Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
5
3
2016
03
01
Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians
149
153
EN
Nir
Eyal
Department of Global Health and Population, Harvard TH Chan School of
Public Health, Boston, MA, USA
nir.eyal@rutgers.edu
Corrado
Cancedda
Division of Global Health Equity, Brigham
and Women’s Hospital, and Department of Global Health and Social Medicine,
Harvard Medical School, Boston, MA, USA
ccancedd@gmail.com
Patrick
Kyamanywa
School of Medicine, University of
Rwanda, Butare, Rwanda
pkyamanywa0@gmail.com
Samia
A.
Hurst
0000-0002-1980-5226
Institute for Ethics, History, and the Humanities,
Faculty of Medicine, Geneva University, Geneva, Switzerland
samia.hurst@unige.ch
10.15171/ijhpm.2015.215
Responding to critical shortages of physicians, most sub-Saharan countries have scaled up training of nonphysician clinicians (NPCs), resulting in a gradual but decisive shift to NPCs as the cornerstone of healthcare delivery. This development should unfold in parallel with strategic rethinking about the role of physicians and with innovations in physician education and in-service training. In important ways, a growing number of NPCs only renders physicians more necessary – for example, as specialized healthcare providers and as leaders, managers, mentors, and public health administrators. Physicians in sub-Saharan Africa ought to be trained in all of these capacities. This evolution in the role of physicians may also help address known challenges to the successful integration of NPCs in the health system.
Physician Assistants,Professional Delegation,Human Resources for Health,Rural Health Services,Developing Countries,Emigration and Immigration,Delivery of Healthcare,Medical Education,Ethics
https://www.ijhpm.com/article_3144.html
https://www.ijhpm.com/article_3144_91afcfc7085316debee7e4a082213e43.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
5
3
2016
03
01
Preferred Primary Healthcare Provider Choice Among Insured Persons in Ashanti Region, Ghana
155
163
EN
Micheal
Kofi
Boachie
Department of Economics, Annamalai University, Annamalai Nagar, TN, India
mkboachie@gmail.com
10.15171/ijhpm.2015.191
Background <br />In early 2012, National Health Insurance Scheme (NHIS) members in Ashanti Region were allowed to choose their own primary healthcare providers. This paper investigates the factors that enrolees in the Ashanti Region considered in choosing preferred primary healthcare providers (PPPs) and direction of association of such factors with the choice of PPP. <br /> <br />Methods <br />Using a cross-sectional study design, the study sampled 600 NHIS enrolees in Kumasi Metro area and Kwabre East district. The sampling methods were a combination of simple random and systematic sampling techniques at different stages. Descriptive statistics were used to analyse demographic information and the criteria for selecting PPP. Multinomial logistic regression technique was used to ascertain the direction of association of the factors and the choice of PPP using mission PPPs as the base outcome. <br /> <br />Results <br />Out of the 600 questionnaires administered, 496 were retained for further analysis. The results show that availability of essential drugs (53.63%) and doctors (39.92%), distance or proximity (49.60%), provider reputation (39.52%), waiting time (39.92), additional charges (37.10%), and recommendations (48.79%) were the main criteria adopted by enrolees in selecting PPPs. In the regression, income (-0.0027), availability of doctors (-1.82), additional charges (-2.14) and reputation (-2.09) were statistically significant at 1% in influencing the choice of government PPPs. On the part of private PPPs, availability of drugs (2.59), waiting time (1.45), residence (-2.62), gender (-2.89), and reputation (-2.69) were statistically significant at 1% level. Presence of additional charges (-1.29) was statistically significant at 5% level. <br /> <br />Conclusion <br />Enrolees select their PPPs based on such factors as availability of doctors and essential drugs, reputation, waiting time, income, and their residence. Based on these findings, there is the need for healthcare providers to improve on their quality levels by ensuring constant availability of essential drugs, doctors, and shorter waiting time. However, individual enrolees may value each criterion differently. Thus, not all enrolees may be motivated by same concerns. This requires providers to be circumspect regarding the factors that may attract enrolees. The National Health Insurance Authority (NHIA) should also ensure timely release of funds to help providers procure the necessary medical supplies to ensure quality service.
Ghana,Insurance,Healthcare Provider,Patient Choice,Multinomial Logit
https://www.ijhpm.com/article_3119.html
https://www.ijhpm.com/article_3119_5dc4bfcc579c8194b4ab47231ff3449d.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
5
3
2016
03
01
Improving Fraud and Abuse Detection in General Physician Claims: A Data Mining Study
165
172
EN
Hossein
Joudaki
Health Economics Group, Social Security Organization, Tehran, Iran
hjoodaki@alumnus.tums.ac.ir
Arash
Rashidian
0000-0002-4005-5183
Department of Health Management and Economics, School of Public
Health, Tehran University of Medical Sciences, Tehran, Iran
arash.rashidian@gmail.com
Behrouz
Minaei-Bidgoli
School of Computer Engineering, Iran University of Science and Technology, Tehran, Iran
bminaei@gmail.com
Mahmood
Mahmoodi
Department of Epidemiology and Biostatistics, School of Public Health,
Tehran University of Medical Sciences, Tehran, Iran
mahmoodim@tums.ac.ir
Bijan
Geraili
Department of Education Management, School of Psychology and Education, University of Tehran, Tehran, Iran
geraili.bijan@gmail.com
Mahdi
Nasiri
School of Computer Engineering, Iran University of Science and Technology, Tehran, Iran
mn.nasiri@gmail.com
Mohammad
Arab
0000-0002-5637-287X
Department of Health Management and Economics, School of Public
Health, Tehran University of Medical Sciences, Tehran, Iran
arabmoha@tums.ac.ir
10.15171/ijhpm.2015.196
Background <br />We aimed to identify the indicators of healthcare fraud and abuse in general physicians’ drug prescription claims, and to identify a subset of general physicians that were more likely to have committed fraud and abuse. <br /> <br />Methods <br />We applied data mining approach to a major health insurance organization dataset of private sector general physicians’ prescription claims. It involved 5 steps: clarifying the nature of the problem and objectives, data preparation, indicator identification and selection, cluster analysis to identify suspect physicians, and discriminant analysis to assess the validity of the clustering approach. <br /> <br />Results <br />Thirteen indicators were developed in total. Over half of the general physicians (54%) were ‘suspects’ of conducting abusive behavior. The results also identified 2% of physicians as suspects of fraud. Discriminant analysis suggested that the indicators demonstrated adequate performance in the detection of physicians who were suspect of perpetrating fraud (98%) and abuse (85%) in a new sample of data. <br /> <br />Conclusion <br />Our data mining approach will help health insurance organizations in low-and middle-income countries (LMICs) in streamlining auditing approaches towards the suspect groups rather than routine auditing of all physicians.
Healthcare,Fraud,Abuse,Insurance,Data Mining,General Physician
https://www.ijhpm.com/article_3127.html
https://www.ijhpm.com/article_3127_3e4792d84fde50fbb5afb2c8e6a207b2.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
5
3
2016
03
01
Decentralisation of Health Services in Fiji: A Decision Space Analysis
173
181
EN
Jalal
Mohammed
0000-0002-7665-7266
Health Systems Section, School of Population Health, The University of Auckland, Auckland, New Zealand
mohammed.jalal@gmail.com
Nicola
North
Health Systems Section, School of Population Health, The University of Auckland, Auckland, New Zealand
n.north@auckland.ac.nz
Toni
Ashton
Health Systems Section, School of Population Health, The University of Auckland, Auckland, New Zealand
toni.ashton@auckland.ac.nz
10.15171/ijhpm.2015.199
Background <br />Decentralisation aims to bring services closer to the community and has been advocated in the health sector to improve quality, access and equity, and to empower local agencies, increase innovation and efficiency and bring healthcare and decision-making as close as possible to where people live and work. Fiji has attempted two approaches to decentralisation. The current approach reflects a model of deconcentration of outpatient services from the tertiary level hospital to the peripheral health centres in the Suva subdivision. <br /> <br />Methods <br />Using a modified decision space approach developed by Bossert, this study measures decision space created in five broad categories (finance, service organisation, human resources, access rules, and governance rules) within the decentralised services. <br /> <br />Results <br />Fiji’s centrally managed historical-based allocation of financial resources and management of human resources resulted in no decision space for decentralised agents. Narrow decision space was created in the service organisation category where, with limited decision space created over access rules, Fiji has seen greater usage of its decentralised health centres. There remains limited decision space in governance. <br /> <br />Conclusion <br />The current wave of decentralisation reveals that, whilst the workload has shifted from the tertiary hospital to the peripheral health centres, it has been accompanied by limited transfer of administrative authority, suggesting that Fiji’s deconcentration reflects the transfer of workload only with decision-making in the five functional areas remaining largely centralised. As such, the benefits of decentralisation for users and providers are likely to be limited.
Decentralisation,Health Reform,Decision Space,Access to Healthcare,Principal Agent Approach,Fiji
https://www.ijhpm.com/article_3128.html
https://www.ijhpm.com/article_3128_82c870d9bed8431e780e78766ce3e3bb.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
5
3
2016
03
01
Health Insecurity and Social Protection: Pathways, Gaps, and Their Implications on Health Outcomes and Poverty
183
187
EN
Elvis
Gama
Centre for Applied Health Research & Delivery (CAHRD), Liverpool School of Tropical Medicine, Liverpool, UK
empakati@yahoo.com
10.15171/ijhpm.2015.203
Health insecurity has emerged as a major concern among health policy-makers particularly in low- and middle-income countries (LMICs). It includes the inability to secure adequate healthcare today and the risk of being unable to do so in the future as well as impoverishing healthcare expenditure. The increasing health insecurity among 150 million of the world’s poor has moved social protection in health (SPH) to the top of the agenda among health policy-makers globally. This paper aims to provide a debate on the potential of social protection contribution to addressing health insecurity, poverty, and vulnerability brought by healthcare expenditure in low-income countries, to explore the gaps in current and proposed social protection measures in healthcare and provide suggestions on how social protection intervention aimed at addressing health insecurity, poverty, and vulnerability may be effectively implemented.
Health Insecurity,Social Protection for Healthcare,Poverty,Vulnerability
https://www.ijhpm.com/article_3132.html
https://www.ijhpm.com/article_3132_b1336a37c8babbb48adf1d90bc3981f9.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
5
3
2016
03
01
Whistleblowing: Don’t Encourage It, Prevent It; Comment on “Cultures of Silence And Cultures of Voice: The Role Of Whistleblowing in Healthcare Organisations”
189
191
EN
D. Robert
MacDougall
Department of Social Sciences, New York City College of Technology (CUNY), New York City, NY, USA
dmacdougall@citytech.cuny.edu
10.15171/ijhpm.2015.190
In a recent article, Mannion and Davies argue that there are a multitude of ways in which organizations (such as the National Health Service [NHS]) can deal with wrongdoing or ethical problems, including the formation of policies that encourage and protect would-be whistleblowers. However, it is important to distinguish internal reporting about wrongdoing from whistleblowing proper, because the two are morally quite different and should not be dealt with in the same way. This article argues that we should not understand the authors’ conclusions to apply to “whistleblowing” proper, because their recommended approach would be both unfeasible and undesirable for addressing whistleblowing defined in this way.
Whistleblowing,Moral Dilemma,Organizational Policy,Public Policy,Ethics
https://www.ijhpm.com/article_3116.html
https://www.ijhpm.com/article_3116_7f94ef89eb911e1f0f2551cdac47c74c.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
5
3
2016
03
01
Policies and Processes for Social Inclusion: Using EquiFrame and EquIPP for Policy Dialogue; Comment on “Are Sexual and Reproductive Health Policies Designed for All? Vulnerable Groups in Policy Documents of Four European Countries and Their Involvement in Policy Development”
193
196
EN
Malcolm
MacLachlan
Centre for Global Health, Trinity College Dublin, Dublin 2, Ireland
malcolm.maclachlan@tcd.ie
Hasheem
Mannan
0000-0001-6209-2586
Centre for Global Health, Trinity College Dublin, Dublin 2, Ireland
hasheem.mannan@ucd.ie
Tessy
Huss
Centre for Global Health, Trinity College Dublin, Dublin 2, Ireland
husst@tcd.ie
Alister
Munthali
0000-0002-3495-3446
Centre for Social Research, Chancellor College, Zomba, Malawi
amunthali@cc.ac.mw
Mutamad
Amin
Ahfad University for Women, Omdurman, Sudan
mutamedamin@gmail.com
10.15171/ijhpm.2015.200
The application of EquiFrame in the analysis of sexual and reproductive health policies by Ivanova et al to a new thematic area, their selection of only some of the Core Concepts of human rights in health service provision and the addition of new vulnerable groups relevant to the purpose of their analysis, are all very welcome developments. We also applaud their application of EquiFrame to policies in countries where it has not previously been used, along with their use of interviews with policy-makers to produce a deeper understanding of policy processes. We argue that clear justification for the inclusion of additional, or replacement of some exiting vulnerable groups within EquiFrame should be accompanied by clear definitions of such groups, along with the evidence-base that justifies their classification as a vulnerable or marginalised group. To illustrate the versatility of EquiFrame, we summarise a range of ways in which it has been used across a number of regions; including a brief Case Study of its use to develop the National Health Policy of Malawi. While EquiFrame focuses on policy content, we preview a new policy analysis tool – Equity and Inclusion in Policy Processes (EquIPP) – which assesses the extent of equity and inclusion in broader policy processes. Together, EquiFrame and EquIPP can be used to help governments and civil society ensure that policies are addressing the much stronger emphasis on social inclusion, now apparent in the Sustainable Development Goals (SDGs).
Policy Analysis,EquiFrame,Equity and Inclusion in Policy Processes (EquIPP),Human Rights
https://www.ijhpm.com/article_3129.html
https://www.ijhpm.com/article_3129_604cbeddae195a4e1621825d0d65ffd0.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
5
3
2016
03
01
The Ghost Is the Machine: How Can We Visibilize the Unseen Norms and Power of Global Health?; Comment on “Navigating Between Stealth Advocacy and Unconscious Dogmatism: The Challenge of Researching the Norms, Politics and Power of Global Health”
197
199
EN
Lisa
Forman
Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
lisa.forman@utoronto.ca
10.15171/ijhpm.2015.206
In his recent commentary, Gorik Ooms argues that “denying that researchers, like all humans, have personal opinions … drives researchers’ personal opinion underground, turning global health science into unconscious dogmatism or stealth advocacy, avoiding the crucial debate about the politics and underlying normative premises of global health.” These ‘unconscious’ dimensions of global health are as Ooms and others suggest, rooted in its unacknowledged normative, political and power aspects. But why would these aspects be either unconscious or unacknowledged? In this commentary, I argue that the ‘unconscious’ and ‘unacknowledged’ nature of the norms, politics and power that drive global health is a direct byproduct of the processes through which power operates, and a primary mechanism by which power sustains and reinforces itself. To identify what is unconscious and unacknowledged requires more than broadening the disciplinary base of global health research to those social sciences with deep traditions of thought in the domains of power, politics and norms, albeit that doing so is a fundamental first step. I argue that it also requires individual and institutional commitments to adopt reflexive, humble and above all else, equitable practices within global health research.
Global Health,Norms,Power,Interdisciplinarity,Reflexivity,Equity
https://www.ijhpm.com/article_3136.html
https://www.ijhpm.com/article_3136_a264834a99451ce75501b91a36e42f28.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
5
3
2016
03
01
Politics or Technocracy – What Next for Global Health?; Comment on “Navigating Between Stealth Advocacy and Unconscious Dogmatism: The Challenge of Researching the Norms, Politics and Power of Global Health”
201
204
EN
Ilona
Kickbusch
Global Health Programme, Graduate Institute of International and Development Studies, Geneva, Switzerland
ilona.kickbusch@graduateinstitute.ch
10.15171/ijhpm.2015.209
Politics play a central part in determining health and development outcomes as Gorik Ooms highlights in his recent commentary. As health becomes more global and more politicized the need grows to better understand the inherently political processes at all levels of governance, such as ideological positions, ideas, value judgments, and power. I agree that global health research should strengthen its contribution to generating such knowledge by drawing more on political science, such research is gaining ground. Even more important is – as Ooms indicates – that global health scholars better understand their own role in the political process. It is time to acknowledge that expert-based technocratic approaches are no less political. We will need to reflect and analyse the role of experts in global health governance to a greater extent and in that context explore the links between politics, expertise and democracy.
Global Health,Political Science,Politics,Power,Governance,Interdisciplinarity
https://www.ijhpm.com/article_3139.html
https://www.ijhpm.com/article_3139_6a833f0078d63643aba7d316be676a17.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
5
3
2016
03
01
How Can a Global Social Support System Hope to Achieve Fairer Competiveness?; Comment on “A Global Social Support System: What the International Community Could Learn From the United States’ National Basketball Association”
205
206
EN
Peter
Goldblatt
UCL Institute of Health Equity, UCL Department of Epidemiology and Public Health, University College London, London, UK
p.goldblatt@ucl.ac.uk
10.15171/ijhpm.2015.211
Ooms et al sets out some good general principles for a global social support system to improve fairer global competitiveness as a result of redistribution. This commentary sets out to summarize some of the conditions that would need to be satisfied for it to level up gradients in inequality through such a social support system, using the National Basketball Association (NBA) example as a point of reference. From this, the minimal conditions are described that would be required for the support system, proposed in the article by Ooms et al, to succeed.
Gradient,Inequality,Proportionate Universalism,Governance,Capacity Building
https://www.ijhpm.com/article_3142.html
https://www.ijhpm.com/article_3142_e8831fb2b928529c462327472d4264ab.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
5
3
2016
03
01
Global Health Warning: Definitions Wield Power; Comment on “Navigating Between Stealth Advocacy and Unconscious Dogmatism: The Challenge of Researching the Norms, Politics and Power of Global Health”
207
209
EN
Robert
Marten
https://orcid.org/00
Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
robert.marten@lshtm.ac.uk
10.15171/ijhpm.2015.213
Gorik Ooms recently made a strong case for considering the centrality of normative premises to analyzing and understanding the underappreciated importance of the nexus of politics, power and process in global health. This critical commentary raises serious questions for the practice and study of global health and global health governance. First and foremost, this commentary underlines the importance of the question of what is global health, and why as well as how does this definition matter? This refocuses discussion on the importance of definitions and how they wield power. It also re-affirms the necessity of a deeper analysis and understanding of power and how it affects and shapes the practice of global health.
Global Health,Power,Policy
https://www.ijhpm.com/article_3143.html
https://www.ijhpm.com/article_3143_d3f9a4b2b8c046efc805aa60bfc77f7f.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
5
3
2016
03
01
Future Challenges and Opportunities in Online Prescription Drug Promotion Research; Comment on “Trouble Spots in Online Direct-to-Consumer Prescription Drug Promotion: A Content Analysis of FDA Warning Letters”
211
213
EN
Brian
G.
Southwell
Center for Communication Science, RTI International, Research Triangle Park, NC, USA
bsouthwell@rti.org
Douglas
J.
Rupert
Center for Communication Science, RTI International, Research Triangle Park, NC, USA
drupert@rti.org
10.15171/ijhpm.2016.05
Despite increased availability of online promotional tools for prescription drug marketers, evidence on online prescription drug promotion is far from settled or conclusive. We highlight ways in which online prescription drug promotion is similar to conventional broadcast and print advertising and ways in which it differs. We also highlight five key areas for future research: branded drug website influence on consumer knowledge and behavior, interactive features on branded drug websites, mobile viewing of branded websites and mobile advertisements, online promotion and non-US audiences, and social media and medication decisions.
Direct-to-Consumer (DTC) Advertising,Prescription Drug,Social Media,Health Communication
https://www.ijhpm.com/article_3148.html
https://www.ijhpm.com/article_3148_a15379b02e461e001087c32a31e42b81.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
5
3
2016
03
01
Single Versus Multi-Faceted Implementation Strategies – Is There a Simple Answer to a Complex Question? A Response to Recent Commentaries and a Call to Action for Implementation Practitioners and Researchers
215
217
EN
Gill
Harvey
0000-0003-0937-7819
School of Nursing, University of Adelaide, Adelaide, SA, Australia
gillian.harvey@flinders.edu.au
Alison
Kitson
0000-0003-3053-8381
School of Nursing, University of Adelaide, Adelaide, SA, Australia
alison.kitson@flinders.edu.au
10.15171/ijhpm.2015.214
Knowledge Translation,Implementation,Evidence-Based Healthcare,Complex Interventions
https://www.ijhpm.com/article_3141.html
https://www.ijhpm.com/article_3141_5679ae481b695ad4e2ae1d4e11ada19e.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
5
3
2016
03
01
The Pill Really Can Be Mightier Than the Sword: A Response to Recent Commentaries
219
220
EN
Malcolm
Potts
The OASIS Initiative, Bixby Center for Population, Health and Sustainability, School of Public Health, University of California, Berkeley, CA, USA
potts@berkeley.edu
Alisha
Graves
The OASIS Initiative, Bixby Center for Population, Health and Sustainability, School of Public Health, University of California, Berkeley, CA, USA
agraves.oasis@gmail.com
10.15171/ijhpm.2016.02
Family Planning,Girls’ Education,Terrorism,Population
https://www.ijhpm.com/article_3146.html
https://www.ijhpm.com/article_3146_5cb838eee0bb28fa2f0185ff362fc0b3.pdf