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Everybody’s Business: Improving Health Systems’ Performance to Deliver Value for Patients
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Everybody’s Business: Improving Health Systems’ Performance to Deliver Value for Patients

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Economics".

Deadline for manuscript submissions: closed (30 June 2021) | Viewed by 24694

Special Issue Editors

Prof. Dr. Iga Rudawska

E-Mail Website
Guest Editor
Uniwersytet Szczecinski, Szczecin, Poland
Interests: health economics; public health, service sector; relationship marketing; buyer-supplier relationships; networks; research methodology
Dr. Jahangir A. M. Khan

E-Mail Website
Assistant Guest Editor
Liverpool School of Tropical Medicine, Pembroke Place, Liverpool L3 5QA, UK
Interests: healthcare financing; health insurance; equity in health, healthcare and healthcare financing; econometric analysis and modelling; cost analysis and economic evaluation of health interventions
Prof. Dr. Judith E. Arnetz

E-Mail Website
Assistant Guest Editor
Department of Family Medicine, College of Human Medicine, Michigan State University, College of Human Medicine, East Lansing, USA
Interests: workplace violence in the healthcare sector; physician and nurse well-being and patient safety; implementation science of interventions in healthcare settings; mental health conditions associated with interpersonal violence and trauma

Special Issue Information

Dear Colleagues,

Background: Health systems are strongly context-specific, so there is no single set of best practices that can be applied as a model for improved performance. But health systems that deliver value for patients have something in common. Firstly, they are built upon a shared goal, which is the improvement of health outcomes. They have distribution systems that actually deliver services to those in need. They employ financing systems that are inclusive, sustainable, and fair. They focus on a team-oriented approach to patient care so that care is coordinated and outcomes can be measured easily.

Scope and aims: This issue of IJERPH focuses on research and experiences related to different aspects of health systems’ performance and measurement. This may include a description of new system challenges and value-based care models, approaches, methods, and instruments to assess provider efficiency and patient satisfaction, hospital value-based purchasing, payers cost control and risk reduction, management of a chronic condition, disease self-management, managing relationships among health sector stakeholders, coordinating and integrating health care delivery.

Invitation: This Special Issue welcomes contributions presenting both conceptual frameworks, systematic literature reviews, as well as empirical results of implementing a patient-centered approach, presenting evidence of reduced health spending and better health outcomes, managing of patients’ experiences, and assessing the strengthening health systems through a value-based approach, both from a macro- and micro-perspectives. 

We invite researchers in health economics, management, quality assurance, public health, and other social sciences to submit high quality papers related to the issues in this research area.

Prof. Dr. Iga Rudawska
Dr. Jahangir Khan
Prof. Dr. Judith E. Arnetz
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • value-based health care
  • service delivery
  • financing and paying for performance
  • relationship management
  • managing health workforce
  • leadership and governance (stewardship)
  • key performance indicators in macro and micro scale
  • economic evaluation of health systems and organizations

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Published Papers (7 papers)

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Research

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15 pages, 954 KiB  
Article
How Public Trust in Health Care Can Shape Patient Overconsumption in Health Systems? The Missing Links
by Katarzyna Krot and Iga Rudawska
Int. J. Environ. Res. Public Health 2021, 18(8), 3860; https://doi.org/10.3390/ijerph18083860 - 7 Apr 2021
Cited by 11 | Viewed by 3163
Abstract
Overconsumption of health care is an ever-present and complex problem in health systems. It is especially significant in countries in transition that assign relatively small budgets to health care. In these circumstances, trust in the health system and its institutions is of utmost [...] Read more.
Overconsumption of health care is an ever-present and complex problem in health systems. It is especially significant in countries in transition that assign relatively small budgets to health care. In these circumstances, trust in the health system and its institutions is of utmost importance. Many researchers have studied interpersonal trust. Relatively less attention, however, has been paid to public trust in health systems and its impact on overconsumption. Therefore, this paper seeks to identify and examine the link between public trust and the moral hazard experienced by the patient with regard to health care consumption. Moreover, it explores the mediating role of patient satisfaction and patient non-adherence. For these purposes, quantitative research was conducted based on a representative sample of patients in Poland. Interesting findings were made on the issues examined. Patients were shown not to overconsume health care if they trusted the system and were satisfied with their doctor-patient relationship. On the other hand, nonadherence to medical recommendations was shown to increase overuse of medical services. The present study contributes to the existing knowledge by identifying phenomena on the macro (public trust in health care) and micro (patient satisfaction and non-adherence) scales that modify patient behavior with regard to health care consumption. Our results also provide valuable knowledge for health system policymakers. They can be of benefit in developing communication plans at different levels of local government. Full article
(This article belongs to the Special Issue Everybody’s Business: Improving Health Systems’ Performance to Deliver Value for Patients)
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15 pages, 2997 KiB  
Article
Costing of Cesarean Sections in a Government and a Non-Governmental Hospital in Cambodia—A Prerequisite for Efficient and Fair Comprehensive Obstetric Care
by Eva Glaeser, Bart Jacobs, Bernd Appelt, Elias Engelking, Ir Por, Kunthea Yem and Steffen Flessa
Int. J. Environ. Res. Public Health 2020, 17(21), 8085; https://doi.org/10.3390/ijerph17218085 - 2 Nov 2020
Cited by 2 | Viewed by 2272
Abstract
Knowing the cost of health care services is a prerequisite for evidence-based management and decision making. However, only limited costing data is available in many low- and middle-income countries. With a substantially increasing number of facility-based births in Cambodia, costing data for efficient [...] Read more.
Knowing the cost of health care services is a prerequisite for evidence-based management and decision making. However, only limited costing data is available in many low- and middle-income countries. With a substantially increasing number of facility-based births in Cambodia, costing data for efficient and fair resource allocation is required. This paper evaluates the costs for cesarean section (CS) at a public and a Non-Governmental (NGO) hospital in Cambodia in the year 2018. We performed a full and a marginal cost analysis, i.e., we developed a cost function and calculated the respective unit costs from the provider’s perspective. We distinguished fixed, step-fixed, and variable costs and followed an activity-based costing approach. The processes were determined by personal observation of CS-patients and all procedures; the resource consumption was calculated based on the existing accounting documentation, observations, and time-studies. Afterwards, we did a comparative analysis between the two hospitals and performed a sensitivity analysis, i.e., parameters were changed to cater for uncertainty. The public hospital performed 54 monthly CS with an average length of stay (ALOS) of 7.4 days, compared to 18 monthly CS with an ALOS of 3.4 days at the NGO hospital. Staff members at the NGO hospital invest more time per patient. The cost per CS at the current patient numbers is US$470.03 at the public and US$683.23 at the NGO hospital. However, the unit cost at the NGO hospital would be less than at the public hospital if the patient numbers were the same. The study provides detailed costing data to inform decisionmakers and can be seen as a steppingstone for further costing exercises. Full article
(This article belongs to the Special Issue Everybody’s Business: Improving Health Systems’ Performance to Deliver Value for Patients)
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17 pages, 311 KiB  
Article
The Impact of Public Health Insurance on Household Credit Availability in Rural China: Evidence from NRCMS
by Qing Yang, Qing Xu, Yufeng Lu and Jin Liu
Int. J. Environ. Res. Public Health 2020, 17(18), 6595; https://doi.org/10.3390/ijerph17186595 - 10 Sep 2020
Cited by 2 | Viewed by 2516
Abstract
A large body of literature has shown that the burden of healthcare can push individuals and households into the burden of medical care and income loss. This makes it difficult for rural or low-income households to obtain and use safe and affordable formal [...] Read more.
A large body of literature has shown that the burden of healthcare can push individuals and households into the burden of medical care and income loss. This makes it difficult for rural or low-income households to obtain and use safe and affordable formal credit services. In 2003, China’s government implemented a new rural public health insurance, which was called the New Rural Cooperative Medical Scheme (NRCMS). This study provides evidence of the impact of NRCMS on household credit availability using the China Family Panel Studies (CFPS) for 2010. The tobit regression approach and mediator model are used. The results show that, as a public health insurance system sustained by the participation of government investment, the NRCMS provides good “collateral” and significantly enhances rural households’ formal credit availability level. Furthermore, this positive effect is mainly reflected in the economic effect of NRCMS. Our results are robust to alternative statistical methods. Our findings suggest that expanding access, fulfilling the NRCMS mortgage function, and providing more financial services for rural households would have big benefits with regard to easing credit constraints for rural residents. Full article
(This article belongs to the Special Issue Everybody’s Business: Improving Health Systems’ Performance to Deliver Value for Patients)
17 pages, 2123 KiB  
Article
Patient-Related Complexity of Care in Healthcare Organizations: A Management and Evaluation Model
by Fiorella Pia Salvatore and Simone Fanelli
Int. J. Environ. Res. Public Health 2020, 17(10), 3463; https://doi.org/10.3390/ijerph17103463 - 15 May 2020
Cited by 10 | Viewed by 3884
Abstract
In times of economic stringency, the prerequisite for the provision of healthcare services differentiated by complexity is identified in the right patients’ allocation. Since access to high-intensity care units is restricted, it is necessary both to promptly diagnose patients who are at risk [...] Read more.
In times of economic stringency, the prerequisite for the provision of healthcare services differentiated by complexity is identified in the right patients’ allocation. Since access to high-intensity care units is restricted, it is necessary both to promptly diagnose patients who are at risk of rapid clinical deterioration or death and to define criteria to identify the correct allocation of patients based on clinical-care needs. Although the so-called “early warning scores” were used by healthcare professionals to alert medical staff, nowadays, they can also be used as decision rules for managing patient admissions, increasing their effective usefulness. The procedure for assessing the complexity of care profiles needs to be based on a multidisciplinary approach. The primary objective of scientific research was to determine the intensity of care (clinical instability and care dependence) of the patients allocated in different settings of the medical area. To correctly frame the phenomenon, the main methods and strategies developed for different care models were discussed. In the Italian healthcare organization, the indicators, methodologies and tools to evaluate the clinical-care complexity were identified and subsequently applied. In conclusion, the findings and proposals for improvement actions are shown. Full article
(This article belongs to the Special Issue Everybody’s Business: Improving Health Systems’ Performance to Deliver Value for Patients)
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15 pages, 1116 KiB  
Article
Continuity of Care Is Associated with Medical Costs and Inpatient Days in Children with Cerebral Palsy
by Kuang-Tsu Yang, Chun-Hao Yin, Yao-Min Hung, Shih-Ju Huang, Ching-Chih Lee and Tsu-Jen Kuo
Int. J. Environ. Res. Public Health 2020, 17(8), 2913; https://doi.org/10.3390/ijerph17082913 - 23 Apr 2020
Cited by 11 | Viewed by 3335
Abstract
Background: Children with cerebral palsy (CP) place a considerable burden on medical costs and add to an increased number of inpatient days in Taiwan. Continuity of care (COC) has not been investigated in this population thus far. Materials and Methods: We [...] Read more.
Background: Children with cerebral palsy (CP) place a considerable burden on medical costs and add to an increased number of inpatient days in Taiwan. Continuity of care (COC) has not been investigated in this population thus far. Materials and Methods: We designed a retrospective population-based cohort study using Taiwan’s National Health Insurance Research Database. Patients aged 0 to 18 years with CP catastrophic illness certificates were enrolled. We investigated the association of COC index (COCI) with medical costs and inpatient days. We also investigated the possible clinical characteristics affecting the outcome. Results: Over five years, children with CP with low COCI levels had higher medical costs and more inpatient days than did those with high COCI levels. Younger age at CP diagnosis, more inpatient visits one year before obtaining a catastrophic illness certificate, pneumonia, and nasogastric tube use increased medical expenses and length of hospital stay. Conclusions: Improving COC reduces medical costs and the number of inpatient days in children with CP. Certain characteristics also influence these outcomes. Full article
(This article belongs to the Special Issue Everybody’s Business: Improving Health Systems’ Performance to Deliver Value for Patients)
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14 pages, 328 KiB  
Article
The Impact of Health Insurance on Healthcare Utilization by Migrant Workers in China
by Fei Zhang, Xinjie Shi and Yun Zhou
Int. J. Environ. Res. Public Health 2020, 17(6), 1852; https://doi.org/10.3390/ijerph17061852 - 12 Mar 2020
Cited by 24 | Viewed by 4347
Abstract
Health insurance is an essential instrument to ensure equal access to medical resources and promote the health of the general population. Robust evidence regarding whether migrant workers have benefited from available insurance schemes is limited. Drawing on survey data from the Rural Urban [...] Read more.
Health insurance is an essential instrument to ensure equal access to medical resources and promote the health of the general population. Robust evidence regarding whether migrant workers have benefited from available insurance schemes is limited. Drawing on survey data from the Rural Urban Migration in China (RUMiC) Project, this paper examines the effects of health insurance on migrant workers’ utilization of routine medical services, the medical burden, and the utilization of preventive medical services using a two-part model, the Heckman model, the Tobit model, and a probit model. Our findings indicate that, first, participating in medical insurance increases migrant workers’ probability of visiting a doctor. Unlike other medical insurance programs that positively affect migrant workers’ medical expenditure, the new rural cooperative medical system fails to play an effective role. Second, participation in any medical insurance program effectively reduces migrant workers’ medical burden and can improve the probability of preventive medical service utilization. Third, self-reported health and disease severity are pivotal to determining migrant workers’ medical expenditure. Fourth, high-income people have a good health status and a lower probability of becoming ill and can afford relatively higher medical expenses once they become ill. China’s medical insurance appears to mainly serve to reduce the financial burden for serious illnesses, reflecting important policy implications for policy-makers. Full article
(This article belongs to the Special Issue Everybody’s Business: Improving Health Systems’ Performance to Deliver Value for Patients)

Review

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19 pages, 340 KiB  
Review
Misalignment of Stakeholder Incentives in the Opioid Crisis
by Alireza Boloori, Bengt B. Arnetz, Frederi Viens, Taps Maiti and Judith E. Arnetz
Int. J. Environ. Res. Public Health 2020, 17(20), 7535; https://doi.org/10.3390/ijerph17207535 - 16 Oct 2020
Cited by 2 | Viewed by 4497
Abstract
The current opioid epidemic has killed more than 446,000 Americans over the past two decades. Despite the magnitude of the crisis, little is known to what degree the misalignment of incentives among stakeholders due to competing interests has contributed to the current situation. [...] Read more.
The current opioid epidemic has killed more than 446,000 Americans over the past two decades. Despite the magnitude of the crisis, little is known to what degree the misalignment of incentives among stakeholders due to competing interests has contributed to the current situation. In this study, we explore evidence in the literature for the working hypothesis that misalignment rooted in the cost, quality, or access to care can be a significant contributor to the opioid epidemic. The review identified several problems that can contribute to incentive misalignment by compromising the triple aims (cost, quality, and access) in this epidemic. Some of these issues include the inefficacy of conventional payment mechanisms in providing incentives for providers, practice guidelines in pain management that are not easily implementable across different medical specialties, barriers in adopting multi-modal pain management strategies, low capacity of providers/treatments to address opioid/substance use disorders, the complexity of addressing the co-occurrence of chronic pain and opioid use disorders, and patients’ non-adherence to opioid substitution treatments. In discussing these issues, we also shed light on factors that can facilitate the alignment of incentives among stakeholders to effectively address the current crisis. Full article
(This article belongs to the Special Issue Everybody’s Business: Improving Health Systems’ Performance to Deliver Value for Patients)
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