Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
9
4
2020
04
01
Defining the Benefit Package of Thailand Universal Coverage Scheme: From Pragmatism to Sophistication
133
137
EN
Viroj
Tangcharoensathien
0000-0003-3235-0091
International Health Policy Program, Ministry of Public Health, Nonthaburi,
Thailand
viroj@ihpp.thaigov.net
Walaiporn
Patcharanarumol
0000-0003-1798-8767
International Health Policy Program, Ministry of Public Health, Nonthaburi,
Thailand
walaiporn@ihpp.thaigov.net
Waraporn
Suwanwela
0000-0003-3217-8172
National Health Security Office, Bangkok, Thailand
waraporn.s@nhso.go.th
Somruethai
Supangul
0000-0001-9888-9722
National Health Security Office, Bangkok, Thailand
somruethai.s@nhso.go.th
Warisa
Panichkriangkrai
0000-0003-3567-3128
International Health Policy Program, Ministry of Public Health, Nonthaburi,
Thailand
warisa@ihpp.thaigov.net
Hathairat
Kosiyaporn
0000-0002-7203-8089
International Health Policy Program, Ministry of Public Health, Nonthaburi,
Thailand
hathairat@ihpp.thaigov.net
Woranan
Witthayapipopsakul
0000-0003-1817-8264
International Health Policy Program, Ministry of Public Health, Nonthaburi,
Thailand
woranan@ihpp.thaigov.net
10.15171/ijhpm.2019.96
<span class="fontstyle0">Benefit package is crucial for implementing universal health coverage (UHC). This editorial analyses how the benefit package of the Thai Universal Coverage Scheme (UC Scheme) evolved from an implicit comprehensive package which covered all conditions and interventions (with a few exceptions), to additional explicit positive lists. In 2002 when the Thai UC Scheme was launched; the comprehensive benefit package, including medicines in the national essential list of medicines, formerly offered by the previous schemes were pragmatically adopted. Later, when capacities of producing evidence on health technology assessment (HTA) increased, rigorous assessment of cost effectiveness is mandatorily required for inclusion of new interventions into the Thai UC Scheme benefit package. This contributed to evidence-informed policy decisions. To prevent emptied promises, whichever policy choices are made about the benefit package, either using a negative or a positive list, developing country governments need to make quality health services available and accessible by the entire population. Political decision on benefit package should be informed by evidence on cost effectiveness, equity dimension and health system capacity to deliver equitable services. Low- and middle-income countries need to strengthen HTA capacity to generate evidence and inform policies.</span>
Health Benefit Package,Health Insurance,Essential Medicines List,Universal Health Coverage,Thailand
https://www.ijhpm.com/article_3685.html
https://www.ijhpm.com/article_3685_35ff6b9aff1f920a2fe7551b024df789.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
9
4
2020
04
01
Team-Based Integrated Knowledge Translation for Enhancing Quality of Life in Long-term Care Settings: A Multi-method, Multi-sectoral Research Design
138
142
EN
Janice
Keefe
0000-0003-3073-8535
Department of Family Studies and Gerontology and Nova Scotia Centre on
Aging, Mount Saint Vincent University, Halifax, NS, Canada
janice.keefe@msvu.ca
Mary Jean
Hande
0000-0001-9741-3925
Mount Saint
Vincent University, Halifax, NS, Canada
maryjean.hande@msvu.ca
Katie
Aubrecht
Department of Sociology, Saint
Francis Xavier University, Antigonish, NS, Canada
caubrech@stfx.ca
Tamara
Daly
Faculty of Health and York
University Centre for Aging Research and Education, York University, Toronto,
ON, Canada
dalyt@yorku.ca
Denise
Cloutier
Department of Geography, University of Victoria, Victoria, BC,
Canada
dcloutier@uvic.ca
Deanne
Taylor
Interior Health Authority British Columbia, Kelowna, BC, Canada
deanne.taylor@interiorhealth.ca
Matthias
Hoben
Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
matthias.hoben@ualberta.ca
Kelli
Stajduhar
Institute
on Aging and Lifelong Health and School of Nursing, University of Victoria,
Victoria, BC, Canada
kis@uvic.ca
Heather
Cook
Office of the Seniors Advocate, Victoria, BC, Canada
heather.g.cook@gov.bc.ca
Ivy Lynn
Bourgeault
Tefler School of Management, University of Ottawa, Ottawa, ON, Canada
ivy.bourgeault@uottawa.ca
Leah
MacDonald
Vancouver Island Health Authority, Victoria, BC, Canada
leah.macdonald@viha.ca
Carole A.
Estabrooks
Faculty of Nursing
and School of Public Health, University of Alberta, Edmonton, AB, Canada
carole.estabrooks@ualberta.ca
10.15171/ijhpm.2019.123
<span class="fontstyle0">Multi-sectoral, interdisciplinary health research is increasingly recognizing integrated knowledge translation (iKT) as essential. It is characterized by diverse research partnerships, and iterative knowledge engagement, translation processes and democratized knowledge production. This paper reviews the methodological complexity and decision-making of a large iKT project called Seniors - Adding Life to Years (SALTY), designed to generate evidence to improve late life in long-term care (LTC) settings across Canada. We discuss our approach to iKT by reviewing iterative processes of team development and knowledge engagement within the LTC sector. We conclude with a brief discussion of the important opportunities, challenges, and implications these processes have for LTC research, and the sector more broadly.</span>
Late Life,Long-term Care,Integrated Knowledge Translation,Quality of Life,Canada
https://www.ijhpm.com/article_3708.html
https://www.ijhpm.com/article_3708_99c1311b91d2009e9811ecb42b2d32bf.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
9
4
2020
04
01
Special Measures for Quality and Challenged Providers: Study Protocol for Evaluating the Impact of Improvement Interventions in NHS Trusts
143
151
EN
Naomi
Fulop
0000-0001-5306-6140
Department of Applied Health Research, University College London, London,
UK
n.fulop@ucl.ac.uk
Estela
Capelas Barbosa
0000-0002-7621-7957
Department of Applied Health Research, University College London, London,
UK
e.barbosa@ucl.ac.uk
Melissa
Hill
0000-0003-3900-1425
Department of Applied Health Research, University College London, London,
UK
melissa.hill@ucl.ac.uk
Jean
Ledger
0000-0003-2523-7971
Department of Applied Health Research, University College London, London,
UK
j.ledger@ucl.ac.uk
Christopher
Sherlaw-Johnson
Research Team, The Nuffield Trust, London, UK
christopher.sherlaw-johnson@nuffieldtrust.org.uk
Jonathan
Spencer
Research Team, The Nuffield Trust, London, UK
jonathan.spencer@nuffieldtrust.org.uk
Cecilia
Vindrola-Padros
0000-0001-7859-1646
Department of Applied Health Research, University College London, London,
UK
c.vindrola@ucl.ac.uk
Steve
Morris
Department of Public
Health and Primary Care, University of Cambridge, Cambridge, UK
sm2428@medschl.cam.ac.uk
10.15171/ijhpm.2019.100
Background<br /> Healthcare organisations in England rated as inadequate in terms of leadership and one other domain enter the Special Measures for Quality (SMQ) regime to receive increased support and oversight. There is also a ‘watch list’ of challenged National Health Service (NHS) providers at risk of going into SMQ that receive support. There is limited knowledge about whether the interventions used to deliver this support drive improvements in quality, their costs, and whether they strike the right balance between support and scrutiny. The study will seek to determine how provider organisations respond to these interventions, and whether and how these interventions impact organisations’ capacity to achieve and sustain quality improvements over time.<br /> <br /> Methods<br /> This is a multi-site, mixed methods study. We will carry out interviews at national level to understand the programme theory underpinning the interventions. We will conduct 8 NHS case studies to explore the impact and implementation of the interventions that form part of the SMQ and challenged providers programme. We will use a conceptual framework based on models of organisational readiness for change and draw on board maturity research for implementing quality improvement. We will also review the use of quantitative metrics and data for tracking the progress of improvements in quality of care and sustainability upon leaving SMQ, as well as the costs and benefits of the interventions through a cost-consequence analysis (CCA).<br /> <br /> Discussion<br /> High-quality interventions that successfully support struggling healthcare organisations are essential and an issue that is an international concern. Our study will allow a greater understanding of the programme theory, impact, and staff views and experiences of the SMQ and challenged providers regime. Formative feedback will be reported to key stakeholders.
Organisational Failure,Special Measures for Quality,National Health Service (NHS),Mixed Methods Research
https://www.ijhpm.com/article_3696.html
https://www.ijhpm.com/article_3696_0ac4f9eeebcfc816f2ad6748c1b9ebc7.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
9
4
2020
04
01
Gaming New Zealand’s Emergency Department Target: How and Why Did It Vary Over Time and Between Organisations?
152
162
EN
Tim
Tenbensel
0000-0001-7832-3318
Faculty of Medical and Health Sciences, The University of Auckland, Auckland,
New Zealand
t.tenbensel@auckland.ac.nz
Peter
Jones
0000-0003-1560-1186
Auckland District Health Board Faculty of Medical and Health
Sciences, University of Auckland, Auckland, New Zealand
peterj@adhb.govt.nz
Linda Maree
Chalmers
Auckland District
Health Board, Auckland, New Zealand
lchalmers@adhb.govt.nz
Shanthi
Ameratunga
0000-0001-8042-2251
School of Population Health, Faculty of
Medical and Health Sciences, University of Auckland, Auckland, New Zealand
s.ameratunga@auckland.ac.nz
Peter
Carswell
0000-0002-8416-9561
Faculty of Medical and Health Sciences, The University of Auckland, Auckland,
New Zealand
p.carswell@auckland.ac.nz
10.15171/ijhpm.2019.98
Background<br /> Gaming is a potentially dysfunctional consequence of performance measurement and management systems in the health sector and more generally. In 2009, the New Zealand government initiated a Shorter Stays in Emergency Department (SSED) target in which 95% of patients would be admitted, discharged or transferred from an emergency department (ED) within 6 hours. The implementation of similar targets in England led to well-documented practices of gaming. Our research into ED target implementation sought to answer how and why gaming varies over time and between organisations.<br /> <br /> Methods<br /> We developed a mixed-methods approach. Four organisation case study sites were selected. ED lengths of stay (ED LOS) were collected over a 6-year period (2007-2012) from all sites and indicators of target gaming were developed. Two rounds of surveys with managers and clinicians were conducted. Interviews (n = 68) were conducted with clinicians and managers in EDs and the wider hospital in two phases across all sites. The interview data was used to develop explanations of the patterns of variation across time and across sites detected in the ED LOS data.<br /> <br /> Results<br /> Our research established that gaming behaviour – in the form of ‘clock-stopping’ and decanting patients to short-stay units (SSUs) or observation beds to avoid target breaches – was common across all 4 case study sites. The opportunity to game was due to the absence of independent verification of ED LOS data. Gaming increased significantly over time (2009-2012) as the means to game became more available, usually through the addition or expansion of short-stay facilities attached to EDs. Gaming varied between sites, but those with the highest levels of gaming differed substantially in terms of organisational dynamics and motives. In each case, however, high levels of gaming could be attributed to the strategies of senior management more than to the individual motivations of frontline staff.<br /> <br /> Conclusion<br /> Gaming of New Zealand’s ED target increased after the real benefits (in terms of process improvement) of the target were achieved. Gaming of ED targets could be minimised by eliminating opportunities to game through independent verification, or by monitoring and limiting the means and motivations to game.
Gaming,Targets,Performance Management,Emergency Departments,New Zealand
https://www.ijhpm.com/article_3686.html
https://www.ijhpm.com/article_3686_f791de1c122d2f784f2d7b845c432ff0.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
9
4
2020
04
01
HIV-Related Stigma Among Healthcare Providers in Different Healthcare Settings: A Cross-Sectional Study in Kerman, Iran
163
169
EN
Fatemeh
Tavakoli
HIV/STI Surveillance Research Center, and WHO Collaborating Center for
HIV Surveillance, Institute for Futures Studies in Health, Kerman University
of Medical Sciences, Kerman, Iran
fatemehtavakoli98@yahoo.com
Mohammad
Karamouzian
0000-0002-5631-4469
School of Population and Public Health,
University of British Columbia, Vancouver, BC, Canada
karamouzian.m@gmail.com
Ali Ahmad
Rafiei-Rad
Department of
Sociology, Allameh Tabatabai University, Tehran, Iran
a.ahmad.r.rad@gmail.com
Abedin
Iranpour
0000-0002-7746-5709
Neuroscience Research
Center, Institute of Neuropharmacology, Kerman University of Medical Sciences,
Kerman, Iran
iranpourabedin89@gmail.com
Mehrdad
Farrokhnia
Department of Internal Medicine, Afzalipour School of Medicine,
Kerman University of Medical Sciences, Kerman, Iran
mehrdad_farrokhnia@yahoo.com
Mehdi
Noroozi
Substance Abuse and
Dependence Research Center, University of Social Welfare and Rehabilitation
Sciences, Tehran, Iran
noroozimehdi04@gmail.com
Ali
Sharifi
Department of Ophthalmology, Afzalipour School of
Medicine, Kerman University of Medical Sciences, Kerman, Iran
a-sharifi@kmu.ac.ir
Brandon D.L.
Marshall
0000-0002-0134-7052
Department
of Epidemiology, Brown University School of Public Health, Providence, RI,
USA
brandon_marshall@brown.edu
Mostafa
Shokoohi
0000-0002-3810-752X
Department of Epidemiology & Biostatistics, The University of Western
Ontario, London, ON, Canada
shokoohi.mostafa2@gmail.com
Hamid
Sharifi
0000-0002-9008-7618
HIV/STI Surveillance Research Center, and WHO Collaborating Center for
HIV Surveillance, Institute for Futures Studies in Health, Kerman University
of Medical Sciences, Kerman, Iran
sharifihami@gmail.com
10.15171/ijhpm.2019.92
<span class="fontstyle0">Background</span><br /> <span class="fontstyle0">Stigmatizing attitudes among healthcare providers are an important barrier to accessing services among people living with HIV (PLHIV). This cross-sectional study aimed to assess the status and correlates of HIV-related stigma among healthcare providers in Kerman, Iran.<br /></span><br /> <br /> <span class="fontstyle0">Methods</span><br /> <span class="fontstyle0">Using a validated and pilot-tested stigma scale questionnaire, we measured HIV-related stigma among 400 healthcare providers recruited from three teaching hospitals (n = 363), private sectors (n = 28), and the only voluntary counseling and testing (VCT) center (n = 9) in Kerman city. Data were gathered using self-administered questionnaires at participants’ workplace during Fall 2016. To examine the correlates of stigmatizing attitudes, we constructed bivariable and multivariable linear regression models.<br /></span><br /> <br /> <span class="fontstyle0">Results</span><br /> <span class="fontstyle0">The mean ± standard deviation (SD) of stigma score was 25.95 ± 7.20 out of the possible 50, with higher scores reflecting more stigmatizing attitudes. Paramedics, nurses’ aides, and housekeeping staff had the highest, and VCT personnel had the lowest average stigma scores, respectively. Multivariable regression analyses showed that prior experience of working with PLHIV (β = -2.48; </span><span class="fontstyle0">P </span><span class="fontstyle0">= .03), exposure to HIV-related educational courses (β = -2.03; </span><span class="fontstyle0">P </span><span class="fontstyle0">= .02), and <span class="fontstyle0">P </span><span class="fontstyle0">< .001) were associated with lower stigma scores.<br /></span><br /> <br /> <span class="fontstyle0">Conclusion</span><br /> <span class="fontstyle0">Our findings highlight the need for health managers to provide training opportunities for healthcare providers, including programs that focus on improving HIV-related knowledge for healthcare providers. Enforcing policies that aim to reduce HIV-related stigma and discrimination among healthcare providers in Iran are urgently needed.</span></span>
HIV,Stigma,Healthcare Providers,Kerman,Iran
https://www.ijhpm.com/article_3689.html
https://www.ijhpm.com/article_3689_223ef8339928fa8e2647803ba5f27d79.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
9
4
2020
04
01
The Embedded Health Management Academic: A Boundary Spanning Role for Enabling Knowledge Translation; Comment on “CIHR Health System Impact Fellows: Reflections on ‘Driving Change’ Within the Health System”
170
174
EN
Kathy
Eljiz
0000-0002-0970-1888
Australian Institute of Health Service Management (AIHSM), University of Tasmania, Sydney, NSW, Australia
kathy.eljiz@utas.edu.au
David
Greenfield
0000-0002-0927-6025
Australian Institute of Health Service Management (AIHSM), University of Tasmania, Sydney, NSW, Australia
david.greenfield@utas.edu.au
Robyn
Taylor
0000-0002-1459-1011
Australian Institute of Health Service Management (AIHSM), University of Tasmania, Sydney, NSW, Australia
robyn.taylor0@utas.edu.au
10.15171/ijhpm.2019.108
<span class="fontstyle0">Healthcare organisations are looking at strategies and activities to improve patient outcomes, beyond clinical interventions. Increasingly, health organisations are investing significant resources in leadership, management and team work training to optimise professional collaboration, shared decision-making and, by extension, high quality services. Embedded clinical academics are a norm in, and considered a strength of, healthcare organisations and universities. Their role contributes, formally and informally, to clinical teaching, knowledge sharing and research. An equivalent, but significantly less common role, addressing the management of healthcare organisations, is the embedded health management academic (EHMA). A stimulus encouraging this intertwined embedded academic role, in both clinical and managerial fields, is the demand for the translation of knowledge between academic and industry contexts. In this essay, we describe the EHMA role, its value, impact and potential for enabling healthcare organisation improvement. Focusing on the business of healthcare, the EHMA is a conduit between sectors, stakeholders and activities, enabling different organisations and experts to co-create, share and embed knowledge. The value and impact achieved is significant and ongoing, through the nurturing of an evidence-based management culture that promotes ongoing continuous improvement and research activities.</span>
Boundary Spanning,Integrated Knowledge Translation,Collaboration,Healthcare Organisational Improvement
https://www.ijhpm.com/article_3693.html
https://www.ijhpm.com/article_3693_d58668f99e5d502a6d2d0e1d4248977b.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
9
4
2020
04
01
Neoliberalism 4.0: The Rise of Illiberal Capitalism; Comment on “How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention”
175
178
EN
Ronald
Labonté
0000-0002-0615-740X
Globalization and Health Equity, Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
rlabonte@uottawa.ca
10.15171/ijhpm.2019.111
<span class="fontstyle0">Neoliberal logic and institutional lethargy may well explain part of the reason why governments pay little attention to how their economic and development policies negatively affect health outcomes associated with the global diffusion of unhealthy commodities. In calling attention to this the authors encourage health advocates to consider strategies other than just regulation to curb both the supply and demand for these commodities, by better understanding how neoliberal logic suffuses institutional regimes, and how it might be coopted to alternative ends. The argument is compelling as possible mid-level reform, but it omits the history of the development of neoliberalism, from its founding in liberal philosophy and ethics in the transition from feudalism to capitalism, to its hegemonic rise in global economics over the past four decades. This rise was as much due to elites (the 1% and now 0.001%) wanting to reverse the progressive compression in income and wealth distribution during the first three decades that followed World War Two. Through three phases of neoliberal policy (structural adjustment, financialization, austerity) wealth ceased trickling downwards, and spiralled upwards. Citizen discontent with stagnating or declining livelihoods became the fuel for illiberal leaders to take power in many countries, heralding a new, autocratic and nationalistic form of neoliberalism. With climate crises mounting and ecological limits rendering mid-level reform of coopting the neoliberal logic to incentivize production of healthier commodities, health advocates need to consider more profound idea of how to tame or erode (increasingly predatory) capitalism itself.</span>
Liberalism,Neoliberalism,Capitalism,Health Inequities
https://www.ijhpm.com/article_3694.html
https://www.ijhpm.com/article_3694_25c8692de1f5aef2ab6d1738ad8fd916.pdf
Kerman University of Medical Sciences
International Journal of Health Policy and Management
2322-5939
9
4
2020
04
01
Financing Long-term Care: The Role of Culture and Social Norms; Comment on “Financing Long-term Care: Lessons From Japan”
179
181
EN
Peter
Alders
0000-0002-8901-5107
Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
pg.alders@minvws.nl
Frederik
Schut
0000-0002-5748-5403
Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
f.schut@erasmusmc.nl
10.15171/ijhpm.2019.110
<span class="fontstyle0">Based on the experiences of Japan and Germany, Ikegami argues that middle-income countries should introduce public long-term care insurance (LTCi) at an early stage, before benefits have expanded as a result of ad hoc policy decisions to win popular support. The experience of the Netherlands, however, shows that an early introduction of public LTCi may not prevent, but instead even facilitate later extensions of public coverage. We argue that social norms and cultural values about caring for the elderly might be the main driver of expansions of LTCi coverage. Furthermore, we posit that this expansion may reinforce the social norms supporting it. Hence, politicians and policy-makers should be aware of this possible self-reinforcing effect.</span>
Long-term Care Insurance,Public Insurance,Social Norms,Universal Coverage
https://www.ijhpm.com/article_3695.html
https://www.ijhpm.com/article_3695_a78d3820a966c3fcce480b9fb1278510.pdf