Public Hospital Services Research Articles

Persistent and Transient Inefficiency of Australian States and Territories in Providing Public Hospital Services: An Application of Bayesian Stochastic Finite Mixture Frontier Analysis

Current literature on public hospital efficiency in Australia only reveals information on how efficient public hospitals are in the short run. The presence of persistent technical inefficiency arising from long‐term systemic problems and government‐related regulatory constraints does not appear to have been addressed. Using the aggregated hospital panel data for the period 2002–2018 on eight Australian states and territories, this study incorporates the measure of both transient and persistent technical inefficiency while controlling for unobserved heterogeneity to obtain a more precise measure of technical efficiency. This study’s findings estimate the national average transient efficiency to be 0.96. In contrast, the national average persistent efficiency is estimated to be 0.83. Further, Queensland (0.67), Victoria (0.66) and New South Wales (0.60) posted the lowest overall technical efficiency driven by the high level of persistent inefficiency. On the other hand, Northern Territory (0.96), Australian Capital Territory (0.95) and Tasmania (0.95) are the top performers. This study’s findings call on policy‐makers and regulators to disclose hospital‐level data to researchers to gain further insight into the causes of persistence in inefficiency, especially among bigger states, which will help formulate more targeted policy interventions.

Patient satisfaction with in-patient hospital services in Public and Private Hospitals in Borama, Northwest Somalia

Patient satisfaction with in-patient hospital services in Public and Private Hospitals in Borama, Northwest Somalia

La Qualité dans les hôpitaux publics marocains : Enjeux et pistes d’amélioration

Public hospitals in Morocco suffer from a lot of dysfunctions and shortcomings, which have in their turn perverse effects on the quality of their practices, their activities and services (shortage and lack of management of resources, governance problems, staff demotivation, accessibility difficulties, user dissatisfaction, etc.). Several efforts have been made by the ministry of health through the implementation of a set of reforms, strategies and action plans, in order to control and reduce the impact of those dysfunctions in the public hospital world. From the 1990s, the ministry of health have focused mainly on quality procedures (Competition for quality, certifications, hospital accreditation, etc.), to ensure both the correction of certain dysfunctions and the improvement of the quality of services offered to public hospital services users. However, all these efforts could not succeed. As a matter of fact, they were not able to make the change in the Moroccan public hospital world work. In this article, we try to dissect the main quality initiatives that have been established in the public hospitals of the kingdom, to shed some light on the main obstacles that hinder their success, and therefore, suggest ways of improvement to allow their sustainability. We implicitly target, through this work, the identification and the contribution to the fixing of the major dysfunctions of the Moroccan public hospitals that strive to improve their services, performances and ability to cope with various challenges, issues and risks such as the serious repercussions and the devastating consequences of the current covid-19 pandemic.

Metafrontier efficiency analysis for hospital pharmacy services using dynamic network DEA framework

Medication management is a complex but critical process within the healthcare delivery system. The pharmacy department in healthcare facilities is responsible for acquisition, distribution and dispensing of medication to patients that involves a series of network process. This process can be categorized into two main subprocesses: i) pharmacy store and ii) patient services (i.e., ambulatory and inpatient pharmacy). The objective of this study was to investigate the relative efficiency level of the two subprocesses of pharmacy services in Malaysia's public hospitals. We used a nonconvex metafrontier technology to estimate technical efficiency of hospital pharmacies between specialist and nonspecialist hospital categories under the dynamic network data envelopment analysis (DNDEA) framework. For overall efficiency, both specialist and nonspecialist categories had similar mean efficiency scores. However, when measuring the efficiency level according to pharmacy store and patient services separately, the nonspecialist category had a higher mean efficiency score in pharmacy store, whereas for patient service efficiency, both categories had similar results. The patient service efficiency level was lower consistently over time, suggesting that the overall inefficiency of hospital pharmacy is greatly influenced by the inefficiency of the patient service. This suggests that systematic improvements in patient service efficiency should be a higher priority than pharmacy store efficiency to further increase the overall efficiency level. We believe that our findings will provide valuable information to policymakers towards achieving an efficient public healthcare service.

A comparative study of quality of health care services of public and private hospitals in Ghana

The standard of health care service is very important to the development of every nation as indicated in the Millennium Sustainable Development Goals. There are already a growing number of reports in developing countries on the quality of health care. Nevertheless, there is scant literature in Ghana regarding the quality of health care provided by private and public health care providers. This study sought to assess and compare the quality of health care services rendered by public and private hospitals in the metropolitan cities of Ghana. The study target population was patients using the selected health care facilities involved in this study. This study followed quantitative methods using a social survey designed questionnaire to obtain data from 255 hospital participants receiving care. The findings revealed that in contrast with the public hospitals, private hospitals offered patients a higher quality of health care services. There was no difference in meaning in terms of consistency; however, the biggest explanation was that private hospitals aimed at increasing profits and tried to attract customers to retain them as compared to public hospitals that offered basic social services to an enormous number of patients. The study concluded that better health care services are provided by private hospitals. It was recommended that public health care providers should improve upon their quality health care services as more people visit the public health care centres due to their low health care cost.

Time-Flow Study for Receipt of Outpatient Services in Public and Private Hospitals: Implications for Lean Approach in Health Facilities in Rivers State, Nigeria.

Waiting time is an important indicator of the quality of healthcare services in public and private health facilities. This study compared the waiting time at the general outpatient clinics (GOPC) in a private and public hospital in Rivers State. A comparative cross-sectional survey using a multi-stage sampling technique was used to select a total of 299 ambulatory adult patients attending the GOPC in a public and a private hospital. Time spent at service stations was obtained using a record sheet. SPSS version 23 was used to analyze data and p-values ≤0.05 were considered significant. Ambulatory patients on average spend 122.6 minutes for GOPC encounters in the public hospital and 44.9 minutes in the private hospital. This difference of 77.8 (95%CI: 66.6, 89.0) minutes was statistically significant (p = 0.001). The duration of time spent to access GOPC services underscores the need for system redesign to reduce the time spent and improve the satisfaction of patients attending the GOPC.

Behavioral factors associated with utilization of healthcare services among elderly in Pakistan: evidence from a nationally representative survey

BackgroundIn Pakistan, health system is facing unprecedented challenges to deal with the healthcare demand of the growing ageing population. Using conceptual framework, this study aims to analyze the factors associated with the utilization of healthcare services in private and public hospitals by the elderly population.MethodsThis study used a sample of 5319 individuals aged 60 and above extracted from the Pakistan Social and Living Standards Measurement Survey 2014–15. We followed the Anderson’s Behavioral model of healthcare utilization. The behavioral factors, including predisposing, enabling and need factors, associated with the use of healthcare care were analyzed using exploratory data analysis and binary logistic regressions. The utilization of healthcare service in the study refers to the visits to private and government hospital.ResultsOut of total 5319 participants around three-fourth or 72.4% of participants visited private hospitals for their healthcare needs. Multivariate analysis showed that older age-group (80 years and above) and participants from urban were 1.35 and 1.53 times more likely to avail healthcare service in private hospitals, respectively. The elderly persons from Khyber Pakhtunkhwa were three times (AOR: 3.29, 95%CI 2.5–4.8) more likely to visit government hospitals than their peers in Punjab. Participants who attended school (AOR: 1.21, 95%CI 0.82–1.31) were more likely to utilize healthcare service in private hospitals. Elders from rich (AOR: 1.04, 95%CI 0.84–1.13) and richest (AOR: 1.29, 95%CI 0.89–1.87) wealth quintiles were more likely to use healthcare in private hospitals. The likelihood of the utilization of healthcare service in private hospitals was 1.7 times higher for three or more consulting visits than the single visit, and 1.5 times higher in the public hospital.ConclusionsOur findings underscore a dire need for expanding the outreach of healthcare services for the elderly population. It calls for effective implementation of policies which aim at improving equitable access to private healthcare services, and upgrading of government hospitals Moreover, the knowledge generated through this research may be employed to make social protection programs more responsive to age-related healthcare needs, and focused on caregiving for elderly living without spouse.

Sociodemographic profile of intensive nursing and its relations with engagement and workaholism

The aim of this study was to analyze how sociodemographic variables explain the levels of engagement and workaholism in the work of intensivist nursing professionals. An exploratory study with quantitative approach to the data was adopted as a method, conducted with a non-probabilistic sample of nursing professionals working in adult intensive care services in public and private hospitals in the State of Rio de Janeiro. Descriptive analyses of the participants and Pearson correlations were performed between the variables explored through the Software Statistical Package for Social Sciences version 19.0. The results showed that the sociodemographic variables were weakly related or even not related to engagement and workaholism. It was concluded that the weekly workload was positively related to the levels of remuneration of the participants, and this with their schooling. It was also observed that the levels of education of intensivist nursing professionals did not establish a statistically significant relationship with the participants’ engagement indexes.

Cataract Services in Greek Public Hospitals through and after the Austerity Period.

The recent financial crisis caused several problems in the health systems of affected countries like Greece. The present short report highlights several issues regarding the operation of cataract services in Greek public hospitals while certain acts are proposed to cope with recently appeared tight spots. The final aim is to promote relevant discussion in Greece and countries in the region that similar conditions may apply. The cataract service is one of the busiest parts of modern ophthalmology clinics and since they are considered high cost procedures, are affected by limited monetary funding. Institution of a national cataract institute could improve the quality of provided services: To reduce waiting period for a cataract operation, secure safety of procedures and maintain an adequate level of cataract surgeons training.

العوامل المؤثرة فی عدالة توزیع الخدمات الطبیة بالمستشفیات العامة

الملخص العوامل المؤثرة في عدالة توزيع الخدمات الطبية بالمستشفيات العامة يعتبر الحق في الصحة من أهم الحقوق التي تقدم من خلال المؤسسات والمستشفيات عبر الخدمات الصحية التي تقدمها کل مؤسسة، ولکن تواجه الأنظمة الصحية في مختلف المجتمعات عوامل رئيسية تتعلق بإنتاج وجودة خدمات الرعاية الصحية وعدالة توزيع هذه الخدمات ، لذلک جاءت قضية الدراسة الحالية والتي تسعى إلى تحديد العوامل المؤثرة في عدالة توزيع الخدمات الطبية بالمستشفيات العامة ، وتضمنت عدة مفاهيم أساسية ( العوامل المؤثرة – عدالة التوزيع –الخدمات الطبية ) ، وتعتبر هذه الدراسة من الدراسات الوصفية التحليلية التى استخدم فيها المسح الاجتماعى بالعينة للمرضى المحتجزين بالأقسام الداخلية بمستشفى الفيوم العام وعددهم ( 100) مفردة ، واستخدمت الباحثة فى دراستها لجمع البيانات استمارة قياس تم تطبيقها على المرضى ، وأسفرت النتائج عن إرتفاع مستوى عدالة توزيع الخدمات الطبية بالمستشفيات العامة ، ومستوى متوسط في عدالة إجراءات الحصول على الخدمة بالمستشفى ، وتوصي الدراسة بضرورة توفير الأجهزة الطبية المتطورة داخل المستشفيات الحکومية ، وتيسير فرص الحصول على الخدمة الطبية وتوفير معامل مجهزة للأشعة ومعامل مجهزة للتحاليل الطبية . Factors affecting the Equitable Distribution of Medical services in public The right to health is one of the most important rights provided through institutions and hospitals through the health services provided by each institution, but health systems in different societies face major factors related to the production and quality of health care services and the equity of the distribution of these services, so the issue of the current study, which seeks to identify the factors affecting the equity of the distribution of medical services in public and included several basic concepts (factors affecting distribution justice - medical services), and this study is considered a descriptive analytical study in which it was used. The social survey of patients detained in the internal departments of Fayoum General Hospital and their number (100) individual, and the researcher used in her study to collect data a measurement form applied to patients, and resulted in a high level of fairness distribution of medical services in public hospitals, and an average level in the fairness of procedures to get service in the hospital, and recommends the need to provide advanced medical devices within government hospitals, facilitate access to medical service and provide laboratories equipped with radiation and equipped for medical analysis laboratories.

Is there unwarranted variation in obstetric practice in Australia? Obstetric intervention trends in Queensland hospitals.

Objective The aim of this study was to report on the rates of obstetric interventions within each hospital jurisdiction in the state of Queensland, Australia. Methods This project used a whole-of-population linked dataset that included the health and cost data of all mothers who gave birth in Queensland, Australia, between 2012 and 2015 (n=186789), plus their babies (n=189909). Adjusted and unadjusted rates of obstetric interventions and non-instrumental vaginal delivery were reported within each hospital jurisdiction in Queensland. Results High rates of obstetric intervention exist in both the private and public sectors, with higher rates demonstrated in the private than public sector. Within the public sector, there is substantial variation in rates of intervention between hospital and health service jurisdictions after adjusting for confounding variables that influence the need for obstetric intervention. Conclusions Due to the high rates of obstetric interventions statewide, a deeper understanding is needed of what factors may be driving these high rates at the health service level, with a focus on the clinical necessity of the provision of Caesarean sections. What is known about the topic? Variation in clinical practice exists in many health disciplines, including obstetric care. Variation in obstetric practice exists between subpopulation groups and between states and territories in Australia. What does this paper add? What we know from this microlevel analysis of obstetric intervention provision within the Australian population is that the provision of obstetric intervention varies substantially between public sector hospital and health services and that this variation is not wholly attributable to clinical or demographic factors of mothers. What are the implications for practitioners? Individual health service providers need to examine the factors that may be driving high rates of Caesarean sections within their institution, with a focus on the clinical necessity of Caesarean section.

Perceptions of risk and motivation for healthy living among immigrants from non-western countries with prior gestational diabetes mellitus living in Denmark

ABSTRACT Objective To explore perceptions of risk and motivation for healthy living among immigrant women from non-western countries with prior gestational diabetes mellitus (GDM) living in Denmark. Design Seventeen semi-structured interviews were conducted with 12 female immigrants with prior GDM from non-western countries living in Denmark. The women were recruited through a public hospital and other health services and nongovernmental organisations. The theoretical approach was inspired by Arthur Kleinman’s Explanatory Models. Data were analysed using qualitative content analysis. Results A diagnosis of GDM entailed great worry for the future. Participants’ fears were primarily linked to the potential later development of type 2 diabetes (T2D) and poor health. Women’s perceptions of GDM reflected their experiences with T2D-related complications and even death among relatives. The risk perception of GDM was also influenced by participants’ challenges and trauma unrelated to diabetes. Their motivation for healthy living was strengthened by their experiences with T2D among relatives, while unrelated challenges and trauma generally reduced their capacity for healthier behaviours. Conclusion Among women with a non-western immigrant background and prior GDM living in Denmark, experiences with T2D among family members and their close communities affect their perceptions of risk and motivation to prevent the development of T2D. Furthermore, the challenges of daily life and past trauma were critical factors in their levels of available resources for health. Health promotion in this population should address health in a holistic way by integrating mental and social health with interventions aimed at preventing the development of T2D.

Skills adequacy and service delivery among healthcare professionals at Umphumulo Public Hospital, KwaZulu-Natal Province of South Africa

For decades, South Africa has experienced skills inadequacy challenges and poor service delivery in the health sector, and the case of Umphumulo Hospital is of particular concern. In many organisations, there is a strong link between skills adequacy and service delivery quality. The shortage of skilled healthcare professionals negatively affects employees' performances and denies South Africans quality healthcare services in public hospitals. Using data from unstructured interviews with 32 participants, this article examined the state of service delivery in Umphumulo Hospital. It also evaluated the coping skills of healthcare workers and assessed whether relevant skills were adequately shared among health professionals in the quest to enhance service delivery in the hospital. The study found compelling evidence of poor service delivery, employers’ display of unprofessionalism, and policy-gaps in the health sector. In conclusion, it is the government’s responsibility to promote human capacity building programmes and commit the required financial resources for the optimal functioning of public hospitals.

The impacts and unintended consequences of the nationwide pricing reform for drugs and medical services in the urban public hospitals in China

BackgroundSince 2015, China has been rolling out the pricing reform for drugs and medical services (PRDMS) in the urban public hospitals in order to reduce drug expenditures and to relieve financial burdens of patients. This study aims at evaluating the effectiveness of the reform and investigating its positive impacts and unintended consequences to provide evidence basis for further policy making.MethodsThe Difference-in-difference (DID) approach was employed to analyze the reform impacts on the 31 provincial administrative areas in China based on data abstracted from China Statistics Yearbooks and China Health Statistics Yearbooks from 2012 to 2018.ResultsThe reform resulted in a decrease of 7.59% in drug cost per outpatient visit, a decrease of 5.73% in drug cost per inpatient admission, a decrease of 3.63% in total cost per outpatient visit and an increase of 9.10% in surgery cost per inpatient admission in the intervention group. However, no significant change in examination cost was found. The reduction in the medical cost per inpatient admission was not yet demonstrated, nor was that in the total outpatient/ inpatient expenses. The nationwide pricing reform for drugs and medical services in urban public hospitals (PRDMS-U) in China is demonstrated to be effective in cutting down the drug expenditures. However, the revealed unintended consequences indicate that there are still significant challenges for the reform to reach its ultimate goal of curbing the medical expenditures.ConclusionWe conclude that the pricing reform alone may not be enough to change the profit-driven behavior of medical service providers as the root cause lies in the unchanged incentive scheme for providers in the service delivery. This holds lessons for policy making of other low- and middle-income countries (LMICs) with similar health systems set up in the achievement of Universal Health Coverage (UHC).

Malta's only acute public hospital service during COVID-19: a diary of events from the first wave to transition phase.

IntroductionCOVID-19 has challenged healthcare systems worldwide. Some countries collapsed under surge conditions, while others (such as Malta) showed resilience. Public health measures in Malta quickly reined in COVID-19 spread. This review summarizes pandemic preparedness measures in Malta and the impact on routine services.MethodsA literature search was conducted using Google, Google Scholar and PubMed and by reviewing Maltese online newspapers. A comprehensive summary of internal operations conducted at Mater Dei Hospital (MDH) was made available.ResultsA hospital ‘Incident Command Group’ was set up to plan an optimal COVID-19 response strategy. A ‘rapid response team’ was also created to cater for the logistics and management of supplies. A ‘COVID-19 Emergency Operation Centre’ simulated different COVID-19 scenarios. All elective services were suspended and all staff were mandatorily trained in wearing personal protective equipment. Staff were also retrained in the care of COVID-19 patients. In preparation for potential admission surges, MDH underwent rapid expansion of normal and intensive care beds. Swabbing was ramped up to one of the highest national rates worldwide. The cost for hospital COVID-19 preparedness exceeded €100 million for Malta’s half a million population.ConclusionMalta and its sole acute hospital coped well with the first wave with 680 cases and 9 deaths. The increased ability to deal with COVID-19 (a principally respiratory pathogen) will serve well for the anticipated combined annual influenza and the COVID-19 second wave this coming winter.

Unpacking the implementation blackbox using 'actor interface analysis': how did actor relations and practices of power influence delivery of a free entitlement health policy in India?

Exploring the implementation blackbox from a perspective that considers embedded practices of power is critical to understand the policy process. However, the literature is scarce on this subject. To address the paucity of explicit analyses of everyday politics and power in health policy implementation, this article presents the experience of implementing a flagship health policy in India. Janani Shishu Suraksha Karyakram (JSSK), launched in the year 2011, has not been able to fully deliver its promises of providing free maternal and child health services in public hospitals. To examine how power practices, influence implementation, we undertook a qualitative analysis of JSSK implementation in one state of India. We drew on an actor-oriented perspective of development and used ‘actor interface analysis’ to guide the study design and analysis. Data collection included in-depth interviews of implementing actors and JSSK service recipients, document review and observations of actor interactions. A framework analysis method was used for analysing data, and the framework used was founded on the constructs of actor lifeworlds, which help understand the often neglected and lived realities of policy actors. The findings illustrate that implementation was both strengthened and constrained by practices of power at various interface encounters. The implementation decisions and actions were influenced by power struggles such as domination, control, resistance, contestation, facilitation and collaboration. Such practices were rooted in: Social and organizational power relationships like organizational hierarchies and social positions; personal concerns or characteristics like interests, attitudes and previous experiences and the worldviews of actors constructed by social and ideological paradigms like their values and beliefs. Application of ‘actor interface analysis’ and further nuancing of the concept of ‘actor lifeworlds’ to understand the origin of practices of power can be useful for understanding the influence of everyday power and politics on the policy process.

Measuring and Assessing the Wealth Influence on the Efficiency of the Health System through the Private Sector

The aim of the paper is to provide an analysis of the dynamics of the public and private health sectors in Romania. Using descriptive statistics, it first investigates whether the public health sector follows the reformation trends suggested by official strategies and reports, and to what extent the private health sector is a viable alternative to the public one, by analysing the demand for private inpatient services. We look into the reduction in the occupancy degree in public hospitals as a means to increase the efficiency of public health expenditures, which represents one way to reform the public health sector. We also find that the increase in the occupancy degree in private hospitals is negatively correlated with the quality of services provided by public hospitals, but positively correlated with population wealth. Increase in the occupancy degree in private hospitals is an indicator of poor quality of services in public hospitals. It can also be explained by increasing expectations and requirements of beneficiaries as a reflection of increase in wealth and of their will to preserve their health capital. Using regression models, the paper then proposes the Wealth-Health Index, a composite indicator to explore the connection between wealth and health and the dynamics of the private health sector. Investment in physical infrastructure and the size of medical staff in the private sector is positively correlated with wealth increase.

Analysis of health administration data to inform health service planning for paediatric palliative care

BackgroundHealth service planning in paediatric palliative care is complex, with the diverse geographical and demographic characteristics adding to the challenge of developing services across different nations. Accurate and reliable data...

PROFILE OF PATIENTS RECEIVING PALLIATIVE HOME CARE IN AN URBAN PRIMARY HEALTH UNIT IN THIRUVANANTHAPURAM - KERALA, INDIA

Background: Community based approach to palliative care considers home based care as the corner stone of palliative care services. To ensure the services available and accessible to all, thrust should be given for a primary health care based approach. However there is an acute shortage of trained manpower. The primary health care physicians need to be trained in effective pain and symptom palliation. We aimed to study the clinical and socio-demographic profile of patients receiving palliative home care which would be helpful for the training of more man power and effective planning in this interdisciplinary endeavor. Methods: Cross sectional study among 345 participants who were registered with the palliative care unit at the Urban Primary Health Care Unit in Thiruvananthapuram, Kerala. Statistical Analysis: The data were entered using Microsoft excel for Windows XP and analyzed using SPSS 16.0 (Statistical Package for Social Sciences; SPSS Inc., Chicago, IL, USA). Results: Mean age was 70.9 years and 56.8% were females. 98% of the patients have care givers and 50% caregivers were elementary educated and 25% caregivers were employed. 51% participants have benefits of pension schemes and others did not receive any kind of financial assistance. 70.7% did not have any kind of insurance coverage. 84.3% participants availed services of public hospitals. Majority had Hypertension (70.4%) followed by diabetes mellitus (49.3%) and dyslipidemia (26.7%) as comorbidities. Conclusions: Contrary to the existing conventional expensive hospital care model, LSG supported home-based palliative care conducted by local primary health care system to certain extend can give comprehensive health care to bed ridden patients and thus improve the quality of life. The interface between institutional care and home care needs more exploration and prospective studies.

Informal Payments for Maternal and Neonatal Health Services in Public Hospitals in Central India

Background: Informal payments are unauthorised ‘unregistered’ out-of-pocket payments, outside the official payment system, for purchase or service meant to be covered/provided by the healthcare system. This study attempts to measure and report the extent and magnitude of informal payments based on the entitlements in Janani-Shishu Suraksha Karyakram (JSSK) in the Indian context. Methods: A cross-sectional study using convenience sampling and a semi-structured interview schedule was conducted among 281 participants in 2016 in 26 JSSK-notifying health facilities from all five divisions of Chhattisgarh. Pregnant women and women who delivered in the previous year, and provided informed consent, were included. After reviewing various definitions, informal payment was operationally defined in the context of JSSK for India as ‘payments made in cash or kind, unregistered or non-reimbursed, made by/on behalf of the beneficiary or someone related thereof, for free and cashless entitlements in a JSSK-listed health facility, to an individual or institutional healthcare provider/staff who provides/arranges for provision of the service’. Results: Of 281 participants, 91.8 per cent reported informal payments across all JSSK entitlements categories. A relative majority of these payments was made at the district hospital (37%), ranging from ₹2 to ₹6,500 (US$0.03–101). Investigations incurred the greatest median amount of informal payments, at, ₹455 (US$7). Informal payments ranged between three and seven times higher than the JSSK price cap in Chhattisgarh. No significant association was found between participant characteristics and informal payments. Conclusion: Further research is required to understand the magnitude and motivation of informal payments made in programmes like JSSK.