Recent innovations in long-term care coverage and financing: a rapid scoping review.

OBJECTIVES: To identify, chart and analyse the literature on recent initiatives to improve long-term care (LTC) coverage, financial protection and financial sustainability for persons aged 60 and older. DESIGN: Rapid scoping review. DATA SOURCES: Four databases and four sources of grey literature were searched for reports published between 2017 and 2022. After using a supervised machine learning tool to rank titles and abstracts, two reviewers independently screened sources against inclusion criteria. ELIGIBILITY CRITERIA: Studies published from 2017-2022 in any language that captured recent LTC initiatives for people aged 60 and older, involved evaluation and directly addressed financing were included. DATA EXTRACTION AND ANALYSIS: Data were extracted using a form designed to answer the review questions and analysed using descriptive qualitative content analysis, with data categorised according to a prespecified framework to capture the outcomes of interest. RESULTS: Of 24 reports, 22 were published in peer-reviewed journals, and two were grey literature sources. Study designs included quasi-experimental study, policy analysis or comparison, qualitative description, comparative case study, cross-sectional study, systematic literature review, economic evaluation and survey. Studies addressed coverage based on the level of disability, income, rural/urban residence, employment and citizenship. Studies also addressed financial protection, including out-of-pocket (OOP) expenditures, copayments and risk of poverty related to costs of care. The reports addressed challenges to financial sustainability such as lack of service coordination and system integration, insufficient economic development and inadequate funding models. CONCLUSIONS: Initiatives where LTC insurance is mandatory and accompanied by commensurate funding are situated to facilitate ageing in place. Efforts to expand population coverage are common across the initiatives, with the potential for wider economic benefits. Initiatives that enable older people to access the services needed while avoiding OOP-induced poverty contribute to improved health and well-being. Preserving health in older people longer may alleviate downstream costs and contribute to financial sustainability.

Conflict and conflict management in hospitals.

PURPOSE: Hospitals are complex and complicated organizations and are prone to the conflict. The purpose of this paper is to identify the intensity and type of conflict experienced by hospital managers and explore their conflict management strategies in hospitals affiliated with Tehran University of Medical Sciences. DESIGN/METHODOLOGY/APPROACH: This quantitative, descriptive and cross-sectional study was conducted in 2015. A self-administered questionnaire was used to collect data from top, middle and front line managers. In total, 563 managers from 14 hospitals responded to the questionnaires. Data were analyzed using SPSS software version 19. FINDINGS: Hospital managers reported average level of conflict (2.73 score out of 5). Organizational factors produced more conflict for managers than personal factors. High workload, resource shortage, bureaucracy and differences in managers' personality, knowledge, capabilities and skills were the main causes of organizational and personal conflict. Top managers experienced more conflict than middle and front line managers. Conflict was higher in specialized hospitals compared to general hospitals. Less conflict was observed in administrative and support departments than diagnostic and therapeutic departments. Conflict was meaningfully associated with management level, education, size of hospital, number of employees and willingness to leave the hospital. The dominant conflict management style of managers was collaborating. There were significant relationships between collaborating style and management level, manager's age, work experience and management experience. PRACTICAL IMPLICATIONS: The nature of hospitals requires that managers use collaborating, compromising and accommodating styles to interact better with different stakeholders. Managers by acquiring necessary training and using the right conflict resolution strategies should keep the conflict in a constructive level in hospitals. ORIGINALITY/VALUE: This is the first study conducted in Iran examining the level of conflict, its types and identifying managers' dominant conflict resolution strategies at front line, middle and top management levels.