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Hospital reform

Irene Papanicolas, Liana R Woskie, Ashish K Jha
Importance: Health care spending in the United States is a major concern and is higher than in other high-income countries, but there is little evidence that efforts to reform US health care delivery have had a meaningful influence on controlling health care spending and costs. Objective: To compare potential drivers of spending, such as structural capacity and utilization, in the United States with those of 10 of the highest-income countries (United Kingdom, Canada, Germany, Australia, Japan, Sweden, France, the Netherlands, Switzerland, and Denmark) to gain insight into what the United States can learn from these nations...
March 13, 2018: JAMA: the Journal of the American Medical Association
Ekwutosi M Okoroh, Debra J Kane, Rebekah E Gee, Lyn Kieltyka, Brittni N Frederiksen, Katharyn M Baca, Kristin M Rankin, David A Goodman, Charlan D Kroelinger, Wanda D Barfield
Rates of short interval pregnancies resulting in unintended pregnancies remain high in the United States and contribute to adverse reproductive health outcomes. Long-acting reversible contraception (LARC) methods have annual failure rates of less than 1% compared with 9% for oral contraceptive pills, and are an effective strategy to reduce unintended pregnancies. To increase access to LARCs in the immediate postpartum period, several State Medicaid programs, including those in Iowa (IA) and Louisiana (LA), recently established reimbursement policies to remove the barriers to reimbursement of immediate postpartum LARC insertion...
March 9, 2018: American Journal of Obstetrics and Gynecology
J Hiquet, E Christin, F Tovagliaro, J Fougas, O Dubourg, C Chevalier, F Abel, M Ebouat, M-E Ploquin, M Malo, S Gromb-Monnoyeur
BACKGROUND: The Forensic medicine reform in 2011 enabled the development of forensic units specialized in multidisciplinary care of victims of criminal offences. Thanks to an annual budgetary allocation, the Ministry of Justice handles the financing of judicial acts, while the health care facilities assume the medical, psychological and social aspects. The objective of this study was to determine the direct costs of medical care provided to rape victims (such as defined in the article 222-23 of the Penal Code) in order to see how its funding could be reconsidered to prevent any additional cost that could be caused by non-sufficient medical, psychological and social care...
March 9, 2018: Revue D'épidémiologie et de Santé Publique
Marc Beltempo, Karin Clement, Guy Lacroix, Sylvie Bélanger, Anne-Sophie Julien, Bruno Piedboeuf
OBJECTIVE:  This article assesses the effect of reducing consecutive hours worked by residents from 24 to 16 hours on yearly total hours worked per resident in the neonatal intensive care unit (NICU) and evaluates the association of resident duty hour reform, level of trainee, and the number of residents present at admission with mortality in the NICU. STUDY DESIGN:  This is a 6-year retrospective cohort study including all pediatric residents working in a Level 3 NICU ( N  = 185) and infants admitted to the NICU ( N  = 8,159)...
February 8, 2018: American Journal of Perinatology
Muktesh Daund, Sushma Sonavane, Amresh Shrivastava, Avinash Desousa, Sanjay Kumawat
Mental hospitals are an integral part of mental health services in India. It is an interesting story how mental hospitals have responded to the challenges of contemporary period they were built in. It is beyond doubt that it is a progressive journey along with advances in mental health both in India and internationally. As in other countries, mental hospitals in India have responded to the social challenges, disparities, and poor resources of workforce and fiscal investment. Historically, there have been changes and three major reforms are needed, namely attempt to facilitate discharge and placing patients back into the family, introducing teaching and research in mental hospitals, and accountability to civil rights as per the requirements of the National Human Rights Commission...
February 2018: Indian Journal of Psychiatry
Kenneth Munge, Stephen Mulupi, Edwine W Barasa, Jane Chuma
BACKGROUND: Purchasing refers to the process by which pooled funds are paid to providers in order to deliver a set of health care interventions. Very little is known about purchasing arrangements in low- and middle-income countries (LMICs), and certainly not in Kenya. This study aimed to critically analyse purchasing arrangements in Kenya, using the National Hospital Insurance Fund (NHIF) as a case study. METHODS: We applied a principal-agent relationship framework, which identifies three pairs of principal-agent relationships (government-purchaser, purchaser-provider, and citizen-purchaser) and specific actions required within them to achieve strategic purchasing...
July 18, 2017: International Journal of Health Policy and Management
Andrew E Clark, Carine Milcent
In this paper, we address two issues: i) how hospital employment changes with local unemployment, according to the type of hospital ownership, and ii) whether this relationship changed after the implementation of a pro-competitive reform that made hospitals more similar. A 2006-2010 French panel of 1695 hospitals over five waves allows us to consider within-hospital employment changes. We first find that higher local unemployment is associated with greater employment in State-owned hospitals, but not for any other hospital ownership type: French local authorities then seem to respond to depressed local labour markets by increasing employment in State-owned hospitals...
March 1, 2018: Social Science & Medicine
Shuang Liu, Jing Wang, Liang Zhang, Xiang Zhang
BACKGROUND: In China, increases in both the caesarean section (CS) rates and delivery costs have raised questions regarding the reform of the medical insurance payment system. Case payment is useful for regulating the behaviour of health providers and for controlling the CS rates and excessive increases in medical expenses. New Cooperative Medical Scheme (NCMS) agencies in Xi County in Henan Province piloted a case payment reform (CPR) in delivery for inpatients. We aimed to observe the changes in the CS rates, compare the changes in delivery-related variables, and identify variables related to delivery costs before and after the CPR in Xi County...
March 9, 2018: BMC Pregnancy and Childbirth
Xiaolei Xiong, Zhiguo Zhang, Jing Ren, Jie Zhang, Xiaoyun Pan, Liang Zhang, Shiwei Gong, Si Jin
BACKGROUND: China's universal medical insurance system (UMIS) is designed to promote social fairness through improving access to medical services and reducing out-of-pocket (OOP) costs for all Chinese. However, it is still not known whether UMIS has a significant impact on the accessibility of medical service supply and the affordability, as well as the seeking-care choice, of patients in China. METHODS: Segmented time-series regression analysis, as a powerful statistical method of interrupted time series design, was used to estimate the changes in the quantity and quality of medical service supply before and after the implementation of UMIS...
2018: PloS One
A I Vialkov, G P Skvirskaia, I M Son, A Sh Senenko, I A Kupeieva, V B Rosanov, S A Leonov, F K Bilalov, A V Gajeva, V A Evdakov, N A Kravtchenko
The article presents analysis of the system of organization of primary medical sanitary care in the Russian Federation, its strong and weak aspects are emphasized. The main indices of out-patient care of population and their dynamics are considered. The necessity of system development is substantiated with the purpose of supporting accessibility and quality of medical care in out-patient conditions. The concept of development of organizational functional model of primary medical sanitary care in actual conditions is presented...
July 2017: Problemy Sot︠s︡ialʹnoĭ Gigieny, Zdravookhranenii︠a︡ i Istorii Medit︠s︡iny
Floortje B Moes, Eddy S Houwaart, Diana M J Delnoij, Klasien Horstman
RATIONALE, AIMS, AND OBJECTIVES: This paper examines a remarkable dispute between Dutch insurers, hospitals, doctors, and patients about a set of quality indicators. In 2013, private insurers planned to drastically reform Dutch emergency care using quality indicators they had formulated drawing from clinical guidelines, RCTs, and systematic reviews. Insurers' plans caused much debate in the field of emergency care. As quality indicators have come to play a more central role in health care governance, the questions what constitutes good evidence for them, how they ought to be used, and who controls them have become politically and morally charged...
March 6, 2018: Journal of Evaluation in Clinical Practice
Mohanraj Karunanithi, Qing Zhang
Australian population aged over 65 years is 14% (3.3 million) and this expected to increase to 21% by 2053 (8.3 million), of which 1.9% to 4.2% is attributed to Australians over 85 years. With increase in ageing, there is high prevalence in long-term health conditions and more likely multiple visits to the doctors or the hospitals, particularly when one's functional condition declines. This adds burden to the already stretched health system such as the overcrowding of emergency departments in hospitals. This is partly due to many ageing patients with high care needs occupying significant number of hospital beds because they are waiting for entry to the limited placements in residential care...
2018: Studies in Health Technology and Informatics
P Maxwell Courtney, Michael E West, William J Hozack
BACKGROUND: With recent healthcare reform efforts focusing on rewarding value instead of volume, it has become important for orthopedic surgeons to partner and align with their hospitals. We report our experience in aligning clinical and financial incentives with 6 health systems in our geographic area. METHODS: By managing the entire episode-of-care continuum for total hip and total knee arthroplasty patients, our standardized, evidence-based protocols have improved the quality of care for our joint arthroplasty patients...
January 31, 2018: Journal of Arthroplasty
R Mezzina
AIM: Italy pioneered deinstitutionalisation over the past 60 years and enforced a famous mental health (MH) reform law in 1978. Deinstitutionalisation has been completed with the very closure of all psychiatric hospitals over two decades. METHODS: After 40 years of implementation, this article presents the main achievements and challenges of the Italian MH reform law, including its long-term effect and impact in Italy and abroad. RESULTS: The Legislation of 1978 was based on the discovery of rights as a key tool in mental healthcare...
March 6, 2018: Epidemiology and Psychiatric Sciences
Tsegahun Manyazewal, Mokgadi C Matlakala
Background: Understanding the way health care reforms have succeeded or failed thus far would help policy makers cater continued reform efforts in the future and provides insight into possible levels of improvement in the health care system. This work aims to assess and describe the implications of health care reform on the performance of public hospitals in central Ethiopia. Methods: A facility-based, cross-sectional study was carried out in five public hospitals with different operational characteristics that have been implementing health care reform in central Ethiopia...
June 2018: Journal of Global Health
Craig Wotherspoon, Cylie M Williams
Objective There continue to be disparate health outcomes for people who are Aboriginal and Torres Strait Islander. The aim of the present study was to measure whether there were any differences in in-patient experiences between Aboriginal and Torres Strait Islander people and those without an Aboriginal or Torres Strait Islander background. Methods Random samples of people were invited to complete a survey following admission at the hospitals at Peninsula Health, Victoria, Australia. This survey was based on the Victorian Patient Satisfaction Monitor...
March 2, 2018: Australian Health Review: a Publication of the Australian Hospital Association
Haichen Zhang, Yunxiao Song, Xiong Zhang, Jun Hu, Suwei Yuan, Jin Ma
OBJECTIVES: The currently implemented healthcare reform in China requires substantial capital investment. Although overtreatment results in serious waste, inappropriate laboratory use is widespread, and overuse of tumour markers (TMs) has attracted increasing attention. DESIGN: Retrospective study. SETTING: The respiratory, thoracic surgery and oncology departments of three hospitals in Shanghai from 2014 to 2015. PARTICIPANTS: Patients with chronic obstructive pulmonary disease (COPD) and primary bronchogenic lung cancer (PLC)...
February 28, 2018: BMJ Open
Taklu Marama, Hinsermu Bayu, Mulualem Merga, Wakgari Binu
Background: To improve the quality of services, satisfying patients is the primary goal of the Ethiopian reform programme. Objectives: To assess patient satisfaction and associated factors among clients admitted to obstetrics and gynecology wards of public hospitals in Mekelle town. Method : Institution-based cross-sectional study design was conducted on 413 participants using systematic sampling methods. Data were collected from March 9 to May 8, 2016, using structured questionnaires...
2018: Obstetrics and Gynecology International
Paul J Martin, N James Skill, Leonidas G Koniaris
Academic health centres have historically treated patients with the most complex of diseases, served as training grounds to teach the next generations of physicians and fostered an innovative environment for research and discovery. The physicians who hold faculty positions at these institutions have long understood how these key academic goals are critical to serve their patient community effectively. Recent healthcare reforms, however, have led many academic health centres to recruit physicians without these same academic expectations and to partner with non-faculty physicians at other health systems...
February 26, 2018: Journal of Medical Ethics
Koen Van den Heede, Cécile Dubois, Patriek Mistiaen, Sabine Stordeur, Audrey Cordon, Marie Isabel Farfan-Portet
PURPOSE: In light of the international evolutions to establish inclusive trauma systems and to concentrate the care for the most severely injured in major trauma centres, we evaluated the degree of dispersion of trauma care in Belgium. METHODS: We used descriptive statistics to illustrate the dispersion of major trauma care in Belgium based on two independent administrative databases: the registry of Mobile Intensive Care Units (2009-2015) and the Belgian Hospital Discharge Dataset (2009-2014)...
February 26, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
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