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Article
Publication date: 31 August 2012

Mohammad Nurunnabi and Syed Kamrul Islam

The purpose of this paper is to examine the perceived Bangladesh privatized healthcare sector accountability gap.

Abstract

Purpose

The purpose of this paper is to examine the perceived Bangladesh privatized healthcare sector accountability gap.

Design/methodology/approach

Data were collected from 533 patients using services in 45 Dhaka city privatized hospitals. A questionnaire was designed based on 60 patient focus study group and the literature.

Findings

Structural equation modeling provides a comprehensive picture that allows healthcare constructs and accountability to be tested. The goodness‐of‐fit statistics supported the four factors of professionals, administration and management, legal enforcement, ethics and government, which were significantly associated with accountability. Despite Bangladeshi privatized healthcare growth, the study revealed that accountability mainly depends on government initiatives and effectively implementing existing laws.

Research limitations/implications

The study covered one Bangladesh city (Dhaka) owing to resource constraints. Qualitative methods may have enriched the findings.

Practical implications

The accountability dimensions may be applicable to other countries to examine the perceived accountability gap. The study looked at the current Bangladesh privatized healthcare sector. Major issues of Bangladesh privatized healthcare accountability are discussed and recommendations for policymakers are suggested to improve the current circumstances.

Originality/value

The study is the first of its kind to examine accountability among privatized healthcare providers in developing countries. Patients’ accountability views require urgent attention from policy makers.

Details

International Journal of Health Care Quality Assurance, vol. 25 no. 7
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 24 July 2007

Randolph K. Quaye

The purpose of this paper is to explore, 14 years since the introduction of market reforms, the extent to which changes have altered the nature of Sweden's health care

Abstract

Purpose

The purpose of this paper is to explore, 14 years since the introduction of market reforms, the extent to which changes have altered the nature of Sweden's health care financing, examine how these changes have affected the views of Sweden's physicians, and to judge the impact of these reforms on the delivery and quality of care.

Design/methodology/approach

Swedish physicians', Federation of County Council members' and health economists' views, were explored. The data were obtained from in‐depth interviews with 31 respondents in the summer of 2005. The sample was drawn from Stockholm County and the Skane Region.

Findings

The respondents generally believed that the Swedish health care system basic structure had remained intact and that several early 1990s reforms, to introduce financial incentives into health care system, had worked well. The diagnostic‐related groups system, though not popular among some health care providers, seemed to have worked for the purposes intended. The majority of Swedish physicians interviewed expressed general satisfaction with their work. Several praised the internal reforms as contributing to more stable health care expenditures, which are low compared with other countries. A majority of respondents supported the care guarantee provisions.

Originality/value

This paper points out that Sweden is showing what governments can do in a global society where access to health care is paramount. All Swedes can feel proud of a well‐planned health care system.

Details

International Journal of Health Care Quality Assurance, vol. 20 no. 5
Type: Research Article
ISSN: 0952-6862

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Book part
Publication date: 21 October 2008

Elizabeth Anne Jenner

Health care has become one of the paramount issues of the 21st century as governments and individuals grapple the complex problems associated with contemporary medical care

Abstract

Health care has become one of the paramount issues of the 21st century as governments and individuals grapple the complex problems associated with contemporary medical care such as cost, affordability, and shifting demographic trends. One response has been the growth of medical tourism (sometimes called health tourism or global healthcare). Medical tourism is an example of how the forces of globalization are re-shaping what has previously been a relatively stable localized service, medical treatment, in the face of changes to health care. While traveling to distant locations in search of health restoring locations is not new as the affluent have long traveled to spas or exotic locales to derive health benefits. What has changed is who is doing it and why they are doing it as insurers and patients alike become eager participants in the outsourcing of medical care. The rising number of uninsured and underinsured Americans, particularly in the middle class, has been coupled with effective marketing by medical tourism companies to produce growing numbers of Americans traveling to foreign countries for healthcare. China, India, Korea, Malaysia, the Philippines, South Africa, and Thailand are only a few of the competitors for overseas patients as a source for economic development. Using analytic frameworks of Immanuel Wallerstein and Anthony Giddens to provide a social analysis of this phenomenon yields an exploration of this trend.

Details

Care for Major Health Problems and Population Health Concerns: Impacts on Patients, Providers and Policy
Type: Book
ISBN: 978-1-84855-160-2

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Article
Publication date: 1 February 1997

Judith D. Smyth

Competition is now widely used as the means of choosing the providers of essential public services in the USA and the UK. Many different approaches are found in the USA…

Abstract

Competition is now widely used as the means of choosing the providers of essential public services in the USA and the UK. Many different approaches are found in the USA and there are useful lessons for the UK. With particular reference to mental health and substance abuse services, describes the effects of using competitive tendering on users, providers, purchasers and citizens and examines the problems of specification, transaction costs, the use of consultants, supply, the level playing field, trust, innovation, local accessibility and accountability. Ends with discussion of co‐operation and collaboration and the emergence of monopolies and integrated delivery systems in the USA and concludes by finding politics and political decision making of overriding importance.

Details

International Journal of Public Sector Management, vol. 10 no. 1/2
Type: Research Article
ISSN: 0951-3558

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Book part
Publication date: 1 January 2008

Susan M. Chambré and Melinda Goldner

Health care systems all over the world are undergoing rapid and profound transformations. These changes are the result of a broad array of economic and social trends…

Abstract

Health care systems all over the world are undergoing rapid and profound transformations. These changes are the result of a broad array of economic and social trends including neo-liberal economic policies that are contributing to the trend toward privatization, the commodification of health services and products, institutional restructuring (e.g., managed care) to contain costs in the context of technological advances, globalization and demographic changes such as population aging in post-industrial societies. Questions about the accessibility and quality of health care delivery in the face of persistent health disparities, growing numbers of medical errors, and new and uncertain risks posed by emerging infectious diseases, some of them drug-resistant, have also contributed to rethinking about health policy.

Details

Patients, Consumers and Civil Society
Type: Book
ISBN: 978-1-84855-215-9

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Book part
Publication date: 10 November 2005

Rachel Collins Wilson

Recent invasions, coups, civil wars, and ethnic crusades have caused many individuals and families around the world to flee their homelands for fear of their own safety…

Abstract

Recent invasions, coups, civil wars, and ethnic crusades have caused many individuals and families around the world to flee their homelands for fear of their own safety. The exodus of refugees to foreign nations causes a strain on those nations’ health care systems and resources. With the assistance of outside organizations, these countries can develop a health care management system for refugees that provides for both their immediate survival and long-term health stability, while preserving critical national resources. This chapter reviews the refugee problem and presents the short-term tactics and long-term strategies undertaken by seven very different national governments to care for the refugees that cross their borders. A model of a sound health care management system is used to incorporate the best practices of each country into a framework for approaching this multi-billion dollar issue.

Details

International Health Care Management
Type: Book
ISBN: 978-0-76231-228-3

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Book part
Publication date: 22 December 2006

Dennis J. Gayle and Jonathan N. Goodrich

As both concept and process, privatization possesses ambiguous connotations and multiple meanings. Webster's Dictionary (1981) defines one related noun, privatism, as “an…

Abstract

As both concept and process, privatization possesses ambiguous connotations and multiple meanings. Webster's Dictionary (1981) defines one related noun, privatism, as “an attitude of uncommitment or uninvolvement in anything beyond one's immediate interests,” while another associated noun, privacy, denotes a state of “withdrawal from society or the public interest” (Oxford English Dictionary, 1972). If government is a means of providing a wide range of collective goods, which do not necessarily lend themselves to market exchange, the public sector is naturally a highly visible target.4 At the same time, unrestrained public-sector expansion inevitably leads to public policy failure, as problems of communication, coordination, effective cost–benefit control, and revenue satiation accumulate.5 Privatization represents a logical reaction.

Details

Comparative Public Administration
Type: Book
ISBN: 978-1-84950-453-9

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Article
Publication date: 27 July 2012

David Birnbaum

This paper aims to summarize significant changes in Medicaid, a safety net health insurance program on which one in five Americans depend.

Abstract

Purpose

This paper aims to summarize significant changes in Medicaid, a safety net health insurance program on which one in five Americans depend.

Design/methodology/approach

The paper takes the form of a narrative review.

Findings

During the same period that a downturn in its economy increased the number of uninsured and under‐insured Americans, falling government revenues led to decreases in Medicaid coverage and a shift from administration by non‐profit government to for‐profit health maintenance organization entities. Hospitals in the USA scored as better managed than those of other countries in one study, but wide variation in local health service performance between and within its states also has been documented, and too many American families are foregoing needed care because of insurance and affordability problems. Whether shifting a public safety net healthcare system from public to private administration will make the situation better or worse has become the subject of political debate and court cases.

Originality/value

Perhaps masked by political party rhetoric focusing news attention on the future of the Patient Protection and Affordable Care Act (“ObamaCare”), America's public Medicaid system is increasingly being given over to control by private sector health maintenance organizations. This viewpoint article attempts to put that trend into perspective.

Details

Clinical Governance: An International Journal, vol. 17 no. 3
Type: Research Article
ISSN: 1477-7274

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Article
Publication date: 16 October 2009

Wendy L. Kraglund‐Gauthier, Sue Folinsbee, B. Allan Quigley and Hélène Grégoire

Many Canadians presume their universal health care system provides equitable opportunity and access to health, yet this is not necessarily the case, especially for…

Abstract

Purpose

Many Canadians presume their universal health care system provides equitable opportunity and access to health, yet this is not necessarily the case, especially for marginalized populations. The purpose of this paper is to conceptualize how marginalized, yet resilient, communities are able to build capacity and contribute to their own learning about health.

Design/methodology/approach

Environmental scan, state of the field review and community consultations on a national scale.

Findings

For adults living in rural and remote areas that fall below health norms, health knowledge and care is often not enough to build capacity and support resilient communities. More learning needs to be done by all members of community and government.

Practical implications

Consultations with selected members of marginalized populations and their service providers reveal a cross‐community, cross‐sector and cross‐government focus on addressing the social determinants of health is needed to increase individual capacity.

Originality/value

Consultations with community members and their service providers reveal rich information about the state of health and learning in selected areas across Canada. Using literature on health and learning as a framework, this paper discusses challenges and promising practices in terms of participants' abilities to sustain their own and their communities' health and learning.

Details

Journal of Enterprising Communities: People and Places in the Global Economy, vol. 3 no. 4
Type: Research Article
ISSN: 1750-6204

Keywords

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Book part
Publication date: 21 April 2010

Jeffrey Shantz

Purpose – For much of the first half of 2003 world attention was captured by news of a mysterious but deadly virus that was claiming lives in places as distant as Toronto…

Abstract

Purpose – For much of the first half of 2003 world attention was captured by news of a mysterious but deadly virus that was claiming lives in places as distant as Toronto and Beijing. In a matter of months there were around 8,000 infections and over 689 deaths related to severe acute respiratory syndrome (SARS). In my hometown, Toronto, 43 people died of SARS during the outbreaks of 2003.

Approach – This chapter examines issues of class and poverty in emergence of SARS. The chapter begins with a discussion of the political economy of the emergence of SARS, and its relation to the spread of the virus. It then discusses issues of public policy, and particularly neo-liberal cuts to social services and public spending, that set the stage for the SARS outbreak, influenced its impact and contributed to the failures of response in Ontario.

Findings – Through analysis of the lack of social resources available to working people in the province and the prioritizing of corporate, particularly tourism industry, concerns, the chapter illustrates how issues of class underpinned public responses to SARS, exacerbating problems. The chapter concludes by giving attention to the need for social solidarity and community mutual aid.

Contributions to the field – The chapter shows the extent to which neo-liberal governments prioritize business security above the health and social security of workers and reveals some of the ways in which the pressures of capitalist social relations make people ill.

Details

Understanding Emerging Epidemics: Social and Political Approaches
Type: Book
ISBN: 978-1-84855-080-3

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