Tackling the mismatch between the supply of and demand for care service is an especially important issue among many healthcare providers and regulators. To entice patient demand distribution to ...become more equilibrated among different regions, some countries' governments have proposed to establish a hospital association with different levels of hospitals to implement patient mobility. However, the sustainable operation and management of the hospital association have not been formally analyzed. In this paper, we develop a Salop model to analyze the strategic behavior of patient welfare and hospital utility maximizations in a hospital association comprised of three hospitals in different income regions. For the former objective, we find that the higher quality provisions may harm patient welfare, and especially there are unique quality thresholds of the hospitals such that the higher quality provisions lead to higher patient welfare only when the quality provisions exceed the thresholds. For the latter objective, we capture the optimal equilibrium quality provisions of the overall hospital association. We consider both the case when the taxation rates are regulated (TRR) and exogenous to the hospitals and the case when taxation rates are adjusted (TRA) and constrained by hospital reimbursement rates. Under the TRA case, we find that a higher reimbursement rate of the local hospital causes a higher and lower quality threshold of the hospital in the local and neighboring regions, respectively; and we also show that with the utility maximization objective, the reimbursement rate's impact depends on regulator's altruism towards patient welfare. For a relatively low altruistic behavior, a TRA could improve the quality provision but lower the number of outflowing patients in the case of a high (and low) hospital's reimbursement rate in the local (and neighboring) region. When the regulator cares more about patient welfare, the findings in the quality provision and patient mobility are just contrary. Our analytical results lead to some important policy implications for facilitating the further deployment of hospital association delivery in the hospitals' quality provision associated with patient mobility.
•We study impacts of healthcare quality/reimbursement rate on hospital association.•We use a Salop model to analyze patient welfare and hospital utility maximizations.•Hospitals' quality provisions increasing can improve patient welfare.•There are unique optimal equilibrium quality provisions for the utility objective.•Higher local reimbursement rate improves quality but lower outflowing patients.
We study the effects of cross-border patient mobility on health care quality and welfare when income varies across and within regions. We use a Salop model with a high-, middle-, and low-income ...region. In each region, a policy maker chooses health care quality to maximise the utility of its residents when health care costs are financed by general income taxation. In equilibrium, regions with higher income offer better quality, which creates an incentive for patient mobility from lower- to higher-income regions. Assuming a prospective payment scheme based on DRG-pricing, we find that lower non-monetary (administrative) mobility costs have (i) no effect on quality or welfare in the high-income region; (ii) a negative effect on quality but a positive effect on welfare for the middle-income region; and (iii) ambiguous effects on quality and welfare for the low-income region. Lower monetary mobility costs (copayments) might reduce welfare in both the middle- and low-income region. Thus, health policies that stimulate cross-border patient mobility can be counterproductive when regions differ in income.
Highlights • This cross-sectional study explored potential pitfalls in the medical travel process. • Health records were not always transferred abroad, especially not in advance. • Provision of ...follow-up care in the home country can be problematic. • Even after the implementation of the PRD, reimbursement issues were experienced. • Member states are recommended to update their policies for safe medical travel.
Inbound and outbound medical travel in Austria Österle, August; Diesenreiter, Carina; Glinsner, Barbara ...
Journal of health organization and management,
12/2020, Letnik:
35, Številka:
9
Journal Article
Recenzirano
Odprti dostop
PurposeThe purpose of this paper is twofold: First, it analyzes demand and supply-side factors that influence patient flows to and from Austria. Second, building on the empirical research and ...existing conceptualizations, the study offers a general extended framework to guide future comparative analysis.Design/methodology/approachThe paper draws on multiple data sources including a literature review, secondary data, website analysis and semi-structured interviews with patients and health providers. Content analysis was carried out to identify common motives for seeking care abroad and providers' orientation towards medical travel.FindingsOutbound medical travel is largely determined by factors of access, affordability and vicinity, while inbound medical travel is predominately driven by a lack of adequate medical infrastructure in source countries and quality, both in terms of medical and service quality. Providers distinguish themselves according to the extent they take part in medical travel.Research limitations/implicationsThe findings emerging from a single country case study approach cannot be generalized across settings and contexts, albeit contributing to a better understanding of current medical travel patterns in Europe.Originality/valueUnlike most recent contributions, this study focuses both on inbound and outbound medical travel in Austria and investigates patient flows for distinctive treatments and drivers. While analysis of the supply-side of medical travel is often limited to tourism studies, this study provides a critical insight into developments in Europe from a health policy perspective, acknowledging that diverse medical travel patterns in Europe coexist.
Aim
This study examines the effect of preoperative training on postoperative mobility and anxiety levels in patients undergoing total knee arthroplasty.
Methods
This was a randomized controlled ...study. The sample of this study consisted of 60 (30 experimental group, 30 control group) total knee arthroplasty patients who were admitted to a public hospital's orthopedic department between January 2019 and May 2019. To collect data, a demographic information form, patient mobility scale, observer mobility scale, and state–trait anxiety inventory were used. The patients in the intervention group practiced bed exercise and mobilization training before total knee arthroplasty surgery. The control group had no intervention.
Results
It was determined that the patient mobility scale (2.0 ± 0.83) and observer mobility scale scores (6.93 ± 1.61) of the patients in the experimental group were significantly lower than the patients in the control group (respectively: 4.16 ± 1.31, 11.0 ± 1.74; p < .05). In the postoperative period, the mean scores of the state (38.86 ± 6.11) and trait anxiety scores (38.26 ± 3.85) of the patients in the experimental group were found to be significantly lower than the patients in the control group (respectively: 59.03 ± 9.10, 43.80 ± 4.38; p < .05).
Conclusion
Preoperative training reduced the postoperative anxiety and increased the level of patient mobility after total knee arthroplasty in this study.
► We propose a method to identify environmental variables that affect efficiency. ► We use bootstrap-DEA and CART analysis in a two stage approach. ► The accuracy of the variable selection thought ...CART increase applying bootstrap-DEA. ► Italian health efficiency is influenced by the decisions of local governments. ► Italian health efficiency is influenced by the patient mobility.
One of the main problems in efficiency analysis is to determinate the environmental variables that have an impact on the production process. This paper shows that applying bootstrap to data envelopment analysis (DEA) before performing classification and regression trees (CART) increase the quality of the results. In particular, employing data on the Italian Health System, the paper highlights that bias corrected DEA allows to individuate variables affecting health efficiency which would remain undiscovered when the traditional DEA model is applied.
Objective: The purpose of this study is to describe the location and patient activity factors associated with falls on one inpatient geriatric psychiatry unit. Methods: This was a descriptive ...retrospective analysis of 61 patient fall events during a 3-year review period. Results: Most falls, 67.8% (n = 40), occurred in the patients' personal areas as compared to the communal areas, 32.2% (n = 19). The most common locations of patient falls were the patient room (44.1%, n = 26), bathroom (23.7%, n = 14), hallway (18.6%, n = 11), and living room (11.9%, n = 7). The most common patient activities at the time of a fall were ambulating (49.1%; n = 28) and transferring (36.8%, n = 21). More than half (57.1%, n = 12) of all transfer-related falls occurred during a bed transfer. Conclusions: The findings suggest that clinical fall risk assessments and interventions in inpatient geriatric psychiatry units should emphasize patient personal space areas and include mobility factors, particularly ambulation and transfers.
Patient travel across borders to access healthcare is becoming increasingly common and widespread. Patients moving from high income to middle income countries for healthcare is well documented, with ...patients seeking treatments that are cheaper or more readily available than at home. Less well understood is when patients move from one low income country to another or from a low income country to a higher income country. In this paper, a realist review was undertaken to explore why, in what contexts and how patients from lower income countries travel to countries with the same, or more advanced, economies for planned healthcare. Based on an initial scoping of the literature and discussions with key informants, we generated an initial theory and set of propositions about why, how, who and in what contexts people cross international borders for planned healthcare. We then systematically located and synthesized (1) peer-reviewed studies from the Scopus, Embase, Web of Science and Econlit databases; (2) non-indexed reports using key informants and Google; and (3) papers from the reference lists of included documents, to glean supportive or contradictory evidence for our initial propositions. As we reviewed the literature and extracted our data, we drew on the work of Pierre Bourdieu to understand the interplay between material and non-material capital and cognitive processes in decisions to cross borders for healthcare. Patient travel was largely undertaken due to a lack of services in the home country and/or unacceptability of local services, with decisions on when, and where, to travel, usually made within the patient's social networks. They were able to travel via use of multiple resources, including social networks, economic and cultural capital, and habitus. Those patients with greater volumes of the aforementioned factors had greater healthcare options; however, even those with limited resources engaged in patient travel. Patient movement challenges traditional ways of thinking about public health and the notion of health systems contained within the nation state. Further research is needed to better understand the effects of patient travel, and how to harness the benefits of patient travel without exacerbating existing health inequalities.
Abstract
In March 2011, a new Directive was adopted by the European Parliament and the Council of the European Union: Directive 2011/24, on the application of patients' rights in cross-border ...healthcare, the primary purpose of which has been to facilitate access to healthcare across national borders. Healthcare safety and the availability of legal remedies in cases of harm are important parameters of quality healthcare and important patients' rights in modern healthcare systems, and they are therefore important issues in a context of cross-border patient mobility. The aim of this article is to shed some light on the provisions of the Healthcare Directive in relation to the issue of legal remedies in cases of harm. It is argued that the current legal state should be considered unsatisfactory, problematic and in need of more clarity and even harmonisation.
•We study the effect of interjurisdictional patient mobility on health care provision and financing.•We use a Hotelling model with two regions that differ in technology and finance health care ...through taxation.•We show that patient mobility may have adverse effects on quality and welfare unless an appropriate transfer payment scheme is implemented.
Patient mobility is a key issue in the EU which recently passed a new law on a patient's right to EU-wide provider choice. In this paper we use a Hotelling model with two regions that differ in technology to study the impact of patient mobility on health care quality, health care financing and welfare. We show that without patient mobility quality is too low (high) and too few (many) patients are treated in the high-skill (low-skill) region. The effects of patient mobility depend on the transfer payment. If the payment is below marginal cost, mobility leads to a ‘race-to-the-bottom’ in quality and lower welfare in both regions. If the payment is equal to marginal cost, quality and welfare remain unchanged in the high-skill region, but the low-skill region benefits. For a socially optimal payment, which is higher than marginal cost, quality levels in the two regions are closer to (but not at) the first best, but welfare is lower in the low-skill region. Thus, patient mobility can have adverse effects on quality provision and welfare unless an appropriate transfer payment scheme is implemented.
PDF
