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Pedawi S, Alzubi A. Effects of E-Government Policy on the Management of Healthcare Systems. Appl Bionics Biomech 2022; 2022:5736530. [PMID: 35047061 PMCID: PMC8763552 DOI: 10.1155/2022/5736530] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 12/24/2021] [Accepted: 12/27/2021] [Indexed: 01/30/2023] Open
Abstract
E-government began by addressing the challenges of new technologies by delivering e-services to its citizens and has since evolved to include a growing number of areas, such as citizen communication, macroeconomic projections, budget management, and e-healthcare services. E-government is known as the use of information technology to provide administrative services, communication transactions, information exchange, integration of various electronic systems, and autonomous services between the government and citizens, the government and business environment, and the government and government. This paper discusses the role of E-government policy in healthcare crises during COVID 19. Data collected from 435 employees in the tourism industry of Iraq was used to verify the abovementioned relationships via SPSS macro. The results indicate that E-government policy has a significant effect on healthcare crises; job insecurity negatively predicted healthcare crises. The results revealed that social support moderated the relationship between E-government policy and job insecurity. Results of the study contributed to the theory within this study by demonstrating that employees who enjoy a high level of social support show less job insecurity than those with a low level of social support.
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Affiliation(s)
- Sarwar Pedawi
- Business Administration Department, Karpas Mediterranean University TRNC, Northern Cyprus, Mersin 10, Turkey
| | - Ahmad Alzubi
- Business Administration Department, Karpas Mediterranean University TRNC, Northern Cyprus, Mersin 10, Turkey
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Migone AR. Trust, but customize: federalism's impact on the Canadian COVID-19 response. POLICY & SOCIETY 2020; 39:382-402. [PMID: 35039727 PMCID: PMC8754695 DOI: 10.1080/14494035.2020.1783788] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This article explores how Canadian federalism, with its complex mix of competencies, and the country's punctuated gradualism policy style interface with urgent, complex decision-making like the COVID-19 pandemic. We find that while punctuated gradualism favors tailored responses to pandemic management it is weaker when coordination and resourcing are to be undertaken during non-crisis situations and that, while the level of cooperation among Canadian jurisdictions has progressively increased over the years, policy is still almost exclusively handled at the federal, provincial and territorial levels. Furthermore, the model appears to have critical 'blind spots' in terms of vulnerable communities that do not emerge as such until after a crisis hits.
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Affiliation(s)
- Andrea Riccardo Migone
- Department of Politics and Public Administration, JOR 724, Ryerson University, Toronto, ON, Canada
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Chowdhury MZI, Chowdhury MA. Canadian Health Care System: Who Should Pay for All Medically Beneficial Treatments? A Burning Issue. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2017; 48:289-301. [PMID: 29095077 DOI: 10.1177/0020731417738976] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Canadian health care system can be characterized as a mix of public and private participation, although it is often described as a publicly funded system. In Canada, "medically necessary" services are covered with public funds; however, the Canada Health Act provides no formal definition of medical necessity. The provincial and territorial health care insurance plans decide which services are medically necessary. As a result, coverage of hospital and medical services differs among provinces. Outpatient prescription drugs are not covered by public plans. The coverage for diagnostics and medications for rare diseases is also limited. Private insurance plans, often provided by employers, are an expensive solution, although coverage is not sufficient. Those who are unemployed, self-employed, or informally employed and those with rare diseases that require expensive treatments and drugs frequently are not covered by any plan and face financial difficulty paying for their prescriptions and treatments. As a result, many Canadians are struggling and facing inequality in acquiring medical services for rare diseases and outpatient prescription drugs due to an unfair Canadian health care system. This paper proposes some recommendation to make medical services more accessible and affordable to every Canadian.
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Affiliation(s)
- Mohammad Ziaul Islam Chowdhury
- 1 Department of Statistics, 113074 Shahjalal University of Science and Technology , Sylhet, Bangladesh.,2 Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Harris C, Green S, Ramsey W, Allen K, King R. Sustainability in Health care by Allocating Resources Effectively (SHARE) 9: conceptualising disinvestment in the local healthcare setting. BMC Health Serv Res 2017; 17:633. [PMID: 28886735 PMCID: PMC5591535 DOI: 10.1186/s12913-017-2507-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 08/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This is the ninth in a series of papers reporting a program of Sustainability in Health care by Allocating Resources Effectively (SHARE) in a local healthcare setting. The disinvestment literature has broadened considerably over the past decade; however there is a significant gap regarding systematic, integrated, organisation-wide approaches. This debate paper presents a discussion of the conceptual aspects of disinvestment from the local perspective. DISCUSSION Four themes are discussed: Terminology and concepts, Motivation and purpose, Relationships with other healthcare improvement paradigms, and Challenges to disinvestment. There are multiple definitions for disinvestment, multiple concepts underpin the definitions and multiple alternative terms convey these concepts; some definitions overlap and some are mutually exclusive; and there are systematic discrepancies in use between the research and practice settings. Many authors suggest that the term 'disinvestment' should be avoided due to perceived negative connotations and propose that the concept be considered alongside investment in the context of all resource allocation decisions and approached from the perspective of optimising health care. This may provide motivation for change, reduce disincentives and avoid some of the ethical dilemmas inherent in other disinvestment approaches. The impetus and rationale for disinvestment activities are likely to affect all aspects of the process from identification and prioritisation through to implementation and evaluation but have not been widely discussed. A need for mechanisms, frameworks, methods and tools for disinvestment is reported. However there are several health improvement paradigms with mature frameworks and validated methods and tools that are widely-used and well-accepted in local health services that already undertake disinvestment-type activities and could be expanded and built upon. The nature of disinvestment brings some particular challenges for policy-makers, managers, health professionals and researchers. There is little evidence of successful implementation of 'disinvestment' projects in the local setting, however initiatives to remove or replace technologies and practices have been successfully achieved through evidence-based practice, quality and safety activities, and health service improvement programs. CONCLUSIONS These findings suggest that the construct of 'disinvestment' may be problematic at the local level. A new definition and two potential approaches to disinvestment are proposed to stimulate further research and discussion.
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Affiliation(s)
- Claire Harris
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Centre for Clinical Effectiveness, Monash Health, Melbourne, Australia
| | - Sally Green
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Wayne Ramsey
- Medical Services and Quality, Monash Health, Melbourne, Australia
| | - Kelly Allen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Centre for Clinical Effectiveness, Monash Health, Melbourne, Australia
| | - Richard King
- Medicine Program, Monash Health, Melbourne, Australia
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Harris C, Green S, Ramsey W, Allen K, King R. Sustainability in Health care by allocating resources effectively (SHARE) 1: introducing a series of papers reporting an investigation of disinvestment in a local healthcare setting. BMC Health Serv Res 2017; 17:323. [PMID: 28472962 PMCID: PMC5418706 DOI: 10.1186/s12913-017-2210-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 03/31/2017] [Indexed: 12/11/2022] Open
Abstract
This is the first in a series of papers reporting Sustainability in Health care by Allocating Resources Effectively (SHARE). The SHARE Program is an investigation of concepts, opportunities, methods and implications for evidence-based investment and disinvestment in health technologies and clinical practices in a local healthcare setting. The papers in this series are targeted at clinicians, managers, policy makers, health service researchers and implementation scientists working in this context. This paper presents an overview of the organisation-wide, systematic, integrated, evidence-based approach taken by one Australian healthcare network and provides an introduction and guide to the suite of papers reporting the experiences and outcomes.
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Affiliation(s)
- Claire Harris
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia. .,Centre for Clinical Effectiveness, Monash Health, Victoria, Australia.
| | - Sally Green
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Wayne Ramsey
- Medical Services and Quality, Monash Health, Victoria, Australia
| | - Kelly Allen
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,Centre for Clinical Effectiveness, Monash Health, Victoria, Australia
| | - Richard King
- Medicine Program, Monash Health, Victoria, Australia
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Pringle J, Coley KC. Improving medication adherence: a framework for community pharmacy-based interventions. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2015; 4:175-183. [PMID: 29354532 PMCID: PMC5741023 DOI: 10.2147/iprp.s93036] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Evidence supports that patient medication adherence is suboptimal with patients typically taking less than half of their prescribed doses. Medication nonadherence is associated with poor health outcomes and higher downstream health care costs. Results of studies evaluating pharmacist-led models in a community pharmacy setting and their impact on medication adherence have been mixed. Community pharmacists are ideally situated to provide medication adherence interventions, and effective strategies for how they can consistently improve patient medication adherence are necessary. This article suggests a framework to use in the community pharmacy setting that will significantly improve patient adherence and provides a strategy for how to apply this framework to develop and test new medication adherence innovations. The proposed framework is composed of the following elements: 1) defining the program's pharmacy service vision, 2) using evidence-based, patient-centered communication and intervention strategies, 3) using specific implementation approaches that ensure fidelity, and 4) applying continuous evaluation strategies. Within this framework, pharmacist interventions should include those services that capitalize on their specific skill sets. It is also essential that the organization's leadership effectively communicates the pharmacy service vision. Medication adherence strategies that are evidence-based and individualized to each patient's adherence problems are most desirable. Ideally, interventions would be delivered repeatedly over time and adjusted when patient's adherence circumstances change. Motivational interviewing principles are particularly well suited for this. Providing effective training and ensuring that the intervention can be delivered with fidelity within a specified workflow process are also essential for success. Utilizing this proposed framework will lead to greater and consistent success when implementing pharmacist-led medication adherence interventions in the community pharmacy setting.
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Affiliation(s)
- Janice Pringle
- Program Evaluation and Research Unit, Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kim C Coley
- Department of Pharmacy and Therapeutics, School of Pharmacy, University of Pittsburgh, Pittsburgh, PA, USA
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Guzman J, Tompa E, Koehoorn M, de Boer H, Macdonald S, Alamgir H. Economic evaluation of occupational health and safety programmes in health care. Occup Med (Lond) 2015; 65:590-7. [PMID: 26290408 DOI: 10.1093/occmed/kqv114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Evidence-based resource allocation in the public health care sector requires reliable economic evaluations that are different from those needed in the commercial sector. AIMS To describe a framework for conducting economic evaluations of occupational health and safety (OHS) programmes in health care developed with sector stakeholders. To define key resources and outcomes to be considered in economic evaluations of OHS programmes and to integrate these into a comprehensive framework. METHODS Participatory action research supported by mixed qualitative and quantitative methods, including a multi-stakeholder working group, 25 key informant interviews, a 41-member Delphi panel and structured nominal group discussions. RESULTS We found three resources had top priority: OHS staff time, training the workers and programme planning, promotion and evaluation. Similarly, five outcomes had top priority: number of injuries, safety climate, job satisfaction, quality of care and work days lost. The resulting framework was built around seven principles of good practice that stakeholders can use to assist them in conducting economic evaluations of OHS programmes. CONCLUSIONS Use of a framework resulting from this participatory action research approach may increase the quality of economic evaluations of OHS programmes and facilitate programme comparisons for evidence-based resource allocation decisions. The principles may be applicable to other service sectors funded from general taxes and more broadly to economic evaluations of OHS programmes in general.
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Affiliation(s)
- J Guzman
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - E Tompa
- Institute for Work and Health, Toronto, Ontario, Canada
| | - M Koehoorn
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - H de Boer
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - S Macdonald
- Institute for Work and Health, Toronto, Ontario, Canada
| | - H Alamgir
- Division of Epidemiology, Human Genetics and Environmental Sciences, University of Texas School of Public Health, San Antonio, TX, USA.
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Fit for the Future? A New Approach in the Debate about What Makes Healthcare Systems Really Sustainable. SUSTAINABILITY 2014. [DOI: 10.3390/su7010294] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Enhancing Learning, Innovation, Adaptation, and Sustainability in Health Care Organizations. Health Care Manag (Frederick) 2014; 33:183-204. [DOI: 10.1097/hcm.0000000000000014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Myth: When it comes to drugs and devices, newer is always better. J Health Serv Res Policy 2014; 19:192-194. [PMID: 24951236 DOI: 10.1177/1355819614531721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Shigayeva A, Coker RJ. Communicable disease control programmes and health systems: an analytical approach to sustainability. Health Policy Plan 2014; 30:368-85. [PMID: 24561988 DOI: 10.1093/heapol/czu005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
There is renewed concern over the sustainability of disease control programmes, and re-emergence of policy recommendations to integrate programmes with general health systems. However, the conceptualization of this issue has remarkably received little critical attention. Additionally, the study of programmatic sustainability presents methodological challenges. In this article, we propose a conceptual framework to support analyses of sustainability of communicable disease programmes. Through this work, we also aim to clarify a link between notions of integration and sustainability. As a part of development of the conceptual framework, we conducted a systematic literature review of peer-reviewed literature on concepts, definitions, analytical approaches and empirical studies on sustainability in health systems. Identified conceptual proposals for analysis of sustainability in health systems lack an explicit conceptualization of what a health system is. Drawing upon theoretical concepts originating in sustainability sciences and our review here, we conceptualize a communicable disease programme as a component of a health system which is viewed as a complex adaptive system. We propose five programmatic characteristics that may explain a potential for sustainability: leadership, capacity, interactions (notions of integration), flexibility/adaptability and performance. Though integration of elements of a programme with other system components is important, its role in sustainability is context specific and difficult to predict. The proposed framework might serve as a basis for further empirical evaluations in understanding complex interplay between programmes and broader health systems in the development of sustainable responses to communicable diseases.
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Affiliation(s)
- Altynay Shigayeva
- Communicable Diseases Policy Research Group, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard J Coker
- Communicable Diseases Policy Research Group, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Bridging the gap between the economic evaluation literature and daily practice in occupational health: a qualitative study among decision-makers in the healthcare sector. Implement Sci 2013; 8:57. [PMID: 23731570 PMCID: PMC3674944 DOI: 10.1186/1748-5908-8-57] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 05/31/2013] [Indexed: 11/30/2022] Open
Abstract
Background Continued improvements in occupational health can only be ensured if decisions regarding the implementation and continuation of occupational health and safety interventions (OHS interventions) are based on the best available evidence. To ensure that this is the case, scientific evidence should meet the needs of decision-makers. As a first step in bridging the gap between the economic evaluation literature and daily practice in occupational health, this study aimed to provide insight into the occupational health decision-making process and information needs of decision-makers. Methods An exploratory qualitative study was conducted with a purposeful sample of occupational health decision-makers in the Ontario healthcare sector. Eighteen in-depth interviews were conducted to explore the process by which occupational health decisions are made and the importance given to the financial implications of OHS interventions. Twenty-five structured telephone interviews were conducted to explore the sources of information used during the decision-making process, and decision-makers’ knowledge on economic evaluation methods. In-depth interview data were analyzed according to the constant comparative method. For the structured telephone interviews, summary statistics were prepared. Results The occupational health decision-making process generally consists of three stages: initiation stage, establishing the need for an intervention; pre-implementation stage, developing an intervention and its business case in order to receive senior management approval; and implementation and evaluation stage, implementing and evaluating an intervention. During this process, information on the financial implications of OHS interventions was found to be of great importance, especially the employer’s costs and benefits. However, scientific evidence was rarely consulted, sound ex-post program evaluations were hardly ever performed, and there seemed to be a need to advance the economic evaluation skill set of decision-makers. Conclusions Financial information is particularly important at the front end of implementation decisions, and can be a key deciding factor of whether to go forward with a new OHS intervention. In addition, it appears that current practice in occupational health in the healthcare sector is not solidly grounded in evidence-based decision-making and strategies should be developed to improve this.
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Ye C, Browne G, Grdisa VS, Beyene J, Thabane L. Measuring the degree of integration for an integrated service network. Int J Integr Care 2012; 12:e137. [PMID: 23593050 PMCID: PMC3601536 DOI: 10.5334/ijic.835] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Revised: 06/26/2012] [Accepted: 06/26/2012] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Integration involves the coordination of services provided by autonomous agencies and improves the organization and delivery of multiple services for target patients. Current measures generally do not distinguish between agencies' perception and expectation. We propose a method for quantifying the agencies' service integration. Using the data from the Children's Treatment Network (CTN), we aimed to measure the degree of integration for the CTN agencies in York and Simcoe. THEORY AND METHODS We quantified the integration by the agreement between perceived and expected levels of involvement and calculated four scores from different perspectives for each agency. We used the average score to measure the global network integration and examined the sensitivity of the global score. RESULTS Most agencies' integration scores were <65%. As measured by the agreement between every other agency's perception and expectation, the overall integration of CTN in Simcoe and York was 44% (95% CI: 39%-49%) and 52% (95% CI: 48%-56%), respectively. The sensitivity analysis showed that the global scores were robust. CONCLUSION Our method extends existing measures of integration and possesses a good extent of validity. We can also apply the method in monitoring improvement and linking integration with other outcomes.
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Affiliation(s)
- Chenglin Ye
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton ON, L8S 4L8 Canada
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Karmali S. The effect of professional identity on comprehensiveness in strategic decision making: physician executives in the Canadian health care context. Adv Health Care Manag 2012; 13:95-121. [PMID: 23265068 DOI: 10.1108/s1474-8231(2012)0000013009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE This paper explores differences in decision-making approaches between physician executives and nonphysician executives in a managerial setting. DESIGN/METHODOLOGY/APPROACH Fredrickson and Mitchell's (1984) conceptualization of the construct of comprehensiveness in strategic decision making is the central construct of this paper. Theories of professional identity, socialization, and institutional/dominant logics are applied to illustrate their impact on strategic decision-making approaches of physician and nonphysician executives. FINDINGS This paper proposes that high-status professionals, specifically physicians, occupying senior management roles are likely to approach decision making in a way that is consistent with their professional identity, and by extension, that departments led by physician executives are less likely to exhibit comprehensiveness in strategic decision-making processes than departments led by nonphysician executives. ORIGINALITY/VALUE This paper provides conceptual evidence that physicians and nonphysicians approach management differently, and introduces the utility of comprehensiveness as a construct for strategic decision making in the context of health care management.
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Affiliation(s)
- Shazia Karmali
- Gustavson School of Business, University of Victoria, British Columbia, Canada
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Hogg-Johnson S, Cole DC, Lee H, Beaton DE, Kennedy C, Subrata P. Changes in Physiotherapy Utilization in One Workforce: Implications for Accessibility among Canadian Working-Age Adults. Healthc Policy 2011; 6:e93-e108. [PMID: 22294994 PMCID: PMC3082390 DOI: 10.12927/hcpol.2011.22180] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
In debates over access to essential medical care, comparatively little attention has been paid to the provision of outpatient physiotherapy services. We examined physiotherapy utilization for musculoskeletal disorders (MSDs) among approximately 2,000 employees of a large, unionized, Ontario workplace. We obtained MSD-related physiotherapy claims and service data from the public Workplace Safety and Insurance Board, two private medical insurance carriers, a workplace special fund starting in 1995 and a workplace-contracted, on-site physiotherapy clinic starting in 1999. We observed substantial increases in overall physiotherapy utilization for MSDs: a median of 234 services per quarter for 1992-1994 to 1,281 for 1999-2002. With inclusive workplace provision policies, most physiotherapy utilization occurred on-site by 1999-2002 (70%). With a user-pay orientation to outpatient physiotherapy services increasing among working-age adults in Ontario, there is substantial potential for unequal access among those not privately insured or in workplaces with direct service provision.
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Affiliation(s)
- Sheilah Hogg-Johnson
- Senior Scientist, Institute for Work & Health, Dalla Lana School of Public Health, Toronto, ON
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