江苏省常州市区域医疗机构服务协同案例分析

目的:分析常州市区域医疗机构服务协同的背景、主要做法和实施效果,总结典型经验,为推进整合型医疗卫生服务体系建设提供借鉴和参考。方法:运用定性访谈方法收集资料,基于管理协同理论对资料进行分析。结果:常州市通过市级层面统筹建设医疗联合体,建立信息共享平台,推动医联体内部资源整合,建立问题反馈机制等措施初步实现了区域医疗机构服务协同。结论:市政府制定政策统筹推进、促进信息互联互通和医联体内部资源整合有力促进了区域医疗机构服务协同,但仍存在协同程度不紧密,利益分配机制不完善等问题,建议扩大紧密型区域医疗服务协同实施范围,进一步完善利益分配政策。     

Young adults' healthcare utilisation and healthcare needs: Perceptions and experiences of healthcare providers

BackgroundHealth care in many countries entails long waiting times. Avoidable healthcare visits by young adults have been identified as one probable cause.ObjectiveThe aim of this study was to explore healthcare providers'' experiences and opinions about young adults'' healthcare utilisation in the first line of care.MethodThis study used latent qualitative conventional content analysis with focus groups. Four healthcare units participated: two primary healthcare centres and two emergency departments. This study included 36 participants, with 4–7 participants in each group, and a total of 21 registered nurses and 15 doctors. All interviews followed an interview guide.ResultsData were divided into eight categories, which all contained the implicit theme of distribution of responsibility between the healthcare provider and the healthcare user. Young adult healthcare consumers were considered to be highly influenced by external resources, often greatly concerned with small/vague symptoms they had difficulty explaining and unable to wait with. The healthcare provider''s role was much perceived as being part of a healthcare structure—a large organisation with multiple units—and having to meet different priorities while also considering ethical dilemmas, though feeling supported by experience.ConclusionHealthcare personnel view young adults as transferring too much of the responsibility of staying healthy to the healthcare system. The results of this study show that the discussion of young adults unnecessarily seeking health care includes an underlying discussion of scarcity of resources.Patient or Public ContributionThe conduct of this study is based on interviews with young adult patients about their experiences of seeking healthcare.     

医疗费用控制约束下医疗卫生资源配置绩效评价研究

目的:评价医疗费用控制约束下2004—2015年中国医疗卫生资源配置绩效。方法:基于医疗费用控制约束构建投入产出绩效评价指标体系,运用非期望产出的SBM模型对医疗卫生资源配置效率水平进行测度。结果:全国和区域层面按非期望产出的SBM模型测算的医疗卫生资源配置效率均显著低于传统CCR模型;全国和区域层面非期望产出冗余率和期望产出不足率远大于卫生资源投入冗余率;区域内部各省份医疗卫生资源配置效率损失的原因不尽相同。结论:传统DEA模型高估了中国卫生资源配置的绩效,且对其变化特征敏感性较弱;非期望产出冗余和期望产出不足是中国卫生资源配置绩效损失的主要原因。应建立"投入—期望产出—非期望产出"一体化的医疗卫生资源配置绩效评价指标体系,开发与之契合的评价技术;并建立医疗卫生资源配置绩效考核与评价、监督与反馈机制,健全区域医疗卫生规划政策内涵。     

Austeridad y privatización sanitaria en época de crisis: ¿existen diferencias entre las comunidades autónomas?

ObjectiveTo analyse the differences between autonomous communities in Spain according to their policies of austerity and healthcare privatization during the economic crisis.MethodsChanges in the application of legal reforms, healthcare privatization and healthcare financing/resources in the autonomous communities were analysed, and a summary indicator of each dimension was constructed.ResultsThe Basque Country showed the clearest behaviour towards a weak policy of austerity and privatization, as opposed to La Rioja, Madrid, and the Balearic Islands.ConclusionsThe three classifications will enable analysis of the mediating effect of policies of austerity and privatization in the relationship between the economic crisis and health in the Spanish context.     

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.     

Policy scorecard for gender mainstreaming: gender equity in health policy

Objectives : To examine whether gender mainstreaming for women's health is included in national and state health policies. Methods : A policy analysis tool (Policy Scorecard) was developed and then applied to Australia's National Health Priority Areas as well as policies of three Australian States. Results : Despite Australia's leadership in women's health policy, its health policies are largely devoid of gender equity concerns at both national and state levels. Mainstreaming of gender equity outcomes has not yet occurred in Australia. Conclusions : Applying the Policy Scorecard for Gender Mainstreaming to local and country‐specific policies is revealing of governments’ commitment to women, and how well gender equity goals are embedded into policies and programs. Policy analysis using this gender‐sensitive Policy Scorecard provides opportunities for advocacy to advance women's health and gender equity at any level of government, in any country.     

Our roles are not at ease: The work of engaging a youth advisory council in a mental health services delivery organization

ObjectivesThere is growing policy impetus for including youth voices in health services research and health system reform. This article examines the perspectives of professionals in a mental healthcare organization charged with engaging young people as advisors in service transformation.MethodsAn institutional ethnography of a youth mental health services organization in Ontario, Canada, was conducted. Fieldwork consisted of twelve months of observation of meetings, interviews with youth advisors and adult service providers, with subsequent text analysis of engagement training and policy materials. The present article reports data from six adult professionals and related field observations.ResultsService providers’ efforts to engage youth were observed in three areas: a) supporting youth''s development as advisors, b) retaining and deepening youth participation while waiting for organizational change and c) embedding relationships between youth and adults at various levels within the system of care. This work denotes existing tensions between the values and ideals of youth engagement and the everyday demands of services delivery.ConclusionIn this setting, a fundamental dimension of this work consisted of negotiating tensions between the policy enthusiasm for engagement and its realization in a health services context. In describing these contextual challenges, we outline implications for consideration by other youth mental health services. Engagement efforts that are authentic and sustained require resources and flexibility, and leadership commitment to instil service users’ perspectives throughout multiple levels within the organization.     

Women's Health Policies Associated with Obesity,Diabetes, High Blood Pressure,and Smoking: A Follow-Up on the Women's Health Report Card

ABSTRACT

This study sought to elucidate associations between state-level policies related to women's health and state prevalence of obesity, smoking, high blood pressure, and diabetes among women. Using data from national sources compiled for Making the Grade on Women's Health: A National and State-by-State Report Card, state policies on key women's health issues were evaluated on the degree to which policies adequately protected women's health. Blocked regressions assessed the policies associated with state outcomes. Anti-discrimination policies were prominent for high blood pressure, smoking, and obesity; models accounted for significant variance for all outcomes. State policies that support women may improve women's health.     

Provision of healthcare in the context of financial crisis: approaches to the Greek health system and international implications

Both healthcare professionals and the healthcare system must defend each patient's health individually while simultaneously seeking to protect the population's health in general. Nowadays, there is an important increase in the cost of healthcare supply, mainly due to the developments of medical science, the public's expectations and the demographic ageing. Since healthcare resources are not unlimited, it is obvious that immoderate consumption of them by certain patients limits the use of the same funds by others. Therefore, we have to seek an optimal distribution of the existing resources in order to manage a constriction of expenses, especially under the circumstances of the modern economic crisis. The criteria of effectiveness and efficiency should be used. Health policies focus on both the public's behaviour and the rules of medical practice. Under the modern challenges the physician's role is particularly important for the protection of the patient's health and the promotion of public health.     

Intergovernmental engagement on health impacts of climate change

ObjectiveTo examine countries’ engagement with the health impacts of climate change in their formal statements to intergovernmental organizations, and the factors driving engagement.MethodsWe obtained the texts of countries’ annual statements in United Nations (UN) general debates from 2000 to 2019 and their nationally determined contributions at the Paris Agreement in 2016. To measure countries’ engagement, we used a keyword-in-context text search with relevant search terms to count the total number of references to the relationship of health to climate change. We used a machine learning model (random forest predictions) to identify the most important country-level predictors of engagement. The predictors included political and economic factors, health outcomes, climate change-related variables and membership of political negotiating groups in the UN.FindingsFor both UN general debate statements and nationally determined contributions, low- and middle-income countries discussed the health impacts of climate change much more than did high-income countries. The most important predictors of engagement were health outcomes (infant mortality, maternal deaths, life expectancy), countries’ income levels (gross domestic product per capita), and fossil fuel consumption. Membership of political negotiating groups (such as the Group of 77 and Small Island Developing States) was a less important predictor.ConclusionOur analysis indicated a higher engagement in countries that carry the heaviest climate-related health burdens, but lack necessary resources to address the impacts of climate change. These countries are shouldering responsibility for reminding the global community of the implications of climate change for people’s health.     

基于PMC指数模型的我国健康医疗大数据发展的政策环境研究

目的：分析目前我国健康医疗大数据发展的政策环境,并为我国健康行业决策制定和完善提供理论依据,为我国健康医疗大数据行业高质量发展提供方向指引。方法：以我国国家层面出台的与健康医疗大数据相关的政策为研究对象,采用文本挖掘的方法遴选出政策文本中的高频词,结合专家访谈结果构建PMC指数模型,对我国健康医疗大数据的相关政策进行量化评价。结果：PMC指数模型结果表明,我国9项健康医疗大数据政策PMC指数的平均值为4.72,其中2项政策表现良好,7项政策表现及格;国家层面健康医疗大数据政策整体质量良好,但仍有较大提升空间。结论：我国健康医疗大数据管理政策基本完善,政策在性质与功能上较为明确,本文着重从政策内容、激励约束和生命周期三方面进行具体分析并提出改进建议。     

Value of Triage Treatment Strategies to Distribute Hepatitis C Direct-Acting Antiviral Agents in an Integrated Healthcare System: A Cost-Effectiveness Analysis

ObjectivesThis study aimed to assess the cost-effectiveness of fibrosis-based direct-acting antiviral treatment policies for patients with chronic hepatitis C virus at the Kaiser Permanente Mid-Atlantic States health system.MethodsWe used a Markov model to compare the lifetime costs and effects of treating patients with chronic hepatitis C virus at different stages of disease severity, or all stages simultaneously, based on a fibrosis score from the US healthcare sector perspective and societal perspective. The initial distribution of patients across fibrosis scores, the effectiveness of direct-acting antiviral therapy, and follow-up and monitoring protocols were specific to the Kaiser Permanente Mid-Atlantic States health system. Direct and indirect costs, transition probabilities, and utilities were derived from the literature. Deterministic and probabilistic sensitivity analyses were performed to assess the robustness of our results.ResultsThe “Treat All” option was dominant from both the societal and healthcare sector perspectives. The conclusion was robust in deterministic sensitivity analysis. The range of incremental costs between the less restrictive policies was small—the difference between the “Treat F1+” and the “Treat All” option was only $111 per person. Probabilistic sensitivity analyses showed, at both the $100 000/quality-adjusted life-year and $150 000/quality-adjusted life-year thresholds, there was a 70% chance that the “Treat All” option was more cost-effective than the “Treat F1+” option.ConclusionsWe found that expanded treatment access is cost-effective and, in many cases, cost saving. Although our results are primarily applicable to a regional integrated healthcare system, it offers some direction to any healthcare setting faced with resource constraints in the face of highly priced drugs.     

Incentives and intrinsic motivation in healthcare

ObjectiveIt has been established in the literature that workers within public organisations are intrinsically motivated. This paper is an empirical study of the healthcare sector using methods of qualitative analysis research, which aims to answer the following hypotheses: 1) doctors are intrinsically motivated; 2) economic incentives and control policies may undermine doctors’ intrinsic motivation; and 3) well-designed incentives may encourage doctors’ intrinsic motivation.MethodWe conducted semi-structured interviews à-la-Bewley with 16 doctors from Navarre's Healthcare Service (Servicio Navarro de Salud-Osasunbidea), Spain. The questions were based on current theories of intrinsic motivation and incentives to test the hypotheses. Interviewees were allowed to respond openly without time constraints. Relevant information was selected, quantified and analysed by using the qualitative concepts of saturation and codification.ResultsThe results seem to confirm the hypotheses. Evidence supporting hypotheses 1 and 2 was gathered from all interviewees, as well as indications of the validity of hypothesis 3 based on interviewees’ proposals of incentives.ConclusionsThe conclusions could act as a guide to support the optimal design of incentive policies and schemes within health organisations when healthcare professionals are intrinsically motivated.     

Adolescent Preferences Regarding a Web Site to Empower Adolescents to Talk With Their Healthcare Providers

PurposeAdolescents experience challenges managing their chronic conditions, partly owing to limited involvement in medical visits. Because adolescents are “digital natives,” providing a specific Web site with educational resources may support better adolescent-provider communication. Our purpose was to determine adolescents' opinions about a health communication–focused Web site.MethodsSixty English-speaking adolescents aged 11–17 years with a chronic health condition (mean age: 13.3 years; SD 1.9) were enrolled at a pediatric clinic in rural North Carolina.ResultsAdolescents most commonly accessed YouTube and Google for online health information. Nearly all adolescents supported the creation of a Web site and resources on how to communicate with their healthcare provider. Adolescents most often wanted to talk to specialists about their health and to pharmacists about their medications.ConclusionsA Web site and educational resources are currently being codeveloped with adolescents. It is essential that we find ways to engage adolescents in their healthcare management.     

Motivaciones y experiencias emocionales del primer equipo multidisciplinario hospitalario entrenado para atender casos de Ébola en Andalucía (2014-2016)

ObjectiveThe Hospital Universitario Virgen del Rocío (HUVR) of Seville was chosen as the reference Andalusian site to treat possible cases of Ebola. After the health alert (WHO, 2014), a voluntary group of healthcare and non-healthcare professionals was set up, which, after being trained, treated a possible case. In this light, the aim is to understand the motivations and emotional experiences of this group and to identify the facilitators of and obstacles to its operation.MethodQualitative, interpretative and phenomenological study. Observation unit: professional team of the HUVR trained to treat Ebola cases. Analysis units: teamwork, motivations and emotions. Three interviews with key informants were conducted, as well as three discussion groups involving 23 of the 60 team members (2014–2016). A content analysis of the motivations, emotions and elements affecting the team's operation was conducted with QSRNUDISTVivo10. Validity: data sources, techniques and disciplinary perspectives were triangulated. The results were presented to the team, which duly agreed with the findings.ResultsTraining, professional responsibility, professional self-esteem, risk appetite or loyalty to the leader stood out as motivations to voluntarily join the team. Emotional experiences evolved from fear and stress to self-pressure control, while essential elements for the team's operation were found to be calmness and confidence based on training and teamwork. Family, source department, resources, communication media and emotional management were facilitators of or obstacles to the team's success.ConclusionAn understanding of the key motivational and influential factors may be important in the management of effective and successful multidisciplinary teams during health alerts.     

A socio-ecological analysis of Ethiopian immigrants’ interactions with the Israeli healthcare system and its policy and service implications

Objective. Despite receiving full medical care and many social services, many Ethiopian immigrants in Israel feel frustrated, and even alienated, by the care they receive. This study uses a qualitative approach to explore the obstacles Ethiopian immigrants face regarding effective health seeking behavior and optimal interactions with healthcare providers in Israel.

Design. We gained a three-cornered perspective by conducting semi-structured interviews with healthcare providers, immigrants, and interpreters who mediate between the two. An ecological system or socio-ecological model guided the data analysis. It allowed organizing the varied and complex relationship between the factors that influence healthcare delivery and receipt among this population.

Results. The advanced analysis of our results delineated four themes which we grouped into two domains: the cultural divide and the interpreters. Within each of these themes, we explored influences on health or healthcare at each level of the socio-ecological model. We demonstrated that the problems surrounding health seeking behaviors and receiving treatment stem mainly from a cultural divide. This cultural incongruity and its effects are apparent at multiple levels of the ecological model and must be recognized and addressed programmatically at these levels.

Conclusions. Necessary program and service modifications include that cultural mediation become an integral part of health personnel's training for healthcare delivery and a necessary criterion for good practices. We recommend that professionals from within the health system be trained to act as interpreters. Lastly, the integration of traditional healers into the allopathic health system should be considered. These modifications require a system-wide change in policy, structure of services, and practices.     

Changing global essential medicines norms to improve access to AIDS treatment: Lessons from Brazil

Abstract

Brazil's large-scale, successful HIV/AIDS treatment programme is considered by many to be a model for other developing countries aiming to improve access to AIDS treatment. Far less is known about Brazil's important role in changing global norms related to international pharmaceutical policy, particularly international human rights, health and trade policies governing access to essential medicines. Prompted by Brazil's interest in preserving its national AIDS treatment policies during World Trade Organisation trade disputes with the USA, these efforts to change global essential medicines norms have had important implications for other countries, particularly those scaling up AIDS treatment. This paper analyses Brazil's contributions to global essential medicines policy and explains the relevance of Brazil's contributions to global health policy today.     

Estimating community health needs against a Triple Aim background: What can we learn from current predictive risk models?

IntroductionTo support providers and commissioners in accurately assessing their local populations’ health needs, this study produces an overview of Dutch predictive risk models for health care, focusing specifically on the type, combination and relevance of included determinants for achieving the Triple Aim (improved health, better care experience, and lower costs).MethodsWe conducted a mixed-methods study combining document analyses, interviews and a Delphi study. Predictive risk models were identified based on a web search and expert input. Participating in the study were Dutch experts in predictive risk modelling (interviews; n = 11) and experts in healthcare delivery, insurance and/or funding methodology (Delphi panel; n = 15).ResultsTen predictive risk models were analysed, comprising 17 unique determinants. Twelve were considered relevant by experts for estimating community health needs. Although some compositional similarities were identified between models, the combination and operationalisation of determinants varied considerably.ConclusionsExisting predictive risk models provide a good starting point, but optimally balancing resources and targeting interventions on the community level will likely require a more holistic approach to health needs assessment. Development of additional determinants, such as measures of people's lifestyle and social network, may require policies pushing the integration of routine data from different (healthcare) sources.