Gastroenterology training in private hospitals:India vs South Africa

In South Africa,nurses and doctors are emigrating in significant numbers. Job satisfaction,safety and ensuring career progression are important in retaining doctors to make a career in Republic of South Africa (RSA). Due to budgetary constraints many hospitals have not been upgraded. Coming home after overseas training seems difficult. In RSA it takes a minimum of 13 years for a young specialist to become registered and 15 years for subspecialists. Career progression,creating more specialist trainees in public and private hospitals and shortening the period of professional training are potential solutions to the problem. India,which has a population of more than 1 billion people,is struggling with similar problems. For the past 10-15 years,private hospitals have assisted in manpower development for medical specialist and subspecialist careers. Currently their private sector trains 60% of their recognised (sub)specialities fellows. A national task force for specialist training in RSA should be instituted. It should discuss,based on the current status and projected specialist and subspecialist personnel requirements,thefuture structure and logistics of training needs. This is required in all subspecialities including gastroenterology,as has been done in India. It is hoped that as a consequence well-trained doctors,similar to those in India,might move to provincial hospitals in rural areas,upgrading the medical services and keeping medical power in South Africa. South Africa should become a model for Sub-Saharan Africa,as India already is for South-East Asia.

Healthcare waste management in selected government and private hospitals in Southeast Nigeria

Objective:To assess healthcare workers' involvement in healthcare waste management in public and private hospitals.Methods:Validated questionnaires(n = 660) were administered to randomly selected healthcare workers from selected private hospitals between April and July 2013.Results:Among the healthcare workers that participated in the study,187(28.33%) were medical doctors,44(6.67%) were pharmacists,77(11.67%) were medical laboratory scientist,35(5.30%) were waste handlers and 317(48.03%) were nurses.Generally,the number of workers that have heard about healthcare waste disposal system was above average 424(69.5%).More health-workers in the government(81.5%) than in private(57.3%) hospitals were aware of healthcare waste disposal system and more in government hospitals attended training on it.The level of waste generated by the two hospitals differed significantly(P=0.0086) with the generation level higher in government than private hospitals.The materials for healthcare waste disposal were significantly more available(P=0.001) in government than private hospitals.There was no significant difference(P = 0.285) in syringes and needles disposal practices in the two hospitals and they were exposed to equal risks(P =0.8510).Fifty-six(18.5%) and 140(45.5%) of the study participants in private and government hospitals respectively were aware of the existence of healthcare waste management committee with 134(44.4%) and 19(6.2%) workers confirming that it did not exist in their institutions.The existence of the committee was very low in the private hospitals.Conclusions:The availability of material for waste segregation at point of generation,compliance of healthcare workers to healthcare waste management guidelines and the existence of infection control committee in both hospitals is generally low and unsatisfactory.

Private hospital expansion in China:a global perspective

Objective:To assess the private hospital development in China during 2005-2016 from a global perspective.Methods:We searched the English and Chinese literature in PubMed,CNKI and Google Scholar databases with the keywords including“private hospitals in China”,“hospital ownership”,“public and private hospital”,“private hospital development”.Descriptive statistical analysis was used to assess the trend of the private hospital development in China and worldwide.Both the change of private hospitals in supply capacity and health care delivery were studied in this paper.The number of hospitals,number of hospital beds and the average number of hospital beds per hospital were employed to measure the supply capacity.The visit number,inpatients number,and bed occupancy rate(BOR)were used to measure the healthcare delivery.The data was collected from the China Health Statistical Yearbook and the“Organisation for Economic and Co-operation and Development(OECD)Statistics”website.Results:The private sector rapidly expanded in China’s hospital market in recent years.The number of private hospitals exceeded the public in 2015.There has also been a signi cant rise for the indicators of both the supply capacity(including number of hospitals,number of hospital beds and the average number of hospital beds per hospital)and the health care delivery(inpatients number and BOR)of the private hospitals.However,the growth rates of them were relatively lower than the public.The expansion trend of China’s private sector in the hospital market accorded with most the OECD countries around the world.In 2016,China was above the medium level of the share of the private hospitals’number with the OECD countries,but below the medium for the supply capacity,in terms of the hospital beds.Conclusion:As a result of the economic growth and supporting policy,the private sector has experienced a vast expansion in China’s hospital market in the past decade.The rising gap in average size between private and publicly owned hospitals,and the inconsistent development between the private hospitals’supply capacity and their market share,have become the two main challenges.Meanwhile,the future policy in supporting the private sector should be carefully introduced to advance the whole healthcare delivery system development in China.

Experiences of Occupational Stress among Emergency Nurses at Private Hospitals in Bangkok, Thailand

Introduction: Occupational stress has negative effects on employee’s health and organizational productivity. Nurses in emergency department are more exposed to stress than nurses in other departments. Aim: To explore nurses’ experiences of occupational stress in emergency departments in private hospitals in Bangkok, Thailand. Design: A descriptive qualitative design, with a deductive approach based on the Job Demand-Control-Support model was used. Methods: Fifteen emergency department nurses at two different hospitals were interviewed and the data were analyzed using a manifest content analysis. Results: Three main categories: “work context is an issue”, “consequences of reactions to stress”, and “coping with work stress”, including seven sub-categories emerged from the data analysis. Conclusion: The patients’ and their relatives’ behaviors were experienced as the primary stressor at the private hospital, in addition to excessive work tasks. Other important stressors were misunderstanding and conflicts between emergency department nurses and the other health care professionals, presumably related to hierarchy and power relations between health care professions. Creating a better working environment and a balance between the number of patients and nurses would reduce workload and stress, encourage ED nurses to stay in the profession and ultimately maintain patient safety.

Can public report cards affect consumer’s private learning of quality? An evaluation of the impact of Florida hospital report cards on acute myocardial infarction patient admission patterns

The empirical literature on hospital report cards typically assumes that report card cannot interact with consumer’s private learning. This study examines the impact of the implementation of FL hospital quality reporting system in late 2004 on hospital admission patterns using a pre-post difference-in-difference design. The estimation model allows for the possibility that report-card learning may interact with non-report-card learning. The study sample is comprised of all patients admitted to any FL hospital between 2000 and 2008 with a principal diagnosis of acute myocardial infarction (AMI). We find that hospital admission patterns for AMI patients did not respond to report card information. However, we find evidence consistent with the possibility that the implementation of a report card system may stimulate consumers (either patients or physicians) to seek higher quality hospitals through private information channels.

Day of Surgery Cancellation in Urology at a Public Tertiary Hospital and a Private Specialist Hospital

Background: There is a high variability in the reasons for cancellation of elective urological surgery cases. Case cancellation rate is expected to be high in the Public Health System with perceived inefficiencies compared to private facilities in the same developing economy. Aims and Objectives: This comparative analysis was to determine the case cancellation rate and the reasons for cancellation of elective urological surgeries in a public tertiary hospital and a private specialist hospital in Accra. This is intended to form a basis for interventions aimed at reducing the case cancellation rate. Methods: This was a retrospective analysis of prospectively collected data on Day of Surgery cancelled elective urological cases from September 2014 to October 2015 at the urology unit of the Korle-Bu Teaching Hospital (KBTH), a public Tertiary Hospital and the Trust Specialist Hospital (TSH), a privately managed hospital in Accra. The reasons for case cancellation were categorized into structural factors, patient factors and process factors. Results: There was no significant difference between the case cancellation rate for elective urological cases at KBTH and the TSH which were 20.8% and 17.1% respectively (p = 0.317). For KBTH, the reasons for cancellation of elective urological cases were due to structural factors in 11/117 (9.4%), patient factors in 15/117 (12.8%) and process factors in 91/117 (77.8%) which was due mainly to surgery running late. At the TSH, the reasons were due to structural factors in 1/29 (3.4%), patient factors in 27/29 (93.1%) mainly due to patient not turning up and process factors in 1/29 (3.4%). Conclusion: The case cancellation rate of elective urological surgeries in both the Public Tertiary Hospital and the Private Specialist Hospital were high with no significant difference between the two. However, in the Public Tertiary Hospital, process factors predominated as the cause of these cancellations while patient factors were the predominant cause in the privately managed facility. Exposure of theater managers in public facilities to management practices in privately run facilities should be encouraged to help improve the efficiency of the public facilities.

Investigation of Factors Affecting Preparedness of Reporting Adverse Drug Reactions among Nurses in Public and Private Hospitals in Dar Es Salaam, Tanzania

The current study assessed preparedness among nurses about reporting adverse drug reactions in public and private hospitals. Nurses in hospitals are among health providers very close to patients and are involved in the process of administering medications especially to inpatients. A cross sectional study was conducted among nurses in public and private hospitals in Dar es Salaam city in Tanzania to compare their preparedness on reporting adverse drug reactions (ADRs). A total of 384 nurses were involved in this study, of which 50% were drawn from public hospitals and 50% from private hospitals. Majority of respondents (75.25%) in public and 84.73% in private hospitals said they have not received any training about reporting ADRs. Of the few trained nurses, 85.43% and 96.55%, in public and private hospitals, respectively, said they have been trained in a seminar only once, after they started working as nurses. Respondents in public (19.17%) and private (32.8%) hospitals reported to stock ADRS forms (Yellow cards). Less than 50% of respondents agreed to have access to reference materials such as a text books named “Good Dispensing Practice” and a “List of Registered Medicines”. Further results showed more than two third of all respondents in private (74.25%) and public (73.5%) hospitals reported that lack of training affects the process of reporting ADRs in terms of ability and tendency. In this study we found training, availability of Yellow cards and presence of a focal person are among important contributing factors to preparedness of reporting ADRs among nurses in public and private hospitals.

The empirical study on enhancing the management of private hospitals at the beginning of their foundation

The private hospital has increased the capacity of health service delivery in number and is going to become an important supplement for medical resources. The thesis is combined with the actual situation of Chongqing Tongkang Orthopedic Hospital after its opening within half a year, so as to discuss the enlightenment from the position of medical institution, the performance management, the hospital culture and competitive environment at the beginning of the private hospital＇s foundation.

Pharmacy Service in Private Hospitals: Problems and Countermeasures

Objective To improve the quality of pharmacy service in private hospitals on the background of the fact that hospital pharmacy service is an important guarantee to promote rational drug use and the government encourages social capital to enter the field of pharmacy and healthcare, therefore, private hospitals are facing a new stage of development. Methods Questionnaire survey was used to sample and analyze 10 representative private hospitals in local area, and comparisons were made with the status of pharmacy service in level 3 public hospitals. Results and Conclusion It can be found that private hospitals have many problems in pharmacy services, such as the low level of professional skills of pharmaceutical personnel, low recognition and trust from patients, and the imperfect pharmaceutical management system. Some countermeasures and suggestions are put forward to promote the level of pharmacy services in private hospitals on the basis of this study.

Proportion of Cesarean Deliveries According to Hospital Funding in São Paulo Metropolitan Area, Brazil

Introduction: There has been an increase in the proportion of cesarean deliveries, especially in developing countries. Methods: Cross-sectional study of all hospital live births from mothers living in Sao Paulo Metropolitan Area, Brazil. Data were obtained from the Live Birth Information System, which is linked to the National Database of Health Establishments. Hospitals were classified as public, private or mixed. Descriptive analysis and exponential regression were conducted to evaluate time trends. Poisson regression was applied to analyze each hospital type to identify risk factors and the attributable risk fraction for cesarean section. Results: There was an annual increase (1.4%) of cesarean deliveries between 2000 and2013. In2009, the percentage of cesarean deliveries was 53% overall and 83% in private hospitals. The primary risk factor for cesarean delivery was delivery in a private hospital. Other risk factors that were stronger in public hospitals included the following: advanced maternal age, high maternal education, nulliparity, high number of prenatal visits, multiple pregnancy, hospital with low annual volume of deliveries, birth outside the city of residence and white skin color. Discussion: These results may be explained by the obstetric care model of private hospitals, which is not multiprofessional. Prenatal care and delivery are conducted by the same doctor and rarely include the input of another professional, such as a midwife. In addition, the mode of delivery influences the professional’s payment.

Improving the Organizational Forms of Private Colleges from the Perspective of the Common Benefit Company System

The“profit-making”attribute of commercial subjects shapes the classification system of legal representatives and the contents of corresponding norms in the Civil Code of the People’s Republic of China.The division of non-profit and non-commercial in the Law of the People’s Republic of China on Promotion of Privately-Run Schools not only conforms to the provisions of General Principles of the Civil Law of the People’s Republic of China,but also lays an institutional foundation for the classified management of private colleges.However,it cannot solve the problem of substantial profit-making behaviors of non-profit private colleges.As an important organizational form of enterprise organizations,the“Common Benefit Company”has changed the rule-making for traditional for-profit companies,so that the organizational form can be applied to both profit and public welfare enterprises.The functional design of the common benefit company system can now be applied to standardize the organizational structures of private colleges in China.Drawing lessons from the legislative experience regarding the common benefit company,we can enhance the organizational structures of our private colleges by implementing the common benefit company.

DRG支付方式下医院运营现状分析——以山东省青岛市某民营专科医院为例

目的:本研究从民营专科医院角度出发,分析DRG付费模式下民营专科医院的运营现况,总结医院运营发展面临的挑战与问题,并提出针对性的运营发展策略。方法:选取青岛市某三级民营专科医院2022年1月1日至8月31日以及2023年1月1日至8月31日住院病例共6006份。运用描述性分析法,从医疗服务能力、财务类、医疗质量及运营效率四个维度指标出发,对入组DRG病例情况进行基本分析,采用间断时间序列模型评估DRG付费对该院运营的影响程度。结果:在DRG付费改革下,该院面临病组权重赋分值低,诊疗价值难体现;运营收益下降,学科建设发展受影响;医疗服务质量下降,诱发不合理诊疗行为;科室缺乏DRG付费政策认知,存在执行不足等问题。结论:民营专科医院需明确DRG政策要求,通过精准病组权重赋分,规范病案管理体系;构建精细化管理体系,助推医院运营发展;以医疗质量为核心,优化绩效考核方案;提升DRG培训质量,促进学科建设等对策,并结合医院发展实际作出动态调整,提升医院的可持续发展能力。

多维度视角下我国民营医院发展变化研究

目的:基于多维度视角下对民营医院发展变化进行研究,为推动民营医院建设发展和相关部门出台政策提供借鉴。方法:采用描述性分析法,从服务规模、人员配置、财务状况、医疗服务量、医疗服务效率5个维度选取21个指标,对2010-2021年民营医院与公立医院进行分析与比较。结果:民营医院数量与床位数量扩张迅速;各类卫生人员数量年均增速均高于公立医院,2021年医护比高于公立医院;总资产、总收入及总支出均呈快速增长趋势,远高于同期公立医院增长速度;民营医院医疗服务量相关指标平均增速均为负值,公立医院均为正值;民营医院床位使用率低,平均住院日呈上升趋势,人均每日担负诊疗人次呈波动式下降趋势。结论:提升运营效能,打造差异化发展,促进民营医院发展从“量的积累”转为“质的提升”;借助合作,补短板创新机,实现跨越式发展;加大政策扶持力度,推动民营医院健康规范发展。

民营医院医疗服务水平的地区分布特征及影响因素

目的:分析民营医院医疗服务水平的空间分布特征及影响因素,为提升民营医院医疗服务水平以及推进健康中国建设提供借鉴。方法:建立合理的指标体系,运用熵权TOPSIS法、RSR法以及GIS技术分析2017-2019年各省份民营医院医疗服务水平及其空间分布特征,采用灰色系统理论分析影响民营医院医疗服务水平的因素。结果:民营医院的医疗服务水平呈现明显的东南-西北分化特征;民营医院医疗服务水平的高值区为江苏省、广东省等经济发达省份和河南省、山东省等人口众多的省份;基本医疗保险参保人数以及卫生技术人员数量与民营医院医疗卫生服务水平的关联序分别为第1和第2,在各因素中处于较高水平。结论:建议逐步消除医保壁垒,加强人才队伍建设,明确市场定位,因地制宜合理规划,提高民营医院医疗服务水平。

激励扭曲视角下我国民营医院激励机制问题研究

基于激励扭曲视角,深入分析我国民营医院激励机制存在的问题及原因,认为多任务并行、产出结果难以测量、多重委托代理关系和忽视代理人特征是造成民营医院激励扭曲现象产生的主要原因。针对上述原因,提出4点建议:提高民营医院多任务管理能力;健全民营医院治理机制;规范民营医院绩效考核标准;推进民营医院企业文化建设。期望藉此优化民营医院激励机制,促进我国民营医院稳定发展。

Women on Boards of Directors

This research aims to measure the current gender representation in membership of boards of directors,and to study the factors affecting the presence of women on boards.The results of the study will support the decision makers and policy makers at all levels by providing knowledge that contributes to bridging the current gap in participation of women boards.The methodology used in this research is the descriptive analytical approach,which relies on quantitative methods in the process of collecting and analyzing data.This study represents the boards of directors in the three sectors(public,private,and non-profit)in the Kingdom of Saudi Arabia,The study sample contained 350 targets,where a random sample of 150 people in the public sector,100 people in the private sector,and 100 people in the non-profit sector were selected.The research result found that the majority of the responses believe that the lack of experience and training,and social factors,are the most impact areas of explaining the reasons for the existence of a gap in women’s membership in boards of directors in the three sectors.And the most important reasons for the existence of a gender gap in board membership are:there is no statutory minimum percentage for women’s representation on boards of directors,and scarcity of female competencies in general,and the lack of women occupying leadership positions.

就医体验视角下的重庆市民营康复医院住院患者满意度影响因素分析

目的分析重庆市民营康复医院住院患者就医体验视角下的满意度现状及其影响因素,为民营康复医院改进医疗服务质量提供参考。方法采用方便抽样对重庆市3家民营康复医院的467名住院患者进行问卷调查,运用χ^(2)检验和Logistic回归探讨患者满意度及其影响因素。结果住院患者就医整体满意率为78.6%,总体满意度得分为(3.84±0.52)分,其中投诉与建议服务得分最高,后勤与环境服务和康复治疗服务得分较低。回归分析显示,家庭月人均收入2001~4000元(OR=0.221,95%CI:0.077~0.635)、4001~6000元(OR=0.296,95%CI:0.125~0.700),医疗付费方式中的自费(OR=4.198,95%CI:1.035~17.027)、其他(商业保险等)(OR=9.591,95%CI:1.767~52.049)均是重庆市民营康复医院住院满意度的影响因素。结论住院患者就医体验总体满意度尚可,但仍有较大的提升空间,建议从多维度提升住院患者的满意度。

广西民营医院运行效率及影响因素研究

目的分析广西二级及以上民营医院运行效率及其影响因素,为优化广西医疗卫生资源配置并推动广西民营医院高质量发展提供参考建议。方法通过问卷调查收集民营医院运行数据,分别采用DEA法和Tobit回归模型测算效率、探究影响因素。结果专科民营医院及综合民营医院综合效率均值、纯技术效率均值、规模效率均值分别为0.612和0.646、0.799和0.770、0.748和0.820。14个地市中仅有崇左市为DEA有效。非DEA有效医院投入冗余主要为万元以上设备总价值及实际开放床位数,设备及床位资源利用率有待提高;门急诊人次数产出不足率均值>100%,是民营医院产出不足的主要方面。是否为医保定点与专科、综合民营医院效率均成负向关系;患者次均诊疗费用、住院费用及人均GDP与专科、综合民营医院效率均成负向关系;人口密度与专科、综合民营医院分别成负向、正向关系;药占比及平均床位使用率与综合民营医院成正向关系。结论民营医院效率存在区域差异且环境因素对医院效率影响显著,规模扩张时应充分考虑外部因素的差异性,强化其战略布局及优化配置。专科民营医院与综合民营医院效率低下且原因各异,应精准施策以提升效率。医疗费用过高不利于患者的就医选择和医院发展,应提高服务效率及控费效果。

民营专科医院的设计思考与实践--以湖南妇女儿童医院为例

随着我国民营医院的蓬勃发展,其数量与质量均实现了稳步提升,这使得对民营专科医院设计的研究与思考变得尤为重要。如何在设计层面,针对性地匹配民营专科医院特点,成为了一个值得深入探讨的课题。文章以湖南妇女儿童医院设计为例,探讨民营专科医院的设计思路。