Public-private partnership in the Portuguese health sector.

Since 2001, in Portugal, constant reforms in hospital management have accompanied the transformations in the management models applied to public administration, intending to ensure a higher quality of services and, simultaneously, a more significant economic efficiency. This study aims to analyse, for the period between 2012 and 2021, the economic and financial results (value-for-money) of the PPP model, compared with the public management hospitals (PMH). It used a mixed research approach based on multiple case studies and archival research. As the main results, it was found that: i) the PPP model, applied to the health sector, appears to be advantageous, not only regarding the economic and financial results but also concerning the quality of service provision; and ii) despite the value-for-money generated by the PPP model, the lower operating costs and the superior performance in comparison with PMH, the government has permanently opted to revert from a PPP model to a PMH model. This study concluded that the hospital management model is instead seen as an instrumentalised political instrument than a management tool that could generate savings for the taxpayers. Several practical implications are presented.

The Alonissos Study: Cross-Sectional Study of the Healthcare Access and User Satisfaction in the Community of a Non-Profit-Line Greek Island.

Healthcare access and a high quality of the provided services to healthcare users are fundamental human rights according to the Alma Ata Declaration of 1978. Although 45 years have passed since then, health inequalities still exist, not only among countries but also within populations of the same country. For example, several small Greek islands have only a small Primary Healthcare Center in order to provide healthcare services to the insular population. In the current study, we investigated the level of self-reported overall, dental and mental health status and the level of satisfaction regarding the access to and the quality of the healthcare services provided by the Primary Healthcare center of Alonissos, along with registering the requirements for transportation to the mainland in order to receive such services. In this questionnaire-based cross-sectional study, 235 inhabitants of the remote Greek island of Alonissos that accounts for nearly 9% of the population participated (115 males and 120 females). The self-reported overall health status was reported to be moderate to very poor at a percentage of 31.49%, and the results were similar for dental and self-reported mental health status. Although nearly 60% of the participants reported very good/good quality of the healthcare provision, only 37.45% reported that the access to healthcare was very good/good, while around 94% had at least one visit to the mainland in order to receive proper healthcare services. Strategies for improving access to healthcare services need to be placed in remote Greek islands like Alonissos.

The impact of community-based health insurance on universal health coverage in Ethiopia: a systematic review and meta-analysis.

BACKGROUND: Ideally health insurance aims to provide financial security, promote social inclusion, and ensure equitable access to quality healthcare services for all households. Community-based health insurance has been operating in Ethiopia since 2011. However, its nationwide impact on universal health coverage has not yet been evaluated despite several studies being conducted. OBJECTIVE: We evaluated the impact of Ethiopia's community-based health insurance (2012-2021) on universal health coverage. METHODS: On 27 August 2022, searches were conducted in Scopus, Hinari, PubMed, Google Scholar, and Semantic Scholar. Twenty-three studies were included. We used the Joana Briggs Institute checklists to assess the risk of bias. We included cross-sectional and mixed studies with low and medium risk. The data were processed in Microsoft Excel and analyzed using RevMan-5. The impact was measured first on insured households and then on insured versus uninsured households. We used a random model to measure the effect estimates (odds ratios) with a p value < 0.05 and a 95% CI. RESULTS: The universal health coverage provided by the scheme was 45.6% (OR = 1.92, 95% CI: 1.44-2.58). Being a member of the scheme increased universal health coverage by 24.8%. The healthcare service utilization of the beneficiaries was 64.5% (OR = 1.95, 95% CI: 1.29-2.93). The scheme reduced catastrophic health expenditure by 79.4% (OR = 4.99, 95% CI: 1.27-19.67). It yielded a 92% (OR = 11.58, 95% CI: 8.12-16.51) perception of health service quality. The health-related quality of life provided by it was 63% (OR = 1.71, 95% CI: 1.50-1.94). Its population coverage was 40.1% (OR = 0.64, 95% CI: 0.41-1.02). CONCLUSION: Although the scheme had positive impacts on health service issues by reducing catastrophic costs, the low universal health coverage on a limited population indicates that Ethiopia should move to a broader national scheme that covers the entire population.

The association between chronic disease and depression in middle-aged and elderly people: The moderating effect of health insurance and health service quality.

Background: Depression in chronic disease patients was an important public health problem. However, limited work has been done on how to alleviate the depression of chronic disease patients. This paper attempted to explore the alleviating effect of health insurance and health service quality. Methods: A total of 11,500 middle-aged and elderly people were drawn from four waves (2011, 2013, 2015, and 2018) of the China Health and Retirement Longitudinal Study (CHARLS). We analyzed the effect of chronic disease on depression in middle-aged and elderly people in China, and explored the mechanism of action from health insurance and health service quality. Results: After adjusting for sociodemographic factors, any chronic disease (coefficient 1.471, p < 0.01) and multiple chronic diseases (coefficient 1.733, p < 0.01) could significantly increase the depression score. Any chronic disease increased the depression score (165.3 and 147.4% in non-health insurance group and health insurance group, respectively), the multiple chronic diseases increased the depression score (190.6 and 173.5% in non-health insurance group and health insurance group, respectively). Any chronic disease increased the depression score (161.3 and 139.5% in lower health service quality group and higher health service quality group, respectively), the multiple chronic diseases increased the depression score (228.4 and 162.9% in lower health service quality group and higher health service quality group, respectively). And similar results were obtained after using depression status instead of depression score. Conclusions: Chronic disease and multiple chronic diseases were important determinants of depression in middle-aged and elderly people. Health insurance and health service quality were the key factors in relieving the depression of chronic disease patients. Several strategies were urgently needed: paying attention to the mental health of chronic disease patients, increasing the participation rate of health insurance, further improving the quality of health service, and alleviating the psychological harm caused by chronic disease.

Patient Satisfaction With Healthcare Service Quality and Its Associated Factors at One Polyclinic in Hanoi, Vietnam.

Introduction: Patient satisfaction is one of the most important components of measuring healthcare quality. Objectives: The study aimed to evaluate the validity and reliability of the patient satisfaction scale with the quality of health services and its associated factors. Methods: A cross-sectional study was conducted to collect data on patient satisfaction with 301 outpatients at one polyclinic in Hanoi, Vietnam. Results: The overall outpatient satisfaction was 53.5%. There were five factors (facilities, services provision results, information transparency and administrative procedures, accessibility, and interaction and communication of staff) including one major factor with high Eigenvalues coefficient, 22.5 for satisfaction with facility, and four others with lower Eigenvalues coefficient, 3.2, 2.0, 1.5, and 1.2 for satisfaction with service provision results, information transparency and administrative procedures, accessibility, and interaction and communication of staff respectively. All satisfaction-factors show internal consistency reliability, with a Cronbach's Alpha of over 0.9. The insured are 3.5 times (95% CI: 1.9-6.2) more likely to be satisfied with health services than the uninsured. Conclusion: The patient satisfaction measurement tool should be used for intervention to improve the quality of health services at the clinic.

Patient perception of doctor communication skills and patient trust in rural primary health care: the mediating role of health service quality.

BACKGROUND: This study aimed to explore the relationship between communication skills, health service quality, and patient trust in primary health services. METHOD: This study was conducted in village clinics in rural China. A simple random sampling method was used to select volunteer village clinics and patients. In total, 574 participants from 25 village clinics were selected with the help of local health officers and village doctors. The response rate was 90%. Statistical analyses (hierarchical linear regression analysis and a structural equation model) were performed to analyze the data. RESULTS: Patient trust in doctors in rural primary health was influenced by patient perceptions of doctors' communication skills and health service quality. However, health service quality fully mediated the relationship between doctors' communication skills and patient trust in village clinics. In other words, doctors' communication skills indirectly influence patients' trust in doctors. CONCLUSIONS: This study found a link between doctors' communication skills and patient trust. The findings suggest that health managers and doctors should attach great value to communication skills and health service quality in promoting the rural doctor-patient relationship. Moreover, the relationship between doctors and patients should be considered when reforming the primary health system.

Patient-centred care and patient autonomy: doctors' views in Chinese hospitals.

BACKGROUND: Patient-centred care and patient autonomy is one of the key factors to better quality of service provision, hence patient outcomes. It enables the development of patients' trusts which is an important element to a better doctor-patient relationship. Given the increasing number of patient disputes and conflicts between patients and doctors in Chinese public hospital, it is timely to ensure patient-centred care is fully and successfully implemented. However, limited studies have examined the views and practice in different aspects of patient-centred care among doctors in the Chinese public hospitals. METHODS: A quantitative approach was adopted by distributing paper-based questionnaires to doctors and patients in two hospitals (Level III and Level II) in Jinan, Shandong province, China. RESULTS: In total, 614 doctors from the surgical and internal medicine units of the two hospitals participated in the survey yielding 90% response rates. The study confirmed the inconsistent views among doctors in terms of their perception and practice in various aspects patient-centred care and patient autonomy regardless of the hospital where they work (category II or category III), their unit speciality (surgical or non-surgical), their gender or seniority. The high proportion of doctors (more than 20%) who did not perceive the importance of patient consultation prior to determining diagnostic and treatment procedure is alarming. This in in part due to the belief held by more than half of the doctors that patients were unable to make rational decisions and their involvement in treatment planning process did not necessarily lead to better treatment outcomes. CONCLUSION: The study calls for the development of system level policy and organisation wide strategies in encouraging and enabling the practice of patient-centred care and patient autonomy with the purposes of improving the quality of the service provided to patients by Chinese hospitals.

A meta-analysis of the determinants of patient satisfaction and loyalty.

In the contemporary competitive environment, healthcare providers have had to ensure that their customers are satisfied with the quality of medical service they receive as this is critical in customer retention and their repeated use of the service of the healthcare provider. Taking the patient's perspective, several studies have attempted to identify the determinants of patient satisfaction and their loyalty toward healthcare providers. Studies have yielded mixed results and to get a clearer understanding of these relationships, we perform a meta-analysis of 13 studies to test nine hypotheses. We discuss the implications of the results.

Patients' Satisfaction with Ophthalmology Clinic Services in a Public Teaching Hospital.

Purpose: To evaluate patients' satisfaction with ophthalmology health services in a teaching clinic of a tertiary public hospital. Patients and Methods: This was a cross-sectional study in ophthalmology clinic of Dr. Sardjito teaching hospital, Yogyakarta, Indonesia conducted in 2019. Patients were surveyed using the Patient Satisfaction Questionnaire-18 (PSQ-18). PSQ-18 subscale score was analyzed based on patients' characteristics. The main outcome was the odds of reaching top satisfaction score (TSS) of 4-5 from a Likert scale 1 to 5. Results: Our study recorded 269 participants who consisted of 138 males (51.3%) and 131 females (48.7%) with median age of 52 (18-87) years old. Variables with higher odds of reaching TSS on "patient overall satisfaction" was public health insurance (OR: 7.959 [95% CI: 1.989-31.852], p=0.003) while examination time (OR: 0.955 [95% CI: 0.923-0.988], p=0.008) had lower odds. Examination waiting time (OR: 0.992 [95% CI: 0.985-0.999], p=0.027) and examination time (OR: 0.941 [95% CI: 0.908-0.976], p=0.001) had lower odds of reaching TSS in "general satisfaction". Family monthly income (OR: 1.829 [95% CI: 1.038-3.223], p=0.037) had higher odds of reaching TSS in "technical quality" while examination time (OR: 0.961 [95% CI: 0.931-0.993], p=0.017) and education (OR: 0.549 [95% CI: 0.322-0.934], p=0.027) had lower odds. Comorbidities (OR: 0.533 [95% CI: 0.301-0.944], p=0.031) had lower odds of reaching TSS in "financial aspects". Retina subspecialty clinic (OR: 3.436 [95% CI: 1.154-10.232], p=0.027) had higher odds of reaching TSS in "time spent with doctor". Registrar as attending physician (OR: 0.427 [95% CI: 0.205-0.89], p=0.0230) and examination time (OR: 0.957 [95% CI: 0.924-0.991], p=0.013) had lower odds of reaching TSS in "accessibility-convenience". Conclusion: Examination time and examination waiting time should be shortened, specialist doctors should always see the patients whenever possible, and registrars' technical and communication skill should be improved. Alternative funding for patients without health insurance also should be provided to increase satisfaction.

Health Services Quality Between Hypertension And Diabetes Mellitus Patients In Community Health Services In The Sleman District, Yogyakarta, Indonesia

@#The implementation of the Chronic Disease Management Program or PROLANIS has been adopted in Indonesia by National Social Security Implementation on Health Agency (BPJS-K) since 2015. The program focuses on hypertension (HT) and diabetes mellitus (DM). However, since the first time the program was implemented, there was no comprehensive evaluation of it. The aim of this study was to analyze health service quality among HT and DM patients based on five dimensions of quality in 25 community health services (CHSs) in the Sleman district, Yogyakarta, Indonesia. This is a cross-sectional study with a simple random sampling technique that included 230 respondents from 25 CHSs. The instrument was SERVQUAL that consisted of 35 items of a questionnaire. The data were analyzed by a gap analysis, Customer Satisfaction Index (CSI) and Importance Performance Analysis (IPA); meanwhile, a Man–Whitney test was proposed to determine differences in health services quality in the PROLANIS program. Based on the gap analysis, it was found that whole dimensions were below 0-point; the CSI analysis obtained 74.45 for HT and 75.15 for DM; and the IPA analysis found that the distribution of respondents’ answers in the questionnaire were in quadrants 1 and 2. The Man–Whitney analysis was used to get the assurance aspect correlated with health service quality in DM and HT patients (p = 0.001). Health service quality in the PROLANIS program was based on five dimensions of quality was low, unless assurance dimension. The government should improve health services quality in aspects of tangibility, responsiveness, empathy, and reliability to get satisfaction among HT and DM patients in the PROLANIS program.

The Conceptualization of Mental Health Service Quality Assessment: Consumer Perspective.

This review synthesises theoretical approaches and methodological considerations in mental health service quality assessment from consumers-perspective. We searched published articles from databases: EMBASE, MEDLINE, CIHNAL, Scopus, Web of Science, and PsycINFO. Of the 30 included papers, 16 contained instruments used to mental health quality assessment and 14 focused on theoretical constructs. The review finds that mental health quality assessment is explained and measured using constructs that focus on structure, process and outcome. The methodological issues that need critical consideration are the context and cultural norms of services, outcome perspectives, evaluator, sources of information as well as the selection of consumers and instruments. The review recommends that researchers and clinicians should consider the theoretical constructs and methodological issues in mental health quality assessment.

Immediate antiviral therapy for HIV-infected persons faces with various obstacles.

Human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) ranks eighth in the global burden of disease, making seriously threatens to global health. Given there is not yet a cure for HIV infection, antiretroviral therapy (ART) holds a key role not only in improving the prognosis of the patients, but also reducing the risk of HIV transmission. The immediate initiation of ART has been recommended in domestic and foreign policies and guidelines, yet the implementation of this strategy is not satisfactory. In developing countries and even in some developed countries, it still takes a long time for patients to go from the diagnosis of HIV infection to the acceptance of ART. Clarifying the obstacles to the implementation of immediate ART and finding strategies to cope with them have emerged as key problems in response to HIV/AIDS.

[Patient satisfaction in the Spanish National Health System]. / Satisfacción del paciente en el Sistema Nacional de Salud español.

BACKGROUND: Determine which key indicators of the Spanish National Health Service (NHS) influence patient satisfaction with the Spanish NHS and physicians (family doctors and specialists). METHOD: The mean for each indicator for each autonomous community, published by the Ministry of Health, Social Services and Equality, corresponding to the years 2005 to 2014, was related to patient satisfaction by means of multiple linear regression. RESULTS: Patient satisfaction with the NHS was ascertained at 57.32%, with general practitioners at 54.45% and specialist doctors at 55.11%. In the three types of satisfaction, the number of specialist doctors, hospital admissions and in-hospital mortality had a positive and significant influence, while the number of surgical interventions had a negative influence. The greater use of computerized tomography equipment and the hospital infection rate had a negative effect on satisfaction with the NHS and with specialist physicians, while the percentage of outpatient surgery had a positive effect. The average hospital stay shows a negative relationship with satisfaction with family doctors and specialists. CONCLUSIONS: Health policies should consider an increase in the number of medical specialists, favour ambulatory surgery, facilitate hospital treatment, monitor the effectiveness of surgical interventions, control hospital infections and moderate the prescription of drugs through the use of alternatives in order to increase patient satisfaction.

Innovating New Rural Cooperative Medical Scheme (NCMS) for Better Patient Satisfaction in Rural China.

With the broadening application of the New Rural Cooperative Medical Scheme (NCMS), its role in patient satisfaction in rural China has shifted to be the focus of academic research. Based on a technology acceptance model, this study will investigate the factors and mechanisms influencing patient satisfaction on NCMSS in rural places in China. In this study, based on a technology acceptance model, we developed a model that is associated with the influencing factors, patients' continued participation and patient satisfaction, and conducted an empirical analysis based on data collected from rural areas of China's Anhui Province. A NCMS's reputed reliability, value, and convenience played a key role in positively influencing patient satisfaction. However, long-term patient participation was not significantly influenced by other social factors. In order to increase patient satisfaction, NCMS policy and implementation procedure needs further government modification and innovation with the goal of improving the reimbursement ratio, reducing the financial burden, and improving patient convenience.

Service quality in public health clinics: perceptions of users and health professionals.

Purpose The purpose of this paper is to investigate the expectations and quality gaps in services provided at city public health clinics in the city of Natal, Brazil, from the perspective of patients and healthcare service providers. Design/methodology/approach The research sample consisted of 1,200 patients who used public health services and 265 providers - doctors, nutritionists, physiotherapists, psychologists, pharmacists and managers at three health clinics in the city of Natal, Brazil. A scale with 25 health service attributes was used in data collection. Summary statistics and t-test were used to analyze the data. Findings The results show that the providers think that users have lower levels of expectations than those indicated by the users in all attributes. Providers and users have the most approximate insights into what attributes are considered most important: explanations, level of knowledge and attention dispensed by health professionals. Users and providers perceived similar quality gaps for most of the attributes. The gaps were statistically the same, when comparing the mean quality shortcomings by means of a Student's test, considering a significance level of 5 percent, obtained independently by the manifestation of users and providers. Research limitations/implications The results reveal only a photograph of the moment. The study did not consider the differences that may exist between groups with different income levels, genders or age groups. A qualitative study could improve the understanding of the differences and coincidences of the diverse points of views. A more advanced research could even study possibilities so that health managers could promote changes in the service, some of them low cost, as the health professionals training for contact with patients. Practical implications The evaluation of the service quality complemented by the matrix of opportunities, importance × quality gaps generates information to help make decisions in the rational allocation of available resources and improvement of the quality of the service delivered to patients. Besides, it offers a focus to prioritize specific actions. Originality/value It is important to compare the perceptions of service quality between patients and the healthcare service providers who work in direct contact with them. The managers can smooth out these differences and ensure, over time, customer satisfaction. In this study, providers were asked to express what they think about the expectations of patients and about their own service performance delivered. Thus, not only the traditional gap 5 was measured, but it was also possible to evaluate the distance between what providers think that patients need and their actual needs.

Dispensing doctor practices and community pharmacies: exploring the quality of pharmaceutical services.

AIMS: This research sought (a) to investigate the similarities and differences in how pharmaceutical services are provided by community pharmacies (CPs) and dispensing doctor practices (DPs) and (b) to identify the issues relevant to determining the quality of pharmaceutical services in these settings. BACKGROUND: UK pharmaceutical services, including dispensing prescriptions and public health advice, can be provided from both (CP) and, in rural areas, (DP). While there is much similarity between CPs and DPs in the types of services provided, there is also the potential for variation in service quality across settings. METHODS: A postal questionnaire of DPs and CPs in South West England was conducted to provide a descriptive overview of pharmaceutical services across the settings. A subsection of questionnaire respondent sites were selected to take part in case studies, which involved documentary analyses, observation and staff interviews. FINDINGS: Survey response was 39% for CPs (52/134) and 48% (31/64) for DPs. There were three CP and four DP case study sites, with 17 staff interviews. More pharmacies than practices were open at the weekend and they had more staff trained above NVQ level 2. Both doctors and pharmacists saw themselves as medicines experts, as being accessible and having good relationships with patients. Workplace practices and organisational ethos varied both within and across settings, with good practice observed in both. Overall, CPs and DPs have much in common. Workplace culture and an evidence-based approach to checking prescriptions and error reporting need to be considered in future assessments of service quality.

Interactional aspects of care during hospitalization: perspectives of family caregivers of psychiatrically ill in a tertiary care setting in India.

There are very few studies on user-perspectives about mental health care services that explore perspectives of family caregivers in India. An exploratory study was undertaken to understand the perceived importance of various aspects of interactions with mental health service providers during hospitalization, from the perspectives of family caregivers. In addition, it also aimed at documenting their actual experience of interactional aspects of care during the hospitalization of their relatives. The study was conducted on fifty family caregivers of patients with varied psychiatric diagnoses hospitalized in a tertiary psychiatric care setting in South India. Measures of Interactional aspects of care were developed to assess perceived importance of six different interactional domains of care and the actual experience of care in these domains. Provision of informational inputs and addressing of concerns raised emerged as the domains of care given highest importance. The item pertaining to 'sharing with the caregiver about different alternatives for treatment' received negative ratings in terms of actual experience by maximum number of participants (18%). Significant differences on perceived importance of four domains of interactional aspects of care (dignity, confidentiality and fairness, addressing concerns raised, informational inputs and prompt attention and consistent care) emerged between caregiver subgroups based on educational level of the caregiver, socio-economic status, hospitalization history and broad diagnostic categories. In addition, the care givers of patients with psychoses assigned significantly more positive ratings on actual experience for all the domains of interactional aspects of care. The findings have implications for further research and practice.