Comparative study of length of stay of COVID-19 recovered patients in government and private tertiary care setup

Background: COVID-19 pandemic placed an unprecedented strain on health-care systems. The demand for healthcare in hospitals and intensive care units increased everywhere in the world in the form of beds, staff, equipment, medicines, etc. In this process, length of stay in hospital of COVID-infected patients is a crucial point for hospital authorities to plan to provide effective healthcare to patients arriving at the hospital and also to treat non-COVID patients and other medical emergencies. Aims and Objectives: The aims of this study were to find the difference in length of stay in government and private tertiary care setup, to find the length of stay of COVID recovered patient with and without morbidities. Materials and Methods: After taking due permission from the ethical committee and respective authorities concerned in private and government tertiary care hospitals, case sheets of patient recovered from COVID were taken and analyzed in terms of patients condition while presentation to hospital, SpO2, morbidities, number of days symptoms developed, and length of stay in hospital. Results: In my study, the length of stay of COVID-infected people in private and government setup was almost the same, around 11–12 days. Patients with comorbidities had a higher length of stay in hospital in both private and government setup, but the duration of stay was higher in government setup 14 days in government setup, 11–12 days in private setup. Good SpO2 at time of admission had decreased the length of stay of hospital in both setups. There is no correlation between length of stay in hospital and period of symptoms before admission in both private and government setup. Conclusions: In my study, the length of stay of patient with COVID infection was higher in government setup by 1 day without morbidities and 2–3 days with morbidities.

Influencia de factores psicosociales en el clima y estrés laboral del personal de un hospital ecuatoriano / Influence of psychosocial factors on work climate and stress in Ecuadorian hospital personnel

RESUMEN Introducción: actualmente, el estudio de las relaciones del individuo con las condiciones de su trabajo resulta de gran interés. Objetivo: analizar la influencia de factores psicosociales de riesgo en el clima y estrés laboral de los trabajadores de un hospital básico en la ciudad de Ambato, en Ecuador. Materiales y métodos: estudio no experimental, transversal y prospectivo. A cincuenta trabajadores se le aplicaron tres encuestas: CoPsoq-istas21 (versión 2), cuestionario de clima laboral FOCUS-93 y el cuestionario para la evaluación del estrés (versión 3) de la Pontificia Universidad Javeriana. Se utilizaron la prueba de Chi-cuadrado de Pearson, con un nivel de significancia del 0,05, para descartar la hipótesis nula, y la regresión lineal curvilínea para determinar la influencia de los factores en las dos variables dependientes. Resultados: la estima (100 % de desfavorabilidad), las exigencias psicológicas (94 %) y la doble presencia (90 %) fueron los factores psicosociales peor calificados por los informantes. Solo el 40,5 % de los participantes consideraron su clima laboral como satisfactorio; y se registró en el 80 % de la población la presencia de síntomas fisiológicos y psicoemocionales provocados por el estrés. La inseguridad sobre el futuro y el apoyo social/calidad de liderazgo, fueron las subvariables que mayor número de inferencias estadísticas tuvieron con el estrés y el clima laboral. Conclusiones: los factores de riesgo psicosociales influyeron en la percepción negativa del clima laboral y en el incremento de la sintomatología del estrés.

ABSTRACT Introduction: currently, the study of the relationships between people and their work conditions are of great interest. Objective: to analyze the influence of risk psychosocial factors in the labor climate and stress of the workers of a basic hospital in the city of Ambato, Ecuador. Materials and methods: non-experimental, cross-sectional and prospective study. Three surveys were applied to 50 workers: the CoPsoQ-ista21 (version 2), the FOCUS-93 labor climate questionnaire, and the stress evaluation inventory of the Pontificia Universidad Javeriana (version 3). Pearson's Chi-square test, with a significance level of 0.05, was used to discard the null hypothesis, and curvilinear linear regression was used to determine the influence of the factors on the two dependent variables. Results: esteem (100 % unfavorableness), psychological demands (94 %) and double presence (90 %) were the psychosocial factors the informers rated worst. Only 40.5 % of the participants considered their work climate as satisfactory; and the presence of physiological and psycho-emotional symptoms caused by stress was recorded in 80 % of the population. Conclusions: psychosocial risk factors influenced the negative perception of the labor environment and the increase of stress symptoms.

Out Of Pocket (OOP) Health Expenditure and Utilization of Financial Risk Protection Measures Among COVID-19 Affected Individuals in Chennai- A Cross-Sectional Study

Background: Pandemic has affected people physically, mentally and economically. India being a growing economic power house, spends only around 1.2% of GDP on health which thereby leads to high OOP spending. This study aims to estimate out of pocket health expenditure and proportion of financial risk protection. Methods: Cross sectional study conducted among Covid-19 affected individuals in Chennai. It was a questionnaire-based study with questions about covid-19 management status, cost and insurance utili-zation. Descriptive statistics and regression analysis was used for analysis. Results: Total of 47 were treated at hospital and 85% of them were treated at private hospital. The mean cost investigations for patients treated at hospital was of Rs. 50000+11547 and for medicines was Rs. 110000+57735. 53% of study participants had health insurance. 29 (54.72%) of them had Covid-19 treatment cost covered under insurance. The multiple regression analysis showed a statistically signifi-cant association between total OOPE incurred and age, religion and socio-economic status. Conclusion: Majority of participants spent for their treatment through savings and borrowing money. OOPE was compensated by reimbursement through health insurance. Provision of quality health care in government hospitals, increase public health spending and creating awareness about health insurance are ways to reduce OOP costs.

Mortalidade por Covid-19 em hospitais públicos e privados de Florianópolis/SC / Covid-19 mortality in public and private hospitals of Florianópolis/SC

Introdução: O acesso ao tratamento hospitalar adequado é importante para amenizar o impacto causado pelas questões socioeconômicas, auxiliando no combate às iniquidades em saúde. Objetivo: Analisar a diferença da atenção hospitalar pública e privada na mortalidade por Covid-19 em Florianópolis/SC. Métodos: Coorte histórica com dados de pacientes confirmados para Covid-19 entre 22 de fevereiro de 2020 e 09 de novembro de 2020. Utilizou-se abordagem de dupla-robustez. Na primeira etapa, parearam-se indivíduos notificados em hospitais públicos e privados por algoritmo genético. A seguir, estimou-se a probabilidade de óbito em hospitais públicos e privados, por meio de regressão logística. Analisou-se, então, a diferença entre as densidades de probabilidade de óbito dos dois tipos hospitalares. Resultados: Analisaram-se 2.497 pessoas, 1.244 de hospitais públicos e 1.253 de privados. A diferença entre a probabilidade condicional de óbito assumindo que todos os pacientes fossem notificados em hospitais públicos ou que todos fossem notificados em hospitais privados foi de -0,0002 (IC 95% -0,0013; 0,0005). Conclusão: A probabilidade de óbito por Covid-19 mostrou-se semelhante entre pacientes de hospitais públicos e privados.

Introduction: Access to adequate hospital treatment is important to alleviate the impact of socioeconomic issues, helping in the fight against health inequities. Objective: To analyze differences between public and private hospital care regarding COVID-19 mortality in Florianópolis/SC. Methods: This is a historical cohort study with data from patients who had a COVID-19 diagnosis confirmed between February 22, 2020 and November 9, 2020. We used a doubly robust approach. In the first stage, we paired individuals reported by public and private hospitals through a genetics algorithm. Subsequently, we estimated the probability of death in public and private hospitals using a logistic regression. We then analyzed the difference between probability densities of death in both hospital types. Results: This study analyzed 2,497 people, 1,244 public hospitals, and 1,253 private institutions. The difference between conditional probabilities of death assuming that all patients were reported by public hospitals or that all of them were reported by private hospitals was -0.0002 (95%CI -0.0013; 0.0005). Conclusion: The probability of death due to COVID-19 was shown to be similar between patients of public or private hospitals.

Repercusiones de la alimentación temprana en la lactancia materna exclusiva / Impact of early initiation of breastfeeding on exclusive breastfeeding

Resumen OBJETIVO: Comparar el efecto de la alimentación temprana y su repercusión en la lactancia materna exclusiva con los cuidados neonatales convencionales en un hospital privado. MATERIALES Y MÉTODOS: Estudio comparativo, observacional, de cohortes, prospectivo y analítico llevado a cabo en el Hospital Ángeles de Querétaro de abril 2015 a octubre de 2021. Criterios de inclusión: madres con periodos intraparto y posparto inmediato, cualquier vía de nacimiento y aplicación o no de anestesia y neonatos de uno y otro sexo, de término, sin patología neonatal o malformaciones congénitas, Apgar a los 5 minutos más o menos mayor a 7 y peso mayor de 2500 g. Criterios de exclusión: embarazos múltiples, recién nacidos con algún padecimiento después del nacimiento o condiciones que impidieron la lactancia. Para la comparación entre grupos de las variables cualitativas se aplicó la prueba de χ2 y, en su caso, corrección de Yates con estimaciones de riesgo. RESULTADOS: Se analizaron 1175 madres de las que 687 (58.4%) recién nacidos tomaron lactancia exclusiva y 488 (41.6%) no lo hicieron. Las características clínicas y sociodemográficas entre los dos grupos de comparación fueron similares. Sobresalió que las madres y neonatos que lograron lactancia materna exclusiva exitosa fueron los del grupo de alimentación temprana en comparación con quienes no la hicieron (91.9 vs 52.6%; p < 0.001, RR 4.85, IC95%: 3.80-6.18). CONCLUSIONES: La alimentación temprana, en la primera hora de vida, tiene un efecto benéfico, protector y positivo en la lactancia exclusiva, incluso de hasta casi cinco veces más que cuando no se consigue.

Abstract OBJECTIVE: To compare the effect of early feeding and its impact on exclusive breastfeeding with conventional neonatal care in a private hospital. MATERIALS AND METHODS: Comparative, observational, cohort, prospective and analytical study conducted at the Hospital Ángeles de Querétaro from April 2015 to October 2021. Inclusion criteria: mothers with intrapartum and immediate postpartum periods, any birth route and application or not of anesthesia and neonates of either sex, term, without neonatal pathology or congenital malformations, Apgar at 5 minutes plus or minus greater than 7 and weight greater than 2500g. Exclusion criteria: multiple pregnancies, newborns with any condition after birth or conditions that prevented breastfeeding. For the comparison between groups of qualitative variables, the 2's test was applied and, if necessary, Yates' correction with risk estimates. RESULTS: We analyzed 1175 mothers of whom 687 (58.4%) newborns were exclusively breastfed and 488 (41.6%) were not. The clinical and sociodemographic characteristics between the two comparison groups were similar. It stood out that mothers and infants who achieved successful exclusive breastfeeding were those in the early feeding group compared to those who did not (91.9 vs 52.6%; p < 0.001, RR 4.85, 95%CI: 3.80-6.18). CONCLUSIONS: Early feeding, in the first hour of life, has a beneficial, protective and positive effect on exclusive breastfeeding even up to almost five times more than when it is not achieved.

Semimonthly Table of Contents Nationwide investigation and problems analysis of pharmaceutical preparations in medical institutions / 中国药房

@#OBJECTIVE To investigate the situation of pharmaceutical pr eparations in medical institutions （hereinafter refer to hospital preparations ），and to promote the sustained and healthy development of hospital preparations. METHODS Under the organization of National Pharmacy Administration & Quality Control Center ，internet survey was adopted to statistically analyze the data of hospital preparations in 2019 that was completed and reported by the secondary general hospitals and above in provinces （cities，districts）and Xinjiang Production and Construction Corps. RESULTS Among the 4 639 hospitals，9.36％ had drug approval numbers and 8.15％ had preparation laboratories. The average ratio of the number of hospital preparations in production to the number of preparations approved was 0.72，and that of 41.52％ hospital was concentrated in 1-0.9. Self-produced by hospital was the main production mode of hospital preparations ；the higher hospital level was ，the higher the proportion of self-production combined with commissioned processing ，while the lower the proportion of commissioned processing only. In hospitals with preparation approval numbers ，the proportion of owning TCM preparations was the highest （73.66％），followed by common chemical preparations （69.93％）. From perspective of annual output value of hospital preparations ，tertiary hospitals were higher than secondary hospitals ，and private hospitals were higher than public hospitals ；it was related to the production mode ，varieties of hospital preparations and the establishment of the preparation laboratories. There was a trend that the development of hospital preparations in C entral China ，North China and South China was better than that in the Northeast China ，Northwest China and Southwest China. CONCLUSIONS At present ，hospital preparations in China are mainly made in medical institutions ， com and the types are relatively limited. The regional developmentis unbalanced and the scale of hospital preparations is reduced.It is suggested that medical institutions should pay attention to the innovation of hospital preparations ，especially to deve lopment of characteristic preparations with definite curative effect ，so as to give full play to their role of “shortage make-up ”. Great importance also should be paid to the policy support of dispensing and the establishment of regional dispensing centers.

Comparación cesáreas de no emergencia y parto normal, en servicios públicos/privados durante los años 2016-2019 en Chile / Comparison of non-emergency cesarean section and normal childbirth, in public/private services during the years 2016-2019 in Chile

Introducción: La Organización Mundial de la Salud (OMS) propuso que el porcentaje de cesáreas debería ser entre un 10 y 15%. Sin embargo, en los últimos años, a nivel mundial, se ha visto un aumento en su realización. El objetivo de este estudio fue describir la población de embarazadas en Chile durante los años 2016-2019 que tuvieron parto vaginal (PV) o cesárea de no emergencia (CNE), y compararlos entre servicio público y privado. Material y Método: Estudio ecológico realizado en embarazadas que se sometieron a CNE o PV en Chile entre los años 2016-2019. Se obtuvieron datos del Departamento de estadística e información de Salud. No se requirió comité de ética. Resultados: Durante el periodo estudiado hubo 57,60% (339.592) de PV y 42,39% (249.925) de CNE. En el sistema público hubo una diferencia de 54,94% (187.046) de PV por sobre el sistema privado. Mientras que la diferencia de CNE en el sistema privado fue un 10,06% (25.153) por sobre el sistema público. Discusión: Durante los cuatro años, las PV superaron a las CNE, sin embargo, las CNE representaron más del 40% del total de nacimientos, superando ampliamente las recomendaciones de la OMS. Las falencias a nivel nacional en el sistema de clasificación, y en la recopilación de datos limitan el desarrollo de estudios más acabados. Conclusión: Para enfrentar las altas cifras de CNE, es necesario unificar, ampliar y regularizar un base de datos nacional que dé paso a la creación de guías y protocolos que limiten el uso mal justificado de CNE.

Introduction: The World Health Organization (WHO) proposed that the percentage of caesarean sections should be between 10 and 15%. However, in recent years, worldwide, there has been an increase in its realization. The objective of this study was to describe the population of pregnant women in Chile during the years 2016-2019 who had a vaginal delivery (VD) or non-emergency cesarean section (NECS), and to compare them between public and private services. Material and Method: Ecological study carried out in pregnant women who underwent NECS or VD in Chile between the years 2016-2019. Data were obtained from the Department of Statistics and Health Information. No ethics committee was required. Results: During the studied period there were 57.60% (339,592) of VD and 42.39% (249,925) of NECS. In the public system there was a difference of 54.94% (187,046) of VD over the private system. While the difference of NECS in the private system was 10.06% (25,153) over the public system. Discussion: During the four years, VD exceeded NECS, however, NECS represented more than 40% of all births, far exceeding the WHO recommendations. Shortcomings at the national level in the classification system and in data collection limit the development of more complete studies. Conclusion: To face the high numbers of NECS, it is necessary to unify, expand and regularize a national database that gives way to the creation of guides and protocols that limit the poorly justified use of NECS.

Research on the organizational capability and maturity status of private hospitals in China / 中华医院管理杂志

Objective:To evaluate the current organizational capacity and maturity of private hospitals in China, in references improving their organizational capacity and promoting their sustainable development.Methods:The purposive sampling method was used from May to November 2019, and private hospitals of continuous operation for 5 years or above were selected for a questionnaire survey. Self-evaluation was made on the organization capacity of these hospitals in such 12 aspects as positioning, normalization, decision making, execution, supervision, marketing, coerciveness, risk exposure, innovation, learning capacity and leadership. Based on existing models, five levels of maturity models from low to high were established, namely that of business in difficulty, that of basic stable operation, that of stable development, that of expanding business, and that of independent branding.Factor analysis was used for structural efficiency analysis, the questionnaires were subject to a descriptive analysis, and a maturity scoring was obtained based on self-evaluation of organizational capacity.Results:A total of 45 non-public hospitals were investigated in this study, and 450 valid questionnaires were recovered. The factor analysis classified the organizational capacity into basic capacity, core capacity and development capacity. The organizational capability of the hospitals scored in average 4.14 points; the development capacity scoring(3.87 points) was lower than basic capacity(4.16 points) and core capacity(4.06 points). 80% of the private hospitals were in the basic stable stage or stable development stage.Conclusions:Private hospitals feature in general lower maturity, good basic capacity and core capacity, while they tend to have weak development capacity, not to mention innovation and construction of learning organizations.

Morbilidad y mortalidad del recién nacido en un hospital privado de México / Newborn morbidity and mortality in a private hospital in Mexico

Resumen OBJETIVO: Estimar la morbilidad y mortalidad de los recién nacidos vivos en un hospital privado de México, a través de los ingresos a las unidades de cuidados intensivos neonatales y de terapia intermedia neonatal. MATERIALES Y MÉTODOS: Estudio de serie de casos de recién nacidos en el Hospital Ángeles Lomas, Estado de México, que ingresaron a la unidad de cuidados intensivos neonatales o a la unidad de terapia intermedia neonatal entre 2016 y 2019. Se incluyeron todos los recién nacidos vivos, mayores de 24 semanas de gestación. Se efectuó un análisis descriptivo y se calcularon medias, porcentajes y desviaciones estándar. RESULTADOS: Se registraron 4234 recién nacidos, de ellos 13.7% fueron prematuros. Ingresaron 478 (11.3%) neonatos a cuneros dedicados a la atención de sus morbilidades, 203 a la unidad de cuidados intensivos neonatales (4.8%) y 275 a la unidad de terapia intermedia neonatal (6.5%). Las principales causas de ingreso a cuidados intensivos neonatales fueron: retención de líquido pulmonar (32.5%), enfermedad de membrana hialina (27.6%) y sepsis neonatal (10.3%). Las principales causas de ingreso a la unidad de terapia intermedia neonatal fueron: retención de líquido pulmonar (41%), hiperbilirrubinemia multifactorial (15.2%) e hiperbilirrubinemia por incompatibilidad de grupo (11.6%). La tasa de mortalidad neonatal fue de 2.7 por cada 1000 nacidos vivos, las principales causas de defunción fueron: enfermedad de membranas hialinas complicadas con sepsis neonatal y asfixia perinatal. CONCLUSIÓN: No se encontraron diferencias importantes en el hospital privado estudiado en comparación con otros estudios que valoran la morbilidad y mortalidad neonatal. La tasa de mortalidad en este hospital fue menor a la del país, pero la media de días en la unidad de cuidados intensivos neonatales fue mayor y la tasa de prematuridad ligeramente mayor a la reportada en países desarrollados.

Abstract OBJECTIVE: To estimate the morbidity and mortality of live newborns born in a private hospital in Mexico, through admissions to the neonatal intensive care unit (NICU) and the neonatal intermediate therapy unit (NITU). MATERIALS AND METHODS: A series of cases were carried out of the births of the Hospital Ángeles Lomas (State of Mexico) that have entered the NICU / NITU from 2016 to 2019. All live newborns older than 24 weeks were included. A descriptive analysis was performed calculating means, percentages and standard deviations. RESULTS: 4,234 newborns were registered, of which 13.7% were premature. 478 (11.3%) newborns were admitted to pathological nurseries, 203 to the NICU (4.8%) and 275 to the NITU (6.5%). The main causes of admission to the NICU were retention of pulmonary fluid (32.5%), hyaline membrane disease (27.6%), and neonatal sepsis (10.3%). The main causes of admission to the NITU were retention of pulmonary fluid (41%), multifactorial hyperbilirubinemia (15.2%) and hyperbilirubinemia due to group incompatibility (11.6%). The neonatal mortality rate was 2.7 out of 1000 live births, the main causes of death were hyaline membrane disease complicated by neonatal sepsis and perinatal asphyxia. CONCLUSION: No significant differences were found in the private hospital studied compared to other studies evaluating neonatal morbidity and mortality. The mortality rate in this hospital was lower than that registered countrywide, however the average number of days in the NICU was higher and the prematurity rate slightly higher than that reported in developed countries.

Servicio de dolor agudo en un hospital privado, experiencias y recomendaciones / Acute pain service in a private hospital, experiences and recommendations

Resumen: Las bases de la medicina quirúrgica se deben establecer en el marco del cuidado perioperatorio donde el anestesiólogo es pieza fundamental para la toma de decisiones desde el ingreso hasta el alta y rehabilitación; por eso, el manejo del dolor agudo debe entenderse por todos nosotros como una extensión del cuidado que brindamos. Este artículo describe el esfuerzo por crear un Servicio de Dolor Agudo (SDA) en un hospital privado, donde los recursos se ven más limitados en cuestión de recursos humanos y organización. El modelo de la SDA de un hospital privado es una mezcla de tendencias ya descritas donde el principal actor es el residente de anestesia (bajo costo) y cuyos parámetros de actuación estuvieron basados en la iniciativa PAIN-OUT. Se encontraron áreas de oportunidad y se describió la manera de abordarlas; sin embargo, es innegable que la sensibilización de las autoridades es el paso más difícil e importante para lograr la implementación.

Abstract: Surgical medicine must be established within the framework of perioperative care where the anesthesiologist is a fundamental piece for decision-making from admission to discharge and rehabilitation; so the acute pain management should be taken as an extension of the care of this specialty. This paper describes the effort in developing an acute pain unit in a private hospital, where human resources and organization are constrained. The model of this private acute pain service is a mix of various models written in the literature where the residents of anesthesia are the main actors (low cost), and the standards used are based under the PAIN-OUT initiative. Many areas of opportunity were found along with different solutions, however at the end making authorities sensible about this topic is the hardest step.

Patient satisfaction level in outpatient department in a private dental hospital

Background: In the dental field, patient satisfaction played a very important role, specifically finding the strength and weakness in the dental clinic. It also assists in improving the quality of treatment as well as better future planning of treatment. Objective: The present study was planned and conducted with an objective to assess the level of satisfaction among patients attending the outpatient department in a private dental hospital. Materials and Methods: A prospective, cross-sectional, and questionnaire-based study was undertaken in a private dental hospital. Patients of age more than 18 years and of both gender attending outdoor patient department were included in the study. For the purpose of this survey, consecutive sampling was carried out until a sample size of 200 was achieved. The patient satisfaction was assessed using dental satisfaction survey 2002 – questionnaire. Results: Among 31 items, none of the respondents indicated strong agreement or disagreement for 30 items, only for one item, item no. 14 regarding the explanation of cost, respondents indicated strong agreement (106, 53.00%). More than 40% of respondents indicated strong agreement (indicating satisfaction) with the statement for seven items. None of the items have <10% of respondents indicated strong agreement. The respondents expressing strong disagreement (indicating dissatisfaction) with any statement was <10% on 23 of the 31 items. The inter-item reliability of all 31 items of the questionnaire was tested, and the overall satisfaction scale (all items 1–31) produced a high Cronbach’s alpha value of 0.92. Conclusion: Patients’ satisfaction was observed not only for overall satisfaction but also in all sub-scales – context, content, outcome, cost, and facilities.

Private hospitals operated in DEA-Tobit model in Shenzhen: operating efficiency and influencing factors / 中华医院管理杂志

Objective To study the efficiency changes of private hospitals in Shenzhen and explore influencing factors for the utilization efficiency of health resources. Methods DEA-Tobit two-stage model was used to analyze the operating efficiency and influencing factors of Shenzhen′s private hospitals. Results The range of technical efficiency varied between 0.690 to 0.742 in six years, and the index of total factor production was consistent with the technical change index. The input and output indicators showed non-linear growth. The internal and external factors of sample hospitals jointly influence the efficiency of operation. Conclusions The two-stage method effectively reveals the dynamic efficiency change and the influencing factors of these hospitals in Shenzhen. The technical efficiency of sample hospitals fluctuates in waves in six years,with investment redundancy and insufficient output found. Sample hospitals need to strengthen their innovative application of diagnostic and therapeutic technology,and to strengthen their internal management and improve operating efficiency.

Benefit Decision-making Mechanism Research on the Symbiotic Cooperation between Private Hospitals and Public Hospitals Based on Optimized Theory / 中国卫生经济

Objective:To study the problem of the interests decision-making about sharing medical resources between private hospitals and public hospitals research,and to explore the internal symbiosis mechanism of private hospitals and public hospitals.Methods:The maximization method was applied to study in depth the decision-making and benefit distribution mechanism of private bospitals and public hospitals.Results:The symbiotic cooperation of private hospitals and public hospitals could bring the total additional benefits of the medical service market when the supply of the sharing medical resources was greater than demand.Collaborative decision was better than independent decision-making between private hospitals and public hospitals.When the supply of sharing in medical resources was less than demand situation,the symbiotic cooperation decisions of both hospitals could not bring additional benefits from the medical service market.Conclusion:In order to make full use of medical resources,provide better service to the residents and maximize the total benefit of the medical service market,it was recommended to build the information platform,form effctive coordination mechanism and establish collaborative performance evaluation.

Comparison of taxation policies suitable for public hospitals and private hospitals / 中国卫生政策研究

Objective:The aim of this paper intends to reveal the problem of taxation policies suitable for public hospitals and private hospitals so as to provide policy support for guiding the healthy development of public hospitals and private hospitals too. Methods:To achieve the objective of this study, a comparative analysis, and a descriptive analysis were used in comparing the taxable income and taxation policies suitable for public hospitals and private hos-pitals. Results:The findings of the present study show some of the key problems facing the taxation policies in public hospitals and private hospitals which include incomplete linked system of enterprise income tax, business tax changing value added tax pilot, difficult to guide practice;destroying the tax fair principle on account of it regarded the hospi-tal nature as identified conditions of tax payment or dispense tax; high tax hindered private hospital competitiveness and developing power;and financial opaque, absence of supervision, preferential taxation policy hard to implement. Conclusion:As per the analysis of this study, it is needed to define the hospital value added tax taxable items and its accounting system;to determine whether to pay the value-added tax and enterprise income tax according to the nature of hospital medical service project; and establish the disclosure system of hospital financial information, strengthen the transparency on income, expenditure and tax.

Analysis of the development trend of private hospitals in China:Case of Sichuan Province / 中国卫生政策研究

Since the China's new healthcare reform has launched , beneficial policies introduced by the central and local governments has promoted the rapid development of private hospitals .This paper taking Sichuan Province as an ex-ample analyzes the development of private hospitals from four points of view:hospital amount, scale, location and services package, using 2002—2014 hospital-level data, which provides decision support for formulating and improving relative pol-icies.As per the analysis of the data at hand , it has been confirmed that private sector has developed quickly during the 13 years, with the number of hospitals increasing by 19.2%annually.Private hospitals were mainly of small-scale.Although the proportion of services provided by privates sector has grown yearly , it was merely 14.5%in 2014.The hospital location that the private sector selected concentrated mainly in developed regions , but the proportion of private hospital in the un-derdeveloped region has risen steadily .In terms of types of service provided , there were certain differences between private and public sector.Compared to the public sector, the private sector provided a higher proportion of specialized medical services, concentrating on otolaryngology , cosmetic plastic surgery , cardiovascular services , etc.

Prescribing Pattern in Outpatient Departments of Two Tertiary Care Teaching Hospitals in Dhaka.

Background: Medically inappropriate, ineffective and economically inefficient use of drugs is very common in our country. About 40% or more drugs expenditure may be wasted through irrational prescribing and dispensing. The need for promoting rational use of drugs is not only because of economic considerations; also it is an essential element for achieving quality of the health and medical care for patients and the community. For this purpose a cross sectional study was carried out among the individuals attending the outpatient departments (OPD) of Medicine, Surgery, Gynecology & Obstetrics, Pediatrics, Orthopedics, Dermatology & Venereology, Ophthalmology and Otolaryngology of two tertiary care teaching hospitals of Dhaka, Bangladesh. Objective: To observe the prescribing pattern in outpatient departments of two tertiary care teaching hospitals (Dhaka) by using World Health Organization (WHO) core prescribing indicators. Materials and Methods: Six hundred prescriptions of patients attending the OPD of Medicine, Surgery, Gynecology & Obstetrics, Pediatrics, Orthopedics, Dermatology & Venereology, Ophthalmology and Otolaryngology of Enam Medical College Hospital (private hospital) and Sir Salimullah Medical College Hospital (public hospital) were collected randomly on working days from April to September 2014. Then the prescriptions were analyzed by following the “Prescribing indicators form” as recommended by the International Organization of Rational Use of Drugs (INRUD)/WHO. Results: Average number of drugs per prescription was significantly high (3.07 in public hospital and 3.00 in private hospital). Generic prescribing was significantly lower in private hospital (4.00%) than that in public hospital (21.00%). Antibiotic prescription was higher in private hospital (42.35%). Injection prescribed in public hospital was 5.74% whereas 5.66% in private hospital. Drugs prescribed from Essential Drug List of Bangladesh were less in both the hospitals (42.85% in public hospital and 40.06% in private hospital). Conclusion: Average number of drugs per prescription was higher in both hospitals. Generic prescribing was lower in private hospital and prescribing from EDL was low in both hospitals.

Fatores psicossociais e sociodemográficos associados à depressão pós-parto: um estudo em hospitais público e privado da cidade de São Paulo, Brasil / Psychosocial and sociodemographic factors associated with postpartum depression: a study in private and public hospitals in São Paulo, Brazil / Factores psicosociales y sociodemográficos asociados con la depresión posparto: un estudio realizado en hospital público y privado en la ciudad de São Paulo, Brasil

O estudo avaliou a prevalência de depressão pós-parto (DPP) e fatores associados em mulheres que deram à luz em dois hospitais da cidade de São Paulo: um público e outro privado. Foram aplicados questionários padronizados, a Escala de Depressão Pós-parto de Edimburgo (EDPE) e a Escala de Apoio Social de MOS (EAS) a 462 mulheres: 205, no hospital público e 257, no privado. Foram obtidos dados sociodemográficos, psicossociais, obstétricos e do recém-nascido (RN). Consideraram-se deprimidas mulheres com 12 ou mais pontos na EDPE, aplicada no 3º ou 4º mês após o parto. No hospital público, a prevalência de DPP foi de 26% e, no privado, de 9%. Características dos RN foram semelhantes nas duas amostras; idade, escolaridade, número de visitas de pré-natal e de cesarianas das mães foram maiores no hospital privado. Análise de regressão envolvendo características psicossociais das participantes revelou associação positiva de DPP com depressão anterior e com frequência de conflitos com o parceiro e relação negativa com anos de escolaridade e escore de apoio social.

This study evaluated the prevalence of postpartum depression (PPD) and associated factors in women who gave birth at two hospitals in São Paulo City: one public and other private. It was applied standardized questionnaires, the Edinburgh Postnatal Depression Scale (EPDS), and the MOS Social Support Scale to 462 women: 205 in the public hospitals and 257, in the private one. Data collected included sociodemographic, psychosocial, obstetric and newborn (NB) characteristics. It was considered depressed those women with 12 or more points in EPDS, applied in the 3rd. or 4th. month after delivery. In the public hospital, the prevalence of PPD was 26% and in the private, 9%. Characteristics of infants were similar in both samples, Mothers' age, education level, number of prenatal visits and cesarean were higher in the private hospital. Regression analysis involving psychosocial characteristics of women showed a positive association of PPD with previous occurrence of depression and frequency of conflicts with partner and negative relationship with years of schooling, and social support scores.

El estudio evaluó la prevalencia de la depresión posparto (DPP) y factores asociados en mujeres que dieron a luz en dos hospitales de la ciudad de São Paulo: un público y otro privado. Se aplicó dos instrumentos estandarizados, la escala de depresión posparto de Edimburgo (EDPE) y el Cuestionario MOS-SSS de Apoyo Social, a 462 mujeres: 205 en el hospital público y 257 en el hospital privado. Se obtuvieron datos sociodemográficos, psicosociales, obstétricos y del recién nacido (RN). Fueron consideradas deprimidas las mujeres con 12 o más puntos en la EDPE aplicada en el tercero o cuarto mes después del parto. En el hospital público, la prevalencia de DPP fue de 26% y en el privado, 9%. Características de los RN fueron similares en las dos muestras; la edad, la escolaridad, el número de consultas de prenatal y de cesáreas fueron mayores en el hospital privado. El análisis de regresión implicando características psicosociales de las participantes reveló una asociación positiva de la DPP con depresión previa y con frecuencia de conflictos con el compañero y una relación negativa con los años de escolaridad y con el escore de apoyo social.

On the optimal management of the closed-loop management in safe practice of nursing teaching in private hospitals / 中华医学教育探索杂志

Objective To study the optimal management of the closed-loop management in safe practice of nursing teaching in private hospitals.Method Through analyzing the causes and problems during the teaching of nursing adverse events,the closed-loop management in safe practice of nursing teaching was investigated,including the closed-loop management team,implementation cycle and range,etc.Totally 100 teachers and 220 students were chosen in 27 clinical teaching departments of our hospital during January 2013 and March 2014.The teachers were divided into experimental group (n=50) and the control group (n=50).The closed-loop management model was applied in experimental group while routing management was applied in control group.At the same time,220 students' behavior in experimental group was compared before and after the closed-loop management.Through the evaluation of nursing teaching' safe hidden trouble and questionnaire survey,the nursing teaching of both groups were safe.SAS 9.2 was applied to do statistical analysis and non-parametric Wilcoxon Fisher exact test and x2 test were used.Results The number of teachers' operating key points in experimental group was significantly higher than the control group,with statistically significant differences (46 vs.15) (P=0.000).The safety hazard times of nursing teaching were 38 and 8 respectively before and after the closed loop management,and the difference was statistically significant (P=0.000).In addition,the comparison before the students' implementing the check system,hospital safety index patients and regulation for technical operations and hospital infection was significant after the closedloop management (P＜0.01 for all).Conclusion The full implementation of the closed-loop management,effective tracking and prevention in place,can optimize the safety management of nursing teaching.

The SWOT analysis on private hospitals in the background of new healthcare reform / 中国卫生政策研究

Objective:This study aims to ensure the private hospitals development strategy in the background of new healthcare reform and put forward some scientific suggestions to help promote their sustainable development. Methods:The SWOT analysis method was adopted to analyze the private hospitals’ internal strength, weakness, exter-nal opportunity and threats. Results: The results showed a clear property right, advanced management system and other outstanding advantages in the private hospitals. Opportunities like the improved policy environment and people’s medical demand expansion are also very prominent. Meanwhile, the private hospitals development also faces some disadvantages and challenges such as illegal operation, disorder in the market competition, vague orientation, etc. Conclusions:It suggests the strengthening of the personnel and hospital culture construction, adoption of the differen-tiation strategy, improvement of the diagnosis and treatment ability, etc.

Comparative analysis on the current situations of private and public hospitals in Beijing / 中国卫生政策研究

Objective:To put forward some suggestions by comparing the current situation in both private and public hospitals. Methods:Comparing the basic information, scale, human resource and medical service management situation between the private and public hospitals by analyzing the 2014 Beijing health authorities report. Results:There are 355 private hospitals, 76. 1% of them are not rated and 59. 7% are not appointed for the medical insur-ance, and 82. 8% need to rent the land. Although the number of private hospitals is more than that of the public ones, their actual beds and health resources respectively account for only 20. 2% and 16. 4%. Besides, their in-come, assets and services also account for only about 10%. Conclusions:There is a big gap between the private and public hospitals in terms of scale, human resources and service ability. The Government should implement the policy about the ratings, medical insurance and the use of land which is given to support the private hospitals, and speed up the diversified medical model.