International Journal of Health Policy and Management最新文献

Background: Improving healthcare productivity and efficiency through effective management practice is crucial in the healthcare sector. However, the evidence on how management practices affect hospital performance is mixed and limited in the public health system. The objectives of this study are (1) locating Chinese public hospitals' management ability in the global health system community, and (2) investigating how public hospital's management practice is correlated to the objective and subjective performances.

Methods: Using the World Management Survey (WMS) methodology, the national Global Hospital Management Survey-China (GHMS-China) was conducted from 2014 to 2016 to measure Chinese hospitals' management practices. This study utilized a national representative hospital sample from the GHMS-China and used multi-variable linear regression model to examine the association between hospital performance and management practices. This study mainly focused on the clinical outcomes for acute myocardial infarction (AMI), heart failure (HF), pneumonia children (PC), and coronary artery bypass grafting (CABG), as well as satisfaction measurements including staff turnover and subjective ratings from patient and staff.

Results: Hospitals with higher management scores have significantly lower mortality rates on AMI, lower complication rates on CABG and shorter average length of stay (LoS) for PC patients. Hospital management and subjective performance also shows a positive correlation, with a significant increase of inpatient satisfaction rating by 0.72 scores (95% CI: 0.28,1.16; P=0.001). This relationship is more pronounced in hospitals with larger bed capacities, greater competition, more autonomy, and in sub-sample group of hospitals with superior management practice. The potential mechanisms through which hospital management can foster performance include attracting more talented clinical staffs, providing more valuable and continuous training opportunities, as well as providing more standardized clinical care service.

Conclusion: Better management practice is correlated to superior hospital performance in Chinese Public Health Service System. Future studies with religious and causality study design are warranted.

Background: China has developed a novel case-based payment method called the DiagnosisIntervention Packet (DIP) to regulate healthcare providers' behavior. G city, a metropolis in southeast China, has shifted its payment policy from fixed rate per admission to DIP under regional global budget since 2018. This study examined the immediate and trend changes in provider behavior after this payment reform.

Methods: Discharge data in G city between 2016 and 2019 was used, covering more than 10 million inpatient cases in 320 hospitals. A counterfactual scenario was developed to assign insured and uninsured inpatients across the study period to specific DIP groups under consistent rules. Controlled interrupted time-series (ITS) analyses were performed, with uninsured inpatients as control. Outcomes included inpatient volume, average DIP weight (similar to case-mix index in Diagnosis-Related Groups), and two innovative indicators (average diagnostic weight and average treatment weight) to decompose the changes in DIP weight. Subgroup analyses were conducted for different hospital levels and 21 major disease categories.

Results: After the DIP reform, monthly trend of inpatient volume decreased (-1085.34, P=0.052), while monthly growth of average DIP weight increased (2.17, P=0.02). No significant changes in average diagnostic weight were observed. Monthly trend of average treatment weight increased (2.38, P=0.001) after the reform. Secondary and tertiary hospitals experienced insignificantly decreased inpatient volume and elevated average DIP weight, accompanied by negligible change in average diagnostic weight and significant increase in average treatment weight. Primary hospitals experienced reduced inpatient volume and stable average DIP weight, along with increase in average diagnostic weight and decrease in average treatment weight.

Conclusion: By differentiated payments for severity, DIP induced hospitals to shift their focus from volume to weight of inpatients. Instead of diagnostic upcoding, hospitals responded to the DIP reform primarily by increasing treatment intensity. Primary hospitals may face financial risks under regional competition.

This commentary reflects on the principles of research coproduction discussed by Rycroft-Malone et al through our experiences in Uganda, particularly within the partnership between Nottingham Trent University (UK) and Makerere University (Uganda). The commentary highlights the coproduction process we have employed in community health projects in Wakiso district, Uganda, by examining both the opportunities and challenges inherent in this collaborative approach. We further highlight the importance of continuous stakeholder engagement, contextspecific communication, and power-sharing, demonstrating how research coproduction can decolonize research methodologies and enhance the relevance and impact of health interventions. By recognising the inequities between North-South partnerships, this commentary contributes to the discourse on how research coproduction can practically be implemented to drive meaningful, community-centred change while addressing the complexities involved. The lessons drawn from our experiences offer a pathway for other global partnerships aiming to integrate the principles of research coproduction into their work.

Background: Governments worldwide are increasingly interested in scaling up effective public health innovations, but it is not always easy to institutionalize innovations, arising outside the public health system, as a part of national delivery. Evidence on how country governments can practically achieve this is limited. This article describes the institutionalization of the Chipatala Cha Pa Foni (CCPF, Health Center by Phone) social innovation into the Malawian public health, and identifies positive institutional practices that local actors drew on to achieve this.

Methods: A positive-oriented interdisciplinary multi-method qualitative case study design was adopted. Data were collected from key informant interviews, observations, and documents over 18 months. A composite social innovation framework, informed by institutional theory and positive organizational scholarship, guided the thematic content analysis.

Results: Four clusters of positive institutional practices aided the institutionalization of the innovation: building high-quality relationships; creating opportunities for experiential interaction; cultivating hope; and logic attunement and awareness. We describe how these four practices operated together as a process of 'everyday creativity' to achieve institutionalization. We illustrate the importance of high-quality relationships, marked by respect, mutuality, and appreciation, as the foundation upon which hope can be built and the creativity needed for institutionalization to flourish. National ownership and sustainability of innovations are enhanced when implementation and institutionalization approaches are attuned to the logics inherent in national identity.

Conclusion: In this article, we highlight the importance of institutional and interpersonal dynamics in the institutionalization of social innovation in health systems.

In their scoping review Bennett et al. present a summary framework for public health surveillance of unhealthy commodity industries (UCI) that impact human health, which is important in view of the rising burden of non-communicable diseases, especially in low- and middle-income countries (LMICs). The authors focus on the tobacco, alcohol and food and beverage industry and discuss who should 'own' the process; where in the public sector administration the responsibility should lie; and how and which practices or organizations to monitor. They also argue that the monitoring should transition from academia and civil society to (sub)-national governments because of their central role in the protection of public health. This commentary argues that the challenges related to NCD policymaking in LMICs should be viewed from within a political economy perspective and that support for UCI monitoring has to be bolstered by independent accountability mechanisms and rights-based advocacy at national and global level.

This commentary addresses Ronald Labonté's recent editorial, "can a well-being economy save us?" It considers how to assess whether well-being economy policy proposals are likely to achieve real change, or simply represent performative sloganeering. It considers Labonté's discussion of the congruence between the well-being economy and widely held, cross-cultural values. Finally it explores the relationship between "well-being economics" and the key heterodox economic disciplines it has sprung from, especially ecological and feminist economics; and explores the relationship of well-being economics with degrowth and postgrowth economics as policy goals and models, rather than disciplines. Ultimately, a well-being economy can only "save us" if it is fully guided by and constrained within the same hard ecological constraints that must also guide degrowth or post-growth policy prescriptions.

Background: Hospital-acquired pressure ulcers (HAPUs) constitute an important source of concern for healthcare systems due to their negative consequences on patient quality of life and hospital costs. This phenomenon is increasing worldwide, driven by an aging population and increasing prevalence of chronic conditions. This economic evaluation aimed to determine whether using a multilayer, silicone-adhesive polyurethane foam dressing shaped for the sacrum area, alongside standard prevention (SP), is cost-effective in preventing HAPUs for hospitalized patients compared to SP alone.

Methods: We developed a decision-analytic model to estimate the expected costs and clinical benefits of using the polyurethane foam dressing from Italian and US payor perspectives. Model inputs were taken from published studies, and uncertainty was assessed using one-way and probabilistic sensitivity analyses (PSA).

Results: From both US and Italian perspectives, using a foam dressing in addition to SP was found to be cost-saving in all hospital settings. That is, it reduced the incidence of HAPUs at a lower cost overall. The estimated savings were €179 per patient and $305 per patient from Italian and US perspectives. Following sensitivity analysis, the results remained cost-saving, suggesting that our findings are robust.

Conclusion: This is the first economic analysis investigating the cost-effectiveness of preventive dressings and standard prevention for avoiding sacral pressure ulcers for at-risk hospitalized patients. This analysis suggests that using a multilayer polyurethane foam dressing to prevent sacral HAPUs in at-risk hospitalized patients is a cost-effective strategy compared with standard prevention alone and, therefore, should be considered as a strategy for PU prevention in hospital settings.

The impact of COVID-19 on the Italian population is well-known and has been deeply analysed under the clinical and epidemiological perspectives where the majority of the studies focused on the beginning of the first wave (March-May 2020). However, there is a need for analysing this complex phenomenon integrating the clinical side with the economic and social lens to better understand implications of a pandemic for populations. In their paper Masino and Enria focused the attention on four specific perspectives: health system reaction to the pandemic, inequalities in the work world, social care from the elderly point of view and the government communication challenges. In this commentary, I take these different perspectives trying to outline how they have been explored and analysed during these three years after their publication.