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International Journal of Health Policy and Management
IJHPM
2014
2
4
Patient Mobility in the Global Marketplace: A Multidisciplinary Perspective
Neil
Lunt
Russell
Mannion
There is a growing global market in healthcare and patients. And while there is a small body of evidence emerging around this phenomenon commonly known as medical tourism there remain significant unanswered policy and research questions which need to be addressed. We outline some of the key issues set against the six key disciplinary preoccupations of the journal: epidemiology, health economics, health policy ethics, politics of health, health management, and health policy.
Medical Tourism
Patient Mobility
Cross-Border Care
International Patients
Private Healthcare
2014
05
01
155
157
https://www.ijhpm.com/article_2844_0e19d41d8904ab54295fa0d11545f353.pdf
International Journal of Health Policy and Management
IJHPM
2014
2
4
Exploring the Dimensions of Doctor-Patient Relationship in Clinical Practice in Hospital Settings
Saurabh
Shrivastava
Prateek
Shrivastava
Jegadeesh
Ramasamy
The Doctor-Patient Relationship (DPR) is a complex concept in the medical sociology in which patients voluntarily approach a doctor and thus become a part of a contract in which they tends to abide with the doctor’s guidance. Globally, the DPR has changed drastically over the years owing to the commercialization and privatization of the health sector. Furthermore, the dynamics of the DPR has shown a significant change because of the formulation of consumer protection acts; clauses for professional misconduct and criminal negligence; establishment of patient forums and organizations; massive expansion of the mass media sector leading to increase in health awareness among people; and changes in the status of the doctors. Realizing the importance of DPR in the final outcome and quality of life of the patient, multiple measures have been suggested to make a correct diagnosis and enhance healing. To conclude, good DPR is the crucial determinant for a better clinical outcome and satisfaction with the patients, irrespective of the socio-cultural determinants.
Doctor
Doctor-Patient Relationship (DPR)
Communication
Hospital
2014
05
01
159
160
https://www.ijhpm.com/article_2835_14f19dbe5229b49b695d3641a9e14881.pdf
International Journal of Health Policy and Management
IJHPM
2014
2
4
Limited Knowledge of Chronic Kidney Disease and Its Main Risk Factors among Iranian Community: An Appeal for Promoting National Public Health Education Programs
Peyman
Roomizadeh
Diana
Taheri
Amin
Abedini
Mojgan
Mortazavi
Mehrdad
Larry
Bahareh
Mehdikhani
Seyed-Mojtaba
Mousavi
Farid-Aldin
Hosseini
Aidin
Parnia
Manouchehr
Nakhjavani
Background The aim of this survey was to explore the baseline knowledge of the Iranian community about Chronic Kidney Disease (CKD) definition and its two main risk factors, i.e. diabetes and hypertension. This study also introduced a model of public education program with the purpose of reducing the incidence of CKD in high-risk groups and thereby decreasing the economic burden of CKD in Iran. Methods This cross-sectional study was conducted on world kidney day 2013 in Isfahan, Iran. Self-administered anonymous questionnaires evaluating the knowledge of CKD and its risk factors were distributed among subjects who participated in a kidney disease awareness campaign. Chi-square test and logistic regression analysis were used to examine the differences in the level of knowledge across different socio-demographic groups. Results The questionnaires were completed by 748 respondents. The majority of these respondents believed that “pain in the flanks” and “difficulty in urination” was the early symptoms of CKD. Roughly, 10.4% knew that CKD could be asymptomatic in the initial stages. Only 12.7% knew diabetes and 14.4% knew hypertension was a CKD risk factor. The respondents who had a CKD risk factor (i.e. diabetes and/or hypertension) were significantly more likely than respondents without CKD risk factor to select “unmanaged diabetes” [Odds Ratio (OR)= 2.2, Confidence Interval (CI) (95%): 1.4–3.6] and “unmanaged hypertension” [OR= 1.9, CI(95%): 1.2–3.0] as “very likely to result in CKD”. No more than 34.6% of all respondents with diabetes and/or hypertension reported that their physician has ever spoken with them about their increased risk for developing CKD. Conclusion The knowledge of Iranian population about CKD and its risk factors is low. Future public health education programs should put efforts in educating Iranian community about the asymptomatic nature of CKD in its initial stages and highlighting the importance of regular renal care counseling. The high-risk individuals should receive tailored education and be encouraged to adopt lifestyle modifications to prevent or slow the progression of CKD.
Chronic Kidney Disease (CKD)
Knowledge
Diabetes
Hypertension
Prevention
Iran
2014
05
01
161
166
https://www.ijhpm.com/article_2834_99440f9f3630c500deb75464c049b32e.pdf
International Journal of Health Policy and Management
IJHPM
2014
2
4
Strategic Collaborative Quality Management and Employee Job Satisfaction
Ali Mohammad
Mosadeghrad
Background This study aimed to examine Strategic Collaborative Quality Management (SCQM) impact on employee job satisfaction. Methods The study presents a case study over six years following the implementation of the SCQM programme in a public hospital. A validated questionnaire was used to measure employees’ job satisfaction. The impact of the intervention was measured by comparing the pre-intervention and post-intervention measures in the hospital. Results The hospital reported a significant improvement in some dimensions of job satisfaction like management and supervision, organisational policies, task requirement, and working conditions. Conclusion This paper provides detailed information on how a quality management model implementation affects employees. A well developed, well introduced and institutionalised quality management model can improve employees’ job satisfaction. However, the success of quality management needs top management commitment and stability.
Strategic Collaborative Quality Management
Employee Job Satisfaction
Hospital
2014
05
01
167
174
https://www.ijhpm.com/article_2836_48a7d515be7af72a95b39763952c3a32.pdf
International Journal of Health Policy and Management
IJHPM
2014
2
4
National Health Insurance Scheme: How Protected Are Households in Oyo State, Nigeria from Catastrophic Health Expenditure?
Olayinka
Ilesanmi
Akindele
Adebiyi
Akinola
Fatiregun
Background The major objective of the National Health Insurance Scheme (NHIS) in Nigeria is to protect families from the financial hardship of large medical bills. Catastrophic Health Expenditure (CHE) is rampart in Nigeria despite the take-off of the NHIS. This study aimed to determine if households enrolled in the NHIS were protected from having CHE. Methods The study took place among 714 households in urban communities of Oyo State. CHE was measured using a threshold of 40% of monthly non-food expenditure. Descriptive statistics were done, Principal Component Analysis was used to divide households into wealth quintiles. Chi-square test and binary logistic regression were done. Results The mean age of household respondent was 33.5 years. The median household income was 43,500 naira (290 US dollars) and the range was 7,000–680,000 naira (46.7–4,533 US dollars) in 2012. The overall median household healthcare cost was 890 naira (5.9 US dollars) and the range was 10-17,700 naira (0.1–118 US dollars) in 2012. In all, 67 (9.4%) households were enrolled in NHIS scheme. Healthcare services was utilized by 637 (82.9%) and CHE occurred in 42 (6.6%) households. CHE occurred in 14 (10.9%) of the households in the lowest quintile compared to 3 (2.5%) in the highest wealth quintile (P= 0.004). The odds of CHE among households in lowest wealth quintile is about 5 times. They had Crude OR (CI): 4.7 (1.3–16.8), P= 0.022. Non enrolled households were two times likely to have CHE, though not significant Conclusion Households in the lowest wealth quintiles were at higher risk of CHE. Universal coverage of health insurance in Nigeria should be fast-tracked to give the expected financial risk protection and decreased incidence of CHE.
National Health Insurance Scheme (NHIS)
Catastrophic Health Expenditure (CHE)
Households
Wealth Quintiles
Cost
Healthcare Utilization
2014
05
01
175
180
https://www.ijhpm.com/article_2837_a1c2a72b48a82940a19afb06e2e8f6f6.pdf
International Journal of Health Policy and Management
IJHPM
2014
2
4
Does Tuberculosis Have a Seasonal Pattern among Migrant Population Entering Iran?
Mahmood
Moosazadeh
Narges
Khanjani
Abbas
Bahrampour
Mahshid
Nasehi
Background There are few quantitative documents about the seasonal incidence of tuberculosis (TB) among immigrant populations. Concerning the significant role of recognizing seasonal changes of TB in improving the TB control program, this study determines the trend and seasonal temporal changes of TB among immigrants entering Iran. Methods In this longitudinal study, data from the Iranian TB register Program (from 2005 to 2011) was used. The aggregated number of monthly and seasonal TB cases was obtained by adding the daily counts. Data was analyzed by Chi-square, Independent T-test, ANOVA, and Poisson regression using Stata 11 and SPSS 20 software. Results Among 74,155 registered patients with TB, 14.3% (10,587) were non-Iranian who had immigrated to Iran from 29 different countries. The highest aggregated number of seasonal and monthly incidence of TB in immigrants was observed in spring (2824, P= 0.007) and in May (1037, P< 0.001). The number of non-Iranian patients with TB increased significantly over the years (β= 0.016, P= 0.001). Conclusion This study shows that immigrants constitute a significant portion of TB patients recorded in Iran and this trend is increasing. Also, the peak incidence of this disease is the second month of the spring.
Tuberculosis (TB)
Seasonality
Iran
Migrant
2014
05
01
181
185
https://www.ijhpm.com/article_2840_78407f40ceb377be090637c5fbf160b4.pdf
International Journal of Health Policy and Management
IJHPM
2014
2
4
The Financial Cost of Preventive and Curative Programs for Breast Cancer: A Case Study of Women in Shiraz-Iran
Nahid
Hatam
Vahid
Keshtkar
Asiyeh
Salehi
Hamidreza
Rafei
Background This cross-sectional study was conducted to compare the average costs of breast cancer screening and treatment among women with the age of 25 and over in Shiraz-Iran. Methods Three majors hospitals affiliated with Shiraz University of Medical Sciences (SUMS) were selected for data collection. Financial documents and interviews with the hospitals’ financial officers were used for data collection. Results Finding shows that the total cost of screening would be 5,847,544.96 US dollars for age groups of 25–34 and 35 and above, demonstrating the huge expense of screening programs. On the other hand, the average cost of breast cancer treatment for each patient would be 3608.47, 996.89, and 311.47 US dollars for mastectomy, radiotherapy, and chemotherapy, respectively. In addition, the total average cost for treatment of 2217 patients would be 1,466,988.9 US dollars, which is much less than screening programs expenses. Conclusion It is concluded that although screening can be effective for improving quality of life and treatment effectiveness, considering the high costs of screening, it is not economical in Iran. Screening methods within suitable intervals, and also considering patients’ medical history have been recommended by the present study.
Breast Cancer
Screening
Treatment
Cost-Effectiveness
2014
05
01
187
191
https://www.ijhpm.com/article_2841_a5c9c4771dc4c2899b897d33c42efafe.pdf
International Journal of Health Policy and Management
IJHPM
2014
2
4
Improving Immunization Rates of Underserved Children: A Historical Study of 10 Health Departments
Donald
Haley
Background Despite high immunization rates, hundreds of thousands of poor and underserved children continue to lack their necessary immunizations and are at risk of acquiring a vaccine-preventable disease. Local Health Departments (LHDs) and public health clinicians figure prominently in efforts to address this problem. Methods This exploratory research compared ten (10) North Carolina LHDs with respect to immunization delivery factors. The study sample was identified based on urban designation as well as county demographic and socio-economic indicators that identified predicted “pockets” of underimmunization. Survey instruments were used to identify specific LHD immunization delivery factors. Results It was found that hours of operation, appointment policies, use and type of tracking systems, and wait times influence a health department’s ability to immunize underserved children. This exploratory research is of particular importance, because it suggests that the implementation of specific policy interventions may reduce the morbidity and mortality related to vaccine-preventable diseases in poor and underserved children. This research also highlights the significance of the nurses’ role in the policy making process in this important area of community health assurance. Conclusion To improve childhood immunization rates, policy-makers should encourage adequate and appropriate funding for LHDs to adopt service delivery factors that are associated with higher-performing local health departments. LHDs should study the population they serve to further refine service delivery factors to meet the population’s needs.
Health Status
Immunizations
Public Health Department
Children
Uninsured
2014
05
01
193
197
https://www.ijhpm.com/article_2843_8f768301e5c0dcc9d9b29d70cb2660ed.pdf
International Journal of Health Policy and Management
IJHPM
2014
2
4
Toward More Compassionate Healthcare Systems; Comment on “Enabling Compassionate Healthcare: Perils, Prospects and Perspectives”
Beth
Lown
Compassion is central to the purpose of medicine and the care of patients and their families. Compassionate healthcare begins with compassionate people, but cannot be consistently provided without systemic changes that enable clinicians and staff to collaborate and to care. We propose seven essential commitments to foster more compassionate healthcare organizations and systems: a commitment to compassionate leadership, to teach compassion, to value and reward compassionate care, to support clinical caregivers, to involve and partner with patients and families, to build compassion into the organization of healthcare delivery, and a commitment to deepen our understanding of compassion and its impact through research. Acting on these commitments will help us attend with care to the ill, injured, and vulnerable in every interaction.
Compassion
Healthcare Quality
Professional-Patient Relations
2014
05
01
199
200
https://www.ijhpm.com/article_2838_eb9385eac7b3fbf76eb6065928088d1d.pdf
International Journal of Health Policy and Management
IJHPM
2014
2
4
Sharpening the Health Policy Analytical Rapier; Comment on “The Politics and Analytics of Health Policy”
Martin
Powell
This commentary on the Editorial ‘The politics and analytics of health policy’ by Professor Calum Paton focuses on two issues. First, it points to the unclear links between ideas, ideology, values, and discourse and policy, and warns that discourse is often a poor guide to enacted policy. Second, it suggests that realism, particularly ‘programme theory’ are useful tools for health policy analysis. ‘Market reform’ cannot be reduced to a simple ‘four legs good, two legs bad’ verdict, and programme theory might suggest that certain mechanisms may be good for one outcome in a particular context, but bad for another.
Health Policy
British National Health Service (NHS)
Discourse
Realism
2014
05
01
201
202
https://www.ijhpm.com/article_2839_d6fed134fc1b5ea872ae7e7a2d3a6dab.pdf
International Journal of Health Policy and Management
IJHPM
2014
2
4
Ingredients for Good Health Policy-Making: Incorporating Power and Politics into the Mix
Yusra
Shawar
Health Policy
Power
Politics
Policy Analysis
Policy Theory
2014
05
01
203
204
https://www.ijhpm.com/article_2842_47994110c904ba24c33d58ac43012ad5.pdf