A new value stream mapping approach for healthcare environments

Hospitals worldwide are giving a growing emphasis to the application of lean concepts in the healthcare sector, commonly known as ‘lean healthcare’. A fundamental tool that allows such implementations is the value stream mapping (VSM). The problem is that VSM models used in implementations of lean healthcare are simple adaptations of the original VSM model, which was initially directed towards manufacturing and may not always represent important support activities for the patient flow that directly impact treatment time. Within this context, this paper presents a new VSM approach for healthcare environments. This new VSM model, specifically designed for healthcare environments, contemplates all activities that directly affect the treatment time. In addition, the present paper also presents an action research in a Brazilian hospital where the proposed VSM model is compared to other VSM models found in the literature. The results shown that the proposed VSM model was able to identify some operational bottlenecks and wastes that interfere in the patient’s treatment that could not be identified by other mapping models studied.     

Medical Utilization and Health Expenditure of the Elderly in Taiwan

The present analysis, based upon data from the 1989 Taiwan Labor Force Survey, includes two parts. First, the determinants of physician visits and hospitalization by the elderly are analyzed according to the behavioral systems approach, and, second, variation in health expenditures among the elderly are examined using the Tobit model with sample selection. Findings show that elderly with good or poor health conditions are less likely to use medical services than the frail elderly and that married elders are less likely than the non-married to use medical care. The higher the educational level, the lower the probability of using formal medical services, and elderly who have health insurance are more likely to use formal health care than those who have no health insurance. The elderly who live with their children are less likely to use formal medical services than those who do not live with their children. Finally, among the elderly who have used formal health care, individual health expenditures are influenced primarily by three factors: health condition, health insurance, and residential location. Implications for Taiwan's relatively newly established national health insurance program (effective April 1, 1995) are discussed based upon the findings of this research.     

县级城市医疗卫生事业建设中的问题研究

在城市化进程加快的今天,县级城市既有城市的特点,又有农村的特征。医疗卫生是公共事业的重要组成部分,县级城市的医疗卫生事业发展水平对于我国医疗卫生事业的整体发展而言关系重大。从医疗卫生服务体系上来说,县级城市既有向城市专科医疗方向发展的特点,又具有巩固与发展三级医疗卫生网络的特点。因而对于县级城市医疗卫生事业发展的研究具有深远意义。     

Danger control and fear control during public health emergencies: Considering the roles of fear and hope in the EPPM across different levels of trust

Public health emergencies pose considerable threats to global health and safety. The control of these emergencies requires the efforts of healthcare professionals and calls for the public to take protective actions. The present study not only puts fear back in the extended parallel process model (EPPM) but also considers another similarly productive emotion: hope. We examined the mechanisms behind the effects of four cognitive perceptions on protective actions (i.e., danger control) and information avoidance (i.e., fear control). A national online survey was conducted with 1676 participants during the outbreak of COVID-19 in China from February 1 to 29, 2020. The results revealed that perceived severity and susceptibility could lead to fear, positively affecting protective actions. On the other hand, perceived response efficacy and self-efficacy induced hope, which was positively associated with protective actions but negatively associated with information avoidance. Furthermore, the mechanisms behind the relationships among cognitions, emotions, and behaviors varied across levels of trust in healthcare systems.     

Performance Effects Related to the Sequence of Integration of Healthcare Technologies

There is a natural order to most events in life: Everything from learning to read to DNA sequences in molecular biology follows some predetermined, structured methodology that has been refined to yield improved results. Likewise, it would seem that firms could benefit by adopting and implementing technologies in some logical way so as to increase their overall performance. In this study of 555 hospitals, we investigate the order in which medical technologies are transformed into information technologies through a process of converting them from stand‐alone technologies to interoperable, integrated information systems and whether certain configurations of sequences of integration yield additional value. We find that sequence does matter and that hospitals that integrated foundational technologies first—which in this case are known to be more complex—tend to perform better. Theoretical and practical implications of this finding and others are discussed.     

制约高校体育保健课程发展的因素剖析

采用问卷、访谈等方法对浙江省15所高校体育保健课程的发展现状进行了调查分析。结果表明：（1）教学目标欠全面、明确;（2）部分高校教学文件缺乏,教师专业功底不深;（3）个别院校无独立开班,课堂教学多数采用的是统一模式;（4）教学内容不均衡;（5）评价体系单一。同时对出现的问题也提出了发展建议。     

我国医药卫生法制体系建立健全刍议

针对《中共中央国务院关于深化医药卫生体制改革的意见》的相关内容,论述了我国医药卫生法制建设的现状及存在的问题,对建立健全医药卫生法制体系提出了建议。     

Why Ugandan rural households are opting to pay community health insurance rather than use the free healthcare services

Twikirize JM, O'Brien C. Why Ugandan rural households are opting to pay community health insurance rather than use the free healthcare services Uganda reintroduced free healthcare in 2001, but today, nine years later, less than 30 per cent of the population are using these services. This study investigated why rural households were under‐utilising the government's free health services and turning to community health insurance instead. A survey carried out on 260 randomly selected households was triangulated with qualitative data gained from 3 focus groups and 12 in‐depth interviews. The findings showed that 21 per cent of the households always accessed the government's free health services, while 79 per cent used private health services. The reasons given were poor quality services, including frequent drug stock‐outs, unmotivated and insufficiently trained health personnel, and overcrowding. Factors influencing enrolment in community health insurance included easier access to healthcare, financial protection against the cost of care, better quality care and benefits related to mutual assistance. This has both practical and policy implications, which are discussed in this article.     

The impact of health insurance cost-sharing method on healthcare utilisation in China

In current Chinese health insurance programmes, there are two types of cost-sharing methods: the time-of-service copayment policy and the reimbursement policy. In contrast to the copayment participants, reimbursement participants need to pay for all medical expenses in advance. We study the effect of the reimbursement policy on the utilisation of healthcare services in China. The theoretical analysis indicates that the medical consumption of low income households will be less than the optimal consumption level when enrolled in a reimbursement programme instead of a copayment programme. Empirically, using data from the China Health and Retirement Longitudinal Study (CHARLS), we find that the total inpatient expenditure of the reimbursement participants is 12.7% lower than that of copayment enrolees, and the reimbursement arrangement negatively impacts low-income and rural populations. Therefore, reimbursement participants, those who are financially constrained, are more likely to suffer the up-front payment burden and finally reduce their healthcare needs.     

Sequencing and Scheduling Appointments with Potential Call‐In Patients

This paper studies appointment scheduling for a combination of routine patients who book well in advance and last‐minute patients who call for an appointment later that same day. We determine when these same‐day patients should be scheduled throughout the day, and how the prospect of their arrivals affects the appointment times of the routine patients. By formulating the problem as a stochastic linear program, we are able to incorporate random and heterogeneous service times and no‐show rates, ancillary physician tasks, and appointment delay costs for same‐day patients who prefer to see the doctor as early as possible. We find that the optimal patient sequence is quite sensitive to the no‐show probabilities and the expected number of same‐day patients. We also develop two simple heuristic solutions to this combinatorial sequencing problem.