Health promotion programs in prison: attendance and role in promoting physical activity and subjective health status.

Introduction: Maintaining an inmate's health can serve as a challenge due to unhealthy background, risky behavior, and long imprisonment. This study aimed to analyze the prevalence of participation in health promotion activities among Israeli inmates and its association with their physical activity levels and subjective health status. Methods: A cross-sectional study was designed to examine 522 inmates (429 males, 93 females). The data were collected by trained face-to-face interviewers and self-report questionnaires. Results: Most of the participants (82.37%) did not meet the recommended physical activity level. Half of the participants reported that their physical activity levels decreased since they were in prison compared with 29.50% who reported that their physical activity levels increased. Physical activity and subjective health status were significantly higher among younger male inmates. Furthermore, participation in health-promoting activities was associated with higher levels of physical activity and subjective health status. Discussion: Health promotion activities may play an important role in addressing the challenges of maintaining inmate health. Implications of the findings are further discussed.

Assessment of Nutritional Status and Health Perception among Male Inmates in Israeli Prisons.

The nutritional and health perceptions of inmates are crucial to their overall well-being. However, limited research has been conducted on this topic. This study aimed to assess the nutritional and health perception state of male inmates in eleven prisons in Israel. A cross-sectional study was conducted between February and September 2019 with 176 voluntary participants. Structured questionnaires were used to collect data on socio-demographic characteristics, healthy habits, subjective health status, and prison situation variables. The study found that the prevalence of overweight (40%) and obesity (18.1%) among 18-34-year-old inmates was significantly higher than in the reference Israeli population. Short detention periods (up to one year) predicted less weight gain, while older age predicted poorer health status. Better emotional status significantly predicted better subjective health status among male inmates. There is a need for nutrition interventions to improve the health of inmates. The significant weight gain during incarceration and the associated lower health index and stress highlights the importance of increasing knowledge and promoting a healthier lifestyle in incarceration as early as possible and continuing over time.

[THE ADMINISTRATIVE TEAMS CONTRIBUTION TO PATIENT SAFETY IN AN ISRAELI PRIVATE HOSPITAL NETWORK].

AIMS: Assessing the attitudes and perception of risk management among medical secretaries and their effect on patients' safety in actual patient care, in a semi-private medical network and in a public hospital, to evaluate changes in these attitudes over time. BACKGROUND: A hospital is a complex, complicated and a high-risk environment in which, along with other procedures, administrative processes, which are usually performed by the medical secretarial staff, may also have an impact on clinical activities and are prone to errors as well as other hospital activities. METHODS: A retrospective cohort study was conducted. The survey was based on questionnaires completed once a year (during the period 2015-2018) by medical secretaries from seven different medical centers. Over these three years, different instructional and guidance interventions dealing with patients' safety were performed. Changes in attitudes and perceptions towards risk management and patients' safety were collected by comparison of answers at the beginning (2015) and the end (2018) of the study period. A group of medical secretaries of a new public hospital served as a control group. They completed the initial questionnaire and were not exposed to any instructional interventions. Follow-up time was 33 months. RESULTS: A total of 225 participants were recruited at the beginning of the study and 277 were in the study group at the end and 40 were in the control group. A significant and positive correlation was found between the perception and attitude towards patients' safety of the medical secretaries in the study group. Safety perception of the research group was significantly higher in comparison to the control group. CONCLUSIONS: Instructional interventions do have an impact and increase the level of safety perception of the medical secretaries regarding patients' safety. DISCUSSION: Ongoing safety interventions have led to an increased level of safety perception among medical secretaries. The results demonstrated the importance and benefit of the interventions in raising the safety level of hospital care.

Patient preferences and choices as a reflection of trust-A cluster analysis comparing postsurgical perceptions in a private and a public hospital.

BACKGROUND: Active participation of patients in managing their medical treatment is a major component of the patient empowerment process and may contribute to better clinical outcomes. Patient perceptions and preferences affect the patient-physician encounter in a variety of dimensions, such as patient autonomy, freedom of choice and trust in the healthcare system. The Israeli healthcare system is mostly publicly funded, with additional private healthcare services for surgery and other medical treatments. The aim of this study was to compare the perceptions and preferences of patients in the public and private hospitals in Israel. METHODS: A cross-sectional study among 545 individuals who had surgical procedures at two hospitals in Israel (one public and one private). A structured questionnaire comprising 23 items was used to collect perceptions via personal telephone interviews. The responses were categorized into five clusters and compared by type of health services provider (public vs. private) and sociodemographic characteristics (gender, age and education level). RESULTS: A hierarchical cluster analysis methodology identified five conceptual groups: trust, concern towards medical errors, dialogue between medical staff and the patient/patient's family, confidentiality and staff bias towards more informed patients, or those with supportive families. Four main themes that highlight patients' preferences were found: physical conditions, personal empowerment and perceived autonomy, patient experience and patient-provider encounter communication. Significant differences between the private and the public healthcare systems were found in four clusters: trust and patient care, patient's concerns, the extent of explanation and medical staff's commitment. Differences secondary to sociodemographic parameters were noticed: patients treated at the private hospital scored significantly higher items of trust, medical staff caring and the importance of choosing their treating surgeon, while patients treated at the public hospital scored higher staff commitment to the patient than those treated at the private hospital. CONCLUSIONS: The study revealed the perceptions underlying the decisions of patients to undergo surgical procedures in public or private hospitals. Mutual learning could pave the way to better patient-physician encounters. PATIENT OR PUBLIC CONTRIBUTION: Patients from the two hospitals were involved in this study by responding to the questionnaire. The data presented is based on the patient's responses.

Environmental, Social, and Governance Implementation in Healthcare Organizations: A Case Study of Assuta Medical Centers.

BACKGROUND: Environmental, social, and governance (ESG) is a form of international private business self-regulation that aims to contribute to society from a philanthropic, activist, or charitable nature by engaging in or supporting volunteering or ethically oriented practices. The major benefit of ESG is having the organization's workers recruited for the goal of making the world a better place. There is a growing understanding regarding the extent of the environmental impacts of health services. Therefore, the interest in measuring and reporting the sustainability of health system performance is becoming crucial. As population aging and growth in healthcare demand are two of the main challenges of the current and mainly future health services, performance, and quality measurement as well as sustainability metrices are relevant more than ever. OBJECTIVES: To review the ESG activities at Assuta Medical Centers (AMC) that helped the organization earn the Maala Index Platinum + grade in 2021. METHODS: We reviewed the ESG elements that were implemented at AMC. RESULTS: AMC entered an ESG process in November 2019 and earned Platinum and Platinum+ grades from the Maala Index in 2020 and 2021, respectively. AMC won the Workforce Diversity prize for having many employees over 60 years of age. AMC activities are detailed as a case study for other health organizations in Israel and worldwide. CONCLUSIONS: A big leading health organization can spearhead sustainable development goals model in Israel and worldwide.

Less Is More (Healthy): Overuse of Healthcare Services.

BACKGROUND: Overuse of healthcare services is a common phenomenon defined as: "a healthcare service that is provided under circumstances in which its potential for harm exceeds the possible benefit." It is expressed in the gap between desired services and available ones and is accompanied by high financial and human life costs. One-fifth to one-third of patients receives unnecessary, ineffective, or potentially harmful treatments or services. One of the greatest challenges to understanding overuse is the lack of definition for appropriate use. Apart from the physical and mental damage caused by overuse or improper use of medical services, this phenomenon has many implications, such as increasing waiting times for services, creating long queues, and incurring considerable financial costs as over 10% of hospital expenses are used to correct medical errors or preventable infections. Government intervention through economic arrangements such as deductibles and pre-authorization of services by the insurer are partially effective in reducing the overuse of health services. Additional solutions include ensuring safety and quality of care as well as shared decision-making.

[COMPARISON OF QUALITY MEASUREMENT PROGRAMS IN HOSPITALS IN ISRAEL AND ENGLAND].

INTRODUCTION: Quality measurement programs exist in Israel and around the world and their role is, among other things, to monitor and proceed according to quality indicators in order to improve the quality of medical care. In Israel and England, there are programs for measuring quality in hospitals. OBJECTIVES: The purpose of this work is to compare the program for measuring quality in hospitals in Israel with the corresponding program in England in terms of the process of determining indicators, methods of collecting data and ways of reporting and publishing the data. This article reviews the similarities and differences between quality measurement programs in hospitals operating in the two countries and examines the performance rates of similar indicators in the two countries. METHODS: A comprehensive literature review was conducted to learn about the quality measurement programs in hospitals in both countries, and then designated websites for programs from which more information about the programs was derived. RESULTS: We found that in Israel there is an inclusive body, a quality department in the Ministry of Health, which is responsible for the process of determining the indicators in consultation with officials in the Medical Association, while in England there is also a body responsible for the program, the National Health Service (NHS), but it cooperates with other bodies who share some responsibilities. It was also found that in both countries the programs include indicators on common topics such as: acute myocardial infarction, cerebrovascular accident, fractures in the femoral neck and more and in each subject there are identical indices and different indicators. Beyond that there are also different measured issues in the two programs. We also found that in quality measurement programs in hospitals in Israel and England there are 4 identical indicators in all of which the results of hospitals in Israel are better than the results of hospitals in England, even though in England there is a reward for the indicators and in Israel there isn't such a reward. The reason for this is probably because the program in Israel sets targets for the indicators, while England does not. CONCLUSIONS: The two countries can learn from each other in order to improve the quality of health services that are provided.

Changes in the activity levels and financing sources of Israel's private for-profit hospitals in the wake of reforms to the public-private divide.

BACKGROUND: The Israeli National Health Insurance Law provides permanent residents with a basket of healthcare services through non-profit public health insurance plans, independently of the individual's ability to pay. Since 2015, several reforms and programs have been initiated that were aimed at reinforcing public healthcare and redressing negative aspects of the health system, and specifically the constant rise in private health expenditure. These include the "From Reimbursement-to-Networks Arrangement", the "Cooling-off Period" program and the program to shorten waiting times. The objectives of this study were to identify, describe, and analyze changes in private hospitals in 1) the volume of publicly and privately funded elective surgical procedures; and 2) private health expenditure on surgical procedures. METHODS: Data on the volume and funding of surgical procedures during 2013-2018 were obtained from Assuta Medical Center, Hertzelia Medical Center, the Israeli Ministry of Health and the Central Bureau of Statistics. The changes in the volume and financing sources of surgical activities in private hospitals, in the wake of the reforms were analyzed using aggregate descriptive statistics. RESULTS: Between 2013 and 2018 the volume of surgical activities in private for-profit hospitals increased by 7%. Between 2013 and 2017, the distribution of financing sources of surgical procedures in private hospitals remained stable, with most surgical procedures (75-77%) financed by the voluntary health insurance programs of the health plans (HP-VHI). In 2018, following the regulatory reforms, a significant change in the distribution of financing sources was observed: there was a sharp decline in the volume of HP-VHI-funded surgical procedures to 26%. Concurrently, the share of publicly-funded surgical procedures performed in private hospitals increased to 56% in 2018.,. During the study period, private spending on elective surgical procedures in private hospitals declined by 53% while public funding for them increased by 51%. CONCLUSIONS AND POLICY IMPLICATIONS: In the wake of the reforms, there was a substantial shift from private to public financing of elective surgical activity in private hospitals. Private for-profit hospitals have become important providers of publicly-funded procedures. It is likely that the reforms affected the public-private mix in the financing of elective surgical procedures in those hospitals, but due to the absence of a control group, causality cannot be proven. It is also unclear whether waiting times were shortened. Health reforms must be accompanied by a clear and comprehensive set of indicators for measuring their success.

Analyzing Operating Room Utilization in a Private Medical Center in Israel.

BACKGROUND: Surgery is a core activity in hospitals. Operating rooms have some of the most important and vital functions in medical centers. The operating rooms and their staff are a valuable infrastructure resource and their availability and preparedness affect human life and quality of care. OBJECTIVES: To prepare operational suggestions for improving operating room utilization by mapping current working processes in the operating rooms of a large private medical center. METHODS: Data on 23,585 surgeries performed at our medical center between August 2016 and March 2017 were analyzed by various parameters including utilization, capacity, working hours, and surgery delays. RESULTS: Average operating room utilization was 79%, while 21% was considered lost operating room time. The two major factors that influenced the lost operating room time were the time intervals between planned usage blocks and the partial utilization of operating room time. We calculated that each percent of utilized operating room time translates into 440 surgeries annually, resulting in a potential annual increase in income. CONCLUSIONS: Increasing operating room utilization would result in an improvement of operating room availability and an increased number of procedures. Our analysis shows that operating room utilization in the private healthcare system is efficient compared to the public healthcare system in Israel. Therefore the private healthcare system should be treated as a contributing factor to help lower surgery waiting times and release bottlenecks, rather than being perceived as contributing to inequality.

Outcome of bariatric surgery in older patients.

BACKGROUND: People are living longer than they were expected to 2 decades ago. Increased life expectancy and reduced mortality encompasses a simultaneous increase in the number of older adults with obesity that entails an increase of co-morbidities, such as diabetes, hypertension, cancer, and many other diseases. The aim of our study was to compare the outcomes of bariatric surgery in patients age ≥65 in comparison with younger patients. METHODS: This retrospective study compares bariatric surgeries performed in a private institution between the years 2013 and 2015. The study included 9044 patients divided into an older group (451 patients) and the younger group (8593 patients). RESULTS: In the younger group, bariatric surgery is distributed as follows: 77.68% sleeve gastrectomy, 12.72% gastric banding, 9.27% gastric bypass, and .33% duodenal switch or biliopancreatic diversion; in the older group: 70.51% sleeve gastrectomy, 15.08% gastric bypass, 13.97% gastric band, and .44% biliopancreatic diversion. In the control group 550 cases (6.4%) underwent revisional surgery; 64 cases (14.10%) underwent revision in the older group. Older patients lost less excess weight than younger patients (72.44% versus 86.11%, respectively). Older patients presented higher rates of complications (8.42% versus 5.59%), co-morbidities (77.60% versus 55.45%), and revisions (1.33% versus .77%). There was no statistical difference in hospital stay between older group and control group (2.27 versus 2.23, respectively). When performing a Clavien-Dindo classification, we demonstrated significant differences in class 3B and 4A and no differences in other classes. Two deaths occurred in the control group. Diabetes, fatty liver, and sleep apnea have been improved or remitted in >90% of patients in both groups, hypertension and hyperlipidemia by >80%, and hyperuricemia and ischemic heart disease were improved or resolved in >70% of the patients CONCLUSIONS: Bariatric surgery in the elderly has more complications, but it can still be considered safe.

The epidemiology and economic burden of hip fractures in Israel.

BACKGROUND: Hip fractures increase the risks of mortality and major morbidity in the elderly. Hip fractures are associated with chronic pain, reduced mobility, disability and increasing dependence. We evaluated the direct costs incurred to the Israeli healthcare system in 2013 as a result of hip fracture injuries in elderly patients. METHODS: Hip fractures costs evaluation consisted of first-year and long-term direct costs. Data on the incidence of hip fractures resulting in hospitalizations were retrieved from the Israeli Ministry of Health's (MOH) Central Database of Hospital Admissions. Hospitalization, rehabilitation and nursing utilization rates and costs were estimated based on the professional literature and according to the MOH's price list. RESULTS: During 2013, 6285 elderly patients were hospitalized in Israel due to hip fractures. Direct costs of hip fracture, comprising hospitalization, rehabilitation and nursing costs incurred during the first year after the injury, were estimated at 454 million New Israeli Shekels (NIS; 83,841 NIS per person). Long-term nursing care costs in 2013 were 265 million NIS, with an average cost of approximately 49,000 NIS for 1600 elderly persons receiving long-term nursing care as a result of a hip fracture. Overall, the total direct costs of hip fracture in the elderly population in Israel in 2013 were 719 million NIS. CONCLUSIONS: The direct costs of hip fractures in Israel among the elderly are approximately 719 million NIS per year. The majority of costs are associated with the first year following the injury. To reduce healthcare costs in Israel, changes in the country's healthcare policy on hip fractures are required. For example, there is a need for a program for detecting high- risk populations, and for early intervention following the injury.

Driving violations and health promotion behaviors among undergraduate students: Self-report of on-road behavior.

INTRODUCTION: The purposes of this study are to characterize Israeli undergraduate students' driving violations in the terms of problem behavior theory and to identify whether there is any relationship between driving violations and health risk behaviors, daring behaviors, excitement seeking, and health promotion behaviors. METHODS: This study is based on a structured self-reported anonymous questionnaire distributed to undergraduate students in an academic institution. The sample included 533 undergraduate students (374 females and 159 males). The mean age was 23.4 (SD = 1.4, range = 5). RESULTS: A higher prevalence of self-reported driving violations was found among males in comparison to females. All substance use measures were positively related to driving violations; for example, use of cigarettes (OR = 4.287, P <.001) and water pipes (odds ratio [OR] = 3.000, P <.001) as well as binge drinking (OR = 5.707, P <.001) and regular cannabis smoking (OR = 5.667, P <.001) raise the probability of committing rare driving violations. The strongest predictive factors for the frequent driving violations group were alcohol consumption-related variables: binge drinking (OR = 2.560, P <.01) and drunkenness (OR = 2.284, P <.05). Strong odd ratios were also found between the frequent driving violations group and selling or dealing drugs (12.143, P <.001), and stealing something valuable (13.680, P <.001). The strongest predicted variable for the rare driving violations group was physical confrontation due to verbal disagreement (3.439, P <.05) and the concept that selling or dealing drugs is socially acceptable (2.521, P <.05). The probability of executing rare driving violations was higher for subjects who reported intense physical workout regimens (OR = 1.638, P <.05). CONCLUSIONS: Problem behavior theory succeeded in explaining health risk behavior and driving violations. This study shows that bachelors tend to be more involved in risk behaviors, such as substance use, excitement-seeking behaviors, and daring behaviors and are active physically and thus constitute a risk group for driving violations. As such, intervention resources should be directed toward this group.

Managing health and finance: challenges, outcome, and control in the Israel Defense Forces.

BACKGROUND: The Ministry of Defense budget constitutes 16% of the state budget. The budget for the Ministry of Health and for civilian health care is derived from the state budget. The health care funds receive their budgets from several sources. The capitation formula, which is determined by law, is the main factor that affects the size of the budget each fund receives. OBJECTIVE: The objective of this study is to describe the manner of planning, managing, monitoring, and controlling the budget allocated to medical services, which is a public budget for soldiers. METHODS: Several parameters are suggested for comparison, including the interface with the civilian health system, the method for budgeting a health care system, possible results of managing a medically centered budget, and the possibilities for monitoring the provided services. We also examine the potential for decentralization of authority. CONCLUSIONS: Managing the budget and locating appropriate alternatives, as well as the availability and accessibility of medical services, are important for procurement and for forming contracts with both military and civilian systems. Turnover based on updated information might serve to improve future health services.

Development of a capitation scale for IDF career soldiers in Israel.

The Israeli National Health Insurance Law allocates a national healthcare budget to the sickness funds, which provide medical care to civilian population. Medical care for members of the IDF is financed through the budget of the Ministry of Defense and is not included in the national healthcare budget. Benefits provided to soldiers serving in the permanent forces are far more extensive than those provided to civilians. Because of no co-payments, poor management, and the cost-based budget, military healthcare costs in Israel are expected to exceed civilian healthcare costs, adjusting for age and sex. The present paper derives age- and sex-based capitation rates for military personnel, and compares military and civilian age-based expenditure and capitation rates. The study population comprised career soldiers and civilians aged 21-54 years. Expenses of career soldiers were calculated to provide information on the financial costs of medical services for each age group in 2003. Overall expenses for women were higher than for men in all age groups. As anticipated, the older the group, the higher the total expenditure for both men and women. In-patient care represented a higher percentage of the total costs for men (28.3%) than for women (22.1%). Emergency room care was higher for women in the 22-24 age group but comparable to that of men in higher age groups. Specialist visits represented a significantly higher percentage of the total costs for women than for men in the 22-24 and 25-34 age groups (by 6% and 15%, respectively). The difference decreased to 13% in the 35-44 age groups and, in the 45-54 age group, the difference for men was 14% higher than for women. Military costs were similar to civilian costs in the 22-24 age groups, higher in the following two groups, and lower in the 45-54 age group. Like in other organizations, military healthcare services might benefit from outsourcing. The inequality in medical services to soldiers and civilians, the over-use of the military healthcare system, and the decrease of standards and budgetary resources will compel the establishment of more creative means of providing these services through contracts and agreements, perhaps through the civilian sickness funds.