delivers pharmaceutical care and fulfils the needs of patients across healthcare settings. This paper focuses on the present & future perspectives of ambulatory pharmacy practice in India and the factors to be considered for implementing it in patient care.

Assessing Malaysian Health Care Reform

This study assesses the healthcare reform in Malaysia since its independence. Previous studies and official reports on healthcare reform were analyzed through content analysis. The discussion starts with geographical and socioeconomic factors, then moves to the inception of the Malaysian Health Care System, focusing on the development of primary health system reform initiatives in the country. This paper illustrates the rigorous journey of system reform, emphasizing that political commitment and backing from stakeholders and citizens are vital for its success

Time for reform of the Mental Health Act

The editor takes a look at the Parliamentary and Health Service Ombudsman report on the state of discharge from mental health care and the new government's plans to reform the Mental Health Act.

Driving Innovative Healthcare Reform through Meta-governance Strategies

Objectives: This study explores the transformative potential of innovation in public sector governance, specifically within the healthcare sector, through meta-governance strategies. Methods: Employing qualitative case study methodology, the study thoroughly analyzes the impact of Bandar Lampung’s free health service program. Drawing from interviews, documents, and observations, the research highlights the critical influence of meta-governance in guiding innovation within the healthcare sector. Results: The findings contribute significantly to our understanding of public sector innovation, emphasizing the importance of meta-governance in fostering transformative change. Conclusion: By highlighting technological advancements in Bandar Lampung, this study offers actionable insights for policymakers, practitioners, and scholars to enhance public service delivery and promote societal progress through innovation.

The Effects of a Large-Scale Mental Health Reform: Evidence from Brazil

This paper studies the Brazilian Psychiatric Reform, which reorganized the public mental health care provision by introducing mental health centers (CAPS) as a community-based substitute for inpatient care. Our research design exploits the rollout of CAPS in a difference-in-differences framework. We show that these centers increased outpatient mental health care production and reduced psychiatric hospitalizations. These reductions were more pronounced for long-stay admissions and among patients with schizophrenia. We find that the savings implied by fewer admissions do not offset the cost of the policy. Also, the reform did not reduce mental health mortality and it increased violent crimes. (JEL H51, I12, I18, O15)

Evaluating the effect of health insurance reform on health equity and financial protection for elderly in low- and middle-income countries: evidences from China

BackgroundTo achieve Universal Health Coverage (UHC), China have implemented health system reform to expend health coverage and improve health equity. Scholars have explored the implementing effect of this health reform, but gaps remained in health care received by elderly. This study aims to assess the effect of implementing health insurance payment reform on health care received by elderly, as well as to evaluate its effect on cost sharing to identify whether improve financial protection of elderly under this reform.MethodsWe identified hospitalization of 46,714 elderly with cerebral infarction from 2013 to 2023. To examine the determinant role played by DRGs payment reform in healthcare for elderly and their financial protection, this study employs the OLS linear regression model for analysis. In the robustness checks, we validated the baseline results through several methods, including excluding the data from the initial implementation of the reform (2021), reducing the impact of the pandemic, and exploring the group effects of different demographic characteristics.ResultsThe findings proposed that implementing DRGs payment reduces drug expenses but increases treatment expense of chronic disease for elderly in China. This exacerbates healthcare costs for elderly patients and seems to be contrary to the original purpose of health care reform. Additionally, the implementation of DRGs payment reduced the spending of medical insurance fund, while increased the out-of-pocket of patients, revealing a shift in health care expenses from health insurance fund to out-of-pocket.ConclusionsThis study shares the lessons from China’s health reform and provides enlightenment on how to effective implement health reform to improve health equity and achieve UHC in such low- and middle-income countries facing challenges in health financing.

Real-Life Data, a Retrospective Report from Romania Hodgkin’s Lymphoma Registry - Single Center Experience

Background. Hodgkin’s Lymphoma is a type of cancer originating from the lymphatic system, characterized by Reed-Sternberg cells. It is essential due to its distinct clinical presentation, early age at diagnosis, favorable prognosis with early detection and treatment, and the ongoing need for research to optimize therapeutic strategies and improve patient outcomes. Aims: This study evaluates demographic data and clinical features, staging, and treatment options of newly diagnosed Hodgkin’s Lymphoma patients in the biggest Hematology Center in Bucharest, Romania “Fundeni” Clinical Institute Study design: Retrospective study Methods: Demographic data, histopathological and clinical features, treatment modalities, and treatment responses were systematically extracted from hospital records and integrated into the National Hodgkin’s Lymphoma Registry under the auspices of the Romanian Hematology Association. Key dates, including initial diagnosis, remission, relapse, last follow-up, and death, were meticulously documented to facilitate comprehensive survival analysis. Results. We analyzed data from a cohort of Hodgkin Lymphoma patients, comprising both male and female individuals, with a median age of 35. The predominant histological subtype was nodular sclerosis, and the most common stage at diagnosis was stage II. The ABVD chemotherapy regimen (doxorubicin, bleomycin, vinblastine, dacarbazine) was the most frequently administered treatment in the first-line setting. Five-year survival rates were significantly higher in patients diagnosed at an early stage and those with favorable prognostic factors, showing improved overall and relapse-free survival rates. Prognosis factors impacting outcomes included the presence of B-symptoms, serum albumin levels, Eastern Cooperative Oncology Group (ECOG), and LDH levels. Conclusion. The analysis of Hodgkin's Lymphoma data from the Romanian National Registry highlights the critical necessity for the enhancement of diagnostic infrastructure, the promotion of equitable access to advanced treatments, and active engagement in international clinical trials. Addressing these imperative issues through targeted healthcare reforms has the potential to significantly ameliorate patient outcomes and synchronize Romania's management of Hodgkin's Lymphoma with global benchmarks.

EXPRESS: Advancing employees’ mental health and psychological wellbeing research in hospitality and tourism: Systematic review, critical reflections, and future prospects

This study conducts a systematic review and analysis of the research landscape concerning the mental health and psychological wellbeing (MHPW) of employees in the hospitality and tourism sector. Comprehensive bibliometric analysis, intellectual network mapping, and critical qualitative content analysis were performed utilizing a dataset of 184 relevant articles. From these analyses, eight critical reflections were derived, and future research agenda were outlined. These agenda include exploring positive enhancers of MHPW, advocating for holistic conceptualizations of MHPW, encouraging cross-cultural and interdisciplinary collaborations, assessing the impacts of technology on mental health, developing industry-specific assessments, diversifying research methodologies with multidisciplinary theories, conducting multi-level analyses of influencing factors, and investigating the pandemic's long-term impact on career perceptions and mental health reforms within the industry. Findings offer pivotal directions for future research and aim to advance the understanding and enhancement of MHPW in the global hospitality and tourism workforce through impactful scholarship.

Impact of Diagnostic-Related Groups Healthcare Payment Reform on Public Hospitals

The increasing reform of diagnosis-related groups (DRG) healthcare payment plays a crucial role in the reform of the medical and healthcare system, accelerating the high-quality development of public hospitals and serving as a critical path for their reform. The innovation of DRG healthcare payment methods can balance the financial income and expenditure of public hospitals, while also achieving a more harmonized balance of interests among hospitals, patients, and health insurance. This reform effectively controls the operating costs of hospitals, strictly regulates medical behaviors and quality management, and optimizes the patient treatment process. To quickly adapt to this reform trend, public hospitals need to seize the opportunities of healthcare system reform, adopt corresponding strategies to address the impact of DRG payment reform and achieve their own sustainable development goals in health.

Spatial patterns of Mental Health Act apprehensions in Toronto, Canada, 2014-2022.

This research examines the temporal rates and spatial patterns of police-involved Mental Health Act (MHA) apprehensions in Toronto, Canada, from 2014 to 2022. Building from the work of Toronto Police Services (TPS), the goal of this research is to deepen our understanding of MHA apprehensions and provide insights which may be used to guide local mental health reform efforts. Using data collected by TPS, an exploratory, descriptive analysis of spatial patterns of MHA apprehension events between 2014 and 2022 at the neighbourhood level was conducted. To identify high-rate clusters, we used a discrete Poisson model in SaTScan, with a circular moving window. Primary and secondary clusters with a relative risk of 1.5 or greater are reported. From 2014 to 2022, 93,932 MHA apprehensions occurred in Toronto. Apprehension rates were found to vary substantially between neighbourhoods, with approximately 91% of Toronto's 140 neighbourhoods experiencing a net positive increase in rates during the study period after adjusting for population growth. Repeated spatial cluster analysis for each year revealed a range of 4 to 7 clusters annually, with the downtown core consistently emerging as an area of elevated risk (RR range 1.58-1.99). Rising MHA apprehensions within Toronto highlight the pressing need to confront the city's intensifying mental health needs. These findings offer valuable insights into the patterns and nature of police-involved MHA apprehensions, outline reproducible analysis methods that can be used by others, and support targeted evaluation, expansion, and implementation of downstream initiatives to improve mental health responses.

Consilience of healthcare legislation, complexity science & computational analysis

Our US Health Care System (HCS) has evolved from simple to complex and needs reform. Thus far, all legislative initiatives have failed to result in establishing a friendly, cost-effective, quality healthcare system. The question becomes, can Complexity Science (CS) and computational analytic platform modeling be used to help create better Health Care Policies (HCP) and reform our all too complex HCS? Modeling has been used in many diverse disciplines but has yet to be utilized in preemptive evaluation of major US legislative HCPs. Review of US Health Care Policy History (HCPH) viewed in the context of a Complex Adaptive System(CAS) reveals how, unanticipated historical events, politics, social, and personal leadership have tangentially shaped our US HCPs. Future construction of HCPs with the help of CS, and preemptive computational modeling (CM) techniques, will hopefully yield stronger conclusions in legislative HCP construction and advance our US HCS into one with dynamic resilience.

The doctor vote: Interactions between political ideological preferences and healthcare reform strategies among U.S. physicians

IntroImproving the American healthcare system has consistently predominated the domestic policy agenda in the United States for decades. However, physicians have traditionally played a small role in the U.S. legislative process despite their direct observations of the obstacles that cost, access, and quality can have on their patients and their care. The goal of this study was to examine the relationship between physician political ideological preferences and health policy reform options. MethodsWe conducted a cross-sectional survey of 3,001 currently practicing U.S. physicians to predict how self-identification as liberal, moderate, or conservative impacted a physician’s policy preferences under the domains of cost, access, and quality. ResultsA total of 536 (18.8%) out of 3,001 physicians responded to the survey. Overall, 32% of physicians identified as liberal, 43% as moderate, and 22% as conservative. ConclusionLiberal-identifying physicians favored traditionally liberal reform ideas (a national health plan or public option), while conservative physicians preferred conservative policies (free market optimization). However, variation within political groups and domains of healthcare suggest that no single reform policy will be unanimously supported by every physician within a political group. Nonetheless, physicians are unanimously dissatisfied with the state of our current system, and physician-supported healthcare reform should be a national priority.

Assessing urban family physician program challenges in Iran: the insurance organizations’ perspective(2021)

BackgroundThe Family Physician Programme is a key health reform in Iran that faces significant challenges in urban areas, particularly in Mazandaran and Fars provinces The study aims to critically evaluate the challenges encountered in the Urban Family Physician Program, with a particular focus on the perspectives of insurance organizations.MethodsA qualitative approach was adopted, involving semi-structured interviews with 22 experts and managers from basic health insurance funds. Snowball sampling facilitated participant selection, and interviews proceeded until saturation. Data analysis utilized content analysis and Atlas-T software, adhering to COREQ criteria.ResultsImplementation problems of the urban family physician program were categorized into ten Categories and 22 Subcategories, including financing, stewardship, human resources, structure, culture, information system, payment, monitoring and control, the function of insurance organizations, and implementation.ConclusionThe urban family physician program’s implementation challenges, as viewed by health insurance organizations, underscore the necessity for strategic decision-making in financing, payment models, electronic system integration, structural adjustments, comprehensive monitoring, evaluation, cultural considerations, and appropriate devolution to insurance entities.

Unpacking the process of developing South Africa's national drug policy - lessons for universal health coverage.

South Africa's National Drug Policy (NDP) was first issued in 1996, at a time of considerable political change. To revisit the lessons learned from the process of development and initial implementation of the NDP. Six in-depth face-to-face interviews were held with purposively-selected key actors. Interviews, which followed pre-determined semi-structured questions, but were allowed to explore additional areas, were recorded and transcribed, and then subjected to abductive thematic analysis, informed by the Walt and Gilson model. Three key themes emerged, described as 'evidence', 'trust' and 'looking forward'. A paucity of evidence backed some of the key concepts in the NDP, and these have not been addressed as evidence has matured. The lack of trust which characterised the policy process impacted on the ways in which actors were able to or not able to engage, and therefore on the resultant content and the choices exercised. The coherence of the policy, its articulation with other health reforms, and its contribution to subsequent efforts to ensure universal health coverage in South Africa have all been weakened by the failure to revise the document over time. As South Africa advances its plans for universal health coverage, there is an urgent need to revisit key components of the NDP which are no longer fit for purpose.