Knowledge, Moral Claims and the Exercise of Power in Global Health
Jeremy
Shiffman
Department of Public Administration and Policy, American University, Washington, DC, USA
author
text
article
2014
eng
A number of individuals and organizations have considerable influence over the selection of global health priorities and strategies. For some that influence derives from control over financial resources. For others it comes from expertise and claims to moral authority—what can be termed, respectively, epistemic and normative power. In contrast to financial power, we commonly take for granted that epistemic and normative forms of power are legitimate. I argue that we should not; rather we should investigate the origins of these forms of power, and consider under what circumstances they are justly derived.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
3
v.
6
no.
2014
297
299
https://www.ijhpm.com/article_2918_02fc3b26d8e95a86a87160180c383421.pdf
dx.doi.org/10.15171/ijhpm.2014.120
Nurses Exposure to Workplace Violence in a Large Teaching Hospital in Iran
Ehsan
Teymourzadeh
Department of Health Management and Economics, School of Public
Health, Tehran University of Medical Sciences, Tehran, Iran
author
Arash
Rashidian
Department of Health Management and Economics, School of Public
Health, Tehran University of Medical Sciences, Tehran, Iran
author
Mohammad
Arab
Department of Health Management and Economics, School of Public
Health, Tehran University of Medical Sciences, Tehran, Iran
author
Ali
Akbari-Sari
Department of Health Management and Economics, School of Public Health and Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran,
Iran
author
Seyyed Mostafa
Hakimzadeh
Health Management and Economics Research Center, Iran University of
Medical Sciences, Tehran, Iran
author
text
article
2014
eng
Background Workplace violence is one of the factors which can strongly reduce job satisfaction and the quality of working life of nurses. The aim of this study was to measure nurses’ exposure to workplace violence in one of the major teaching hospitals in Tehran in 2010. Methods We surveyed the nurses in a cross-sectional design in 2010. The questionnaire was adapted from a standardized questionnaire designed collaboratively by the International Labor Office (ILO), the International Health Organization (IHO), the International Council of Nurses (ICN), and the Public Services International (PSI). Finally, in order to analyze the relationships among different variables in the study, T-test and Chi-Square test were used. Results Three hundred and one nurses responded to the questionnaire (a response rate of 73%). Over 70% of the nurses felt worried about workplace violence. The participants reported exposure to verbal abuse (64% CI: 59-70%), bullying-mobbing (29% CI: 24-34%) and physical violence (12% CI: 9-16%) at least once during the previous year. Relatives of hospital patients were responsible for most of the violence. Nurses working in the emergency department and outpatient clinics were more likely to report having experienced violence. Nurses were unlikely to report violence to hospital managers, and 40% of nurses were unaware of any existing policies within the hospital for reducing violence. Conclusion We observed a considerable level of nurse exposure to workplace violence. The high rate of reported workplace violence demonstrates that the existing safeguards that aim to protect the staff from abusive patients and relatives are inadequate.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
3
v.
6
no.
2014
301
305
https://www.ijhpm.com/article_2896_751d61d158dc2d41e59d1a74c1c52c2d.pdf
dx.doi.org/10.15171/ijhpm.2014.98
Economic Inequality in Eye Care Utilization and its Determinants: A Blinder–Oaxaca Decomposition
Mohammad Hassan
Emamian
Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
author
Hojjat
Zeraati
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
author
Reza
Majdzadeh
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
author
Mohammad
Shariati
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
author
Hassan
Hashemi
Noor Ophthalmology Research Center, Noor Eye
Hospital, Tehran, Iran
author
Akbar
Fotouhi
Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
author
text
article
2014
eng
Background The current study aimed to determine eye care utilization, to assess the role of economic inequality in the utilization of eye care services, and to identify its determinants in Shahroud, North of Iran. Methods Of the 6,311 invited people, 5,190 (82.24%) individuals aged 40 to 64 years old participated in the study. A history of a visit by an ophthalmologist or optometrist was considered as eye care utilization. The gap between low- and high-economic groups was decomposed into its determinants using the Oaxaca decomposition method. Results Among the participants, 16.32% [95% Confidence Intervals (CI)= 15.31–17.33%] had never been examined by an ophthalmologist or optometrist, and 30.94% (95% CI= 29.69–32.20%) had not undergone an eye examination in the past 5 years. This negative history was significantly higher among female subjects [Odds Ratio (OR)= 1.79, 95% CI= 1.51–2.14], the low-economic group (OR= 2.33, 95% CI= 1.90–2.87), the visually impaired (OR= 1.41, 95% CI= 1.05–1.90), and the uninsured (OR= 1.93, 95% CI= 1.45–2.58). The negative history of eye examination decreased with increasing in age (OR= 0.94, 95% CI= 0.93–0.96) and education (OR= 0.94, 95% CI= 0.92–0.96). In this study, 24.72% (95% CI= 22.30–27.14) of the low-economic group and 9.94% (95% CI= 8.75–11.14) of the high-economic group had no history of eye examination. Decomposition of the gap between the two economic groups showed that education and gender were the most important determinants of inequality. Conclusion A considerable percentage of adults, even those with visual impairment, do not receive appropriate eye care. There is a definite economic inequality in the community for which poverty per se could be the major cause
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
3
v.
6
no.
2014
307
313
https://www.ijhpm.com/article_2899_a8cdd9a7986985b6d945010b07cacbb0.pdf
dx.doi.org/10.15171/ijhpm.2014.100
An Audit of the Knowledge and Attitudes of Doctors towards Surgical Informed Consent (SIC)
Bushra
Ashraf
Department of Obstetrics and Gynecology, Mother and Child Health Centre,
Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical
University, Islamabad, Pakistan
author
Nasira
Tasnim
Department of Obstetrics and Gynecology, Mother and Child Health Centre,
Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical
University, Islamabad, Pakistan
author
Muhammad
Saaiq
Department of Plastic Surgery and Burns,
Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto Medical
University, Islamabad, Pakistan
author
Khaleeq-
Uz-Zaman
Departments of Neurosurgery and Medical
Education, Pakistan Institute of Medical Sciences, Shaheed Zulfiqar Ali Bhutto
Medical University, Islamabad, Pakistan
author
text
article
2014
eng
Background The Surgical Informed Consent (SIC) is a comprehensive process that establishes an informationbased agreement between the patient and his doctor to undertake a clearly outlined medical or surgical intervention. It is neither a casual formality nor a casually signed piece of paper. The present study was designed to audit the current knowledge and attitudes of doctors towards SIC at a tertiary care teaching hospital in Pakistan. Methods This cross-sectional qualitative investigation was conducted under the auspices of the Department of Medical Education (DME), Pakistan Institute of Medical Sciences (PIMS), Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad over three months period. A 19-item questionnaire was employed for data collection. The participants were selected at random from the list of the surgeons maintained in the hospital and approached face-to-face with the help of a team of junior doctors detailed for questionnaire distribution among them. The target was to cover over 50% of these doctors by convenience sampling. Results Out of 231 respondents, there were 32 seniors while 199 junior doctors, constituting a ratio of 1:6.22. The respondents variably responded to the questions regarding various attributes of the process of SIC. Overall, the junior doctors performed poorer compared to the seniors. Conclusion The knowledge and attitudes of our doctors particularly the junior ones, towards the SIC are less than ideal. This results in their failure to avail this golden opportunity of doctor-patient communication to guide their patients through a solidly informative and legally valid SIC. They are often unaware of the essential preconditions of the SIC; provide incomplete information to their patients; and quite often do not ensure direct involvement of their patients in the process. Additionally they lack an understanding of using interactive computer-based programs as well as the concept of nocebo effect of informed consent
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
3
v.
6
no.
2014
315
321
https://www.ijhpm.com/article_2907_b56b640878d9c39d890954acb8a20b38.pdf
dx.doi.org/10.15171/ijhpm.2014.109
Use of Cost-Effectiveness Data in Priority Setting Decisions: Experiences from the National Guidelines for Heart Diseases in Sweden
Nathalie
Eckard
Division of Health Care Analysis, Department of Medical and Health Sciences,
Linköping University, Linköping, Sweden
author
Magnus
Janzon
Department of Cardiology and Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
author
Lars-Åke
Levin
Division of Health Care Analysis, Department of Medical and Health Sciences,
Linköping University, Linköping, Sweden
author
text
article
2014
eng
Background The inclusion of cost-effectiveness data, as a basis for priority setting rankings, is a distinguishing feature in the formulation of the Swedish national guidelines. Guidelines are generated with the direct intent to influence health policy and support decisions about the efficient allocation of scarce healthcare resources. Certain medical conditions may be given higher priority rankings i.e. given more resources than others, depending on how serious the medical condition is. This study investigated how a decision-making group, the Priority Setting Group (PSG), used cost-effectiveness data in ranking priority setting decisions in the national guidelines for heart diseases. Methods A qualitative case study methodology was used to explore the use of such data in ranking priority setting healthcare decisions. The study addressed availability of cost-effectiveness data, evidence understanding, interpretation difficulties, and the reliance on evidence. We were also interested in the explicit use of data in ranking decisions, especially in situations where economic arguments impacted the reasoning behind the decisions. Results This study showed that cost-effectiveness data was an important and integrated part of the decision-making process. Involvement of a health economist and reliance on the data facilitated the use of cost-effectiveness data. Economic arguments were used both as a fine-tuning instrument and a counterweight for dichotomization. Cost-effectiveness data were used when the overall evidence base was weak and the decision-makers had trouble making decisions due to lack of clinical evidence and in times of uncertainty. Cost-effectiveness data were also used for decisions on the introduction of new expensive medical technologies. Conclusion Cost-effectiveness data matters in decision-making processes and the results of this study could be applicable to other jurisdictions where health economics is implemented in decision-making. This study contributes to knowledge on how cost-effectiveness data is used in actual decision-making, to ensure that the decisions are offered on equal terms and that patients receive medical care according their needs in order achieve maximum benefit.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
3
v.
6
no.
2014
323
332
https://www.ijhpm.com/article_2908_63792d28703d9543bc986e6c22e68419.pdf
dx.doi.org/10.15171/ijhpm.2014.105
International Patients on Operation Vacation – Perspectives of Patients Travelling to Hungary for Orthopaedic Treatments
Eszter
Kovacs
Health Services Management Training Centre, Semmelweis University, Budapest, Hungary
author
Gabor
Szocska
Health Services Management Training Centre, Semmelweis University, Budapest, Hungary
author
Cécile
Knai
Research Unit, Faculty of Public Health and Policy,
London School of Hygiene and Tropical Medicine, London, UK
author
text
article
2014
eng
Background The importance of cross-border healthcare, medical and health tourism plays a significant role in the European health policy and health management. After dentistry, orthopaedic treatments are the leading motivation for seeking care in Hungary, as patients with rheumatic and motion diseases are drawn to the thermal spas and well-established orthopaedic centres. This paper aims to gain insight into foreign patients’ perspectives on their experience of having sought medical tourism in orthopaedic care in Hungary. Methods A patient survey was conducted in 2012 on motivations for seeking treatment abroad, orthopaedic care received and overall satisfaction. In addition, health professionals’ interviews, and 17 phone interviews were conducted in 2013 with Romanian patients who had orthopaedic treatment in Hungary. Finally, medical records of foreign patients were analysed. Results The survey was completed by 115 participants – 61.1% females, mean age= 41.9, 87% Romanian origin. Most of the patients came to Hungary for orthopaedic surgeries, e.g. arthroscopy, knee/hip prosthesis or spinal surgery. 72.6% chose Hungary because of related to perceived better quality and longstanding culture of Hungarian orthopaedic care. Over 57% of patients reported being ‘very satisfied’ with care received and 41.6% ‘satisfied’. The follow-up interviews further reflected this level of satisfaction, therefore many respondents stating they have already recommended the Hungarian healthcare to others. Conclusion Based on the findings, patients from neighbouring regions are increasingly seeking orthopaedic care in Hungary. Patients having orthopaedic care are highly satisfied with the quality of care, the whole treatment process from the availability of information to discharge summaries and would consider returning for further treatments.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
3
v.
6
no.
2014
333
340
https://www.ijhpm.com/article_2912_3f5b6d2ad2b52dfa13d80fa2e59b67e3.pdf
dx.doi.org/10.15171/ijhpm.2014.113
Exploring the Relationship between Accreditation and Patient Satisfaction – The Case of Selected Lebanese Hospitals
Wissam
Haj-Ali
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
author
Lama
Bou Karroum
Department of Health Management and Policy,
Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
author
Nabil
Natafgi
Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA
author
Kassem
Kassak
Department of Health Management and Policy,
Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
author
text
article
2014
eng
Background Patient satisfaction is one of the vital attributes to consider when evaluating the impact of accreditation systems. This study aimed to explore the impact of the national accreditation system in Lebanon on patient satisfaction. Methods An explanatory cross-sectional study of six hospitals in Lebanon. Patient satisfaction was measured using the SERVQUAL tool assessing five dimensions of quality (reliability, assurance, tangibility, empathy, and responsiveness). Independent variables included hospital accreditation scores, size, location (rural/urban), and patient demographics. Results The majority of patients (76.34%) were unsatisfied with the quality of services. There was no statistically significant association between accreditation classification and patient satisfaction. However, the tangibility dimension – reflecting hospital structural aspects such as physical facility and equipment was found to be associated with patient satisfaction. Conclusion This study brings to light the importance of embracing more adequate patient satisfaction measures in the Lebanese hospital accreditation standards. Furthermore, the findings reinforce the importance of weighing the patient perspective in the development and implementation of accreditation systems. As accreditation is not the only driver of patient satisfaction, hospitals are encouraged to adopt complementary means of promoting patient satisfaction.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
3
v.
6
no.
2014
341
346
https://www.ijhpm.com/article_2916_ebddbf22c93793a7a3c781dda474ad3a.pdf
dx.doi.org/10.15171/ijhpm.2014.116
Resource Based View: A Promising New Theory for Healthcare Organizations; Comment on “Resource Based View of the Firm as a Theoretical Lens on the Organisational Consequences of Quality Improvement”
Ewan
Ferlie
Department of Management, King’s College London, London, UK
author
text
article
2014
eng
This commentary reviews a recent piece by Burton and Rycroft-Malone on the use of Resource Based View (RBV) in healthcare organizations. It first outlines the core content of their piece. It then discusses their attempts to extend RBV to the analysis of large scale quality improvement efforts in healthcare. Some critique is elaborated. The broader question of why RBV seems to be migrating into healthcare management research is considered. They conclude RBV is a promising new theory for healthcare organizations.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
3
v.
6
no.
2014
347
348
https://www.ijhpm.com/article_2903_86d6f91948d4f4e26398378c793d4c02.pdf
dx.doi.org/10.15171/ijhpm.2014.107
Radically Questioning the Principle of the Least Restrictive Alternative: A Reply to Nir Eyal; Comment on “Nudging by Shaming, Shaming by Nudging”
Yashar
Saghai
Berman Institute of Bioethics, Johns Hopkins University, Baltimore, MD, USA
author
text
article
2014
eng
In his insightful editorial, Nir Eyal explores the connections between nudging and shaming. One upshot of his argument is that we should question the principle of the least restrictive alternative in public health and health policy. In this commentary, I maintain that Eyal’s argument undermines only a rather implausible version of the principle of the least restrictive alternative and I sketch two reasons for rejecting the mainstream and more plausible version of this principle.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
3
v.
6
no.
2014
349
350
https://www.ijhpm.com/article_2906_816d180a9669d0fd4f5d1e8ca1b26728.pdf
dx.doi.org/10.15171/ijhpm.2014.106
Nudging, Shaming and Stigmatising to Improve Population Health; Comment on “Nudging by Shaming, Shaming by Nudging”
Kristin
Voigt
Institute for Health and Social Policy & Department of Philosophy, McGill University, Montréal, Québec, Canada
author
text
article
2014
eng
Nudges are small, often imperceptible changes to how particular decisions present themselves to individuals that are meant to influence those decisions. In his editorial, ‘Nudging by shaming, shaming by nudging’, Eyal highlights links between nudges and feelings of shame on the part of the ‘chooser’. In this commentary, I suggest two further distinctions between different types of shame-based nudges that should affect our assessment of such nudges.
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
3
v.
6
no.
2014
351
353
https://www.ijhpm.com/article_2915_3702c9a81308138c5d8503d01418cc98.pdf
dx.doi.org/10.15171/ijhpm.2014.114
Public Participation: Methods Matter; A Response to Boaz et al.
Paul
Burton
Urban Research Program, Griffith School of Environment, Griffith University, Gold Coast Campus, Southport, Queensland, Australia
author
Jennifer
Whitty
School of Pharmacy,
Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
author
Elizabeth
Kendall
Griffith Health Institute, Griffith University,
Logan Campus, University Drive, Meadowbrook, Queensland, Australia
author
Julie
Ratcliffe
Flinders Health Economics Group, School of Medicine, Flinders University,
Adelaide, Australia
author
Andrew
Wilson
Menzies Centre for Health Policy, University of Sydney, New South Wales, Australia
author
Peter
Littlejohns
Division of Health and Social Care Research,
Faculty of Life Sciences and Medicine, London, UK
author
Paul
Scuffham
Griffith Health Institute, Griffith University,
Logan Campus, University Drive, Meadowbrook, Queensland, Australia
author
text
article
2014
eng
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
3
v.
6
no.
2014
355
355
https://www.ijhpm.com/article_2904_a6c5c3d976406984793bf0afc1a512db.pdf
dx.doi.org/10.15171/ijhpm.2014.108
Essential Medicines for Children: An Endocrine Perspective
Sanjay
Kalra
Department of Endocrinology, Bharti Hospital and BRIDE, Karnal, India
author
Yashdeep
Gupta
Department of Medicine, Government Medical College, Chandigarh, India
author
text
article
2014
eng
International Journal of Health Policy and Management
Kerman University of Medical Sciences
2322-5939
3
v.
6
no.
2014
357
357
https://www.ijhpm.com/article_2909_73ff5181200fddf46070ee4ce8588f91.pdf
dx.doi.org/10.15171/ijhpm.2014.112