Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394220150201Fee-for-Service Payment – An Evil Practice that Must be Stamped Out?5759295210.15171/ijhpm.2015.26ENNaokiIkegamiDepartment of Health Policy and Management, School of Medicine, Keio University, Tokyo, JapanJournal Article20150113Co-opting physicians to regulate Fee-for-Service (FFS) payment is more feasible and simpler to administer than capitation, Diagnosis-Related Groups (DRGs) and pay-for-performance. The key lies in designing and revising the fee schedule, which not only defines and sets the fee for each item, but also the conditions of billing. Adherence to these regulations must be strictly audited in order to control volume and costs, and to assure quality. The fee schedule requires periodic revisions on an item-by-item basis in order to maintain balance among the providers, to list new drugs, devices and equipment, and to reflect the lower market prices of existing ones. Implementing the fee schedule will facilitate the control of balance billing and extra billing, and the introduction of more sophisticated methods of payment in the future.https://www.ijhpm.com/article_2952_e9183f0e980779c3f2be03a59dd9b11f.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394220150201Quaternary Prevention, an Answer of Family Doctors to Overmedicalization6164295010.15171/ijhpm.2015.24ENMarcJamoulleEspace Temps, Maison de Santé, Charleroi, Belgium, and Department of General Practice, University of Liege, Liège, BelgiumJournal Article20141130In response to the questioning of Health Policy and Management (HPAM) by colleagues on the role of rank and file family physicians in the same journal, the author, a family physician in Belgium, is trying to highlight the complexity and depth of the work of his colleagues and their contribution to the understanding of the organization and economy of healthcare. It addresses, in particular, the management of health elements throughout the ongoing relationship of the family doctor with his/her patients. It shows how the three dimensions of prevention, clearly included in the daily work, are complemented with the fourth dimension, quaternary prevention or prevention of medicine itself, whose understanding could help to control the economic and human costs of healthcare.https://www.ijhpm.com/article_2950_ea20f1b4fc4d613ac38b9a7a1bf85ea5.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394220150201Factors Associated with Pediatrician Attitudes over the Use of Complementary and Traditional Medicine on Children in Muscat, Oman6568293910.15171/ijhpm.2015.11ENMuna AhmedAl SaadoonDepartment of Child Health, College of Medicine and Health Sciences, Sultan
Qaboos University, Muscat, OmanMohammed SuweilemAl JafariMinistry of Health, Muscat, OmanBader DarwishAl DhouyaniMinistry of Health, Muscat, OmanSyedRizviFamily
Medicine and Public Health, College of Medicine and Health Sciences, Sultan
Qaboos University, Muscat, OmanJournal Article20140923This study aimed to evaluate the attitude of pediatricians toward the use of complementary and Traditional Medicine (TM) on children in Muscat, Oman. A cross-sectional survey was performed using a self-completed questionnaire during the year 2012. A total of 67 pediatricians, comprising of 30 males (44.8%) and 37 females (55.2%) participated in the study. The majority of the studied group (83.5%) was of the opinion that most types of complementary and TM are not safe for children, except spiritual healing, to which 53.7% considered as safe. About one third (29.9%) of the participants reported that they might recommend complementary and TM for sick children in the future. Almost half the participants (52.2%) acknowledged personal use of complementary and TM in the past and 67.2% reported that their family members used these medicines. Herbal therapy was found to be the most commonly used method (38.9%) followed by spiritual (33.9%), cautery (20.2%) and Curucoma (15.7%). Other methods, which include; acupuncture, bone healing and Chinese healing were also found to be in use but in rare manner. Knowledge level of TM and complementary medicine of most of the doctors was found to be low but one third of them acknowledged that they may recommend these treatments to their patients in future. Therefore, training pediatricians on the types, benefits and side effects of complementary and TM is recommended.https://www.ijhpm.com/article_2939_9cafec55e5f5b0ac515801a07582bc8b.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394220141030Hospitals’ Readiness to Implement Clinical Governance6974291010.15171/ijhpm.2014.111ENFarbodEbadi FardazarHospital Management Research Center, Iran University of Medical Sciences,
Tehran, IranHosseinSafariDepartment of Health Management and Economics, Health
School, Tehran University of Medical Sciences, Tehran, IranFarhadHabibiDepartment of Health Management and Economics, Health
School, Tehran University of Medical Sciences, Tehran, IranFeyzollahAkbari HaghighiDepartment of Health Management and Economics, Health
School, Tehran University of Medical Sciences, Tehran, IranAzizRezapourDepartment of
Health Economics, School of Health Management and Information Science,
Iran University of Medical Sciences, Tehran, IranHealth Management and
Economics Research Center, Iran University of Medical Sciences, Tehran, IranJournal Article20140425Background <br />Quality of health services is one of the most important factors for delivery of these services. Regarding the importance and vital role of quality in the health sector, a concept known as “Clinical Governance” (CG) has been introduced into the health area which aims to enhance quality of health services. Thus, this study aimed to assess private and public hospitals’ readiness to implement CG in Iran. <br /> <br />Methods <br />This descriptive and cross-sectional study was carried out in 2012. Four hundred thirty participants including doctors, nurses, diagnostic departments personnel, and support staff were chosen randomly from four hospitals (equally divided into private and public hospitals). Clinical Governance Climate Questionnaire (CGCQ) was used for data collection. Finally, data were entered into the SPSS 18 and were analyzed using statistical methods. <br /> <br />Results <br />Among the CG dimensions, “organizational learning” and “planned and integrated quality improvement program” scored the highest and the lowest respectively for both types of hospitals. Hospitals demonstrated the worst condition with regard to the latter dimension. Furthermore, both types of hospitals had positive picture regarding “training and development opportunities”. Private hospitals scored better than public ones in all dimensions but there was only a significant difference in “proactive risk management” dimension between both types of hospitals (P< 0.05). <br /> <br />Conclusion <br />Hospitals’ readiness for CG implementation was “average or weak”. In order to implement CG successfully, it is essential to have a quality-centered culture, a culture specified by less paperwork, more selfsufficiency, and flexibility in hospitals’ affairs as well as centring on shared vision and goals with an emphasis on continuous improvement and innovation.https://www.ijhpm.com/article_2910_1c0fb0df283d02a3f89f4e0af843a706.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394220150201Understanding Perception and Factors Influencing Private Voluntary Health Insurance Policy Subscription in the Lucknow Region7583293610.15171/ijhpm.2015.08ENTanujMathurDepartment of Humanities and Social Sciences, National Institute of Technology, Silchar, Assam, India0000-0001-8235-3173Ujjwal KantiPaulDepartment of Humanities and Social Sciences, National Institute of Technology, Silchar, Assam, IndiaHimanshu NarayanPrasadDepartment of Humanities and Social Sciences, National Institute of Technology, Silchar, Assam, IndiaSubodh ChandraDasDepartment of Humanities and Social Sciences, National Institute of Technology, Silchar, Assam, IndiaJournal Article20140624Background <br />Health insurance has been acknowledged by researchers as a valuable tool in health financing. In spite of its significance, a subscription paralysis has been observed in India for this product. People who can afford health insurance are also found to be either ignorant or aversive towards it. This study is designed to investigate into the socio-economic factors, individuals’ health insurance product perception and individuals’ personality traits for unbundling the paradox which inhibits people from subscribing to health insurance plans. <br /> <br />Methods <br />This survey was conducted in the region of Lucknow. An online questionnaire was sent to sampled respondents. Response evinced by 263 respondents was formed as a part of study for the further data analysis. For assessing the relationships between variables T-test and F-test were applied as a part of quantitative measuring tool. Finally, logistic regression technique was used to estimate the factors that influence respondents’ decision to purchase health insurance. <br /> <br />Results <br />Age, dependent family members, medical expenditure, health status and individual’s product perception were found to be significantly associated with health insurance subscription in the region. Personality traits have also showed a positive relationship with respondent’s insurance status. <br /> <br />Conclusion <br />We found in our study that socio-economic factors, individuals’ product perception and personality traits induces health insurance policy subscription in the region.https://www.ijhpm.com/article_2936_11f702188c1da8d400dc7ab961a7fcf0.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394220150201Employee Engagement within the NHS: A Cross-Sectional Study8590294010.15171/ijhpm.2015.12ENYadava BapuraoJeveUniversity Hospitals of Leicester, Leicester, UKChristnaOppenhemierUniversity Hospitals of Leicester, Leicester, UKJustinKonjeUniversity Hospitals of Leicester, Leicester, UKJournal Article20140920Background <br />Employee engagement is the emotional commitment of the employee towards the organisation. We aimed to analyse baseline work engagement using Utrecht Work Engagement Scale (UWES) at a teaching hospital. <br /> <br />Methods <br />We have conducted a cross-sectional study within the National Health Service (NHS) Teaching Hospital in the UK. All participants were working age population from both genders directly employed by the hospital. UWES has three constituting dimensions of work engagement as vigor, dedication, and absorption. We conducted the study using UWES-9 tool. Outcome measures were mean score for each dimension of work engagement (vigor, dedication, absorption) and total score compared with control score from test manual. <br /> <br />Results <br />We found that the score for vigor and dedication is significantly lower than comparison group (P< 0.0001 for both). The score for absorption was significantly higher than comparison group (P< 0.0001). However, total score is not significantly different. <br /> <br />Conclusion <br />The study shows that work engagement level is below average within the NHS employees. Vigor and dedication are significantly lower, these are characterised by energy, mental resilience, the willingness to invest one’s effort, and persistence as well as a sense of significance, enthusiasm, inspiration, pride, and challenge. The NHS employees are immersed in work. Urgent need to explore strategies to improve work engagement as it is vital for improving productivity, safety and patient experience.https://www.ijhpm.com/article_2940_a993c02c925736a05cdeb3a19dda011a.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394220150201“Hearing from All Sides” How Legislative Testimony Influences State Level Policy-Makers in the United States9198294110.15171/ijhpm.2015.13ENSarahMoreland-RussellCenter for Public Health Systems Science, Brown School, Washington
University, St. Louis, MO, USAColleenBarberoCenter for Public Health Systems Science, Brown School, Washington
University, St. Louis, MO, USAStephanieAndersenCenter for Public Health Systems Science, Brown School, Washington
University, St. Louis, MO, USANoraGearyPrevention Research Center, Brown School, Washington University, St. Louis, MO, USAElizabeth A.DodsonPrevention Research Center, Brown School, Washington University, St. Louis, MO, USARossBrownsonPrevention Research Center, Brown School, Washington University, St. Louis, MO, USADivision of Public Health Sciences
and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University, St. Louis, MO, USAJournal Article20140822Background <br />This paper investigates whether state legislators find testimony influential, to what extent testimony influences policy-makers’ decisions, and defines the features of testimony important in affecting policy-makers’ decisions. <br /> <br />Methods <br />We used a mixed method approach to analyze responses from 862 state-level legislators in the United States (U.S.). Data were collected via a phone survey from January-October, 2012. Qualitative data were analyzed using a general inductive approach and codes were designed to capture the most prevalent themes. Descriptive statistics and cross tabulations were also completed on thematic and demographic data to identify additional themes. <br /> <br />Results: Most legislators, regardless of political party and other common demographics, find testimony influential, albeit with various definitions of influence. While legislators reported that testimony influenced their awareness or encouraged them to take action like conducting additional research, only 6% reported that testimony changes their vote. Among those legislators who found testimony influential, characteristics of the presenter (e.g., credibility, knowledge of the subject) were the most important aspects of testimony. Legislators also noted several characteristics of testimony content as important, including use of credible, unbiased information and data. <br /> <br />Conclusion <br />Findings from this study can be used by health advocates, researchers, and individuals to fine tune the delivery of materials and messages to influence policy-makers during legislative testimony. Increasing the likelihood that information from scholars will be used by policy-makers may lead to the adoption of more health policies that are informed by scientific and practice-based evidence.https://www.ijhpm.com/article_2941_5c372898132edf73c4f2d46ca265ba16.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394220150201Emergency Referral Transport for Maternal Complication: Lessons from the Community Based Maternal Death Audits in Unnao District, Uttar Pradesh, India99106294210.15171/ijhpm.2015.14ENSunil SaksenaRajHIV/AIDS Partnership for Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) Project, Public Health Foundation of India, New Delhi, IndiaSuneedhManthriHIV/AIDS Partnership for Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) Project, Public Health Foundation of India, New Delhi, IndiaPratap KumarSahooHealth Promotion Division, Public Health Foundation
of India, New Delhi, IndiaJournal Article20140826Background <br />An effective emergency referral transport system is the link between the home of the pregnant woman and a health facility providing basic or comprehensive emergency obstetric care. This study attempts to explore the role of emergency transport associated with maternal deaths in Unnao district, Uttar Pradesh (UP). <br /> <br />Methods <br />A descriptive study was carried out to assess the causes of and factors leading to maternal deaths in Unnao district, UP, through community based Maternal Death Review (MDR) using verbal autopsy, in a sample of 57 maternal deaths conducted between June 1, 2009, and May 31, 2010. A facility review was also conducted in 15 of the 16 block level and district health facilities to collect information on preparedness of the facilities for treating obstetric complications including referral transportation. A descriptive analysis was carried out using ratios and percentages to analyze the availability of basic facilities which may lead to maternal deaths. <br /> <br />Results <br />It was found that there were only 10 ambulances available at 15 facilities against 19 required as per Indian Public Health Standards (IPHS). About 47% of the deaths took place in a facility, 30% enroute to a health facility and 23% at home. Twenty five percent of women were taken to one facility, 32% were taken to two facilities, and 25% were taken to three facilities while 19% were not taken to any facility before their death. Sixteen percent of the pregnant women could not arrange transportation to reach any facility. The mean time to make arrangements for travel from home to facility-1 and facility-2 to facility-3 was 3.1 hours; whereas from facility-1 to facility-2 was 9.9 hours. The mean travel time from home to facility-1 was 1 hour, from facility-1 to facility-2 was 1.4 hours and facility-2 to facility-3 was 1.6 hours. <br /> <br />Conclusion <br />The public health facility review and MDR, clearly indicates that the inter-facility transfers appropriateness and timeliness of referral are major contributing factor for maternal deaths in Unnao district, UP. The UP Government, besides strengthening Emergency Obstetric and Newborn Care (EmONC) and Basic Emergency Obstetric and Newborn Care (BEmONC) services in the district and state as a whole, also needs to focus on developing a functional and effective referral system on a priority basis to reduce the maternal deaths in Unnao district.https://www.ijhpm.com/article_2942_a78e5e4d554ecd5e14039693f936215b.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394220150201An American Plague: Pro-Market Believers in Health Policy; Comment on “On Health Policy and Management (HPAM): Mind the Theory-Policypractice Gap”107109294310.15171/ijhpm.2015.15ENJeanDe KervasdouéConservatoire National des Arts et Métiers, Paris, FranceJournal Article20150108Although American health policy debates address similar problems to other developed nations, it has factual and ideological specificities. I agree with Chinitz and Rodwin on the dominance of micro-economics thinking. However, I am not certain that learning from management theory or modifying medical education will be powerful enough to change the system. The vested interests of the stakeholders are too powerful, the more so when they are supported by economists who ideologically reinforce them and by neglecting the fact that the basic premises of market ideology are false when applied to medical care. There is enough empirical evidence to support that but, apparently, these facts do not dent these beliefs.https://www.ijhpm.com/article_2943_2399aed6d2edeaa111606828f0a91521.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394220150201Knowledge, Politics and Power in Global Health; Comment on “Knowledge, Moral Claims and the Exercise of Power in Global Health”111113294710.15171/ijhpm.2015.20ENGarrett WallaceBrownDepartment of Politics, University of Sheffield, Sheffield, UKJournal Article20150125This article agrees with recent arguments suggesting that normative and epistemic power is rife within global health policy and provides further examples of such. However, in doing so, it is argued that it is equally important to recognize that global health is, and always will be, deeply political and that some form of power is not only necessary for the system to advance, but also to try and control the ways in which power within that system operates. In this regard, a better focus on health politics can both expose illegitimate sources of power, but also provide better recommendations to facilitate deliberations that can, although imperfectly, help legitimate sources of influence and power.https://www.ijhpm.com/article_2947_7409808661ba75d65da7947791b42858.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394220150201Powerful Concepts in Global Health; Comment on “Knowledge, Moral Claims and the Exercise of Power in Global Health”115117294810.15171/ijhpm.2015.19ENEivindEngebretsenFaculty of Medicine, University of Oslo, Oslo, Norway0000-0001-9455-110XKristinHeggenFaculty of Medicine, University of Oslo, Oslo, NorwayJournal Article20150114In this paper we emphasize the importance of questioning the global validity of significant concepts underpinning global health policy. This implies questioning the concept of global health as such and accepting that there is no global definition of the global. Further, we draw attention to ‘quality’ and ‘empowerment’ as examples of world-forming concepts. These concepts are exemplary for the gentle and quiet forms of power that underpin our reasoning within global health.https://www.ijhpm.com/article_2948_7bcbc20c798d30ed1c28c05642b469c5.pdfKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59394220150201Knowledge and Networks – Key Sources of Power in Global Health; Comment on “Knowledge, Moral Claims and the Exercise of Power in Global Health”119121295110.15171/ijhpm.2015.25ENJohannaHanefeldLondon School of Hygiene and Tropical Medicine, London, UKGillWaltLondon School of Hygiene and Tropical Medicine, London, UKJournal Article20150119Shiffman rightly raises questions about who exercises power in global health, suggesting power is a complex concept, and the way it is exercised is often opaque. Power that is not based on financial strength but on knowledge or experience, is difficult to estimate, and yet it may provide the legitimacy to make moral claims on what is, or ought to be, on global health agendas. Twenty years ago power was exercised in a much less complex health environment. The World Health Organization (WHO) was able to exert its authority as world health leader. The landscape today is very different. Financial resources for global health are being competed for by diverse organisations, and power is diffused and somewhat hidden in such a climate, where each organization has to establish and make its own moral claims loudly and publicly. We observe two ways which allow actors to capture moral authority in global health. One, through power based on scientific knowledge and two, through procedures in the policy process, most commonly associated with the notion of broad consultation and participation. We discuss these drawing on one particular framework provided by Bourdieu, who analyses the source of actor power by focusing on different sorts of capital. Different approaches or theories to understanding power will go some way to answering the challenge Shiffman throws to health policy analysts. We need to explore much more fully where power lies in global health, and how it is exercised in order to understand underlying health agendas and claims to legitimacy made by global health actors today.https://www.ijhpm.com/article_2951_e98be8311138f65f0fa24ac862d206b7.pdf