Health services have long been insulated from the process of European integration. In this article, however, we show that we are witnessing their re-configuration in an emerging EU health-care ...system. The article uncovers the structuring lines of this system by focusing on three interrelated EU-wide processes influencing the integration of national health-care systems into a larger whole. First, the privatisation of health-care services following the constraints of Maastricht economic convergence and the EU accession criteria; second, health-care worker and patient mobility arising from the free movement of workers and services within the European Single Market; and third, new EU laws and country-specific prescriptions on economic governance that the EU has been issuing following the 2008 financial crisis. The article shows that these processes have helped to construct a European health-care system that is uneven in terms of the distribution of patient access to services and of health-care workers’ wages and working conditions, but very similar in terms of EU economic and financial governance pressures on health care across EU Member States.
Interregional patient mobility in a decentralized healthcare system. Regional Studies. Interregional patient mobility, measured as origin-destination patient flows between any two regions, is ...analysed within a dynamic spatial panel data framework using 2001-10 data on Italian hospital discharges. The aim is to assess the effects of the main determinants of patient flows, distinguishing between the impacts of regional health policies and those exerted by exogenous factors (geography, size, neighbouring regions, national policies). Empirical results indicate that the main drivers of mobility are regional income, hospital capacity, organizational structure, performance and technology. Moreover, neighbouring regions' supply factors, specialization and performance largely affect mobility by generating significant local externalities.
(1) Background: Rare disease patients in China usually have to travel a long distance, typically across provinces, for an accurate diagnosis due to the uneven distribution of healthcare resources. ...This study investigated the impact factors of their trans-provincial diagnosis. (2) Methods: An analysis was made of 1531 cases (1032 adults and 499 children) garnered from the 2018 China Rare Disease Survey, representing a large patient community inflicted with 75 rare diseases from across 31 Chinese provinces. Logistic regression models were used for separate analysis of adult and child patient groups. (3) Results: Nearly half (47.2%) of patients obtained their accurate diagnosis outside their home provinces. The uneven geographical distribution of high-quality healthcare had a significant impact on variation in trans-province diagnosis. Adult patients with lower family income, rural hukou and severer physical disability were disadvantaged in accessing trans-provincial diagnosis. Families with a child patient tended to pour resources into obtaining the trans-provincial diagnosis. The rarity of the disease had only a minimal effect on healthcare utilization across the provinces. (4) Conclusions: In addition to medical care, more attention should be paid to the socioeconomic factors that prevent the timely diagnosis of a rare disease, especially the uneven geographical distribution of high-quality healthcare resources, the financial burden on the family and the differences between adult and child patients.
The language barrier and the lack of reliable information were identified as major practical obstacles of European patient mobility. Patients are highly concerned about the ability to communicate ...with their doctors when obtaining healthcare in a country where they do not speak the local language, as well as they find it complicated to gather all the necessary information about an unfamiliar healthcare system or about their cross-border healthcare entitlements conferred on them by the Union legislation. In a multilingual and patient-friendly European Union these issues must be tackled in order to ensure effective healthcare and to enforce patients' right to cross-border healthcare. This article investigates the current legal tools within the European Union on language gap in patient-provider communication and access to information on cross-border healthcare entitlements. Moreover, it offers some possible solutions for the future.
Work-related musculoskeletal disorders (WMSD) are a major safety concern in today’s health care environment due to the manual lifting of patients with higher acuity levels and obesity. Nurses move ...patients multiple times each day, incurring cumulative stress and trauma resulting in chronic pain and potential injury. The purpose of this study was to assess barriers to the use of assistive devices in safe patient handling and mobility (SPHM) that contribute to WMSD in health care workers. Interpersonal, situational, organizational, and environmental influences have both direct and indirect effects on workers’ commitment to use, or their actual likelihood of using, assistive devices. This study confirmed that time constraints contribute to fewer instances of assistive device use. Comprehensive ergonomic programs are needed to promote staff and patient safety. By providing safe environments for health care workers who engage in patient handling and mobility, the risk of injury can be significantly reduced.
Inpatient geriatric psychiatry units have the highest fall rates in the acute care setting and most falls in this population occur during the mobility tasks of transfers and ambulation. The Timed Up ...and Go (TUG) test includes these 2 specific functional tasks and has been used to predict falls in other geriatric populations but has never been tested in an inpatient geriatric psychiatry unit. The purpose of this study was to determine whether the TUG time measurements of inpatient geriatric psychiatry patients were associated with falling.
The study was a retrospective chart review using a case-control design. The sample was obtained from patients admitted to 1 inpatient geriatric psychiatry unit during the 4-month study period.
The total sample size was N = 62 and included older adults with (N = 29; "fallers") and without (N = 33; "nonfallers") a history of falls in the 6 months prior to admission. The mean age of fallers (M = 75.8, SD = 9.6) was not significantly different from the age of nonfallers (M = 74.0, SD = 7.6), P = .424. Both groups had higher proportions of female subjects; nonfallers were 75.8% (n = 25) female and fallers were 69.0% (n = 20) female. Most nonfallers (84.8%) completed the TUG testing without an assistive device, while most fallers (48.3%) used a walker. A significant difference was found between the TUG times of nonfallers and fallers, U = 737.00, z = 3.65, P < .001, r = 0.46. Fallers took longer to complete the TUG test (median = 26.5) than nonfallers (median = 13.6). The TUG time explanatory variable was statistically significant, P = .002. Increasing TUG times were associated with an increased likelihood of patient falls (odds ratio = 1.10). The optimal TUG cutoff score was 16.5 seconds, with 79.3% sensitivity and 72.7% specificity.
The TUG time measurement was found to be associated with falling. A cutoff time of 16.5 seconds is recommended to identify nonfallers from fallers in the inpatient geriatric psychiatry setting.
Patient mobility can be defined as a patient's movement or utilization of a health care service located in a place or region other than the patient's place of residence. Mobility provides freedom to ...patients to obtain health care from providers across regions and even countries. It is essential to monitor patient choices in order to maintain the quality standards and responsiveness of the health system, otherwise, the health system may suffer from geographic disparities in the accessibility to quality and responsive health care. In this article, we study patient mobility in a national health care system to identify medical regions, spatio-temporal and service characteristics of health care utilization, and demands for patient mobility.
We conducted a systematic analysis of province-to-province patient mobility in Turkey from December 2009 to December 2013, which was derived from 1.2 billion health service records. We first used a flow-based regionalization method to discover functional medical regions from the patient mobility network. We compare the results of data-driven regions to designated regions of the government in order to identify the areas of mismatch between planned regional service delivery and the observed utilization in the form of patient flows. Second, we used feature selection, and multivariate flow clustering to identify spatio-temporal characteristics and health care needs of patients on the move.
Medical regions we derived by analyzing the patient mobility data showed strong overlap with the designated regions of the Ministry of Health. We also identified a number of regions that the regional service utilization did not match the planned service delivery. Overall, our spatio-temporal and multivariate analysis of regional and long-distance patient flows revealed strong relationship with socio-demographic and cultural structure of the society and migration patterns. Also, patient flows exhibited seasonal patterns, and yearly trends which correlate with implemented policies throughout the period. We found that policies resulted in different outcomes across the country. We also identified characteristics of long-distance flows which could help inform policy-making by assessing the needs of patients in terms of medical specialization, service level and type.
Our approach helped identify (1) the mismatch between regional policy and practice in health care utilization (2) spatial, temporal, health service level characteristics and medical specialties that patients seek out by traveling longer distances. Our findings can help identify the imbalance between supply and demand, changes in mobility behaviors, and inform policy-making with insights.
Patient mobility is considered one of the main concerns for policy-makers as it impacts financial sustainability of regional health systems due to the high percentage of patients accessing care ...services in other regions. For a better understanding of this phenomenon, it is necessary to define a behavioral model able to represent the patient-system interaction. In this paper we adopted the Agent-Based Modelling (ABM) approach with the aim of simulating patient flow across regions and determining which are the main factors influencing it. This may provide a new insight for policy makers to capture which are the main factors influencing mobility and actions that may contribute to contain this phenomenon.
Abstract Globalization is a key challenge facing health policy-makers. A significant dimension of this is trade in health services. Traditionally, the flow of health services exports went from North ...to South, with patients travelling in the opposite direction. This situation is changing and a number of papers have discussed the growth of health services exports from Southern countries in its different dimensions. Less attention has been paid to assess the real scope of this trade at the global level and its potential impact at the local level. Given the rapid development of this area, there are little empirical data. This paper therefore first built an estimate of the global size and of the growth trend of international trade in health services since 1997, which is compared with several country-based studies. The second purpose of the paper is to demonstrate the significant economic impact of this trade at the local level for the exporting country. We consider the case of health providers in the South-Mediterranean region for which the demand potential, the economic effects and the consequence for the health system are presented. These issues lead to the overall conclusion that different policy options would be appropriate, in relation to the nature of the demand.
Abstract Objectives Contracting health services outside the public, statutory health system entails purchasing capacity from domestic non-public providers or from providers abroad. Over the last ...decade, these practices have made their way into European health systems, brought about by performance-oriented reforms and EU principles of free movement. The aim of the article is to explain the development, functioning, purposes and possible implications of cross-border contracting. Methods Primary and secondary sources on purchasing from providers abroad have been collected in a systematic way and analysed in a structured frame. Results We found practices in six European countries. The findings suggest that purchasers from benefit-in-kind systems contract capacity abroad when this responds to unmet demand; pressures domestic providers; and/or offers financial advantages, especially where statutory purchasers compete. Providers which receive patients tend to be located in countries where treatment costs are lower and/or where providers compete. The modalities of purchasing and delivering care abroad vary considerably depending on contracts being centralised or direct, the involvement of middlemen, funding and pricing mechanisms, cross-border pathways and volumes of patient flows. Conclusions The arrangements and concepts which cross-border contracting relies on suggest that statutory health purchasers, under pressure to deliver value for money and striving for cost-efficiency, experiment with new ways of organising health services for their populations.
PDF
