Health systems and reform最新文献

The recent explosion in online dissemination of health-related information, and its availability to more and more people around the world, has led to a situation in which both healthcare providers and patients are accepting new roles. This paper examines the transformations toward new roles for healthcare professionals and patients, with a focus on Japan, based on the assumption that one of the driving forces accelerating these changes may be the digitalization of patient peer support. The methods used in this study were: 1) questionnaires and interviews with patients and healthcare providers asking about their participation in peer support and the effectiveness of its implementation; and 2) observations, questionnaires, and interviews with three patient groups about the experience of digitalizing peer support (via implementation of peer support in a virtual reality space). Analysis of the data showed that peer support by patient groups has both challenges and benefits, and that peer support in virtual spaces has certain positive effects. The empowerment of patients through digitalized peer support is transforming the relationship between healthcare providers and patients, changing it from a traditional asymmetrical relationship (in which the healthcare professionals are in a dominant position) to a cooperative relationship on a more equal footing.

Digital health covers a wide spectrum of applications of digital technologies in the healthcare field. As a new set of tools to support the health system in achieving its goals-improving access to care, quality of care, and system efficiency-digital health has significantly transformed the landscape of modern medicine and health care. This paper examines the role of digital health under Taiwan National Health Insurance, considering the profound impacts of digital health during the COVID-19 pandemic. It focuses specifically on big data management and analytics (MediCloud and My Health Bank/NHI Mobile Easy Access) and innovative service provision models (telemedicine). We discuss two imminent challenges that any health system is likely to encounter: digital trust and digital divide. For the digital divide, we assessed the use of telemedicine and its determinants during the COVID-19 pandemic. Our study shows that high-income levels and the presence of chronic or severe illness were positively correlated with the use of telemedicine. This observation suggests that poor people who have poorer health status were most likely to suffer from unmet needs for telemedicine. Enhancing cybersecurity to safeguard confidentiality, and effective communications with the public are fundamental and essential steps to regaining public trust in the digital era. When calling for more investment in digital technology, policy makers should be mindful of the potential digital divide across the demographic and socioeconomic strata, and specific policies should be devised to provide support to target the socially disadvantaged group.

The utilization of digital health in India is playing a crucial role in enhancing healthcare services by transitioning from the current inadequate public health structure to a more efficient and patient-centric system. Digital health includes various digital tools, such as electronic health records (EHRs), telemedicine, mobile health applications, health information exchange systems, and other technological advancements to improve access, efficiency, and quality of healthcare delivery. This study investigates the prospects and challenges encountered by the newly-digitized Maharashtra Emergency Medical Services (MEMS). Utilizing the 38,823 MEMS calls from November 2022, this study investigates the current status of emergency service delivery mechanisms in Maharashtra. Through spatial analyses, this study also explores the causes behind calls. The findings of the study show that calls for 108 ambulance services were distributed across the districts and had variable service delivery time periods. Current challenges to the system arise from various urban and healthcare infrastructure problems, as well as socio-cultural challenges. Implementation of the digitized MEMS system reveals key factors that influence the service's success, assisting the policymakers and health administrators in identifying and further improving the service.

This paper documents the results of an intervention conducted in Nigeria to test the effectiveness of a mobile phone technology, text4life, in enabling women to self-report gender-based violence (GBV). Women experiencing GBV and other challenges related to sexual and reproductive health and rights were requested to use their mobile phones to text a code to a central server. In turn, the server relayed the messages to trained nearby health providers and civil society organization (CSO) officials who reached out to provide health care and social management services to the callers. Interviews were conducted with some callers, health care providers, and CSO staff to explore their experiences with the device. The interviews and data from the server were analyzed qualitatively and quantitatively. The results indicate that over a 27-month period, 3,403 reports were received by the server, 34.9% of which were reporting GBV. While interviewees perceived that a large proportion of the women were satisfied with the use of text4life, and many received medical treatment and psychological care, the consensus opinion was that many women reporting GBV did not wish to pursue police or legal action. This was due to women's perceptions that there would be negative cultural and social backlash should they pursue civil punishments for their partners. We conclude that a mobile phone device can be used effectively to report GBV in low-resource settings. However, the device would be more useful if it contributes to equitable primary prevention of GBV, rather than secondary prevention measures.

Motivated by the prevalence of an aging population and the associated increase in chronic diseases, coupled with rising medical expenditure, the Korean government initiated a pilot project in Pyeongchang-gun, Gangwon-do, a rural area, to implement a "smart online-to-offline (O2O) digital health care model" aimed at managing and preventing chronic diseases. However, there is limited understanding regarding perspectives and levels of preparedness for digital health among stakeholders at various levels. In-depth focus group interviews were conducted with elderly and non-elderly community members, health care providers, and staff members at Pyeongchang Health and Medical Center. The study found the presence of both positive and negative perceptions and a lack of preparedness across different levels. At the end-user level, it was observed that community members, especially the elderly, have low levels of health and digital literacy, compounded by limited access to social support. At the health care provider level, there was uncertainty about the acceptance of the digital health program. At the area level, the need to bolster health staff members and enhance their capacity was observed. Recommendations include: customizing the design of the online and offline service components by considering end-user factors (such as age, occupation, and household type) that may contribute to disparities in health; establishing a platform for providers to share their experiences to facilitate the effective incorporation of digital health into their practices; and preparing an appropriate provider payment mechanism.

Around the world, the adoption of digital technologies in health care has accelerated considerably in the wake of the COVID-19 pandemic. Prior to the emergence of the pandemic, China had already embarked on a private sector, technology enterprise-led creation of an innovative internet health care ecosystem, which has dramatically transformed China's health care landscape. In this article, we describe the evolution of China's internet health market, focusing on internet telemedicine. We trace its early origins with the establishment of information networks in the 1980s, to the emergence of a fast-growing internet health market in the 2010s that leveraged the capabilities of technology enterprises in e-commerce, logistics, and payment systems. Private health care platforms have played a central role throughout this transformative process. The supplyside of the market has a unique public-private mix structure, with the coexistence of public and private internet hospitals, and with the majority of telemedicine services provided by public hospital doctors working on private platforms in a dual practice capacity. We conclude with a discussion of the prospects of internet telemedicine, including how it should be optimized and harnessed to improve China's health system. Finally, we set out areas where more research is needed.

Well-functioning supply chains for medicines and other health products are vital for a health system's goals of ensuring access, quality, and efficiency. However, in several countries the performance of government-run supply chains for health products remains subpar. The widespread adoption of digital technology presents new opportunities for enhancing the performance of the health product supply chain. This paper aims to provide a practical and systematic analysis of digital initiatives within health product supply chains. It provides examples of successful digital interventions in each of the Enable, Plan, Source, and Deliver categories of the Supply Chain Operations Reference model. The examples provide clear evidence that the use of digital technology in the health supply chain can improve access and affordability; in some instances, use of digital technology can lead to faster health product adoption and alter the overall architecture of decision making. While many digital interventions in the public sector supply chain target the collection of data and its analysis and use for reporting, the long-term effectiveness of digital solutions hinges on their ability to enhance the agency of supply chain actors. A thorough and systematic inquiry about the logic model of how a particular digital solution enhances agency and improves accountability is essential at the outset. In developing roadmaps to prioritize and sequence digital solutions in health supply chains, governments should start by asking where lack of information is the primary constraint impeding supply chain performance.

South Korea is one of the few countries that has successfully consolidated its national risk pools into a single-payer health insurance system. This study analyzes national health insurance (NHI) consolidation in South Korea between 1980 and 2003, drawing lessons for countries seeking to consolidate their risk pools. The paper contextualizes the development of the South Korean national health insurance system and the consolidation of its risk pools in the changes in the political environment, particularly the processes of political democratization. It examines how these processes have affected the societal meanings and roles of the health insurance system. The paper focuses on two policy stages. During the agenda-setting stage, the government and employers emphasized the efficiency of the health insurance system. This emphasis contributed to the failure of a consolidation plan that emphasized equity over efficiency. However, as democratization expanded, the power of civil society movements and the popular demand for equity grew stronger. During the policy adoption phase, consolidation of health insurance trusts in South Korea was achieved through social and political processes that influenced public opinion, expanded civil society participation in decision-making, and worked with the government to integrate health insurance organizations and funds.