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Book part
Publication date: 20 March 2007

Alfonso R. Oddo

Health care spending in the U.S. continues to outpace inflation and wage growth, which is likely to keep the burden of rising health care costs in the spotlight. As health

Abstract

Health care spending in the U.S. continues to outpace inflation and wage growth, which is likely to keep the burden of rising health care costs in the spotlight. As health care costs increase, health insurers face the challenges of providing quality health care at a reasonable cost. Some health care providers and insurers use economic measures such as return on investment to assess the effectiveness of health care. How does one measure the value of health? What are some of the advantages and disadvantages of using economic measures to evaluate health care?

This paper looks health care costs and who pays for them. What portion of health care costs is borne by employers? What portion by employees? Who does or should pay for health care of people who are uninsured? What is the role of insurance? If people do not have health care insurance, does it matter whether the reason they are uninsured is because they cannot afford it or because they choose not to be insured?

Selvam (2002) belives that the number one ethical dilemma in the U.S. is how to address the almost 40 million Americans who lack health care coverage. With rising hospital costs, even the hardest-working and most prudent persons are at risk. Many workers do not have health insurance and even if they are covered, they may not get what they need. What are some of the ethical issues facing patients, health care providers and insurers? What role should government have in assuring that all people receive quality health care?

Details

Insurance Ethics for a More Ethical World
Type: Book
ISBN: 978-1-84950-431-7

Article
Publication date: 19 May 2022

Alok Kumar Samanta, Varaprasad G. and Anand Gurumurthy

Health care organisations implement lean six sigma (LSS) methodology to achieve improved performance in terms of cost, quality and productivity. However, the way it gets…

Abstract

Purpose

Health care organisations implement lean six sigma (LSS) methodology to achieve improved performance in terms of cost, quality and productivity. However, the way it gets implemented differs between organisations. Hence, this paper deal with a review of case studies describing the implementation of LSS in health care organisations to understand the nuances of implementation and identify future research directions.

Design/methodology/approach

The journal articles indexed in the Web of Science and Scopus database were filtered out. In total, 154 articles were evaluated using specific structural dimensions to categorise the literature into various groups, and content analysis was performed to synthesise the same.

Findings

This review revealed that the number of articles publishing the application of LSS in health care has been increasing in the last five years. Academic hospitals play a pivotal role to bridge the gap between LSS theory and practice. Despite this fact, certain themes remain unexplored. Not many studies are available that document the application of LSS in non-clinical areas such as pharmacy, internal logistics, maintenance and medical records. Only 20% of articles mentioned the post-intervention data up to three years, thus questioning the sustainability aspect of the achieved improvements.

Research limitations/implications

Various research gaps were identified, which can be used by the researchers to build the body of knowledge in the domain of LSS in health care.

Practical implications

This review provides a diversified view regarding the utility of LSS in the health care scenario. The findings will provide valuable insights for the health care practitioners regarding tools, techniques, drivers and performance measures.

Originality/value

To the best of the authors’ knowledge, this is the first study to review only the case studies that describe the implementation of LSS in the health care sector.

Details

International Journal of Lean Six Sigma, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 2040-4166

Keywords

Article
Publication date: 1 October 2005

Vasco Eiriz and José António Figueiredo

To develop a framework for evaluating the quality of Portuguese health care organisations based on the relationship between customers and providers, to define key…

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Abstract

Purpose

To develop a framework for evaluating the quality of Portuguese health care organisations based on the relationship between customers and providers, to define key variables related to the quality of health care services based on a review of the available literature, and to establish a conceptual framework in order to test the framework and variables empirically.

Design/methodology/approach

Systematic review of the literature.

Findings

Health care services quality should not be evaluated exclusively by customers. Given the complexity, ambiguity and heterogeneity of health care services, the authors develop a framework for health care evaluation based on the relationship between customers (patients, their relatives and citizens) and providers (managers, doctors, other technical staff and non‐technical staff), and considering four quality items (customer service orientation, financial performance, logistical functionality and level of staff competence).

Originality/value

This article identifies important changes in the Portuguese health care industry, such as the ownership of health care providers. At the same time, customers are changing their attitudes towards health care, becoming much more concerned and demanding of health services. These changes are forcing Portuguese private and public health care organisations to develop more marketing‐oriented services. This article recognises the importance of quality evaluation of health care services as a means of increasing customer satisfaction and organisational efficiency, and develops a framework for health care evaluation based on the relationship between customers and providers.

Details

International Journal of Health Care Quality Assurance, vol. 18 no. 6
Type: Research Article
ISSN: 0952-6862

Keywords

Article
Publication date: 1 September 2006

Evelien van der Schee, Peter P. Groenewegen and Roland D. Friele

If public trust in health care is to be used as a performance indicator for health care systems, its measurement has to be sensitive to changes in the health care system…

1832

Abstract

Purpose

If public trust in health care is to be used as a performance indicator for health care systems, its measurement has to be sensitive to changes in the health care system. For this purpose, this study has monitored public trust in health care in The Netherlands over an eight‐year period, from 1997 to 2004. The study expected to find a decrease in public trust, with a low point in 2002.

Design/methodology/approach

Since 1997, public trust in health care was measured through postal questionnaires to the “health care consumer panel”. This panel consists of approximately 1,500 households and forms a representative sample of the Dutch population.

Findings

Trust in health care and trust in hospitals did not show any significant trend. Trust in medical specialists displayed an upward trend. Trust in future health care, trust in five out of six dimensions of health care and trust in general practitioners actually did show a decrease. However, only for trust in macro level policies and trust in professional expertise this trend continued. For the remaining trust objects, after 1999 or 2000, an upward trend set in.

Research implications/limitations

No support was found for our overall assumption. Explanations for the fact that trust did increase after 1999 or 2000 are difficult to find. On the basis of these findings the study questions whether the measure of public trust is sensitive enough to provide information on the performance of the health care system.

Originality/value

The aim of this research is to study public trust in health care on its abilities to be used as a performance indicator for health care systems.

Details

Journal of Health Organization and Management, vol. 20 no. 5
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 22 April 2022

Eunice Okyere, Paul Russell Ward, Kissinger Marfoh and Lillian Mwanri

This study seeks to explore health workers' perceptions and experiences on incentives for motivating and retaining them in primary health-care facilities in rural Ghana.

Abstract

Purpose

This study seeks to explore health workers' perceptions and experiences on incentives for motivating and retaining them in primary health-care facilities in rural Ghana.

Design/methodology/approach

Phenomenological research design was used to explore health workers’ experiences and perceptions on their incentive packages. Sixty-eight in-depth interviews were conducted with health-care workers in primary health-care facilities and analyzed using thematic analysis approach.

Findings

The findings show health-care workers’ perceptions on their incentives, ranging from low awareness, unfair distribution, favoritism, means of punishment and incentives regarded unattractive. The preferred incentive packages identified were salary increase, housing availability, recognition, adequate supplies, and risk and responsibility allowances. Health-care workers suggested for the modification of incentives including vehicle importation waiver, reduction in study leave years and opportunity to pursue desired courses.

Originality/value

The findings suggest that incentives that align with health-care workers’ preferences can potentially improve their motivation and influence retention. Health-care workers’ concern on incentives having been used as favors and punishment as well as unfair distribution should be addressed by health managers and policymakers, to achieve the desired purpose of motivating and retaining them in rural areas. Appropriate internal monitoring mechanisms are needed for incentives regulation and to improve health workers’ retention in rural Ghana.

Details

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

Keywords

Article
Publication date: 3 May 2022

Jitesh J. Thakkar, Shashank Thanki and Sunita Guru

The present situation of COVID-19 pandemic has put the health-care systems under tremendous stress and stringent tests for their ability to offer expected quality of…

Abstract

Purpose

The present situation of COVID-19 pandemic has put the health-care systems under tremendous stress and stringent tests for their ability to offer expected quality of health-care services, as it decides the sustainability and growth of health-care service providers. This study aims to deliver a quantitative framework for service quality assessment in the health-care industry by classifying the health-care service quality parameters into four balanced scorecard (BSC) perspectives.

Design/methodology/approach

To determine the service quality for the Indian health-care system, decision-making trial and evaluation laboratory and analytical network process are integrated in a fuzzy environment to contemplate the interaction among BSC perspectives and respective performance measures.

Findings

The results indicate “internal processes” perspective assumes the key role within BSC perspectives, while performance measures “nursing staff turnover” and “staff training” play the key roles. The results also signify that “patient satisfaction” is the most vital issue and can be strongly influenced by measures belonging to the “learning and growth” perspective. In “learning and growth” perspective, “staff training” is the most decisive criteria, very highly influencing “patient satisfaction”, highly influencing “profitability,” “change of cost per patient (both in and out patients)” and “outpatient waiting time” while moderately influencing “staff satisfaction,” “bed occupancy” and “nursing staff turnover”. Moreover, “staff training” criteria have a positive influence on “nursing staff turnover.”

Originality/value

The contributions of this study are in two folds in the domain of quantification of service quality for the health-care system. First, it delivers an assessment framework for Indian health-care service quality. Second, it demonstrates an application of the framework for a case situation and validates the proposed framework.

Details

Journal of Modelling in Management, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1746-5664

Keywords

Open Access
Article
Publication date: 10 May 2022

Simone Fanelli, Lorenzo Pratici, Fiorella Pia Salvatore, Chiara Carolina Donelli and Antonello Zangrandi

This study aims to provide a picture of the current state of art in the use of big data for decision-making processes for the management of health-care organizations.

Abstract

Purpose

This study aims to provide a picture of the current state of art in the use of big data for decision-making processes for the management of health-care organizations.

Design/methodology/approach

A systematic literature review was carried out. The research uses two analyses: descriptive analysis, describing the evolution of citations; keywords; and the ten most influential papers, and bibliometric analysis, for content evaluation, for which a cluster analysis was performed.

Findings

A total of 48 articles were selected for bibliographic coupling out of an initial sample of more than 5,000 papers. Of the 48 articles, 29 are linked on the basis of their bibliography. Clustering the 29 articles on the basis of actual content, four research areas emerged: quality of care, quality of service, crisis management and data management.

Originality/value

Health-care organizations believe strongly that big data can become the most effective tool for correctly influencing the decision-making processes. Thus, more and more organizations continue to invest in big data analytics, and the literature on this topic has expanded rapidly. This study seeks to provide a comprehensive picture of the different streams of literature existing, together with gaps in research and future perspectives. The literature is mature enough for an analysis to be made and provide managers with useful insights on opportunities, criticisms and perspectives on the use of big data for health-care organizations. However, to date, there is no comprehensive literature review on the big data analysis in health care. Furthermore, as big data is a “sexy catchphrase,” more clarity on its usage may be needed. It represents an important tool to be investigated and its great potential is often yet to be discovered. This study thus sheds light on emerging issues and suggests further research that may be needed.

Details

Management Research Review, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 2040-8269

Keywords

Article
Publication date: 12 April 2022

Kamal Gulati, Angel Rajan Singh, Shakti Kumar Gupta and Chitra Sarkar

Leadership skills are vital for efficient delivery of health reforms. India, a low- and middle-income country, is transforming its public health care significantly. The…

Abstract

Purpose

Leadership skills are vital for efficient delivery of health reforms. India, a low- and middle-income country, is transforming its public health care significantly. The health workforce, particularly doctors, however lacks leadership skills. This study aims to highlight the leadership skills gap and raise concerns about how India might achieve its ambitious health reforms in the lack of formal, prospective leadership training for its workforce.

Design/methodology/approach

This study conducted nine management development programmes between 2012 and 2020 and collected data from 416 (N = 444, 94% response rate) health-care professionals using a questionnaire. Participants were asked to inform leadership challenges that they perceived critical. A total of 47 unique challenges were identified, which were distributed across five domains of American College of Healthcare Executives Competency Assessment Tool (2020). Relevant information was also obtained from review of secondary sources including journal articles from scientific and grey literature and government websites.

Findings

Majority of participants (85.36%) had never attended any management training and were from public sector (56.1%). Mean total experience was 18 years. Top 5 challenges were lack of motivation (54.26%), communication (52.38%), contracts management (48.31%), leadership skills (47.26%) and retention of workforce (45.56%). Maximum challenges (29) were in domain of business skills and knowledge, followed by knowledge of health-care environment (9), leadership, professionalism, and communication and relationship management (3 each).

Originality/value

In absence of the leadership training, senior health professionals particularly doctors in India, suffer leadership challenges. Efforts should be made to strengthen leadership capacity in Indian health-care system to advance the country’s ongoing national health reforms.

Details

Leadership in Health Services, vol. 35 no. 3
Type: Research Article
ISSN: 1751-1879

Keywords

Article
Publication date: 3 May 2022

Elham Mehrinejad Khotbehsara, Hossein Safari, Reza Askarizad and Kathirgamalingam Somasundaraswaran

This study aims to explore the impact of spatial configuration on behavioral patterns of visitors in the ground floor of health-care spaces.

Abstract

Purpose

This study aims to explore the impact of spatial configuration on behavioral patterns of visitors in the ground floor of health-care spaces.

Design/methodology/approach

In this study, the Space Syntax analysis was used to combine visibility graph analysis and axial line analysis with empirical observation of visitors’ activities. Two types of observation methods on visitors were conducted to discover the behavioral patterns of individuals, respectively, named “gate counts” and “people following.”

Findings

The outcomes of this research revealed that the spatial arrangements of pathways, public areas, vertical circulations, entrance space, lobby, emergency department, reception desk and pharmacy have a significant influence on the way that visitors perceive the health-care environment.

Research limitations/implications

The current research is limited to two aspects of effective wayfinding (configuration of health care and geometry). Future work can investigate the other potential factors coupled with the current factor as an integrated research for enhancing wayfinding and sustaining accessibility. Another limitation is that the observation results for this study had been conducted before the COVID-19 pandemic and future studies can compare these results with the current COVID-19 situation within health care environments.

Originality/value

A large amount of research has focused on the needs of populations in developed countries. This topic has not been investigated thoroughly by professionals in developing countries such as Iran. Accordingly, this study benefits environmental psychologists and architects by revealing the effective characteristics of legible spaces in health-care environments.

Details

Facilities , vol. 40 no. 9/10
Type: Research Article
ISSN: 0263-2772

Keywords

Book part
Publication date: 22 March 2021

Christoph Sowada and Iwona Kowalska-Bobko

As all countries in the world, Polish health care system has to challenge four fundamental transformations: demographic, technological, epidemiological and cultural. Each…

Abstract

As all countries in the world, Polish health care system has to challenge four fundamental transformations: demographic, technological, epidemiological and cultural. Each of them generates serious threats for the sustainability of the system. The Polish society is ageing even faster than other in the European Union. For the sustainability of the system, the ageing of the population is a double challenge: on the expenditure side and on the financing side.

The Polish health care system is characterised by three negative features: under-financing of health care, misguided organisation of the health sector and health care entities and a dramatic shortage of health care professionals. The share of GDP devoted to health has remained constant over the last years at the level of 6.3%–6.7%. Poland has one of the lowest rates of practicing doctors and nurses in the EU countries. Lack of attractiveness of the medical professions caused by consistently low wages has created a huge generation gap.

Looking from the perspective of cost-effectiveness, we must to state, that the system, with its small financial outlays, provides a relatively high level of health for the population. However, it does not mean that better results could not be achieved. The majority of the public hospitals run in the form of independent public health care units that are highly inefficient and indebted. All attempts to restructure the sector and to solve the problem of arrears of the public hospitals failed so far.

To face the challenges, Poland must change its health policy. An increase in the sector's financing is needed, bearing in mind that increasing outlays alone is certainly not enough to solve all problems and secure sustainability. Deep structural and organisational changes are necessary. Unfortunately, politicians avoid making difficult but necessary decisions, e.g., drastic restructuring of the hospital sector, preferring above all to increase public spending on health.

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