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Multilevel Zero-One Inflated Beta Regression Model for the Analysis of the Relationship between Exogenous Health Variables and Technical Efficiency in the Spanish National Health System Hospitals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910166. [PMID: 34639468 PMCID: PMC8508497 DOI: 10.3390/ijerph181910166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/17/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022]
Abstract
Background: This article proposes a methodological innovation in health economics for the second stage analysis of technical efficiency in hospitals. It investigates the relationship between the installed capacity in regions and hospitals and their ownership structure. Methods: A multilevel zero-one inflated beta regression model is employed to model pure technical efficiency more adequately than other models frequently used in econometrics. Results: Compared to publicly managed hospitals, the mean efficiency index of hospitals with public-private partnership (PPP) formulas was 4.27-fold. This figure was 1.90-fold for private hospitals. Concerning the efficiency frontier, the odds ratio (OR) of PPP models vs. public hospitals was 42.06. The OR of private hospitals vs. public hospitals was 8.17. A one standard deviation increase in the percentage of beds in intensive care units increases the odds of being situated on the efficiency frontier by 50%. Conclusions: The proportion of hospital beds in intensive care units relates to a higher chance of being on the efficiency frontier. Hospital ownership structure is related to the mean efficiency index of Spanish National Health Service hospitals, as well as the odds of being situated on the efficiency frontier.
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Byun DH, Chang RS, Park MB, Son HR, Kim CB. Prioritizing Community-Based Intervention Programs for Improving Treatment Compliance of Patients with Chronic Diseases: Applying an Analytic Hierarchy Process. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020455. [PMID: 33430108 PMCID: PMC7827405 DOI: 10.3390/ijerph18020455] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/26/2020] [Accepted: 01/04/2021] [Indexed: 12/22/2022]
Abstract
The purpose of this study was to apply multicriteria decision making and an analytic hierarchy process (AHP) model for assessing sustainable management of hypertension and diabetes. Perception of two alternative health care priorities was also investigated. One priority was improving treatment compliance of patients with hypertension and diabetes. The other priority was strengthening the healthcare system for continuous care. Our study design to evaluate community-based intervention programs for hypertension and diabetes was developed using brainstorming, Delphi techniques, and content analysis along with literature review. We finally proposed a hierarchical structure of the AHP model with 50 third sub-criteria in six levels. By surveying this AHP questionnaire to a total of 185 community health practitioners in Korea, we found that improving treatment compliance of patients with chronic diseases should be relatively more important than strengthening the healthcare system. Further research is needed to expand survey subjects to primary care physicians and even policymakers of central government for the appropriate application of this AHP model.
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Affiliation(s)
- Do Hwa Byun
- Korean Association for AIDS Prevention, Gangwon Branch, Chuncheon 24405, Korea;
| | - Rho Soon Chang
- Department of Public Administration, Kangwon National University, Chuncheon 24341, Korea;
| | - Myung-Bae Park
- Department of Gerontology Health and Welfare, Pai Chai University, Daejeon 35345, Korea;
| | - Hyo-Rim Son
- Hongcheon County Hypertension and Diabetes Registration and Education Center, Hongcheon 25135, Korea;
| | - Chun-Bae Kim
- Hongcheon County Hypertension and Diabetes Registration and Education Center, Hongcheon 25135, Korea;
- Department of Preventive Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea
- Correspondence: ; Tel.: +82-(0)33-741-0344; Fax: +82-(0)33-747-0409
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Ortega-Díaz MI, Ocaña-Riola R, Pérez-Romero C, Martín-Martín JJ. Multilevel Analysis of the Relationship between Ownership Structure and Technical Efficiency Frontier in the Spanish National Health System Hospitals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165905. [PMID: 32823922 PMCID: PMC7459985 DOI: 10.3390/ijerph17165905] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 11/29/2022]
Abstract
Objective: To evaluate the relationship between the ownership structure of hospitals and the possibility of their being positioned on the frontier of technical efficiency in the economic crisis period 2010–2012, adjusting for hospital variables and regional characteristics in the areas where the Spanish National Health System (SNHS) hospitals are located. Methods: 230 National Health System hospitals were studied over the two-year period 2010–2012 according to their ownership structure—public hospitals, private hospitals and public–private partnership (PPP)—data envelopment analysis orientated to inputs was used to measure the overall technical efficiency, pure efficiency and efficiency of scale. A generalised linear mixed model (GLMM) with binomial distribution and logit link function was used to analyse the hospital and regional variables associated with positioning on the frontier. Results: There are substantial differences between the average pure technical efficiency of public, private and PPP hospitals, as well as a greater number of PPP models being positioned on the efficiency frontier (91.67% in 2012). The odds of being positioned on the frontier are 41.7 times higher in PPP models than in public hospitals. The average annual household income per region is related to the greater odds of hospitals being positioned on the frontier of efficiency. Conclusions: During the most acute period of recession in the Spanish economy, PPP formulas favoured hospital efficiency, by increasing the odds of being positioned on the frontier of efficiency when compared to private and public hospitals. The position on the frontier of efficiency of a hospital is related to the wealth of its region.
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Affiliation(s)
- Mª Isabel Ortega-Díaz
- Departamento de Economía, Universidad de Jaén, Edificio D-3, Campus Las Lagunillas s/n, 23071 Jaén, Spain;
| | - Ricardo Ocaña-Riola
- Escuela Andaluza de Salud Pública, Cuesta del Observatorio 4, Campus Universitario de Cartuja, 18011 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, Doctor Azpitarte 4, 18012 Granada, Spain;
| | - Carmen Pérez-Romero
- Escuela Andaluza de Salud Pública, Cuesta del Observatorio 4, Campus Universitario de Cartuja, 18011 Granada, Spain;
- Correspondence: ; Tel.: +34-958-02-74-10
| | - José Jesús Martín-Martín
- Instituto de Investigación Biosanitaria ibs.GRANADA, Doctor Azpitarte 4, 18012 Granada, Spain;
- Departamento de Economía Aplicada, Universidad de Granada, Facultad de Ciencias Económicas y Empresariales, Campus Universitario de Cartuja s/n, 18071 Granada, Spain
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Le TA, Ha GH, Le MQT, Tran LMH, Pham DTT, Tran NHT, Vu GT, Nguyen LH, Pham HQ, Nguyen CT, Tran TH, Pham KTH, Tran BX, Latkin CA, Ho CSH, Ho RCM. Treatment adherence amongst drug users attending public and private methadone maintenance clinics in a northern province of Vietnam. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:31. [PMID: 32345318 PMCID: PMC7189574 DOI: 10.1186/s13011-020-00271-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 04/08/2020] [Indexed: 12/04/2022]
Abstract
Background Methadone maintenance treatment (MMT) has been proven to be effective in improving health status and the quality of life of illicit drug users. Due to the quick expand of methadone program, socialization through co-payment service is a critical to the success of it. In Nam Dinh, Vietnam, MMT has been used in public clinics and one private clinic. Such effectiveness of this treatment has been found to depend largely on adherence to treatment. This study aims to explore the compliance rate and its influencing factors among drug users between public and private clinics in Nam Dinh province, Vietnam. Methods A cross-sectional study was conducted on 395 participants from January to September in 2018 in three MMT clinics in Nam Dinh, Vietnam. We applied the convenience sampling technique to recruit respondents. Data on socioeconomics characteristics, MMT adherence (measured by Visual Analogue Scale – VAS) and level of social/family support were collected. Results 43.3% of participants reported complete adherence to the MMT program during the time of research. Significant factors affect MMT adherence among illicit drug users including family income, history of drug rejections, concurrence in drug usage, far distance from MMT clinics, and having only peer. Patients in MMT private clinic had higher complete adherence than that of public MMT (OR = 1.82, 95% CI = 1.13; 2.94). Having contacts with peer drug users associated with a higher rate of incomplete adherence (OR = 2.83, 95% CI = 1.39; 5.73). Conclusions The findings support the establishment of private MMT clinics alongside public ones, while further researches to determine the optimal dose and ways to reduce the impact of peer drug user’s influence are encouraged to be conducted.
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Affiliation(s)
- Tuan Anh Le
- National Institute of Hygiene and Epidemiology, Hanoi, 100000, Vietnam
| | - Giang Hai Ha
- Institute for Global Health Innovations, Duy Tan University, Da Nang, 550000, Vietnam
| | - Mai Quynh Thi Le
- National Institute of Hygiene and Epidemiology, Hanoi, 100000, Vietnam
| | | | | | | | - Giang Thu Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh city, 700000, Vietnam
| | - Long Hoang Nguyen
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh city, 700000, Vietnam
| | - Hai Quang Pham
- Institute for Global Health Innovations, Duy Tan University, Da Nang, 550000, Vietnam
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang, 550000, Vietnam.
| | - Tung Hoang Tran
- Institute of Orthopaedic and Trauma Surgery, Vietnam - Germany Hospital, Hanoi, 100000, Vietnam.,Department of Lower Limb Surgery, Vietnam - Germany Hospital, Hanoi, 100000, Vietnam
| | - Kiet Tuan Huy Pham
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, 100000, Vietnam
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, 100000, Vietnam.,Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Carl A Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, 21205, USA
| | - Cyrus S H Ho
- Department of Psychological Medicine, National University Hospital, Singapore, 119074, Singapore
| | - Roger C M Ho
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh city, 700000, Vietnam.,Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore.,Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore, 119077, Singapore
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Bastani P, Barati O, Sadeghi A, Ramandi S, Javan-Noughabi J. Can public-private partnership (PPP) improve hospitals' performance indicators? Med J Islam Repub Iran 2019; 33:4. [PMID: 31086783 PMCID: PMC6504942 DOI: 10.34171/mjiri.33.4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Indexed: 12/03/2022] Open
Abstract
Background: This study was conducted to compare the main performance indicators of Hasheminejad hospital before and after implementing PPP model.
Methods: This cross sectional study was conducted in Iran in 2015. Performance indicators of Hasheminejad hospital, the only Iranian unit that implemented PPP model, were applied. Data were collected based on a researcher-designed checklist after ensuring its validity and reliability. Data were analyzed applying SPSS21, and the Shapiro-Wilk test was used to examine the relevant data normalization. After confirming the normality of the data, descriptive statistics and paired t test were used to analyze the data at a significant level of 0.05.
Results: Dramatic variations were observed in the status of the studied indicators after the implementation of PPP in Hasheminejad hospital, and the changes were statistically significant in all these indicators (p<0.05).
Conclusion: It seems that implementing PPP in Hasheminejad hospital can be considered as a successful experience in Iran’s health sector. The significant improvement in this hospital’s performance indicators can emphasize the effective role of PPP in administration of this hospital. However, service quality and patient satisfaction should be considered as qualitative indicators, along with the present quantitative indicators because better judgment about the changes was achieved in this hospital after implementing PPP.
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Affiliation(s)
- Peivand Bastani
- Health Human Resources Research Center, School of Management & Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Omid Barati
- Health Human Resources Research Center, School of Management & Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.,School of Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Sadeghi
- Imam Khomeini Educational, Research and Treatment Center, Esfarayen Faculty of Medical Sciences, Esfarayen, Iran
| | - Sajad Ramandi
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Javad Javan-Noughabi
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
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Sadeghi A, Barati O, Bastani P, Daneshjafari D, Etemadian M. Strategies to develop and promote public-private partnerships (PPPs) in the provision of hospital services in Iran: a qualitative study. Electron Physician 2016; 8:2208-14. [PMID: 27279993 PMCID: PMC4886559 DOI: 10.19082/2208] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/05/2016] [Indexed: 11/29/2022] Open
Abstract
Introduction Public-Private Partnerships (PPPs) have been constructively considered in recent years to reform health sectors in many countries. This study aimed at explaining the strategies to develop and promote PPPs in the provision of hospital services in Iran. Methods This qualitative study was conducted in 2015. The study population consisted of experts and professionals of the health system and individuals familiar with PPPs and roles in the development of such models in hospital services in Iran that were selected through purposeful sampling, and semi-structured interviews were used for data collection. To this end, 18 experts and professionals of the health system and individuals familiar with PPPs and roles in the development of such models in hospital services in Iran were selected. The data were analyzed and classified using MAXQDA10 software and content analysis, respectively. Results According to the results of this study, four main themes and 20 subthemes in terms of strategies to develop and promote PPPs in the provision of hospital services in Iran were identified, including changes in policies and laws, socio-cultural changes, improvement of mechanisms and current processes, and financial and capital capacity building. Conclusion To develop and promote PPPs in the provision of hospital services, there is a need to consider prerequisites and measures to help such partnerships to be effective and produce valuable results.
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Affiliation(s)
- Ahmad Sadeghi
- Ph.D. Candidate of Health Services Management, Department of Health Services Management, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Omid Barati
- Ph.D. of Health Services Management, Assistant Professor, Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Peivand Bastani
- Ph.D. of Health Services Management, Assistant Professor, Health Human Resources Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Davood Daneshjafari
- Ph.D. of Economics, Assistant Professor, Department of Economics, Allameh Tabatabai University, Tehran, Iran
| | - Masoud Etemadian
- Urologist, Associate Professor, Department of Urology, Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran
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