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Balancing of Payments for Sustainable Clinical Laboratory Growth
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Background
Reporting standards, such as PRISMA aim to ensure that the methods and results of systematic reviews are described in sufficient detail to allow full transparency. Flow diagrams in evidence syntheses allow the reader to rapidly understand the core procedures used in a review and examine the attrition of irrelevant records throughout the review process. Recent research suggests that use of flow diagrams in systematic reviews is poor and of low quality and called for standardised templates to facilitate better reporting in flow diagrams. The increasing options for interactivity provided by the Internet gives us an opportunity to support easy‐to‐use evidence synthesis tools, and here we report on the development of a tool for the production of PRISMA 2020‐compliant systematic review flow diagrams.
Methods and Findings
We developed a free‐to‐use, Open Source R package and web‐based Shiny app to allow users to design PRISMA flow diagrams for their own systematic reviews. Our tool allows users to produce standardised visualisations that transparently document the methods and results of a systematic review process in a variety of formats. In addition, we provide the opportunity to produce interactive, web‐based flow diagrams (exported as HTML files), that allow readers to click on boxes of the diagram and navigate to further details on methods, results or data files. We provide an interactive example here; https://prisma-flowdiagram.github.io/.
Conclusions
We have developed a user‐friendly tool for producing PRISMA 2020‐compliant flow diagrams for users with coding experience and, importantly, for users without prior experience in coding by making use of Shiny (https://estech.shinyapps.io/prisma_flowdiagram/). This free‐to‐use tool will make it easier to produce clear and PRISMA 2020‐compliant systematic review flow diagrams. Significantly, users can also produce interactive flow diagrams for the first time, allowing readers of their reviews to smoothly and swiftly explore and navigate to further details of the methods and results of a review. We believe this tool will increase use of PRISMA flow diagrams, improve the compliance and quality of flow diagrams, and facilitate strong science communication of the methods and results of systematic reviews by making use of interactivity. We encourage the systematic review community to make use of the tool, and provide feedback to streamline and improve their usability and efficiency.
Background:
Equity in health financing as one main aspect of health equity plays an essential role on the path toward universal health coverage. Out of pocket payment (OOP), a source with high share to total health expenditure, is an inequitable mechanism for health financing.
Main body:
The OOP has been considered regressive (Kakwani index with a negative value) in nature. However, in some studies especially in developing countries, it is reported to be progressive (Kakwani index with a positive value). The main questions are: Is the progressive OOP equitable? What causes this contradiction? What can we do for the proper interpretation? And what are policy implications of this issue? In this commentary we briefly elaborate on these issues. We present several reasons for progressivity of OOP, and several methodological and policy issues for addressing it.
Conclusions:
Even if the OOP is progressive and the share of poor people is low, this may financially limit their access to health services, increase their risk of incurring catastrophic health expenditure (CHE), and even pushing them more into poverty. In order to provide a comprehensive picture of equity in health financing, other financial protection indicators such as the redistributive effect, re-rating, exposure to CHE, and impoverishment due to health expenditure should also be estimated and reviewed.
Sustainability, as well as the sustainable use of resources and related issues, has inspired a long-lasting and lively debate among scholars of different disciplines. Due to under-investigation of several of the sustainability-related challenges, this paper aims to better understand the system dynamics that, supported by some digital enablers (e.g., digital technologies and platforms), boost the sustainability of complex service systems such as healthcare. To this end, the theoretical meta-model of interaction types, which inspired the prototype digital platform dedicated to the online delivery of health-related services, is presented. Moreover, some healthcare usage scenarios, based on the prototype’s functions, are analysed and discussed. This allows understanding of how important the role of technologies and, in particular, digital platforms, are in empowering actors and in making them willing to interact, and share their own resources in continually new ways. This paves the way for ongoing value co-creation, which is essential for healthcare system sustainability.
Background: Achieving Universal Health Coverage (UHC) has by now become a key health policy goal in many countries and some form of National Health Insurance (NHI) is often used for this. The Philippines has had more than 50 years’ experience with social health insurance and in 1995 established PhilHealth, the country’s national health insurer.
Objectives: Analyzing the role of the Philippine NHI scheme in moving towards UHC, identifying potential avenues for improvement as well as indicating challenges and areas for further development.
Methods: This paper is based on a mixed methods approach including extensive literature search, data from PhilHealth and other sources, and key informant interviews with staff at PhilHealth, health care providers, and policy experts at national and international level.
Results: Major achievements were the expansion of population coverage using an earmarked revenue source (‘Sin Tax’), the introduction of the no-balance-billing to prevent co-payments, and the Health Facilities Enhancement Program to improve quality. The share of PhilHealth in total health expenditures is still only 14%, managing quality and cost of providers remains insufficient, the benefit coverage does not reflect the country’s burden of disease, and financial protection for PhilHealth members is low. The UHC bill would provide a massive jump forward as all Filipinos would then be automatically enrolled in and thus entitled to the benefits of PhilHealth.
Conclusions: For expanding a contribution-based NHI beyond formal employment there needs to be a large increase in budget transfers to cover for citizens unable to contribute. The Philippine UHC bill shifts from the idea of contribution leading to entitlement to the idea of citizenship leading to entitlement and can thus be seen as a paradigmatic change in thinking about NHI. There are three areas that we believe are of key importance in developing further NHI: (i) governance, (ii) financial impact, and (iii) strategic purchasing.
Purpose
Poverty, hunger, inequalities, diseases, unsustainable use of resources, etc., in spite of scientific progress, still remains unsolved worldwide issues. All these issues relate to the challenges of sustainability and sustainable development that now call for urgent answers. The purpose of this paper is to explore how the service research community can respond to this call and to identify key areas of potential contribution.
Design/methodology/approach
After a brief review of selected service literature aimed at exploring its interest in the topics of sustainability and sustainable development, the authors develop the interpretative proposal identifying the key requirements of a global engagement in the challenge of sustainability and sustainable development and highlighting the potential contribution of service research.
Findings
Findings highlight the potential contribution of service research to the global challenge of sustainability and suggest acting upon education by considering the “T-Shaped” professional model as a possible reference for embedding sustainability in the education of future managers and addressing the need of interdisciplinary thinking through the systems approach.
Research limitations/implications
The proposed study of service literature is only an exploratory analysis of main contributions that does not aim to identify gaps but only to highlight the potential of a greater engagement of service research in the global call for a more sustainable and inclusive development.
Practical implications
A trans-disciplinary approach is also required. This implies the involvement of the business and the social real world.
Originality/value
This paper represents a novel call for engaging the service research community in a boundary-crossing collaboration with the aim of contributing to address the challenge of sustainability.
Building trust through collaboration, institutional development, and social learning enhances efforts to foster ecosystem management and resolve multi-scale society-environment dilemmas. One emerging approach aimed at addressing these dilemmas is adaptive co-management. This method draws explicit attention to the learning ( experiential and experimental) and collaboration ( vertical and horizontal) functions necessary to improve our understanding of, and ability to respond to, complex social-ecological systems. Here, we identify and outline the core features of adaptive co-management, which include innovative institutional arrangements and incentives across spatiotemporal scales and levels, learning through complexity and change, monitoring and assessment of interventions, the role of power, and opportunities to link science with policy.
Regional form of Organization of the health care that are called today DyPE, have as a main goal to promote more rational resource allocation through decentralization in the decision making process. The concern for more effective and efficient use of resources devoted into the health care sector renders hospitals a critical vehicle of the quest for superior economic performance, especially if we take into our consideration their mounting over time deficits. Economic performance is primarily traced through a set of specific financial ratios, which embrace important elements that constitute the substance of the financial well-being of hospitals as economic units. An array of financial ratios is critically reviewed and a combination of them is proposed as a means of effective financial management. The later is necessary to ameliorate the funding strain imposed on the health care system and especially on hospitals. The financial performance is determined by the return on capital (profitability) in connection with the risk involved. Both factors determine the value created, which in turn affects the amount of financing attracted in the sector. The financial information available to the supervising regional bodies (DyPE), don’t considered sufficient for their management to assess financial management of hospitals effectively. The lack of the appropriate economic data is due to the fact that double entry accounting has not yet fully adopted by the economic units that report to the corresponding DyPE. So, double entry accounting is prerequisite for reporting and monitoring acceptable financial performance. The later is vital in securing that the financial needs of the health sector that are growing at an ever accelerating pace, are met.
Public opinion surveys uniformly show low support for medical-care systems in developed countries. The longstanding conflict between equal access to care and efficient service provision partly explains this dissatisfaction. But the trade-off is particularly acute in medical care, as new technologies developed over time have increased the cost of care and made the equity commitment even more expensive. Countries first dealt with rising costs by maintaining equal access and restricting total spending. Efficiency suffered, however. As a result, many countries are considering a move away from spending controls and toward incentive-based medical-care reform.
Healthcare, and in particular, clinical laboratories, are major contributors to carbon emissions and waste. Sustainability in healthcare has shifted from an environmental concern towards a holistic definition that includes balancing socio-ecological and socio-technical systems, including health services effectiveness and cost efficiency. Digital transformation can reduce waste and the cost of services by enhancing effectiveness while maintaining quality. Digital health interventions can provide personalized patient-centered care on a global scale and include decision support systems that have the potential to improve the performance and quality of healthcare. The right interfaces must be used so that the advantages of going digital are felt throughout the health system: a successful and sustainable implementation of digital innovation depends on its integration into a functional health ecosystem. Telehealth has the potential to reduce carbon emissions due to the reduced daily commute of health professionals, although research is limited. Recently, economic models have changed from the linear "take-make-dispose" to circular models based on recycling and upcycling that have the goal of keeping products, components, and materials at their highest utility and value. The previous linear models threaten human health and well-being and harm natural ecosystems.
We examine how hospital treatment intensity is affected by an exogenous change in average reimbursement for an admission. Theory predicts that treatment intensity would be most affected for highly profitable services but unaffected for unprofitable services. We use Medicare inpatient data from 11 states for 16 disease categories that vary in the generosity of reimbursement to test this prediction. Using the coefficients from quantile regressions, we calculate a difference‐in‐difference estimate of the effect of the Balanced Budget Act (BBA) of 1998, comparing the pre‐ and post‐BBA change in treatment intensity at high Medicare share hospitals to low Medicare share hospitals. We find that not‐for‐profit hospitals cut treatment intensity at the 50th, 75th, and 95th quantiles only for generously reimbursed services. Intensity at the 25th percentile was unaffected, regardless of generosity. We did not measure a statistically significant response at for‐profit or public hospitals to the BBA.
This article analyzes differences in the financial performance, cost, and productivity between system-affiliated and independent hospitals. Data for the study were obtained from the 1981 American Hospital Association (AHA) Annual Survey of Hospitals for the State of Iowa and included 94 nonstate or nonfederal short-term hospitals without long-term care units. An interpretation of the results indicated that system-affiliated hospitals are more profitable, have better access to capital markets, are more effective price setters, and experience higher costs per case which are related to longer lengths of stay and less productive use of plant and equipment in generating revenues.
Financial pressure mounted for hospitals nationwide during the late 1990s. Our study examines how this affected the quality of their operations in terms of organizational infrastructure and processes that support the delivery of care. Our sample consisted of community hospitals operating between 1995 and 2000. Financial pressure was measured based on changes in net patient revenues per adjusted patient day and the ratio of cash flow to total revenues. The authors examined effects on hospital investments in plant and equipment and on hospital standards compliance with selected Joint Commission on Accreditation of Healthcare Organization performance areas. The results suggest that increasing financial pressures did lead to cutbacks in these areas. These findings suggest the importance of looking broadly across hospital operations to identify factors that may contribute to poor patient outcomes. Given the findings of earlier studies, these results suggest that poor outcomes may in part result from deterioration in supporting infrastructure and organizational processes.
Examining Financial Performance Indicators for Acute Care Hospitals
- David Bloom
The Philippines Health System Review
- M M Dayrit
The Viable System Model
- Angela Espinosa
Introduction to Laboratory Finance: The Key to Sustainable Operations
- Matthys Greeff
What Is the Balance of Payments?
- Reem Heakal
The Role of Medical Laboratories in Disease Management
- Michael Walekhwa
Redefining Health Care: Creating Value-Based Competition on Results
- Michael Porter