公私合作制度对我国发展社会办医的启示

新医改形势下,政府大力鼓励社会办医,其中公私合作制度(PPP)是解决公立医院融资困难,加快公立医院改革与建设的重要路径和尝试.结合PPP在国内外的成功经验,立足我国公立医院发展实际,探讨更好地让社会办医落地的政策建议:一是加强PPP模式的制度建设:将社会办医纳入医保,鼓励医师多点执业;二是完善社会办医补偿机制;三是将社会办医纳入医联体共建.     

DMAIC methodology for achieving public satisfaction with health departments in various districts of Punjab and optimizing CT scan patient load in urban city hospitals

The health care delivery system in Pakistan is in a process of rapid growth, and it consists of public and private sectors. The provincial government is preliminarily responsible for providing health care facilities within its province except in federally administered areas. In Pakistan, there are three tiers of governmental healthcare delivery systems, which comprise government, semi-government, and parastatal organizations. The purpose of this study is to understand the rapid increase in influx of patients in major city hospitals of the Punjab province. The reasons for patient flow towards the major city areas can vary, but our point of focus is mainly on those patients who are prescribed to get a computed tomography (CT) scan done for better diagnosis and early treatment, including but not limited to roadside accident cases. The study targets the define, measure, analyze, improve and control (DMAIC) problem solving approach to assess the potential cause of CT patient flow and the challenges that the health department is facing to cater to such a patient niche and process while minimizing the congestion in city government hospitals. The approach in this study summarizes with numerous quality tools like Voice of Customer (VOC) which is customer feedback, Customer Output Process Input and Supplier (COPIS) processes use for high-level process map to know what your customer value, Approver Resource Member Interested (ARMI) chart which is use to analyze the stakeholders on management of the project, evaluation with the help of fishbone diagram and house of quality, and for process improvement methodology we use the team brainstorming technique and the kaizen 5-why technique. The technique came up with an idea of a public-private partnership (PPP) project—partnership between public agency and private firm, as the health care industry in Punjab province is going through budgetary issues. In a PPP project, the Government will allocate the space to a private firm to build the facility on their own and provide quality service for CT scan diagnosis to the public of Punjab. The study identified the top 10 critical factors that the patients have expected from the government to be provided on priority. The Kaizen process improvement methodology has been adopted to provide the possible solution of government budgetary issues. The set of tools in this study can be adopted by other PPP projects to enhance the project performance.     

医疗机构产权制度改革探讨

探讨医疗机构产权制度的形成;医疗机构产权制度改革的动因;医疗机构产权制度改革的主要形式,以及医疗机构产权制度改革的评价,认为医院改制既有积极效应,又有待解决的问题.     

Proceed with caution: Potential challenges and risks of developing healthcare tourism in Indonesia

ABSTRACT

The Indonesian government is set to take part in the region’s growing healthcare tourism industry. However, Indonesia would need to do much more than just develop world-class hospitals at major tourist destinations to provide a thriving healthcare tourism industry that could attract patients from abroad. Moreover, the amount of resources needed to ensure the success of a healthcare tourism industry attracting foreign patients also raises the question of potential resource allocation diversion, as the country still has a long list of public health issues to address. There is also the potential of intensifying the migration of healthcare professionals from the public to the private sector or from rural to urban areas. Policymakers in Indonesia, and other resource-constrained countries, contemplating the development of healthcare tourism have an ethical obligation to weigh the evidence on potential positive and negative impacts before moving forward.     

The motivations for participation in public–private partnerships for the provision of tuberculosis treatment in South Africa

Abstract

There is increasing interest in public–private partnerships (PPPs) generally, and more specifically for the provision of tuberculosis (TB) treatment, yet little is known about the motivations for such partnerships and the nature of the incentives that are required to achieve a desirable outcome of the partnerships. Using the new institutional economics approach, this study examines the motivations for participation in existing and potential models of PPPs for the provision of TB treatment in South Africa. Fourteen semi-structured interviews were conducted with private providers and government officials. Both current and potential private partners were interviewed. The study found that private providers in existing and potential partnerships appear to have both financial and non-financial motivations for participation in partnership for the provision of TB. For a partnership to be successful, in addition to sufficient motivation, the level of competition between private providers, regulatory framework, and social and political awareness becomes increasingly important.     

Factors associated with the utilization of electronic medical records in the Eastern Region of Ghana

ObjectivesThis study examined the factors associated with the use of Electronic Medical Records (EMR) in public hospitals in the Eastern Region of Ghana.MethodsThree hundred and ninety-six (396) healthcare professionals were surveyed from the various public hospitals in the Eastern Region of Ghana. The participants included physicians, physician assistants, nurses, laboratory technicians, radiologists, pharmacists, record managers, and ICT staff. Frequency and Chi-Square analyses were performed on the data.ResultsThe results showed that approximately 59% (n=212) of health professionals indicated low use of EMR services in their hospitals. Lack of computer competence (p<0.001), poor communication between users (p=0.050), cost of EMR resources and facilities (p<0.001), lack of technical personnel to install and operate EMR technology resources (p<0.001), and lack of EMR software packages (p<0.001) had significant negative relationships with EMR utilization.ConclusionUtilization of EMR services is low among the healthcare professionals in the Eastern Region. Therefore, the Ghana Health Service needs to provide training to their employees and supply the needed resources to encourage and support the hospitals and healthcare workers to increase the utilization of the EMR services that improve healthcare delivery in the Region. To enhance EMR utilization, it will be essential that government supports health facilities who have challenges using EMR. To better understand the issues, a mixed method approach is recommended to be used to study healthcare workers from both private and public healthcare facilities in the Eastern Region of Ghana.     

Assessing the future direction of sustainable development in public hospitals: Time-horizon,path and action

PurposeTo assess the future direction of sustainable development in public hospitals, focusing on their short- versus long-term time horizons, top-down versus bottom-up paths, and intra-organizational versus inter-organizational actions.Design/Methodology/approachThe selection of significant health care organizations was based on judgmental sampling. This study applied an inductive approach. The interviewees were identified according to their knowledge of the future direction of their organizations’ sustainable development.FindingsThe sustainable development of the studied public hospitals is aimed at the synchronization of actions with other hospitals in the public healthcare system. The public hospitals studied differ in their interconnected elements of time (short- versus long-time horizons), paths (top-down versus bottom-up) and specific actions (intra-organizational versus inter-organizational).Research limitations/implications Offers insights into how to assess the direction of sustainable development in public hospitals. We stress the importance of time, path and action in conjunction. Furthermore, this study provides a three-dimensional framework to assess the future direction of sustainable development in organizations as well as in industries. Both the former and latter characteristics are shaped by the elements of time, path and action.Managerial ImplicationsProvides a three-dimensional framework of criteria to assess the direction of sustainable development in organizations. The assessment criteria may be used by organizations to assess the direction of other organizations in their industry. Industry associations or authorities may look into the status and future direction of sustainable development in industries or sectors as a whole. The assessment criteria provide an opportunity and foundation to benchmark against others in the same industry and insights to face pandemic as Covid-19.Originality/ValueFirst study to consider a three-dimensional framework based on time, path and action to assess the future direction of sustainable development in an organization.     

基于分享经济理论的社会办医参与紧密型医共体协同发展研究

目的:社会办医在紧密型医共体建设中仍处于较为模糊的位置,在此背景下分析社会办医与公立医院协同发展需求具有重要意义。方法:本研究以湖北省黄冈市黄州区为例,对紧密型医共体建设下的社会办医发展现状进行分析,结合分享经济理论探究社会办医参与紧密型医共体的作用。结果:社会办医院从医院数量、人力资源、床位配置等方面都出现了萎缩情况,社会办医院的投资者在运营过程中出现了降低投资消耗的现象。结论:基于分享经济理论,将社会办医参与紧密型医共体进行统筹有助于解决公立医院与社会办医院间的目标异质性、缓解社会办医院发展资源薄弱、减少社会环境的不确定性影响等问题。     

高端医疗服务发展的国际经验与启示

高端医疗服务业是健康服务业发展的关键领域,但由于公立医院特需服务不断扩张、社会办医政策存"玻璃门"等原因,我国高端医疗服务业的发展尚处于初期阶段。事实上,高端医疗服务业在部分国家(特别是发达国家)已经初具规模,并在发展基础、运营模式、保障体系等方面积累了比较丰富的经验。本研究介绍了英国、美国、德国、新加坡、澳大利亚和印度发展高端医疗服务业的经验:建立国家安全网医院起兜底作用,实行分层定价和差异化补贴政策,借助商业健康保险,运用公私合作模式,优先发展若干领域。并结合我国实际情况,提出我国发展高端医疗服务业的启示:在确保基本医疗服务的前提下,实行有差别的支付政策;推广商业健康保险,拓展公私合作,确定发展高端医疗的优先领域。     

公私合作模式在我国公立医院投资建设领域中应用的探讨

作者介绍了公私合作（PPP）模式的概念和国外应用的情况。对我国引入公私合作模式投资公立医院的可行性进行了探讨，详细分析并提出了该模式与传统政府投资模式相比，具有提高投资效率和质量、转移风险、降低建造成本、避免短期投资决策、弥补公共财力不足、促进革新、提高建筑质量和维护保养水平的优势，将使政府部门、公立医院、病人及私立投资部门四方共同受益。     

Technical efficiency of healthcare systems in African countries: An application based on data envelopment analysis

AimThis study aimed to measure the healthcare system efficiency of 36 African countries and to compare efficiency levels between countries.MethodData envelopment analysis (DEA) was used to evaluate efficiency. The input variables employed within the scope of DEA consisted of the proportion of total health expenditures in the gross domestic product (HE); the number of physicians (PHY), nurses (NUR) and hospital beds (BN) per 1000 people; the unemployment rate (UN); and the Gini coefficient (Gini). The study's output variables were life expectancy at birth and 1/(infant mortality rate). After DEA, the variables affecting the performance of national healthcare systems were identified using a Tobit regression model.ResultsAccording to DEA results, 21 (58.33%) of 36 African healthcare systems were found to be efficient. Among the efficient countries, Senegal was the country most referenced for inefficient countries. According to the Tobit regression analysis results, the number of nurses per 1000 people and Gini coefficient variables statistically significantly affected the inefficiency of national healthcare systems.ConclusionThis study's results suggest that in order to achieve the same health outcomes, national healthcare systems need to use public and private health resources more effectively and efficiently. By assessing the efficiency of countries’ healthcare systems and health services through international comparison, effectiveness and efficiency can be ensured within these systems.     

To serve or to leave: a question faced by public sector healthcare providers in Pakistan

Background

The availability of properly trained and motivated providers is a prerequisite for provision of easily accessible healthcare. Pakistan has been listed by the World Health Organization in its World Health Report 2006 as one of 57 countries with a critical health workforce deficiency. This study examines the factors associated with the willingness of public sector healthcare providers to leave government service and recommends measures that can be adopted to attract and retain staff in the country’s public healthcare system.

Methods

A stratified, random sampling methodology was adopted to recruit a nationally representative sample of 1,296 public sector healthcare providers, including paramedics, medical doctors, and specialists. A semi-structured questionnaire was used to interview these providers. Logistic regressions measured the association with determinants of their willingness to leave the public health sector for better prospects elsewhere.

Results

A third of all healthcare providers who were interviewed were of the view that, provided the opportunity, they would leave government service. The odds of willingness to leave service were highest among providers from the region of Azad Jammu and Kashmir (adjusted odds ratio [AOR] = 4.33; 95% CI, 2.49–7.54) followed by the province of Balochistan (AOR = 4.21; 95% CI, 2.41–7.33), and the region of Gilgit Baltistan (AOR = 3.34; 95% CI, 1.67–6.67). Providers who expressed dissatisfaction in the manner their performance was evaluated and those who were dissatisfied with the current salary, each had higher odds of considering leaving government service (AOR = 1.67; 95% CI, 1.18–2.40 and AOR = 2.03; 95% CI, 1.47–2.81, respectively). Providers who reported experiencing interference in their work by influential politicians of the area were more inclined to leave (AOR = 1.44; 95% CI, 1.05–1.98).

Conclusion

This study clearly highlights the need to implement more focused strategies in the public healthcare system in Pakistan in order to build sufficient staff motivation and prevent providers from leaving government service. In order to improve coverage of healthcare services in Pakistan, the government will have to introduce more focused interventions to attract and retain healthcare providers, especially in remote and rural areas of the country.

     

公立医院公私合作面临的投融资政策困境及其出路

本文回顾了公立医院PPP适用的投融资政策和主要实践模式,分析了公立医院PPP面临的如何合理确定PPP设备设施项目,评估公立医院投资资产价值,让合作双方获得合理回报等投融资政策困境,在此基础上提出了公立医院摆脱困境的出路,包括加强合作项目前期可行性论证,贯彻区域卫生规划和医疗机构设置规划要求;加强公立医院PPP项目有形资产和无形资产的评估,防止国有资产流失;加强公立医院PPP财务信息披露,维护公立医院公益性和职工合法权益。     

Comparison of services of public, private and foreign hospitals from the perspective of Bangladeshi patients

Despite recent developments in the Bangladesh healthcare sector, there is still great concern about the quality of healthcare services in the country. This study compared the quality of healthcare services by different types of institutions, i.e. public and private hospitals, from the perspective of Bangladeshi patients to identify the relevant areas for development. A survey was conducted among Bangladeshi citizens who were in-patients in public or private hospitals in Dhaka city or in hospitals abroad within the last one year. About 400 exit-interviews were conducted using a structured questionnaire that addressed the probable factors of the quality of healthcare services in 5-point interval scales. The results gave an overview of the perspectives of Bangladeshi patients on the quality of service in three types of hospitals. The quality of service in private hospitals scored higher than that in public hospitals for nursing care, tangible hospital matters, i.e. cleanliness, supply of utilities, and availability of drugs. The overall quality of service was better in the foreign hospitals compared to that in the private hospitals in Bangladesh in all factors, even the 'perceived cost' factor. This paper provides insights into the specific factors of the quality of hospital services that need to be addressed to meet the needs of Bangladeshi patients.     

Healthcare waste management in Uganda: management and generation rates in public and private hospitals in Kampala

Aim

The aim of this study was to assess the management, characteristics and generation of healthcare waste (HCW) in public and private hospitals in Kampala City, Uganda.

Methods

We employed mainly qualitative methods through the use of a waste inventory, observations, document review and key informant interviews. The HCW inventory was done to determine the rate of generation of infectious waste and general waste in one public and one private hospital. Observations using an observation checklist were done to establish HCW management practices in three hospitals.

Results

The average generation rate for infectious waste from Nsambya hospital (private hospital) was 0.23?kg/patient/day as compared to 0.25?kg/patient/day for Mulago (public hospital). Generation is influenced by type and state of sickness/condition, the level or seriousness of the sickness, the number of people nursing the patient, the visitation rate/number of people visiting a patient and the items they carry to the ward. These factors can be used by health facility managers to minimize the quantities of healthcare waste generated.

Conclusion

The study found no evidence that either public or private ownership is a decisive factor for the successful management of healthcare waste. However, contracting of healthcare waste management services to a private party as was seen in the public hospital had resulted in improved services and this strategy should also be tried in private hospitals.     

Eficiencia técnica de los hospitales públicos y de las empresas públicas hospitalarias de Andalucía

ObjectiveTo assess the technical efficiency of traditional public hospitals without their own legal identity and subject to administrative law, and that of public enterprise hospitals, with their own legal identities and partly governed by private law, all of them belonging to the taxypayer-funded health system of Andalusia during the period 2005 -2008.MethodsThe study included the 32 publicly-owned hospitals in Andalusia during the period 2005-2008. The method consisted of two stages. In the first stage, the indices of technical efficiency of the hospitals were calculated using Data Envelopment Analysis, and the change in total factor productivity was estimated using the Malmquist index. The results were compared according to perceived quality, and a sensitivity analysis was conducted through an auxiliary model and bootstrapping. In the second stage, a bivariate analysis was performed between hospital efficiency and organization type.ResultsPublic enterprises were more efficient than traditional hospitals (on average by over 10%) in each of the study years. Nevertheless, a process of convergence was observed between the two types of organizations because, while the efficiency of traditional hospitals increased slightly (by 0.50%) over the study period, the performance of public enterprises declined by over 2%.DiscussionThe possible reasons for the greater efficiency of public enterprises include their greater budgetary and employment flexibility. However, the convergence process observed points to a process of mutual learning that is not necessarily efficient.     

实现人人享有基本医疗卫生服务的关键问题探讨

探讨了基本医疗卫生服务的内涵,提出了基本人力、基本设施、基本药物、基本技术和基本服务规程等五个要素。另外,还介绍了建立卫生体制的基本共识和经验,并对我国建立基本医疗卫生制度提出了建议：增加公共筹资,控制个人支付比例;利用和发挥公立服务机构的作用;促进各类卫生筹资方式融合;促进财政投入政策和价格政策配合;公共投入优先支持和提供预防服务和基层卫生组织提供的初级诊疗服务;发展公立与私立机构、政府保障与商业健康保险之间的合作互补关系;构建精简统一效能的行政管理体制。     

Patient satisfaction, feasibility and reliability of satisfaction questionnaire among patients with pulmonary tuberculosis in urban Uganda: a cross-sectional study

Background

A comprehensive understanding of the barriers to and facilitators of poor tuberculosis (TB) treatment outcome is still lacking; posing a major obstacle to finding effective solutions. Assessment of patient satisfaction in TB programs would contribute to the understanding of gaps in healthcare delivery and the specific needs of individual patients. However, tools for assessing patient satisfaction are lacking.

Objective

To establish patient satisfaction, the feasibility and reliability of a questionnaire for healthcare service satisfaction and a questionnaire for satisfaction with information received about TB medicines among adult TB patients attending public and private program clinics in Kampala, Uganda.

Methods

In a cross-sectional study, we recruited 133 patients of known HIV status and confirmed pulmonary TB receiving care at the public and private hospitals in Kampala, Uganda. Participants were enrolled based on length of TB treatment as follows: starting therapy, completed two months of therapy, and completed eight months of therapy. A translated and standardized 13-item patient healthcare service satisfaction questionnaire (PS-13) and the Satisfaction with Information about Medicines Scale (SIMS) tool were administered by trained interviewers. Factor analysis was used to systematically group the PS-13 questionnaire into three factors of technical quality of care, responsiveness to patient preference, and management of patient preference satisfaction subscales. The SIMS tool was analyzed with two subscales of information about the action and usage of medication and the potential problems with medication.

Results

Of the 133 participants, 35% (46/133) were starting, 33% (44/133) had completed two months, and 32% (43/133) had completed eight months of TB therapy. The male to female and public to private hospital ratios in the study population were 1:1. The PS-13 and the SIMS tools were highly acceptable and easily administered. Both scales and the subscales demonstrated acceptable internal consistency with Cronbach's alpha above 0.70. Patients that were enrolled at the public hospital had relatively lower PS-13 satisfaction scores (0.48 (95% confidence interval (CI), 0.42 - 0.52)), (0.86 (95% CI, 0.81 - 0.90)) for technical quality of care and responsiveness to patient preferences, respectively compared to patients that were enrolled at the private hospital. For potential problems SIMS subscale, male patients that were recruited at the public hospital had relatively lower satisfaction scores (0.58 (95% CI, 0.40 - 0.86)) compared to female patients after adjusting for other factors. Similarly, patients that had completed eight months of TB treatment had relatively higher satisfaction scores (1.23 (95% CI, 1.06 - 1.44)) for action and usage SIMS subscale, and higher satisfaction scores (1.09 (95% CI, 1.03 - 1.16)) for management of patient preference (PS-13 satisfaction subscale) compared to patients that were starting treatment, respectively.

Conclusion

The study provides preliminary evidence that the PS-13 service satisfaction and the SIMS tools are reliable measures of patient satisfaction in TB programs. Satisfaction score findings suggest differences in patient satisfaction levels between public and private hospitals; between patients starting and those completing TB therapy.     

Public-private partnerships and efficiency in public procurement of primary healthcare infrastructure: a qualitative research in the NHS UK

Aim

There is growing interest in the contribution of public-private partnerships (PPPs) bridging the shortage of financial resources and management expertise in developing public healthcare infrastructure. However, few studies have evidenced PPPs’ ability in increasing efficiency in public procurement of primary healthcare infrastructure. The aim of this study was to assess to what extent PPPs would increase efficiency in public procurement of primary healthcare facilities.

Subject and methods

A qualitative analysis, adopting a realistic research evaluation method, used data collected from a purposive sample of public (n?=?23) and private sector staff (n?=?2) directly involved in the UK National Health Service Local Improvement Finance Trust (LIFT).

Results

We find a positive association of LIFT helping to bridge public sector capital shortages for developing primary care surgeries. LIFT is negatively associated with inefficient procurement because it borrows finance from private banks, leaving public agencies paying high interest rates. The study shows that some contextual factors and mechanisms in LIFT play a major part in obstructing public staff from increasing procurement efficiency.

Conclusion

PPP’s ability to increase efficiency may be determined by contextual factors and mechanisms that restrict discretion over critical decisions by frontline public sector staff. Developing their capacity in monitoring PPP activities may make partnerships more efficient.