Mobilising patients towards transnational healthcare markets – insights into the mobilising work of medical travel facilitators in Delhi

ABSTRACT

Medical travel facilitators play an important role in mobilising patients towards transnational healthcare markets. However, little is known about the actual mobilising work of medical travel facilitators located at destination sites, such as Delhi, India. The following ethnographic study suggests conceptualising medical travel facilitators as brokers who are productive of a mobility infrastructure. This allows categorising three mobilisation strategies: direct patient mobilisation, channel partner mobilisation and patient testimonial mobilisation. These strategies draw attention to practices that build trust over distance, the power of word-of-mouth and the importance of nurturing personal relationships that translate into transnational channels that direct people to particular destinations.     

Healthcare Experiences of Latinos in a Nontraditional Destination Area

The purpose of this study was to describe the health and healthcare experiences of immigrant Latinos compared to USA-born Latinos, Whites, and African Americans in Greater Cincinnati, Ohio, a nontraditional immigrant destination area. Immigrant Latinos had significantly worse physical and mental health than other groups and significantly more barriers to healthcare. Latinos rated the degree to which their town is socially accepting of Latinos. Lower social acceptance was correlated with worse mental health and more barriers to healthcare. Geographic information system (GIS) mapping techniques revealed geographic patterns in the association between social acceptance of Latinos and health outcomes.     

费孝通教授谈补课

本文摘录了费孝通教授在不同场合谈补课的相关言论 ,为中国社会学的学科建设和人才培养等问题提出了建议     

The Effect of Integrated Scheduling and Capacity Policies on Clinical Efficiency

In outpatient healthcare clinics, capacity, patient flow, and scheduling are rarely managed in an integrated fashion, so a question of interest is whether clinic performance can be improved if the policies that guide these decisions are set jointly. Despite the potential importance of this issue, we find surprisingly few studies that look at how the allocation of capacity, paired with various appointment scheduling policies and different patient flow configurations, affects patient flow and clinical efficiency. In this paper, we develop an empirically based discrete‐event simulation to examine the interactions between patient appointment policies and capacity allocation policies (i.e., the number of available examination rooms) and how they jointly affect various performance measures, such as resource utilization and patient waiting time. Findings suggest that scheduling lower‐variance, shorter appointments earlier in the clinic (and, conversely, higher‐variance, longer appointments later) results in less overall patient waiting without reducing physician utilization or increasing clinic duration. Additionally, exam rooms exhibited classic bottleneck behavior: there was no effect on physician utilization by adding exam rooms beyond a certain threshold, but too few exam rooms were devastating to clinic throughput. Some significant interactions between these variables were observed, but were not influential to the level of managerial concern. Clinicians' intuition about managing capacity in healthcare settings may differ substantially from best policies.     

Lean-healthcare approach to reduce costs in a sterilization plant based on surgical tray rationalization

Abstract

Sterilization plants process all reusable materials used in hospitals during different stages of healthcare provision. Most items sterilized come from the surgical theater in the form of individual instruments, linen and surgical trays. Reducing the number of instruments in trays impacts on the performance of the sterilization process. Here, we propose a three-phase method, based on lean healthcare principles, cluster analysis and kaizen groups of experts to rationalize surgical trays, reducing sterilization processing costs. We innovate by proposing a strategy to approach tray rationalization prioritizing surgical specialties that are both complex and frequent, and by using group technology to cluster surgical trays expediting expert analyses carried out by kaizen groups. Our propositions were tested in a high complexity, tertiary care hospital, covering 12 surgical specialties, reducing the number of instruments by average 9.75%, and the time-to-assemble trays by average 9.68%, obtaining annual savings of US$285.756,00 in sterilization processing costs.     

Ice‐Breaker vs. Standalone: Comparing Alternative Workflow Modes of Mid‐level Care Providers

Capitalizing on the operational concept of division‐of‐labor, clinics often reduce physician service time by off‐loading some of his/her clinical activities to lower‐cost personnel. These personnel, such as nurse practitioners and physician assistants, are often collectively referred to as “mid‐level providers” (MLPs) and can perform many patient‐consultation tasks. The common rationale is that using an MLP allows the physician to serve more patients, increase patients’ access to care, and, due to MLPs’ lower salaries, improve the clinic's financial performance. An MLP is typically integrated into the outpatient clinic process in one of two modes: as an “ice‐breaker,” seeing each patient before the physician, or as a “standalone” provider, a substitute for the physician for the entirety of some patients’ visits. Despite both of these modes being widely used in practice, we find no research that identifies the circumstances under which either one is preferable. This study examines these two modes’ effects on operational performance, such as patient flow and throughput, as well as on financial measures. Using queueing and bottleneck analysis, discrete‐event simulation, and profit modeling, we compare these two deployment modes and identify the optimal policies for deploying MLPs as either ice‐breakers or as standalone providers. Interestingly, we also find there exists a range of scenarios where not hiring an MLP at all (i.e., the physician works alone) is likely to be most profitable for the clinic. Implications for practice are discussed.     

Is coverage enough? Persistent health disparities in marginalised Latino border communities

ABSTRACT

What has been the fate of those living in the place once dubbed the ‘county that needs the Affordable Care Act the most’? This article presents results from a longitudinal, five-year ethnographic study of healthcare access in the Rio Grande Valley of Texas. It explores reasons why this region along the U.S./Mexico border has the highest rate of uninsured persons in the country and remains among the most medically underserved, despite some increases in coverage accompanying the Affordable Care Act (ACA). It argues that the convergence of healthcare and immigration policy, framed by a unique regional history and social environment, has had multiple direct and indirect impacts on health and healthcare access. It examines the impact of the ACA on access for Latino immigrants and mixed-status households, which contain a mix of citizens, legal residents, and undocumented persons. It argues that the ACA aided in shifting the conversation to promoting private insurance coverage and away from more fundamental access barriers for low-income working populations ineligible for its benefits. This has eclipsed discussions about fundamental causes of persistent and highly racialised health disparities.     

Disclosure among victims of elder abuse in healthcare settings: a missing piece in the overall effort toward detection

Elder abuse remains a largely hidden problem in our society and only a small minority of victims are connected to formal support/protective services. Healthcare settings have been identified as a critical milieu to uncover cases of elder abuse; however, under-detection in these settings is a major issue. Victimization disclosure is an important component within the overall detection effort, yet it has received little attention in the elder abuse literature. Drawing on relevant literature from other domains of family/interpersonal violence, this article highlights the disclosure process, as well as disclosure barriers, facilitators, and competencies to consider when working with older adults.     

“三下乡”社会实践活动的德育价值——湖南工业大学“三下乡”活动调查与分析

在当前德育方法存在脱离实际,局限于规范和教条等情况下,湖南工业大学的"三下乡"社会实践活动独辟蹊径,以明确的德育目标、科学的德育过程等举措或途径,收到了道德自主、自觉形成和内化等成效,发挥了重大的德育作用.     

存在爽约行为的异质患者序列预约调度优化

针对服务时间不同且存在爽约行为的异质患者,考虑患者的动态预约过程,设计患者的序列调度优化方案。给定患者集合,以最小化患者等待时间成本和医生空闲及加班成本为目标,建立混合整数规划模型,分别在不考虑患者超订和允许患者超订两种情况下优化排序方案。在此基础上,设计患者动态到达的序列预约调度优化方案,在患者发出预约请求时立即决定是否接受该患者,同时为接受预约的患者安排相应的服务时间,即为其分配服务开始时间。进一步地,提出将服务时间差异较大的患者进行分类调度、分时段就诊的预约方案,以减少医生加班和空闲时间。通过数值计算验证模型和算法的有效性。此外,数值结果显示,基于患者服务时间差异进行分类分时段的调度方案可以在一定程度上降低系统成本,提高服务效率。