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1 – 10 of 553Decentralization has profound implications for many health systems. This study investigates the effect of health system decentralization in Organization for Economic Co-operation…
Abstract
Purpose
Decentralization has profound implications for many health systems. This study investigates the effect of health system decentralization in Organization for Economic Co-operation and Development (OECD) countries on public health security capacity and health service satisfaction.
Design/methodology/approach
Multiple linear regression analyses were employed for variables related to the level of health security capacity and satisfaction with the healthcare system while controlling for all socio-demographic variables from the European Social Survey, including over 44,000 respondents from 25 OECD countries. The Health Systems in Transition series of countries were used for assessing the decentralization level.
Findings
The result of multiple linear regression analyses showed that the level of decentralization in health systems was significantly associated with higher health security capacity (ß-coefficient 3.722, 95% confidence interval (CI) [3.536 3.908]; p=<0.001) and health service satisfaction (ß-coefficient 1.463, 95% CI [1.389 1.536]; p=<0.001) in the study. Countries with a higher level of decentralization in health policy tasks and areas were significantly likely to have higher health services satisfaction, whereas this satisfaction had a significant negative relation with the lower level of decentralization status of secondary/tertiary care services in OECD countries (ß-coefficient −5.250, 95% CI [−5.757–4.743]; p = 0.001).
Originality/value
This study contributes to a better understanding of the extent to which decentralization of health services affects public health safety capacity and satisfaction with health services, whereas the level of decentralization in OECD countries varies considerably. Overall, the findings highlight the importance of public health security and satisfaction with health care delivery in assessing the effects of decentralization in health services.
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Victor Pimentel and Carlo A. Mora-Monge
This study aims to benchmark the operational efficiency of fifty-eight public hospitals across Mexico between 2015 and 2018 and identifies the most critical inputs affecting their…
Abstract
Purpose
This study aims to benchmark the operational efficiency of fifty-eight public hospitals across Mexico between 2015 and 2018 and identifies the most critical inputs affecting their efficiency. In doing so, the study analyzes the impact of policy changes in the Mexican healthcare system introduced in recent years.
Design/methodology/approach
To measure the operational efficiency of Mexican public hospitals, data envelopment analysis (DEA) window analysis variable returns to scale (VRS) methodology using longitudinal data collected from the National Institute for Transparency and Access to Information (IFAI). Hospital groups are developed and compared using a categorization approach according to their average and most recent efficiency.
Findings
Results show that most of the hospitals in the study fall in the moving ahead category. The hospitals in the losing momentum or falling behind categories are mostly large units. Hospitals with initially low efficiency scores have either increased their efficiency or at least maintained a steady improvement. Finally, the findings indicate that most hospitals classified as moving ahead focused on a single care area (cancer, orthopedic care, child care and trauma).
Research limitations/implications
This study examined the technical efficiency of the Mexican healthcare system over a four-year period. Contrary to conventional belief, results indicate that most public Mexican hospitals are managed efficiently. However, recent changes in public and economic policies that came into effect in the current administration (2018) will likely have long-lasting effects on the hospitals' operational efficiency, which could impact the results of this study.
Originality/value
To the best of authors’ knowledge, this is the first study that examines the efficiency of the complex Mexican healthcare system using longitudinal data.
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A large number of studies indicate that coercive forms of organizational control and performance management in health care services often backfire and initiate dysfunctional…
Abstract
Purpose
A large number of studies indicate that coercive forms of organizational control and performance management in health care services often backfire and initiate dysfunctional consequences. The purpose of this article is to discuss new approaches to performance management in health care services when the purpose is to support innovative changes in the delivery of services.
Design/methodology/approach
The article represents cross-boundary work as the theoretical and empirical material used to discuss and reconsider performance management comes from several relevant research disciplines, including systematic reviews of audit and feedback interventions in health care and extant theories of human motivation and organizational control.
Findings
An enabling approach to performance management in health care services can potentially contribute to innovative changes. Key design elements to operationalize such an approach are a formative and learning-oriented use of performance measures, an appeal to self- and social-approval mechanisms when providing feedback and support for local goals and action plans that fit specific conditions and challenges.
Originality/value
The article suggests how to operationalize an enabling approach to performance management in health care services. The framework is consistent with new governance and managerial approaches emerging in public sector organizations more generally, supporting a higher degree of professional autonomy and the use of nonfinancial incentives.
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Atsushi Katsuda, Yoshiyuki Naito and Toshihiko Ishihara
In Japan, health-care systems have long been supported by physicians' long working hours. To solve this problem, there is an urgent need to improve the working environment for…
Abstract
Purpose
In Japan, health-care systems have long been supported by physicians' long working hours. To solve this problem, there is an urgent need to improve the working environment for physicians while practicing patient-centered medicine and controlling health-care costs. This paper aims to examine the effect of task shifting to nurses and discuss its usefulness from the perspective of health-care value co-creation.
Design/methodology/approach
This paper analyzes task shifting to nurses in acute care hospitals in Japan as a solution for the shortage of anesthesiologists. The authors discuss how the value was created from the perspective of the health-care ecosystem, with conceptual consideration of the value co-creation mechanism through patient-centered practices.
Findings
The study showed that task shifting initiatives in Japan can improve the motivation of nurses through human resource development while maintaining high quality. The study also suggested that task shifting from physicians to nurses may contribute to improving net income and maintaining the health-care system.
Practical implications
The findings are highly reproducible and can be immediately applied to initiatives at other medical institutions in Japan. Furthermore, it is suggested that these findings might provide some perspective on the realignment of fragmented healthcare in the USA.
Originality/value
It was confirmed in practical terms that micro-level initiatives have an impact on the macro level as well. In addition, the academic presentation of the concept has contributed to the deepening of value research.
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As part of a national plan to govern professional and organizational development in Norwegian specialist healthcare, the country’s hospital clinics are tasked with constructing…
Abstract
Purpose
As part of a national plan to govern professional and organizational development in Norwegian specialist healthcare, the country’s hospital clinics are tasked with constructing development plans. Using the development plan as a case, the paper analyzes how managers navigate and legitimize the planning process among central actors and deals with the contingency of decisions in such strategy work.
Design/methodology/approach
This study applies a qualitative research design using a case study method. The material consists of public documents, observations and single interviews, covering the process of constructing a development plan at the clinical level.
Findings
The findings suggest that the development plan was shaped through a multilevel translation process consisting of different contending rationalities. At the clinical level, the management had difficulties in legitimizing the process. The underlying tension between top-down and bottom-up steering challenged involvement and made it difficult to manage the contingency of decisions.
Practical implications
The findings are relevant to public sector managers working on strategy documents and policymakers identifying challenges that might hinder the fulfillment of political intentions.
Originality/value
This paper draws on a case from Norway; however, the findings are of general interest. The study contributes to the academic discussion on how to consider both the health authorities’ perspective and the organizational perspective to understand the manager’s role in handling the contingency of decisions and managing paradoxes in the decision-making process.
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Olusola Joshua Olujobi and Tunde Ebenezer Yebisi
The purpose of this study is to examine the corruption prevalent in the distribution of COVID-19 palliatives during the lockdown and movement restrictions in the country. This…
Abstract
Purpose
The purpose of this study is to examine the corruption prevalent in the distribution of COVID-19 palliatives during the lockdown and movement restrictions in the country. This study seeks to analyse the current state of corruption in the distribution of COVID-19 palliatives and public health facilities in Nigeria while also providing a legal insight and strategic blueprint to combat corruption. To this end, this study will address the current legal framework for combating corruption and build upon this to formulate a working strategy for tackling corruption in the future.
Design/methodology/approach
Using a doctrinal legal research methodology, this study draws upon existing literature, tertiary data sources and information from the Nigeria Centre for Disease Control. The collected data is analysed and compared with current literature to identify key findings. Rent-seeking and utilitarian theories of the law were examined to guide this study. This study offers useful insights into combating corruption. The use of this method is justified, as it enhances the credibility of the findings on the importance of strategies for future emergencies. This legal research approach is consistent with the law and can be easily verified. The empirical aspect of this study involved a survey of multidimensional health-care and economic data set of 36 states in Nigeria plus the Federal Capital Territory on COVID-19 in Nigeria. A survey linearised regression model was estimated to determine the influence of government revenue and public health-care facilities in the control of the virus spread in Nigeria.
Findings
This study reveals the need for emphasis on the imperative of combating corruption in the distribution of COVID-19 palliatives and establishing economic resilience through transparent and accountable practices, supported by legal frameworks.
Research limitations/implications
Rent-seeking and utilitarian theories of law are evaluated because of their impacts on combating corruption. The limitation of this study is the intricacy of gathering data on COVID-19 palliatives corruption in Nigeria because of secrecy and the absence of reliable data on the subject.
Practical implications
Estimating the exact number of stolen palliatives and their fiscal impact on Nigeria's economy proves to be a formidable task because of the covert nature of corruption. This study equips policymakers in Nigeria with a better understanding of the legal challenges posed by corruption in the health care sector and provides an effective strategy to combat it.
Social implications
The lack of reliable data on the extent of palliative theft hinders the ability of lawmakers to enact effective legislation and strategies for combating corruption in the distribution of COVID-19 palliatives and addressing future emergencies in Nigeria. The policy implications of this study can assist policymakers in Nigeria and other countries in formulating measures to combat corruption in the distribution of COVID-19 palliatives and other future emergencies. Furthermore, it recommends the overhaul of anti-corruption laws and mechanisms in Nigeria to ensure effective measures against corruption.
Originality/value
In conclusion, this study contributes to knowledge by proposing a legal model centred on people's participation to enhance transparency and accountability in future palliative distribution processes. This study recommends legal strategies that can effectively address corruption in future emergencies or shocks. This study proposes a strategic blueprint to tackle corruption in the future. This blueprint includes an analysis of existing laws and regulations, as well as potential policy changes and legislative reform. This study also includes recommendations for improved enforcement and oversight mechanisms and for improved public awareness and education. As part of this, this study considers the potential for public–private partnerships to increase transparency and accountability in public health and health-care services.
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Idris Abdullahi Abdulqadir, Bello Malam Sa'idu, Ibrahim Muhammad Adam, Fatima Binta Haruna, Mustapha Adamu Zubairu and Maimunatu Aboki
This article investigates the dynamic implication of healthcare expenditure on economic growth in the selected ten Sub-Saharan African countries over the period 2000–2018.
Abstract
Purpose
This article investigates the dynamic implication of healthcare expenditure on economic growth in the selected ten Sub-Saharan African countries over the period 2000–2018.
Design/methodology/approach
The study methodology included dynamic heterogenous panel, using mean group and pooled mean group estimators. The investigation of the healthcare expenditure and economic growth nexus was achieved while controlling the effects of investment, savings, labor force and life expectancy via interaction terms.
Findings
The results from linear healthcare expenditure have a significant positive impact on economic growth, while the nonlinear estimates through the interaction terms between healthcare expenditure and investment have a negative statistically significant impact on growth. The marginal effect of healthcare expenditure evaluated at the minimum and maximum level of investment is positive, suggesting the impact of health expenditure on growth does not vary with the level of investments. This result responds to the primary objective of the article.
Research limitations/implications
In policy terms, the impact of investment on healthcare is essential to addressing future health crises. The impact of coronavirus disease 2019 (COVID-19) can never be separated from the shortages or low prioritization of health against other sectors of the economy. The article also provides an insight to policymakers on the demand for policy reform that will boost and make the health sector attractive to both domestic and foreign direct investment.
Originality/value
Given the vulnerability of SSA to the health crisis, there are limited studies to examine this phenomenon and first to address the needed investment priorities to the health sector infrastructure in SSA.
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Mijeong Kim, Inseong Jeong and Johngseok Bae
Research has suggested that employees interpret high-performance work systems (HPWSs) as targeting two distinct organizational objectives: enhancing performance and promoting…
Abstract
Purpose
Research has suggested that employees interpret high-performance work systems (HPWSs) as targeting two distinct organizational objectives: enhancing performance and promoting employee well-being. These attributions often exert divergent effects on employee attitudes. Thus, this study aims to investigate this dynamic within the context of the Korean nursing occupation, clarifying how the HPWS can simultaneously evoke dual attributions: human resource (HR) well-being and HR performance attributions. Additionally, the authors examine the contrasting effects of these attributions and identify a moderating variable that could reconcile them. Drawing on the psychological experience of status theory, the authors conceptualize and test the moderating effect of employees' self-perceived status on the relationship between HR performance attribution and affective commitment.
Design/methodology/approach
Data were collected from 475 nurses in 82 work units in Korean hospitals. Hypotheses were tested in a multilevel moderated mediation model.
Findings
The findings revealed that an HPWS elicits HR well-being and HR performance attributions. While HR well-being attribution was positively associated with affective commitment, HR performance attribution was positively related to affective commitment when employees' self-perceived status was high. Moreover, the HPWS demonstrated an indirect relationship with affective commitment via increasing HR performance attribution when self-perceived status was high.
Originality/value
Although the personal meaning of HR attributions differs depending on the perceiver’s situation, this aspect has received little attention in the field of research. This study advances the understanding of HR attributions derived from the HPWS within the specific context of Korean nursing. Furthermore, the authors suggest that the two attributions may not conflict with each other, indicating that the impact of HR performance attribution is conditional on an individual’s self-perceived status.
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Rostand Arland Yebetchou Tchounkeu
This work aims to analyse the relationship between public health efficiency and well-being considering a panel of 102 Italian provinces from 2000 to 2016 and evaluates if there…
Abstract
Purpose
This work aims to analyse the relationship between public health efficiency and well-being considering a panel of 102 Italian provinces from 2000 to 2016 and evaluates if there are omitted variable biases and endogeneity biases and also evaluates if there are heterogeneous effects among provinces with different income levels.
Design/methodology/approach
We use a multi-input and output bootstrap data envelopment analysis to assess public health efficiency. Then, we measure well-being indices using the min-max linear scaling transformation technique. A two-stage least squares model is used to identify the causal effect of improving public health efficiency on well-being to account for time-invariant heterogeneity, omitted variable bias and endogeneity bias.
Findings
After controlling for important economic factors, the results show a significant effect of an accountable and efficient public health system on well-being. Those effects are concentrated in the North, the most economically, geographically and environmentally advantageous areas.
Research limitations/implications
The use of the sample mean, probably the oldest and most used method for aggregating the indicators, could be affected by variable compensation, with consequent misleading results in the process of constructing the well-being index. Another limitation is the use of lagged values of the main predictor as an instrument in the instrumental variables setting because it could lead to information loss. Finally, the availability of data over a long period of time.
Practical implications
The findings could help policymakers adopt measures to strengthen the public health system, encourage private providers and inspire countries worldwide.
Social implications
These results draw the attention of local authorities, who play an important role in designing and implementing policies to stimulate local public health efficiency, which puts individuals in the conditions of achieving overall well-being in their communities.
Originality/value
For the first time in Italy, a panel of well-being indices was constructed by developing new methodologies based on microeconomic theory. Furthermore, for the first time, the assessment of the relationship between public health efficiency and well-being is carried out using a panel of 102 Italian provinces.
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Gabriella Karakas and Daniel R. du Plooy
Despite the substantial body of international research exploring the effects of forced migration on mental health and the obstacles faced by refugee cohorts in accessing mental…
Abstract
Purpose
Despite the substantial body of international research exploring the effects of forced migration on mental health and the obstacles faced by refugee cohorts in accessing mental health services, there is a lack of in-depth studies specifically focusing on Bosnian refugees in Australia – one of the largest ethnic groups of displaced peoples. This qualitative investigation seeks to convey the experiences of mental health services by five Bosnian refugees in Melbourne, highlighting perceived pathways and barriers to service utilisation. This study aims to address two primary research questions: firstly, what characterises the experiences of Bosnian refugees in Australia when accessing mental health services? Secondly, what are the main barriers encountered by this population when seeking mental health services?
Design/methodology/approach
This study used qualitative inquiry and in-depth interviews to investigate the experiences of Bosnian refugees with mental health services in Australia. Data was collected through face-to-face interviews with five Melbourne-based Bosnian refugees who had previously accessed mental health services. Participants were recruited from community groups or associations using purposive sampling. Thematic analysis was used.
Findings
Key themes were revealed, such as the crucial role of social and community services, preferences for individual vs group therapy, potential re-traumatisation from therapeutic engagement, distrust of government-run mental health services and concerns regarding psychopharmaceutical prescription practices. Addressing barriers to mental health service access necessitates a multifaceted approach, including flexible social and community service support, an increased number of co-ethnic professionals and a recognition of cultural variations for effective service provision. Implementing these strategies can enhance help-seeking behaviours, provide culturally appropriate mental health services and improve the experiences of Bosnian refugees in Australia.
Originality/value
To the best of the authors’ knowledge, this study is the first to qualitatively explore how Bosnian refugees in Melbourne perceived the adequacy and availability of mental health services upon arrival to Australia. They are a large and potentially vulnerable community, due to experiences of war trauma and dislocation from country of origin. A lack of understanding regarding how this cohort engage with mental health services can lead to persistent inequities and ineffective service provision. This study identifies unique experiences and perspectives of Bosnian refugee participants, including distrust of government-run mental health services, and concerns regarding psychopharmaceutical prescription practices. This research is expected to contribute positively to the discourse on mental health service provision for Bosnian refugees and wider refugee communities in Australia.
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