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Background: Proper understanding of concepts of physiology forms basis of good clinical practice. To make the lectures in physiology more interesting and understanding, one has to review the teaching methods at regular intervals. Aims and Objectives: This study is designed to get feedback regarding teaching methods in physiology from MBBS students of Government Medical College, Kozhikode, to make teaching more effective. Materials and Methods: Two hundred randomly selected students who successfully completed 1st-year MBBS are included in the study group. The standard questionnaire is shared to study group through Google forms and adequate time is given to record their responses. Descriptive statistics are used. Frequency is expressed in percentage. Results: Most of students prefer interactive teaching methodologies such as group discussion as their preferred mode of learning rather than conventional didactic lectures in whole batch. Students also like to have integration with other subjects and early clinical exposure to understand the concepts precisely. Conclusion: Teaching in small groups with proper integration and alignment with other subjects will make maximum results rather than the traditional teacher centered medical education. Periodic review of teaching methods is very much essential to make the subject more interesting.
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Introduction: This study compared perceptions of interprofessional collaboration and recognition of work between clinic/small hospital staff and those at regional core hospitals.Methods: An anonymous, self-administered questionnaire was administered to the staff at 4 clinics/small hospital and those at 3 regional core hospitals responsible for regional medical care. The following items were compared between the 2 groups: Assessment of Interprofessional Team Collaboration (AITCS) Japanese version, Readiness for Interprofessional Learning Scale (RIPLS) Japanese version, workplace satisfaction, and relationship with neighboring facilities.Results: The subjects were 74 staff members at clinics and small hospital and 576 staff members at regional core hospitals; their average ages were 41.9 years and 40.6 years, respectively. Compared to staff at regional core hospitals, those at the clinics and small hospitals had significantly higher AITCS scores, RIPLS scores, and workplace satisfaction, and they also considered their institutions to have better relationship with neighboring facilities.Conclusion: The staff of clinics and small hospital were more aware of interprofessional collaboration than hospital staff, and were more satisfied with their workplaces. Understanding the underlying organizational differences may facilitate vertical integration in community-based integrated care systems.
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Objetivo: Verificar se a alteração do formato jurídico do hospital Amato Lusitano e a simultânea integração com a atenção primária gerou melhoria dos resultados de eficiência em seus serviços clínicos. Metodologia: Para avaliar os resultados de eficiência, utilizou-se à técnica da análise envoltória de dados, considerando como insumos os custos e como resultados a produção registrada de cada serviço clínico ao longo de um período de 15 anos. Os dados de custo e produção foram obtidos através do Gabinete de Apoio à Gestão e do Gabinete de Contabilidade do hospital. A amostra incluiu todos os serviços clínicos de internação, imagem e patologia clínica. Resultados: A mudança da gestão pública para a condição corporativa resultou em melhoria nos resultados de eficiência em 16 dos 17 serviços analisados apresentando um aumento médio de 19,0%. Conclusões: A adoção da gestão empresarial e do modelo de unidade de saúde local tem sido benéfica para o desempenho dos serviços clínicos, com melhoria geral nos resultados de eficiência técnica.
Objective: Verify that the change of the legal form of the Amato Lusitano Hospital and the simultaneous integration with primary care led to improved results in efficiency in their clinical services. Methodology: For evaluate the efficiency results, we used the technique of data envelopment analysis, considering as inputs the costs and as results the recorded production of each clinical service over a period of 15 years. Cost and production data were obtained through the Office of Management Support and the Accounting Office of the hospital. The sample included all clinical inpatient services, imagiology and clinical pathology. Results: The change of public management for corporate condition resulted in improvement in efficiency results, with 16 of the 17 services analyzed with an average increase of 19.0%. Conclusions: The adoption of business management and the local health unit model has been beneficial to the performance of clinical services, overall improvement in technical efficiency results.
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Humans , Efficiency , Hospital AdministrationABSTRACT
Objective To evaluate the quality of primary healthcare institutions entrusted to private hospitals as seen by the consumers. Methods The vertical integrated model between Renhe Hospital and Lixian township health center was selected as the case study. Consumer survey data of both November 2016 and September 2017 were collected by using Primary Care Assessment Tool(PCAT) (n=376). Stata 14.0 and Excel 2013 were used for descriptive statistics and multiple linear regression. Results Scoring in such key domains as continuity, comprehensiveness and coordination, and the derivative domains was higher in 2017 than those of 2016. And the differences were significant except for the domain of continuity and coordination (referral). PACT total score in 2017 was 21.28,higher than 19.83 in 2016 and the difference was significant(P<0.01). Conclusions Under the vertical integrated model between Renhe and Lixian, the quality of primary healthcare institutions was improving from 2016 to 2017 from the perspective of consumers. First contact (accessibility), comprehensiveness (services availability) and community orientation of primary healthcare institutions need to be strengthened in the future.
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This article addresses the issue of the classification of healthcare systems, with the intent to take a step further than the previously analysed models of healthcare organisation. As concerns the financing of healthcare services, the standard tripartite classification ( according to which healthcare systems are divided into three groups:voluntary insurance, social health insurance and universal coverage) is enriched with two additionaltypes: compul-sory national health insurance and residual programs. With respect to the provision of services and the relationship between insurers and providers, it is important to distinguish between vertically integrated and separated systems. What differentiates this analysis from the majority of previous studies is its underlying logic. Assuming that all sys-tems are hybrid,the article proposes to put aside the classic logic for classifying healthcare systems ( according to which individual countries are pigeonholed into different classes depending on the prevailing system) in favour of the identikit logic. The concept of segmentation ( of healthcare services or population) proves to be remarkably use-ful to this purpose.
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Objective: On the basis of typical cases, the objective of this study is to assess the service quality of primary healthcare institutions under the vertically integrated model from the perspective of demanding side.Methods: The vertical model between Renhe Hospital and Lixian Township Health Center was selected as the case study.Quantitative data were collected by exit review using Primary health-Care quality service Assessment Tool (PCAT)-Chinese version from the patients seeking services in Lixian.Quantitative data were analyzed by descriptive statistics and multiple linear regression equations while qualitative data were analyzed by thematic framework analysis.Results: Under the vertical model, the PCAT total score was 20.09.The scores on the first diagnosis, continuity of care, and comprehensiveness of care and coordination of care were 6.59, 3.27, 4.58 and 5.62 respectively.The scores on the three dimensional extensions, family-centered, community-oriented, medical culture were 3.07, 1.86 and 2.67 respectively.The difference was significant for the PCAT total score between a number of visits and the length of waiting time for services in Lixian.Conclusions: Under the vertical model, primary healthcare institutions did better in the first diagnosis while weaker in continuity and the three dimensional extensions.With the development of the integration, the primary healthcare institutions need to strengthen the continuity and downward referral in the future.Future researches and follow-up, analysis is needed to track the impact of the vertically integrated model.
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Objective:Based on the framework of reference point contract theory,the experimental economics methodwas used to explore the medical institution managers' motivation and reflection of the profit allocation in vertical integrated?medical service system.Methods:Z-tree software was applied to design the experimental program.40 undergraduate students majoring in health management were recruited as the subjects.Sharing rates and effort levels were collected and calculated by Excel 2007 and SPSS 17.0.Results:The median of sharing rate hospital managers allocated to community health centers?was 35.00％.The median of effort level that community health center directors chose was 8.00.The proportion of sharing rates equal to or less than 50.00％ accounted for 98％.The proportion of the highest effort level was 23.50％.The correlation between sharing rate and effort level was significant(P＜0.05).Conclusion:In the process of establishing vertical integration of medical service system,sharing rates and effort levels were closely related while the community health centers' effort was shading.
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Objective: In order to better understand the influencing factors of vertical rural health services integration and put forward policy suggestions for its sustainable development.Methods: 288 residents were investigated through questionnaire survey in three sample areas of Jiangsu province in August 2015.Results: In this study, 4 common factors have been found, namely organizational management, incentive mechanism, policy and supporting measures, as well as information sharing and business communication.The overall scores given by health managers, doctors and nurses, and public healthcare professionals were 0.03, 0.04 and-0.02 respectively.Conclusions: Therefore, in order to succeed, it is very necessary to introduce targeted supporting policies, establish a mutual communication mechanism, and make an effective incentive mechanism.
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The fragmentation of health care system within a county and serious capacity constraints of health-care services in township health centers are generally the most significant problems facing underdeveloped counties in western China. Under constraints of limited public financial resources, how to increase service capability of township health centers and improve service quality, continuity and convenience of health care system has become one of the most severe challenges in implementing China’s county health care system reform. This paper takes Huangzhong coun-ty, Qinghai province as a case study. It investigates how the locals use health care alliance to vertically integrate county health care resources during reform implementation, analyzes various aspects of reform measures and the corre-sponding structural characteristics such as the integration of administrative management, integration of human re-sources, dual diagnosis referral, interoperability of information systems, sharing of resources and test results, etc. , and provides similar China’s counties with a case study to be used for reference.
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Objective:To analyze the mechanism on integration of health care services at the county and town-ship level from the perspective of stakeholder theory. Methods: The stakeholder interest demand was determined by word frequency analysis of interview data from stakeholders in the three regions of Qianjiang, Huangpi, and Zhen-jiang;the degree of attention and gains and losses of stakeholders towards various demands was investigated from the three regions through interest demand questionnaires;the impact of demand benefits on behavioral responses has been evaluated through comprehensive evaluation theory and game theory. Results:Regional integration policies reflect the interest demands of stakeholders in varying degrees; the higher were the scores of demand benefits in interest de-mands questionnaires, the stronger was the willingness of stakeholders to coordinate integration policies. Conclusion:The policies of integration of health care services in rural China should consider all stakeholder interest demands;the better the interest demands of the stakeholders are satisfied, the stronger their motivation for integration reform will be, which may affect the implementation effects of local integration reforms to some extent.
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Objective To establish an influencing factors system for the implementation effect of the vertical integration of services between the hospitals and community health service institutions.Methods Primary data related to influencing indicators were collected by literature review,questionnaire method and in-depth interview,and then the analytic hierarchy process (AHP) and Delphi method were used for the construction of final influencing factors indicator system.Results An influencing factors indicator system which coincides with the status of the vertical integration between hospitals and community health service institutions in Nanjing,Wuhan and Zhenjiang was established,including 4 firstlevel indicators,10 second-level indicators and 36 third-level indicators.Conclusion This study can provide a basis for hospitals and community health centers to improve the integration service system,and fill the gap of research on the influencing factors of the vertical integration of the domestic health care system,which are meaningful for the vertical integration of health care system in other districts and patterns.
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Background & Objectives : In traditional medical curriculum, the main focus is on understanding of physiological concepts; however application, relevance and clinical co-relation of basic knowledge remains uncovered. Therefore retention of basic knowledge by students till later years of clinical exposure is not adequate and hence is seldom applied for patient care. Vertical integration if introduced in physiology can bridge the gap between physiology and clinical subjects, improving knowledge retention and student’s capacity for clinical correlation. A pilot study was undertaken in first year medical students, to study the impact of vertical integration on learning and retention of physiology concepts. Methods: Two topics of endocrinology were taught through traditional and integrated approach to two groups of students with cross over for second topic. In integrated approach, integrated modules were developed and taught by faculties from Physiology, Pathology and Medicine together; whereas traditional approach included usual didactic lectures in Physiology. Knowledge based tests were carried out immediately post intervention (post- test) and after three months interval (repeat post- test). Results Students obtained significantly higher marks in repeat post- test when taught by integrated method than by traditional method (paired t test, p<0.001), implying better knowledge retention in integrated group. Conclusion: There is better retention of knowledge after three months in group that underwent vertical integration. Therefore we recommend introduction of vertical integration along with traditional physiology teaching in first year of medical curriculum.
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Covered herein are the milestones and researches made on healthcare resources integration in China and abroad,focusing on characteristic horizontal and vertical integration of healthcare resources based on medical service value chain.It also analyzed influencing factors on healthcare resources integration,such as health insurance payment and informationization.With reference to global experiences,suggestions are made on the horizontal integration of the resources,in terms of governance,operation mechanism,health insurance payment,informationization and discipline development.
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The article summarized relevant theories and successful practical experience about medical resource integration, analyzed the background of regional medical-trust in Shanghai, and discussed three different model of regional medical-trust building, and their own advantages and disadvantages. Furthermore it discussed the main framework of regional medical-trust pilot reform,including administrative and operational model, insurance-payment model and visiting-doctor model. Then, it introduced the reform strategies of regional medical-trust pilot and present progress.
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Objective To study the effect of public hospitals vertical integration on scale economy in Shanghai. MethodsA total of 401 samples of 67 hospitals from 1999 to 2004 in Shanghai were collected.Median regression was performed to estimate the multi-output cost function and marginal cost of discharge patients,and scale economies were calculated.Results The independent variables Beds,W,X1,X23,Region,Level,Y03,and Y04 were all predictors of cost.Conclusion Both integrated tertiary and secondary hospitals had scale economy before and after integration.Integration enhanced the output and improved the efficiency of integrated secondary hospitals.To some extent,patients were dispersed to secondary hospitals.
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La expedición de la Ley 100 de 1993 otorgó muchos beneficios a la población colombiana, sin embargo, la implementación de la misma tuvo muchos inconvenientes, los cuales se reflejaron tanto en los temas de aseguramiento, como en los casos de corrupción, principalmente en las A.R.S. y en los temas de salud pública, pues reaparecieron enfermedades como la malaria, el sarampión y la fiebre amarilla; es así, como se llegó a la elaboración y radicación de proyectos ante el Senado de la República, los cuales plantean: creación del Plan de Salud Pública colectiva en reemplazo del Plan de Atención Básica, universalidad en la cobertura a través del aseguramiento, la reorganización del SGSSS, y el fortalecimiento del Sistema de Vigilancia y Control. Como también, eliminación de la integración vertical por parte de las E.P.S., creación del Fondo Territorial Colombia para la salud (FOCOS) para el financiamiento de la prestación de los servicios de salud, creación del Fondo de Garantía para la prestación de servicios de salud y desarrollo de un Sistema Único de códigos de procedimientos. Debido a la importancia que reviste éste tema tan crucial para los colombianos y especialmente para el sector salud, todos los profesionales debemos tener conocimiento de los posibles cambios que se avecinan, y como afectarían nuestro quehacer profesional.
The issuing of law 100 of 1993 granted lots of benefits to Colombian population. Nevertheless, its implementations had lost of inconvenients, which reflected either on insurance matters as well as on corruption cases, meanly inside the ARS on Public Health issus. This was evident due to the re-emergence of diseases such as Malaria, Measles, yellow fever. All of these facts, led to the elaboration of proyects before the Senate. These proyects include themes such as the creation of a Colective Public Health Plan instead of the current PAB: Besides this, the proyects include universal coverage in health through insurance; reorganization of the SGSSS as well as the Control and Surveillance System. On the other hand, these new proyects pretend to eliminate vertical integration by EPS; creation of the Colombian Territorial Fund for health (Focos) which is created to finance health care4delivery. Finally, the new proyects aim to create the Guarantee Fund for health care delivery as well as the development of an Unique System for Procedures Code. Due to the highly importance of this subject to Colombians and especially for the Health Care Sector, all health professionals shall be aware of possible incoming changes as well as the way them will change our professional life.
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Insurance Benefits , Social SecurityABSTRACT
Medical ethics was traditionally not taught as a part of the formal medical curriculum. However, medical ethics has become a common feature of medical education in some Western countries because of the increased interest in bioethics since the 1970's. A growing number of Japanese medical schools are now teaching medical ethics in independent courses, therefore, the establishment of integrated teaching programs will become an important issue. The concept of vertical and horizontal integration, a recommended feature of medical ethics programs in the West, should also be applicable in Japan. Strategies are discussed regarding: 1) biological education and health education at junior and senior high schools; 2) liberal arts education for medical students; 3) clinical education; 4) postgraduate education and reeducation for medical teachers; and required core organization.
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The term 'curriculum' refers of a series of planned activities which are intended to bring about specific learning outcomes in the students. Subject-centred curriculum, integrated curriculum, competency-based curriculum and problem-oriented curriculum are employed in medical schools. Among them, the subject-centred curriculum is the most widespread model for medical education. When the subject-centred curriculum is discussed, large doses of scientific fact ad theory and isolated fragments of knowledge and information, together with instruction, are provided through discrete courses and independent medical disciplines that cover such classical subjects as anatomy, physiology, internal medicine and surgery. The emphasis is on learning the disciplines rather than their application to the practice of medicine. Faculty and students began to question the relevance of content and meaningful learning. As knowledge grew, it became impossible for the body of medical knowledge to be contained within one discipline. These factors led to a demand for the integrated medical curriculum. Integration is the combining of different parts to from a whole, which is meaningful. To integrate is to make whole or complete by the organization and bringing together of separate parts. In terms of curriculum development, the term 'integration' usually relates to the organization and teaching of subject matter in the form of horizontal integration or vertical integration in order to achieve meaningful and relevant experiences for the learner. The integrated curriculum attempts to fuse independent disciplines into a more unified whole. It is recommended that the innovative curriculum such as integrated curriculum or problem-oriented curriculum should be adopted to renovate the existing conventional discipline-based curriculum in established medical schools.