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1.
Front Public Health ; 10: 970922, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36033782

RESUMO

Syria is a developing country that face enormous healthcare challenges that aggravated with the outbreak of COVID-19. In the study, we evaluate the perceived healthcare service quality based on hospital type, public and private, using five HEALTHQUAL dimensions. We find that service quality in Syrian private hospitals is perceived better that in public hospitals. However, neither type of hospitals scores exceptionally high in any of the examined HEALTHQUAL dimensions. On the contrary, both hospitals score extremely low in the Improvement dimension. We argue that crowdedness environment, medical staff availability and their low salaries, pricing policies as well as the health insurance system, are to blame for such low perceived quality.


Assuntos
COVID-19 , Satisfação do Paciente , Hospitais Privados , Humanos , Inquéritos e Questionários , Síria
2.
PLoS One ; 17(8): e0273405, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36001608

RESUMO

BACKGROUND: To facilitate implementation of home-based care following an elective total knee or hip replacement in a private hospital, we explored patient and caregiver barriers and enablers and components of care that may increase its acceptability. METHOD: Thirty-one patients (mean age 71 years, 77% female) and 14 caregivers (mean age 69 years, 57% female) were interviewed. All themes were developed using thematic analysis, then categorised as barriers or enablers to uptake of home-based care or acceptable components of care. Barrier and enabler themes were mapped to the Theoretical Domains Framework. RESULTS: Eight themes emerged as barriers or enablers: feeling unsafe versus confident; caregivers' willingness to provide support and patients' unwillingness to seek help; less support and opportunity to rest; positive feelings about home over the hospital; certainty about anticipated recovery; trusting specialist advice over family and friends; length of hospital stay; paying for health insurance. Five themes emerged as acceptable components: home visits prior to discharge; specific information about recovery at home; one-to-one physiotherapy and occupational therapy perceived as first-line care; medical, nursing and a 24/7 direct-line perceived as second-line care for complications; no one-size-fits-all model for domestic support. Theoretical domains relating to barriers included emotion (e.g., feeling unsafe), environmental context and resources (e.g., perceived lack of physiotherapy) and beliefs about consequences (e.g., unwillingness to burden their caregiver). Theoretical domains relating to enablers included beliefs about capabilities (e.g., feeling strong), skills (e.g., practising stairs), procedural knowledge (e.g., receiving advice about early mobility) and social influences (e.g., caregivers' willingness to provide support). CONCLUSIONS: Multiple factors, such as feeling unsafe and caregivers' willingness to provide support, may influence implementation of home-based care from the perspectives of privately insured patients and caregivers. Our findings provide insights to inform design of suitable home-based care following joint replacement in a private setting.


Assuntos
Cuidadores , Serviços de Assistência Domiciliar , Idoso , Cuidadores/psicologia , Feminino , Hospitais Privados , Humanos , Masculino , Alta do Paciente , Pesquisa Qualitativa
3.
Ethiop J Health Sci ; 32(4): 729-738, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35950075

RESUMO

Background: Acute abdomen is a major surgical problem in Ethiopia with surgery for acute abdominal conditions accounting for roughly one-third of total emergency operations in many centers. This study was conducted with the aim of studying the pattern and outcome of surgically managed acute abdominal cases in a private general hospital in Addis Ababa, Ethiopia. Methods: This was a retrospective cross-sectional study of acute abdominal cases in adult patients operated at Teklehaimanot General Hospital between January 1, 2018 and August 1, 2019. Results: A total of 267 patients' medical records were reviewed. The male to female ratio was 1.5:1 and majority of patients were between the age range of 20 to 40 years with mean age of 36±16 years. The average duration of symptoms before arrival was 71.1±84.4 hours (range 3 to 504 hours) and only 85 (31.8%) of patients reached to the Hospital within 24 hours or less of onset of symptoms. Acute appendicitis was the most common cause of acute abdomen; observed in 193 (72.3%) of the cases. Overall post-operative complication rate was 14.8% and post-operative mortality rate was 1.9%. It was found that delayed presentation (OR 2.01, 95% CI 1.64-7.84), old age (OR 1.51, 95% CI 1.89-3.59), and tachycardia at presentation (OR 2.85, 95% CI 1.03-6.82) were major predictors of morbidity and mortality in operated patients. Conclusion: In this study acute appendicitis accounted for the majority of cases operated for acute abdomen. Length of post-operative hospital stay, early post-operative complication rate, and overall mortality rate were found to be significantly lower in our series than other reports.


Assuntos
Abdome Agudo , Apendicite , Abdome Agudo/cirurgia , Doença Aguda , Adulto , Apendicite/cirurgia , Estudos Transversais , Etiópia , Feminino , Hospitais Privados , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Adulto Jovem
4.
PLoS One ; 17(8): e0273847, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36037184

RESUMO

BACKGROUND: Caesarean section and associated factors require detailed investigation globally. This study aims to determine the rate and associated factors of caesarean deliveries in urban areas of Vietnam. METHODS: A cross-sectional study using questionnaire answered by women who had infants aged under 30 months was conducted from March to May 2021. Data were collected in 18 commune health centres in two cities during the day of routine immunization. Multivariable logistic regression was performed to assess factors associated with caesarean section. RESULTS: The overall caesarean section rate was 49.6%. The caesarean section rate in private hospitals (57.8%) were significantly higher than in public hospitals (49.1%). Caesarean section rate in first-time mothers (47.1%) were as high as this rate among mothers who had given birth before (50.6%). Factors associated with higher rate of caesarean section include increasing in women's age, pre-pregnancy body mass index, gestational weight gain, and infant's birth weight; first-time mothers; mothers living in urban areas; and mothers giving birth in private hospitals. CONCLUSIONS: This study revealed a high rate of caesarean deliveries in urban areas of Vietnam. Comprehensive investigations of both medical and non-medical reasons for caesarean deliveries in Vietnam are urgent needs to shape the prioritized interventions.


Assuntos
Cesárea , Parto , Estudos Transversais , Feminino , Hospitais Privados , Humanos , Gravidez , Vietnã/epidemiologia
5.
JAMA Health Forum ; 3(5): e221018, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35977260

RESUMO

Importance: The COVID-19 pandemic has had a negative association with hospital operations. To help health care facilities and clinicians stay financially viable during the COVID-19 pandemic, Congress provided $175 billion in subsidies. It remains unclear how much financial losses hospitals incurred owing to operational disruptions during the COVID-19 pandemic and whether subsidies were sufficient to offset the financial losses. Objective: To assess changes in the operational financial performance and overall financial viability of hospitals during the COVID-19 pandemic. Design Setting and Participants: This cross-sectional study included 1378 US hospitals whose fiscal years began in January and 785 hospitals whose fiscal years began in July (all with continuous observations from 2016 through 2020). RAND Hospital Data, a compiled and processed version of Medicare Cost Reports, were used. The data were analyzed on March 12, 2022. Exposures: The operational disruptions experienced and relief funds received by US hospitals during the COVID-19 pandemic. Main Outcomes and Measures: A hospital's annual operating margin, overall profit margin, and other nonoperating income as a share of total revenue from January 2016 to December 2020. Results: Among the 1378 hospitals with fiscal years beginning in January, the mean operating margin declined from -1.0% (95% CI,-1.9% to -0.1%) in 2019 to -7.4% (95% CI, -8.5% to -6.3%) in 2020. The mean share of other nonoperating income grew from 4.4% (95% CI, 4% to 4.7%) in 2019 to 10.3% (95% CI, 9.9% to 10.8%) in 2020. The mean overall profit in 2020 (6.7%; 95% CI, 5.4% to 8.1%) remained as stable as prior years. Government, rural, and smaller hospitals showed higher mean overall profit margins in 2020 than in 2019 (7.2% vs 3.7%, 7.5% vs 1.9%, and 6.7% vs 3.5%, respectively). These results remained consistent when hospitals whose fiscal years began in July were examined. Conclusions and Relevance: The results of this cross-sectional study suggest that although hospitals experienced a sizeable reduction in operating margins in 2020, their overall profit margins remained similar to those in prior years, suggesting that the COVID-19 relief fund effectively offset the financial losses for hospitals during the COVID-19 pandemic. Government, rural, and smaller hospitals, which were supported by some targeted fund allocations, generated higher overall profit margins during 2020 than in prior years.


Assuntos
COVID-19 , Idoso , COVID-19/epidemiologia , Estudos Transversais , Hospitais Privados , Humanos , Medicare , Pandemias , Estados Unidos/epidemiologia
6.
Rev Gaucha Enferm ; 43: e20210262, 2022.
Artigo em Inglês, Português | MEDLINE | ID: mdl-36043648

RESUMO

OBJECTIVE: To compare safety elements and the understanding of guidelines at discharge from the Neonatal Intensive Care Unit between public and private hospitals. METHOD: Cross-sectional study, developed in two Neonatal Intensive Care Units in the Midwest of Brazil. The Checklist for patient safety in preparing for discharge from the Neonatal Intensive Care Unit and the Assessment Scale of Patient Understanding about Discharge Guidelines were used for a sample (n=105) of caregivers of newborns. Descriptive and inferential statistical analysis was performed. RESULTS: The Checklist item "skin care and body hygiene" had greater conformity in the private sector (96.9%) than in the public sector (73.2%) (p-value<0.000) and the understanding of discharge guidelines had an overall mean of 62.9±8.3 points, with no significant difference between the locations. CONCLUSION: Compliance with safety elements and understanding of guidelines at discharge were equal among hospitals.


Assuntos
Unidades de Terapia Intensiva Neonatal , Alta do Paciente , Brasil , Estudos Transversais , Hospitais Privados , Humanos , Recém-Nascido , Unidades de Terapia Intensiva
7.
Cir Cir ; 90(4): 497-502, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35944456

RESUMO

BACKGROUND: The onset of the SARS-Cov-2 pandemic brought with it important changes in the hospital care for all diseases. According to the international literature, since the beginning of the pandemic there has been an impact in the incidence, etiology, and severity of head trauma, all these changes as a direct consequence of lockdown. OBJECTIVE: In this article we analyzed the characteristics of craniofacial trauma in patients admitted to a private hospital in Mexico City during the SARS-CoV-2 pandemic. METHOD: Medical records from patients admitted in Medica Sur between March 2020 and June 2021. In this study, incidence, etiology, severity of the injuries and the SARS-CoV-2 PCR result performed upon admission were analyzed. RESULTS: Although there is no study in Mexico like ours, the results were similar to those reported by other hospital centers worldwide, presenting a greater number of cases classified as mild craniofacial trauma, in addition to finding that the main age group affected were older adults. CONCLUSIONS: The reported information in our study provides a general view of craniofacial trauma characteristics during SARS-CoV-2 pandemic.


INTRODUCCIÓN: El inicio de la pandemia provocada por SARS-CoV-2 trajo consigo importantes cambios en los cuidados hospitalarios para todas las enfermedades. De acuerdo con la literatura internacional, desde el comienzo, y a consecuencia del aislamiento, ha existido un impacto en la incidencia, la etiología y la gravedad del trauma craneomaxilofacial. OBJETIVO: Estudiar las características del trauma craneofacial en los pacientes ingresados a un hospital privado en la Ciudad de México durante la pandemia por SARS-CoV-2. MÉTODO: Se revisaron los expedientes clínicos de los pacientes ingresados a Médica Sur, entre marzo de 2020 y junio de 2021. Se analizaron la incidencia, la etiología, la gravedad de las lesiones y el resultado de la prueba de reacción en cadena de la polimerasa para SARS-CoV-2 que se realizó durante la atención hospitalaria. RESULTADOS: En México no existe un estudio semejante al nuestro, pero los resultados fueron similares a los reportados por otros centros hospitalarios en el mundo, presentando un mayor número de casos clasificados como traumatismo craneofacial leve, además de encontrar que el principal grupo de edad afectado fueron los adultos mayores. CONCLUSIONES: La información reportada en nuestro estudio brinda un panorama general sobre las características del trauma craneofacial durante la pandemia por SARS-CoV-2.


Assuntos
COVID-19 , Traumatismos Craniocerebrais , Traumatismos Faciais , Hospitais Privados , Pandemias , Idoso , COVID-19/diagnóstico , COVID-19/epidemiologia , COVID-19/prevenção & controle , Cidades/epidemiologia , Controle de Doenças Transmissíveis , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/etiologia , Traumatismos Craniocerebrais/terapia , Traumatismos Faciais/epidemiologia , Traumatismos Faciais/etiologia , Traumatismos Faciais/terapia , Humanos , Escala de Gravidade do Ferimento , México/epidemiologia , SARS-CoV-2/isolamento & purificação
8.
BMC Health Serv Res ; 22(1): 1056, 2022 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-35982425

RESUMO

BACKGROUND: The Pradhan Mantri Jan Arogya Yojana (PMJAY), a publicly funded health insurance scheme for the poor in India, was launched in 2018. Early experiences of states with various purchasing arrangements can provide valuable insights for its future performance. We sought to understand the institutional agencies and performance of the trust and insurance models of purchasing with respect to; a) Provider contracting b) Claim management c) Implementation costs. METHODS: A mixed methods case study design was adopted. Two states, Uttar Pradesh (representing a trust model) and Jharkhand (representing the insurance model) were purposively selected. Data sources included document reviews, key informant interviews, quantitative scheme data from the provider empanelment and claims database, and primary data on costs. Descriptive statistics were reported for quantitative data, content analysis was used for thematic reporting of qualitative data. RESULTS: In both models, the state was the final authority on empanelment decisions, with no significant influence of the insurance company. Private hospitals constituted the majority of empanelled providers, with wide variations in district-wise distribution of bed capacities in both states. The urgency of completing empanelment in the early days of the scheme created the need for both states to re-review hospitals and de-empanel those not meeting requirements. Very few quality- accredited private hospitals were empaneled. The trust displayed more oversight of support agencies for claim management, longer processing times, a higher claim rejection rate and numbers of queries raised, as compared to the insurance model. Support agencies in both states faced challenges in assessing the clinical decisions of hospitals. Cost-effectiveness showed mixed results; the trust cost less than the insurance model per beneficiary enrolled, but more per claim generated. CONCLUSIONS: Efforts are required to enable a better distribution and ensure quality of care in empanelled hospitals. The adoption of standard treatment guidelines is needed to support hospitals and implementing agencies in better claim management. The oversight of agencies through enforcement of contracts remains vital in both models. Assessing the comparative performance of trusts and insurance companies in more states at later stages of scheme implementation, would be further useful to determine their cost-effectiveness as purchasers.


Assuntos
Atenção à Saúde , Seguro Saúde , Hospitais Privados , Humanos , Índia
9.
Cad Saude Publica ; 38Suppl 2(Suppl 2): e00188721, 2022.
Artigo em Português | MEDLINE | ID: mdl-36043626

RESUMO

Hospitals have shown changes in their role in health systems. In Brazil, private hospitals have always stood out, with charitable hospitals gaining increasing importance in the 21st century. Especially in the United States, there has been a trend towards consolidation of hospitals, concentrating great market power, in keeping with the capitalist phenomenon of financialization. This study aims to describe the current evolution in the Brazilian context in private hospitals and hospital groups, identifying the principal characteristics and trends according to the current capital dynamics. A descriptive exploratory study was performed, focused on dimensions of net worth, accounting-finance, and policy. The study covered the period from 2009 to 2015, analyzing 10 hospitals and 3 hospital groups selected intentionally. Datasets were created from different sources, used to calculate indicators and to analyze information on each of these dimensions. The private hospital sector in Brazil, including charitable hospitals, already displayed strategies that are characteristic of financialization, such as the formation of oligopolies through mergers and acquisitions and diversification to other areas such as teaching and management of public units, a focus on high profit, and internationalization, backed by the sector's own policy agenda. The trend is intrinsically exclusionary, concentrating wealth, inconsistent with the constitutional principles of universal care and the right to health, and it requires the adoption of public policies, regulation, and social control to contain it.


Os hospitais apresentam mudanças em seu papel nos sistemas de saúde. No Brasil, os hospitais privados sempre tiveram destaque, com os filantrópicos voltando a ganhar maior importância no século XXI. Observa-se uma tendência, em especial nos Estados Unidos, de consolidação de hospitais, concentrando grande poder de mercado, consonante com o fenômeno capitalista de financeirização. O objetivo deste estudo é descrever, no contexto brasileiro, o movimento em curso nos hospitais e grupos hospitalares privados, identificando suas principais características e tendências à luz das dinâmicas atuais do capital. Realizou-se um estudo exploratório, descritivo, que teve como eixo de análise as dimensões patrimonial, contábil-financeira e política. O estudo cobriu o período entre 2009 e 2015, analisando 10 hospitais e três grupos hospitalares selecionados de modo intencional. Foram criados bancos de dados oriundos de diversas fontes a partir dos quais foram calculados indicadores e analisadas informações sobre cada uma das dimensões de análise. Observou-se que o setor hospitalar privado no Brasil já apresentava estratégias características de processo de financeirização, inclusive nos filantrópicos, tal como a formação de oligopólios por meio de fusões e aquisições e da dinâmica de diversificação para outras áreas como ensino e gestão de unidades públicas, foco em alta renda e internacionalização, apoiada por uma agenda política própria do setor. Trata-se de movimento intrinsecamente excludente, concentrador de riqueza, incompatível com os princípios constitucionais da universalidade e do direito à saúde, que requer a adoção de políticas públicas, regulamentação e controle social para sua contenção.


Los hospitales presentan cambios en su papel dentro de los sistemas de salud. En Brasil, los hospitales privados siempre tuvieron relevancia, con los filantrópicos volviendo a ganar mayor importancia en el siglo XXI. Se observa una tendencia, en especial en los EE.UU., de consolidación de hospitales, concentrando un gran poder de mercado, consonante con el fenómeno capitalista de financiarización. El objetivo de este estudio es describir en el contexto brasileño el movimiento en curso en los hospitales y grupos hospitalarios privados, identificando sus principales características y tendencias a la luz de las dinámicas actuales del capital. Se realizó un estudio exploratorio, descriptivo, que tuvo como eje de análisis las dimensiones patrimoniales, contable-financiera y política. El estudio cubrió el período entre 2009 y 2015, analizando 10 hospitales y 3 grupos hospitalarios seleccionados de modo intencional. Se crearon bancos de datos procedentes de diversas fuentes, a partir de los cuales se calcularon indicadores y analizó información sobre cada una de las dimensiones de análisis. Se observó que el sector hospitalario privado en Brasil ya presentaba estrategias características de proceso de financiarización, inclusive en los filantrópicos, tales como la formación de oligopolios mediante fusiones y adquisiciones, así como la dinámica de diversificación hacia otras áreas como formación y gestión de unidades públicas, enfocadas en rentas altas e internacionalización, apoyadas por una agenda política propia del sector. Se trata de un movimiento intrínsecamente excluyente, concentrador de riqueza, incompatible con los principios constitucionales de la universalidad y del derecho a la salud, y que requiere la adopción de políticas públicas, regulación y control social para su contención.


Assuntos
Hospitais Privados , Setor Privado , Brasil , Humanos
10.
Rev Gastroenterol Peru ; 42(1): 7-12, 2022.
Artigo em Espanhol | MEDLINE | ID: mdl-35896067

RESUMO

Digestive diseases are the fourth leading cause of outpatient care in Peruvian healthcare centers, with gastritis and peptic ulcers being the most common. This is a retrospective, cross-sectional, descriptive study of secondary analysis of medical record data to evaluate the prevalence of Helicobacter pylori in patients undergoing upper digestive endoscopy during 2019 at Clinica Delgado, Lima, Peru. An association between males (PRa 1.27, 95% CI 1.10-1.48, p<0.001), age categories and upper digestive endoscopy (PRa 2.53, 95% CI 2.16-2.97, p<0.001) was reported. Based on these findings, it is recommended that other causes of gastritis be identified, especially in young women with deep chronic gastritis. Furthermore, we present a review of the scientific literature of Peru on factors associated with the positivity of Helicobacter pylori in the results of superior digestive endoscopy.


Assuntos
Gastrite , Infecções por Helicobacter , Helicobacter pylori , Estudos Transversais , Endoscopia Gastrointestinal , Feminino , Gastrite/complicações , Gastrite/diagnóstico , Gastrite/epidemiologia , Infecções por Helicobacter/complicações , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/epidemiologia , Hospitais Privados , Humanos , Masculino , Prevalência , Estudos Retrospectivos
11.
Sci Rep ; 12(1): 12856, 2022 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-35896806

RESUMO

During the last decades, there has been an increase in the rate of surgery for degenerative disorders of the cervical spine and in the use of supplementary private health insurance. Still, there is limited knowledge about the differences in characteristics of patients operated in public and private hospitals. Therefore, we aimed at comparing sociodemographic-, clinical- and patient management data on patients operated for degenerative cervical radiculopathy and degenerative cervical myelopathy in public and private hospitals in Norway. This was a cross-sectional study on patients in the Norwegian Registry for Spine Surgery operated for degenerative cervical radiculopathy and degenerative cervical myelopathy between January 2012 and December 2020. At admission for surgery, we assessed disability by the following patient reported outcome measures (PROMs): neck disability index (NDI), EuroQol-5D (EQ-5D) and numerical rating scales for neck pain (NRS-NP) and arm pain (NRS-AP). Among 9161 patients, 7344 (80.2%) procedures were performed in public hospitals and 1817 (19.8%) in private hospitals. Mean age was 52.1 years in public hospitals and 49.7 years in private hospitals (P < 0.001). More women were operated in public hospitals (47.9%) than in private hospitals (31.6%) (P < 0.001). A larger proportion of patients in private hospitals had high education (≥ 4 years of college or university) (42.9% vs 35.6%, P < 0.001). Patients in public hospitals had worse disease-specific health problems than those in private hospitals: unadjusted NDI mean difference was 5.2 (95% CI 4.4 - 6.0; P < 0.001) and adjusted NDI mean difference was 3.4 (95% CI 2.5 - 4.2; P < 0.001), and they also had longer duration of symptoms (P < 0.001). Duration of surgery (mean difference 29 minutes, 95% CI 27.1 - 30.7; P < 0.001) and length of hospital stay (mean difference 2 days, 95% CI 2.3 - 2.4; P < 0.001) were longer in public hospitals. In conclusion, patients operated for degenerative cervical spine in private hospitals were healthier, younger, better educated and more often men. They also had less and shorter duration of symptoms and seemed to be managed more efficiently. Our findings indicate that access to cervical spine surgery in private hospitals could be skewed in favour of patients with higher socioeconomic status.


Assuntos
Radiculopatia , Doenças da Medula Espinal , Vértebras Cervicais/cirurgia , Estudos Transversais , Feminino , Hospitais Privados , Humanos , Masculino , Pessoa de Meia-Idade , Radiculopatia/cirurgia , Doenças da Medula Espinal/epidemiologia , Doenças da Medula Espinal/cirurgia , Resultado do Tratamento
12.
BMC Health Serv Res ; 22(1): 944, 2022 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-35870912

RESUMO

BACKGROUND: A study from a tertiary care center in Pakistan demonstrated that a leadership development intervention led to improved family experience of care outcomes. The objective of the current paper is to assess the implementation of this intervention and identify barriers and facilitators to inform sustainability and scalability. METHODS: A working group designed the intervention using a theory-of-change model to strengthen leadership development to achieve greater employee engagement. The interventions included: i) purpose and vision through purpose-driven leadership skills trainings; ii) engaging managers via on-the-job mentorship programme for managers, iii) employee voice i.e., facilitation of upward communication to hear the employees using Facebook group and subsequently inviting them to lead quality improvement (QI) projects; and iv) demonstrating integrity by streamlining actions taken based on routine patient experience data. Implementation outcomes included acceptability, adoption, fidelity across degree & quality of execution and facilitators & barriers to the implementation. Data analyzed included project documentation records and posts on the Facebook group. Analysis indicated acceptability and adoption of the intervention by the employees as178 applications for different QI projects were received. Leadership sessions were delivered to 455 (75%) of the employees and social media communication was effective to engage employees. However, mentorship package was not rolled out nor the streamlined processes for action on patient experience data achieved the desired fidelity. Only 6 QI projects were sustained for at least a year out of the 18 approved by the working group. Facilitators included leadership involvement, real-time recognition and feedback and value-creation through participation by national and international celebrities. Challenges identified were the short length of the intervention and incentives not being institutionalized. The authors conclude that leadership development through short training sessions and on-going communications facilitated by social media were the key processes that helped achieve the outcomes. However, a long-term strategy is needed for individual managerial behaviours to sustain.


Assuntos
Liderança , Melhoria de Qualidade , Criança , Atenção à Saúde , Hospitais Privados , Humanos , Paquistão
13.
Artigo em Inglês | MEDLINE | ID: mdl-35805844

RESUMO

In Portugal, the government has accepted private management within public hospitals since 1996. The objectives of the state were to ensure more efficiency in resource management and maintain or increase the service quality provided to the users. Four public hospitals have been managed with a public-private partnership (PPP) approach. This study aimed to empirically analyse the degree of satisfaction of the Portuguese population regarding the service quality provided by PPP and Public Management Hospitals (PMH) within a structural equation model, and verify if people's literacy level, age, education, and income moderate their opinions. The study used 2077 valid questionnaire responses applied in the four regions served by the eight hospitals. The results show that the users of the PPP hospitals are more satisfied than those from PMH with statistical significance. Literacy level moderates the relationship between perceived quality and users' satisfaction, and education moderates the same relationship only in the context of PPP hospitals. More educated people with a high literacy level are more demanding, both regarding PPP and PMH hospitals. Nevertheless, the results are very beneficial to the PPP model; thus, improved decision-making regarding contract renewal might help policymakers consider the findings of this paper.


Assuntos
Satisfação Pessoal , Parcerias Público-Privadas , Governo , Hospitais Privados , Hospitais Públicos , Humanos
14.
Int Breastfeed J ; 17(1): 54, 2022 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-35871076

RESUMO

BACKGROUND: Enhancing timely breastfeeding initiation within the first hour postpartum is a goal the WHO's Early Essential Newborn Care (EENC) and Baby-friendly Hospital Initiative (BFHI) aim to achieve globally. However, many health professionals and facilities have yet to adopt these guidelines in Cambodia, impeding timely initiation progress and maternal-infant health goals. METHODS: This secondary data analysis used the 2014 Cambodia Demographic and Health Survey (CDHS) data of 2,729 women who gave birth in the two years preceding the survey to examine the association between place of birth and timely breastfeeding initiation. Descriptive statistics, chi-square test and multivariable logistic regression were performed. Pairwise interaction terms between place of birth and each covariate were included in the regression model to examine the presence of multiplicative effect modification. RESULTS: The prevalence of timely breastfeeding initiation was 62.9 percent. Most women gave birth in public health facilities (72.8%) followed by private health facilities (15.9%) and at home (11.2%). The proportions of timely breastfeeding initiation differ by place of birth (p < 0.001). In the multivariable model, there was a significant interaction between place of birth and household wealth index and between place of birth and residence on timely initiation. Among women who reside in poor households, the odds of timely initiation were lower among women who gave birth at home compared to those who gave birth in public health facilities, adjusted odds ratio (95% confidence interval) 0.43 (0.21, 0.88). For urban settings, the odds of timely breastfeeding initiation were lower among women who gave birth in private health facilities compared to those who gave birth in public health facilities 0.52 (0.36, 0.75). For rural settings, the odds of timely breastfeeding initiation were lower among women who gave birth at home compared to those who gave birth in public health facilities 0.55 (0.31, 0.97). CONCLUSIONS: Wealth index and residence moderated the association between place of birth and timely breastfeeding initiation in Cambodia. To improve breastfeeding outcomes and eliminate practices impeding timely initiation, breastfeeding advocacy programs need greater integration and follow-up in Cambodia's health systems, including among home birth attendants and private health facilities.


Assuntos
Aleitamento Materno , Asiáticos , Camboja , Distribuição de Qui-Quadrado , Feminino , Parto Domiciliar , Hospitais Privados , Hospitais Públicos , Humanos , Recém-Nascido , Modelos Logísticos , Análise Multivariada , Parto , Gravidez , População Rural , Fatores Socioeconômicos , Fatores de Tempo , População Urbana
15.
Cad Saude Publica ; 38(6): e00073621, 2022.
Artigo em Inglês, Português | MEDLINE | ID: mdl-35857919

RESUMO

This study aimed to describe cesarean and repeated cesarean section rates in Brazil according to gestational age (GA) at birth and type of hospital. This is an ecologic study using data from the Brazilian Information System on Live Births and the 2017 National Registry of Health Facilities. Overall and repeated cesarean section rates were calculated and analyzed according to GA, region of residence, and type of hospital. Spearman correlations were performed between cesarean and repeated cesarean section rates by GA subgroups at birth (≤ 33, 34-36, 37-38, 39-41, and ≥ 42 weeks) and analyzed according to the type of hospital. Overall and repeated cesarean section rates were 55.1% and 85.3%, respectively. More than 60% of newborns between 37-38 weeks were delivered via cesarean section. Private hospitals in all regions showed the highest cesarean section rates, especially those in the Central-West Region, with more than 80% at all GAs. The overall cesarean section rate was highly correlated with all cesarean section rates of GA subgroups (r > 0.7, p < 0.01). Regarding repeated cesarean sections, the overall rate was strongly correlated with the rates of 37-38 and 39-41 weeks in public/mixed hospitals, differing from private hospitals, which showed moderate correlations. This finding indicates the decision for cesarean section is not based on clinical factors, which can cause unnecessary damage to the health of both the mother and the baby. Then, changes in the delivery care model, strengthening public policies, and encouragement of vaginal delivery after a cesarean section in subsequent pregnancies are important strategies to reduce cesarean section rates in Brazil.


O objetivo deste estudo foi descrever as taxas de cesariana e cesariana recorrente no Brasil segundo a idade gestacional (IG) ao nascer e o tipo de hospital. Trata-se de um estudo ecológico, utilizando dados do Sistema de Informação sobre Nascidos Vivos e do Cadastro Nacional de Estabelecimentos de Saúde de 2017. As taxas de cesariana geral e recorrente foram calculadas e analisadas de acordo com a IG, região de residência e tipo de hospital. Foram realizadas correlações de Spearman entre as taxas de cesariana e cesariana recorrente por subgrupos de IG ao nascer (≤ 33, 34-36, 37-38, 39-41 e ≥ 42 semanas), analisadas segundo o tipo de hospital. Verificaram-se taxas de cesariana geral e recorrente de 55,1% e 85,3%, respectivamente. Mais de 60% dos recém-nascidos entre 37-38 semanas ocorreram via cesariana. Os hospitais privados de todas as regiões concentraram as maiores taxas de cesariana, sobretudo os do Centro-oeste, com mais de 80% em todas as IG. A taxa geral de cesariana foi altamente correlacionada com todas as taxas de cesariana dos subgrupos de IG (r > 0,7, p < 0,01). Quanto à cesariana recorrente, verificou-se forte correlação com as taxas de 37-38 e 39-41 semanas no hospital público/misto, diferindo do hospital privado, que apresentou correlações moderadas. Isso indica que a decisão pela cesariana não é pautada em fatores clínicos, o que pode causar danos desnecessários à saúde da mulher e do bebê. Conclui-se que mudanças no modelo de atenção ao parto, fortalecimento de políticas públicas e maior incentivo do parto vaginal após cesárea em gestações subsequentes são estratégias importantes para a redução das cesarianas no Brasil.


El objetivo de este estudio fue describir las tasas de cesárea y de cesárea recurrente en Brasil según la edad gestacional (EG) al nacer y el tipo de hospital. Estudio ecológico a partir de los datos del Sistema de Información de Nacidos Vivos y del Registro Nacional de Establecimientos de Salud 2017. Se calcularon y analizaron las tasas de cesárea general y recurrente según EG, región de residencia y tipo de hospital. Se aplicaron las correlaciones de Spearman entre las tasas de cesárea y de cesárea recurrente por subgrupos de EG al nacer (≤ 33, 34-36, 37-38, 39-41 y ≥ 42 semanas) y se analizaron según el tipo de hospital. Las tasas de cesárea general y recurrente fueron del 55,1% y 85,3%, respectivamente. Más del 60% de los recién nacidos entre 37-38 semanas nacieron por cesárea. Los hospitales privados de todas las regiones concentraron las tasas más altas de cesáreas, especialmente los del Centro-Oeste, con más del 80% en todas las EG. En general, la tasa general de cesáreas estuvo altamente correlacionada con todas las tasas de cesáreas de los subgrupos de EG (r > 0,7, p < 0,01). En cuanto a la cesárea recurrente, se encontró que la tasa general se correlacionó fuertemente con las tasas de 37-38 y 39-41 semanas en el hospital público/mixto, a diferencia del hospital privado que mostró correlaciones moderadas. Esto indica que la decisión de hacer la cesárea no se basa en factores clínicos, lo que puede causar daños innecesarios a la salud de la mujer y del bebé. Por lo tanto, los cambios en el modelo de asistencia al parto, el fortalecimiento de las políticas públicas y una mayor promoción del parto vaginal en los embarazos posteriores de la cesárea se encuentran entre las estrategias importantes para reducir esta práctica en Brasil.


Assuntos
Cesárea , Parto , Brasil/epidemiologia , Feminino , Idade Gestacional , Hospitais Privados , Humanos , Recém-Nascido , Gravidez
17.
PLoS One ; 17(6): e0268858, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35657934

RESUMO

INTRODUCTION: The Megha Health Insurance Scheme (MHIS) was launched in 2013 in the North-East Indian state of Meghalaya to reduce household out-of-pocket expenditure on health and provide access to high-quality essential healthcare. Despite substantial expansion of the MHIS since the scheme's inception, there is a lack of comprehensive documentation and evaluation of the scheme's performance against its Universal Health Care (UHC) objectives. METHODS: We analysed six years of enrolment and claims data (2013-2018) covering three phases of the scheme to understand the pattern of enrolment, utilisation and care provision under the MHIS during this period. De-identified data files included information on age, sex, district of residence, the district of provider hospital, type of hospital, date of admission, status at discharge, claimed category of care, package codes, and amount claimed. Descriptive statistics were generated to investigate key trends in enrolment, service utilisation, and Government health spending under the MHIS. RESULTS: Approximately 55% of the eligible population are currently enrolled in MHIS. Enrolment increased consistently from phase I through III and remained broadly stable across districts, gender, age group and occupation categories, with a small decline in males 19-60 years. Claims were disproportionately skewed towards private provision; 57% of all claims accrued to the 18 empanelled private hospitals and 39% to the 159 public sector facilities. The package 'General Ward Unspecified' was responsible for the highest volume of claims and highest financial dispensation across all three phases of the scheme. This likely indicates substantial administrative error and is potentially masking both true burden of disease and accurate financial provision for care under the MHIS. Anti-rabies injections for dog/cat bite contributed to 11% of total claims under MHIS III, and 1.6% of all claims under MHIS II. This warrants investigation to better understand the burden of animal bites on the Meghalayan population and inform the implementation of cost-effective strategies to reduce this burden. CONCLUSIONS: This paper describes the first analysis of health insurance enrolment and claims data in the state of Meghalaya. The analysis has generated an important evidence base to inform future MHIS enrolment and care provision policies as the scheme expands to provide Universal Health Coverage to the state's entire population.


Assuntos
Atenção à Saúde , Seguro Saúde , Governo , Hospitais Privados , Humanos , Índia
18.
ANZ J Surg ; 92(9): 2229-2234, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35642256

RESUMO

BACKGROUND: Total hip replacement (THR) and total knee replacement (TKR) are cost-effective interventions to reduce pain and disability associated with osteoarthritis, however there is no clear guidelines available to determine appropriate patient selection and the timing of surgery. This prospective cohort study aimed to evaluate the hospital- and surgeon-level variation in the severity of patient-reported symptoms prior to THR and TKR. METHODS: Patients undergoing primary THR (n = 4330) or TKR (n = 7054) for osteoarthritis who participated in a national registry-led Patient Reported Outcome Measures (PROMs) pilot program were included in the analysis. Pre-operative Oxford Hip Score (OHS) and Oxford Knee Score (OKS) (range 0-48; representing worst to best hip/knee pain and function) data were examined for variation between private and public hospitals and between surgeons using linear mixed models. RESULTS: Pre-operative mean OHS was significantly higher (better) in patients whose surgery was performed in a private hospital compared to public hospitals; 21.39 versus 18.11 (mean difference 3.27, 95% CI 1.75, 4.79). For OKS, the difference between private hospital and public hospital scores was dependent on BMI and gender. Most of the variation in pre-operative OHS and OKS was not at the individual hospital- or surgeon-level, which explained only a negligible proportion of the model variance (⟨5%) for THR and TKR. CONCLUSION: Apart from a difference between private and public hospitals, there was little between-hospital or between-surgeon symptom variation in joint-specific pain and function prior to THR or TKR. The findings suggest consistency in the surgical thresholds for patients being offered hip and knee joint replacement procedures.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Osteoartrite do Quadril , Osteoartrite do Joelho , Osteoartrite , Cirurgiões , Hospitais Privados , Humanos , Osteoartrite/cirurgia , Osteoartrite do Quadril/cirurgia , Osteoartrite do Joelho/cirurgia , Dor/cirurgia , Estudos Prospectivos
19.
Health Policy ; 126(7): 661-667, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35610065

RESUMO

Private hospitals are an important pillar in many hybrid systems. In Italy they are bound to grow, but we have little knowledge of how they are coping with financial pressures. We use a configurational approach to determine the relationship between the macroprofiles of Italian private hospitals and their performance. We built a unique dataset with governance and financial statements data of all Italian private hospitals. We use a combination of partial triadic analysis (PTA) and clustering technique to identify both the main explicative financial dimensions and hospital configurations, and trace their evolutionary paths from the beginning of Regional Health Care Turnaround Plans (2008) to 2016. Understanding the evolution of configurations, our study entails also some implications for policy and practice.


Assuntos
Hospitais Privados , Humanos , Itália
20.
PLoS One ; 17(5): e0268940, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35622836

RESUMO

BACKGROUND: In 2019, Zambia introduced the national health insurance (NHI) as a healthcare financing strategy to increase universal access to health care services. The private health sector can complement public sector providers as service providers under the NHI. As such, the NHI Management Authority seeks to accredit for-profit private healthcare facilities in the NHI. Ascertaining factors that influence private-for-profit health providers to participate in the NHI is essential, but the evidence is lacking. In this study, we aimed to explore and characterize perceptions and experiences of for-profit private hospitals, dental clinics, eye clinics, diagnostic centres, and pharmacies regarding their inclusion in the NHI. METHODS: We conducted in-depth interviews with owners or management officers of purposively sampled private health care providers in Lusaka, Zambia (n = 22) between May and June 2020. Qualitative content analysis was used to analyse data. RESULTS: The findings highlight low awareness of the NHI among providers and a need to understand the NHI. Providers revealed their positions and views on the accreditation process and payment arrangements and stated that their participation would complement the NHI. They also cited conditions to participate in the NHI, highlighted opportunities and challenges of engaging in the NHI, and expressed a need for sustainable ways of governing the scheme. CONCLUSION: The assessment of health providers' inclusion in the NHI scheme is multifaceted. The results of this study surfaced factors such as raising awareness on the NHI among providers and how their concerns on aspects such as payments can be considered as inputs to enlighten consensual agreements between the NHI authority and health providers in leveraging the private health sector. Private providers' concerns must be further understood and considered as the NHI strives to include this group as health care providers in the scheme.


Assuntos
Programas Nacionais de Saúde , Setor Privado , Pessoal de Saúde , Hospitais Privados , Humanos , Zâmbia
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