Hospital Reform Research Articles

Two-stage hospital efficiency analysis including qualitative evidence: A Greek case

Background: The European Union health policy agenda stresses the importance of environmental and qualitative factors in structural hospital reforms. In response to the economic crisis, both cost containment and performance improvements of the Greek hospital sector, have become a pertinent issue for overall reforms.Objective: The study examines the efficiency of 112 Greek public hospitals, by applying bootstrapping techniques and investigating the effect of contextual factors on hospital efficiency. Furthermore, the effect of qualitative evidence, on hospital efficiency is explored by focusing on a subset of 28 large hospitals.Methods: The quality aspects of the Greek hospitals are investigated by applying two models of Data Envelopment Analysis (DEA), augmented by bootstrapping techniques, in order to assess the importance of quality dimensions on the efficiency of hospital scores. In addition, two Tobit regression models are estimated assessing the contribution of contextual factors, in the efficiency and bias-corrected efficiency scores.Results: Efficiency analysis indicated that only 23.2% of the hospitals are fully efficient (0.96-1.00), 37.5% are efficient (0.71-0.95) while 39.3% are inefficient (0.30-0.70). The Kolmogorov-Smirnov test, between the original and the bootstrap-corrected efficiency, indicates that their distributions are significantly different (p-value < .001). The environmental factors, influencing efficiency, are Occupancy Rate and the ratio between Outpatient Visits and Inpatient Days. Results indicate that the inclusion of Risk-Adjustment Mortality Rate significantly influences (p-value < .05) the efficiency of the hospitals.Conclusions: In the era of economic crisis, the inclusion of quality variables and the use of bootstrapping techniques provide a vital framework in assessing the efficiency of the hospital sector.

Factors influencing the optimization of management in the public hospital reform plan

Factors influencing the optimization of management in the public hospital reform plan

Patients’ Opinions on Family Doctor Accessibility in Estonia

Patients’ Opinions on Family Doctor Accessibility in Estonia

Comparative Study of Three Commonly Used Methods for Hospital Efficiency Analysis in Beijing Tertiary Public Hospitals, China.

Background:Tertiary hospitals serve as the medical service center within the region and play an important role in the medical and health service system. They are also the key targets of public hospital reform in the new era in China. Through the reform of health system, the public hospital efficiency has changed remarkably. Therefore, this study aimed to provide some advice for efficiency assessment of public hospitals in China by comparing and analyzing the consistency of results obtained by three commonly used methods for examining hospital efficiency, that is, ratio analysis (RA), stochastic frontier analysis (SFA), and data envelopment analysis (DEA).Methods:The theoretical basis, operational processes, and the application status of RA, SFA, and DEA were learned through literature analysis. Then, the empirical analysis was conducted based on measured data from 51 tertiary public hospitals in Beijing from 2009 to 2011.Results:The average values of hospital efficiency calculated by SFA with index screening and principal component analysis (PCA) results and those calculated by DEA with index screening results were relatively stable. The efficiency of specialized hospitals was higher than that of general hospitals and that of traditional Chinese medicine hospitals. The results obtained by SFA with index screening results and the results obtained by SFA with PCA results showed a relatively high correlation (r-value in 2009, 2010, and 2011 were 0.869, 0.753, and 0.842, respectively, P < 0.01). The correlation between results obtained by DEA with index screening results and PCA results and results obtained by other methods showed statistical significance, but the correlation between results obtained by DEA with index screening results and PCA results was lower than that between results obtained by SFA with index screening results and PCA results.Conclusions:RA is not suitable for multi-index evaluation of hospital efficiency. In the given conditions, SFA is a stable efficiency analysis method. In the evaluation of hospital efficiency, DEA combined with PCA should be adopted with caution due to its poor stability.

Hospital Managers’ Perception of Recent Health Care Reform in Teaching Hospitals of Qazvin, Iran

Background: The main purpose of any government from a healthcare reform is to improve the service quality and raised public satisfaction. Objectives: As the important role of managerial human resources in any organizational changes, this paper tried to examine the point of view of this group about the recent reform in governmental hospitals of Qazvin. Patients and Methods: This cross-sectional study was conducted in January 2015. The statistical population consisted of 50 executive managers of Qazvin teaching hospitals. The data gathering instrument was a research-made questionnaire with approved reliability and validity (α = 0.84). Data analyse was performed in SPSS version 20 using descriptive and analytic statistics (analysis of variance (ANOVA), Pearson correlation test and one sample t-test). Results: A total of 43.2% of managers believed that this reform was a good restrictor for malpractices in healthcare and 31.8% believed that it will not be so useful to improve the society health status. The average score of resource preparation, insurance companies coordination, changing the routine workflows, and finally achieving the goals, had a meaningful difference (P ˂ 0.05) and the average score of these fields were upper than average. Conclusions: The findings showed that based on the managers’ point of view, the reform plan was able to achieve its primary goals; however, it could not meet their exceptions in improving the society health status. Therefore, it is necessary to design some interventions for changing this perception.

Impact of China's Public Hospital Reform on Healthcare Expenditures and Utilization: A Case Study in ZJ Province.

BackgroundHigh drug costs due to supplier-induced demand (SID) obstruct healthcare accessibility in China. Drug prescriptions can generate markup-related profits, and the low prices of other medical services can lead to labor-force underestimations; therefore, physicians are keen to prescribe drugs rather than services. Thus, in China, a public hospital reform has been instituted to cancel markups and increase service prices.MethodsA retrospective pre/post-reform study was conducted in ZJ province to assess the impact of the reform on healthcare expenditures and utilization, ultimately to inform policy development and decision-making. The main indicators are healthcare expenditures and utilization.ResultsPost-reform, drug expenditures per visit decreased by 8.2% and 15.36% in outpatient and inpatient care, respectively; service expenditures per visit increased by 23.03% and 27.69% in outpatient and inpatient care, respectively. Drug utilization per visit increased by 5.58% in outpatient care and underwent no significant change in inpatient care. Both were lower than the theoretical drug-utilization level, which may move along the demand curve because of patient-initiated demand (PID); this indicates that SID-promoted drug utilization may decrease. Finally, service utilization per visit increased by 6% in outpatient care and by 13.10% in inpatient care; both were higher than the theoretical level moving along the demand curve, and this indicates that SID-promoted service utilization may increase.ConclusionThe reform reduces drug-prescription profits by eliminating drug markups; additionally, it compensates for service costs by increasing service prices. Post-reform, the SID of drug prescriptions decreased, which may reduce drug-resource waste. The SID of services increased, with potentially positive and negative effects: accessibility to services may be promoted when physicians provide more services, but the risk of resource waste may also increase. This warrants further research. It is recommended that comprehensive measures that control SID and promote physician enthusiasm be carried out concurrently.

Das Qualitätsziel der Krankenhausreform 2015: eine ökonomische Analyse

Mit dem Krankenhausstrukturgesetz (KHSG), das zum 1.1.2016 in Kraft treten soll, mochte der Gesetzgeber den Strukturwandel uber eine qualitativ hochwertige Krankenhausplanung erreichen. In der gewahlten Ausgestaltung ist dies eher unwahrscheinlich, da die Bedeutung der Struktur-, Prozess- und Ergebnisqualitat hinter dem Ziel einer flachendeckenden und wohnortnahen Versorgung zuruckbleibt.

Public-private-partnership in healthcare delivery reform of public hospitals

Xuzhou Cancer Hospital explored a development and reform of the hospital in the PPP framework, while adhering to the principles ofPublic nature as before, staff status as before, and government supervision as before. The reform features proactive attempts in operation and management, personnel management, and remuneration system, in an effort to build an operation system featuring board governance, total cost accounting, and dynamic total salary management in its reform toward building an innovative mixed ownership. Key words: Public-private partnership; Public hospital; Operation; Mechanism; Reform

Effect of employment and social medical insurance on hospital admissions for people living with multimorbidity in China: analysis of a large community household survey

BackgroundChina's comprehensive health-care reform was embarked on in 2009, targeting health-care financing, care delivery, drug supply, and hospital reform. The aim of this study was to explore the extent to which being people with multiple long-term disorders who are unemployed and uninsured are prevented from accessing hospital inpatient care. MethodsWe analysed data from a large community household survey of about 5% of the general resident population with household registry in three prefectures in southern China in 2011. Close-ended questions on demographics, socioeconomics, and lifestyle behaviours were derived from the National Health Services Survey (NHSS) 2008. Open-ended questions on chronic disorders (clinically diagnosed or being treated) and admissions to hospitals at the secondary level or above in the previous 12 months were designed by a research panel. The multistage sample designs and sampling weights were taken into account in the binary logistic regression analysis of the survey response. We cross-validated self-reported chronic disorders with paper-based medical reports obtained from previous health-care visits and annual check-ups. Multimorbidity was defined as having two or more chronic disorders from a validated list of 40 morbidities. Findings124 829 residents (aged ≥20 years) from 53 760 households participated in the survey. In the previous 12 months, 7211 (5·8%, 95% CI 5·7–5·9) residents had at least one admission to hospital, of whom 3002 (42%, 40·8–42·4) had multimorbidity. Admission to hospital was associated with the number of chronic disorders (≥4 disorders vs none: adjusted odds ratio 17·13 [95%CI 16·15–18·16]), having social medical insurance (1·41 [1·37–1·44]), household income per head (highest household income group vs the lowest household income group: 1·80 [1·74–1·85]), and unemployment (1·61 [1·55–1·66]). We found a statistically significant interaction between employment status and the presence of medical insurance on hospital admission, meaning that patients who were unemployed and not covered by a social medical insurance were least likely to be admitted to a hospital (0·50, 0·47–0·52). InterpretationThe ability to pay a medical bill seems to be significantly predictive of inpatient service use for multimorbidity. A better designed social medical insurance system with more government contribution would be of particular necessity to improve equitable access to health care, particularly for people with less affordability because of unemployment. FundingDepartment of Health, Guangdong province, China (C2009006/2009–2013), Department of Education, Guangdong province, China (BKZZ2011047/2010–2013), Medical Research Fund, Chinese Medical Association, China (2010-08-05), and Community Health Research Fund, Community Health Association of China, China (2012-2-91). HHXW was supported by a postdoctoral research fellowship in the Hong Kong-Scotland Partners in Post Doctoral Research programme, Research Grants Council of Hong Kong, and the Scottish Government, UK (S-CUHK402/12). JJW is supported by Guangdong Exemplary Centres for Exploratory Teaching in Higher Education Institutions – General Practice Exploratory Teaching Centre [GDJG-2010-N38-35, Guangdong Department of Education, China], and The Ninth Round of Guangdong Key Disciplines – General Practice [GDJY-2012-N13-85, Guangdong Department of Education, China], both of which he leads. The Scottish School of Primary Care partly supported SWM's post and the development of the National Research Programme on Multimorbidity, which he leads.

Screening Policies for Health Impact Assessment: cluster analysis for easier decision making

Background Health Impact Assessment (HIA) is a combination of procedures, methods and tools by which a policy may be judged as to its potential effects and its distribution on a population’s health. Screening policies to identify candidates for applying HIA is an essential first step, generally qualitative. Our aim is to show how to use exploratory multivariate statistical methods such as cluster analysis to screen through policies and pinpoint priorities for HIA quickly and reliably. Methods A panel of 7 public health experts from Nova University in 2011 rated 76 policies proposed by a Technical Group planning the Portuguese hospital reform on a 10-point scale (1-Very low to 10-Very high) regarding Potential Impact, Ease of implementation and Implementation costs. Hierarchical cluster analysis is used to identify groups of similar policies and prioritize those more pertinent of being considered for HIA. Results We identify 7 groups of policies and find that Ease of implementation is not as relevant to differentiate groups as Potential impact and Implementation costs: 3 groups present higher mean levels of potential impact (with respectively higher, intermediate and lower mean levels of implementation. costs); 2 groups present intermediate mean levels of potential impact (with higher and lower mean costs respectively); 2 groups present lower mean levels of potential impact (with higher and lower mean costs respectively). Groups of policies are then re-ranked through different priority criteria, but Group 1 leads all possible scenarios pinpointing the most obvious candidates for HIA. Conclusions Applying methods such as hierarchical cluster analysis as early as the screening step of HIA may be very helpful towards obtaining evidence based, reliable, participatory, flexible and more efficient ways of selecting policies for HIA. Partially funded by FCT, QREN, COMPETE (HMSP-ICT/ 0013/2011) Key messages Although multivariate statistical methodologies may seem complex, decision-makers obtain more evidence-based knowledge and in an easy way to grasp This methodology may be used in other forms of assessments and in different countries

Analysis of progress and problems in coordinated care delivery

Authors described the patterns, core measures and mechanisms of coordinated care delivery in the localities and analyzed initial outcomes of this practice. It is found that such practice has optimized distribution of regional healthcare resources, implemented first visit to primary institutions, and the care delivery to separate emergency from outpatient service. In addition, the paper analyzed problems found in localities in terms of policy, public hospitals and primary institutions, and proposed elements required for coordinated care delivery system to succeed, such as enhanced policy support, enhanced multi-departmental coordination, and public hospital reform to explore feasible approaches. Key words: Coordinated care; Public hospital reform

Policy recommendations on accelerating coordinated care delivery

Coordinated care delivery is faced with various challenges to carry out in China, which are major decisions to make for decision makers, including how to push forward, how to deliver resources, services and patients to primary institutions, and how to ease the difficulties and affordability of seeing doctors.Based on analysis of roadblocks in coordinated care delivery in China, the authors provided near-term and long-term policy recommendations on the system, including how to build a scientific and reasonable healthcare delivery system, coordinated care delivery by stages, building incentives and constraint mechanisms, and enhancing public awareness and patient-doctor education. Key words: Coordinated care delivery; Public hospital reform; Policy; Recommendation

Exploration of public hospitals reform by Shanghai Hospital Development Center: ten years of experience

Ten-year experience of state-owned public hospitals reform of Shanghai was reviewed and analyzed according to theGuiding Opinion of General Reform of Public Hospitals in Urban areas. The paper focused on administration and operation mechanisms reform, modes transition on service delivery and management with support from information technology were thoroughly introduced, and further working plans were provided based on the analysis of problems and challenges. Key words: Shanghai; Public hospitals; Reform

Practice and insight of building a performance evaluation system of public hospitals in Beijing

The role of public hospital performance evaluation has become a roadblock for the current reform of public hospitals. By summarizing the performance evaluation of Beijing municipal hospitals in recent three years, the authors systematically introduced the practice of Beijing Municipal Administration of Hospitals in establishing a public hospital performance evaluation mechanism. In addition, the paper introduced the achievements of the Administration in the evaluation methods of public hospital evaluation, governmental responsibilities in hospital governance, guidance of hospitals' orderly development, and positive interactions between the government and hospitals. This way the paper provided useful references for guiding the hospitals back to public service nature, positive interactions, refined management of hospitals and better performance management. Key words: Health reform; Public hospital reform; Hospital management; Performance evaluation

Perceived patient satisfaction with in-patient services at Jimma University Specialized Hospital, Southwest Ethiopia.

BackgroundPatient satisfaction is an attitude resulting from a person’s general orientation towards a total experience of health care. It is a key determinant and a legitimate measure for quality of care. In developing countries, satisfaction studies were conducted mainly on nursing care and outpatient services.ObjectiveThis study aims to measure and describe the level of patient satisfaction within inpatient health care services.MethodsAcross sectional study design was conducted from 8 May 2011 to 2 June 2011 at Jimma University Specialized Hospital. Systematic random sampling technique was employed to recruit participants. A standardized structured questionnaire developed by reviewing similar literatures was used to assess the level of patient satisfaction towards the inpatient services. SPSS version 19 statistical packages were used for data management and analysis.ResultA total of 189 patients participated. The proportion of overall net patient satisfaction was 117 (61.9%). Majority of the respondents 148 (78.3%) reported that they got the kind of service they anticipated. Cleanliness of the ward 145 (76.7%) and time to get back to home 27 (14.3%) were found to have the highest and the lowest proportion of satisfied respondents, respectively. Patients with no formal education 60 (76.9%) and patients from the rural areas 75 (68.8%) were satisfied higher than those from their counterparts. Patients at medical 22 (61.1%) and ophthalmology 10 (62.5%) wards were less satisfied than patients in other departments.ConclusionNearly two third of the patients were found to be satisfied by the service they received from the hospital. Most of the patients found to be dissatisfied with the nursing, pharmacy and laboratory services, while some others were still dissatisfied with the level of health education, communication and information they received about their illness. Therefore, the hospital administration system should best work on new innovative approach to keep and improve the administrative system, waiting time, hospital stay, hospital accommodation, access for medications and laboratory services to bring patient satisfaction. Nurses and physicians should have to work best to improve health education, communication and understanding between doctors/nurses and patients. Hospital reformation and modern hospital administration system could work best to keep and improve the level of patient satisfaction.

What is the job satisfaction and active participation of medical staff in public hospital reform: a study in Hubei province of China.

BackgroundIn China, public hospital reform has been underway for almost 5 years, and 311 pilot county hospitals are the current focus. This study aimed to assess the job satisfaction and active participation of medical staff in the reform. A total of 2268 medical staff members in pilot and non-pilot county hospitals in Hubei, China, were surveyed.MethodsQuestionnaires were used to collect data. The Pearson chi-square statistical method was used to assess the differences between pilot and non-pilot county hospitals and identify the factors related to job satisfaction as well as the understanding and perception of the reform. Binary logistic regression was performed to determine the significant factors that influence the job satisfaction of medical staff in pilot county hospitals.ResultsMedical staff members in pilot county hospitals expressed higher satisfaction on current working situation, performance appraisal system, concern showed by leaders, hospital management, and compensation packages (P < 0.05). They were exposed to work-related stress at a higher extent (P < 0.05) and half of them worked overtime. Within pilot county hospitals, less than half of the medical staff members were satisfied with current job and they have evidently less satisfaction on compensation packages and learning and training opportunities. The working hours and work stress were negatively related to the job satisfaction (P < 0.05). Satisfaction on the performance appraisal system, hospital management, compensation packages, and learning and training opportunities were positively related to job satisfaction (P < 0.05). Medical staff in pilot county hospitals exhibited better understanding of and more positive attitude towards the reform (P < 0.05).ConclusionsPilot county hospitals have implemented some measures through the reform, but there still are deficiencies. The government officials and hospital administrators should pay attention to influencing factors of job satisfaction and focus on the reasonable demands of medical staff. In addition, the medical staff in pilot county hospitals exhibited a better understanding of the public hospital reform programme and showed more firm confidence, but there still were some medical staff members who hold negative attitude. The publicity and education of the public hospital reform still need improvement.

Introduction to nurse-staffing ladder and compensation system in NHS UK

Objective To explore ladder and compensation system of nurse-staffing which is suitable for the situation of our country. Methods The ladder management and compensation system to nursestaffing of National Health Service (NHS) in UK were given detailed introduction and analysis through the official documents, references and personal study experiences, and summarize its scientific and referenced aspects. Results NHS has formed a set of mature -based ladder system, and linked the ladder system to compensation system, made a relative scientific performance appraisal system, realized the scientific competency matches the level, salary changes along with the level model. Conclusions It provides references and thinking to the in-depth reform of public hospitals in our country, and the development of high quality nursing service, as well as the implementation of nursing ladder management and compensation reform. Key words: Nursing administration; Ladder management; Compensation; National Health Service

Practice and reflection on "Hanchuan model" of hospital hosting

The ongoing health reform features direct hosting of county-level hospitals by provincial level hospitals as an important means and effective attempt to improve comprehensive service capacity of the former.This paper introduces the Model, in which Hubei People’s Hospital has hosted Hanchuan city People’s Hospital, and analyzed the operation performance and hurdles found.Based on such studies, the authors recommend on the vertical integration of medical resources by means of hosting, and comprehensive reforms of county public hospitals. Key words: Hospital hosting; Hanchuan model; County-level hospital reform

Performance agreements management in public hospital governance

Performance agreements management plays an important role in transforming government functions, improving public management efficiency and quality of public services. The international experience shows that: performance agreements management, as a new tool, is also applicable to public hospital governance yet calling for basic policy environment, incentive mechanism and technical support. This paper analyzed the performance agreements managements' applicability in the governance of public hospitals, the implementation conditions and environment, the mechanism and so on, in order to provide a theoretical reference for the introduction of performance agreements for the pilot cities of the public hospital reform. Key words: Performance agreements management; Public hospital; Governance

Professional responses to post bureaucratic hospital reforms and their impact on care provision.

Post bureaucracy is increasingly shaping how health care professionals work. Within hospital settings, post bureaucracy is frequently connected to loss of professional autonomy and protocol-based care. However, this development also affects relationships between care providers and care receivers. To explore experiences of post bureaucratic hospital reforms and their impact on care provision. Data builds on nine mini group interviews with midwives (n=three), nurses (n=three) and physiotherapists (n=three), in all thirty participants. Data was analysed using existing theories of professionalism and post bureaucracy. Two overarching themes were identified: 'Time, tasks and institutional duties' which referred to transformations in care practices, increased use of screening procedures, efficiency requirements and matching linear time to the psychosocial needs of patients. 'Managerial control of work' which described rising administrative demands, engaging in protective measures, younger professionals pressured by documentation obligations and fear of disciplinary procedures. The institutional context appears to play a key role shaping care practices. Although midwives, nurses and physiotherapists share similar experiences of post bureaucratic hospital reforms, changes in care provision can impact these professions in different ways. As a discipline, midwifery is founded on relationships between women and midwives. Standardised clinical care, performativity demands, litigation risks and rising administrative obligations are liable to challenge the provision of woman centred care. These changes may also result in increased inequity in maternity care by affecting some groups of women more than others.