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The Covid-19 pandemic encourages organized structures across health sectors to react to the outbreak and digital health technologies have been identified as promising pillars to respond to the outbreak across the globe. The purpose of this study is to address the scoping review aimed at identifying the innovative entrepreneurial opportunities in digital health-care ecosystems. The study highlights the barriers to digital health in developing countries. The study is a forum for the introduction of entrepreneurship prospects in the Indian sense through other foreign readers in developing countries.

This archival study highlights topical literature to explore successful ways of improving market potential in developed countries with respect to digital health. The research offers insights into how a digital health environment could be applied, provides a trajectory that concentrates on key skills and a creative approach.

Health service providers require developing their competency and skills to accelerate and enhance their entrepreneurial opportunities. Social network dynamics analyzes are particularly helpful in modeling pandemic trends and in tracking post-pandemic digital health needs. The acceptability of digital solutions has to be confronted across developing countries especially in rural areas and a collective public health benefit in form of entrepreneurship to serve the society.

The research temporarily indicates a creative solution to entrepreneurship in developed countries that can be applied in today’s digital arena.

To raise public understanding of the advantages of digital health systems in developed regions, health education and promotion campaigns should be focused. The idea analysis can be useful benchmarks for policymakers rather than digital health jurisdictions. The post-pandemic provides developed countries a great opportunity for advanced technology to expand connectivity and networking to digital health entrepreneurship.

Hospital information system (HIS) can be examined as a vital factor for developing the quality of health care and cost managing. There exists abundant literature on HISs, but implementation-based literature of HIS is rare, typically about progressive countries. However, a study that can comprehensively review published articles is scarce. Therefore, this paper aims to examine the systematic and comprehensive study of HIS in developed countries. Together, the benefits and harms relevant to HIS’s different mechanisms have been considered, and the fundamental challenges of them are addressed to design more efficient HIS in the future.

HIS has been used globally for numerous years and is now being used in a wide area. HIS is broadly used in clinical settings. Information technology (IT) and information system have been suggested as a required piece to solve the health-care-related issues. Hence, to improve HIS’s ability, this paper conducted a review method concentratating on research related to HIS until 2019. A total of 21 papers were recognized and examined as principal research for the summary.

The authors found that HIS can help in reduction of medical mistakes, enhancement doctors’ performance and increase in the quality of the care provided. HIS management can be used to provide better health-care services. Therefore, HIS must be sensible and use clear structures. The authors conclude that, generally, with an increase in awareness, acceptability and the need for HIS worldwide, there will be more strategies and approaches available.

First, this paper provides an outline of the status of HIS. Second, it identifies some distinct research gaps that could be worth studying. Some flawless work may be removed because of applying some filters to select the original articles. Surveying all the papers on the topic of HIS is impossible, too.

Design and sustainability of HIS is still a big issue for most developing countries, despite its wide usage in the developed countries. The technology is changing rapidly, so the field should be reviewed regularly. This paper suggests a suitable framework that will guide HIS in the local conditions of developing countries.

The government will be assisted by the suggested solving ways in its performance and design of electronic health-care projects.

The study brings the viewpoints on the state of HIS mechanisms in developing countries. The paper’s results can offer visions into future research requirements. By providing comparative information and analyzing the current growths in this area, this study will support researchers and professionals to understand the progress in HIS mechanisms better.

The purpose of this study is to explore the direct and indirect effects of perceived provider professionalism and service recovery in enhancing patient satisfaction in a developing country.

This study used a survey method to investigate satisfaction among health-care consumers. This study used data collected from 210 health-care consumers to empirically test the hypotheses via structural equation modeling

This study found that service recovery has a significant direct effect on patient satisfaction. Though this study did not find perceived provider professionalism to have a direct effect on patient satisfaction, it found an indirect effect in the relationship via service experience. Thus, service experience fully/completely mediates the relationship between perceived provider professionalism and patient satisfaction, while partially mediating the significant relationship between service recovery and patient satisfaction.

The results further underscore the need for health-care organizations in developing countries to focus on mindfully developing operations-oriented strategies that lead to the delivery of memorable service experiences for patients.

The purpose of this paper is to gauge the health-care services from a patient’s perspective in five private hospitals in the Syrian capital Damascus.

The five dimensions-SERVQUAL model (tangibility, empathy, assurance, reliability and responsiveness) was implemented to measure the gap between patient’s perception and expectation in health-care service quality.

The SERVQUAL tool proved to be reliable and valid in assessing service quality in Syrian health-care setting. The assessment of the service quality from a patient’s perspective shows that all SERVQUAL dimensions were negative except for tangible element that scored (+0.57) gap. Based on patient’s expectation, empathy scored the highest score with (4.37), followed by responsiveness (4.17), reliability (3.90), tangibility (3.82) and assurance (3.45). The widest negative gaps among the 22 SERVQUAL items were related to listening skills of hospital staffs (−1.52) and for spending enough time with patient (−1.81). This study indicated that tangible dimension plays a significant role in balancing the deficiency in other service quality dimensions. In addition, communication skills of medical and paramedical staff should be improved to ameliorate patient’s perception about health-care services.

This study provides valuable insights into the patient’s perception, but the feedback from hospital staffs (doctor, nurses) and hospital’s senior managers also considered potential rich information sources. This survey is conducted in the capital, and future research should include replication of this study in the other 13 Syrian governorates before generalizing the findings of this research.

Hospital administrator could use SERVQUAL model to improve their operational performance as well as to benchmark their behavior against other competitors in the health-care market in Damascus. This paper provides valuable information to policymakers and top hospital management to understand patient-centered care and to improve health-care system in Syria. Besides, this research provides a marketing insight to realize what patient expects and how she/he assesses the care service.

To the author’s knowledge, this is one of very few studies conducted to assess service quality in private health-care sector in Damascus. The main contribution of this study is providing the empirical evidence that the five dimensions-SERVQUAL scale proved to be reliable and valid instrument for measuring and analyzing health-care service quality in Syria.

Health-care building maintenance has been receiving concern because of the recent global pandemic. However, there are inadequate broad studies affecting health-care facilities maintenance and feasible solutions in Nigeria. This study aims to conduct an all-inclusive review of public hospital building maintenance issues and proffer possible solutions to improve maintenance practices in health-care buildings via a framework that will support studies in the future.

A review of published papers from 2006 to 2020 was conducted. Based on the keywords, 3 pertinent databases were searched and descriptions of the findings from 40 studies were recognised and used in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Two main themes (issues and feasible solutions to improve practices) emerged from public health-care building maintenance practices. The study developed a framework that describes the relationship between issues and possible solutions with an emphasis on how to improve human development, management efficiency, technical competence and professional skills, cost-minimisation and others.

As part of the paper implications, emerged issues were group into five categories (human development, management, technical, limited financial resources and others). The proposed framework for future studies will attempt to mitigate issues and proffer feasible solutions to improve hospital building maintenance practices in Nigeria and other developing countries that are facing similar challenges.

To the best of the author’s knowledge, this paper is possibly the first comprehensive review of public health-care building maintenance practices in Nigeria. Moreover, this review demonstrates how the proposed feasible solutions can mitigate problems.

This paper presents three models of funding health care in 130 developing countries, based upon a public system, a private system and personal remittances.

The authors trace the funding of health from foreign aid to health funding and health outcomes in the public system, foreign direct investment to health funding in the private system, and personal remittances to health outcomes. This is followed by panel data, fixed effects models subjected to 2-, 3- and 4-stage least squares regressions.

Findings from the first model were that aid in the form of Technical Cooperation Grants funded Infrastructure. Infrastructure Spending due to aid funds Government Health Plans, which reduced the Incidence of Tuberculosis, which in turn reduced Undernourishment and increases Life Expectancy. Other positive health outcomes included reduced Birth Rate and reduced Maternal Mortality. In the second model, Foreign Direct Investment increased Female Employment and GDP per Person, funding Private Health Plans, which increase Life Expectancy, reduced Undernourishment, increased Skilled Care at Birth, increased the Number of Hospital Beds, reduced Maternal Mortality and increased the Birth Rate. In the third model, Remittances influenced both Out-of-Pocket Medical Expenses and Private Plans.

Publicly funded programs may be directed to nutrition, increasing life expectancy. Private funding may be directed to improving maternal conditions, with remittances removing the liquidity constraints.

This paper is the first attempt to trace health funding from its sources of foreign aid, foreign direct investment and personal remittances using three separate paths.

This paper aims to validate an initially developed e-Health readiness assessment model.

The authors thematically analysed an initial qualitative data collected and used the outcome to develop survey instruments for this study. To collect the quantitative data, the authors used the drop and collect survey approach given the research setting. The quantitative data was analysed using factor and regression analyses of SPSS 23 in which hypotheses formulated were tested.

The results suggest that the model [R² = 0.971; F (5, 214) = 1414.303], which is made up of readiness assessment factors (constructs) and measuring tools explain about 97% of the variance of the overall health information technology/e-Health adoption readiness at Komfo Anokye Teaching Hospital. The measuring tools were reliable for assessing the composite variables (constructs): technology readiness; operational resource readiness; organizational and cultural readiness; regulatory and policy readiness; and core readiness, which have significant influence on eHealth adoption readiness assessment..

This study has successfully validated empirically developed eHealth readiness assessment model with complete reliable indicators given that existing eHealth readiness assessment models have not been effective due to a general lack of standard indicators for measuring assessment factors. The study also contributes to the growing research on the adoption of information technology/systems in health-care environment using the Technology–Organization–Environment framework.

The purpose of this paper is to explore the supply-side factors that determines the quality of global healthcare services from medical tourism healthcare providers’ (MTHP) perspective, which provide value-in-medical-travel to foreign patients/medical tourists, who travel to India for medical treatment/surgery.

The thematic content analysis of in-depth interviews with 15 senior MTHP, from 15 private hospitals in India was undertaken, to generate the themes, and identify the supply-side factors necessary for sustainable medical tourism management.

The findings conclude that MTHP ranked in ascending order, less waiting-time for surgery, healthcare quality and accreditation, staff/surgeon’s expertise, healthcare information, hospital facilities and services, patient-safety, travel-risk, surgical costs and holiday opportunity as essential factors for providing sustainable quality and value-in-medical-travel to patients.

Many private hospital spokespersons declined to be interviewed due to confidentiality and privacy policy

The findings are generalised in case of global private hospitals treating foreign patients. Policy implications suggest that private hospitals in developing countries need to focus on providing value-in-medical-travel, such as accreditation quality of healthcare, no waiting-time, patient-safety, qualified and experienced medical and non-medical staff, hospital facilities and post-surgery care with positive healthcare outcomes.

Medical-tour facilitators, hotels and tourism sites need to collaborate with agencies to provide inclusive built environment, first-aid and wheelchair access, to medical tourists, having financial and legal implications for business.

There is little qualitative empirical research on the views of MTHP, regarding management of essential supply-side factors that provide value-in-medical-travel to attract medical tourists to India.

医疗保健提供者对印度医疗旅行价值的看法

本文的目的是从医疗旅游医疗保健提供者的角度探讨决定全球医疗服务质量的供应方因素, 这些因素可为前往印度求医的外国患者/医疗游客提供医疗旅行的价值治疗/手术.

对印度15家私立医院的15家高级医疗旅游保健提供者（MTHP）进行了深度访谈, 对主题内容进行了分析, 以生成主题并确定可持续医疗旅游管理所必需的供应方因素。

研究结果得出结论, MTHP以升序排列的顺序是：手术等待时间, 医疗质量和认证, 工作人员/外科医生的专业知识, 医疗保健信息, 医院设施和服务, 患者安全, 旅行风险, 手术费用和度假时间机会是为患者提供医疗旅行可持续质量和价值的重要因素。

由于医院的机密性和隐私权政策, 许多私立医院发言人拒绝接受采访。

如果全球私立医院为外国医疗游客提供治疗, 那么研究结果将得到概括。政策含义表明, 发展中国家的私立医院需要集中精力提供医疗旅行价值, 例如无需等待时间的医疗保健认证质量和患者安全, 合格和经验丰富的医务人员和非医务人员, 医院设施和后期医疗服务。具有积极医疗效果的手术护理。

旅馆, 医疗旅行促进者和旅游景点需要与机构合作, 为医疗游客提供紧急急救和轮椅通道, 这对企业有财务和法律影响。

关于MTHP观点的定性实证研究很少, 涉及对提供医疗旅行价值以吸引医疗游客前往印度的基本供应方因素的管理。

印度, 医疗旅游, 全球化 等待时间, 患者安全, 认证质量

研究论文

Perspectiva del valor de los proveedores del cuidado de la salud en viajes con propositos medicos a la India

El propósito de esta investigación es explorar los factores que del lado de la oferta determinan la calidad de los servicios globales de salud desde el punto de vista del proveedor, el cual agrega valor al viaje con propósitos médicos a pacientes/turistas médicos quienes viajan a la India para tratamientos médicos ó cirugía.

El análisis de contenido temático de las detalladas entrevistas, con-15 proveedores experimentados de asistencia sanitaria de turismo medico, en-15 hospitales de la India, fué realizado para generar los temas é identificar los factores que del lado de la oferta son necesarios para la gestión sostenible del turismo médico.

Los hallazgos concluyen que proveedores experimentados de turismo ranquearon en orden ascendente la reducción en tiempos de espera para cirugías, acreditación de la calidad del cuidado de la salud, experticia del personal no médico y de cirugía, información del cuidado de la salud, servicios é instalaciones de los hospitales, seguridad del paciente, riesgos de viaje, costos de cirugías, y oportunidades vacacionales, como factores esenciales para proveer calidad sostenible y valor en los viajes con propósitos médicos a los pacientes.

Muchos representates de los hospitales privados se rehusaron a ser entrevistados debido las políticas de privacidad y confidencialidad del hospitales.

Los hallazgos son generalizables en el caso de hospitales privados globales que tratan a turistas médicos extranjeros. Las implicaciones políticas sugieren que los hospitales privados en los países en vía de desarrollo necesitan enfocarse en agregar valor al viaje médico, por medios como la calidad de acreditación de la atención médica, reduccion de tiempos de espera y la seguridad del paciente, personal médico y no médico calificado y experimentado, instalaciones hospitalarias y servicios posoperatorios con resultados sanitarios positivos.

Los hoteles, los facilitadores de toures médicos y los sitios de turismo necesitan colaborar con las agencias para proveer primeros auxilios de emergencia y acceso en silla de ruedas a los turistas médicos, teniendo esto implicaciones financieras y legales para los negocios.

Existe poca investigación empírica cualitativa sobre los puntos-de vista-de (MTHP) proveedores de asistencia sanitaria de turismo médico con respecto a la gestión de los factores esenciales del lado de la oferta que agregan valor al turismo con fiines médicos para atraer turistas médicos a la India.

India, globalización, turismo médico, tiempo-de-espera, calidad, seguridad-del- paciente

Trabajo de investigación

To examine the major factors affecting patients' perception of cumulative satisfaction and to address the question whether patients in Egypt and Jordan evaluate quality of health care similarly or differently.

A conceptual model including behavioural dimensions of patient‐physician relationships and patient satisfaction has been developed. As the empirical research setting, this study concerns three hospitals in Egypt and Jordan. The survey instrument in a questionnaire form was designed to achieve the research objectives. A total of 48 items (attributes) of the newly developed five quality dimensions were identified to be the most relevant. A total of 224 complete and usable questionnaires were received from the in‐patients.

Hospital C has above‐average total and dimensional qualities and patients are the most satisfied in accordance with all dimensions of services. Hospitals A and B have under‐average total qualities as the majority of patients are not satisfied with services. Comparing hospitals A and B, in the majority of dimensions (with the exception of Q5), the quality in hospital B is higher than in hospital A. Patients' satisfaction with different service quality dimensions is correlated with their willingness to recommend the hospital to others. A cure to improve the quality for health‐care services can be an application of total relationship management and the 5Qs model together with customer orientation strategy.

The result can be used by the hospitals to reengineer and redesign creatively their quality management processes and the future direction of their more effective health‐care quality strategies.

In this research a study is described involving a new instrument and a new method which assure a reasonable level of relevance, validity and reliability, while being explicitly change‐oriented. This study argues that a patient's satisfaction is a cumulative construct, summing satisfaction with five different qualities (5Qs) of the hospital: quality of object, processes, infrastructure, interaction, and atmosphere.

Objective – Tanzania, Mexico, and the United States are at vastly different points on the economic development scale. Yet, their health systems can be classified as “developing”: they do not live up to their potential, considering the resources available to them. The three, representing many others, share a common structural deficiency: a segregated health care system that cannot achieve its basic goals, the optimal health of its people, and their possible satisfaction with the system. Segregation follows and signifies first and foremost the lack of financial integration in the system that prevents it from serving its goals through the objectives of equity, cost containment and sustainability, efficient production of care and health, and choice.

Method – The chapter contrasts the nature of the developing health care system with the common goals, objectives, and principles of the Emerging Paradigm (EP) in developed, integrated – yet decentralized –systems. In this context, the developing health care system is defined by its structural deficiencies, and reform proposals are outlined.

Findings – In spite of the vast differences amongst the three countries, their health care systems share strikingly similar features. At least 50% of their total funding sources are private. The systems comprise exclusive vertically integrated, yet segregated, “silos” that handle all systemic functions. These reflect and promote wide variations in health insurance coverage and levels of benefits – substantial portions of their populations are without adequate coverage altogether; a considerable lack of income protection from medical spending; an inability to formalize and follow a coherent health policy; a lack of financial discipline that threatens sustainability and overall efficiency; inefficient production of care and health; and an dissatisfied population. These features are often promoted by the state, using tax money, and donors.

Policy implications – The situation can be rectified by (a) “centralizing” – at any level of development and resource availability – health system finance around a set package of core medical benefits that is made available to the entire population and (b) “decentralizing” consumption and provision of care. The first serves equity and cost containment and sustainability. The second supports efficiency and client satisfaction.

Originality/value of chapter – The chapter views commonly discussed problems of the health care system – a lack of insurance coverage and income protection – as symptoms of a large problem: health system segregation.