Understanding Impacts of Online Dual Practice on Health System Performance: A Qualitative Study in China.

The outbreak of the COVID-19 pandemic has boosted the global development of online healthcare platforms. An increasing number of public hospital doctors are providing online services on private third-party healthcare platforms, creating a new form of dual practice-online dual practice. To explore the impacts of online dual practice on health system performance as well as potential policy responses, we undertook a qualitative approach that uses in-depth interviews and thematic analysis. Following a purposive sampling, we interviewed 57 Chinese respondents involved in online dual practice. We asked respondents for their opinions on the effects of online dual practice on access, efficiency, quality of care, and advice on regulatory policy. The results suggest that online dual practice can generate mixed impacts on health system performance. The benefits include improved accessibility due to increased labor supply of public hospital doctors, better remote access to high-quality services, and lower privacy concerns. It can improve efficiency and quality by optimizing patient flows, reducing repetitive tasks, and improving the continuity of care. However, the potential distraction from designated work at public hospitals, inappropriate use of virtual care, and opportunistic physician behaviors may undermine overall accessibility, efficiency, and quality. Countries should mitigate these adverse consequences via regulations that are appropriate to their healthcare system context, policy priority, and governance capacity.

Mitigating donor interests in the case of COVID-19 vaccine: the implication of COVAX and DAC membership.

INTRODUCTION: The COVID-19 vaccine donation process allegedly prioritised national interests over humanitarian needs. We thus examined how donors allocated vaccines by recipient country needs versus donor national interests and how such decisions varied across donation channels (bilateral vs COVAX with country earmarking) or exposure to foreign aid norms (membership status in the Development Assistance Committee-DAC). METHODS: We used the two-part regression model to examine how the probability of becoming a recipient country and the volume of vaccines received were associated with recipient countries' needs (disease burden and GDP per capita), donor countries' interests (bilateral trade volume and voting distance in the United Nations General Assembly) and recipient countries' population size. The analysis further interacted the determinants with channel and DAC status. RESULTS: Donors preferentially selected countries with higher disease burden, lower GDP per capita, closer trade relations, more different voting preferences, and smaller populations. Compared with bilateral arrangements, COVAX encouraged more needs-based considerations (lower GDP per capita), less interest-based calculus (more distant economic relations and voting preferences) and larger population size. Compared with the DAC counterparts, the non-DAC donors focused more on politically and economically aligned countries but also on less economically developed countries. As for the volume of vaccines donated, countries received more vaccines if they had tighter trade relations with donors, more different voting patterns than donors, and larger populations. COVAX was associated with raising the volumes of vaccines to politically distant countries, and non-DAC donors donated more to countries with stronger trade relations and political alignment. CONCLUSION: Donors consider both recipient needs and national interests when allocating COVID-19 vaccines. COVAX and DAC partially mitigated donors' focus on domestic interests. Future global health aid can similarly draw on multilateral and normative arrangements.

How previous epidemics enable timelier COVID-19 responses: an empirical study using organisational memory theory.

INTRODUCTION: There has been little systematic exploration into what affects timeliness of epidemic response, despite the potential for earlier responses to be more effective. Speculations have circulated that previous exposure to major epidemics helped health systems respond more quickly to COVID-19. This study leverages organisational memory theory to test whether health systems with any, more severe, or more recent exposure to major epidemics enacted timelier COVID-19 policy responses. METHODS: A data set was constructed cataloguing 846 policies across 178 health systems in total, 37 of which had major epidemics within the last 20 years. Hypothesis testing used OLS regressions with World Health Organization region fixed effects, controlling for several health system expenditure and political variables. RESULTS: Results show that exposure to any major epidemics was associated with providing earlier response in the following policy categories: all policies, surveillance/response, distancing, and international travel policies. The effect was about 6-10 days earlier response. The significance of this variable was largely nullified with the addition of the other two independent variables. Neither total cases nor years since previous epidemics showed no statistical significance. CONCLUSION: This study suggests that health systems may learn from past major epidemics. Policymakers ought to institutionalise lessons from COVID-19. Future studies can examine specific generalisable lessons and whether timelier responses correlated with lower health and economic impacts.