Search results

The purpose of this paper is to enhance the knowledge about the use of online communication between patients and health-care professionals in public health care. The study explores digital divide gaps and the impacts of online communication on the overall costs of health care.

This study focuses on online health care in Denmark. The authors rely on population data from 3,500 e-visits (e-mail consultations) between patients and general practitioners (GPs) from 2009 to 2015. Additionally, they include survey data on the use of the internet to search for health-related information.

The analysis of the Danish data reveals a rapid uptake in the use of the internet to search for health-related information and a three-fold increase in e-visits from 2009 to 2015. The results show that the digital divide gaps exist also in the online health-care communication. Further, the study findings suggest that enforced supply of online communication between GPs and patients does not alleviate the costs. Rather, the number of visits to GPs has not been decreased significantly and health-care costs showing a marginal increase.

Further data should be collected and analyzed to explore the impacts of other institutional factors and population cohort on the digital divide and healthcare costs. Also, it is difficult to estimate whether the increased use of online health care in the long run lead to lowering overall health-care costs. While the internal validity of the study is high due to the use of population data, the external validity is lower as the study results are based on the data collected in Denmark only.

The study offers important input for practice. First, leaders in government might reconsider how they can control the health-care costs when opening online channels for communication between patients and doctors. Second, concerns about digital divide issues remains, but the study suggests that the uptake of e-visits does not widen the socio-economic, gender or age gaps. For health policy concern, this is encouraging news to lead to an increasing push of online communication.

The dynamics of online health-care communication may lead to mixed results and unexpected impacts on overall health-care costs.

The paper offers new insights in the impacts of mandatory supply of digital services. The Danish push-strategy has led to an enforced supply of e-visits and a rapid growing use of the online health care without widening digital divide but at the risk of potential increasing the overall costs.

The purpose of this paper is to examine the implications of electronic health records (EHRs) for competitive balance among hospitals in the USA.

To analyze the competitive balance implications of EHR networks on hospitals, the authors reviewed empirical, theoretical and practical literatures bearing on the problem.

US hospitals are increasingly facing decisions regarding whether, when and how to participate in networks of EHRs. EHRs can replace paper‐based medical records, improve the quality of patient care and decrease medical errors. EHRs also support product innovations such as e‐visits and online prescribing. Such a significant innovation will alter the competitive standing of many hospitals, some favorably and others unfavorably. Hospitals with dynamic capabilities, absorptive capacity and organizational designs that facilitate innovation will fair best.

Hospitals can also utilize several strategies to increase their odds of improving their competitive positions as the industry adopts EHR networks. Examples include strategies involving new products, early entry into an EHR network, promotion of organizational learning, and management of social impacts of workflow changes.

The findings show which hospitals are most likely to embrace EHR networks, and how hospitals can best manage the adoption of EHR networks.

This paper aims to evaluate Ghana's National Health Insurance Scheme (NHIS) on healthcare utilisation by exploring its heterogeneous effects based on residential status and wealth.

The study used the Ghana Socioeconomic Panel Survey (GSPS) datasets. An instrumental variable strategy, specifically the two-stage residual inclusion (2SRI), was employed to control endogenous NHIS membership.

Generally, the results show that NHIS improves healthcare utilisation (i.e. visits to a health facility and formal care). Concerning the heterogeneous effects of health insurance on healthcare utilisation, the results revealed that NHIS members are more likely to seek care, irrespective of their residence status. The results further indicate that the probability of visiting a health facility and utilising formal care increases for the poorest NHIS participants. Based on these, the authors conclude that NHIS provides equitable healthcare access and utilisation for its vulnerable populations, who are beneficiaries.

To the best of the authors' knowledge, this paper is the first to explore the heterogeneous effects of NHIS on healthcare utilisation across residential and income subpopulations. Splitting the dataset by residential status to examine healthcare utilisation inequality is worthwhile. In addition, analysing utilisation in terms of health care type would show whether Ghana's NHIS may be viewed as welfare-enhancing through increased formal health care utilisation.

The peer review history for this article is available at: https://publons.com/publon/10.1108/IJSE-05-2023-0330

Technology has revolutionized the delivery of health-care services, with e-consultations becoming popular mode of service delivery, especially during the pandemic. Extant research has examined the adoption of e-health consultation services, with little attention paid to examine the switching behavior. This study aims to identify factors affecting patients’ intentions to switch from conventional mode i.e. visiting hospitals/clinics to e-health consultations.

To understand this we use the push–pull–mooring (PPM) framework and integrate variables from status quo bias framework to the model. A cross-section research design was used, which rendered 413 valid responses which were obtained from the patients visiting a traditional hospital setup. The data was analyzed using partial least square – structural equation modeling using SmartPLS 3.0.

Findings suggest that push effects (inconvenience and perceived risk), pull effects (opportunity for alternatives and ubiquitous care), mooring effects (trust) and inertia significantly influence patients’ switching intentions from visiting hospitals/clinics to e-health consultations. Further, habit and switching cost positively influence inertia.

This study shall enable online health-care service providers and practitioners to understand patients’ intentions to switch to online health platforms and accordingly develop related marketing strategies, services and policies to encourage them to switch to the new offerings.

The current study enriches the previous research on e-health services by applying and extending PPM framework as the base model and showing its efficiency in predicting individuals switching intentions in the context of emerging economies. This study bridges the gap by focusing on switching behavior in context of health services.

The purpose of this paper is to observe and analyse the effects of the use of telemedicine in care homes on the use of acute hospital resources.

The study was an uncontrolled retrospective observational review of data on emergency hospital admissions and Emergency Department (ED) visits for care home residents in Airedale, Wharfedale and Craven. Acute hospital activity for residents was observed before and after the installation of telemedicine in 27 care homes. Data from a further 21 care homes that did not use telemedicine were used as a control group, using the median date of telemedicine installation for the “before and after” period. Patient outcomes were not considered.

Care homes with telemedicine showed a 39 per cent reduction in the costs of emergency admissions and a 45 per cent reduction in ED attendances after telemedicine installation. In the control group reductions were 31 and 31 per cent, respectively. The incremental difference in costs between the two groups of care homes was almost £1.2 million. The cost of telemedicine to care commissioners was £177,000, giving a return on investment over a 20-month period of £6.74 per £1 spent.

The results should be interpreted carefully. There is inherent bias as telemedicine was deployed in care homes with the highest use of acute hospital resources and there were some methodological limitations due to poor data. Nevertheless, controlling the data as much as possible and adopting a cautious approach to interpretation, it can be concluded that the use of telemedicine in these care homes was cost-effective.

There are very few telemedicine studies focused on care homes.

The purpose of this paper is to compare recent developments in adult protection legislation, policy and practice in Scotland in 2015 with the first attempts at protection of adults at risk of harm, in 1857-1862, with a particular focus on people with learning disabilities.

The paper uses comparative historical research, drawing on primary archive material from 1857 to 1862 in the form of Annual Reports of the General Board of Commissioners in Lunacy for Scotland and associated papers.

Growing public awareness of the extent of neglect and abuse, and the need for overarching legislation were common factors in the development of both the “The Lunacy Act” of 1857 and the Adult Support and Protection (Scotland) Act of 2007. Both pieces of legislation also had the common aim of “asylum”, and shared some other objectives.

Total prevention of abuse of vulnerable adults is an aspiration in law and in policy. There is an evidence base of effectiveness, however, in protecting adults at risk of harm from abuse. Some ecological factors recur as challenges to effective safeguarding activity. These include problems of definition, uncovering abuse, enforcing legislation, evaluating impact and protection of people who are not a risk of harm to others.

This paper compares common themes and common challenges in two separate time periods to investigate what can be learned about the development of legislation and practice in adult protection.

Dr Godfrey wrote on the matter of industrial assessment in our June issue. Below he reviews the situation at Woolwich.

The concept of ‘social inclusion’ has become shorthand for all kinds of desirable service outcomes, but what does it actually mean? Can it be deconstructed in to component parts and measured? In this article Peter Bates and Julie Repper have made a start at addressing these issues and are looking to carry forward the discussion through the Social Inclusion Research Network, featured in A life in the day 5.1.

Purpose: While COVID-19 has upended lives, it has also catalyzed innovation with potential to advance health delivery. Yet, we know little about how the delivery system, and primary care in particular, has responded and how this has impacted vulnerable patients. We aimed to understand the impact of COVID-19 on primary care practice sites and their vulnerable patients and to identify explanations for variation. Approach: We developed and administered a survey to practice managers and physician leaders from 173 primary care practice sites, October-November 2020. We report and graphically depict results from univariate analysis and examine potential explanations for variation in practices' process innovations in response to COVID-19 by assessing bivariate relationships between seven dependent variables and four independent variables. Findings: Among 96 (55.5%) respondents, primary care practice sites on average took more safety (8.5 of 12) than financial (2.5 of 17) precautions in response to COVID-19. Practice sites varied in their efforts to protect patients with vulnerabilities, providing care initially postponed, and experience with virtual visits. Financial risk, practice size, practitioner age, and emergency preparedness explained variation in primary care practices' process innovations. Many practice sites plan to sustain virtual visits, dependent mostly on patient and provider preference and continued reimbursement. Value: While findings indicate rapid and substantial innovation, conditions must enable primary care practice sites to build on and sustain innovations, to support care for vulnerable populations, including those with multiple chronic conditions and socio-economic barriers to health, and to prepare primary care for future emergencies.