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The COVID-19 pandemic created a broad array of challenges for hospitals. These challenges included restrictions on admissions and procedures, patient surges, rising costs of labor and supplies, and a disparate impact on already disadvantaged populations. Many of these intersecting challenges put pressure on hospitals' finances. There was concern that financial pressure would be particularly acute for hospitals serving vulnerable populations, including safety-net (SN) hospitals and critical access hospitals (CAHs). Using data from hospitals in Washington State, we examined changes in operating margins for SN hospitals, CAHs, and other acute care hospitals in 2020 and 2021. We found that the operating margins for all three categories of hospitals fell from 2019 to 2020, with SNs and CAHs sustaining the largest declines. During 2021, operating margins improved for all three hospital categories but SN operating margins still remained negative. Both changes in revenue and changes in expenses contributed to observed changes in operating margins. Our study is one of the first to describe how the financial effects of COVID-19 differed for SNs, CAHs, and other acute care hospitals over the first two years of the pandemic. Our results highlight the continuing financial vulnerability of SNs and demonstrate how the factors that contribute to profitability can shift over time.

This study aims to empirically explore and compare the dynamic dependency between health-care sector and Islamic industries before, during and after the COVID-19 pandemic.

Time-varying student-t copula is used for before, during and after COVID-19 periods. The data used are the daily frequency price series of the selected markets from February 2017 to October 2023.

Empirical results found strong evidence of significant impact of the COVID-19 pandemic on the dependence structure of the studied indexes: Co-movements between various sectors are certain. The authors assist also in the birth of new dependence structure with the health-care industry in response to the COVID-19 crisis. This reflects the contagion occurrence from the health-care sector to other sectors.

By specifically examining the Islamic industry, this study sheds light on the resilience, challenges and opportunities within this sector, contributing novel perspectives to the broader discourse on pandemic-related impacts on economies and industries. Also, this paper conducts a comprehensive temporal analysis, examining the dynamics before, during and after the COVID-19 lockdown. Such approach enables an understanding of how the relationship between the health-care sector and the Islamic industry evolves over time, accounting for both short-term disruptions and long-term effects. By considering the pre-pandemic context, the paper adopts a longitudinal perspective, enabling a deeper understanding of how historical trends, structural factors and institutional frameworks shape the interplay between the health-care sector and the Islamic industry.

Nurse leaders are challenged by ethical issues in today’s complex health-care settings. The purpose of this study was to describe and analyze key elements of moral distress identified by nurse leaders from health-care systems in the USA, Germany, Austria and Switzerland. The aim was to develop an understanding of distressing ethical issues nurse leaders face in the USA and three German-speaking European countries.

This descriptive cross-sectional study surveyed a convenience sample of nurse leaders in the USA, Germany, Austria and Switzerland. The voluntary, anonymous survey also included qualitative questions and was distributed using the Qualtrics® platform. A thematic analysis of the qualitative data in each country was carried out and a comparative analysis identified similarities and differences between the groups of nurse leaders comparing the US data to that from three German-speaking European countries.

The survey was completed by 316 nurse leaders: Germany, Austria, and Switzerland (n = 225) and the USA (n = 91). Similar themes identified as causing all nurse leaders moral distress included a lack of individual and organizational integrity, hierarchical and interprofessional issues, lack of nursing professionalism, patient care/patient safety concerns, finances negatively impacting care and issues around social justice. Within these six themes, there were also differences between the USA and the three German-speaking European countries.

Understanding the experiences associated with distressing ethical situations can allow nurse leaders and organizations to focus on solutions and develop resilience to reduce moral distress in the USA and three German-speaking European countries.

This study aims to observe and discuss an emerging disintermediation in transportation, finance and health care, and explain how these three key areas depend on intermediary institutions that are the fruit of modern corporate governance conditions that find their roots in classical sociological theory.

The authors review and incorporate a diversity of research literature to explain the likelihood for the development and continuation of disintermediation.

The authors map two sociological perspectives (Emile Durkheim’s theory of interdependence and Herbert Spencer’s theory of contracts) to two modern corporate governance theories (resource dependence theory and agency theory). The authors then discuss the challenging social situation resulting from modern corporate governance and show how these conditions create the potential for a continuum of disintermediation across the specific and crucial economic sectors of transportation, finance and health care.

The implications of this theoretical integration can help organizational leaders navigate complex social and strategic issues and prepare for the consequences that may result from the emerging disintermediation.

This study aims to apply the Delphi method to explore the possibilities for implementing agility management concepts in Slovenian health-care organisations.

The research is based on a qualitative Delphi study encompassing 15 employees in different Slovenian health-care organisations.

Slovenian health-care organisations need to be more agile currently. For this reason, it is necessary to begin with organisational changes and organisational learning concepts to educate employees about the meaning and content of agile processes. It is essential to ensure that accepting employee mistakes and offering help to employees becomes normal practice, and it is necessary to ensure the greater trust of the management towards the employees.

The research empowers health-care professionals with new management and leadership concepts, such as agile management, sustainable leadership and leadership development methods in health care.

The integration of industry 4.0 has become a priority for many organizations. However, not all organizations are suitable and capable of implementing industry 4.0 because it requires a dynamic and flexible implementation strategy. The implementation of industry 4.0 often involves overcoming several tensions between internal and external stakeholders. This paper aims to explore the paradoxical tensions that arise for health-care organizations when integrating industry 4.0. Moreover, it discusses how a paradox lens can support the conceptualization and proposes techniques for handling tensions during the integration of industry 4.0.

This qualitative and in-depth study draws upon 32 semi-structured interviews. The empirical case concerns how two health-care organizations handle paradoxical tensions during the integration of industry 4.0.

The exploration resulted in six recurring technology tensions: technology invention (modularized design vs. flexible design), technology collaboration (automation vs. human augmentation), technology-driven patient experience (control vs. autonomy), technology uncertainty (short-term experimentation vs. long-term planning), technology invention and diffusion through collaborative efforts among stakeholders (selective vs. intensive collaboration) and technological innovation (market maintenance vs. disruption).

A paradox theory-informed conceptual model is proposed for how to handle tensions during the integration of industry 4.0. To the best of the authors’ knowledge, this is the first paper to introduce paradox theory for quality management, including lean and Six Sigma.

This survey explores the application of real options theory to the field of health economics. The integration of options theory offers a valuable framework to address these challenges, providing insights into healthcare investments, policy analysis and patient care pathways.

This research employs the real options theory, a financial concept, to delve into health economics challenges. Through a systematic approach, three distinct models rooted in this theory are crafted and analyzed. Firstly, the study examines the value of investing in emerging health technology, factoring in future advantages, associated costs and unpredictability. The second model is patient-centric, evaluating the choice between immediate treatment switch and waiting for more clarity, while also weighing the associated risks. Lastly, the research assesses pandemic-related government policies, emphasizing the importance of delaying decisions in the face of uncertainties, thereby promoting data-driven policymaking.

Three different real options models are presented in this study to illustrate their applicability and value in aiding decision-makers. (1) The first evaluates investments in new technology, analyzing future benefits, discount rates and benefit volatility to determine investment value. (2) In the second model, a patient has the option of switching treatments now or waiting for more information before optimally switching treatments. However, waiting has its risks, such as disease progression. By modeling the potential benefits and risks of both options, and factoring in the time value, this model aids doctors and patients in making informed decisions based on a quantified assessment of potential outcomes. (3) The third model concerns pandemic policy: governments can end or prolong lockdowns. While awaiting more data on the virus might lead to economic and societal strain, the model emphasizes the economic value of deferring decisions under uncertainty.

This research provides a quantified perspective on various decisions in healthcare, from investments in new technology to treatment choices for patients to government decisions regarding pandemics. By applying real options theory, stakeholders can make more evidence-driven decisions.

Decisions about patient care pathways and pandemic policies have direct societal implications. For instance, choices regarding the prolongation or ending of lockdowns can lead to economic and societal strain.

The originality of this study lies in its application of real options theory, a concept from finance, to the realm of health economics, offering novel insights and analytical tools for decision-makers in the healthcare sector.

Research has found a strong correlation between maternal healthcare and health insurance coverage. But, despite having one of the best health coverage systems in the developing world, Rwanda still faces formidable challenges in provision certain key maternal health services, leading to higher levels of maternal morbidity and mortality. To understand this paradox, this study will examine the association between maternal health services and insurance coverage, utilizing the latest data from the Rwanda Demographic Health Survey.

Using a sample of 6,167 childbearing women aged 15–49 years, a bivariate and multivariate analysis was conducted to examine the paradoxical relationship between health insurance and maternal health services, such as antenatal care, in Rwanda.

The results reveal significant differences in ANC4+ and the timing of the first ANC, which remain low in Rwanda. Despite significant improvements in delivery factors and skilled ANC providers, ANC4+ rates in the country remain the lowest. However, this study found a positive and significant association between ANC4+ and insurance coverage (AOR = 1.64, p < 0.001).

Rwanda has implemented an effective health insurance policy, but there has been minimal progress in the utilization of maternal health services. Therefore, there is a strong need for policy interventions to reduce barriers to healthcare utilization. Additionally, supply-side factors such as transportation, socio-cultural factors and other logistic barriers should be examined in greater detail. These factors may overshadow the impact of health insurance on the utilization of healthcare services in Rwanda.

The peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-01-2023-0059

This study aims to explore whether globalization and technology are harmful to health using a global panel data set of 52 countries over the period 1990–2019.

The study focused on four continents: Africa, the Americas, Asia/Oceania and Europe. The authors used four advanced econometric methodologies, which include the standard panel fixed effect (FE), Arellano–Bover/Blundell–Bond dynamic panel, Hausman–Taylor specification and two-stage least squares (FE-2SLS)/Lewbel-2SLS approaches.

The empirical evidence highlights the significance of globalization and technology in promoting global health. The findings suggest that globalization has various impacts on global health indicators and that technology is useful in tracking, monitoring and promoting global health. In addition, the empirical evidence indicates that a truly health-centred process of globalization and technological innovation can only be realized by ensuring that the interests of countries and vulnerable populations to health risks are adequately considered in international decision-making regarding global economic integration.

The authors suggest that achieving the aspiration of global health will entail the use of globalization and information technology to extend human activities and provide equal access to global health.

Improving health outcomes requires a robust health-care service model that delivers cost-efficient services and increase customer patronage. The purpose of this study is to examine how service quality and convenience influence perceived value, satisfaction and customer patronage of health insurance policyholders. Based on contemporary research, this study further investigates the moderating role of trust, inertia, insurer type and word-of-mouth (WOM) on relationship between satisfaction and customer patronage.

This study conceptualized the dimensions of SERVQUAL and SERVCON as drivers of perceived value leading to satisfaction and finally customer patronage in presence of four moderators. To test the hypotheses, data from 500 consumers who had a running health insurance policy was collected and analyzed using partial least square path modeling.

The results of this study showed service quality and convenience dimensions significantly affected perceived value. Perceived value strongly influenced satisfaction and customer patronage intentions. Satisfaction had a significant positive effect on patronage. WOM and trust moderated the satisfaction–patronage relationship for recommendation intention but not repurchase intention. The moderators had an indirect bearing on customer patronage.

Such an engagement ecosystem can be considered to be a revolution, as it will change the way businesses are conducted and how stakeholders interact with one another.

This study adapts and integrates the SERVQUAL and SERVCON models to health insurance domain. Second, this study conceptualizes a modified view of post-benefit convenience relevant for health insurance as policy renewal intention rather than returns/exchanges. This addresses a gap in the SERVCON scale's applicability to insurance services. This study also makes a novel attempt of examining implication of WOM and trust in health insurance domain.