Towards the new primary care reform in Greece: a focus on patients' expectations, views and perceptions from rural healthcare centres.

INTRODUCTION: Patient perception of quality of care is an essential component in evaluating healthcare delivery. This article reports data from primary health care (PHC) centers before Greece's most recent PHC reform. The study was undertaken to offer some baseline information about patient experience, support the decision-making processes taking place, and provide valuable input for future policy-making comparisons in Greece. METHODS: The research was conducted across the 16 PHC centers of Epirus, a region of north-western Greece, from June to September 2017, with 532 patients rating the importance of different aspects of three main healthcare domains (clinical behavior, support and services, and organization of care) of PHC provision. The Greek version of the European Task Force on Patient Evaluations of General Practice (EUROPEP) questionnaire was implemented for research purposes. Univariate comparisons were performed for patients with and without chronic disease, using Pearson's χ2 test for categorical data. RESULTS: Study findings support that the organization of care domain is of highest importance and priority, with clinical behavior and support and services following closely. Among recruited patients, on average, only 2.1% of patients with a chronic disease were satisfied (rated 4 or 5 on the Likert scale) with the organization of care aspects under consideration, compared to 18.4% of patients without a chronic disease. Furthermore, only 4% of patients with a chronic disease were satisfied with the aspects examined in the clinical behavior domain, compared to 27% of patients without a chronic disease. Finally, 18% of sampled patients with a chronic disease reported being satisfied with the quality of support and services provided, compared to 38% of patients without a chronic disease. CONCLUSION: It is necessary to back up available past information to afterwards estimate reform imprinting on expectations and perceptions. The items and aspects of EUROPEP, in line with the new tasks of the personal doctor within the PHC system that patients perceive as most essential, can be used to prioritize quality improvement activities to strengthen PHC delivery in Greece. Communication skills, practices, and behavioral change skills seem to need more attention for an efficient PHC model.

Medicare Advantage Supplemental Benefits for Dual-Eligible Benificiaries and Recommendations for Reform.

This Viewpoint discusses Dual Eligible Special Needs Plans supplemental benefits, identifies challenges of benefit coordination and accessibility, and highlights policy reforms to remedy these problems.

Medical device management reform, United Republic of Tanzania.

Health-care technology is central to boosting the productivity and quality of health-care systems. In many sub-Saharan African countries, however, medical device management systems are weak or absent. The aim of this article is to illustrate, using a case study, how policy reforms can help ensure policy on health-care technology is translated into everyday practice and how an integrated systems approach can enhance the operation of medical device management. Between 2011 and 2023, a plan to improve medical device management systems in the United Republic of Tanzania was developed and implemented through Swiss-Tanzanian cooperation within the Health Promotion and System Strengthening Project. The availability of biomedical engineers was increased through new training courses and the creation of permanent positions in government. Moreover, additional district and regional maintenance and repair workshops were built, and a National Centre for Calibration and Training was established to ensure the correct functioning of medical devices. The introduction of an electronic medical device management system provided health facilities and the health ministry with data on the operational status of medical devices and the need for repairs and spare parts. Every level of government was encouraged to allocate more human and financial resources to medical device management. Following this decade-long effort, the percentage of functioning equipment increased substantially, and costs were reduced by repairing rather than replacing equipment. The project also demonstrated the value of an integrated, system-strengthening approach that considered personnel, maintenance and repair facilities, documentation and management, and government policy and budgeting.

Les technologies jouent un rôle crucial dans le renforcement de la productivité et de la qualité des systèmes de santé. Pourtant, dans de nombreux pays d'Afrique subsaharienne, les systèmes de gestion des dispositifs médicaux sont limités, voire inexistants. Cet article a pour but d'illustrer, au moyen d'une étude de cas, comment les réformes peuvent contribuer à faire en sorte que les politiques en matière de technologies sanitaires soient appliquées au quotidien, et comment une approche intégrée peut améliorer la gestion des dispositifs médicaux. Entre 2011 et 2023, un plan visant à développer les systèmes de gestion des dispositifs médicaux en République-Unie de Tanzanie a été défini et mis en œuvre en collaboration avec la Suisse, dans le cadre du Projet de Promotion et de Renforcement du Système de Santé. De nouvelles formations et la création de postes permanents au sein du gouvernement ont permis d'accroître la disponibilité des ingénieurs biomédicaux. En outre, des ateliers supplémentaires d'entretien et de réparation ont été construits dans différentes régions et districts, tandis qu'un Centre National d'Étalonnage et de Formation a ouvert ses portes pour assurer le bon fonctionnement des dispositifs médicaux. L'introduction d'un système électronique de gestion des dispositifs médicaux a fourni aux établissements de soins de santé et au Ministère de la Santé des données concernant le statut opérationnel de ces dispositifs, ainsi que les réparations et pièces détachées requises. Chaque niveau de pouvoir a été encouragé à attribuer davantage de ressources humaines et financières à la gestion des dispositifs médicaux. Au terme de dix ans d'efforts, le pourcentage d'équipements en état de marche a considérablement augmenté et les coûts ont diminué grâce au recours à la réparation plutôt qu'au remplacement. Le projet a également démontré l'importance d'une approche intégrée, qui consiste à renforcer le système en tenant compte du personnel, de l'entretien et des installations de réparation, de la documentation et de la gestion, mais aussi de la politique gouvernementale et du budget.

La tecnología aplicada a la atención sanitaria es fundamental para impulsar la productividad y la calidad de los sistemas sanitarios. Sin embargo, en muchos países del África subsahariana los sistemas de gestión de los productos sanitarios son deficientes o inexistentes. El objetivo de este artículo es ilustrar, mediante un estudio de caso, cómo las reformas políticas pueden ayudar a garantizar que la política sobre tecnología de la atención sanitaria se convierta en una práctica cotidiana y cómo un enfoque de sistemas integrados puede mejorar el funcionamiento de la gestión de los productos sanitarios. Entre 2011 y 2023, se elaboró un plan para mejorar los sistemas de gestión de los productos sanitarios en la República Unida de Tanzania, que se implementó a través de la cooperación suizo-tanzana en el marco del Proyecto de Promoción de la Salud y Fortalecimiento del Sistema. Se aumentó la disponibilidad de ingenieros biomédicos mediante nuevos cursos de formación y la creación de puestos permanentes en el gobierno. Además, se construyeron talleres de mantenimiento y reparación adicionales de distrito y regionales, y se estableció un Centro Nacional de Calibración y Formación para garantizar el correcto funcionamiento de los productos sanitarios. La introducción de un sistema electrónico de gestión de productos sanitarios proporcionó a los centros sanitarios y al Ministerio de Sanidad datos sobre el estado operativo de los productos sanitarios y la necesidad de reparaciones y piezas de repuesto. Se animó a todos los niveles de gobierno a asignar más recursos humanos y financieros a la gestión de los productos sanitarios. Tras este esfuerzo de una década, el porcentaje de equipos en funcionamiento aumentó notablemente y los costes se redujeron al reparar los equipos en lugar de sustituirlos. El proyecto también demostró el valor de un enfoque integrado de refuerzo del sistema que tenía en cuenta el personal, las instalaciones de mantenimiento y reparación, la documentación y la gestión, y la política y los presupuestos gubernamentales.

Health resource allocation within the close-knit medical consortium after the Luohu healthcare reform in China: efficiency, productivity, and influencing factors.

Objective: This study aims to assess the efficiency and productivity of the Luohu Hospital Group after the reform and to identify factors influencing the efficiency to support the future development of medical consortia. Methods: Data on health resources from Shenzhen and the Luohu Hospital Group for the years 2015 to 2021 were analyzed using the super-efficiency slack-based measure data envelopment analysis (SE-SBM-DEA) model, Malmquist productivity index (MPI), and Tobit regression to evaluate changes in efficiency and productivity and to identify determinants of efficiency post-reform. Results: After the reform, the efficiency of health resource allocation within the Luohu Hospital Group improved by 33.87%. Community health centers (CHCs) within the group had an average efficiency score of 1.046. Moreover, the Luohu Hospital Group's average total factor productivity change (TFPCH) increased by 2.5%, primarily due to gains in technical efficiency change (EFFCH), which offset declines in technical progress change (TECHCH). The efficiency scores of CHCs were notably affected by the ratio of general practitioners (GPs) to health technicians and the availability of home hospital beds. Conclusion: The reform in the Luohu healthcare system has shown preliminary success, but continuous monitoring is necessary. Future strategies should focus on strengthening technological innovation, training GPs, and implementing the home hospital bed policy. These efforts will optimize the efficiency of health resource allocation and support the integration and development of resources within the medical consortium.

Perceived outcomes of medical teaching institute reforms: insights from management, faculty, and administration in Pakistani tertiary health care.

OBJECTIVE: The study aims to explore the perceived outcomes of Medical Teaching Institution (MTI) reforms on autonomy and overall performance within tertiary healthcare institutions in Khyber Pakhtunkhwa (KP) province, Pakistan. METHODOLOGY: A cross-sectional study was carried out from September 2023 to March 2024, involving interviews with frontline staff, administrative personnel, and senior management within MTI-affiliated institutions. The methodology employed, using both qualitative and quantitative data analysis techniques. RESULTS: The study showed that institutional staff members' knowledge and understanding of the MTI changes differed. Some observed very minor adjustments, while others saw advances in hospital operations and service delivery. Administrative complexity, political meddling, and resource allocation problems were noted as challenges. Positive results were also observed, though, and they included improved infrastructure, possibilities for staff training, and decision-making procedures. CONCLUSION: Despite significant improved, there are still challenges, such as inconsistent staff comprehension, mixed impacts on service delivery, resource allocation issues, and political meddling. Addressing these issues necessitates improved communication, continuous evaluation, and coordinated efforts to improve administrative systems and obtain consistent funding.

Equity and efficiency of health resource allocation in the Chengdu-Chongqing Economic Circle of China.

Objective: This study aimed to evaluate the fairness and efficiency of health resource allocation (HRAE) in Chengdu-Chongqing Economic Circle after the new healthcare reform. This study also aimed to identify existing problems, providing empirical evidence for the government to formulate regional health plans scientifically and reasonably. Methods: The fairness of health resource allocation was analyzed using the Gini coefficient, Theil index, and agglomeration degree from population and geographical area perspectives. The three-stage data envelopment analysis and the Malmquist productivity index were used to analyze HRAE from static and dynamic perspectives. Results: The Gini coefficient for population allocation in Chengdu-Chongqing Economic Circle was 0.066-0.283, and the Gini coefficient for geographical area allocation was 0.297-0.469. The contribution rate within a region was greater than that between regions, and health resources were mainly concentrated in economically developed core areas. The overall fairness of Chengdu Economic Circle was relatively better than that of Chongqing Economic Circle. Moreover, the adjusted mean technical efficiency was 0.806, indicating room for HRAE improvement in Chengdu-Chongqing Economic Circle. Stochastic Frontier Analysis found that different environmental variables have varying degrees of impact on HRAE. The adjusted mean total factor productivity change (Tfpch) was 1.027, indicating an overall upward trend in HRAE since the new healthcare reform. However, scale efficiency change (Sech) (0.997) limited the improvement of Tfpch. Conclusion: The fairness of health resources allocated by population was better than that allocated by geographical area. The unfairness of health resources mainly stemmed from intra-regional differences, with considerable health resources concentrated in core areas. Over the past 13 years, HRAE has improved but exhibited spatial heterogeneity and Sech-hindered productivity improvement. The study recommends strengthening regional cooperation and sharing to promote the integrated and high-quality development of the health and well-being in Chengdu-Chongqing Economic Circle.

Informing policy with health labour market analysis to improve availability of family doctors in Tajikistan.

BACKGROUND: Tajikistan has embarked on health reforms to orient the health system towards primary health care (PHC). The health labour market analysis (HLMA) was initiated by the Ministry of Health with the World Health Organization (WHO) on policy questions related to the PHC workforce team. This article presents the results with focus on family doctors as a critical part of the PHC team, providing lessons for strengthening family medicine and PHC in the European Region and central Asia. METHODS: The HLMA framework was used to guide the analysis. The data for analysis were provided by the Ministry of Health and Social Protection of the Population of the Republic of Tajikistan. Descriptive means were used to analyse the data. A Technical Working Group guided the process. RESULTS: There has been an increase in the number of health workers in the country over the last 7 years. However, there is a huge shortage of family doctors when compared with norms, with decreasing family doctor densities over the last 7 years. Family doctors have the highest vacancy rates among specialists and also constitute the highest proportion of specialists who migrate. There is inequitable distribution of doctors across the regions. Overall number of enrolments and graduates in family medicine are declining. Although salaries in PHC are higher than in hospitals, the overall health workforce salaries are lower than the national average. While there have been efforts to retain and attract doctors to PHC in rural and remote regions, challenges exist. The attraction of doctors to narrow specialties may be leading to undermining PHC and family medicine. While the optimal skill-mix and availability of nurses provide an opportunity to strengthen multi-disciplinary teams at the PHC level, shortages and unequal distribution of doctors are affecting health services coverage and health indicators. CONCLUSIONS: Application of the HLMA framework has helped identify the bottlenecks in the health labour market flows and the possible explanations for them. The policy considerations emerging out of the HLMA have contributed to improving evidence-based planning for retention and recruitment of the PHC workforce, improvements in medical and nursing education, and higher investments in the PHC workforce and particularly in family doctors. Implementation of the Action Plan will require political commitment, financial resources, strong inter-sectoral collaboration, stakeholder management, and cross-country learning of best practices. Through this process, Tajikistan has shown the way forward in implementing the Central Roadmap for health and well-being in Central Asia and the Framework for Action on the Health and Care Workforce in the WHO European Region.

VECTORS OF DEVELOPMENT OF THE UNIFIED MEDICAL INFORMATION SPACE.

AIM: The aim of the article is to analyze the current state of functioning of the medical information space of Ukraine in order to formulate scientifically sound proposals aimed at improving the implementation of medical reform. MATERIALS AND METHODS: The study is based on the analysis of literary sources of Ukrainian and international scientists, Ukrainian and foreign legislation and judicial practice. The article uses general theoretical and special methods of scientific cognition: theoretical analysis, systemic and structural, analysis and synthesis, sociological and statistical, logical and semantic, comparative and legal, method of ascent from the abstract to the concrete, forecasting and generalization. RESULTS: One of the key categories of the reform of the Ukrainian national medical sphere - the unified medical information space and its constituent elements - is studied. The electronic health care system, which stores medical data about patients in a single place and ensures their exchange between medical institutions, is analyzed. Emphasis is placed on the possibilities of using telemedicine and artificial intelligence, which play a key role in the development of the unified medical information space in accordance with global trends. The importance of legislative provision of efficiency and safety of the unified medical space is emphasized. It is about regulating the protection of personal data, establishing technical standards and requirements for medical information systems, ensuring confidentiality, integrity and data availability of the unified medical information space. CONCLUSIONS: Conclusions are drawn about the importance of proper functioning of each of the elements of the unified medical information space, both individually and in conjunction with each other. The authors' vision of improving the existing system of the unified medical information space is presented.

The child dental care reform in Israel - service uptake from 2011 to 2022.

BACKGROUND: The 2010 Child Dental Care Reform of the National Health Insurance Law marked a turning point in the Israeli oral healthcare system by establishing Universal Health Coverage of dental care for children. Initially, the reform included children up to age 8 and gradually expanded to age 18 in 2019. The basket of services includes preventive and restorative treatments provided by the four Health Maintenance Organizations (HMO). The aim of this study was to examine the uptake of child dental services during the first decade of the reform. METHODS: A retrospective analysis was conducted to determine the treatment uptake, type and amount of the services delivered based on annual service utilization reports submitted by the HMOs to the Ministry of Health in the years 2011-2022. RESULTS: The number of insured children increased from 1,546,857 in 2011 to 3,178,238 in 2022. The uptake of dental services gradually increased during the study period with a slight decrease in 2020. The percentage of children who used the services gradually increased from 8 to 33%, with the incremental inclusion of additional age groups. From 2012 onwards the most common treatments provided were preventive, however the single most common treatment was dental restoration. In 2022 35% of the population of Israel was under the age of 18. Out of these, about a third received dental treatment via the HMOs. This is a significant achievement, since before the reform all treatments were paid out-of-pocket. After a short period of increasing uptake, a stable service utilization pattern was evident that can indicate better public awareness and service acceptance. CONCLUSION: Although this is a reasonable uptake, additional efforts are required to increase the number of children receiving dental care within the public insurance. Such an effort can be part of a multi-disciplinary approach, in which pediatricians and public health nurses can play a vital role in dental caries prevention, enhancement of awareness and service utilization.

Patient regional index: a new way to rank clinical specialties based on outpatient clinics big data.

BACKGROUND: Many existing healthcare ranking systems are notably intricate. The standards for peer review and evaluation often differ across specialties, leading to contradictory results among various ranking systems. There is a significant need for a comprehensible and consistent mode of specialty assessment. METHODS: This quantitative study aimed to assess the influence of clinical specialties on the regional distribution of patient origins based on 10,097,795 outpatient records of a large comprehensive hospital in South China. We proposed the patient regional index (PRI), a novel metric to quantify the regional influence of hospital specialties, using the principle of representative points of a statistical distribution. Additionally, a two-dimensional measure was constructed to gauge the significance of hospital specialties by integrating the PRI and outpatient volume. RESULTS: We calculated the PRI for each of the 16 specialties of interest over eight consecutive years. The longitudinal changes in the PRI accurately captured the impact of the 2017 Chinese healthcare reforms and the 2020 COVID-19 pandemic on hospital specialties. At last, the two-dimensional assessment model we devised effectively illustrates the distinct characteristics across hospital specialties. CONCLUSION: We propose a novel, straightforward, and interpretable index for quantifying the influence of hospital specialties. This index, built on outpatient data, requires only the patients' origin, thereby facilitating its widespread adoption and comparison across specialties of varying backgrounds. This data-driven method offers a patient-centric view of specialty influence, diverging from the traditional reliance on expert opinions. As such, it serves as a valuable augmentation to existing ranking systems.

[Descriptive analysis of the steering potential in the internal medicine in Germany based on an international comparison]. / Deskriptive Analyse des Steuerungspotenzials in der Inneren Medizin im internationalen Vergleich.

BACKGROUND: Healthcare in Germany is not always needs-based and has considerable potential for optimization. Internal medicine (IM) plays a special role in the German healthcare system due to its long tradition. Against this background, a look at the optimization potential to achieve better quality and higher efficiency care seems particularly relevant. OBJECTIVE: Based on an international comparison and taking ambulatory care-sensitive conditions (ACSC) into account, this study aims to identify the steering potential in IM and to discuss it in the context of current reform plans. MATERIAL AND METHODS: The descriptive analysis was carried out as part of a report commissioned by the German Society of Internal Medicine and is based on data from the Federal Statistical Office and Eurostat as well as the ACSC catalogue developed for Germany. RESULTS: The top 10 reasons for inpatient treatment in IM include 7 ACSCs. These diagnoses account for almost one quarter of cases and treatment days and mostly relate to cardiology. The international comparison including numerous other indications shows that other countries have both significantly fewer cases and shorter lengths of stay for most indications. CONCLUSION: The results show that IM in Germany has considerable potential for optimization of inpatient care. In light of the regional variation in service providers and utilization as well as the potential for avoiding inpatient treatment, the current reform plans represent an opportunity for the reorientation of IM. Not least because of its high relevance, also in terms of numbers, it is therefore right and important that it is given such strong consideration within the reform plans.