Towards the Effective use of Diagnostic Radiology in Surgical Practice: Discussion Paper

Assessing the performance of imaging health systems in five selected hospitals in Uganda

OBJECTIVES

The first objective of the study was to develop an index termed as the 'Imaging Coverage' (IC), for measuring the performance of the imaging health systems. This index together with the Hospital-Based Utilization (HBU) would then be calculated for five Ugandan hospitals. Second, was to relate the financial resources and existing health policy to the performance of the imaging systems.

MATERIALS AND METHODS

This was a cross-sectional survey employing the triangulation methodology, conducted in Mulago National Referral Hospital. The qualitative study used cluster sampling, in-depth interviews, focus group discussions, and self-administered questionnaires to explore the non-measurable aspects of the imaging systems' performances.

RESULTS

The IC developed and tested as an index for the imaging system's performance was 36%. General X-rays had the best IC followed by ultrasound. The Hospital-Based Utilization for the five selected hospitals was 186 per thousand and was the highest for general radiography followed by ultrasound.

CONCLUSION

The IC for the five selected hospitals was 36% and the HBU was 186 per thousand, reflecting low performance levels, largely attributable to inadequate funding. There were shortfalls in imaging requisitions and inefficiencies in the imaging systems, financing, and health policy. Although the proportion of inappropriate imaging was small, reducing this inappropriateness even further would lead to a significant total saving, which could be channeled into investigating more patients. Financial resources stood out as the major limitation in attaining the desired performance and there is a need to increase budget funding so as to improve the performance of the imaging health systems.

Long term effects of the introduction of noninvasive investigations in neuroradiology. Part 2: Effects on management of individual patients

Review of imaging investigations undergone by cohorts of in- and outpatients of a neurological hospital at 8 year intervals over a 25 year period showed that while the pattern of investigation of the individual patient was little affected by the introduction of radionuclide studies, the subsequent availability of computed tomography had a rapid and cumulative effect on the use not only of invasive investigations, but also of plain films and other noninvasive examinations.

Risk targetting: an approach to cost-containment

The need for rationing in an insurance-based system of health care is inescapable. The best way to tackle the mismatch between demand and supply is, however, not clear. Of the four general strategies described, increasing the risk of disease in a population is shown to be the most effective way of reducing the outcome cost of a service. This may enable health care systems to provide services which would otherwise be unaffordable. This paper develops a technique for assessing risk using Lorenz curves which could be used by health service managers and clinicians. The paper uses cervical cytology screening to illustrate how variables can be selected in such a way as to maximise the number of potential beneficiaries while minimising the number of people to whom the service is offered.