Asia-Pacific Journal of Health Management (ACHSM)
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Private Equity Investment in Private For-Profit Healthcare in Australia and New Zealand: A scoping review
No full textObjectives: Private Equity (PE) involvement in healthcare has been evident in the United States (US) for some time, with questionable benefits reported. There are significant differences in funding, health insurance and regulation in the US, when compared to Australia and New Zealand (NZ), so it is not clear whether existing US research can be generalised to these settings. This study aims to examine published information regarding PE involvement in the private-for-profit (PFP) healthcare sector in Australia and NZ, including evidence of PE shareholdings and its impacts.
Design: This scoping review considers academic and grey literature, including academic research and commentary papers, media reports, corporate reports, PFP healthcare websites and government submissions.
Main Outcome & Results: Thirty three relevant sources were identified, but no specific information on the impacts of PE investment were discovered. The academic papers highlight an ongoing debate (but limited research evidence) about PFP healthcare, including the quality of clinical care, practice consolidation and a downward trend on clinician ownership. The grey literature offered more information on PE investment and growth of the PFP sector, but limited detail about shareholdings.
Conclusion: With little research on PE investment in Australia and NZ, it is difficult to know if continued PE growth will have a positive or negative affect on operational performance and outcomes, such as clinician engagement and clinical care. The authors conclude that there is a shifting landscape of PFP healthcare in Australia and NZ, to less clinician and greater PE ownership. Given the reports of negative impacts of PE involvement in the US, these trends pose significant immediate and long-term implications. This paper sets the agenda for further research to explore the organisational and system-level impacts of PE growth in Australia and NZ
Developing and Evaluating An Automated Bed Assignment Algorithm in A Tertiary Hospital: A case study in Singapore
No full textObjectives: The primary aim of this quality improvement project was to develop, implement and evaluate an automated bed assignment algorithm (ABAA) which can offer objective and consistent bed assignment recommendations that comply with the unique operational constraints and prioritization rules of a tertiary hospital in Singapore.
Methods: Using the classical process improvement framework of Plan-Do-Study-Act (PDSA), the quality circle workgroup first developed and tested the ABAA prototype to confirm its feasibility and reliability to meet all hospital operational constraints and prioritization rules. PDSA framework was then also employed in the user interface design and integration of ABAA into existing system setup. The staff satisfaction level of the ABAA was subsequently assessed via an anonymized online survey.
Results: In the prototype development phase, the workgroup was able to conclude after nine rounds of review meetings that the ABAA prototype was able to perform bed assignments like hospital staff using data in 64 operational scenarios. Among the 10 eligible staff who completed the online survey, up to 90% of them reported that ABAA was able to generate bed assignment recommendations which met the hospital operational requirements. 90% of these staff also reported that ABAA was easy to use and navigate, while all respondents reported using ABAA before attempting to assign beds manually. 80% of staff felt ABAA was able to reduce human error, while 50% of staff felt ABAA had reduced their time taken for bed assignments by 30 minutes to 2 hours per shift.
Conclusions: Evidently, the user-centric design of ABAA has enabled its high adoption and acceptance rate among staff. Overall, it has allowed the staff to make faster, consistent and objective bed assignment decisions which complied with hospital operational constraints and prioritization rules so that newly admitted patients received the most appropriate care at their point of admission
Performance of Primary Health Centres, Provider’s Perspective of Wellbeing, and Patient’s Assessment of the Centres Using a New Tool in Bangalore, India: An empirical study
No full textBackground: Primary healthcare in India comprises health promotion and preventive health interventions at the population level, which are rendered at dedicated centres called Primary Healthcare Centres (PHCs). The performance of PHCs is vital for overall improvement in the general health of the population, specifically in a low- and middle-income country like India. It is unknown how performance at the centre level is related to performance at the provider and patient levels. The aim of this study is to explore patterns in the performance of three PHCs with a low, medium and the high number of babies delivered.
Methodology: Primary and secondary data from the three selected PHCs were collected. Two questionnaire studies were done: one on the well-being of providers (Quality of Life and Engagement), and another on PHC performance as assessed by patients using the newly developed tool ‘Questionnaire for Patient’s Perspective on Performance of Primary Healthcare Centres’. The data from the centre, provider and patient levels were compared across the three centres using ANOVA tests.
Results: The new tool had high internal consistency at Cronbach’s alpha score of 0.938. It was found that the PHC with the least delivery had significantly higher PHC performance in comparison with high and medium-delivery PHCs (p<0.000).
Conclusion: The PHC performance assessment from multiple perspectives offers a realistic insight into the centres, which is valid even though agreement on the various perspectives could not be obtained. The new Q4PHC is a reliable instrument to assess PHC performance from the patient’s perspective
Benefits And Challenges for Young Australians with Epilepsy Transitioning Into Adult Healthcare: A scoping review
No full textTransitioning from paediatric healthcare into an adult healthcare system is a high-risk time for people with complex epilepsy. This can be a period of significant upheaval as a young person moves away from familiar and safe paediatric environments into unfamiliar adult healthcare. This is compounded by normal adolescent development, the challenges of epilepsy and the lifestyle conditions it demands, including restrictions on driving and levels of independence. Such factors can contribute to suboptimal health engagement which result in increased seizure activity, hospital admissions and reduction in community participation. Effective, well implemented transition programs are key to reducing risks, however little is known about which features of transition pathways define success or best practice.
A scoping review was used to examine a broad range of peer-reviewed literature published between 2017 and 2022. This review examined evidence-based literature relating to experiences of people with epilepsy as they transitioned between paediatric and adult healthcare environments. Specifically, exploring practices that offered benefits, recognising barriers, and identifying findings to inform future research and advance transition practices.
This review found that key to reducing transition-related health impacts for young people was patient-centred, engaging care that acknowledges their psychosocial and mental health needs specific to their level of development. Evidence suggests that engagement is built through multidisciplinary clinics that facilitate education and self-management. This review found that successful programs can deliver this by focusing on four key areas; relationships and continuity, capacity building, processes, and health services and systems. At a paediatric level this involves timely, age-appropriate preparation that builds skills and knowledge through tailored care-plans. At the transfer phase this means coordinated teams that work together across systems to ensure handover continuity, reduce stressors, and to aid navigation. At the adult level, care-teams that welcome young patients with protocols for continued capacity building are required
Participation In Online Health Communities: Decoding the antecedents and outcomes
No full textA significant number (49 %) of Indian users tend to rely on digital media to either access health-related information or use the internet as a precursor to visit a doctor [20]. According to a report by Raheja [48], "The Internet of Things” (IoT) connection has the potential to change the malfunctioning medical system into a comprehensive, effective, and individualised system. This will allow for a more proactive approach to wellness and overall health, reducing medical expenses through these inclusive practices. Online health communities in India demonstrate significant clout to transform the healthcare industry by empowering patients. They offer a platform to all key stakeholders, that are, the healthcare professionals, patients and even the caregivers alike, to come forth, share their experiences and develop remedies for various issues faced by the healthcare industry.
This paper examines the antecedents involved in the empowerment of patients in Online Health Communities (OHCs) and the outcomes of this in the form of participant compliance. The research additionally examines the moderating impact of certain factors such as the patients’ e-health literacy and health locus of control (HLOC) and the physicians’ paternalism, in examining the relationship between patient empowerment and compliance.
The findings of the research propose a construct or a theoretical model for the numerous factors and moderators associated with the patient’s participation in online health communities. The social support available to patients leads to more empowered patients, ultimately resulting in higher Patient compliance. Further, this patient empowerment, which comprises of sense of autonomy, competence and self-efficacy makes people more compliant. The theoretical construct between patient empowerment and patient compliance, is further moderated by the patients’ e-health literacy and health locus of control (HLOC) and the physicians’ paternalism
Evaluation of Patient Discharge Information Between What Is Said and What Is Written
No full textBackground: Patients' discharge from the hospital is considered a crucial transition. Appropriate patient education about their condition and its treatment can reduce adverse events and improve health outcomes.
Objective: Identifying high-risk patients for adverse events after hospital discharge and evaluating patient discharge information to ensure patients are safely discharged.
Method: Between January 2019 and February 2020, a retrospective cross-sectional study examined hospital discharge notes. A random sample of 600 hospital discharges was audited, and a convenience sample of 150 patients was used to gauge patient satisfaction.
Results: The patient's age, medical history, the presence of a physical limitation, and the presence of a surgical wound were all significantly related to readmission at p < .05. In addition, there was a significant correlation between emergency room visits, medical history, and physical or mental impairment p< .05. Lastly, the presence of complications was associated with physical restriction and surgical wound p < .05.
The findings revealed that84.6% (n = 127) of patients did not appear to pay attention to the information on their discharge summaries, but they kept them as a reminder of their follow-up appointments. There were medical abbreviations in all of the discharge summaries (n = 150). Almost all discharge summaries contained at least 70% of the required information (diagnosis, past history, allergies, procedures, laboratory results, medications, and appointments). In contrast, the patients' level of satisfaction was lowest with respect to crucial aspects such as warning signs, recommendations, and educational materials. They were neither verbally nor in writing summarized.
Conclusion: Patient-specific discharge information and summaries should be provided. It should be suitable for the patients' physical, educational, and psychological conditions. Important parts of post-discharge instructions should be provided in a straightforward, written format to improve health outcomes and reduce adverse events
Cost Analysis of Physical Therapy Clinic In Thailand: The impact of the COVID-19 outbreak
No full textObjective: The aim of the study was to identify the financial burden and compare the unit costs that Coronavirus disease 2019 (COVID-19) imposed on a physical therapy clinic that are one of the primary forms of healthcare facilities in Thailand.Design and Setting: The study was a retrospective study conducted at the physical therapy clinic, Khon Kaen University Community Outreach Center (KKUCOMOC) in Thailand. To assess the impact of the outbreak, the service unit was divided into two units: physical therapy (PT) and Thai massage (TM), and the annual report for the 2019-2021 fiscal year was analyzed as representative of before and during an outbreak. The study tool was the Handbook of Unit Cost Analysis from the Office of the Permanent Secretary. Revenue, expenses, and the number of patient visits were all gathered. The data was then analyzed and summarized using Microsoft Excel programs, and descriptive statistics were presented. Results: The COVID-19 pandemic not only reduced the number of patient visits but also the revenue. During the pandemic, the percentage of expense to the facility’s revenue increased in both units. Labor, material, and capital costs were the major cost components, with labor costs accounting for the majority of direct costs. The first emerged in the 2020 fiscal year, resulting in an increase in PT's and TM's unit costs of 26.66% (US12.97) and 22.69% (US8.49), respectively. Following that, it continued to rise in both units throughout the subsequent fiscal year. As a result, at the end of the study, the unit costs of PT and TM were US9.22 respectively.
Conclusions: The COVID-19 pandemic reduced the number of patient visits and revenue. Furthermore, it raised the unit cost of PT and TM to US9.22 respectively
Strategic Management and Planning for Health Care Organizations in Georgia
No full textBackground: In order to better adapt to the constantly changing global environment, the main priority of the healthcare system is the stable functioning of the hospital sector, for which it is necessary to execute efficient strategic management processes. The purpose of the research is to study the barriers to effective implementation of strategic plans in hospitals in Tbilisi (Georgia).
Methods: As part of the quantitative research, a survey of 23 top managers of 10 large hospitals was conducted.
Research results: None of the hospitals employed external consultants for strategic planning. A small number of hospitals attended strategic planning training (13%), only one hospital had a strategic planning committee (4.3%), the majority of hospitals (87%) had a documented strategic plan; Strategic planning was primarily engaged by the management board (69.6%), with doctors participating to a lesser extent (30.4%). Only one-third (34.8%) of hospitals develop their budget according to the strategic plan. Resources (43.5%) and allocation of budget funds (47.8%) are not done in accordance with the goals of the strategic plan. The majority of hospitals are less likely to compare the results of the evaluation of goal achievement indicators with those of other hospitals (52.2%), Only a few of them report the values of actions taken to accomplish the strategic plan's goals to the hospital (43.5%), Most of the hospitals rarely do benchmarking of other hospitals' goal-achieving measures (78.3%).
Discussion, Conclusion: Only a small number of hospitals have a strategic management process that as a consequence affects their success in the healthcare market. Due to inappropriate competence, physicians’ strategic planning skills are low. It is reasonable for the state to impose a requirement that the hospitals must produce a written strategic plan and employ a strategic management manager. It is essential to provide educational training on hospital strategic management processes
Cost Analysis of Outpatient Care for Mental and Behavioral Disorders due to Psychoactive Substance Use: A Study of Four Community and Two General Hospitals in Thailand
No full textThis cost analysis study gathered cost information from four community hospitals and two general hospitals in the fiscal year 2014, including service data, hospital statistics, and financial information. The study aimed to analysis and estimate the treatment costs of outpatient mental and behavioral disorders (MBDs) due to psychoactive substance use, provided at community and general hospitals in Thailand. We used ICD-10 codes, F10-F19, to handle the diagnosis codes of MBDs due to psychoactive substances and cost analysis. The unit cost per OPD visit was analyzed according to the cost analysis guidelines of the Ministry of Public Health, Thailand, using two procedures: a traditional method and a cost-to-charge ratio.
The great majority of service expenses were labour costs (53%), followed by material costs (42%) and capital costs (6%). The unit cost per OPD visit for substance use disorders (SUD) in 2014 ranged between 172 and 762 THB. It was adjusted by the inflation rate to estimate the cost for 2021. The costs were growth in the range of 204 to 905 THB. The median cost estimate in 2021 from four community hospitals and two general hospitals, each accounting for 396 and 769 THB, respectively.
The unit SUD visit costs of OPD from these six hospitals are quite close to the unit costs of the drug treatment centers. The greatest proportion of total service expenses was labor costs. Accordingly, human resources are believed to be a crucial challenge that needs to be considered and planned to deliver successful services.
Notably, these hospitals were selected by purposive sampling and might not be representative of each hospital type. More hospitals should, therefore, be recruited in further research to represent the actual cost by hospital type
Women, Aging, Health and Quality of Life: A framework for action and policy formulations
No full textThe population of the elderly in the world will double from 2015 to 2050, reaching nearly 2.1 billion. The ageing population suffers from physical, mental health, and psychological well-being. There such customized policy that caters to helping the ageing population. The current examination studies ageing women, their health, and their quality of life () in India. The study tried to capture the two major and vast diversified areas.
Respondents were randomly selected from four south and north Indian states. The present investigation covered 64 cities in these four states and collected 1,100 samples. The data analysis revealed that QoL has a significant difference with different demographic factors as well as health status, Literacy level, marital status, socioeconomic status, and health status of elderly women. Most of them suffer from diabetes, hypertension, and digestive system issues, so they need regular medical care and attention. Further data analysis unearthed that most ageing women belong to middle and lower socio-economic backgrounds. The government should focus more on their financial assistance and food security and arrange proper counselling therapy for their mental health to improve their QoL.
The study contributes to the constructive and reflective handling of the health and well-being of the ageing female population. Policymakers must look into the health issues of the elderly population and make customised policies and actions that can assist the elderly population