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Article
Publication date: 15 August 2016

David James Hunter, Katharina Kieslich, Peter Littlejohns, Sophie Staniszewska, Emma Tumilty, Albert Weale and Iestyn Williams

The purpose of this paper is to reflect on the findings of this special issue and discusses the future challenges for policy, research and society. The findings suggest…

Abstract

Purpose

The purpose of this paper is to reflect on the findings of this special issue and discusses the future challenges for policy, research and society. The findings suggest that challenges emerge as a result of legitimacy deficits of both consensus and contestatory modes of public involvement in health priority setting.

Design/methodology/approach

The paper draws on the discussions and findings presented in this special issue. It seeks to bring the country experiences and case studies together to draw conclusions for policy, research and society.

Findings

At least two recurring themes emerge. An underlying theme is the importance, but also the challenge, of establishing legitimacy in health priority setting. The country experiences suggest that we understand very little about the conditions under which representative, or authentic, participation generates legitimacy and under which it will be regarded as insufficient. A second observation is that public participation takes a variety of forms that depend on the opportunity structures in a given national context. Given this variety the conceptualization of public participation needs to be expanded to account for the many forms of public participation.

Originality/value

The paper concludes that the challenges of public involvement are closely linked to the question of how legitimate processes and decisions can be generated in priority setting. This suggests that future research must focus more narrowly on conditions under which legitimacy are generated in order to expand the understanding of public involvement in health prioritization.

Details

Journal of Health Organization and Management, vol. 30 no. 5
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 14 December 2018

Aziz Rezapour, Seyyed Mostafa Hakimzadeh, Sirous Panahi, Ehsan Teymourzadeh, Mohammadkarim Bahadori, Peivand Bastani and Ali Tahernezhad

The purpose of this paper is to identify the most important factors for strategic purchasing of health services in the health sector by the Iran Health Insurance Company…

Abstract

Purpose

The purpose of this paper is to identify the most important factors for strategic purchasing of health services in the health sector by the Iran Health Insurance Company and to provide an applicable model for other similar organizations in developing countries.

Design/methodology/approach

The present qualitative study was conducted in 2017 to identify the factors affecting the implementation of strategic purchasing of health services in the health sector by the Iran Health Insurance Company and to provide an indigenous and practical model through two phases: semi-structured interview followed by a Delphi process.

Findings

According to the findings of this study, Ministry of Welfare, Labor and Social Security plays a central role in the strategic purchasing. In addition, this was also approved by the representatives of citizens in communities concerning professional associations, insurance agencies and representative of the Council of Ministers. Model development explored 9 themes and 54 sub-themes.

Research limitations/implications

Based on the model, most attention has been paid to consumer role and inter-sector leadership of the company with other relevant organizations and systems including other insurance organizations and the welfare ministry. More importantly, the health insurance company should be able to communicate with providers and to choose the best providers, receiving price information through competition in the most appropriate mechanism. Guided by this model, it can strategically buy the best and the most effective services for its insured population.

Social implications

It might help developing societies to promote their health systems based on targeting the health budgeting and financial constraints so that it is prioritized according to the strategic purchasing criteria and consequently, economic evaluation.

Originality/value

The linchpins of the present study are as follow: first, the pragmatic model presented in the paper could help developing health systems to overcome the impediment in the implementation progress of strategic purchasing. Second, the model satisfies the need of enough knowledge to apply strategic purchasing in the health system. Third, the indigents have long been given special protection and consideration in the model that has continued to capture the attention of every policy-maker, in particular, developing countries, the portion of which is significant. Fourth, based on this model, attention has been paid to consumer role and inter-sector leadership of organization with other relevant organizations and systems. Fifth, this model could be correspondent for every insurance company in countries with similar developing conditions.

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Article
Publication date: 1 March 2005

Rute Abreu, Fátima David and David Crowther

Health care is an essential need of the society and it is an integral part thereof. In this sense, everybody is entitled to medical services to provide health and…

Abstract

Health care is an essential need of the society and it is an integral part thereof. In this sense, everybody is entitled to medical services to provide health and well‐being that improves lifestyle. Policymakers and researchers focus substantial attention on hospitals and public spending of financial resources, because they recognise the political power and the general collective obligation of preserving a health care for the present and future generations. The empirical analysis used a sample based in the 31 corporate hospitals that belong to the Portuguese health care system as a National Health Service in the period 2002–2003. The disclosure of information allows comparability and identifies similarities between the hospitals in the sample. Relevant organizational variables were managed statistically through the multivariate analysis. The geographical analysis shows inequalities of the distribution of hospitals facilities in Portugal, with marked concentration in the urban coastal areas, affected by the number of persons that live there. The financial analysis is supported in the Portuguese Official Accounting Plan that follows the same accounting trend of corporations. So, the disclosure and the accountability system are not opened up to a new field for accounting in health care based in the Health Official Accounting Plan. The research shows implications at the operational level, the efficiency and the effectiveness of the health care strategy with differences between hospitals. The authors believe that, as complex organizations, hospitals must based their disclosure police in transparency to allow patients to identify their own orientations that should be driven mainly by corporate social responsibility as a public service and not by the economic perspective of a business. This research confirms that as a global strategy for the health care system, corporate social responsibility is urgently needed. As a finite resource, the health should demand a permanent attention from society, as well as the Government in accomplishment prevention and monitoring systems, with a view to the defence of a sustainable health care system. More than merely investing efforts in fighting for political changes, without any advantage for society it is crucial to invest in prevention of the quality of life as a basic requirement to honour the corporate social responsibility in hospitals. Especially needed are health care improvements and infrastructures. In summary, the health care system exists as a fundamental element that assures life and high standards of living, so it should be available to everybody and for everybody…

Details

Social Responsibility Journal, vol. 1 no. 3/4
Type: Research Article
ISSN: 1747-1117

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Book part
Publication date: 11 June 2009

Phusit Prakongsai, Supon Limwattananon and Viroj Tangcharoensathien

Objective – This chapter assesses health equity achievements of the Thai health system before and after the introduction of the universal coverage (UC) policy. It examines…

Abstract

Objective – This chapter assesses health equity achievements of the Thai health system before and after the introduction of the universal coverage (UC) policy. It examines five dimensions of equity: equity in financial contributions, the incidence of catastrophic health expenditure, the degree of impoverishment as a result of household out-of-pocket payments for health, equity in health service use and the incidence of public subsidies for health.

Methodology – The standard methods proposed by O’Donnell, van Doorslaer, and Wagstaff (2008b) were used to measure equity in financial contribution, healthcare utilization and public subsidies, and in assessing the incidence of catastrophic health expenditure and impoverishment. Two major national representative household survey datasets were used: Socio-Economic Surveys and Health and Welfare Surveys.

Findings – General tax was the most progressive source of finance in Thailand. Because this source dominates total financing, the overall outcome was progressive, with the rich contributing a greater share of their income than the poor. The low incidence of catastrophic health expenditure and impoverishment before UC was further reduced after UC. Use of healthcare and the distribution of government subsidies were both pro-poor: in particular, the functioning of primary healthcare (PHC) at the district level serves as a “pro-poor hub” in translating policy into practice and equity outcomes.

Policy implications – The Thai health financing reforms have been accompanied by nationwide extension of PHC coverage, mandatory rural health service by new graduates and systems redesign, especially the introduction of a contracting model and closed-ended provider payment methods. Together, these changes have led to a more equitable and more efficient health system. Institutional capacity to generate evidence and to translate it into policy decisions, effective implementation and comprehensive monitoring and evaluation are essential to successful system-level reforms.

Details

Innovations in Health System Finance in Developing and Transitional Economies
Type: Book
ISBN: 978-1-84855-664-5

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Article
Publication date: 23 March 2020

Yara Ahmed, Racha Ramadan and Mohamed Fathi Sakr

This paper aims to evaluate the progressivity of health-care financing in Egypt by assessing all five financing sources individually and then combining them to analyze the…

Abstract

Purpose

This paper aims to evaluate the progressivity of health-care financing in Egypt by assessing all five financing sources individually and then combining them to analyze the equity of the whole financing system.

Design/methodology/approach

Lorenz dominance analysis and Kakwani progressivity index were applied on data from 2010/2011 Household Income, Expenditure, and Consumption Survey and the National Health Accounts 2011 using Stata to evaluate the progressivity of each source of health-care finance and the financing system overall.

Findings

The data show that Egypt’s health-care system, which is largely financed by out-of-pocket (OOP) payments, is slightly regressive, with an overall Kakwani index of −0.079. The overall regressive effect was the result of three regressive sources (OOP payments, an earmarked cigarette tax and direct taxes), one proportional finance source (social health insurance) and two slightly progressive sources (indirect taxes and private health insurance). This shows that the burden of financing health care falls more on the poor. These results signal the need for reform of health-care financing in Egypt to reduce dependence on OOP payments to achieve more equitable financing.

Originality/value

The paper seeks to augment the literature on health-care financing in Egypt by calculating specific progressivity estimates for all five sources of financing the Egyptian health-care system and analyzing the overall equity of this financing system. It will, therefore, provide a benchmark for monitoring the equity of finance in the Egyptian health-care system in future studies and allow one to assess the impact of implemented financing reforms in the future on the level of progressivity of health system financing.

Details

Journal of Humanities and Applied Social Sciences, vol. 3 no. 1
Type: Research Article
ISSN: 2632-279X

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Book part
Publication date: 1 January 2004

Nicole C. Raeburn

Amidst the backlash against gay rights in the U.S., a rapidly expanding number of companies are instituting inclusive policies. While in 1990 no major corporations…

Abstract

Amidst the backlash against gay rights in the U.S., a rapidly expanding number of companies are instituting inclusive policies. While in 1990 no major corporations provided health insurance for the partners of lesbian and gay employees, by early 2004, over 200 companies on the Fortune 500 list (approximately 40%) had adopted domestic partner benefits. This study of Fortune 1000 corporations reveals that the majority of adopters instituted the policy change only after facing pressure from groups of lesbian, gay, and bisexual employees. Despite such remarkable success, scholars have yet to study the workplace movement, as it is typically called by activists. Combining social movement theory and new institutional approaches to organizational analysis, I provide an “institutional opportunity” framework to explain the rise and trajectory of the movement over the past 25 years. I discuss the patterned emergence and diffusion of gay employee networks among Fortune 1000 companies in relation to shifting opportunities and constraints in four main areas: the wider sociopolitical context, the broader gay and lesbian movement, the media, and the workplace. Next, using the same wide-angle lens, I explain the apparent decline in corporate organizing since 1995. My multimethod approach utilizes surveys of 94 companies with and without gay networks, intensive interviews with 69 networks and 10 corporate executives, 3 case studies, field data, and print and virtual media on gay-related workplace topics. By focusing on not simply political but also broader institutional opportunities, I provide a framework for understanding the emergence and development of movements that target institutions beyond the state.

Details

Authority in Contention
Type: Book
ISBN: 978-0-76231-037-1

Abstract

Details

Journal of Health Organization and Management, vol. 30 no. 5
Type: Research Article
ISSN: 1477-7266

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Article
Publication date: 8 July 2014

Farung Mee-Udon

The purpose of this paper is to investigate the extent to which the Thai Universal Healthcare Insurance Coverage Scheme (UC) has contributed to villagers’ well-being in…

Abstract

Purpose

The purpose of this paper is to investigate the extent to which the Thai Universal Healthcare Insurance Coverage Scheme (UC) has contributed to villagers’ well-being in the northeast of Thailand. Public opinion polls specifically advocate the schemes are used to justify its ongoing political support. However, the question still remains as to whether it has made a difference in the lives of poorer rural people.

Design/methodology/approach

A multi-methods approach and a well-being focused evaluation (WFE) approach are used to understand villagers’ experiences of having and using the scheme and investigate the villagers’ satisfaction with the scheme and how this satisfaction has contributed to their life as a whole.

Findings

It is found that the scheme had made a valuable contribution to improving perceived well-being amongst villagers. Apart from the direct benefits of having that healthcare when needed, there is also the indirect benefit of increasing villagers’ sense of security that healthcare will be accessible if required.

Research limitations/implications

There are still pertinent issues for policy consideration; for example, almost 31 per cent of the villagers with the card have never used it. Approximately 22 per cent of people using the card reported dissatisfactions. Although healthcare direct-costs were now more affordable, a range of opportunity costs, geographic, social, cultural and other factors still need to be factored into further policy and service development to make the scheme more equitable and effective.

Originality/value

The study proposes “WFE”, a new evaluation approach. WFE may also be applied to other forms of social policy particularly concerning the impact of its policy on people's well-being.

Details

International Journal of Health Care Quality Assurance, vol. 27 no. 6
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 15 August 2016

Albert Weale, Katharina Kieslich, Peter Littlejohns, Aviva Tugendhaft, Emma Tumilty, Krisantha Weerasuriya and Jennifer A Whitty

The purpose of this paper is to introduce the special issue on improving equitable access to health care through increased public and patient involvement (PPI) in…

Abstract

Purpose

The purpose of this paper is to introduce the special issue on improving equitable access to health care through increased public and patient involvement (PPI) in prioritization decisions by discussing the conceptualization, scope and rationales of PPI in priority setting that inform the special issue.

Design/methodology/approach

The paper employs a mixed-methods approach in that it provides a literature review and a conceptual discussion of the common themes emerging in the field of PPI and health priority setting.

Findings

The special issue focuses on public participation that is collective in character, in the sense that the participation relates to a social, not personal, decision and is relevant to whole groups of people and not single individuals. It is aimed at influencing a decision on public policy or legal rules. The rationales for public participation can be found in democratic theory, especially as they relate to the social and political values of legitimacy and representation.

Originality/value

The paper builds on previous definitions of public participation by underlining its collective character. In doing so, it develops the work by Parry, Moyser and Day by arguing that, in light of the empirical evidence presented in this issue, public participatory activities such as protests and demonstrations should no longer be labelled unconventional, but should instead be labelled as “contestatory participation”. This is to better reflect a situation in which these modes of participation have become more conventional in many parts of the world.

Details

Journal of Health Organization and Management, vol. 30 no. 5
Type: Research Article
ISSN: 1477-7266

Keywords

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Article
Publication date: 7 June 2019

Frank Agyire-Tettey, Derek Asuman, Bernardin Senadza and Lucia Addae

This study aims to estimate the degree and nature of socioeconomic-related inequalities in sexual and reproductive health in Ghana and further assesses causes of these…

Abstract

Purpose

This study aims to estimate the degree and nature of socioeconomic-related inequalities in sexual and reproductive health in Ghana and further assesses causes of these inequalities using decomposition technique. The authors assess the contribution of personal characteristics of the woman including access to health information and health seeking behaviours, household and locational characteristics to inequalities in sexual and reproductive health in Ghana. The study uses data from the three rounds of the Ghana Demographic and Health Survey conducted in 2003, 2008 and 2014.

Design/methodology/approach

Two indicators – use of modern contraceptives and intention to use modern contraceptives – are used to measure sexual and reproductive health of sexually active women. A wealth index, based on household ownership of assets, consumer goods and living conditions, is used as a measure of socioeconomic status. The paper estimates a concentration index to the relationship between cumulative health and socioeconomic rank. Paper procedures to apply decomposition techniques to determine the causes of socioeconomic inequalities in health based on a linear health regression model.

Findings

The study finds evidence of varying degrees of socioeconomic-related inequalities in sexual and reproductive health indicators. Specifically, the study finds that whilst use of modern contraceptives was concentrated among women in households with high socioeconomic status in 2003 and 2008, modern contraceptive use was prevalent among women in low socioeconomic status households in 2014. Equally, the study finds significant pro-poor inequalities in the intentions to use modern contraceptives in 2003 and 2014. The degree of socioeconomic inequalities in the intentions to use modern contraceptives increased between 2003 and 2014.

Originality/value

There is the lack of evidence on the degree, nature and causes of socioeconomic-related inequalities, which in tend impedes the design and implementation of sexual and reproductive health policies targeted at vulnerable and under-served populations. In addition, there is the need to study inequalities in health over time to monitor progress of health delivery systems towards equitable and universal coverage and understand the evolution of the determinants.

Details

International Journal of Development Issues, vol. 18 no. 2
Type: Research Article
ISSN: 1446-8956

Keywords

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