MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the 'The International Journal of Health Planning and Management' source. Sat, 20 Mar 2010 15:50:50 +0100 http://www.medworm.com/index.php?rid=3184618&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.997 One of the biggest obstacles identified in achieving Millennium Development Goals (MDGs) was the lack of available qualified health personal to meet the health needs of the global population. With nurses being the main workforce component in health systems, the human resource challenge for most countries is to address the reported shortage of nurses. Skill mix is one suggestion.In Australia, workforce projections indicated a shortage of 40,000 nurses by 2010. Toward the reform of the Australian health workforce, one project aimed to develop a nationally consistent framework for nursing and midwifery specialization based on knowledge and skills to generate the first national database iteration for designated specialties. A literature review looked at the way nursing specialty practices were... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=3184618 Tue, 19 Jan 2010 00:00:00 +0100 3184618 http://www.medworm.com/index.php?rid=3162841&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.972 This study involves a secondary analysis of micro-data collected from a nationally-representative household survey conducted in Tajikistan in 2003. Three empirical models are employed: binomial logit regression for the admission to the hospital; zero truncated negative binomial (ZTNB) regression for the length of hospital stay; and ordinary least square (OLS) for the amount of out-of-pocket expenditures for hospitalization.Variation in hospital admission is due to the differences in ability to pay, long-standing illness, gender, age, and educational level. Factors explaining out-of-pocket expenditures include ability to pay, having long-standing illness, and having surgery and receiving intensive care. The most important out-of-pocket expenditures are payments for pharmaceuticals and suppl... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=3162841 Tue, 12 Jan 2010 00:00:00 +0100 3162841 http://www.medworm.com/index.php?rid=3162845&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.1027 This paper presents an overview of the operating theatre planning and scheduling practice of hospitals in Flanders (Belgium). An electronic survey was sent to 95 hospitals in which surgeries are performed, which eventually resulted in a response set of 52 hospitals (55%). The questionnaire did not only focus on issues related to the elective (inpatient and outpatient) planning and scheduling process, but also questioned how hospitals currently deal with the occurrence of non-elective surgeries (urgencies and emergencies). We indicate what goals health managers try to achieve and how this planning is established. We furthermore pay attention to some possible disruptions to the schedule and the corresponding anticipatory methods. Despite the proliferation of computerized planning and schedul... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=3162845 Mon, 11 Jan 2010 00:00:00 +0100 3162845 http://www.medworm.com/index.php?rid=3162844&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.1025 The aim of the study was to identify the main determinants of grassroots project success among HIV/AIDS NGOs operating in Rakai, Uganda. It was a cross-sectional study using face-to-face interviews in a mixed-methods approach among community members and NGOs involved in providing HIV/AIDS and related health services. The study found that the success of grassroots projects of HIV/AIDS NGOs essentially relies on adequate financial resources, competent human resources, strong organizational leadership, and NGO networking. These data suggest that to increase grassroots project success, HIV and AIDS NGOs in Rakai need to improve not only the budget base and human capacities but as well decision-making processes, organizational vision, mission and strategies, gender allocation in staffing, and b... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=3162844 Mon, 11 Jan 2010 00:00:00 +0100 3162844 http://www.medworm.com/index.php?rid=3162843&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.1014 In 1988, Brazil became one of the first countries in Latin America to frame access to health care as a constitutional right. However, it would be misleading to call Brazil's Unified Health System (Sistema Único de Saúde, or SUS) a public health system that provides universal access and comprehensive care. This paper reveals a strong contradiction between the re-distribution model set out in the Brazilian Constitution and the inadequate level of public spending on health care. The law states that health care is a basic social right, allocated by need rather than means. Meanwhile, in 2003, Brazil spent US$ 597 per capita on health, or 7.6 per cent of its gross domestic product (GDP), while the average country from the Organization for Economic Cooperation and Development (OECD) spent US$ 3... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=3162843 Mon, 11 Jan 2010 00:00:00 +0100 3162843 http://www.medworm.com/index.php?rid=3162842&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.985 This study aims to investigate the patterns in the utilization of infertility services in Iran.We performed a survey of 10 783 women in 28 provinces from 2004 to 2005. We used a systematic sampling method to draw a total of 400 clusters, the probability for selection being proportional to the size of the urban and rural population in each province. The categorization of the woman as "presumed infertile" was based on her own report of infertility at some time during her married life. We also studied the measures taken for the latest episode of presumed infertility. For each of these measures, we recorded the reason(s), the year in which it was taken, and the time interval separating it from contraceptive discontinuation. Data analysis, using the software package STATA 8.0, included descript... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=3162842 Mon, 11 Jan 2010 00:00:00 +0100 3162842 http://www.medworm.com/index.php?rid=3078178&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.1003 This article argues that organizing inter-organizational collaboration in projects tends to be counterproductive, since the purpose of this collaboration is to increase the integration of local authorities. This article is based on case studies of three different collaboration projects. Each project is analyzed in relation to the way collaboration is organized within the project and how the relationship to the local authorities' activities is designed. The outcome of these studies shows that while collaboration projects increase integration between the responsible authorities, the integration stays within the projects. This is due to the fact that the projects were designed as units separate from the responsible authorities. As a result, the collaboration that occurs in the projects is not... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=3078178 Fri, 11 Dec 2009 00:00:00 +0100 3078178 http://www.medworm.com/index.php?rid=2833802&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.983 The objective of the study was to project the future demand for physicians in Kuwait for the years 2007-2020 based on the period 1994-2006. Population projections were derived using the average annual natural increase rate of the 1994-2006 populations. The future demand for physicians was predicted using the average physician to population ratio for the years 1994-2006. The average annual growth rate of indigenous physicians during the period 1994-2006 was 4.08% compared to 2.83% for non-native expatriot physicians. There is a gap between the numbers of native and foreign physicians. In 2006, native physicians constituted 36.6% of the physician workforce in Kuwait. The disparity between the total number of physicians needed and the number of native physicians is expected to decline from 62... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=2833802 Thu, 24 Sep 2009 23:00:00 +0100 2833802 http://www.medworm.com/index.php?rid=2833801&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.980 The health sector in the Punjab (Pakistan) faces many problems, and the government introduced reforms during 1993-2000 to overcome these problems. This paper explores the policy process for the reforms. A case study method was used and, to assist this, a conceptual framework was developed. Analysis of four initiatives indicated that there were deviations from the government guidelines and that the policy processes used were weak. The progress of different reforms was affected by a variety of factors: the immaturity of the political process and civil society, which together with innate conservatism and resistance to change on the part of the bureaucracy resulted in weak strategic sectoral leadership and a lack of clear purpose underpinning the reforms. It also resulted in weaknesses in prep... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=2833801 Thu, 24 Sep 2009 23:00:00 +0100 2833801 http://www.medworm.com/index.php?rid=2694342&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.989 The objective was to estimate the direction, volume, and value of TiHS; analyze country commitments; and assess the challenges and opportunities for health services.Trade liberalization favored an open trade regime and encouraged foreign direct investment. Consumption abroad and movement of natural persons were the two prevalent modes. Yemen and Sudan are net importers, while Jordan promotes health tourism. In 2002, Yemenis spent US$ 80 million out of pocket for treatment abroad, while Jordan generated US$ 620 million. Egypt, Pakistan, Sudan and Tunisia export health workers, while Oman relies on import and 40% of its workforce is non-Omani. There is a general lack of coherence between Ministries of Trade and Health in formulating policies on TiHS.This is the first organized attempt to loo... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=2694342 Wed, 12 Aug 2009 23:00:00 +0100 2694342 http://www.medworm.com/index.php?rid=2575536&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.988 In recent years, the central government in China has been leading the re-establishment of its rural health insurance system, but local government institutions have considerable flexibility in the specific design and management of schemes. Maintaining a reasonable balance of funds is critical to ensure that the schemes are sustainable and effective in offering financial protection to members. This paper explores the financial management of the NCMS in China through a case study of the balance of funds and the factors influencing this, in six counties in two Chinese provinces. The main data source is NCMS management data from each county from 2003 to 2005, supplemented by: a household questionnaire survey, qualitative interviews and focus group discussions with all local stakeholders and pol... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=2575536 Mon, 06 Jul 2009 23:00:00 +0100 2575536 http://www.medworm.com/index.php?rid=2445655&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.992 This analysis identifies salient features of team management that were critical to the efficiency of program implementation and the effectiveness of behavior change management to promote essential newborn care practices in Uttar Pradesh, India. In May 2003, the Johns Hopkins Bloomberg School of Public Health and King George Medical University initiated a cluster-randomized, controlled neonatal health research program. In less than 2 years, the trial demonstrated rapid adoption of several evidence-based newborn care practices and a substantial reduction in neonatal mortality in intervention clusters. Existing literature involving research program management in resource-constrained areas of developing countries is limited and fails to provide models for team organization and empowerment. The... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=2445655 Sun, 31 May 2009 03:23:20 +0100 2445655 http://www.medworm.com/index.php?rid=2363133&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.982 Pharmaceutical care, meant to complement a proper drug supply system, is a key component of a robust health care system and is the direct, responsible provision of medication-related care designed to achieve definite outcomes that improve a patient's quality of life. Beyond simply dispensing medicine, pharmaceutical care promotes adherence to therapeutic regimens and addresses problems such as overdosage, sub-therapeutic dosage, adverse drug reactions, medication errors, and untreated indications. The dearth of health care workers trained in pharmaceutical care coupled with inadequate access to medications creates multiple disease management challenges in Sub-Saharan Africa (SSA), which has 25% of the world's disease burden but only 1.3% of the world's health workforce. To prevent and trea... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=2363133 Fri, 24 Apr 2009 04:00:00 +0100 2363133 http://www.medworm.com/index.php?rid=2352598&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.986 Although accountability drives in the Indian health sector sporadically highlight egregious behaviour of individual health providers, accountability needs to be understood more broadly. From a managerial perspective, while accountability functions as a control mechanism that involves reviews and sanctions, it also has a constructive side that encourages learning from errors and discretion to support innovation. This points to social relationships: how formal rules and hierarchies combine with informal norms and processes and more fundamentally how power relations are negotiated. Drawing from this conceptual background and based on qualitative research, this article analyses the views of government primary health care administrators and workers from Koppal district, northern Karnataka, Indi... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=2352598 Tue, 21 Apr 2009 04:00:00 +0100 2352598 http://www.medworm.com/index.php?rid=2294149&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.978 This study evaluated equity of provision of surgery after the introduction of a prioritization system to manage access. Data for people receiving publicly funded elective joint replacement, prostatectomy or cataract surgery between 2000 and 2005 were obtained, as well as most recent data for people receiving privately funded surgery (2001 and 2002). Denominators were derived from the 2001 census for the population of District Health Board regions. NZDep2001, a small-area deprivation index, was used to identify people in poorest deciles. Despite the introduction of a prioritization system aimed at increased equity and fairness, the provision of elective surgery remains inequitable geographically. High private provision was not associated with better access to publicly funded surgery. Moreov... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=2294149 Sat, 28 Mar 2009 04:00:00 +0100 2294149 http://www.medworm.com/index.php?rid=2294151&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.981 This study shows that perceived obligations and psychological contracts indicate high degree of relational contracts between the hospital and the physicians. These socio-cultural elements should be recognized as important mechanisms of coordination and communication when policy makers and hospital managers are designing hospital management control systems. Copyright © 2009 John Wiley & Sons, Ltd. (Source: The International Journal of Health Planning and Management) The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=2294151 Wed, 25 Mar 2009 04:00:00 +0100 2294151 http://www.medworm.com/index.php?rid=2181094&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.951 This paper describes performance measurement and its indicators for mental health care services. Performance measurement can serve several goals such as accountability, quality improvement and performance management. For all three purposes structure, process and outcome indicators should be measured. Literature was retrieved from Medline and PsychInfo in order to see which performance indicators were used for the three purposes of performance measurement in mental health care. The indicators were classified in structure, process and outcome indicators. The results show no big differences in the indicators used among studies. Performance management is the performance measurement purpose most referred to, followed by accountability, and quality improvement. Outcome and process indicators are... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=2181094 Fri, 13 Feb 2009 05:00:00 +0100 2181094 http://www.medworm.com/index.php?rid=2127907&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.969 Despite a burgeoning literature on global health partnerships (GHPs), there have been few studies of how GHPs, particularly those trying to build a bridge between horizontal and vertical modes of delivering essential health services, operate at global and country levels. This paper will help address this knowledge gap by describing and analyzing the GAVI Alliance's early experience with health systems strengthening (HSS) to improve immunization coverage and other maternal-child health outcomes. To date, the strengths of HSS reside in its potential to optimize GAVI's overall investment in immunization, efforts to harmonize with other initiatives, willingness to acknowledge risk and identify mitigation strategies, engagement of diverse stakeholders, responsiveness to country needs, and effec... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=2127907 Sat, 24 Jan 2009 05:00:00 +0100 2127907 http://www.medworm.com/index.php?rid=2127908&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.970 This study aimed to estimate and analyse the "actual" unit cost of providing key clinical services in selected rural district hospitals in the North of Vietnam. It also examined the relationship between actual costs and the levels of cost covered by the corresponding user fees paid by patients.Methods: This was a facility-based costing study which estimates the costs of health care services from the perspective of the service providers. Three rural district hospitals from three provinces in the North of Vietnam were purposively selected for this study. The "step-down" approach was applied.Results: There was little difference in the costs of an outpatient visit across the hospitals, but the costs of an operation and an inpatient day varied considerably. In terms of cost structure, personnel... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=2127908 Thu, 22 Jan 2009 05:00:00 +0100 2127908 http://www.medworm.com/index.php?rid=1958837&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.966 Conclusions Considerable operating theatre time is wasted while patients are transferred to and from the operating theatre resulting in both anaesthetists and surgeons having to wait between patients in a high proportion of cases, averaging 1 h during a 4 h operating list. Surgery could be made more time efficient by ensuring that patients arrive in the operating theatre complex early enough (to reduce time wasted for anaesthetists and surgeons), and by having two anaesthetists available at the end of surgery, one to reverse the anaesthetic while the other starts the next induction (to reduce time waste for the surgeon), coupled to adequate recovery area capacity. Copyright © 2008 John Wiley & Sons, Ltd. (Source: The International Journal of Health Planning and Management) The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=1958837 Sat, 15 Nov 2008 05:00:00 +0100 1958837 http://www.medworm.com/index.php?rid=1767806&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.950 This study concludes that services for PMTCT of HIV infection can easily be scaled-up and integrated into RCH services using the already existing staff. In the wake of the human resource crisis in the health sector in developing countries, strategies to address the problem will need to go beyond numbers to address issues of staff productivity and their distribution. Copyright © 2008 John Wiley & Sons, Ltd. (Source: The International Journal of Health Planning and Management) The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=1767806 Sat, 06 Sep 2008 04:00:00 +0100 1767806 http://www.medworm.com/index.php?rid=1767807&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.959 The article explores the concept of clinical leadership in the National Health Service in the UK by seeking to establish a workable definition and by contrasting it with managerial leadership, focussing on the 'disconnected hierarchy' in professional organizations. It proposes that the problems faced by clinical leadership relate to the current nature of general management in the NHS and concludes by suggesting that clinical leadership is the 'elephant in the room' - often ignored or unaddressed. Copyright © 2008 John Wiley & Sons, Ltd. (Source: The International Journal of Health Planning and Management) The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=1767807 Thu, 04 Sep 2008 04:00:00 +0100 1767807 http://www.medworm.com/index.php?rid=1641847&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.958 The Democratic Peoples Republic of Korea (DPRK), under the leadership of the Ministry of Public Health (MOPH), undertook the development of a Health System Strengthening (HSS) proposal through the support of the Global Alliance for Vaccines and Immunization (GAVI). The aim of this paper is to outline the approach to the development of the HSS strategy in DPRK, and describe opportunities and challenges associated with its development and future implementation. Sources of information for this review have included national programme plans, in country social sector reviews, information generated through HSS proposal developments and the international literature.Updated assessments in DPRK indicate some recent improvements in the health situation for women and children, but there remain ongoing... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=1641847 Tue, 22 Jul 2008 04:00:00 +0100 1641847 http://www.medworm.com/index.php?rid=1604954&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.938 The study aims to define configurations of factors from local, regional and national levels that, within a context of decentralized health systems, enable or hinder change towards a health care model of promotion and disease prevention as advocated in current Latin American public health discourse. The project developed in-depth case studies of prevention and promotion activities in eight local health systems in rural and urban Brazil and Chile allowing three levels of comparison: national, regional and local. The data are based on interviews, secondary sources, policy documentation and observations. The results are summarized as pathways through configurations of factors leading to what are termed active and basic degrees of activity related to disease prevention and health promotion at t... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=1604954 Fri, 11 Jul 2008 04:00:00 +0100 1604954 http://www.medworm.com/index.php?rid=1534414&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.937 This paper suggests a simple framework to estimate the shortage of medical practitioners in rural and urban areas in developing countries. Shortages are defined with respect to four main considerations. The overall numbers and also the different categories of practitioners in the rural and urban areas, the relatively greater difficulties of access in the rural areas (which reduce the number of accessible practitioners) and the greater health hazards in those areas (which lead to greater need for medical treatment).The quantitative effect of these factors is examined by undertaking simulation exercises with data for the Ujjain district in Madhya Pradesh state, India and also data for that state. The simulations turned up the following results. The un-weighted total number of practitioners, ... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=1534414 Sat, 21 Jun 2008 04:00:00 +0100 1534414 http://www.medworm.com/index.php?rid=1496185&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.947 Ghana has undertaken many public service management reforms in the past two decades. But the implementation of the reforms has been constrained by many factors. This paper undertakes a retrospective study of research works on the challenges to the implementation of reforms in the public health sector. It points out that most of the studies identified: (1) centralised, weak and fragmented management system; (2) poor implementation strategy; (3) lack of motivation; (4) weak institutional framework; (5) lack of financial and human resources and (6) staff attitude and behaviour as the major causes of ineffective reform implementation. The analysis further revealed that quite a number of crucial factors obstructing reform implementation which are particularly internal to the health system have ... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=1496185 Fri, 06 Jun 2008 04:00:00 +0100 1496185 http://www.medworm.com/index.php?rid=1496188&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.946 This paper performs an empirical comparison of health systems.Health systems are seen as networks of delegation relationships among principals and agents, subject to agency problems. Following the institutional economics approach, a health system's efficiency is considered to be determined by the existence and treatment of agency problems. Agency problems can be controlled by mechanisms built into the health system, or can also be controlled by an external actor, for example, the government, either by using the instruments available or by conducting institutional reforms. To explain differences in the amenability of a country's health system to external governmental control, I combine the veto player approach and the incentives for societal actors to exert influence, into the concept of in... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=1496188 Thu, 05 Jun 2008 04:00:00 +0100 1496188 http://www.medworm.com/index.php?rid=1496187&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.949 This study analyzes Guyana's drug policy and regulation, public financing, and drug procurement and delivery. The study also identifies main barriers to drug access and proposes alternatives to strengthen the country's public health functions. Data were collected from the country's regulatory agencies, public procurement agency, pharmacies, wholesalers, and pharmaceutical companies. The information was supplemented with interviews with a convenient sample of Guyanese health authorities and stakeholders. Data were also compiled from scientific databases, and web pages of the country's Ministries of Health, Commerce and Finance, the Bureau of Statistics, and international organizations. Major barriers to drug access include: (1) lack of national drug policy and regulation, and limited role o... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=1496187 Thu, 05 Jun 2008 04:00:00 +0100 1496187 http://www.medworm.com/index.php?rid=1496186&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.948 This study aims to guide costing efforts in Iran and other countries in the region that are pursuing casemix funding, through identifying the main issues facing cost finding approaches and introducing the costing models compatible with their hospitals accounting and management structures. The results show that inadequate financial and utilisation information at the patient's level, poorly computerized 'feeder systems'; and low quality data make it impossible to estimate reliable DRGs costs through clinical costing. A cost modelling approach estimates the average cost of 2.723 million Rials (Iranian Currency) per DRG. Using standard linear regression, a coefficient of 0.14 (CI = 0.12-0.16) suggests that the average cost weight increases by 14% for every one-day increase in average length of... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=1496186 Thu, 05 Jun 2008 04:00:00 +0100 1496186 http://www.medworm.com/index.php?rid=2575537&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.948 This study aims to guide costing efforts in Iran and other countries in the region that are pursuing casemix funding, through identifying the main issues facing cost finding approaches and introducing the costing models compatible with their hospitals accounting and management structures. The results show that inadequate financial and utilisation information at the patient's level, poorly computerized 'feeder systems'; and low quality data make it impossible to estimate reliable DRGs costs through clinical costing. A cost modelling approach estimates the average cost of 2.723 million Rials (Iranian Currency) per DRG. Using standard linear regression, a coefficient of 0.14 (CI = 0.12-0.16) suggests that the average cost weight increases by 14% for every one-day increase in average length of... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=2575537 Wed, 04 Jun 2008 23:00:00 +0100 2575537 http://www.medworm.com/index.php?rid=1453456&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.936 This paper outlines the principal institutional factors affecting the slow progress in reaching agreed targets in Africa regarding the prevention and control of HIV/AIDS, TB and malaria. It focuses on three key factors, political analysis, strategic business approach and international inputs.Much analysis tends to look at the technical aspects of disease prevention and control. Of political analysis there is a marked absence. Yet we know that wider contextual or macro factors such as power and political decision-making can make or break a programme.Many senior managers in public sector institutions are preoccupied with the day-to-day. Successful businesses in the private sector have some things in common with each other: outstanding leadership, a strategic and action orientated culture, ve... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=1453456 Tue, 20 May 2008 04:00:00 +0100 1453456 http://www.medworm.com/index.php?rid=1425435&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.934 This study examines care provided by obstetricians in all 19 facilities in a typical Russian region. A first set of structured interviews was conducted with 52 obstetricians, with emerging themes explored in a second set of interviews with 36 of the original interviewees. Accounts were compared with quantitative data on patterns of practice.Obstetricians had little access to information, with only limited use of Russian journals and textbooks and minimal access to international evidence.The decisions made by obstetricians largely determined the overall pattern of care, with midwives, nurses and anaesthetists clearly subordinate. Care was highly medicalized, with many interventions long discarded in the west. There was no obvious reason for widespread variations.Obstetric care in Russia is ... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=1425435 Wed, 07 May 2008 04:00:00 +0100 1425435 http://www.medworm.com/index.php?rid=1404869&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.928 Since the 1993 publication of Disease Control Priorities in Developing Countries and World Development Report: Investing in Health, micronutrient fortification and supplementation interventions have been recognized as being among the most cost-effective public health interventions. This paper reviews nearly 100 studies of the cost of micronutrient interventions. The literature contains enormous variation in the estimated costs of these programs due to differences in program structure, delivery systems and a host of country-specific factors, differences in the studies' objectives, designs and costing methodologies. The most diverse estimates reported are those of vitamin A supplementation programs, where estimates vary by a factor of more than 1000. The costs of fortification programs, too,... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=1404869 Tue, 29 Apr 2008 04:00:00 +0100 1404869 http://www.medworm.com/index.php?rid=1404870&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.932 Sustainability is a critical determinant of scale and impact of health sector development assistance programs. Working with USAID/Nepal implementing partners, we adapted a sustainability assessment framework to help USAID test how an evaluation tool could inform its health portfolio management. The essential first process step was to define the boundaries of the local system being examined. This local system - the unit of analysis of the study - was defined as the health district.We developed a standardized set of assessment tools to measure 53 indicators. Data collection was carried out over 4 weeks by a Nepalese agency. Scaling and combining indicators into six component indices provided a map of progress toward sustainable maternal and child, health, and family planning results for the ... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=1404870 Mon, 28 Apr 2008 04:00:00 +0100 1404870 http://www.medworm.com/index.php?rid=1398756&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.929 Portfolio analysis is a business management tool that can assist health care managers to develop new organizational strategies. The application of portfolio analysis to US hospital settings has been frequently reported. In Europe however, the application of this technique has received little attention, especially concerning public hospitals. Therefore, this paper examines the peculiarities of portfolio analysis and its applicability to the strategic management of European public hospitals. The analysis is based on a pilot application of a multi-factor portfolio analysis in a Dutch university hospital. The nature of portfolio analysis and the steps in a multi-factor portfolio analysis are reviewed along with the characteristics of the research setting. Based on these data, a multi-factor po... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=1398756 Fri, 25 Apr 2008 04:00:00 +0100 1398756 http://www.medworm.com/index.php?rid=1398758&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.931 The Ministry of Public Health (MOPH) of Afghanistan has adopted the Balanced Scorecard (BSC) as a tool to measure and manage performance in delivery of a Basic Package of Health Services. Based on results from the 2004 baseline round, the MOPH identified eight of the 29 indicators on the BSC as priority areas for improvement. Like the 2004 round, the 2005 and 2006 BSCs involved a random selection of more than 600 health facilities, 1700 health workers and 5800 patient-provider interactions. The 2005 and 2006 BSCs demonstrated substantial improvements in all eight of the priority areas compared to 2004 baseline levels, with increases in median provincial scores for presence of active village health councils, availability of essential drugs, functional laboratories, provider knowledge, healt... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=1398758 Thu, 24 Apr 2008 04:00:00 +0100 1398758 http://www.medworm.com/index.php?rid=1398757&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.930 In the last 20 years, orphan drug legislation (ODL) has been adopted in several countries around the world (USA, Japan, Australia, and the European Union) and has successfully promoted R&D investments to develop new pharmaceutical products for the treatment of rare diseases. Without these incentives, many life-saving new drugs would have not been developed and produced.For economic reasons, the development of medicines for the treatment of diseases prevalent in the developing world (or tropical diseases) is lagging behind. Among several factors, the low average per-capita income makes pharmaceutical markets in developing countries appear relatively unprofitable and therefore unattractive for R&D-oriented companies.The case of ODL may offer some useful insights and perspectives for the figh... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=1398757 Thu, 24 Apr 2008 04:00:00 +0100 1398757 http://www.medworm.com/index.php?rid=1274640&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.926 No Abstract. (Source: The International Journal of Health Planning and Management) The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=1274640 Mon, 03 Mar 2008 05:00:00 +0100 1274640 http://www.medworm.com/index.php?rid=1188215&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.919 The study aims to define configurations of factors from local, regional and national levels that, within a context of decentralized health systems, enable or hinder change towards a health care model of promotion and disease prevention as advocated in current Latin American public health discourse. The project made in-depth case studies of prevention and promotion activities in eight local health systems in rural and urban Brazil and Chile allowing three levels of comparison: national, regional and local. The data are based on interviews, secondary sources, policy documentation and observations.The results are summarized as pathways through configurations of factors leading to what are termed active and basic degrees of activity related to disease prevention and health promotion at the loc... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=1188215 Wed, 30 Jan 2008 05:00:00 +0100 1188215 http://www.medworm.com/index.php?rid=1156595&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.916 This study focuses on how the inter-organizational collaboration was conducted in the care for drug abusers over a period of 5 years. The study sought to answer the following questions: Which effect does inter-organizational collaboration have on ways-of-working among professionals and which effect does inter-organizational collaboration have on the services provided by the clients?We argue that inter-organizational collaboration is developed through three processes. First, the professionals redefine 'areas of responsibilities' in the different organizations. Second, the professionals 'reconstruct their ways of working' with clients. Third, the professionals 'organize a networking model with the client as citizen in the centre'. This paper describes how the three processes appeared in the ... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=1156595 Wed, 16 Jan 2008 05:00:00 +0100 1156595 http://www.medworm.com/index.php?rid=1112573&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.917 To explore the determinants of public satisfaction with the National Health Insurance, this study re-analyzed the 2004 public satisfaction survey with the Korean National Health Insurance (KNHI) conducted by Korean National Health Insurance Corporation (KNHIC). One thousand samples were selected with probability proportional to population size (by region/sex/age). The data collected by home-visit interview were transformed into the final data set by matching them to the insured's benefit database and the qualification database. The results showed that metropolitan residence, insured type, relationship between respondent and householder, subjective health status, benefit-cost ratio, and attitudes toward KNHI were direct determinants of satisfaction with KNHI. In addition, various demographi... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=1112573 Sat, 22 Dec 2007 05:00:00 +0100 1112573 http://www.medworm.com/index.php?rid=1112574&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.915 Through health sector reform in developing countries, Ministries of Health have sought to enhance health care through greater community governance and improved management effectiveness in their public hospitals. In this paper, we present a partnership-mentoring model for enhancing management capacity that has been piloted in Ethiopia and may be useful in other developing countries. The model included needs assessment and baseline evaluation using a hospital management indicator checklist, deployment of 24 Fellows (US and international hospital administrators) for 1 year to work as mentors with hospital management teams in 14 Ethiopian hospitals, continuing didactic and practical training in quality improvement methods for hospital management teams, and 24 management improvement projects to... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=1112574 Fri, 21 Dec 2007 05:00:00 +0100 1112574 http://www.medworm.com/index.php?rid=1060798&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.914 This paper contributes to analysing and understanding the demand for (social) health insurance of informal sector workers in Kenya by assessing their perceptions and knowledge of and concerns regarding health insurance and the Kenyan National Hospital Insurance Fund (NHIF). It serves to explore how informal sector workers could be integrated into the NHIF.To collect data, focus group discussions were held with organized groups of informal sector workers of different types across the country, backed up by a self-administered questionnaire completed by heads of NHIF area branch offices.It was found that the most critical barrier to NHIF enrolment is the lack of knowledge of informal sector workers about the NHIF, its enrolment option and procedures for informal sector workers. Inability to p... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=1060798 Fri, 30 Nov 2007 05:00:00 +0100 1060798 http://www.medworm.com/index.php?rid=1060799&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.911 The present work analyzed the association between hospital costs and patient admission characteristics in a general public hospital in the city of Rio de Janeiro, Brazil. The unit costs method was used to estimate inpatient day costs associated to specific hospital clinics. With this aim, three "cost centers" were defined in order to group direct and indirect expenses pertaining to the clinics. After the costs were estimated, a standard linear regression model was developed for correlating cost units and their putative predictors (the patients gender and age, the admission type (urgency/elective), ICU admission (yes/no), blood transfusion (yes/no), the admission outcome (death/no death), the complexity of the medical procedures performed, and a risk-adjustment index). Data were collected f... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=1060799 Thu, 29 Nov 2007 05:00:00 +0100 1060799 http://www.medworm.com/index.php?rid=1027961&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.912 A reward and recognition (RR) system is a tool widely applied by organizations to motivate their employees. Outstanding employees expect their effort to be acknowledged by the organization. However, the variety of rewards and recognitions systems used by organizations may be perceived differently by different employees. The diverse workforce structure in the United Arab Emirates (UAE) poses various challenges for organization managers. Managers need to implement the shrewd RR system which best fits their diverse workforce. This research studied how medical sector employees in the private and public health sector view the RR systems in the UAE. Two lists, comprising 26 major approaches to RR, were prepared and its items prioritized by taking inputs from 250 employees working in more than 30... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=1027961 Thu, 15 Nov 2007 05:00:00 +0100 1027961 http://www.medworm.com/index.php?rid=1027962&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.913 To determine, from the perspective of providers, community leaders and users of health services, equity, governance and health financing outcomes of the Mexican health system reform.Cross-sectional study oriented towards the qualitative analysis of financing, governance and equity indicators for the uninsured population. Taking into account feasibility, as well as political and technical criteria, six Mexican states were selected as study populations and a qualitative research was conducted during 2004-2006. Two hundred and forty in-depth interviews were applied, in all selected states, to 60 decision-makers, including medical and administrative personnel; 60 service providers at health centres; 60 representatives of civil organizations, including municipal representatives and, finally, 60... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=1027962 Wed, 14 Nov 2007 05:00:00 +0100 1027962 http://www.medworm.com/index.php?rid=867892&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.899 A simple information system for primary care clinics was designed to support the USAID funded health system strengthening project in the Suez Governorate in Egypt. This system (FACT - Feedback and Analytic Comparison Tool) was implemented in December 2003 in 14 primary care clinics. The MS Access-based system was designed and prototyped in several months, and was easily and cheaply modified several times after implementation. A total of 128 562 persons have been registered in the system (as of June 2005) and 36 083 visits have been documented. A key feature of FACT is the ease with which clinicians can conduct exploratory research about practice patterns, and variations in them across doctors and the other clinics. This analytic feature enables the clinicians to self-diagnose quality probl... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=867892 Thu, 13 Sep 2007 04:00:00 +0100 867892 http://www.medworm.com/index.php?rid=845271&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.901 A questionnaire survey (QS) among stakeholders in Tanzania had shown that in-kind drug donations (DDs) are important to boost the drug supply system. Major problems were their insufficient quantity for sustainable treatment and the discrepancy between the needs of the recipients and the donors' supply. Objectives in this study were to discuss these findings and to learn from key informants (KIs) how to improve the DD process. Data were collected through KI interviews in 2001/2002.A 30% gap in drug supply has to be bridged by DDs. KIs confirmed the importance of the World Health Organisation and Tanzanian DD guidelines as a tool for good donation practice and emphasized the role of the government in their implementation. They requested that donors meet the recipient country's regulatory req... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=845271 Thu, 06 Sep 2007 04:00:00 +0100 845271 http://www.medworm.com/index.php?rid=833081&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.902 Over the last decade, outsourcing has become one of the major issues in health care. Two major concerns are related to public health care outsourcing practice. The first one involves the suitability of the outsourcing strategy in the public sector, principally with reference to the outsourcing of essential clinical services. The second one relates to the actual benefits of the outsourcing practice in health care, in terms of cost reduction and increasing efficiency.This paper aims to contribute to the debate and literature on outsourcing through a national survey carried out in the Italian National Health Service.In order to achieve the research objective, a questionnaire was developed and, after a pilot test, it was mailed to all Italian public providers. The total response rate was aroun... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=833081 Fri, 31 Aug 2007 04:00:00 +0100 833081 http://www.medworm.com/index.php?rid=830619&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.900 This study also identified challenges to implementing integration and the solutions found. These include the importance of focusing on the professional development of disease-specific program staff as their roles change, strengthening specific weakness in the general health system and finding alternative solutions where these are not easily solved, actively engaging senior management at an early stage, continually evaluating the impact of integration and not pushing integration for the sake of integration. Copyright © 2007 John Wiley & Sons, Ltd. (Source: The International Journal of Health Planning and Management) The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=830619 Thu, 30 Aug 2007 04:00:00 +0100 830619 http://www.medworm.com/index.php?rid=829466&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.897 In recent years, primary health care in Uzbekistan has seen dramatic changes in organization, management and financing. The Soviet multi-tiered system of primary care is being replaced by a two-tiered system, consisting in rural areas of rural physician points (SVPs) and outpatient clinics of central rayon hospitals. A state-guaranteed benefits package of primary care services has been introduced and financing is increasingly based on capitation. In addition, a considerable number of physicians and nurses have been trained in general practice. There are, however, a number of challenges that remain. One of them is the considerable regional differences that exist in health financing. Another challenge is that some rural areas have difficulties attracting primary care workers. Overall, the in... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=829466 Wed, 29 Aug 2007 04:00:00 +0100 829466 http://www.medworm.com/index.php?rid=811651&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.898 Community-based health insurance (CBHI) schemes have developed in response to inadequacies of alternate systems for protecting the poor against health care expenditures. Some of these schemes have arisen within community-based organizations (CBOs), which have strong links with poor communities, and are therefore well situated to offer CBHI. However, the managerial capacities of many such CBOs are limited. This paper describes management initiatives undertaken in a CBHI scheme in India, in the course of an action-research project. The existing structures and systems at the CBHI had several strengths, but fell short on some counts, which became apparent in the course of planning for two interventions under the research project. Management initiatives were introduced that addressed four featu... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=811651 Tue, 21 Aug 2007 04:00:00 +0100 811651 http://www.medworm.com/index.php?rid=806373&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.896 This paper outlines the principal institutional factors affecting the slow progress in reaching agreed targets in Africa regarding the prevention and control of HIV/AIDS, TB and Malaria. It focuses on three key factors: political analysis, strategic business approach and international inputs.Most of the analyses tend to look at the technical aspects of disease prevention and control, of political analysis there is a marked absence. Yet, we know that wider contextual or macro factors such as power and political decision making can make or break a programme.Many senior managers in public sector institutions are preoccupied with day-to-day work. Successful businesses in the private sector have some things in common with each other. Outstanding leadership, a strategic and action orientated cul... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=806373 Sat, 18 Aug 2007 04:00:00 +0100 806373 http://www.medworm.com/index.php?rid=668181&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.890 This article reports on a study of one type of HEF, based in Kirivong Operational Health District (KOD) and operated through local pagoda structures, which demonstrates minimal reliance on external funding and low administrative overheads. We utilize an adapted sustainability assessment framework to assess the ability of pagoda structures to enable financial access for the poorest to public sector health services. We further analyse the strengths and limitations of the pagoda-managed equity fund initiative, with a view to assessing not only its sustainability but its potential for replication in other settings.Our study shows that, against key sustainability indicators (health service utilization and health outcomes; management capacity and financial viability; community mobilization and g... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=668181 Sat, 16 Jun 2007 04:00:00 +0100 668181 http://www.medworm.com/index.php?rid=660232&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.882 Knowledge of what constitutes best practice in human resource management (HRM) in public-oriented services is limited and the operational aspects of managing health workers at provision level have been poorly studied. The magnet hospital concept offers some insights into HRM practices that are leading to high commitment. These have been shown to lead to superior performance in not only industrial business firms, but also service industries and the public service. The mechanisms that drive these practices include positive psychological links between managers and staff, organizational commitment and trust. Conditions for successful high commitment management (HiCoM) include health service managers with a strong vision and able to transmit this vision to their staff, appropriate decision spac... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=660232 Wed, 06 Jun 2007 04:00:00 +0100 660232 http://www.medworm.com/index.php?rid=660233&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.880 In a move to achieve a better equity in the funding of access to health care, particularly for the poor, a better efficiency of hospital functioning and a better financial balance, the analysis of hospital costs in Mali brings several key elements to improve the pricing of medical services. The method utilized is the classical step-down process which takes into consideration the entire set of direct and indirect costs borne by the hospital. Although this approach does not allow to estimate the economic cost of consultations, it is a useful contribution to assess the financial activity of the hospital and improve its performance, financially speaking, through a more relevant user fees policy. The study shows that there are possibilities of cross-subsidies within the hospital or within servi... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=660233 Tue, 05 Jun 2007 04:00:00 +0100 660233 http://www.medworm.com/index.php?rid=607489&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.881 Assessing public sector ICT investments represents the premise for successful implementation of an e-health strategy. The recent literature stresses the importance of going beyond the mere financial and/or technical dimensions of the analysis. Consequently, the paper proposes an example of e-health project evaluation aiming to develop measures which get close to the notion of benefits to the different stakeholders involved: top management, patients, local community. The case study refers to an Italian health care organization that implemented a project of digitalization of its clinical reports production few years ago. Based on on-field research, different approaches are used to assess costs and benefits from different stakeholders' perspectives. The results of a multidimensional evaluatio... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=607489 Thu, 17 May 2007 04:00:00 +0100 607489 http://www.medworm.com/index.php?rid=607490&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.883 This paper presents an application of the data mining method to determine the financial profiles of the public hospitals in Turkey. The study is based on the data compiled in 2004, covering 645 public hospitals run by the Ministry of Health (MoH) as the main provider of primary and secondary health services in Turkey. The public hospitals, currently financed by a mixture of funds allocated from the general budget and individually operated revolving funds, need urgent solutions to their financial problems as a part of an ongoing national reform effort. The analysis adopts the Chi-Square Automatic Interaction Detector (CHAID) decision tree algorithm, as one of the most efficient and up-to-date data mining method used for segmentation.The study has found that the public hospitals could be cat... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=607490 Fri, 04 May 2007 04:00:00 +0100 607490 http://www.medworm.com/index.php?rid=583601&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.884 During the last decade, as a response to the need for inter- as well as intra-organizational integration, management models initially developed for industry have been spread to health care organizations. Based on 62 in-depth interviews, this qualitative study aims at describing and analyzing the limited success of implementation of process orientation at a Swedish hospital and in doing so, the traditional and the critical approaches are combined. Applying a traditional approach, the limited success of the implementation of process orientation is explained in terms of difficulties to challenge deeply institutionalized organizational routines and the inter-disciplinary boundaries. This might be condensed to the dilemma of how to maintain and develop the specialization of the medical professi... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=583601 Wed, 02 May 2007 04:00:00 +0100 583601 http://www.medworm.com/index.php?rid=567549&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.878 This study details the process of determining national health priorities, creating a basic package of services, and estimating per capita and unit costs for providing those services, with an emphasis on the costing exercise. Strategies for obtaining a rapid yet reasonably accurate estimate of health service costs nationwide are discussed. In 2002 this costing exercise indicated that the basic package of services could be provided for US$4.55 per person. In 2006, the findings were validated: the four major donors who contracted with non-governmental organizations (NGOs) to provide basic health services for nearly 80% of the population found per capita costs ranging from $4.30 to $5.12. This study is relevant for other post-conflict countries that are re-establishing health services and seek... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=567549 Tue, 24 Apr 2007 04:00:00 +0100 567549 http://www.medworm.com/index.php?rid=551208&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.879 To assess the cost of public and private hospitalizations in urban Kerala and discuss policy implications of social disparities in the economic burden of hospital care.The NSSO survey on health care (1995-1996) for urban Kerala was analysed with regards to expenditure incurred by hospital episodes. Multilevel linear models were built to assess factors associated with levels of health expenditure.Hospital care involves paying admission fees in 68% of cases of hospitalizations (98% in private and 20% in public sector) in urban Kerala. Poor households and those headed by casual workers show significantly lower levels of health expenditure and a higher proportion of health-related loss of income than other social groups. Although there is significant expenditure in both sectors for these group... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=551208 Wed, 18 Apr 2007 04:00:00 +0100 551208 http://www.medworm.com/index.php?rid=465624&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.871 This paper suggests a simple framework to estimate the shortage of medical practitioners in rural and urban areas in developing countries. Shortages are defined with respect to four main considerations. The overall numbers and also the different categories of practitioners in the rural and urban areas, the relatively greater difficulties of access in the rural areas (which reduce the number of accessible practitioners) and the greater health hazards in those areas (which lead to greater need for medical treatment).The quantitative effect of these factors is examined by undertaking simulation exercises with data for the Ujjain district in Madhya Pradesh state, India and also data for that state. The simulations turned up the following results. The un-weighted total number of practitioners, ... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=465624 Sun, 11 Mar 2007 05:00:00 +0100 465624 http://www.medworm.com/index.php?rid=410703&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.870 Local health care in Sweden is an emerging form of integrated care, linked together by chains of care. Experiences show, however, that the development of chains of care is making slow progress. In order to study the factors behind this development, an embedded multiple-case study design was chosen. The study compared six health authorities in Sweden, three with successful and three with unsuccessful chain of care development.Three major determinants of integrated health care development were identified: professional dedication, legitimacy and confidence. In more detail, space for prime movers and trust between participants were crucial success factors, while top-down approaches targeting at the same time a change of management systems were negative for the development of chains of care. Re... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=410703 Mon, 12 Feb 2007 07:00:00 +0100 410703 http://www.medworm.com/index.php?rid=375107&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.866 This paper examines the experience of developing primary care organizations (PCOs) in New Zealand and England, exploring how far these new institutional forms have been able to 'tip the balance' of their host health system in favour of primary care. The original objectives for establishing PCOs in the two countries are assessed using published research evidence on the impact of PCOs covering: efficiency and cost containment; the development of clinical engagement and leadership; the development of primary care; and the purchasing of secondary and referred services. It is concluded that in both countries, progress has been made in aligning more closely the individual focus of general practice with the population perspective of the wider public health system. The New Zealand approach of usin... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=375107 Tue, 23 Jan 2007 07:00:00 +0100 375107 http://www.medworm.com/index.php?rid=375106&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.869 The purpose of this study is to assess the impact of a primary health care strengthening intervention on bypassing behavior in Albania, a middle-income country that has experienced substantial structural changes that affect PHC and where bypassing among health care clients is common. The intervention aimed to improve the quality of health care in low-level facilities through improved availability and use of health information, the adoption of clinical practice guidelines, and provider training. The study employs a quasi-experimental research design to evaluate the impact of the intervention on health care utilization. The survey findings suggest that the pilot areas outperformed the control areas with respect to a number of key population-based indicators of health care utilization. For ex... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=375106 Tue, 23 Jan 2007 07:00:00 +0100 375106 http://www.medworm.com/index.php?rid=375109&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.868 The market-inspired control models that go under the name of New Public Management (NPM) are no longer being debated in the arena of public health care as they once were, although there are still very clear signs of NPM in many countries. One manifestation of NPM in health care is activity-based financing. The first purpose of this paper is to describe what impacts activity-based financing has had in Sweden's public health service. The second purpose is to explain why the application of the payment model has been gradually changed. The basis for the paper comprises research done on activity-based financing. The review of the development within Swedish health care regarding activity-based financing shows that effects appear. But it also becomes evident that the models often are adjusted and... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=375109 Mon, 22 Jan 2007 07:00:00 +0100 375109 http://www.medworm.com/index.php?rid=375108&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.867 This article looks at the issue of sustaining funding for a public programme through the case study of the delivery exemptions policy in Ghana. The Government of Ghana introduced the policy of exempting users from delivery fees in September 2003 in the four most deprived regions of the country, and in April 2005 it was extended to the remaining six regions in Ghana. The aim of the policy of free delivery care was to reduce financial barriers to using maternity services. Using materials from key informant interviews at national and local levels in 2005, the article examines how the policy has been implemented and what the main constraints have been, as perceived by different actors in the health system. The interviews show that despite being a high-profile public policy and achieving positi... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=375108 Mon, 22 Jan 2007 07:00:00 +0100 375108 http://www.medworm.com/index.php?rid=264322&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.862 Personnel in public hospitals had relatively low job satisfaction despite of tenure employment. High turnover rates degrade hospital image and incur additional costs related to recruitment and training. The purposes of this study were to describe the occupational differences and to identify factors affecting turnover intention among public hospital personnel.A questionnaire survey was conducted as part of Administrative Services Quality Evaluation Program by Seoul metropolitan municipality from 1 November to 1 December in 2003. The subjects were 1251 entire hospital personnel in four hospitals. The questionnaire was designed to measure job satisfaction, organizational commitment, turnover intention, and demographic characteristics. Logistic regression analysis was performed to determine fa... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=264322 Mon, 06 Nov 2006 07:00:00 +0100 264322 http://www.medworm.com/index.php?rid=251759&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.857 Private health insurance plays a large and increasing role around the world. This paper reviews international experiences and shows that private health insurance is significant in countries with widely different income levels and health system structures. It contrasts trends in private health insurance expansion across regions and highlights countries with particularly important experiences of private coverage. It then discusses the regulatory approaches and policies that can structure private health insurance markets in ways that mobilize resources for health care, promote financial risk protection, protect consumers and reduce inequities. The paper argues that policy makers need to confront the role that private health insurance will play in their health systems and regulate the sector a... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=251759 Fri, 27 Oct 2006 06:00:00 +0100 251759 http://www.medworm.com/index.php?rid=239933&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.861 This article examines the implementation of managerialism in an attempt to evaluate its overall achievements and shortcomings. Overall, managerialism seems to have made good progress: managerial skills are improving; several management tools have been adapted to health-care and public-sector peculiarities; health-care organizations have adopted a wide range of technical solutions to fit their specific needs. At the same time, managerial innovations have often focused on structures as opposed to processes, on the way the organization looks as opposed to the way it works, on the tools it has as opposed to those it actually needs and uses. We thus suggest that research, training and policy-making should stop focusing on the technical features and theoretical virtues of specific tools and shou... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=239933 Wed, 18 Oct 2006 06:00:00 +0100 239933 http://www.medworm.com/index.php?rid=237131&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.859 This study is on the evaluation of quality of health care within first line health services in rural Zimbabwe. It took place between 2001 and 2002, and consisted of a cross-sectional survey designed to compare the quality of health care on offer at a newly created health centre with that provided by the district hospital's outpatient department. The hypothesis to be tested was that the health centre offered better quality of care. A comprehensive quality of care evaluation framework was designed. The concept of patient enablement was incorporated into the study's assessment of health care delivery outcomes. The results did not provide conclusive evidence that the care offered at the health centre was better than the care on offer at the hospital OPD. The reasons for these unexpected findin... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=237131 Tue, 17 Oct 2006 06:00:00 +0100 237131 http://www.medworm.com/index.php?rid=233702&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.858 When tertiary health centers face capacity constraint, one feasible strategy to meet service demand is outsourcing clinical services to qualified community providers. Clinical outsourcing enables tertiary health centers to meet the expectations of service timeliness and provides good opportunities to collaborate with other health care providers. However, outsourcing may result in dependence and loss of control for the tertiary health centers. Other parties involved in clinical outsourcing such as local partners, patients, and payers may also encounter potential risks as well as enjoy benefits in an outsourcing arrangement. Recommendations on selecting potential outsourcing partners are given to minimize the risks associated with an outsourcing contract. Copyright © 2006 John Wiley & Sons,... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=233702 Fri, 13 Oct 2006 20:57:02 +0100 233702 http://www.medworm.com/index.php?rid=233701&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.860 This article studies strategic behavior in municipal health care consortia where neighboring municipalities form a partnership to supply high-complexity health care. Each municipality partially funds the organization. Depending on the partnership contract, a free rider problem may jeopardize the organization. A municipality will default its payments if it can still benefit from the services, especially when political pressures for competing expenditure arise. The main result is that the partnership sustainability depends on punishment mechanisms to a defaulting member, the gains from joint provision of services and the overall economic environment. Possible solutions to the incentive problem are discussed. Copyright © 2006 John Wiley & Sons, Ltd. (Source: The International Journal of Heal... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=233701 Fri, 13 Oct 2006 06:00:00 +0100 233701 http://www.medworm.com/index.php?rid=214891&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.855 This paper examines the recent trends in public hospital autonomy as an integral part of health systems reforms. It reviews literature produced on the subject across a range of developing countries and explores varying viewpoints, arguments, and rationale for hospital autonomy developed over the past two decades. It then leads onto a discussion of two experiences of autonomy reforms in Pakistan: the provinces of Punjab and NWFP. Derived from the lessons learned from these initiatives, a set of guidelines is suggested as sustainable frameworks for reviewing the current measures and for designing future autonomy initiatives in Pakistan. Copyright © 2006 John Wiley & Sons, Ltd. (Source: The International Journal of Health Planning and Management) The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=214891 Sat, 30 Sep 2006 06:00:00 +0100 214891 http://www.medworm.com/index.php?rid=204499&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.854 In this research, it was aimed to examine the effectiveness of health management departments of universities that train health managers in Turkey. The study was taken on hand as comparative in respect to positions (lecturers and students) and variables of universities. Organisational effectiveness was attempted to describe in nine dimensions by being inspired from Cameron's study. Factor analysis was used for construction validity of the scale developed by the researcher. For internal consistency and reliability, Cronbach Alpha reliability coefficient and item total correlation were applied. A questionnaire was applied on total 207 persons in health management departments that form up the population in Turkey. In analysis of data were descriptive statistics and t-test used. According to re... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=204499 Mon, 25 Sep 2006 04:00:00 +0100 204499 http://www.medworm.com/index.php?rid=203245&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.856 This paper reports on comparative analysis of health planning and its relationship with health care reform in three countries, Eritrea, Mozambique and Zimbabwe. The research examined strategic planning in each country focusing in particular on its role in developing health sector reforms. The paper analyses the processes for strategic planning, the values that underpin the planning systems, and issues related to resources for planning processes. The resultant content of strategic plans is assessed and not seen to have driven the development of reforms; whilst each country had adopted strategic planning systems, in all three countries a more complex interplay of forces, including influences outside both the health sector and the country, had been critical forces behind the sectoral changes ... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=203245 Sun, 24 Sep 2006 04:00:00 +0100 203245 http://www.medworm.com/index.php?rid=203247&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.853 After the break-up of the Soviet Union, the country of Georgia suffered from intense civil unrest and socio-economic deterioration, which particularly affected the health sector. To remedy the situation, the government initiated health sector reform, which introduced major changes in healthcare financing in Georgia: the previously free healthcare model was replaced by social insurance, and patients were required to pay out-of-pocket for services not covered by insurance. This paper is an attempt to determine if the health system of Georgia is reaching the WHO health system goals of improved health status, responsiveness to patients' needs (consumer satisfaction), and financial risk protection as a result of health reforms. Copyright © 2006 John Wiley & Sons, Ltd. (Source: The Internationa... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=203247 Sun, 24 Sep 2006 01:01:01 +0100 203247 http://www.medworm.com/index.php?rid=203246&cid=s_33639_51_f&fid=33639&url=http%3A%2F%2Fdx.doi.org%2F10.1002%252Fhpm.852 On the basis of a case study in Pakistan, the paper argues that good governance, characterized by transparency, accountability and meaningful community participation, plays a critical role in the sustainability of donor-funded health systems projects in the public health sector.The Family Health Project (FHP) (1992-1999), funded by the World Bank, has been used as a case study. Critical analysis of secondary data mainly obtained from the Department of Health (DoH) in the province of Sindh in Pakistan is the major tool used for the study. Data from other sources including the World Bank have also been used.The analysis reveals that the existing health care system could not fully absorb and sustain major "sociopolitical" thrusts of the project, meaningful community participation and "democra... The International Journal of Health Planning and Management journals http://www.medworm.com/rss/comments.php?id=203246 Sun, 24 Sep 2006 01:01:01 +0100 203246