The Impact of Different Factors on Repeat Visits to Selected International Tourism Enterprises: Case Study From Czechia

The aim of this article is to identify the influence of the different factors on the repeat visits to selected international tourism enterprises based on the responses of customers in Czechia. The selected factors were divided into three main groups: service, environment, and offer, and each of these groups consists of other different factors. Primary data were analyzed using SPSS software. Statistical hypotheses were formed, reflecting the relationship between the difference in customer responses and selected quality factors, which can affect repeated visits to selected tourism enterprises. Most customers of repeat visits to selected tourism enterprises are affected by professional behavior, staff empathetic approach, offer knowledge and ability to provide as much information as possible, cleanliness and tidiness, overall atmosphere of the establishment, lighting and thermal comfort, air cleanliness, and plenty of space, taste and quality of food and ingredients, and last but not least also corresponding ratio of price/quality, good experience and attractive price level. Studying consumer behavior is important because it helps marketers understand what influences consumers' buying decisions not only in the tourism area in the Czechia but can fill in the market gap and identify the new products and services that are needed.

Influences of a Luck Game on Offers in Ultimatum and Dictator Games: Is There a Mediation of Emotions?

The ultimatum (UG) and dictator (DG) games are two tasks where a sum of money has to be divided between two players: a proposer and a receiver. Following the rational choice theory, proposers should offer the minimum in the UG and nothing in the DG, due to the presence/absence of the receivers' bargaining power. The fact that people generally make non-negligible offers in both games has suggested divergent explicative hypotheses and has generated extensive research to examine exogenous and endogenous factors underlying such decisions. Among the contextual factors affecting the proposers' offers, the sense of entitlement or of ownership has been shown to reduce offers significantly. A frequent way to induce the sense of entitlement/ownership has been to assign the role of proposer to the player who apparently has better scored in skill tasks executed before the UG or DG or has more contributed, through a previous luck game, to the amount to be shared. Such manipulations, however, could produce a possible overlapping between "ownership" and "merit," that in this study we aimed to disentangle. We manipulated the participants' initial endowment through a luck game, by increasing, decreasing or leaving it unchanged, to investigate whether winnings or losses by chance influenced offers in UG and DG in similar or different ways depending on their respective features. All participants played as proposers but this role was apparently random and disconnected from the outcomes of the luck game. Furthermore, we investigated whether the putative effect of experimental manipulation was mediated by the changes in emotions elicited by the luck game and/or by the emotions and beliefs related to decision-making. We used a non-economic version of the games, in which tokens were divided instead of money. In the study, 300 unpaid undergraduates (M = 152) from different degree programs, aged between 18 and 42 years, participated. The results revealed that the effect of outcome manipulation on offers was moderated by the specific structure of the UG and DG. Instead, emotional reactions barely mediated the effect of the experimental manipulation, suggesting that their role in those decisions is less relevant than is assumed in the literature.

[The Medical Activity and Satisfaction of Population Need in Medical Care]

The article considers phenomenon of medical activity as a determinant of population demand for medical services and needs in medical care. The medical activity is determined as both a criterion of formation of health of patients by force of active using medical care and a criterion of efficiency of functioning of physicians in satisfaction of needs of patients in medical care. The results are presented related to phenomenon of medical activity using methodology of analysis of opinions of patients and level of medical care appealability of population. Medical activity of population and level of satisfaction of demand and needs in medical services is to be considered as an evidence of commitment of population to treatment and prevention. The investigation of these issues acquires particular specificity in conditions of health care system of large municipal agglomeration with developed network of medical organizations of budget insurance, departmental and private forms of property. In these conditions, patients and population are provided with various possibilities of choosing different forms and types of satisfaction of need in medical care independently of cause and motive of using it that is an advantage for implementing medical activity.

Views of the obstetric profession on non-invasive prenatal testing in Aotearoa New Zealand: A national survey

BACKGROUND

Non-invasive prenatal testing (NIPT) has been available in Aotearoa New Zealand (NZ) for approximately four years. It is likely to be introduced into the publicly funded prenatal screening service.

AIM

To explore obstetrician use and views of NIPT, with consideration to its implementation into screening services for Down syndrome and other conditions.

METHODS

An anonymous online survey combining Likert scales and free text was designed to assess current practice, knowledge, ethical considerations, counselling and views toward public funding of NIPT. The survey was distributed through the New Zealand members of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (n = 418) and responses collected over a two-month period in 2016.

RESULTS

There were 134/418 (32.1%) respondents. Current knowledge influenced decisions to offer NIPT (70.3%, 85/121). Confidence in offering NIPT was: 'not at all' (0.8%, 1/128); 'a little' (7.03%, 9/128), 'somewhat' (16.4%, 21/128), 'quite' (40.6%, 52/128) and 'very' (35.2%, 45/128). A total of 83.5% (101/121) stated NIPT should be publicly funded and NIPT capability developed within NZ (89.1%, 106/119). More information and support on the provision of NIPT was called for.

CONCLUSION

There was strong support for public funding of NIPT, and for NIPT capability to be developed in NZ. The call for more training, education and support needs to be actioned in order to facilitate the introduction of NIPT into screening services.

Progress at the Intersection of Patient Safety and Medical Liability: Insights from the AHRQ Patient Safety and Medical Liability Demonstration Program

OBJECTIVE

To identify lessons learned from the experience of the Agency for Healthcare Research and Quality (AHRQ) Patient Safety and Medical Liability (PSML) Demonstration Program.

DATA SOURCES/STUDY SETTING

On September 9, 2009, President Obama directed the Secretary of Health and Human Services to authorize demonstration projects that put "patient safety first" with the intent of reducing preventable adverse outcomes and stemming liability costs. Seven demonstration projects received 3 years of funding from AHRQ in the summer of 2010, and the program formally came to a close in June 2015.

STUDY DESIGN

The seven grantees implemented complex, broad-ranging innovations addressing both patient safety and medical liability in "real-world" contexts. Some projects featured novel approaches, while others implemented adaptations of existing models. Each project was funded by AHRQ to collect data on the impact of its interventions. In addition, AHRQ funded a cross-cutting qualitative evaluation focused on lessons learned in implementing PSML interventions.

DATA COLLECTION/EXTRACTION METHODS

Site visits and follow-up interviews supplemented with material abstracted from formal project reports to AHRQ.

PRINCIPAL FINDINGS

The PSML demonstration projects focused on three broad approaches: (1) improving communication around adverse events through disclosure and resolution programs; (2) preventing harm through implementation of clinical "best practices"; and (3) exploring alternative methods of settling claims. Although the demonstration contributed to accumulating evidence that these kinds of interventions can positively affect outcomes, there is also evidence to suggest that these interventions can be difficult to scale.

CONCLUSIONS

In addition to producing at least preliminary positive outcomes, the demonstration also lends credence to the idea that targeted interventions that improve some aspect of patient safety or malpractice performance may also contribute more broadly to institutional culture and the alignment of all parties around reducing risk and preventing harm. However, more empirical work needs to be carried out to quantify the effect of such interventions.

Individual health services

BACKGROUND

The German statutory health insurance (GKV) reimburses all health care services that are deemed sufficient, appropriate, and efficient. According to the German Medical Association (BÄK), individual health services (IGeL) are services that are not under liability of the GKV, medically necessary or recommendable or at least justifiable. They have to be explicitly requested by the patient and have to be paid out of pocket.

RESEARCH QUESTIONS

The following questions regarding IGeL in the outpatient health care of GKV insurants are addressed in the present report: What is the empirical evidence regarding offers, utilization, practice, acceptance, and the relation between physician and patient, as well as the economic relevance of IGeL?What ethical, social, and legal aspects are related to IGeL? FOR TWO OF THE MOST COMMON IGEL, THE SCREENING FOR GLAUCOMA AND THE SCREENING FOR OVARIAN AND ENDOMETRIAL CANCER BY VAGINAL ULTRASOUND (VUS), THE FOLLOWING QUESTIONS ARE ADDRESSED: What is the evidence for the clinical effectiveness?Are there sub-populations for whom screening might be beneficial?

METHODS

The evaluation is divided into two parts. For the first part a systematic literature review of primary studies and publications concerning ethical, social and legal aspects is performed. In the second part, rapid assessments of the clinical effectiveness for the two examples, glaucoma and VUS screening, are prepared. Therefore, in a first step, HTA-reports and systematic reviews are searched, followed by a search for original studies published after the end of the research period of the most recent HTA-report included.

RESULTS

29 studies were included for the first question. Between 19 and 53% of GKV members receive IGeL offers, of which three-quarters are realised. 16 to 19% of the insurants ask actively for IGeL. Intraocular tension measurement is the most common single IGeL service, accounting for up to 40% of the offers. It is followed by ultrasound assessments with up to 25% of the offers. Cancer screening and blood or laboratory services are also frequent and represent a major proportion of the demand. The ethical, social, and legal aspects discussed in the context of IGeL concern eight subject areas: autonomous patient decisions versus obtrusion,commercialization of medicine, duty of patient information, benefit, evidence, and (quality) control, role and relation of physicians and patients,relation to the GKV, social inequality,formally correct performance. For glaucoma screening, no randomized controlled trial (RCT) is identified that shows a patient relevant benefit. For VUS three RCT are included. However, they do not yet present mortality data concerning screened and non-screened persons. VUS screening shows a high degree of over-diagnosis in turn leading to invasive interventions. To diagnose one invasive carcinoma, 30 to 35 surgical procedures are necessary.

CONCLUSION

IGeL are a relevant factor in the German statutory health care system. To provide more transparency, the requests for evidence-based and independent patient information should be considered. Whether official positive and negative-lists could be an appropriate instrument to give guidance to patients and physicians, should be examined. Generally, IGeL must be seen in the broader context of the discussions about the future design and development of the German health care system.