Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396120170101Integrated Care: A Pill for All Ills?13325010.15171/ijhpm.2016.111ENMariaGoddardCentre for Health Economics, University of York, York, UKAnne R.MasonCentre for Health Economics, University of York, York, UKJournal Article20160719There is an increasing policy emphasis on the integration of care, both within the healthcare sector and also between the health and social care sectors, with the simple aim of ensuring that individuals get the right care, in the right place, at the right time. However, implementing this simple aim is rather more complex. In this editorial, we seek to make sense of this complexity and ask: what does integrated care mean in practice? What are the mechanisms by which it is expected to achieve its aim? And what is the nature of the evidence base around the outcomes delivered?Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396120170101Erosion of Trust in the Medical Profession in India: Time for Doctors to Act58329210.15171/ijhpm.2016.143ENSumitKaneKIT Health, Royal Tropical Institute, Amsterdam, The NetherlandsGokhale
Institute of Politics and Economics, Pune, India0000-0002-4858-7344MichaelCalnanSchool of Social Policy and
Social Research, University of Kent, Canterbury, UK0000-0002-7239-6898Journal Article20160830In India, over the last decade, a series of stewardship failures in the health system, particularly in the medical profession, have led to a massive erosion of trust in these institutions. In many low- and middle-income countries (LMICs), the situation is similar and has reached crisis proportions; this crisis requires urgent attention. This paper draws on the insights from the recent developments in India, to argue that a purely control-based regulatory response to this crisis in the medical profession, as is being currently envisaged by the Parliament and the Supreme Court of India, runs the risk of undermining the trusting interpersonal relations between doctors and their patients. A more balanced approach which takes into account the differences between system and interpersonal forms of trust and distrust is warranted. Such an approach should on one hand strongly regulate the institutions mandated with the stewardship and qualities of care functions, and simultaneously on the other hand, initiate measures to nurture the trusting interpersonal relations between doctors and patients. The paper concludes by calling for doctors, and those mandated with the stewardship of the profession, to individually and collectively, critically self-reflect upon the state of their profession, its priorities and its future direction.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396120170101Measuring the Capacity Utilization of Public District Hospitals in Tunisia: Using Dual Data Envelopment Analysis Approach918321510.15171/ijhpm.2016.66ENChokriArfaIational Institute of Labour and Social Studies (INTES), University of Carthage,
Tunisia, TunisHervéLeleuLEM-CNRS, IÉSEG School of Management, Lille, FranceMohamedGoaïedLEFA-IHEC, University of Carthage, Tunisia, TunisCornelisVan MosseveldHealth Economist Expert
(free lance)0000-0001-8869-4964Journal Article20150820Background <br />Public district hospitals (PDHs) in Tunisia are not operating at full plant capacity and underutilize their operating budget. <br /> <br />Methods <br />Individual PDHs capacity utilization (CU) is measured for 2000 and 2010 using dual data envelopment analysis (DEA) approach with shadow prices input and output restrictions. The CU is estimated for 101 of 105 PDH in 2000 and 94 of 105 PDH in 2010. <br /> <br />Results <br />In average, unused capacity is estimated at 18% in 2010 vs. 13% in 2000. Of PDHs 26% underutilize their operating budget in 2010 vs. 21% in 2000. <br /> <br />Conclusion <br />Inadequate supply, health quality and the lack of operating budget should be tackled to reduce unmet user’s needs and the bypassing of the PDHs and, thus to increase their CU. Social health insurance should be turned into a direct purchaser of curative and preventive care for the PDHs.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396120170101An investigation Into Traditional Chinese Medicine Hospitals in China: Development Trend and Medical Service Innovation1925321710.15171/ijhpm.2016.72ENLiangWangState Key Laboratory of Quality Research in Chinese Medicine, Institute of
Chinese Medical Sciences, University of Macau, Taipa, MacauSizhuoSuoState Key Laboratory of Quality Research in Chinese Medicine, Institute of
Chinese Medical Sciences, University of Macau, Taipa, MacauJianLiFaculty of Arts
and Humanity, University of Macau, Taipa, MacauYuanjiaHuState Key Laboratory of Quality Research in Chinese Medicine, Institute of
Chinese Medical Sciences, University of Macau, Taipa, MacauPengLiState Key Laboratory of Quality Research in Chinese Medicine, Institute of
Chinese Medical Sciences, University of Macau, Taipa, MacauYitaoWangState Key Laboratory of Quality Research in Chinese Medicine, Institute of
Chinese Medical Sciences, University of Macau, Taipa, MacauHaoHuState Key Laboratory of Quality Research in Chinese Medicine, Institute of
Chinese Medical Sciences, University of Macau, Taipa, Macau0000-0001-9441-106XJournal Article20151121Background <br />This paper aims to investigate the development trend of traditional Chinese medicine (TCM) hospitals in China and explore their medical service innovations, with special reference to the changing co-existence with western medicine (WM) at TCM hospitals. <br /> <br />Methods <br />Quantitative data at macro level was collected from official databases of China Health Statistical Yearbook and Extracts of Traditional Chinese Medicine Statistics. Qualitative data at micro level was gathered through interviews and second-hand material collection at two of the top-level TCM hospitals. <br /> <br />Results <br />In both outpatient and inpatient sectors of TCM hospitals, drug fees accounted for the biggest part of hospital revenue. Application of WM medical exanimation increased in both outpatient and inpatient services. Even though the demand for WM drugs was much higher in inpatient care, TCM drugs was the winner in the outpatient. Also qualitative evidence showed that TCM dominated the outpatient hospital service with WM incorporated in the assisting role. However, it was in the inpatient medical care that WM prevailed over TCM which was mostly applied to the rehabilitation of patients. <br /> <br />Conclusion <br />By drawing on WM while keeping it active in supporting and strengthening the TCM operation in the TCM hospital, the current system accommodates the overriding objective which is for TCM to evolve into a fully informed and more viable medical field.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396120170101Beyond “Two Cultures”: Guidance for Establishing Effective Researcher/Health System Partnerships2742322110.15171/ijhpm.2016.71ENSarahBowenSchool of Epidemiology, Public Health and Preventive Medicine, University of
Ottawa, Ottawa, ON, Canada0000-0002-1341-5307IngridBottingHealth Services Integration, Winnipeg Regional Health Authority, Winnipeg, MB, CanadaCommunity Health Sciences, University of Manitoba, Winnipeg, MB, Canada0000-0002-5141-5631Ian D.GrahamSchool of Epidemiology, Public Health and Preventive Medicine, University of
Ottawa, Ottawa, ON, Canada0000-0002-3669-1216Lori-AnneHuebnereHealth Centre of Excellence, Centre for Family Medicine, Kitchener, ON,
CanadaJournal Article20151209Background <br />The current literature proposing criteria and guidelines for collaborative health system research often fails to differentiate between: (a) various types of partnerships, (b) collaborations formed for the specific purpose of developing a research proposal and those based on long-standing relationships, (c) researcher vs. decision-maker initiatives, and (d) the underlying drivers for the collaboration. <br /> <br />Methods <br />Qualitative interviews were conducted with 16 decision-makers and researchers who partnered on a Canadian major peer-reviewed grant proposal in 2013. Objectives of this exploration of participants’ experiences with health system research collaboration were to: (a) explore perspectives and experience with research collaboration in general; (b) identify characteristics and strategies associated with effective partnerships; and (c) provide guidance for development of effective research partnerships. Interviews were audio-recorded and transcribed: transcripts were qualitatively analyzed using a general inductive approach. <br /> <br />Results <br />Findings suggest that the common “two cultures” approach to research/decision-maker collaboration provides an inadequate framework for understanding the complexity of research partnerships. Many commonlyidentified challenges to researcher/knowledge user (KU) collaboration are experienced as manageable by experienced research teams. Additional challenges (past experience with research and researchers; issues arising from previous collaboration; and health system dynamics) may be experienced in partnerships based on existing collaborations, and interact with partnership demands of time and communication. Current research practice may discourage KUs from engaging in collaborative research, in spite of strong beliefs in its potential benefits. Practical suggestions for supporting collaborations designed to respond to real-time health system challenges were identified. <br /> <br />Conclusion <br />Participants’ experience with previous research activities, factors related to the established collaboration, and interpersonal, intra- and inter-organizational dynamics may present additional challenges to research partnerships built on existing collaboration. Differences between researchers and KUs may pose no greater challenges than differences among KUs (at various levels, and representing diverse perspectives and organizations) themselves. Effective “relationship brokering” is essential for meaningful collaboration.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396120170101Fair Processes for Priority Setting: Putting Theory into Practice; Comment on “Expanded HTA: Enhancing Fairness and Legitimacy”4347323710.15171/ijhpm.2016.85ENMaarten P.JansenRadboud Institute for Health Sciences, Radboud University Medical Center,
Nijmegen, The NetherlandsJan-KeesHeldermanInstitute for Management Research, Radboud
University, Nijmegen, The NetherlandsBertBoerInstitute of Health Policy and
Management, Erasmus University Rotterdam, Rotterdam, The NetherlandsRobBaltussenRadboud Institute for Health Sciences, Radboud University Medical Center,
Nijmegen, The Netherlands0000-0002-8364-2847Journal Article20160516Embedding health technology assessment (HTA) in a fair process has great potential to capture societal values relevant to public reimbursement decisions on health technologies. However, the development of such processes for priority setting has largely been theoretical. In this paper, we provide further practical lead ways on how these processes can be implemented. We first present the misconception about the relation between facts and values that is since long misleading the conduct of HTA and underlies the current assessmentappraisal split. We then argue that HTA should instead be explicitly organized as an ongoing evidenceinformed deliberative process, that facilitates learning among stakeholders. This has important consequences for whose values to consider, how to deal with vested interests, how to consider all values in the decisionmaking process, and how to communicate decisions. This is in stark contrast to how HTA processes are implemented now. It is time to set the stage for HTA as learning.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396120170101Governance Must Dive Into Organizations to Make a Real Difference; Comment on “Governance, Government, and the Search for New Provider Models”4951323610.15171/ijhpm.2016.89ENJean-LouisDenisCanada Research Chair in Governance and Transformation of Health
Organizations and Systems, École nationale d’administration publique,
Montréal, QC, Canada0000-0003-1295-332XSusanUsherHealth Innovation Forum, Montréal, QC, CanadaInstitute for Strategic Analysis and Innovation, McGill University Health Centre,
Montréal, QC, CanadaÉcole nationale d’administration publique, Montréal,
QC, CanadaJournal Article20160423In their 2016 article, Saltman and Duran provide a thoughtful examination of the governance challenges involved in different care delivery models adopted in primary care and hospitals in two European countries. This commentary examines the limited potential of structural changes to achieve real reform and considers that, unless governance arrangements actually succeed in penetrating organizations, they are unlikely to improve care. It proposes three sets of levers influenced by governance that have potential to influence what happens at the point of care: harnessing the autonomy and expertise of professionals at a collective level to work towards better safety and quality; creating enabling contexts for cross-fertilization of clinical and organizational expertise, notably through teamwork; and patient and public engagement to achieve greater agreement on improvement priorities and overcome provider/manager tensions. Good governance provides guidance at a distance but also goes deep enough to influence clinical habits.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396120170101The Evolution of the Physician Role in the Setting of Increased Non-physician Clinicians in Sub-Saharan Africa: An Insistence on Timing and Culturally-Sensitive, Purposefully Selected Skill Development; Comment on “Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians”5355323910.15171/ijhpm.2016.90ENAgnesBinagwahoMinister of Health, Kigali, RwandaHarvard Medical School, Boston, MA,
USAGeisel School of Medicine, Dartmouth University, Hanover, NH, USAUniversity of Global Health Equity, Kigali, Rwanda0000-0002-6779-3151GabrielaSarrieraUniversity of Vermont,
Burlington, VT, USAArielleEaganThe Dartmouth Institute of Health Policy and Clinical Practice, Hanover, NH, USAJournal Article20160531As Eyal et al put forth in their piece, <em>Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians</em>, task-shifting across sub-Saharan Africa through non-physician clinicians (NPCs) has led to an improvement in access to health services in the context of physician-shortages. Here, we offer a commentary to the piece by Eyal et al, concurring that physician’s roles should evolve into specialized medicine and that skills in mentorship, research, management, and leadership may create more holistic physicians clinical services. We believe that learning such non-clinical skills will allow physicians to improve the outcome of their clinical services. However, at the risk of a local, clinical brain drain as physicians shift to explore beyond the clinical sphere, we advocate strongly for increased caution to be exercised by leadership over the encouragement of this evolution. In the context of still-present physician shortages across many developing countries, we advocate to analyze this changing role and to purposefully select each new skill according to the context, giving careful consideration to the timing and degree of its evolution.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396120170101A New Generation of Physicians in Sub-Saharan Africa?; Comment on “Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians”5759324410.15171/ijhpm.2016.97ENGillesDussaultGlobal Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical,
Universidade Nova de Lisboa, Lisbon, Portugal0000-0002-5976-3454Nadia M.CobbOffice for the Promotion of
Global Healthcare Equity, Division of Physician Assistant Studies, Department
of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USAJournal Article20160606This commentary follows up on an editorial by Eyal and colleagues in which these authors discuss the implications of the emergence of non-physician clinicians (NPCs) on the health labour market for the education of medical doctors. We generally agree with those authors and we want to stress the importance of clarifying the terminology to describe these practitioners and of defining more formally their scope of practice as prerequisites to identifying the new competencies which physicians need to acquire. We add one new competencies domain, the utilization of new communication technologies, to those listed in the editorial. Finally, we identify policy issues which decision-makers will need to address to make medical education reform work.Kerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59396120170101Decentralisation; The Question of Management Capacity: A Response to Recent Commentaries6163328110.15171/ijhpm.2016.134ENJalalMohammedHealth Systems Section, School of Population Health, The University of Auckland, Auckland, New Zealand0000-0002-7665-7266NicolaNorthHealth Systems Section, School of Population Health, The University of Auckland, Auckland, New ZealandToniAshtonHealth Systems Section, School of Population Health, The University of Auckland, Auckland, New ZealandJournal Article20160920