Quality Competition, Location Choice and Ownership Conversion in Health Care Market

2018 ◽  
Author(s):  
Tsuyoshi Takahara
Keyword(s):  
Health Care ◽  
Location Choice ◽  
Quality Competition ◽  
Health Care Market

scholarly journals Private health care market shaping and changes in inequities in childhood diarrhoea treatment coverage: evidence from the analysis of baseline and endline surveys of an ORS and zinc scale-up program in Nigeria

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Tiwadayo Braimoh ◽  
Isaac Danat ◽  
Mohammed Abubakar ◽  
Obinna Ajeroh ◽  
Melinda Stanley ◽  
...  
Keyword(s):  
Health Care ◽  
Scale Up ◽  
Principal Component ◽  
Oral Rehydration Salt ◽  
Health Coverage ◽  
Health Care Market ◽  
Survey Period ◽  
Policy Objective ◽  
Oral Rehydration ◽  
Concentration Indices

Abstract Background Nearly 90,000 under-five children die from diarrhoea annually in Nigeria. Over 90% of the deaths can be prevented with oral rehydration salt (ORS) and zinc treatment but coverage nationally was less than 34% for ORS and 3% for zinc with wide inequities. A program was implemented in eight states to address critical barriers to the optimal functioning of the health care market to deliver these treatments. In this study, we examine changes in the inequities of coverage of ORS and zinc over the intervention period. Methods Baseline and endline household surveys were used to measure ORS and zinc coverage and household assets. Principal component analysis was used to construct wealth quintiles. We used multi-level logistic regression models to estimate predictive coverage of ORS and zinc by wealth and urbanicity at each survey period. Simple measures of disparity and concentration indices and curves were used to evaluate changes in ORS and zinc coverage inequities. Results At baseline, 28% (95% CI: 22–35%) of children with diarrhoea from the poorest wealth quintile received ORS compared to 50% (95% CI: 52–58%) from the richest. This inequality reduced at endline as ORS coverage increased by 21%-points (P <  0.001) for the poorest and 17%-points (P <  0.001) for the richest. Zinc coverage increased significantly for both quintiles at endline from an equally low baseline coverage level. Consistent with the findings of the pairwise comparison of the poorest and the richest, the summary measure of disparity across all wealth quintiles showed a narrowing of inequities from baseline to endline. Concentration curves shifted towards equality for both treatments, concentration indices declined from 0.1012 to 0.0480 for ORS and from 0.2640 to 0.0567 for zinc. Disparities in ORS and zinc coverage between rural and urban at both time points was insignificant except that the use of zinc in the rural at endline was significantly higher at 38% (95%CI: 35–41%) compared to 29% (95%CI, 25–33%) in the urban. Conclusion The results show a pro-rural improvement in coverage and a reduction in coverage inequities across wealth quintiles from baseline to endline. This gives an indication that initiatives focused on shaping healthcare market systems may be effective in reducing health coverage gaps without detracting from equity as a health policy objective.

The Managed Health Care Market

1992 ◽  
Vol 5 (2) ◽  
pp. 67-71
Author(s):  
William A. Hemberger
Keyword(s):  
United States ◽  
Health Care ◽  
Managed Care ◽  
Health Care Delivery ◽  
Care Delivery ◽  
The United States ◽  
Health Care Market ◽  
Managed Health Care ◽  
Program Benefit

Health care delivery and benefits in the United States are changing. This article provides a basic description of the present-day components, managed care constructs, and impact of medical/hospital program/ benefit designs on pharmacy programs.

De arbeidsmarkt van de Nederlandse gezondheidszorg als ‘patiënt’: een diagnose en enkele behandeladviezen

2012 ◽  
Vol 28 (3) ◽  
Author(s):  
Ronald Batenburg ◽  
Margo Brouns
Keyword(s):  
Health Care ◽  
Labor Market ◽  
Meta Analysis ◽  
Health Sector ◽  
Training System ◽  
Health Care Market ◽  
Labor Market Policy ◽  
Market Policy ◽  
Patient Diagnosis ◽  
Dutch Health

The labor market of the Dutch health sector as patient: diagnosis and some advices for treatment The labor market of the Dutch health sector as patient: diagnosis and some advices for treatment In this article we discuss the labor market and job structure of the health care in the Netherlands. The health care market is under cost and capacity pressure which calls for a fundamental change of the job and training system. A meta-analysis based on two leading trend reports shows that there is a watershed between the labor market for physicians and non-physicians. The labor market for doctors is centrally planned, while for the much larger group of nurses the labor market is not governed. Another observation is that bottlenecks are mainly approached by increasing the capacity, less by innovations in the educational and occupational structure. Following this analysis, this article advocates for a comprehensive labor market policy that takes into account different segments of care, that require different skills mixes and competence bundles. We also argue that segmentation on the regional level is required to achieve a demand-based health labor market policy.

scholarly journals Patient Journeys of Nonintegration in Hungary: A Qualitative Study of Possible Reasons for Considering Medical Modalities as Mutually Exclusive

2018 ◽  
Vol 17 (4) ◽  
pp. 1270-1284 ◽  
Author(s):  
Szilvia Zörgő ◽  
Olga L. Olivas Hernández
Keyword(s):  
Health Care ◽  
Qualitative Study ◽  
Conventional Medicine ◽  
Health Problems ◽  
Patient Relationship ◽  
Health Care Market ◽  
Personal Factors ◽  
Therapy Choice ◽  
Health And Illness ◽  
Cam Use

Introduction: Complementary and alternative medicine (CAM) use has been increasing in the past decades in tandem with changes regarding the notions of health and illness. Comparing conventional medicine (CM) and CAM in how they address health problems has been a point of focus for both the health sciences and individuals dealing with health problems. Various social, cultural, political, economic, and personal factors play a role in whether different health approaches are integrated or not when addressing illness experiences. Methods: The qualitative study comprised semistructured interviews (N = 9) and participant observation involving 105 patients conducted between January 2015 and May 2017 at 4 clinics of Traditional Chinese Medicine in Budapest, Hungary. Code structures were created inductively with Interpretative Phenomenological Analysis. Results: The mutually exclusive view of CM/CAM use occurred due to loss of trust in the doctor-patient relationship causing problems in communication, and also as a result of the patient espousing certain cultural dispositions. Significant dispositions included a preference for the “natural” and psychologization, the latter often manifested in psychosocial etiology, vitalism, and illness symbolism. Discussion: A polarized choice of therapy may occur as a result of a competitive health care market in which medical modalities and their underlying cultural systems compete within a global milieu of information proliferation and a hybridization of individual worldviews. Through a process of “cultural creolization”, changing concepts of health and illness create varying patient expectations and meanings regarding illness, which in turn affect therapy choice as well. Conclusion: Mirrored in the articulation of an individual’s illness trajectory is a tension that is also reflected in the struggles in the health care system to more adequately understand health/illness processes from a pluralistic perspective. The power relations in the health arena (among CAM/CM practitioners and systems) play a role in legitimizing or undermining different health practices, which as consequence affects the possibility of integrating them into the processes of care. Thus, therapy choice is not only linked to changing notions of health and illness, but also to shifting conceptualizations of self, identity, and the practitioner-patient relationship.

scholarly journals Educating Physicians-in-Training About Resource Utilization and Their Own Outcomes of Care in the Inpatient Setting

2010 ◽  
Vol 2 (2) ◽  
pp. 175-180 ◽  
Author(s):  
C. Jessica Dine ◽  
Jean Miller ◽  
Alexander Fuld ◽  
Lisa M. Bellini ◽  
Theodore J. Iwashyna
Keyword(s):  
Health Care ◽  
Resource Utilization ◽  
Resource Use ◽  
Practice Patterns ◽  
Action Plan ◽  
Inpatient Setting ◽  
Health Care Market ◽  
Outcomes Of Care ◽  
Attending Physician ◽  
The Impact

Abstract Background Despite significant policy concerns about the role of inpatient resource utilization on rising medical costs, little information is provided to residents regarding their practice patterns and the effect on resource use. Improved knowledge about their practice patterns and costs might reduce resource utilization and better prepare physicians for today's health care market. Methods We surveyed residents in the internal medicine residency at the Hospital of the University of Pennsylvania. Based on needs identified via the survey, discussions with experts, and a literature review, a curriculum was created to help increase residents' knowledge about benchmarking their own practice patterns and using objective performance measures in the health care market. Results The response rate to our survey was 67%. Only 37% of residents reported receiving any feedback on their utilization of resources, and only 20% reported receiving feedback regularly. Even fewer (16%) developed, with their attending physician, a concrete improvement plan for resource use. A feedback program was developed that included automatic review of the electronic medical record to provide trainee-specific feedback on resource utilization and outcomes of care including number of laboratory tests per patient day, laboratory cost per patient day, computed tomography scan ordering rate, length of stay, and 14-day readmission rate. Results were benchmarked against those of peers on the same service. Objective feedback was provided biweekly by the attending physician, who also created an action plan with the residents. In addition, an integrated didactic curriculum was provided to all trainees on the hospitalist service on a biweekly basis. Conclusions Interns and residents do not routinely receive feedback on their resource utilization or ways to improve efficiency. A method for providing objective data on individual resource utilization in combination with a structured curriculum can be implemented to help improve resident knowledge and practice. Ongoing work will test the impact on resource utilization and outcomes.

scholarly journals Ineffable Cultures or Material Devices: What Valuation Studies can Learn from the Disappearance of Ensured Solidarity in a Health Care Market

2015 ◽  
Vol 3 (1) ◽  
pp. 45-73 ◽  
Author(s):  
Teun Zuiderent-Jerak ◽  
Stans Van Egmond
Keyword(s):  
Health Care ◽  
Decisive Role ◽  
Cultural Value ◽  
Health Care Market ◽  
A Value ◽  
Dutch Health ◽  
Short Time ◽  
Regulated Competition ◽  
Made In

Valuation studies addresses how values are made in valuation practices. A next - or rather previous - question becomes: what then makes valuation practices? Two oppositional replies are starting to dominate how that question can be answered: a more materially oriented focus on devices of valuation and a more sociologically inclined focus on ineffable valuation cultures. The debate between proponents of both approaches may easily turn into the kind of leapfrog debates that have dominated many previous discussions on whether culture or materiality would play a decisive role in driving history. This paper explores a less repetitive reply. It does so by analyzing the puzzling case of the demise of solidarity as a core value within the recent Dutch health care system of regulated competition. While “solidarity among the insured” was both a strong cultural value within the Dutch welfare-based health system, and a value that was built into market devices by health economists, within a fairly short time “fairness” became of lesser importance than “competition”. This makes us call for a more historical, relational, and dynamic understanding of the role of economists, market devices, and of culture in valuation studies.

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