Inquiry-The Journal of Health Care Organization Provision and Financing最新文献

This study proposes a multi-level model of institutional innovation in the healthcare sector-in other words, field-level institutional change pressures that start as network-level institutional innovation by hospitals and government for their organizational performance, with an emphasis on the effect of organizational-level construct-knowledge creation capabilities. A case study using in-depth interviews and a historical inquiry approach has been used to qualitatively analyze our cases during the development of Taiwan's National Health Insurance (NHI). Our results propose a multi-level explanation of institutional innovation by showing how field-level institutional change pressures can stimulate the government's institutional innovation at the network level. Moreover, knowledge creation capabilities may positively influence the government hospitals' ongoing institutional change pressures induced institutional innovation activity for their performance at the organizational level in an institutional setting. This study contributes to health organization management researchers and administrators by developing explanations of institutional innovation and creating a much-needed multi-level insight into hospital behavior in the highly institutionalized healthcare sector.

To evaluate the psychometric properties of the Arabic-language Patient Health Questionnaire-9 (PHQ-9) among Saudi caregivers of patients with chronic diseases. Using a cross-sectional design, 94 Saudi caregivers (37 male and 57 female) in the medical city participated in the study. A comparative assessment was conducted on 4 models proposed in the existing PHQ-9 literature to gauge their compatibility through confirmatory factor analyses. This study evaluates convergent validity through a correlation analysis, examining the relationship between the PHQ-9 and the Depression, Anxiety, and Stress Scale-21 (DASS-21). Among the various models we examined, the single-factor structure of the PHQ-9 displayed the best fit with the data we gathered. Notably, the Cronbach alpha coefficient for the PHQ-9 registered at .81, indicating a high level of internal consistency. Factor loadings spanned a range from .39 to .76. The convergent validity of the PHQ-9 and DASS-21 was deemed satisfactory. It is established that the PHQ-9 serves as an effective tool for depression screening among Saudi caregivers in Saudi Arabia. Its strengths lie in its demonstrated validity, dependability, brevity, and convenience of administration, positioning it as a valuable resource for preventative measures and performance assessment within mental health settings.

The aim of this study was to investigate whether seafarers' self-reported work experiences were associated with wellbeing and happiness while onboard. The study also examined which indicators of the work experiences had an effect in what direction. We analyzed the survey responses from 13 008 seafarers onboard, from 154 different nationalities, serving in 44 different international shipping companies. The outcome measures were wellbeing and happiness, and the exposure variables were work environment factors: satisfaction, expectations, ideal, skills and training, challenges, and workload. General psychosocial work environment onboard and socioeconomic independent variables were also included. We conducted different logistic regression analyses, and presented the results as odds ratios (OR) and 95% confidence intervals (CIs). The study found that most seafarers reported high levels of wellbeing and happiness and that these were significantly associated to the work environment factors, except for workload. A stratified analysis, showed that workload modified the effect of the other work environment factors. The study found that there were independently significant associations between work related factors and wellbeing and happiness among seafarers at sea. The findings suggest that a greater emphasis on these outcomes could have a positive impact both on crew retention and safety at sea.

Improving the productivity of healthcare delivery and optimizing the allocation of regional healthcare resources are crucial for the health providers. The objective of this study is to evaluate the productivity dynamics of healthcare delivery at the regional (provincial) level in China, to provide evidence-based policy implications. After a review of literature, actual number of open beds, number of occupational or assistant doctors, number of registered nurses, and number of other staff were selected as input variables. The number of diagnostic visits and number of discharged inpatients were adopted as the output indicators. The panel data of 31 provinces in mainland China from 2010 to 2019 were extracted from Health Statistics Yearbook. Bootstrap-Malmquist Data Envelopment Analysis (DEA) model was used to measure the total factor productivity changes (TFPC) and its components. During the study period, the analysis of total factor productivity (TFP) in China revealed a declining trend with an average annual decline of 0.9% (ranging from 0.860 to 1.204). For each of the 31 provinces, the annual TFP scores varied from 0.971 to 1.029. On average, technical efficiency changes (TEC) had showed a downward trend from 2010-2011 (0.980) to 2013-2014 (0.982), and then an upward trend in 2014-2015 (1.029) and the following three consecutive years since 2016-2017 (1.000, 1.013, 1.009). Similarly, the trend in technological changes (TC) was consistent with the TEC from 2010-2019, which fluctuated between 0.969 and 1.011 on average per year at the provincial level. Notably, the point of inflection appeared at 2013-2014. Regional healthcare inputs and outputs in mainland China saw an upward trend from 2010 to 2019. However, TFPC, TEC, and TC decreased across all 31 provinces. TFP experienced a declining trend from 2010 to 2014, followed by growth until 2019. This may be related to the new healthcare reform being implemented since 2009, as service efficiency and capacity may undergo a reversal at the beginning of the reform.

The goal of the Abia State Health Insurance Agency (ABSHIA) has been to increase coverage since its implementation. However, the sustainability of the scheme is crucial to continue providing affordable healthcare in the State. This study aimed to identify and compare factors that influence the sustainability of ABSHIA in rural-urban areas of Abia State. The study used a mixed-method cross-sectional design that involved collecting data through a questionnaire on enrollment, satisfaction, and willingness to renew membership. Key informant interviews and focus group discussions were also conducted to obtain qualitative data from healthcare providers and ward development committees. The collected data were analyzed using appropriate statistical tests. The results showed a higher enrollment in rural areas compared to urban areas, with no significant difference in satisfaction and willingness to renew membership between the 2 locations. The study also identified factors that positively influenced willingness to renew membership, but it was found that traveling a distance of 15 min or more decreased willingness to renew membership in urban Abia. Furthermore, poor health status was found to have a low influence on willingness to renew membership in rural Abia. Among other barriers to renewal, poor quality of care and, nonpayment of health workers' capitation was identified as significant factors. It is crucial to prioritize the sustainability of ABSHIA to achieve the sustainable development goal of health for all in the State.

Asthma symptoms and experiences of dyspnea challenge participation in physical activity (PA). Therefore, in-depth understanding of experiences with PA is essential. In this meta-ethnography, we synthesized published qualitative studies of experiences of children and adolescents with asthma that influenced, or limited, participation in PA. We followed Noblit and Hare's 7 phases of meta-ethnography. We searched relevant databases by December 18, 2023 for published peer-reviewed studies (Medline (OVID), Embase (OVID), PsycINFO (OVID), CINAHL (EBSCHOhost), SPORTDiscus (EBSCHOhost), SocINDEX (EBSCHOhost), and Social Science Citation Index (WoS)) and theses (ProQuest Nursing & Allied Health Source, ProQuest Healthcare Administration Database, and ProQuest Public Health Database). We conducted study selection and assessment of methodological quality and data extraction using Joanna Briggs Institute's methodology. Sixteen reciprocally related qualitative studies, representing experiences of 238 children and adolescents aged 4 to 18 years were included. We translated primary study concepts and findings into 3 themes covering relationships with others, emotions, and behaviors related to PA participation: (1) feeling related to and connected with friends and family in PA; (2) acquiring and managing new PA and asthma skills; and (3) enjoying PA and experiencing well-being. We also defined 3 themes covering aspects related to PA limitations: (4) feeling misunderstood and penalized in relation to PA; (5) experiencing nervousness, embarrassment, shame, and sadness during PA; and (6) withdrawing from PA due to asthma, environment, and/or socially imposed attitudes. The themes were synthesized into the following lines of argument: children and adolescents with asthma experience that PA enforces empathic/non-empathic relationships, vulnerability, and awareness; PA enhances resilient participation and well-being, or reinforces resignment to isolation and shame. From the outset of either relatedness or being penalized, youngsters with asthma either manage well and experience well-being, or experience shame and withdrawal.Registration: PROSPERO No. 164797.

Scientific research has shown that the sustainability of public health insurance is crucial for governments to effectively manage the risks associated with populations aging. In response, the Chinese government has initiated efforts to ensure the long-term viability of its medical insurance funds. This study utilizes data from 24 484 respondents in the 2013, 2015, 2018, and 2020 waves of the China Health and Retirement Longitudinal Study (CHARLS), treating the digital supervision of medical insurance funds as a quasi-natural experiment. The study employs a difference-in-differences (DID) model to evaluate the policy effects and uses heterogeneity analysis to explore variations in impact. The objective is to assess the effectiveness of digital supervision and understand how it achieves its policy goals. The findings indicate that digital supervision of medical insurance funds has a significant positive impact on residents' out-of-pocket medical expenditure. Heterogeneity analysis reveals that the policy's effect is particularly strong in urban samples, especially among younger and elderly urban residents, while showing no significant impact on rural populations. This suggests that the policy has a greater influence on groups with higher moral hazard. By implementing digital supervision of medical insurance funds, the Chinese government has ensured the sustainability of these funds, laying a foundation for mitigating the risks associated with population aging. Additionally, the policy has contributed to promoting healthcare equity and reducing the waste of medical resources.

Financial wellbeing and financial literacy are crucial aspects of personal and professional lives, particularly in graduate medical education. Low financial literacy among healthcare professionals, including physicians, has been identified as a concern, impacting job satisfaction, productivity, and burnout. Few studies have used validated methods, assessed financial wellbeing, or compared financial outcomes across the continuum of medical education and practice. This study aims to measure the financial wellbeing of healthcare professionals and trainees and its predictors using validated instruments on a nationwide scale in Lebanon. This is a multi-institutional cross-sectional study using an online survey using validated instruments, including the CFPB Financial Well-Being Scale and Lusardi and Mitchell's "Big Five" financial literacy questions. The data was collected in April and May 2020. The population includes medical students, residents, and practicing physicians in all six private medical schools and their affiliated medical centers in Lebanon. A total of 330 responded, with a response rate of 20.7%. The financial wellbeing score (out of 10 was 57.2 ± 9.7 before the financial crisis and dropped to 45.2 ± 10.1 during the country's financial crisis. With a passing grade of 60%, 75.3% (195/259) failed the financial knowledge questions. Attending physicians outperformed students and residents/fellows regarding knowledge scores. Financial wellbeing was positively associated with age, family socioeconomic status, and household income. It was negatively associated with the crowding index and agreement with the attitude of living for today and letting tomorrow take care of itself. Medical students, residents, and physicians in Lebanon had low financial literacy. Attending physicians have high financial wellbeing despite low financial literacy and lack of formal education. The COVID-19 pandemic and economic crisis adversely affected the financial wellbeing of all three groups.

Maintaining health cannot be achieved individually; it is influenced by social, legal, and institutional factors surrounding the individuals. This study aimed to identify regional-level factors that may influence the occurrence of chronic diseases among people with disabilities. To achieve this, we conducted a Delphi survey with experts to identify a set of regional indicators required for studying the health status of people with disabilities, particularly for predicting the occurrence of chronic diseases. Through the process of the Delphi survey, 24 indicators were finally selected. The major categories of the indicators were demographic factors (4 indicators), health behaviors (6 indicators), healthcare resources and utilization (11 indicators), and local community policies (3 indicators). Each category and subcategory of indicators plays a crucial role in understanding and improving the health and well-being of people with disabilities at the regional level. By addressing these factors comprehensively, policymakers and healthcare providers can develop more effective and targeted interventions, ultimately fostering a more inclusive and supportive environment for people with disabilities. The findings underscore the importance of a holistic approach to health assessment and the need for continued monitoring and evaluation to inform policy and practice.

To investigate the factors influencing the colonoscopy screening behavior of first-degree relatives of colorectal cancer patients and to provide a basis for formulating screening intervention strategies. In this study, 15 first-degree relatives of colorectal cancer patients in the Department of Medical Oncology of a tertiary hospital in Baoding City from May to July 2024 were selected as the research subjects, and face-to-face semi-structured interviews were conducted. The theme was analyzed and summarized based on the theory of planned behavior and Colaizzi's 7-step analysis method. Results of this study identified 12 themes from 3 aspects. For behavioral attitudes, 4 themes emerged: (1) Negative screening emotions caused by psychological stress, (2) Lack of awareness of the importance of screening due to cognitive biases, (3) Screening behavior caused by fatalistic views is systematically underestimated, and (4) Affirm the value of early screening. For subjective norms (The impact of external information on screening behavior), 4 themes emerged: (1) Family support, (2) Advice from a healthcare professional, (3) information support from online media, (4) Personal experience and suggestions from friends. For perceived behavior control, 4 themes emerged: (1) Unbearable pain and embarrassment, (2) Busyness of life and work, (3) Medical treatment process and transportation convenience, and (4) Screening costs. The colonoscopy screening behavior of first-degree relatives of colorectal cancer patients is affected by behavioral attitudes, subjective norms (The impact of external information on screening behavior), and perceived behavior control. Clinical medical staff should correct their behavioral cognitive biases from the perspective of first-degree relatives, use positive belief factors to avoid wrong cognition, pay attention to a variety of sources of support, stimulate the self-efficacy of first-degree relatives, and create a suitable environment for colonoscopy screening, to promote the change of colonoscopy screening behavior of first-degree relatives.