Purchaser–provider splits in health care—The case of Finland

The purchaser–provider split (PPS) is a service delivery model in which third-party payers are kept organizationally separate from service providers. The operations of the providers are managed by contracts. One of the main aims of PPS is to create competition between providers. Competition and other incentive structures built into the contractual relationship are believed to lead to improvements in service delivery, such as improved cost containment, greater efficiency, organizational flexibility, better quality and improved responsiveness of services to patient needs. PPS was launched in Finland in the early 1990s but was not widely implemented until the early 2000s. Compared to other countries with PPS the development and implementation of PPS in Finland has been unusual. Firstly, purchasing is implemented at the level of municipalities, which means that the size of the Finnish purchasers is extremely small. Elsewhere purchasing is mostly implemented at the regional or national levels. Secondly, PPS is also applied to primary health care and A&E services while in other countries the services mainly include specialized health care and residential care for the elderly. Thirdly, PPS in health and social services is not regulated by any specific legislation, regulative mechanisms or guidelines. Instead it is regulated within the same framework as public procurement in general.     

Referring physicians' experiences of outsourcing radiological examinations – A variety of views on the consequences

IntroductionThere are strengths, weaknesses, opportunities and challenges when outsourcing advanced radiological examinations such as magnetic resonance examinations from university hospitals to external private institutions.AimThe aim of this study was to explore the experiences of referring physicians when their referrals for radiological examinations are outsourced from a university hospital in Stockholm, Sweden.MethodThis qualitative study is a part of a larger study investigating the consequences of outsourcing referrals for radiological examinations from a university hospital to private external units. Ten referring physicians from orthopedic and oncology departments, representing clinics with large volumes of radiological referrals at a university hospital, were interviewed.ResultsThe results showed that the requirements for radiological services differ between these specialties. The overall opinion was that examinations performed by external radiology departments needed additional re-assessment work which causes higher costs for their clinics. This indicates that there is insufficient communication between referring physicians and the radiological department at the University Hospital.ConclusionsFor better planning of radiological services, radiology departments must consider the referring physicians' needs and develop suitable contract when organizing the practice of outsourcing. The management structure in radiology departments and communication between referring physicians and radiologists in the radiology departments should be studied further, to promote better understanding and improve the efficiency of the outsourcing process.     

医院信息技术外包的利弊分析

医院信息技术外包是数字化医院建设的一种创新思路，通过分析比较医院信息技术外包的利处和弊端，使医院在选择信息技术外包策略时，准确把握医院信息技术需求，选择合适的外包策略，可以有效规避信息技术外包带来的风险。     

医院支持服务系统的框架初探

应医院后勤社会化改革的大趋势,在广州数家医院近几年实践的基础上进行总结。以ERP(Enterprise ResourcePlanning)理论、CRM(Client Relationship Management)理论、设施管理(Facility Management)理论为基础,强调在医院只有将支持服务与医疗服务进行有效的、充分的融合,才能为客户提供优质服务。医院支持服务系统所服务的客户应包括就诊者(外部顾客)和医扩人员(内部顾客)两个部分,绝不可以顾此失彼或厚此薄彼。基于这种认识,设计适合国内医院实际的以支持服务中心(Service Hub)为核心的框架结构,将过去被动型的后勤服务提升为主动型的支持服务。     

医院合同制工人用工形式改革探索

医院合同制工人是直接与医院签订劳动合同,建立劳动关系的工人,主要从事辅助性、临时性、替代性工作,保障临床一线的需求。随着医院合同制工人数量逐渐增加,医院承担的管理成本和用工风险也相应提高。因此,医院积极探索,通过外包、劳务派遣等方式,对合同制工人用工形式进行改革,做到既保障临床需求、提高合同制工人的积极性,又能实现合法、高效、低风险用工。     

Identifying and Prioritizing Effective Factors on Outsourcing in Public Hospitals Using Fuzzy BWM

Abstract

The outsourcing of health services has gained prominence over the past decades. Because numerous factors affect outsourcing in the field of health services, identifying and prioritizing these factors is specifically important. This study sought to identify and prioritize the factors affecting outsourcing, and to propose a model for the effective outsourcing of hospital services in Shiraz, Iran. The study drew on an exploratory mixed research method. In the first stage, all the criteria affecting the outsourcing of activities in hospitals were identified through the theoretical framework, a literature review, and interviews with hospital experts. Next, the criteria were finalized and prioritized using the fuzzy best-worst method (BWM). Following the literature review, 34 criteria for outsourcing were identified based on the studies explored and the interviews with the experts; the criteria were categorized into seven dimensions including “strategy”, “management”, “economy”, “quality”, “security and keeping patients’ records”, “service”, and “agility.” These dimensions formed the final outsourcing model of hospitals in Shiraz. Finally, the fuzzy BWM analysis revealed that “security and keeping patient’s records” had the highest priority in outsourcing-related decision-making. The findings can help hospital managers make the right decision concerning the outsourcing of hospital services. The dimensions found in this research might also have been identified in other models, although this study was different in that it concentrated on the criteria in the specialized area of hospital management, while identifying the importance and weights of all the criteria involved.     

医院后勤服务外包精细化管理实践

结合医院后勤服务外包精细化管理实践,总结出完善管理制度、选择供应商的方式、对服务公司的监管等方面的经验;以职工食堂为例,介绍了后勤服务外包精细化管理的具体做法.     

Selected factors determining outsourcing of basic operations in healthcare entities in Poland

BackgroundIn light of insufficient financial resources allocated to the functioning of the health care system in Poland, healthcare entities undertake several restructuring measures aimed at cost reduction, improvement of effectiveness and optimisation of operations. One of the elements of this restructuring is outsourcing.ObjectiveThe objective of the study is to determine the significance of selected factors determining the outsourcing of basic operations in healthcare entities in Poland.MethodsThe research tool was the authors’ questionnaire. The study was conducted at healthcare entities using the CAWI method in 2018. The outsourcing of laboratory diagnostics, diagnostic imaging and medical personnel was examined.ResultsOut of 750 healthcare entities, 241 outsource medical personnel, 484 outsource laboratory diagnostics, 445 outsource imaging diagnostics. The use of outsourcing primarily results from the excessively high cost of maintaining own employees, the desire to gain access to the top-quality knowledge and technology as well as the need for financial savings.ConclusionsThe scale of outsourcing of medical personnel may be greater than it results from the obtained study results. Excessively high costs of maintaining own employees as the most important reason for using outsourcing is a consequence of high personnel costs occurring in the case of establishing cooperation on the basis of an employment relationship.