Types Of Health Care Services Research Articles

The primary health care services in Libya

In this short article I am going to display the current situation of Primary Health Care services in my country Libya and talk about some of the pitfalls that need to be fixed in order to improve the Primary Health Care outcome as it is the core of all other health services. In order to give a true definition to primary care we need to describe the different types of health care services we deliver to patients, in addition, we must identify who are the primary care providers whether they were physicians or non physicians health care providers.

Healthcare managers’ perception of economies of scale

PurposeThe purpose of this paper is to explore how healthcare managers perceive economies of scale and the underlying mechanisms for how scale/size affects performance.Design/methodology/approachData were collected in 20 in-depth interviews with healthcare professionals from 13 healthcare delivery organizations and from a public authority that finances and contracts healthcare services. Data were coded and analysed using content analysis.FindingsThe study concludes that the impact of scale on performance is perceived by healthcare professionals to be different for different types of healthcare services: For surgery, significant scale effects related to spreading of fixed cost, the experience curve, and potential for process improvement. For inpatient care, moderate scale effects related to spreading of fixed costs and costs of doctors on on-call duty. For outpatient care, small or no scale effects.Research limitations/implicationsThe small sample of interviewees from a single geographical region and healthcare system limits the applicability of the findings.Originality/valueThe paper provides insights into how healthcare managers experience scale effects and how they consider economies of scale when planning hospital configuration. Also, past studies of economies of scale in hospitals proffer mixed results and the findings in this paper indicate a possible explanation for this inconclusiveness, i.e. differences in service mix between different hospitals.

Dental Care Presents The Highest Level Of Financial Barriers, Compared To Other Types Of Health Care Services

The Affordable Care Act is improving access to and the affordability of a wide range of health care services. While dental care for children is part of the law's essential health benefits and state Medicaid programs must cover it, coverage of dental care for adults is not guaranteed. As a result, even with the recent health insurance expansion, many Americans face financial barriers to receiving dental care that lead to unmet oral health needs. Using data from the 2014 National Health Interview Survey, we analyzed financial barriers to a wide range of health care services. We found that irrespective of age, income level, and type of insurance, more people reported financial barriers to receiving dental care, compared to any other type of health care. We discuss policy options to address financial barriers to dental care, particularly for adults.

Time to rethink dental “insurance”

Time to rethink dental “insurance”

George Alexander McDonald

<h3>Abstract</h3> <h3>Background</h3> Low back pain (LBP) is prevalent, costly, and a common reason for a visit to a primary care provider (PCP). Guidelines recommend a stepped approach to management. <h3>Objective</h3>...

Doctor-Patient Relationship Between Individuals With Fibromyalgia and Rheumatologists in Public and Private Health Care in Mexico.

The aim of this article was to describe and analyze the doctor-patient relationship between fibromyalgia patients and rheumatologists in public and private health care contexts within the Mexican health care system. This medical anthropological study drew on hospital ethnography and patients' illness narratives, as well as the experiences of rheumatologists from both types of health care services. The findings show how each type of medical care subsystem shape different relationships between patients and doctors. Patient stigmatization, overt rejection, and denial of the disease's existence were identified. In this doctor-patient-with-fibromyalgia relationship, there are difficult encounters, rather than difficult patients. These encounters are more fluid in private consultations compared with public hospitals. The doctor-centered health care model is prevalent in public institutions. In the private sector, we find the characteristics of the patient-centered model coexisting with the traditional physician-centered approach.

Relationship between morale and motivation in teamwork environments: A research in the health sector

Hospitals in which wide variety of types of health care services are provided require the work of many professionals working together in a harmony. However, it is possible to provide the harmony by teamwork. For the quality health care, it is a must to keep the morale-motivation at high level of the hospital employees who serve 24-hour continuously. Teamwork, same in all other businesses, is considered as a factor that affects the morale and motivation of hospital employees in a positive manner.The purpose of this research is to determine the relationship between teamwork and morale-motivation levels of employees at surgery section of Pamukkale University Hospital in the province of Denizli. For this purpose, hypothesis of the research are determined by considering the theoretical discussions in the literature and research findings. Research hypothesis were tested by using the data obtained from the survey method with 58 employees of Pamukkale University Hospital in the province of Denizli. Descriptive statistical methods, correlation and regression analysis were used to analyze the data. Statistically significant relationship between some demographic characteristics of employees and the teamwork environment and morale-motivation level was found in the results. Relation between the teamwork environment and morale-motivation level was measured by correlation regression analysis, and no statistical significance was observed between two concepts. However, a statistical significance was found between the support for sub-dimension of innovation within the teamwork environment-team vision dimension and morale-motivation level.

Novel Measure of Opioid Dose and Costs of Care for Diabetes Mellitus: Opioid Dose and Health Care Costs.

Diabetes mellitus (DM) has well known costly complications but we hypothesized that costs of care for chronic pain treated with opioid analgesic (OA) medications would also be substantial. In a statewide, privately insured cohort of 29,033 adults aged 18 to 64years with DM and noncancer pain who filled OA prescription(s) from 2008 to 2012, our outcomes were costs for specific health care services and total costs per 6-month intervals after the first filled OA prescription. Average daily OA dose (4 categories) and total dose (quartiles) in morphine-equivalent milligrams were calculated per 6-month interval after the first OA prescription and combined into a novel OA dose measure. Associations of OA measures with costs of care (n=126,854 6-month intervals) were examined using generalized estimating equations adjusted for clinical conditions, psychotherapeutic drugs, and DM treatment. Incremental costs for each type of health care service and total cost of care increased progressively with average daily and total OA dose versus no OAs. The combined OA measure identified the highest incremental total costs per 6-month interval that were increased by $8,389 for 50- to 99-mg average daily dose plus >900mg total dose and, by $9,181 and $9,958 respectively, for ≥100mg average daily dose plus 301- to 900-mg or >900mg total dose. In this statewide DM cohort, total health care costs per 6-month interval increased progressively with higher average daily OA dose and with total OA dose but the greatest increases of >$8,000 were distinguished by combinations of higher average daily and total OA doses. The higher costs of care for opioid-treated patients appeared for all types of services and likely reflects multiple factors including morbidity from the underlying cause of pain, care and complications related to opioid use, and poorer control of diabetes as found in other studies.

A study on corporate social responsibility for the health care of the elderly by private health care providers of Mangalore city: A health systems research

Introduction: Private sector is the largest provider of health care services in India. But it is expensive. Self-driven corporate social responsibility (CSR) providing free or subsidised services will be useful to the elderly. There are no published data reporting the pattern or types of health care services provided to elderly by the private health care sector of India through CSR initiative. So this study was undertaken. Objectives: To know the pattern (Subsidised/free) and type (Medical, Surgical etc.,) of Health care services received by the elderly people as a part of CSR. Materials and Methods: A questionnaire based cross-sectional study conducted among all private health care providers of Mangalore city. List of all private health care providers which included various types of hospitals (corporate hospitals, multispecialty hospitals etc...) were obtained from the local chapter of Indian Medical Association. The data was collected form hospitals fulfi lling the study criteria. The data was analysed using SPSS software for windows, version 16.0. Results are presented as frequencies and proportions in appropriate tables. Results: Totally 24 hospitals had participated in this study. Most (n = 16, 66.7%) reported providing some free or subsidised services. Among them only 7 (29.2%) were providing free services like: Health check-up camps, subsidised medical and surgical treatment. However most of them did not respond to the “criteria for selecting of the elderly for such free services.” Conclusion: Most of the private hospitals in Mangalore do not provide free or subsidised health care services to the elderly through a self-driven CSR initiative.

Differences in health care utilisation between elderly from ethnic minorities and ethnic Dutch elderly.

IntroductionIn the Netherlands, as in other Western countries, ethnic minority elderly are more often in poorer health than the indigenous population. The expectation is that this health disadvantage results in more frequent use of health care services.MethodsWe studied registered data on the proportion of health care receivers, frequency of use, and health care costs collected by a major Dutch health insurance company in 2010. Data from 10,316 Turkish, 14,490 Moroccan, 8,619 Surinamese, and 1,064 Moluccan adults aged 55 years and older were compared with data from a sample of 33,725 ethnic Dutch older adults.ResultsUnadjusted and adjusted (for age and gender) analyses showed the following. Moluccans had lower usage levels for all types of health care services. Use of primary health care facilities was higher for Turks, Moroccans, and Surinamese compared with the ethnic Dutch, with the exception that physical therapy was less frequently used among the Turks and Moroccans. Use of hospital care was lower, except for the Surinamese, who had a similar level of usage to that of the ethnic Dutch.ConclusionsThe health disadvantage previously observed within most ethnic minority elderly populations does not result in an overall more frequent use of health care services. Further research is needed for the interpretation of the ethnic variations in health care use as potentially inequitable, by taking medical need, patient treatment preferences, and treatment adherence into account.

Utilization and Satisfaction With Major Health Care Services Amongst the Slum Dwellers of Dhaka City

The main objectives of this study are to find out the extent of utilization of health care services and satisfaction with major types of health care services amongst the slum dwellers of Dhaka city. This descriptive cross sectional study was conducted for a period of 6 months starting from July 2013 to December 2013. A house to house survey was conducted and a total of 1029 slum dwellers were enrolled for the study. Purposive sampling technique was used in the study. Data were collected through pre-tested and semi-structured questionnaire. The study showed that pharmacy quacks 476 (46.3%) were the most dominant source of health care for the slum dwellers in Dhaka city. Medical College Hospital 238 (23.1%) was the second most dominant source of health care in slum areas. The other main sources were government hospitals, private practitioners respectively. Most of the respondents 429 (41.69%) were satisfied with the services of pharmacy quack and 268 (26.04%) respondents were satisfied with the services of medical college hospital. Among rest, 132 (12.82%) were satisfied with government hospitals and 121(11.75%) were satisfied with private practitioners. Majority of the respondents selected pharmacy quack to receive health care services due to affordability 127 (24.6%) and feasibility 107 (20.7%). In the study, 51 (16.1%) respondents selected medical college hospital for availability of facilities, effective treatment, good doctor-patient communication and better investigation facilities. According to the respondents 291 (38.1%) the main barrier to access health care was treatment cost. Highly significant association was found between educational status of the slum dwellers and selection of pharmacy quack (p=0.000) and medical college hospital (p=0.000). Significant association was also found between occupational status and selection of pharmacy quack (0.003) and medical college hospital (0.011). Highly significant association was found between monthly income and selection of medical college hospital (p=0.000). Pharmacy quack was the most dominant healthcare service in slum area. As persons running pharmacy quacks often provide poor quality of healthcare services, they need continuous training and back-up supports to improve their quality of services and to strengthen the overall healthcare system in Bangladesh.&#x0D; JCMCTA 2014 ; 25 (2) : 7-13

What factors are associated with the provision of assistive technologies: the Bogotá D.C. case

Aim: To examine what demographics and clinical factors are associated with the provision of assistive technology (AT) devices in a low-income country. Method: Retrospective cross-sectional exploratory study design including 15 of the 20 localities across Bogotá D.C., Colombia, a city with 6 776 009 inhabitants. Results: The type of AT device provided was significantly dependent (p < 0.001) on the client’s diagnosis, impairment, age, and socio-economic strata, whether the client has a care giver, the geographical zone in which the client lives, the year of the AT provision, and the total number of AT delivered. In contrast, the client’s gender (p > 0.05) and the client’s affiliated type of healthcare service had no effect. In addition to that, the client’s age, the client’s socio-economic strata, the number of AT devices provided to the client, and the diagnostic type were the factors with the strongest level of association with the type of AT device provided. Conclusions: Our research showed that the provision of AT in Bogotá D.C. prioritizes both people who are at the highest levels of vulnerability, and as many people as possible with the budget. That is, the low socio-economic strata, younger and older people, and the provision of at least one AT device.Implications for RehabilitationProvision of AT is intended for equal opportunities for the social participation of people with a disability. Also, people with disabilities have the right to access AT regardless of the type of limitation, gender, race, age or region where they live.Research regarding AT in developing countries is scarce; thus, there is a need to conduct studies in such contexts. This study provides scientific evidence to support the development of models, approaches and strategies of AT provision in low-income countries where resources for rehabilitation are scarce.

Pilot-testing service-based planning for health care in rural Zambia.

BackgroundHuman resources for health (HRH) planning in Zambia, as in other countries, is often done by comparing current HRH numbers with established posts, without considering whether population health needs are being met. Service-based HRH planning compares the number and type of services required by populations, given their needs, with the capacity of existing HRH to perform those services. The objective of the study was to demonstrate the effectiveness of service-based HRH planning through its adaptation in two rural Zambian districts, Gwembe and Chibombo.MethodsThe health conditions causing the greatest mortality and morbidity in each district were identified using administrative data and consultations with community health committees and health workers. The number and type of health care services required to address these conditions were estimated based on their population sizes, incidence and prevalence of each condition, and desired levels of service. The capacity of each district’s health workers to provide these services was estimated using a survey of health workers (n=44) that assessed the availability of their specific competencies.ResultsThe primary health conditions identified in the two districts were HIV/AIDS in Gwembe and malaria in Chibombo. Although the competencies of the existing health workforces in these two mostly aligned with these conditions, some substantial gaps were found between the services the workforce can provide and the services their populations need. The largest gaps identified in both districts were: performing laboratory testing and interpreting results, performing diagnostic imaging and interpreting results, taking and interpreting a patient’s medical history, performing a physical examination, identifying and diagnosing the illness in question, and assessing eligibility for antiretroviral treatment.ConclusionsAlthough active, productive, and competent, health workers in these districts are too few to meet the leading health care needs of their populations. Given the specific competencies most lacking, on-site training of existing health workers to develop these competencies may be the best approach to addressing the identified gaps. Continued use of the service-based approach in Zambia will enhance the country’s ability to align the training, management, and deployment of its health workforce to meet the needs of its people.

Cost and technical efficiency of physician practices: a stochastic frontier approach using panel data

This is the first study to use stochastic frontier analysis to estimate both the technical and cost efficiency of physician practices. The analysis is based on panel data from 3,126 physician practices for the years 2006 through 2008. We specified the technical and cost frontiers as translog function, using the one-step approach of Battese and Coelli to detect factors that influence the efficiency of general practitioners and specialists. Variables that were not analyzed previously in this context (e.g., the degree of practice specialization) and a range of control variables such as a patients' case-mix were included in the estimation. Our results suggest that it is important to investigate both technical and cost efficiency, as results may depend on the type of efficiency analyzed. For example, the technical efficiency of group practices was significantly higher than that of solo practices, whereas the results for cost efficiency differed. This may be due to indivisibilities in expensive technical equipment, which can lead to different types of health care services being provided by different practice types (i.e., with group practices using more expensive inputs, leading to higher costs per case despite these practices being technically more efficient). Other practice characteristics such as participation in disease management programs show the same impact throughout both cost and technical efficiency: participation in disease management programs led to an increase in both, technical and cost efficiency, and may also have had positive effects on the quality of care. Future studies should take quality-related issues into account.

P.7.7 Health care services received by patients with Duchenne/Becker muscular dystrophy (DBMD): Data from the Muscular Dystrophy Surveillance, Tracking and Research Network (MD STARnet)

Anecdotal reports from families and care providers suggest a wide variation in services received by patients with DBMD. To document the type of health care services received by patients with DBMD. MD STARnet is a multistate collaboration that conducts population based surveillance for individuals with DBMD and interviews and surveys with their care givers. Telephone interviews were conducted between April 2007 and March 2012. In addition to demographic and clinical information, the interview included questions about the type of health care provider seen [primary care, neuromuscular, orthopedist, pulmonologist, cardiologist, physical therapist (PT), occupational therapist (OT), speech therapist (ST), and other] and type of services received (respiratory, dietary, mental health, social work, pastoral, pain management and case management) over the previous 12months. Frequencies among states were compared with Chi square tests. Statistical significance was set at <i>p</i><0.05. Two hundred and ninety-six care givers (66%) of those contactable, completed the interview. Care givers (%) reported seeing these providers: primary care (88%), neuromuscular (87%), cardiologist (71%), pulmonologist (54%), orthopedist (33%), PT (69%), OT (42%), ST (20%), other (20%). Services received included case management (42%), respiratory (27%), social work (25%), dietary (22%), pastoral (16%), mental health (15%) and pain management (5%). There were significant differences among states in regards to the primary care, cardiac, pulmonary, orthopedic, physical and occupational therapy providers seen and dietary and case management services received. This study supports and provides a quantitative assessment relative to the anecdotal reports of variation in health care services received by patients with DBMD. Whether these differences affect outcomes needs to be determined.

Alcohol consumption, smoking and overweight as a burden for health care services utilization: a cross-sectional study in Estonia.

BackgroundAlcohol consumption, smoking and weight problems are common risk factors for different health problems. We examine how these risk factors are associated with the use of health care services.MethodsData for 6500 individuals in the 25–64 age group came from three cross-sectional postal surveys conducted in 2004, 2006, and 2008 in Estonia. The effect of alcohol consumption, smoking and weight problems on the use of primary and specialist care services, hospitalizations and ambulance calls was analysed separately for men and women by using binary logistic regression.ResultsOverweight and/or obesity were strongly related to the use of primary care and out-patient specialist services for both genders, and to hospitalizations and ambulance calls for women. Current smoking was related to ambulance calls for both genders, whereas smoking in the past was related to the use of primary care and specialist services among men and to hospitalizations among women. Beer drinking was negatively associated with all types of health care services and similar association was found between wine drinking and hospitalizations. Wine drinking was positively related to specialist visits. The frequent drinking of strong alcohol led to an increased risk for ambulance calls. Drinking light alcoholic drinks was positively associated with all types of health care services (except ambulance calls) among men and with the use of specialist services among women.ConclusionsOverweight and smoking had the largest impact on health care utilization in Estonia. Considering the high prevalence of these behavioural risk factors, health policies should prioritize preventive programs that promote healthy lifestyles in order to decrease the disease burden and to reduce health care costs.

Caring for Kids New to Canada: Part II

1St Michael’s Hospital, Toronto; 2Children’s Hospital of Eastern Ontario, Ottawa, Ontario Correspondence: Dr Tony Barozzino, St Michael’s Hospital, 61 Queen Street East, 2nd Floor, Toronto, Ontario M5C 2T2. Telephone 416-867-3655, fax 416-867-3736, e-mail barozzinot@smh.ca Accepted for publication June 10, 2013 In the April 2013 issue of Pediatrics & Child Health, we outlined some of the intricacies and challenges facing individuals who provide clinical care to children and youth new to Canada (1). With approximately 50,000 children and youth younger than 15 years of age immigrating to Canada annually (2), not to mention the children born in Canada to immigrant/refugee families within their first decade of living in this country, the importance of understanding these intricacies and challenges becomes even more acute. We highlighted the need to understand both the official definitions of status, or lack thereof, for families and children new to Canada (3) (which can have implications for the type of health care services that individuals may or may not qualify for) as well as the unique backgrounds, cultures, migration stories, belief/ support systems, positive/negative experiences and health perceptions that can greatly impact each child’s physical and mental health and well-being. In our previous commentary, we also briefly touched on the importance of migration process factors (4), immigrant-specific factors (eg, the ‘healthy immigrant effect’, ‘resettlement stress’ and ‘convergence effect’, among others) (5-7), and the social determinants of health (8) (Box 1) including the disproportionate role that they have in the health of children and youth new to Canada. As stated in a previous commentary (9): Anyone who has worked with an immigrant child and family, be it in an office, emergency room, home visit, school meeting, or elsewhere, can relate to the sense of frustration at knowing or at least feeling that there are barriers and challenges that we could do a better job of alleviating.

Women Veterans’ Healthcare Delivery Preferences and Use by Military Service Era: Findings from the National Survey of Women Veterans

ABSTRACTBACKGROUNDThe number of women Veterans (WVs) utilizing the Veterans Health Administration (VA) has doubled over the past decade, heightening the importance of understanding their healthcare delivery preferences and utilization patterns. Other studies have identified healthcare issues and behaviors of WVs in specific military service eras (e.g., Vietnam), but delivery preferences and utilization have not been examined within and across eras on a population basis.OBJECTIVETo identify healthcare delivery preferences and healthcare use of WVs by military service era to inform program design and patient-centeredness.DESIGN AND PARTICIPANTSCross-sectional 2008–2009 survey of a nationally representative sample of 3,611 WVs, weighted to the population.MAIN MEASURESHealthcare delivery preferences measured as importance of selected healthcare features; types of healthcare services and number of visits used; use of VA or non-VA; all by military service era.KEY RESULTSMilitary service era differences were present in types of healthcare used, with World War II and Korea era WVs using more specialty care, and Vietnam era-to-present WVs using more women’s health and mental health care. Operations Enduring Freedom, Iraqi Freedom, New Dawn (OEF/OIF/OND) WVs made more healthcare visits than WVs of earlier military eras. The greatest healthcare delivery concerns were location convenience for Vietnam and earlier WVs, and cost for Gulf War 1 and OEF/OIF/OND WVs. Co-located gynecology with general healthcare was also rated important by a sizable proportion of WVs from all military service eras.CONCLUSIONSOur findings point to the importance of ensuring access to specialty services closer to home for WVs, which may require technology-supported care. Younger WVs’ higher mental health care use reinforces the need for integration and coordination of primary care, reproductive health and mental health care.

The utilization and perceived usefulness of health care and other support services by people exposed to traumatic events related to the war in the Balkans

To explore which health care and other support services people exposed to traumatic events related to the war use, how helpful they perceive them in the course of their post-war adaptation and whether utilization and perceived usefulness depend on the mental health status of participants. A community sample of 3304 adults exposed to at least one war-related traumatic event was randomly selected in different regions in the former Yugoslavia. A specifically designed instrument, the Matrix for the Assessment of Community and Healthcare Services, was used to record service utilization and their perceived usefulness. The mental health status of participants was assessed using the Mini International Neuropsychiatric Interview. Primary health care was the most frequently used type of service (80.5%). Services providing help with leisure activities, social support and social contacts were perceived as most helpful. Participants with current post-traumatic stress disorder used all types of health care services and employment support services significantly more often than participants without mental disorders and participants with other mental disorders. They were more satisfied with primary health care services than participants without mental disorders and less satisfied with financial and material support services as compared to participants with other mental disorders. The frequency of utilization of different types of services varies greatly in war affected communities. Medical services are widely used and therefore have a central role in the care provision following a war. Services providing help with leisure activities and social support are most appreciated and may be more widely established.

하이브리드 앱을 이용한 모바일 헬스케어 시스템 구현에 관한 연구

Mobile Healthcare is a new type of health care services for managing health and life irrespective of time and space by uniting IT and BT. For this service bio-signal measurement using WBAN, and data analysis and monitoring technologies based on mobile devices are essential. Generally, however, mobile application has low compatibility because of the features of mobile platform, we have to redevelop it to support the corresponding platform. In this paper we introduce a Mobile Healthcare System which can function as gateway and monitoring based on hybrid app to create ubiquitous healthcare monitoring system compatible with various mobile devices by overcoming the difference of platforms. The proposed system consists of sensor composition part, monitoring composition part, and server composition part.