Health services pricing in Turkey

One of the most important and complex decisions that public services managers have to make is pricing. This is especially difficult within public health care because pricing decisions are influenced by a myriad of ideological, political, economic and professional arguments. In Turkey the majority of health care services are provided under public auspice; however, recent changes in governmental policy have led to increased competition among hospitals in both the public and private sector. Therefore, all institutions are being watched and remain open to government scrutiny and regulation. The aim of the study is to analyze how the private and governmental hospitals determine pricing or the actual cost of services in Turkey. Also, comparisons are made between health services expenditures and the Consumer Price Index with suggestions provided for public and private hospital managers in regard to the general cost of health services.     

The Role of Public Relations Activities in Hospital Choice

Public relations activities for all organizations can have an important effect on consumer decision-making when buying goods or services. This study examines the effect that public relations activities can have regarding consumer decisions and choice. To explore exemplify this relationship a questionnaire was given to 971 patients within public, university and private hospitals in Ankara, Turkey. Study results show that public relations activities were a crucial factor in determining consumer hospital choice. The majority of respondents reported that the behaviors and attitude of personnel as public relations activities that support the hospital's reputation within the public were the primary variables in hospital choice. Health care managers can use these findings to further understand how patients make informed choices related to usage of a health care facility and to develop and/or improve public relations activities.     

The Impact of Accessibility on the Use of Specialist Health Care in Norway

The aim of this study is to explore to what extent the policy goal of allocating health care according to medical need is fulfilled in Norway. Hence, we are interested in studying the impact of a person's health relative to the impact of access to specialist care. We distinguish between services provided by public hospitals and services provided by private specialists financed by the National Insurance Scheme. While a person's self-assessed health plays a major role in the utilization of hospitals, we find no significant effect of this variable on the utilization of private specialists. The accessibility indices for specialist care have significant effects on the utilization of private specialists, but not on hospital visits and inpatient stays. The challenge to policy makers is to consider measures that bring the utilization of publicly funded private specialists in accordance with national health policy.     

Have out‐of‐pocket health care payments risen under free health care policy? The case of Sri Lanka

Compared to its neighbors, Sri Lanka performs well in terms of health. Health care is provided for free in the public sector, yet households' out‐of‐pocket health expenditures are steadily increasing. We explore whether this increase can be explained by supply shortages and insufficient public health care financing or whether it is rather the result of an income‐induced demand for supplementary and higher quality services from the private sector. We focus on total health care expenditures and health care expenditures for specific services such as expenses on private outpatient treatments and expenses on laboratory and other diagnostic services. Overall, we find little indication that limited supply of public health care per se pushes patients into the private sector. Yet income is identified as one key driver of rising health care expenditures, ie, as households get richer, they spend an increasing amount on private services suggesting a dissatisfaction with the quality offered by the public sector. Hence, quality improvements in the public sector seem to be necessary to ensure sustainability of the public health care sector. If the rich and the middle class increasingly opt out of public health care, the willingness to pay taxes to finance the free health care policy will certainly shrink.     

南非公立医院改革的主要做法与特点

相对于私立医院占有五分之三的卫生支出为20%的人群提供服务,南非公立医院约使用五分之二的卫生支出,为南非80%的人群提供医疗卫生服务,但面临着资源不足和人力短缺的问题。为此,南非政府着重建立公平导向的卫生管理体制,加大政府财政投入,重点保障基层公立医院发展,探索公私合作,在优先保障弱势人群基本医疗服务的同时,动员可利用的所有医疗资源,着力保障居民公平地获得基本医疗卫生服务。改革的主要特点是建立以基本医疗卫生保健为基础的医疗管理体制,以更公平的方式分配医疗资源,建立公私合作机制,动员民营机构力量,优先保障居民对基本医疗卫生服务的可及性和公平性。这些经验对于同属于发展中国家的中国有良好启示。     

Comparative quality of private and public health services in rural Vietnam

BACKGROUND: Private health care services were officially recognized in Vietnam in 1989, and for the last 15 years have competed with the public health system in providing primary curative care and pharmaceutical sales to rural populations. However, the quality of these private and public health care services has not been evaluated and compared. METHODS: A community-based survey was conducted in 30 of the 160 communes in Hung Yen, which were selected by probability proportional to population size (PPS) sampling. All commune health centres (CHCs) and private health care providers in the selected communes were surveyed on human resources, services provided, availability of medical equipment and pharmaceuticals, knowledge and clinical performance for acute and chronic problems. Patient satisfaction and cost of care associated with recent illness were measured using a random household survey covering 30 households from each of the selected communes. RESULTS: There were 11.5 private providers per 10,000 population, compared with 6.7 public providers per 10,000. A quarter of private providers were employees of the public health sector. Less than 20% of the private providers had registered their practice with the government system. Eleven per cent (26/234) had no professional qualifications. Fifty-eight per cent (135/234) provided treatment as well as selling medications. Public sector infrastructure was superior to that of the private providers. The quality of services provided by public providers was poor but significantly better than that of private providers. Patient satisfaction and costs of care were similar between the two groups. CONCLUSIONS: Private providers are successfully competing with the public health centre system in rural areas but not because they provide cheaper or better services. The quality of private health care services is not controlled and is significantly poorer than public services. Current practice in both systems falls below the national standard, especially for the management of chronic health problems. The low quality of health care services at a community level may help explain the previously observed phenomena of high levels of self-medicating, low utilization of commune health centres and over-utilization of tertiary health care facilities.     

The Swedish health care system--an economist's view

This article compares the organization of the Swedish health care system with that in three other countries, the U.S., the U.K., and Canada, focussing on three main areas: (1) the provision and financing (public or private) of health insurance, including the question of the quality of the insurance protection offered; (2) the organization of the production of health services, and the economic incentives on the system's decision-makers (doctors, hospital managers, politicians, etc.). Possible answers are suggested to the question why one country (the U.K.) is able to provide health care to its population at an average cost considerably below that of the others: Differences in the quality of the insurance protection and health services; in the incentives on the system managers to exercise cost control; and in the incentives on service providers such as physicians, to consider cost-effectiveness when making treatment decisions. An attempt is made to suggest lessons for health care reform in Sweden and elsewhere.     

Performance-based budgeting in the public sector: an illustration from the VA health care system

This paper estimates frontier cost functions for US Department of Veterans Affairs (VA) hospitals in FY2000 that are consistent with economic theory and explicitly account for cost differences across patients' risk, level of access to care, quality of care, and hospital-specific characteristics. Results indicate that on average VA hospitals in FY2000 operate at efficiency levels of 94%, as compared to previous studies on US private sector hospitals that average closer to 90% efficient. Using these cost frontiers, management systems potentially could be implemented to enhance the equitable allocation of the VA medical care global budget and systematically distribute funds across hospitals and networks. The paper also provides recommendations to improve the efficiency of delivering health care services applicable to public sector organizations.     

Perceptions and utilization of primary health care services in Iraq: findings from a national household survey

Background

After many years of sanctions and conflict, Iraq is rebuilding its health system, with a strong emphasis on the traditional hospital-based services. A network exists of public sector hospitals and clinics, as well as private clinics and a few private hospitals. Little data are available about the approximately 1400 Primary Health Care clinics (PHCCs) staffed with doctors. How do Iraqis utilize primary health care services? What are their preferences and perceptions of public primary health care clinics and private primary care services in general? How does household wealth affect choice of services?

Methods

A 1256 household national survey was conducted in the catchment areas of randomly selected PHCCs in Iraq. A cluster of 10 households, beginning with a randomly selected start household, were interviewed in the service areas of seven public sector PHCC facilities in each of 17 of Iraq's 18 governorates. A questionnaire was developed using key informants. Teams of interviewers, including both males and females, were recruited and provided a week of training which included field practice. Teams then gathered data from households in the service areas of randomly selected clinics.

Results

Iraqi participants are generally satisfied with the quality of primary care services available both in the public and private sector. Private clinics are generally the most popular source of primary care, however the PHCCs are utilized more by poorer households. In spite of free services available at PHCCs many households expressed difficulty in affording health care, especially in the purchase of medications. There is no evidence of informal payments to secure health services in the public sector.

Conclusions

There is widespread satisfaction reported with primary health care services, and levels did not differ appreciably between public and private sectors. The public sector PHCCs are preferentially used by poorer populations where they are important providers. PHCC services are indeed free, with little evidence of informal payments to providers.     

Quality of Care for Maternal and Newborn Health in Health Facilities in Nepal

Introduction

Nepal has pledged to substantially reduce maternal and newborn death by 2030. Improving quality of intrapartum health services will be vital to reduce these deaths. This paper examines quality of delivery and newborn services in health facilities of Nepal.

Methods

Data were sourced from the Nepal Health Facility Survey 2015, which covered a national representative sample of health facilities. The datasets were analysed to assess service readiness, availability and quality of delivery and newborn care in a sample of 992 health facilities.

Results

Of the 992 facilities in the sample, 623 provided delivery and newborn care services. Of the 623 facilities offering delivery and newborn care services, 13.3% offered comprehensive emergency obstetric care (CEmONC), 19.6% provided basic emergency obstetric care (BEmONC) and 53.9% provided basic delivery and newborn service. The availability of essential equipment for delivery and newborn care was more than 80% in health facilities. Except for the coverage of vitamin K injection, the coverage of immediate newborn care was more than 85% in all health facilities. The coverage of use of chlorhexidine ointment to all newborns was more than 70% in government hospitals and primary health care centers (PHCCs) and only 32.3% in private hospitals.

Conclusions

These findings show gaps in equipment and drugs, especially in PHCCs and private health facilities. Improving readiness and availability of equipment and drugs in PHCCs and private health facility will help improve the quality of care to further reduce maternal and newborn mortality in Nepal.

     

Patient satisfaction with health services in Bangladesh

Concern over the quality of health care services in Bangladesh has led to loss of faith in public and private hospitals, low utilization of public health facilities, and increasing outflow of Bangladeshi patients to hospitals in neighbouring countries. Under the circumstances, assessment of the country's quality of health care service has become imperative, in which the patient's voice must begin to play a greater role. This study attempts to identify the determinants of patient satisfaction with public, private and foreign hospitals. A survey was conducted involving inpatients in public and private hospitals in Dhaka City and patients who have experienced hospital services in a foreign country. Their views were obtained through exit polls using probability and non-probability (for foreign hospital patients) sampling procedures. Regression models were derived to identify key factors influencing patient satisfaction in the different types of hospitals. Doctors' service orientation, a composite of 13 measures, is the most important factor explaining patient satisfaction. Policy implications are discussed.     

Private health expenditure in the Greek health care system: Where truth ends and the myth begins

Greece today has the most “privatized” health care system among EU countries. Given the country's universal coverage by a public system this may be called “the Greek paradox”. The Objective of this paper is to analyze private health payments by provider and type of service in order to bring to light the reasons for and the nature of the extraordinary private expenditure in Greece. Methods: We used a randomized countrywide sample of 1616 households. Regression analysis was used to determine the extent to which social and economic household characteristics influence the frequency of use of certain health services and the size of household payments for such services. In all statistical analyses we used the p < 0.05 level of significance. Results: Out of the total private household health expenditure (€6141 million), 66% is for outpatient services, with the largest share for dental services, absorbing 31.1% (€1912 million or 1.5% of GDP) of the total out-of-pocket health expenditure. Rural dwellers seek private outpatient care more often, because of the understaffed public primary facilities. The hospital sector absorbs less than 15% (or €884 million) of household private health expenditure. A significant part (20%) of hospital care financed privately concerns informal payments within public hospitals, an amount almost equal with formal payments in the form of cost sharing. Admissions to private hospitals are only 16% of total admissions. Our results indicate that this is a result of the political emphasis in public hospitals and of the considerably high cost of private hospital care. Conclusions: The rise in private health expenditure and the development of the private sector during the last 20 years in Greece is associated with public under financing. The gap was filled by the private sector through increased investment, mostly in upgraded amenities and new technology. Today, the complementary nature of private care in Greece is no longer disputed, but is a matter of serious concern, as it undermines the constitutionally guaranteed free access and equitable distribution of health resources.     

Costing of services of Vietnamese hospitals: identifying costs in one central, two provincial and two district hospitals using a standard methodology

BACKGROUND: The People's Republic of Vietnam is currently in a period of transition from a purely socialistic country towards a so-called socialist market economy. Since the introduction of the Doi Moi policy in 1987, health care services have been liberalized, medical practitioners have received the right to open private hospitals and private pharmacies are booming. However, the majority of inhabitants strongly depends on governmental hospital services. These services are currently going through a financial crisis. This demands the quest for efficiency and the wise allocation of public funds. RESEARCH QUESTION: The efficient allocation of funds depends on the quotient between costs and health outcomes, but the costs of health services in Vietnamese hospitals are unknown. Therefore the study analysed five hospitals in Vietnam and determined the average costs as well as the main cost drivers. METHODOLOGY: The full costs of five hospitals were analysed, including depreciation and the value of donations. The costs were allocated to cost centres and cost units by a stepping-stone method. MAJOR FINDINGS: As expected, the average costs per inpatient day at a central hospital are about 300% of the costs of provincial hospitals and about 600% of the costs of district hospitals. However, the costs of some laboratory procedures and operations done at district hospitals are higher than those of provincial or even central hospitals. The main reason for the high costs of some procedures at district hospitals was the low quantity of these procedures at that level. This is a strong indicator that some procedures, in particular major operations, should not be performed in Vietnamese district hospitals.     

The cost and efficiency of public and private health care facilities in Ogun state,Nigeria

During the 1980s, Nigeria faced difficult economic conditions resulting in a severely constrained budget for public health services. To assess more carefully the costs and efficiency of the public and private health sectors, the Federal Ministry of Health in Nigeria undertook a comprehensive survey of health care facilities in Ogun State in 1987, the analysis of which is presented in this study. The findings suggest that there is potential to increase service delivery within existing budgets by more cost-effective allocation of inputs. Many public and private providers are not operating at full technical capacity. It also appears that public facilities are not using cost-minimizing combinations of high and low-level health workers, in particular, too many low-level staff are being used to support high-level workers. The cost analysis indicates that there are short-run increasing returns to scale for inpatient and nearly constant returns to scale for outpatient services. Economies of scope for joint production of inpatient and outpatient services are not being realized. A major implication of such analysis is that improved resource allocation decisions heavily depend on the existence of information systems at the health facility level which carefully integrate financial information with other appropriate and adequate measures of service inputs, health care quality, facility utilization and ultimately health status.     

Costs and determinants of privately financed home-based health care in Ontario, Canada

The Canadian context in which home-based healthcare services are delivered is characterised by limited resources and escalating healthcare costs. As a result, a financing shift has occurred, whereby care recipients receive a mixture of publicly and privately financed home-based services. Although ensuring that care recipients receive efficient and equitable care is crucial, a limited understanding of the economic outcomes and determinants of privately financed services exists. The purposes of this study were (i) to determine costs incurred by families and the healthcare system; (ii) to assess the determinants of privately financed home-based care; and (iii) to identify whether public and private expenditures are complements or substitutes. Two hundred and fifty-eight short-term clients (<90 days of service utilisation) and 256 continuing care clients (>90 days of utilisation) were recruited from six regions across the province of Ontario, Canada, from November 2003 to August 2004. Participants were interviewed by telephone once a week for 4 weeks and asked to provide information about time and monetary costs of care, activities of daily living (ADL), and chronic conditions. The mean total cost of care for a 4-week period was $7670.67 (in 2004 Canadian dollars), with the overwhelming majority of these costs (75%) associated with private expenditures. Higher age, ADL impairment, being female, and a having four or more chronic conditions predicted higher private expenditures. While private and public expenditures were complementary, private expenditures were somewhat inelastic to changes in public expenditures. A 10% increase in public expenditures was associated with a 6% increase in private expenditures. A greater appreciation of the financing of home-based care is necessary for practitioners, health managers and policy decision-makers to ensure that critical issues such as inequalities in access to care and financial burden on care recipients and families are addressed.     

Poor medicine for poor people? Assessing the impact of neoliberal reform on health care equity in a post-socialist context

Abstract

Driven in part by a resurgent interest in social inequality and health, and in part by increasing scrutiny of the social and health consequences of neoliberal economic reform, principles of health equity and social justice, the centerpieces of the Health for All strategy drafted at Alma Ata in 1978, are once again at center stage in global public health debates. Whether and how equity in access to health care can be maintained in a context of market-based health sector reform has not been systematically addressed, particularly from the perspective of local communities. This paper will explore how health reform affects health care in post-socialist Mongolia. Through a mixed-methods household-based study of low-to-middle income communities in urban and rural Mongolia we find that despite explicit and concerted efforts to reduce inequities, the reform system is unable to provide equitable health care either vertically or horizontally. Emphasis on privatization of the secondary and tertiary sectors of the system, coupled with deployment of universally-accessible, but from a clinical standpoint, limited, version of essential primary care, produces a fragmented system. Particularly for the vulnerable poor, access to services beyond the primary care system is compromised by financial, opportunity, and informational cost barriers. This research suggests that new models of health reform are needed that will effectively bridge the growing gaps between public and private resources, primary and secondary and/or tertiary care, and clinical and public health services.     

THE DETERMINANTS OF HEALTH CARE EXPENDITURE TOWARD THE END OF LIFE: EVIDENCE FROM TAIWAN

This paper empirically investigates the relationship between the health care expenditure of end‐of‐life patients and hospital characteristics in Taiwan where (i) hospitals of different ownership differ in their financial incentives; (ii) patients are free to choose their providers; and (iii) health care services are paid for by a single public payer on a fee‐for‐services basis with a global budget cap. Utilizing insurance claims for 11 863 individuals who died during 2005–2007, we trace their hospital expenditures over the last 24 months of their lives. We find that end‐of‐life patients who are treated by private hospitals in general are associated with higher inpatient expenditures than those treated by public hospitals, while there is no significant difference in days of hospital stay. This finding is consistent with the difference in financial incentives between public and private hospitals in Taiwan. Nevertheless, we also find that the public–private differences vary across accreditation levels. Copyright © 2013 John Wiley & Sons, Ltd.     

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.     

What Is the Impact of Health Reforms on Uncompensated Care in Critical Access Hospitals? A 5‐Year Forecast in Washington State

Context: The 2008 financial crisis had a far‐reaching impact on nearly every sector of the economy. As unemployment increased so did the uninsured. Already operating on a slim margin and poor payer mix, many critical access hospitals are facing a tough road ahead. Purpose: We seek to examine the increasing impact of uncompensated care on the revenues earned by Washington's critical access hospitals; to forecast uncompensated care to the year 2014; and to forecast the financial impact on rural hospital uncompensated care of HR 3590, the Affordable Care Act (ACA). Findings: For critical access hospitals in the state of Washington, total uncompensated care increased by almost $16 million, a 22% increase from 2008 to 2009. By 2014, total uncompensated care is forecast to more than double from 2009, totaling $174 million annually without health reforms. Using the Urban Institute's Health Insurance Policy Simulation Model, uncompensated care is forecast to fall by $106 million in 2014, thereby reducing the uncompensated care percentage from 5.31% to 2.07%. Conclusions: Policy makers and health care managers should note that a substantial portion of the newly insured from the ACA will most likely be Medicaid participants. Given this source of lower revenue per case, critical access hospital administrators should seek additional public and private sources of revenue. Most importantly, rural hospital managers must maintain or improve their cost efficiency, while serving the needs of their rural population as we move closer toward the implementation of health reforms.     

Inpatient and outpatient health care demand in Cairo,Egypt

This paper uses the results of a household survey conducted in Cairo, Egypt in 1992 to examine the factors that influence the demand for inpatient and outpatient health services. Multi-stage discrete choice models of the demand for health care, which identify the importance of individual, household, and facility level variables on each treatment decision, are estimated separately for outpatients and inpatients. Consumers are assumed to decide whether to seek any treatment and then choose between three categories of providers: a large public hospital (Embaba Hospital), all other public providers, and private/charitable providers. The results confirm that more affluent consumers prefer the higher cost, higher quality private and charitable hospitals. Age, sex, education, and insurance are also found to strongly impact the use of medical services. The results are suggestive but do not conclusively show that inpatient care is less price responsive than outpatient care. Price responsiveness of inpatient and outpatient demand are imprecisely estimated because price is highly correlated with quality, and the available data on facility quality do not permit us to adequately control for quality variations across facilities.