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The International Journal of Health Planning and Management

Impact factor: 0.787 5-Year impact factor: 0.928 Print ISSN: 0749-6753 Online ISSN: 1099-1751 Publisher: Wiley Blackwell (John Wiley & Sons)

Subjects: Health Policy & Services, Public, Environmental & Occupational Health

Most recent papers:

  • Challenges of Rashtriya Swasthya Bima Yojana (RSBY) in West Bengal, India: An exploratory study.
    Satarupa Bandyopadhyay, Kasturi Sen.
    The International Journal of Health Planning and Management. October 20, 2017
    This study reviews the economic viability of the Rashtriya Swasthya Bima Yojana (RSBY), India's landmark health insurance program for below poverty line (BPL) populations in West Bengal state of India. It addresses the issue through in‐depth analysis of literature, national and state level data, and a number of key stakeholder interviews. The study argues that the market failure conditions of this insurance model will continue to perpetuate losses for not only the state, but also for insurance companies, unless they adjust on a continuous basis for profit by raising the premium rate. This will further deplete state budgets for health care affecting the viability of the scheme in the long run.
    October 20, 2017   doi: 10.1002/hpm.2453   open full text
  • Relative reductions in health care utilization among young adults before aging out of extended dependent coverage.
    Weiwei Chen.
    The International Journal of Health Planning and Management. October 18, 2017
    The 2010 Affordable Care Act extended dependent coverage for adult children up to age 26 in the USA. Since then, considerable studies have assessed its various impacts among young adults. However, little is known about whether there is any change in health care use when young adults age out of dependent coverage. This study examines health care consumption changes among young adults prior to their aging out process. I used data from a large insurance claim database and studied health care utilization of young adults under parents' coverage during a 2‐year period in a difference‐in‐difference framework. I found that young adults had relative reductions in health services use, except ER visits, compared with individuals who stayed under parents' coverage. This pattern was the same for both male and females. Individuals with regular medical needs had greater relative reductions compared with those without regular medical needs. The relative reductions in health care use during the aging out process may have an important impact on young adults' health, especially for those with regular medical needs. More efforts could be made to help them maintain regular medical utilization during the transition.
    October 18, 2017   doi: 10.1002/hpm.2466   open full text
  • Determinants of bed net policy implementation: A case study of Southern Benin.
    Georges Danhoundo, Mary E. Wiktorowicz, Shahirose Sadrudin Premji, Khalidha Nasiri.
    The International Journal of Health Planning and Management. October 13, 2017
    Background Malaria is a major global health challenge. This study aims to clarify the manner in which contextual factors determine the use and maintenance of bed nets and the extent to which malaria prevention policy is responsive to them in Southern Benin. Methods Semi‐structured interviews and direct observations were undertaken with 30 pregnant women in the municipality of So‐Ava from June to August 2015. Key informants in the Ministry of Health and local community health workers were also interviewed regarding malaria prevention policy formation, and the monitoring and evaluation of bed net interventions, respectively. Data were analyzed through categorical content analysis and grouped into themes. Results The majority of pregnant women participants (80%) declared non‐adherence to instructions for hanging and maintaining insecticide‐treated nets (ITNs). The distributed bed nets were washed like clothes, which affected their bio‐efficacy, and were in poor condition (ie, torn or had holes). Multiple factors contributed to the poor condition of ITNs: Pregnant women's limited understanding of risk including their inability to connect the key environmental factors to personal risk, gendered responsibility for installing bed nets, and lack of public measures that would enable women to re‐treat or access new bed nets as needed. Poverty that determined structural aspects of housing such as the size and quality of homes and access to bed nets exacerbated the challenges. Conclusion Institutionalizing an iterative process of monitoring, review, and responsive adaptation throughout the entire policymaking cycle would better support malaria preventive policy implementation in Benin.
    October 13, 2017   doi: 10.1002/hpm.2465   open full text
  • How and why do countries differ in their governance and financing‐related administrative expenditure in health care? An analysis of OECD countries by health care system typology.
    Luc L. Hagenaars, Niek S. Klazinga, Michael Mueller, David J. Morgan, Patrick P.T. Jeurissen.
    The International Journal of Health Planning and Management. October 12, 2017
    Introduction Administration is vital for health care. Its importance may increase as health care systems become more complex, but academic attention has remained minimal. We investigated trends in administrative expenditure across OECD countries, cross‐country spending differences, spending differences between health care system typologies, and differences in the scale and scope of administrative functions across typologies. Methods We used OECD data, which include health system governance and financing‐related administrative activities by regulators, governance bodies, and insurers (macrolevel), but exclude administrative expenditure by health care providers (mesolevel and microlevel). Results We find that governance and financing‐related administrative spending at the macrolevel has remained stable over the last decade at slightly over 3% of total health spending. Cross‐country differences range from 1.3% of health spending in Iceland to 8.3% in the United States. Voluntary private health insurance bears much higher administrative costs than compulsory schemes in all countries. Among compulsory schemes, multiple payers exhibit significantly higher administrative spending than single payers. Among single‐payer schemes, those where entitlements are based on residency have significantly lower administrative spending than those with single social health insurance, albeit with a small difference. Discussion These differences can partially be explained because multi‐payer and voluntary private health insurance schemes require additional administrative functions and enjoy less economies of scale. Studies in hospitals and primary care indicate similar differences in administrative costs across health system typologies at the mesolevel and microlevel of health care delivery, which warrants more research on total administrative costs at all the levels of health systems.
    October 12, 2017   doi: 10.1002/hpm.2458   open full text
  • Shortening gestational age at term and organisation of birth care in the Czech Republic.
    Martina Štípková.
    The International Journal of Health Planning and Management. October 10, 2017
    A trend of the shortening duration of pregnancies carried to term has been observed in several countries and represents a growing public health concern. This paper describes the trend in the Czech Republic and shows its relation to the changing demographic structure of mothers and the organisation of maternity care. Data from the birth register are used and supplemented with information about the capacity of maternity care (number of beds at maternity clinics, number of obstetricians and midwives). Logistic regression is used to estimate the odds of 37 to 39 vs 40+ completed weeks of gestation. The results show that the average gestational age at term decreased by 2.1 days between 2000 and 2013. The odds of 37 to 39 weeks of gestational duration increased, mainly due to the reduction in the number of beds at maternity clinics (adjusted odds ratio of 1.51). The effects of the number of health care staff members were weaker. The number of midwives positively influenced gestational duration, while the number of obstetricians had a negative effect. Maternal demographic structure cannot explain the trend. A likely explanation is the increased use of planned early term caesarean sections.
    October 10, 2017   doi: 10.1002/hpm.2467   open full text
  • Boundary‐spanning actors in complex adaptive governance systems: The case of multisectoral nutrition.
    David Pelletier, Suzanne Gervais, Hajra Hafeez‐ur‐Rehman, Dia Sanou, Jackson Tumwine.
    The International Journal of Health Planning and Management. October 10, 2017
    A growing literature highlights complexity of policy implementation and governance in global health and argues that the processes and outcomes of policies could be improved by explicitly taking this complexity into account. Yet there is a paucity of studies exploring how this can be achieved in everyday practice. This study documents the strategies, tactics, and challenges of boundary‐spanning actors working in 4 Sub‐Saharan Africa countries who supported the implementation of multisectoral nutrition as part of the African Nutrition Security Partnership in Burkina Faso, Mali, Ethiopia, and Uganda. Three action researchers were posted to these countries during the final 2 years of the project to help the government and its partners implement multisectoral nutrition and document the lessons. Prospective data were collected through participant observation, end‐line semistructured interviews, and document analysis. All 4 countries made significant progress despite a wide range of challenges at the individual, organizational, and system levels. The boundary‐spanning actors and their collaborators deployed a wide range of strategies but faced significant challenges in playing these unconventional roles. The study concludes that, under the right conditions, intentional boundary spanning can be a feasible and acceptable practice within a multisectoral, complex adaptive system in low‐ and middle‐income countries.
    October 10, 2017   doi: 10.1002/hpm.2468   open full text
  • Management of syphilis in pregnancy: Knowledge and practices of health care providers and barriers to the control of disease in Teresina, Brazil.
    Danielle Carvalho Rodrigues, Rosa Maria Soares Madeira Domingues.
    The International Journal of Health Planning and Management. October 06, 2017
    Aims The aim of the study is to verify the knowledge and practices of health professionals working in prenatal care (PNC) related with syphilis during pregnancy and to identify the main barriers to the implementation of protocols for the control of this disease. Methods A cross‐sectional study in Teresina, Brazil, from January to May 2015, was conducted with 366 physicians and nurses working in PNC, corresponding to 70% of eligible professionals. We evaluated 20 knowledge and practice criteria related to the diagnosis and treatment of syphilis during pregnancy with a 95% compliance standard. We performed descriptive analysis of the data and used χ2 statistical test to verify differences according to professional category. Results Only 2 criteria, “knowledge about mother to child transmission according to gestational age” and “counselling on infection,” reached 95% compliance. Knowledge of the epidemiological profile of congenital syphilis and the goal of elimination of congenital syphilis and knowledge about serological tests had scores below 50%, while practices related with posttest counselling, cure control, and treatment of partners reached 60%. We identified organisational barriers related to the late initiation of PNC, to the delayed return of syphilis test results, to the application of benzathine penicillin in primary care units and to the treatment of partners. Conclusions Strategies for early initiation of PNC, implementation of rapid tests for syphilis, ensuring treatment of pregnant women with penicillin, adequate partner treatment, and continued education of health professionals on clinical management and counselling in sexually transmitted diseases are necessary to eliminate congenital syphilis.
    October 06, 2017   doi: 10.1002/hpm.2463   open full text
  • Programmes for the prevention of parent‐to‐child transmission of HIV in Papua New Guinea: Health system challenges and opportunities.
    Anna Tynan, Lisa Vallely, Martha Kupul, Ruthy Neo, Voletta Fiya, Heather Worth, Grace Kariwiga, Glen D.L. Mola, John Kaldor, Angela Kelly‐Hanku.
    The International Journal of Health Planning and Management. September 27, 2017
    Background Prevention of parent‐to‐child transmission (PPTCT) of HIV is a highly complex package of interventions, which spans services in both maternal and child health programmes. In Papua New Guinea (PNG), a commitment to ensure that all pregnant women and their partners have access to the full range of PPTCT interventions exists; however, efforts to increase access and utilisation of PPTCT remain far from optimal. The aim of this paper is to examine health care worker (HCW) perception of health system factors impacting on the performance of PPTCT programmes. Method Sixteen interviews were undertaken with HCWs involved in the PPTCT programme. Application of the WHO 6 building blocks of a health system was applied, and further thematic analysis was conducted on the data with assistance from the analysis software NVivo. Results Broken equipment, problems with access to medication and supplies, and poorly supported workforce were reported as barriers for implementing a successful PPTCT programme. The absence of central coordination of this complex, multistaged programme was also recognised as a key issue. Conclusion The study findings highlight an important need for investment in appropriately trained and supported HCWs and integration of services at each stage of the PPTCT programme. Lessons from the PPTCT experience in PNG may inform policy discussions and considerations in other similar contexts.
    September 27, 2017   doi: 10.1002/hpm.2450   open full text
  • Impact of chronic disease on the mid‐age employment in Taiwan.
    Chun‐Chih Chen, Ying‐Tzu Lin.
    The International Journal of Health Planning and Management. September 22, 2017
    Chronic diseases, also known as non‐communicable diseases (NCDs), have become the leading causes of deaths and disability around the world. Cardiovascular disease, cancer, and diabetes are also listed in the top 10 causes of deaths in Taiwan for decades. This study aims to investigate the relationship the chronic diseases and the mid‐age employment in Taiwan. We estimate the impact of the chronic diseases on employment using the 2009 NHIS data of Taiwan using 2 kinds of probit model. In addition, we show that a usual probit model can underestimate the negative effect of NCDs on mid‐age employment. To reduce the productivity loss from the NCDs, policymakers can increase the awareness of risk of these chronic diseases through media and the adult preventive care services, which is free for the people aged 40 and above in Taiwan.
    September 22, 2017   doi: 10.1002/hpm.2457   open full text
  • Challenges facing community health workers in Brazil's Family Health Strategy: A qualitative study.
    Rebecca Grossman‐Kahn, Julia Schoen, John William Mallett, Alexandra Brentani, Elizabeth Kaselitz, Michele Heisler.
    The International Journal of Health Planning and Management. September 21, 2017
    Community health worker (CHW) programs are implemented in many low‐ and middle‐income countries such as Brazil to increase access to and quality of care for underserved populations; CHW programs have been found to improve certain indicators of health, but few studies have investigated the daily work of CHWs, their perspectives on what both helps and hinders them from fulfilling their roles, and ways that their effectiveness and job satisfaction could be increased. To examine these questions, we observed clinic visits, CHW home visits, and conducted semistructured interviews with CHWs in 7 primary care centers in Brazil—2 in Salvador, Bahia, and 5 in São Paulo, SP—in which CHWs are incorporated into the work of all primary care health teams. In addition to enhancing communication between the medical system and the community, CHWs consider their key roles to be helping persuade community members to seek medical care and increasing health professionals' awareness of the social conditions affecting their patients' health. Key obstacles that CHWs face include failure to be fully integrated into the primary care team, inability to follow‐up on identified health needs due to limited resources, as well as community members' lack of understanding of their work and undervaluing of preventative medicine. Increased training, better incorporation of CHWs into clinic flow and decision making, and establishing a clear community awareness of the roles and value of CHWs will help increase the motivation and effectiveness of CHWs in Brazil.
    September 21, 2017   doi: 10.1002/hpm.2456   open full text
  • Patient satisfaction with health care services at a national institute of ophthalmology.
    Nguyen Van Huy, Nguyen Ngoc Dung, Cao Duc Thang, Le Thuy Hanh.
    The International Journal of Health Planning and Management. September 11, 2017
    Little is known about how patients in developing countries, such as Vietnam, are satisfied with eye care services. The purpose of this study was to assess the satisfaction with health services and its associated factors among patients attending a national institute of ophthalmology in Vietnam. In a cross‐sectional study utilizing quantitative methods, 500 inpatients and their relatives attending a national institute of ophthalmology in Vietnam were approached for data collection. The results indicated that under 50% of the patients were satisfied with eye care services. However, when classified by level of satisfaction, only 6.8% were very satisfied with all domains of care. There was no significant difference in satisfaction by gender and income, while significant differences by department, residence, and education were found. Patients who were from rural areas, were better educated, and used the services of the glaucoma department, were more satisfied with eye care than those from urban areas, were less educated, and used the services of treatment‐on‐demand department. Multivariable regression detected 2 main factors, gender and location, associated with patient satisfaction. Patients who were female and came from rural and remote areas were more likely to be satisfied than patients who were male and living in urban areas. The study suggests that to continue to improve health care quality, it is important to eliminate differences in providing eye care services regardless of whether patients are male or female, and whether they come from a rural or urban area.
    September 11, 2017   doi: 10.1002/hpm.2449   open full text
  • Evolution of HIV/AIDS response in Brazil: Policy innovations and challenges in the fourth decade of the epidemic.
    Elize Massard Fonseca, Francisco Inacio Bastos.
    The International Journal of Health Planning and Management. September 06, 2017
    Brazil was the first low‐ and middle‐income country to provide universal treatment access to people living with the acquired immunodeficiency syndrome (AIDS), becoming a widely acclaimed model for best practice to managing this epidemic. However, we know little about important challenges to the key pillars of Brazil's response. This article discusses how the evolution of the country's health system institutions and international advancements in AIDS treatment and prevention affected the national response. Decentralization of health system resources and policy making brought fresh challenges to the centralized governance of the national AIDS program and to civil society, weakening their coordination and advocacy capacity. Regardless, AIDS treatment and prevention strategies in Brazil remain aligned with the current international protocols, but unfortunately have been restricted in some geographic areas and/or populations.
    September 06, 2017   doi: 10.1002/hpm.2452   open full text
  • Motivation of the nurses in pre‐hospital emergency and educational hospitals emergency in the southeast of Iran.
    Hojjat Sheikhbardsiri, Gholamreza Khademipour, Mahmoud Nekoei‐Moghadam, Mohsen Aminizadeh.
    The International Journal of Health Planning and Management. September 06, 2017
    Introduction Nurses, as the largest human resource element of health care systems, have a major role in providing ongoing, high‐quality care to patients. Therefore, due to the importance of this issue, this study aimed to determine job motivation of the nurses in pre‐hospital and educational hospitals emergency in the southeast of Iran. Methods In this study, a cross‐sectional method was used, and it was conducted in educational hospitals and pre‐hospital emergencies under supervision of the Kerman University of Medical Sciences in 2017. Using a valid and reliable questionnaire, we assessed job motivation of the nurses using a census method (N = 275). Data were analyzed by implementing descriptive statistics including mean and standard deviation (SD), and analytical statistics such as Kolmogorov‐Smirnov, ANOVA, t‐test, X2, Pearson, and multivariate regression tests using SPSS 16 and P ≤ 0.05. Results Among the pre‐hospital emergency nurses, the average of the educational factors was 25.33, financial factors was 6.34, psychological factors was 20.07, welfare factors was 0.63, and administrative factors was 8.16. Among the nurses of the educational hospitals emergency, these factors were 25.33, 6.51, 20.34, 16.55, and 8.39, respectively. Two group's nurses were at the intermediate level of the job motivation. Conclusion Dynamic and predetermined goals of emergency include providing services as soon as possible and stabilizing patient's condition during the golden and vital time of rescue. Findings suggest that national and local policies in Iran may need to examine factors that contribute to the promotion of the motivation as well as focusing on how to improve them.
    September 06, 2017   doi: 10.1002/hpm.2455   open full text
  • “Enticing case study” or “celebrated anomaly”? Policy learning from the Cuban health system.
    Rob Baggott, George Lambie.
    The International Journal of Health Planning and Management. September 06, 2017
    Cuba is regarded as having achieved very good health outcomes for its level of economic development. It has adopted policies and programs that focus on prevention, universal access to healthcare, a strong primary care system, the integration of health in all policies, and public participation in health. It has also established a strong and accessible system of medical education and provides substantial medical aid and support to other countries. Why then, it may be asked, has the Cuban experience not had greater influence on health policies and reforms elsewhere? This article, based on a literature review and new primary sources, analyzes various factors highlighted in the policy transfer literature to explain this. It also notes other factors that have created greater awareness of Cuban health achievements in some countries and which provide a basis for learning lessons from its policies.
    September 06, 2017   doi: 10.1002/hpm.2451   open full text
  • Raising quality whilst reducing cost in health care: A retrospective cohort study.
    Yadava B. Jeve.
    The International Journal of Health Planning and Management. August 31, 2017
    Objective The objective of this study was to investigate the relationship between cost and quality within the health care sector and to establish which factors could influence this relationship. The aim was to investigate the dynamics of the relationship, in order to improve the quality whilst reducing the cost. Design This is a retrospective cohort study, analysing quality, safety, and financial data from a 5‐year period. Setting A publicly funded tertiary hospital. Participants The dependent variable was cost saved, and the independent variables were patient safety, patient satisfaction, and clinical efficiency. Main outcome measures: Financial savings and quality domains. Results A statistically significant relationship between the variables was found. Multivariate analysis derived the equation Y = βX1 + c, where Y is the cost saved, β is the beta coefficient, X1 is the clinical efficiency, and c is a constant. R2 = 0.874 (coefficient of determination), which suggested that the cost saved by the unit varied due to clinical efficiency. Clinical efficiency accounted for 87.4% of the variation in the cost saved by the unit. Conclusions The results indicated that, after the trade‐off value, an improvement in the quality would result in reduced costs for the unit. Clinical efficiency of the services was found to be the key factor determining this relationship. Therefore, strategies to increase clinical efficiency, and thus overall quality, above the trade‐off level could result in significant financial savings. Patient safety and patient experience were positively correlated with clinical efficiency.
    August 31, 2017   doi: 10.1002/hpm.2454   open full text
  • Fiscal transfers based on inputs or outcomes? Lessons from the Twelfth and Thirteenth Finance Commission in India.
    Victoria Y. Fan, Smriti Iyer, Avani Kapur, Rifaiyat Mahbub, Anit Mukherjee.
    The International Journal of Health Planning and Management. August 30, 2017
    Background There is limited empirical evidence about the efficacy of fiscal transfers for a specific purpose, including for health which represents an important source of funds for the delivery of public services especially in large populous countries such as India. Objective To examine two distinct methodologies for allocating specific‐purpose centre‐to‐state transfers, one using an input‐based formula focused on equity and the other using an outcome‐based formula focused on performance. Materials and Methods We examine the Twelfth Finance Commission (12FC)'s use of Equalization Grants for Health (EGH) as an input‐based formula and the Thirteenth Finance Commission (13FC)'s use of Incentive Grants for Health (IGH) as an outcome‐based formula. We simulate and replicate the allocation of these two transfer methodologies and examine the consequences of these fiscal transfer mechanisms. Results The EGH placed conditions for releasing funds, but states varied in their ability to meet those conditions, and hence their allocations varied, eg, Madhya Pradesh received 100% and Odisha 67% of its expected allocation. Due to the design of the IGH formula, IGH allocations were unequally distributed and highly concentrated in 4 states (Manipur, Sikkim, Tamil Nadu, Nagaland), which received over half the national IGH allocation. Discussion The EGH had limited impact in achieving equalization, whereas the IGH rewards were concentrated in states which were already doing better. Greater transparency and accountability of centre‐to‐state allocations and specifically their methodologies are needed to ensure that allocation objectives are aligned to performance.
    August 30, 2017   doi: 10.1002/hpm.2444   open full text
  • Public strategies for improving eHealth integration and long‐term sustainability in public health care systems: Findings from an Italian case study.
    Sabina De Rosis, Sabina Nuti.
    The International Journal of Health Planning and Management. August 08, 2017
    eHealth is expected to contribute in tackling challenges for health care systems. However, it also imposes challenges. Financing strategies adopted at national as well regional levels widely affect eHealth long‐term sustainability. In a public health care system, the public actor is among the main “buyers” eHealth. However, public interventions have been increasingly focused on cost containment. How to match these 2 aspects? This article explores some central issues, mainly related to financial aspects, in the development of effective and valuable eHealth strategies in a public health care system: How can the public health care system (as a “buyer”) improve long‐term success and sustainability of eHealth solutions? What levers are available to match in the long period different interests of different stakeholders in the eHealth field? A case study was performed in the Region of Tuscany, Italy. According to our results, win‐win strategies should be followed. Investments should take into account the need to long‐term finance solutions, for sustaining changes in health care organizations for obtaining benefits. To solve the interoperability issues, the concept of the “platform approach” emerged, based on collaboration within and between organizations. Private sector as well as beneficiaries and final users of the eHealth solutions should participate in their design, provision, and monitoring. For creating value for all, the evidence gap and the financial needs could be addressed with a pull mechanism of funding, aimed at paying according to the outcomes produced by the eHealth solution, on the base of an ongoing monitoring, measurement, and evaluation of the outcomes.
    August 08, 2017   doi: 10.1002/hpm.2443   open full text
  • Active offer of health services in French in Ontario: Analysis of reorganization and management strategies of health care organizations.
    Elina Farmanova, Luc Bonneville, Louise Bouchard.
    The International Journal of Health Planning and Management. August 02, 2017
    Background The availability of health services in French is not only weak but also inexistent in some regions in Canada. As a result, estimated 78% of more than a million of Francophones living in a minority situation in Canada experience difficulties accessing health care in French. To promote the delivery of health services in French, publicly funded organizations are encouraged to take measures to ensure that French‐language services are clearly visible, available, easily accessible, and equivalent to the quality of services offered in English. Objective This study examines the reorganization and management strategies taken by health care organizations in Ontario that provide health services in French. Methods Review and analysis of designation plans of a sample of health care organizations. Results Few health care organizations providing services in French have concrete strategies to guarantee availability, visibility, and accessibility of French‐language services. Conclusions Implementation of the active offer of French‐language services is likely to be difficult and slow. The Ontario government must strengthen collaboration with health care organizations, Francophone communities, and other key actors participating in the designation process to help health care organizations build capacities for the effective offer of French‐language services.
    August 02, 2017   doi: 10.1002/hpm.2446   open full text
  • Great expectations: An analysis of researchers' and policy makers' perceptions of the potential value of the Australian indigenous burden of disease study for policy.
    Aaron Katz, Deepa Gajjar, Anthony B. Zwi, Peter S. Hill.
    The International Journal of Health Planning and Management. July 30, 2017
    The “Burden of disease and injury in Aboriginal and Torres Strait Islander Peoples” was commissioned by the Australian government as part of the Australian Burden of Disease study. This paper explores the extent to which key actors in the research and policy communities expected the Indigenous Burden of Disease study's findings to inform, influence, or drive federal decisions concerning Indigenous health in Australia. This qualitative research undertook interviews with 13 key informants with significant involvement in the Indigenous Burden of Disease study: six researchers, five policy makers, and two knowledge brokers. Interviews were recorded, transcribed, and analyzed, and the findings were triangulated with a review of the literature. Policy makers and researchers anticipated that the Indigenous Burden of Disease study would improve the available information for policy deliberations about Indigenous health. Beyond that, their expectations about its policy influence differed substantially, with researchers more confident of the study's capacity to guide health priorities, and policy makers situating findings in the context of other critical inputs. Expectations of policy influence are shaped by the disciplinary perspectives of actors, and their relationship to policy outcomes and cannot be examined without also considering the policy, political, and financing context of the study being analyzed.
    July 30, 2017   doi: 10.1002/hpm.2445   open full text
  • The impact of changes in China's family patterns on family pension functions.
    Zhongxin Su, Z. Hu, Xizhe Peng.
    The International Journal of Health Planning and Management. July 24, 2017
    Using data from the Chinese census and the China Statistical Yearbook, this paper will analyze the historical changes and future trends of family households in China over the past 30 years and explore the changes of family pension functions and corresponding policies. Our analysis yielded 3 notable results. First, in family size miniaturization and structural simplification, 1‐ and 2‐generation family households are the main body of contemporary China. Second, for family aging and changes in living patterns, which primarily manifest as an increase in; the proportion of elderly households and in middle‐aged and elderly people in the family, the elderly model and the “multigenerational model” have become the 2 major residence models for the elderly in China. Third, nontraditional families have emerged in large numbers, such as the exclusively elderly family, empty nest family, grandparents family, Double Income, No Kids (DINK) family, older single family, and single‐parent family. We argue that in the process of simplification, China's family structure is increasingly showing characteristics of networking. The change in family patterns entails the restoration of traditional functions and taking on new functions of the family by issuing relevant social policies. Only when these social policies are based on family functions and demands can they provide effective help to social members, particularly regarding the family's responsibilities to parent children and support the elderly.
    July 24, 2017   doi: 10.1002/hpm.2436   open full text
  • Does hospital ownership influence hospital referral region health rankings in the United States.
    Hanadi Hamadi, Emma Apatu, Aaron Spaulding.
    The International Journal of Health Planning and Management. July 21, 2017
    Extensive evidence demonstrates that a hospital's organizational ownership structure impacts its overall performance, but little is known concerning the influence of hospital structure on the health of its community. This paper explores the association between US hospital referral region (HRR) health rankings and hospital ownership and performance. Data from the 2016 Commonwealth Fund Scorecard on Local Health System Performance, the American Hospital Association dataset, and the Hospital Value‐Based Purchasing dataset are utilized to conduct a cross‐sectional analysis of 36 quality measures across 306 HRRs. Multivariate regression analysis was used to estimate the association among hospital ownership, system performance measures—access and affordability, prevention and treatment, avoidable hospital use and cost, and healthy lives—and performance as measured by value‐based purchasing total performance scores. We found that indicators of access and affordability, as well as prevention and treatment, were significantly associated across all 3 hospitals' organizational structures. Hospital referral regions with a greater number of not‐for‐profit hospitals demonstrated greater indications of access and affordability, as well as better prevention and treatment rankings than for‐profit and government hospitals. Hospital referral regions with a greater number of government, nonfederal hospitals had worse scores for healthy lives. Furthermore, the greater the total performance scores score, the better the HRR score on prevention and treatment rankings. The greater the per capita income, the better the score across all 4 dimensions. As such, this inquiry supports the assertion that performance of a local health system is dependent on its community's resources of health care delivery entities and their structure.
    July 21, 2017   doi: 10.1002/hpm.2442   open full text
  • Equity in maternal‐ and infant‐care services in China: A trend analysis based on residence and area (2000‐2014).
    Hong Liang, Shuai Fang, Shanshan Liu, Xinyu Liu, Yanting Li, Ming Li, Yimin Zhang.
    The International Journal of Health Planning and Management. July 14, 2017
    Equity in maternal‐ and infant‐care services is key to achieving equity in maternal and infant health outcomes. In this study, 12 indicators of maternal and infant services were selected to measure equity in maternal and infant services in China from 2000‐2014 using the Theil index and between‐group variance, with the result showing that equity has improved steadily and significantly, though serious inequities in premarital and reproductive health services remain. Relatively speaking, equity at the interprovincial level has increased, but equity in urban‐rural stratification has improved more, indicating that policies should focus on interprovincial inequities and premarital and reproductive health services.
    July 14, 2017   doi: 10.1002/hpm.2438   open full text
  • Evidence for capitation reform in a New Rural Cooperative Medical Scheme in Pudong New Area, Shanghai: A longitudinal study.
    Yanmei Wang, Zhiqun Shu, Jianjun Gu, Xiaoming Sun, Limei Jing, Jie Bai, Xuan Huang, Jiquan Lou, Qunfang Zhang, Ming Li.
    The International Journal of Health Planning and Management. July 14, 2017
    Currently, China has been experiencing rapid growth of medical costs, serious waste of medical resources, increasing disease burden for residents, and a medical insurance fund deficit. Therefore, an urgent problem that needs to be solved is to choose a rational payment for the insurance system. To empirically evaluate the long‐term effects of capitation reform in a New Rural Cooperative Medical Scheme in Pudong New Area, we collected and analysed data regarding financing, fund operation, medical service cost, and medical care–seeking behaviour from 2011 to 2015, a duration that includes data before and after reform. The data for financing and behaviours were compared year by year, and the monthly data for inpatient and outpatient costs were evaluated in a retrospective time series study. The capitation reform in Pudong New Area showed strong evidence of the power of medical cost control in the long run, while it was weak in reversing the number of patients flowing into secondary and tertiary hospitals. To make the payment of capitation play a bigger role in cost control in China, a tighter alignment of capitation with the general practitioner system and achieving dual referral is critical for future studies.
    July 14, 2017   doi: 10.1002/hpm.2432   open full text
  • Twelve months of implementation of health care performance‐based financing in Burkina Faso: A qualitative multiple case study.
    Valéry Ridde, Maurice Yaogo, Sylvie Zongo, Paul‐André Somé, Anne‐Marie Turcotte‐Tremblay.
    The International Journal of Health Planning and Management. July 03, 2017
    To improve health services' quantity and quality, African countries are increasingly engaging in performance‐based financing (PBF) interventions. Studies to understand their implementation in francophone West Africa are rare. This study analysed PBF implementation in Burkina Faso 12 months post‐launch in late 2014. The design was a multiple and contrasted case study involving 18 cases (health centres). Empirical data were collected from observations, informal (n = 224) and formal (n = 459) interviews, and documents. Outside the circle of persons trained in PBF, few in the community had knowledge of it. In some health centres, the fact that staff were receiving bonuses was intentionally not announced to populations and community leaders. Most local actors thought PBF was just another project, but the majority appreciated it. There were significant delays in setting up agencies for performance monitoring, auditing, and contracting, as well as in the payment. The first audits led rapidly to coping strategies among health workers and occasionally to some staging beforehand. No community‐based audits had yet been done. Distribution of bonuses varied from one centre to another. This study shows the importance of understanding the implementation of public health interventions in Africa and of uncovering coping strategies.
    July 03, 2017   doi: 10.1002/hpm.2439   open full text
  • The development and impact of primary health care in China from 1949 to 2015: A focused review.
    Huazhang Li, Kun Liu, Jianjun Gu, Yimin Zhang, Yun Qiao, Xiaoming Sun.
    The International Journal of Health Planning and Management. July 02, 2017
    High‐quality primary health care (PHC) services are associated with better health outcomes and positive health equity. Providing PHC services to all inhabitants is one of the Chinese government's health care objectives. However, an imbalance between people's increasing health needs and effective health service utilization exists in China. The objective of this review is to identify evidence for PHC development in China and to summarize the challenges as a reference for the future improvement of China's PHC system. Literature searches related to China's PHC were performed in PubMed, Web of Science, China National Knowledge Infrastructure, and Wan‐fang databases. Related data were collected from the China Statistical Yearbook on Health and Family Planning 2003–2016, the China National Health Accounts Report 2015, and An Analysis Report of National Health Services Survey in China, 2013. The PHC network and the population's health have improved in China in recent years, with general practitioners as “gatekeepers” who have gradually taken the initiative to offer health services to residents. The limitation of input and shortages of resources and skilled health care providers may restrict the sustainable development of China's PHC system. Therefore, policy support from the government is necessary.
    July 02, 2017   doi: 10.1002/hpm.2435   open full text
  • Welfare, wellness, and job satisfaction of Chinese physicians: A national survey of public tertiary hospitals in China.
    Jing Sun, Jing Ma, Guangyu Hu, Qi Zhao, Changzheng Yuan, Wen Si, Xinqing Zhang, Yuanli Liu.
    The International Journal of Health Planning and Management. June 30, 2017
    Little national data are available on Chinese physicians' welfare, wellness, and job satisfaction. We conducted a self‐administered smartphone‐based national survey in early 2016 of 17 945 physicians from 136 tertiary hospitals across 31 provinces in China. In addition to collecting the physicians' basic information, we also measured 5 domains (the ethical and working environments, welfare, wellness, and job satisfaction). Half of the physicians reported a hospital‐based annual income of less than RMB 72 000 ($10 300), and 60.31% of them did not think that the current medical pricing system reflects physicians' value. More than half (58.64%) of them did not have or did not know about medical malpractice insurance. These physicians worked long hours (an average of 10 h) and slept short hours (average 6 h). Only 35.78% of them thought that they were in good health, and 51.03% were in good mental health. Approximately, a quarter of them had helped to pay medical bills for patients who could not afford care, and 1 in 7 has been penalised for seeing patients who generated bad debts. Only 33.42% of them thought that their occupation receives social recognition and respect, and 70.98% would not encourage their children to pursue a medical career. The top 3 factors that may influence physician job satisfaction as chosen by the physicians were as follows: (1) the income distribution policy (45.92%), (2) working environment safety (25.86%), and (3) public trust and respect for their job (16.10%). In conclusion, we found that Chinese physicians bear heavy physical, mental, and financial stress, and many of them lack confidence that they receive trust and respect from society.
    June 30, 2017   doi: 10.1002/hpm.2420   open full text
  • Development and enrolee satisfaction with basic medical insurance in China: A systematic review and stratified cluster sampling survey.
    Limei Jing, Ru Chen, Lisa Jing, Yun Qiao, Jiquan Lou, Jing Xu, Junwei Wang, Wen Chen, Xiaoming Sun.
    The International Journal of Health Planning and Management. June 29, 2017
    Basic Medical Insurance (BMI) has changed remarkably over time in China because of health reforms that aim to achieve universal coverage and better health care with adequate efforts by increasing subsidies, reimbursement, and benefits. In this paper, we present the development of BMI, including financing and operation, with a systematic review. Meanwhile, Pudong New Area in Shanghai was chosen as a typical BMI sample for its coverage and management; a stratified cluster sampling survey together with an ordinary logistic regression model was used for the analysis. Enrolee satisfaction and the factors associated with enrolee satisfaction with BMI were analysed. We found that the reenrolling rate superficially improved the BMI coverage and nearly achieved universal coverage. However, BMI funds still faced dual contradictions of fund deficit and insured under compensation, and a long‐term strategy is needed to realize the integration of BMI schemes with more homogeneous coverage and benefits. Moreover, Urban Resident Basic Medical Insurance participants reported a higher rate of dissatisfaction than other participants. The key predictors of the enrolees' satisfaction were awareness of the premium and compensation, affordability of out‐of‐pocket costs, and the proportion of reimbursement. These results highlight the importance that the Chinese government takes measures, such as strengthening BMI fund management, exploring mixed payment methods, and regulating sequential medical orders, to develop an integrated medical insurance system of universal coverage and vertical equity while simultaneously improving enrolee satisfaction.
    June 29, 2017   doi: 10.1002/hpm.2430   open full text
  • Progress and policy implication of the Insurance Programs for Catastrophic Diseases in China.
    Wenhui Mao, Luying Zhang, Wen Chen.
    The International Journal of Health Planning and Management. June 23, 2017
    The State Council encouraged the involvement of commercial insurance companies (CICs) in the development of the Insurance Program for Catastrophic Diseases (IPCD), yet its implementation has rarely been reported. We collected literature and policy documentation and conducted interviews in 10 cities with innovative IPCD policies to understand the details of the implementation of IPCD. IPCDs are operated at the prefectural level in 14 provinces, while in 4 municipalities and 6 provinces, unified IPCDs have been implemented at higher levels. The contribution level varied from 5% to 10% of total Basic Medical Insurance (BMI) funds or CNY10‐35 per beneficiary in 2015. IPCD provides an additional 50% to 70% reimbursement rate for the expenses not covered by BMI with various settings in different locations. Two models of CIC operation of IPCD have been identified according to the financial risks shared by CICs. Either the local department of Human Resources and Social Security or a third party performs assessments of the IPCD operation, service quality, and patients' satisfaction. A number of IPCDs have been observed to use 1% to 5% of the funds as a performance‐based payment to the CIC(s). CIC involvement in operating the IPCD raises concerns regarding the security of the information of beneficiaries. Developing appropriate data sharing mechanisms between the local department of Human Resources and Social Security and CICs is still in progress. In conclusion, the IPCD relieves the financial burden on patients by providing further reimbursement, but its benefit package remains limited to the BMI reimbursable list. CICs play an important role in monitoring and supervising health service provision, yet their capacity for actuarial services or risk control is underdeveloped.
    June 23, 2017   doi: 10.1002/hpm.2431   open full text
  • A study of regulatory policies and relevant issues concerning electronic cigarette use in Taiwan.
    Tzuu Hwa Jiang, Li Min Cheng, Matthew A. Hawkins.
    The International Journal of Health Planning and Management. June 23, 2017
    Recent technological innovations have increased the amount of tobacco products available to smokers. In particular, electronic cigarettes, sometimes call e‐cigarettes, have received substantial attention as their sales have rapidly increased. Electronic cigarettes were invented in China and now have become prevalent worldwide. Electronic cigarettes can be considered fashionable and come in numerous flavors; accordingly, many young adults and students have begun to use e‐cigarettes. However, like traditional tobacco products, e‐cigarettes have negative influences on human health. After e‐cigarettes were introduced into Taiwan, they have not been effectively managed and regulated because of insufficient supporting measures. Related legislation in developed countries can serve as a reference for Taiwan. For this study, the development of e‐cigarettes is described and a theoretical analysis was performed from the administration and legal perspectives. In addition to clarifying related problems and offering measures to prevent students from using e‐cigarettes, we propose suggestions to help governments improve their strategies to protect students' health.
    June 23, 2017   doi: 10.1002/hpm.2440   open full text
  • The association of hospital governance with innovation in Taiwan.
    Chen‐Wei Yang, Yu‐Hua Yan, Shih‐Chieh Fang, Syeda Noorein Inamdar, Hsien‐Cheng Lin.
    The International Journal of Health Planning and Management. June 23, 2017
    Hospitals in Taiwan are facing major changes and innovation is increasingly becoming a critical factor for remaining competitive. One determinant that can have a significant impact on innovation is hospital governance. However, there is limited prior research on the relationship between hospital governance and innovation. The purpose of this study is to propose a conceptual framework to hypothesize the relationship between governance mechanisms and innovation and to empirically test the hypotheses in hospital organizations. We examine the relationship between governance mechanisms and innovation using data on 102 hospitals in Taiwan from the Taiwan Joint Commission on Hospital Accreditation and Quality Improvement. We model governance mechanisms using board structure, information transparency and strategic decision‐making processes. For our modeling and data analysis we use measurement and structural models. We find that in hospital governance, information transparency and strategic decision making did impact innovation. However, governance structure did not. To facilitate innovation, hospital boards can increase information transparency and improve the decision‐making process when considering strategic investments in innovative initiatives. To remain competitive, hospital boards need to develop and monitor indices that measure hospital innovation to ensure ongoing progress.
    June 23, 2017   doi: 10.1002/hpm.2441   open full text
  • Changes in chronic disease management among community health centers (CHCs) in China: Has health reform improved CHC ability?
    Zhaoxin Wang, Jianwei Shi, Zhigui Wu, Huiling Xie, Yifan Yu, Ping Li, Rui Liu, Limei Jing.
    The International Journal of Health Planning and Management. June 22, 2017
    Since the 1980s, China has been criticized for its mode of chronic disease management (CDM) that passively provides treatment in secondary and tertiary hospitals but lacks active prevention in community health centers (CHCs). Since there are few systematic evaluations of the CHCs' methods for CDM, this study aimed to analyze their abilities. On the macroperspective, we searched the literature in China's largest and most authoritative databases and the official websites of health departments. Literature was used to analyze the government's efforts in improving CHCs' abilities to perform CDM. At the microlevel, we examined the CHCs' longitudinal data after the New Health Reform in 2009, including financial investment, facilities, professional capacities, and the conducted CDM activities. A policy analysis showed that there was an increasing tendency towards government efforts in developing CDM, and the peak appeared in 2009. By evaluating the reform at CHCs, we found that there was an obvious increase in fiscal and public health subsidies, large‐scale equipment, general practitioners, and public health physicians. The benefited vulnerable population in this area also rose significantly. However, rural centers were inferior in their CDM abilities compared with urban ones, and the referral system is still not effective in China. This study showed that CHCs are increasingly valued in managing chronic diseases, especially after the New Health Reform in 2009. However, we still need to improve collaborative management for chronic diseases in the community and strengthen the abilities of CHCs, especially in rural areas.
    June 22, 2017   doi: 10.1002/hpm.2433   open full text
  • Surveillance and early warning systems of infectious disease in China: From 2012 to 2014.
    Honglong Zhang, Liping Wang, Shengjie Lai, Zhongjie Li, Qiao Sun, Peng Zhang.
    The International Journal of Health Planning and Management. June 20, 2017
    Appropriate surveillance and early warning of infectious diseases have very useful roles in disease control and prevention. In 2004, China established the National Notifiable Infectious Disease Surveillance System and the Public Health Emergency Event Surveillance System to report disease surveillance and events on the basis of data sources from the National Notifiable Infectious Disease Surveillance System, China Infectious Disease Automated‐alert and Response System in this country. This study provided a descriptive summary and a data analysis, from 2012 to 2014, of these 3 key surveillance and early warning systems of infectious disease in China with the intent to provide suggestions for system improvement and perfection.
    June 20, 2017   doi: 10.1002/hpm.2434   open full text
  • The contextual‐level effects of social trust on health in transitional countries: Instrumental variable analysis of 26 countries.
    Nazim Habibov, Alex Cheung.
    The International Journal of Health Planning and Management. June 19, 2017
    We analyse the effect of contextual‐level social capital on health status in a sample of 26 transitional countries of Central and South Europe, Mongolia, and the former Soviet Union for 2006‐2010 (N = 51 911). Contextual‐level social capital is conceptualized as country‐level social trust, while health status is conceptualized as self‐rated health. We use ordinary least squares and instrumental variable regressions to address endogeneity and especially to rule out reverse causality. Both instrumental variable and ordinary least squares regressions suggest a strong positive effect of country‐level trust on health. This finding is consistent for the whole sample as well as separate regional estimations.
    June 19, 2017   doi: 10.1002/hpm.2427   open full text
  • China's health care system reform: Progress and prospects.
    Ling Li, Hongqiao Fu.
    The International Journal of Health Planning and Management. June 14, 2017
    This paper discusses the progress and prospects of China's complex health care reform beginning in 2009. The Chinese government's undertaking of systemic reform has achieved laudable achievements, including the expansion of social health insurance, the reform of public hospitals, and the strengthening of primary care. An innovative policy tool in China, policy experimentation under hierarchy, played an important role in facilitating these achievements. However, China still faces gaps and challenges in creating a single payer system, restructuring the public hospitals, and establishing an integrated delivery system. Recently, China issued the 13th 5‐year plan for medical reform, setting forth the goals, policy priorities, and strategies for health reform in the following 5 years. Moreover, the Chinese government announced the “Healthy China 2030” blueprint in October 2016, which has the goals of providing universal health security for all citizens by 2030. By examining these policy priorities against the existing gaps and challenges, we conclude that China's health care reform is heading in the right direction. To effectively implement these policies, we recommend that China should take advantage of policy experimentation to mobilize bottom‐up initiatives and encourage innovations.
    June 14, 2017   doi: 10.1002/hpm.2424   open full text
  • WHO's Service Availability and Readiness Assessment of primary health care services of commune health centers in a rural district of Northern Vietnam.
    Nguyen Van Huy, You‐Seon Nam, Nguyen Van Thanh, Ngo Tri Tuan, Nguyen Thi Thu Ha, Luu Ngoc Hoat, Nguyen Minh Hoang, Do Mai Hoa.
    The International Journal of Health Planning and Management. June 14, 2017
    The objective of this study was to assess the availability and readiness of the primary health care (PHC) services of commune health centers (CHCs) in Quoc Oai, a rural district of Northern Vietnam based on the World Health Organization's Service Availability and Readiness Assessment (SARA) tool. The study was done in 2 steps. First, the heads of the 21 CHCs of Quoc Oai district were interviewed using SARA, a quantitative survey, and the responses were then validated by direct observations of each facility. The results showed that although the average number of health staffs in each CHC met the national standards (at least 5 staffs per CHC), its allocation within each CHC was not properly met because some CHCs had only 2 health staffs. Several health equipment and facilities were not fully available in many CHCs, and although the majority of the PHC services were available at the CHCs, their readiness remained limited. Several significant correlates between the availability of health care workers and the availability of the facilities and the PHC services were observed, suggesting that they depend upon and affect one another in the health system. Using the SARA‐based inventory, the study helps health managers and policy makers to prioritize efforts and allocate resources more appropriately. To be effective, attention should be given to how to make facilities, services, and human resources for health ready for PHC activities—more investment and support from the system (from higher to lower level) and the government.
    June 14, 2017   doi: 10.1002/hpm.2429   open full text
  • Efficiency performance of China's health care delivery system.
    Luyu Zhang, Gang Cheng, Suhang Song, Beibei Yuan, Weiming Zhu, Li He, Xiaochen Ma, Qingyue Meng.
    The International Journal of Health Planning and Management. June 07, 2017
    Improving efficiency performance of the health care delivery system has been on the agenda for the health system reform that China initiated in 2009. This study examines the changes in efficiency performance and determinants of efficiency after the reform to provide evidence to assess the progress of the reform from the perspective of efficiency. Descriptive analysis, Data Envelopment Analysis, the Malmquist Index, and multilevel regressions are used with data from multiple sources, including the World Bank, the China Health Statistical Yearbook, and routine reports. The results indicate that over the last decade, health outcomes compared with health investment were relatively higher in China than in most other countries worldwide, and the trend was stable. The overall efficiency and total factor productivity increased after the reform, indicating that the reform was likely to have had a positive impact on the efficiency performance of the health care delivery system. However, the health care delivery structure showed low system efficiency, mainly attributed to the weakened primary health care system. Strengthening the primary health care system is central to enhancing the future performance of China's health care delivery system.
    June 07, 2017   doi: 10.1002/hpm.2425   open full text
  • Reconstruction of a clinician training system in China—A successful “5 + 3” model from Shanghai.
    Zhaojun Chen, Ling Wang.
    The International Journal of Health Planning and Management. June 01, 2017
    To promote medical educational reforms and improve the quality of health care services in China, Shanghai has embarked on a pilot reform programme to combine 3‐year graduate education with standardized residency training, which is called the 5 + 3 model and consists of 5 years of undergraduate studies plus 3 years of graduate studies integrated with standardized residency training. In the current review, we present the reconstruction and practice of the model in China.
    June 01, 2017   doi: 10.1002/hpm.2426   open full text
  • Regulating the for‐profit private healthcare providers towards universal health coverage: A qualitative study of legal and organizational framework in Mongolia.
    Uranchimeg Tsevelvaanchig, Indermohan S. Narula, Hebe Gouda, Peter S. Hill.
    The International Journal of Health Planning and Management. May 29, 2017
    Background Regulating the behavior of private providers in the context of mixed health systems has become increasingly important and challenging in many developing countries moving towards universal health coverage including Mongolia. This study examines the current regulatory architecture for private healthcare in Mongolia exploring its role for improving accessibility, affordability, and quality of private care and identifies gaps in policy design and implementation. Methods Qualitative research methods were used including documentary review, analysis, and in‐depth interviews with 45 representatives of key actors involved in and affected by regulations in Mongolia's mixed health system, along with long‐term participant observation. Results There has been extensive legal documentation developed regulating private healthcare, with specific organizations assigned to conduct health regulations and inspections. However, the regulatory architecture for healthcare in Mongolia is not optimally designed to improve affordability and quality of private care. This is not limited only to private care: important regulatory functions targeted to quality of care do not exist at the national level. The imprecise content and details of regulations in laws inviting increased political interference, governance issues, unclear roles, and responsibilities of different government regulatory bodies have contributed to failures in implementation of existing regulations.
    May 29, 2017   doi: 10.1002/hpm.2417   open full text
  • Feeding preference as a main determinant of microscale patchiness among terrestrial nematodes.
    Casper W. Quist, Gerrit Gort, Christian Mulder, Ruud H. P. Wilbers, Aad J. Termorshuizen, Jaap Bakker, Johannes Helder.
    The International Journal of Health Planning and Management. April 21, 2017
    Soil biota are responsible for essential ecosystem services such as carbon storage, nutrient cycling and water retention. However, assessment of the condition of soil biota is hampered by an overwhelming level of diversity. With representatives in all trophic levels of the food web, nematode communities can be used as bioindicators. Accurate assessment of nematode assemblages requires insight into the distribution of specimens with distinct food preferences. With the availability of taxon‐specific quantitative PCR assays, distribution patterns of multiple nematode groups can be investigated simultaneously. Here, microscale patchiness of 45 nematode taxa was studied on 12 sampling sites (each with four adjacent microplots) located on arable fields or semi‐natural grasslands (‘system’), and on marine, river clay or sandy soils (‘soil type’). From each microplot, five composite samples were collected. Contrary to our expectations, an increase in the number of cores per composite sample did not result in more accurate measurements, and apparently the levels of microscale patchiness of the taxa are low compared to what has been reported for oligophagous plant‐parasites. System and soil type did not affect microscale distribution. To investigate the level of patchiness in more detail, detection probability (DP) and variability of abundances were calculated. Common and widespread bacterivorous and fungivorous taxa had DP ≥ 90%, confirming low level of microscale patchiness. With DPs of 40%–70%, predators and most omnivores showed degrees of local clustering. An overview of mean variabilities of abundances is presented that offers insight into how feeding preferences impact the microscale distribution both between and within trophic groups.
    April 21, 2017   doi: 10.1111/1755-0998.12672   open full text
  • gesp: A computer program for modelling genetic effective population size, inbreeding and divergence in substructured populations.
    Fredrik Olsson, Linda Laikre, Ola Hössjer, Nils Ryman.
    The International Journal of Health Planning and Management. April 21, 2017
    The genetically effective population size (Ne) is of key importance for quantifying rates of inbreeding and genetic drift and is often used in conservation management to set targets for genetic viability. The concept was developed for single, isolated populations and the mathematical means for analysing the expected Ne in complex, subdivided populations have previously not been available. We recently developed such analytical theory and central parts of that work have now been incorporated into a freely available software tool presented here. gesp (Genetic Effective population size, inbreeding and divergence in Substructured Populations) is R‐based and designed to model short‐ and long‐term patterns of genetic differentiation and effective population size of subdivided populations. The algorithms performed by gesp allow exact computation of global and local inbreeding and eigenvalue effective population size, predictions of genetic divergence among populations (GST) as well as departures from random mating (FIS, FIT) while varying (i) subpopulation census and effective size, separately or including trend of the global population size, (ii) rate and direction of migration between all pairs of subpopulations, (iii) degree of relatedness and divergence among subpopulations, (iv) ploidy (haploid or diploid) and (v) degree of selfing. Here, we describe gesp and exemplify its use in conservation genetics modelling.
    April 21, 2017   doi: 10.1111/1755-0998.12673   open full text
  • Squamate Conserved Loci (SqCL): a unified set of conserved loci for phylogenomics and population genetics of squamate reptiles.
    Sonal Singhal, Maggie Grundler, Guarino Colli, Daniel L. Rabosky.
    The International Journal of Health Planning and Management. April 18, 2017
    The identification of conserved loci across genomes, along with advances in target capture methods and high‐throughput sequencing, has helped spur a phylogenomics revolution by enabling researchers to gather large numbers of homologous loci across clades of interest with minimal upfront investment in locus design. Target capture for vertebrate animals is currently dominated by two approaches – anchored hybrid enrichment (AHE) and ultraconserved elements (UCE) – and both approaches have proven useful for addressing questions in phylogenomics, phylogeography, and population genomics. However, these two sets of loci have minimal overlap with each other; moreover, they do not include many traditional loci that that have been used for phylogenetics. Here, we combine across UCE, AHE, and traditional phylogenetic gene locus sets to generate the Squamate Conserved Loci (SqCL) set, a single integrated probe set that can generate high‐quality and highly complete data across all three loci types. We use these probes to generate data for 44 phylogenetically‐disparate taxa that collectively span approximately 33% of terrestrial vertebrate diversity. Our results generated an average of 4.29 Mb across 4709 loci per individual, of which an average of 2.99 Mb was sequenced to high enough coverage (≥10×) to use for population genetic analyses. We validate the utility of these loci for both phylogenomic and population genomic questions, provide a comparison among these locus sets of their relative usefulness, and suggest areas for future improvement. This article is protected by copyright. All rights reserved.
    April 18, 2017   doi: 10.1111/1755-0998.12681   open full text
  • Effective mosquito and arbovirus surveillance using metabarcoding.
    J Batovska, S E Lynch, N O I Cogan, K Brown, J M Darbro, E A Kho, M J Blacket.
    The International Journal of Health Planning and Management. April 18, 2017
    Effective vector and arbovirus surveillance requires timely and accurate screening techniques that can be easily upscaled. Next‐generation sequencing (NGS) is a high‐throughput technology that has the potential to modernise vector surveillance. When combined with DNA barcoding, it is termed ‘metabarcoding’. The aim of our study was to establish a metabarcoding protocol to characterise pools of mosquitoes and screen them for virus. Pools contained 100 morphologically identified individuals, including one Ross River virus (RRV) infected mosquito, with three species present at different proportions: 1, 5, 94%. Nucleic acid extracted from both crude homogenate and supernatant was used to amplify a 269 bp section of the mitochondrial cytochrome c oxidase subunit I (COI) locus. Additionally, a 67 bp region of the RRV E2 gene was amplified from synthesised cDNA to screen for RRV. Amplicon sequencing was performed using an Illumina MiSeq, and bioinformatic analysis was performed using a DNA barcode database of Victorian mosquitoes. Metabarcoding successfully detected all mosquito species and RRV in every positive sample tested. The limits of species detection were also examined by screening a pool of 1000 individuals, successfully identifying the species and RRV from a single mosquito. The primers used for amplification, number of PCR cycles, and total number of individuals present all have effects on the quantification of species in mixed bulk samples. Based on the results, a number of recommendations for future metabarcoding studies are presented. Overall, metabarcoding shows great promise for providing a new alternative approach to screening large insect surveillance trap catches. This article is protected by copyright. All rights reserved.
    April 18, 2017   doi: 10.1111/1755-0998.12682   open full text
  • Taxonomy‐free molecular diatom index for high‐throughput eDNA biomonitoring.
    Laure Apothéloz‐Perret‐Gentil, Arielle Cordonier, François Straub, Jennifer Iseli, Philippe Esling, Jan Pawlowski.
    The International Journal of Health Planning and Management. April 13, 2017
    Current biodiversity assessment and biomonitoring are largely based on the morphological identification of selected bioindicator taxa. Recently, several attempts have been made to use eDNA metabarcoding as an alternative tool. However, until now, most applied metabarcoding studies have been based on the taxonomic assignment of sequences that provides reference to morphospecies ecology. Usually, only a small portion of metabarcoding data can be used due to a limited reference database and a lack of phylogenetic resolution. Here, we investigate the possibility to overcome these limitations using a taxonomy‐free approach that allows the computing of a molecular index directly from eDNA data without any reference to morphotaxonomy. As a case study, we use the benthic diatoms index, commonly used for monitoring the biological quality of rivers and streams. We analysed 87 epilithic samples from Swiss rivers, the ecological status of which was established based on the microscopic identification of diatom species. We compared the diatom index derived from eDNA data obtained with or without taxonomic assignment. Our taxonomy‐free approach yields promising results by providing a correct assessment for 77% of examined sites. The main advantage of this method is that almost 95% of OTUs could be used for index calculation, compared to 35% in the case of the taxonomic assignment approach. Its main limitations are under‐sampling and the need to calibrate the index based on the microscopic assessment of diatoms communities. However, once calibrated, the taxonomy‐free molecular index can be easily standardized and applied in routine biomonitoring, as a complementary tool allowing fast and cost‐effective assessment of the biological quality of watercourses.
    April 13, 2017   doi: 10.1111/1755-0998.12668   open full text
  • Draft genomes of the corallimorpharians Amplexidiscus fenestrafer and Discosoma sp.
    Xin Wang, Yi Jin Liew, Yong Li, Didier Zoccola, Sylvie Tambutte, Manuel Aranda.
    The International Journal of Health Planning and Management. April 13, 2017
    Corallimorpharia are the closest non‐calcifying relatives of reef‐building corals. Aside from their popularity among aquarium hobbyists, their evolutionary position between the Actiniaria (sea anemones) and the Scleractinia (hard corals) makes them ideal candidates for comparative studies aiming at understanding the evolution of hexacorallian orders in general and reef‐building corals in particular. Here we have sequenced and assembled two draft genomes for the Corallimorpharia species Amplexidiscus fenestrafer and Discosoma sp.. The draft genomes encompass 370 Mbp and 445 Mbp respectively and encode for 21,372 and 23,199 genes. To facilitate future studies using these resources, we provide annotations for the predicted gene models—not only at gene level, by annotating gene models with the function of the best‐matching homolog, and GO terms when available; but also at protein domain level, where gene function can be better verified through the conservation of the sequence and order of protein domains. Further, we provide an online platform (, which includes a BLAST interface as well as a genome browser to facilitate the use of these resources. We believe that these two genomes are important resources for future studies on hexacorallian systematics and the evolutionary basis of their specific traits such as the symbiotic relationship with dinoflagellates of the genus Symbiodinium or the evolution of calcification in reef‐building corals. This article is protected by copyright. All rights reserved.
    April 13, 2017   doi: 10.1111/1755-0998.12680   open full text
  • Methodological considerations for detection of terrestrial small‐body salamander eDNA and implications for biodiversity conservation.
    Donald M. Walker, Jacob E. Leys, Kelly E. Dunham, Joshua C. Oliver, Emily E. Schiller, Kelsey S. Stephenson, John T. Kimrey, Jessica Wooten, Mark W. Rogers.
    The International Journal of Health Planning and Management. April 11, 2017
    Environmental DNA (eDNA) can be used as an assessment tool to detect populations of threatened species and provide fine‐scale data required to make management decisions. The objectives of this project were to use quantitative PCR (qPCR) to: (i) detect spiked salamander DNA in soil, (ii) quantify eDNA degradation over time, (iii) determine detectability of salamander eDNA in a terrestrial environment using soil, faeces, and skin swabs, (iv) detect salamander eDNA in a mesocosm experiment. Salamander eDNA was positively detected in 100% of skin swabs and 66% of faecal samples and concentrations did not differ between the two sources. However, eDNA was not detected in soil samples collected from directly underneath wild‐caught living salamanders. Salamander genomic DNA (gDNA) was detected in all qPCR reactions when spiked into soil at 10.0, 5.0, and 1.0 ng/g soil and spike concentration had a significant effect on detected concentrations. Only 33% of samples showed recoverable eDNA when spiked with 0.25 ng/g soil, which was the low end of eDNA detection. To determine the rate of eDNA degradation, gDNA (1 ng/g soil) was spiked into soil and quantified over seven days. Salamander eDNA concentrations decreased across days, but eDNA was still amplifiable at day 7. Salamander eDNA was detected in two of 182 mesocosm soil samples over 12 weeks (n = 52 control samples; n = 65 presence samples; n = 65 eviction samples). The discrepancy in detection success between experiments indicates the potential challenges for this method to be used as a monitoring technique for small‐bodied wild terrestrial salamander populations.
    April 11, 2017   doi: 10.1111/1755-0998.12667   open full text
  • The impact of economic crisis on the Greek hospitals' productivity.
    Panagiotis Mitropoulos, Ioannis Mitropoulos, Haralampos Karanikas, Nikolaos Polyzos.
    The International Journal of Health Planning and Management. April 10, 2017
    During the recent economic crisis, Greece implemented a comprehensive reform in the health care system. The 2010 health reform occurred under the constraints imposed by the memorandum of understanding that the Greek Government signed with its EU/International Monetary Fund creditors to control its deficit. The objective of the study is to examine the impact of the reform on the efficiency and productivity of public hospitals in Greece. We use the Malmquist productivity index to comparatively examine the potential changes before and after the reform years. We compare productivity, efficiency, and technological changes using panel data of 111 public acute hospitals operating in Greece throughout the recession period of 2009 to 2012. Bootstrapping methods are applied to allow for uncertainty owing to sampling error and for statistical inference for the Malmquist productivity index and its decompositions. The analysis indicates that the productivity has been increased following the policy changes. It appears that the expected benefits from the reform in general have been achieved, at least in the short‐term. This result is examined in the light of management and operations activities, which are related with the reform process. Therefore, at a second stage, the Malmquist index is regressed on variables that may potentially be statistically associated with productivity growth.
    April 10, 2017   doi: 10.1002/hpm.2410   open full text
  • Ancient DNA analysis identifies marine mollusc shells as new metagenomic archives of the past.
    Clio Der Sarkissian, Vianney Pichereau, Catherine Dupont, Peter C. Ilsøe, Mickael Perrigault, Paul Butler, Laurent Chauvaud, Jón Eiríksson, James Scourse, Christine Paillard, Ludovic Orlando.
    The International Journal of Health Planning and Management. April 10, 2017
    Marine mollusc shells enclose a wealth of information on coastal organisms and their environment. Their life history traits as well as (palaeo‐) environmental conditions, including temperature, food availability, salinity, and pollution, can be traced through the analysis of their shell (micro‐) structure and biogeochemical composition. Adding to this list the DNA entrapped in shell carbonate biominerals potentially offers a novel and complementary proxy both for reconstructing palaeoenvironments and tracking mollusc evolutionary trajectories. Here, we assess this potential by applying DNA extraction, high‐throughput shotgun DNA sequencing and metagenomic analyses to marine mollusc shells spanning the last ~7,000 years. We report successful DNA extraction from shells, including a variety of ancient specimens, and find that DNA recovery is highly dependent on their biomineral structure, carbonate layer preservation, and disease state. We demonstrate positive taxonomic identification of mollusc species using a combination of mitochondrial DNA genomes, barcodes, genome‐scale data, and metagenomic approaches. We also find shell biominerals to contain a diversity of microbial DNA from the marine environment. Finally, we reconstruct genomic sequences of organisms closely related to the Vibrio tapetis bacteria from Manila clam shells previously diagnosed with Brown Ring Disease. Our results reveal marine mollusc shells as novel genetic archives of the past, which opens new perspectives in ancient DNA research, with the potential to reconstruct the evolutionary history of molluscs, microbial communities, and pathogens in the face of environmental changes. Other future applications include conservation of endangered mollusc species and aquaculture management. This article is protected by copyright. All rights reserved.
    April 10, 2017   doi: 10.1111/1755-0998.12679   open full text
  • Genome‐wide survey of nuclear protein‐coding markers for beetle phylogenetics and their application in resolving both deep and shallow‐level divergences.
    Li‐Heng Che, Shao‐Qian Zhang, Yun Li, Dan Liang, Hong Pang, Adam Ślipiński, Peng Zhang.
    The International Journal of Health Planning and Management. April 06, 2017
    Beetles (Coleoptera) are the most diverse and species‐rich insect group, representing an impressive explosive radiation in the evolutionary history of insects, and their evolutionary relationships are often difficult to resolve. The amount of ‘traditional markers’ (e.g. mitochondrial genes and nuclear rDNAs) for beetle phylogenetics is small, and these markers often lack sufficient signals in resolving relationships for such a rapidly radiating lineage. Here, based on the available genome data of beetles and other related insect species, we performed a genome‐wide survey to search nuclear protein‐coding (NPC) genes suitable for research on beetle phylogenetics. As a result, we identified 1470 candidate loci, which provided a valuable data resource to the beetle evolutionary research community for NPC marker development. We randomly chose 180 candidate loci from the database to design primers and successfully developed 95 NPC markers which can be PCR amplified from standard genomic DNA extracts. These new nuclear markers are universally applicable across Coleoptera, with an average amplification success rate of 90%. To test the phylogenetic utility, we used them to investigate the backbone phylogeny of Coleoptera (18 families sampled) and the family Coccinellidae (39 species sampled). Both phylogenies are well resolved (average bootstrap support >95%), showing that our markers can be used to address phylogenetic questions of various evolutionary depth (from species level to family level). In general, the newly developed nuclear markers are much easier to use and more phylogenetically informative than the ‘traditional markers’, and show great potential to expedite resolution of many parts in the Beetle Tree of Life.
    April 06, 2017   doi: 10.1111/1755-0998.12664   open full text
  • Pedigree reconstruction from SNP data: parentage assignment, sibship clustering and beyond.
    Jisca Huisman.
    The International Journal of Health Planning and Management. April 06, 2017
    Data on hundreds or thousands of single nucleotide polymorphisms (SNPs) provide detailed information about the relationships between individuals, but currently few tools can turn this information into a multigenerational pedigree. I present the r package sequoia, which assigns parents, clusters half‐siblings sharing an unsampled parent and assigns grandparents to half‐sibships. Assignments are made after consideration of the likelihoods of all possible first‐, second‐ and third‐degree relationships between the focal individuals, as well as the traditional alternative of being unrelated. This careful exploration of the local likelihood surface is implemented in a fast, heuristic hill‐climbing algorithm. Distinction between the various categories of second‐degree relatives is possible when likelihoods are calculated conditional on at least one parent of each focal individual. Performance was tested on simulated data sets with realistic genotyping error rate and missingness, based on three different large pedigrees (N = 1000–2000). This included a complex pedigree with overlapping generations, occasional close inbreeding and some unknown birth years. Parentage assignment was highly accurate down to about 100 independent SNPs (error rate <0.1%) and fast (<1 min) as most pairs can be excluded from being parent–offspring based on opposite homozygosity. For full pedigree reconstruction, 40% of parents were assumed nongenotyped. Reconstruction resulted in low error rates (<0.3%), high assignment rates (>99%) in limited computation time (typically <1 h) when at least 200 independent SNPs were used. In three empirical data sets, relatedness estimated from the inferred pedigree was strongly correlated to genomic relatedness.
    April 06, 2017   doi: 10.1111/1755-0998.12665   open full text
  • Using a butterflyfish genome as a general tool for RAD‐Seq studies in specialized reef fish.
    Joseph D. DiBattista, Pablo Saenz‐Agudelo, Marek J. Piatek, Xin Wang, Manuel Aranda, Michael L. Berumen.
    The International Journal of Health Planning and Management. April 06, 2017
    Data from a large‐scale restriction site‐associated DNA sequencing (RAD‐Seq) study of nine butterflyfish species in the Red Sea and Arabian Sea provided a means to test the utility of a recently published draft genome (Chaetodon austriacus) and assess apparent bias in this method of isolating nuclear loci. We here processed double‐digest restriction site‐associated DNA (ddRAD) sequencing data to identify single nucleotide polymorphism (SNP) markers and their associated function with and without our reference genome to see whether it improves the quality of RAD‐Seq. Our analyses indicate (i) a modest gap between the number of nonannotated versus annotated SNPs across all species, (ii) an advantage of using genomic resources for closely related but not distantly related butterflyfish species based on the ability to assign putative gene function to SNPs and (iii) an enrichment of genes among sister butterflyfish taxa related to calcium transmembrane transport and binding. The latter result highlights the potential for this approach to reveal insights into adaptive mechanisms in populations inhabiting challenging coral reef environments such as the Red Sea, Arabian Sea and Arabian Gulf with further study.
    April 06, 2017   doi: 10.1111/1755-0998.12662   open full text
  • Demerelate: calculating interindividual relatedness for kinship analysis based on codominant diploid genetic markers using R.
    Philipp Kraemer, Gabriele Gerlach.
    The International Journal of Health Planning and Management. April 06, 2017
    The Demerelate package offers algorithms to calculate different interindividual relatedness measurements. Three different allele sharing indices, five pairwise weighted estimates of relatedness and four pairwise weighted estimates with sample size correction are implemented to analyse kinship structures within populations. Statistics are based on randomization tests; modelling relatedness coefficients by logistic regression, modelling relatedness with geographic distance by mantel correlation and comparing mean relatedness between populations using pairwise t‐tests. Demerelate provides an advance on previous software packages by including some estimators not available in R to date, along with FIS, as well as combining analysis of relatedness and spatial structuring. An UPGMA tree visualizes genetic relatedness among individuals. Additionally, Demerelate summarizes information on data sets (allele vs. genotype frequencies; heterozygosity; FIS values). Demerelate is – to our knowledge – the first R package implementing basic allele sharing indices such as Blouin's Mxy relatedness, the estimator of Wang corrected for sample size (wangxy), estimators based on Morans I adapted to genetic relatedness as well as combining all estimators with geographic information. The R environment enables users to better understand relatedness within populations due to the flexibility of Demerelate of accepting different data sets as empirical data, reference data, geographical data and by providing intermediate results. Each statistic and tool can be used separately, which helps to understand the suitability of the data for relatedness analysis, and can be easily implemented in custom pipelines.
    April 06, 2017   doi: 10.1111/1755-0998.12666   open full text
  • A new promising phylogenetic marker to study the diversity of fungal communities: the GLYCOSIDE HYDROLASE 63 gene.
    L. Pérez‐Izquierdo, E. Morin, J.P. Maurice, F. Martin, A. Rincón, M. Buée.
    The International Journal of Health Planning and Management. April 06, 2017
    In molecular ecology, the development of efficient molecular markers for fungi remains an important research domain. Nuclear ribosomal internal transcribed spacer (ITS) region was proposed as universal DNA barcode marker for Fungi, but this marker was criticized for idel‐induced alignment problems and its potential lack of phylogenetic resolution. Our main aim was to develop a new phylogenetic gene and a putative functional marker, from single‐copy gene, to describe fungal diversity. Thus, we developed a series of primers to amplify a polymorphic region of the Glycoside Hydrolase GH63 gene, encoding exo‐acting α‐glucosidases, in Basidiomycetes. These primers were validated on 125 different fungal genomic DNAs and GH63 amplification yield was compared with that of already published functional markers targeting genes coding for laccases, N‐acetylhexosaminidases, cellobiohydrolases and class II Peroxidases. Specific amplicons were recovered for 95% of the fungal species tested and GH63 amplification success was strikingly higher than rates obtained with other functional genes. We downloaded the GH63 sequences from 483 fungal genomes publicly available at the JGI MycoCosm database. GH63 was present in 461 fungal genomes belonging to all phyla, except Microsporidia and Neocallimastigomycota divisions. Moreover, the phylogenetic trees built with both GH63 and Rpb1 protein sequences revealed that GH63 is also a promising phylogenetic marker. Finally, a very high proportion of GH63 proteins was predicted to be secreted. This molecular tool could be a new phylogenetic marker of fungal species as well as potential indicator of functional diversity of Basidiomycotes fungal communities in term of secretory capacities. This article is protected by copyright. All rights reserved.
    April 06, 2017   doi: 10.1111/1755-0998.12678   open full text
  • Stakeholders' views on maternity care shortcomings in rural Ghana: An ethnographic study among women, providers, public, and quasiprivate policy sector actors.
    Martin Amogre Ayanore, Milena Pavlova, Regien Biesma, Wim Groot.
    The International Journal of Health Planning and Management. April 06, 2017
    Access to skilled provider and emergency obstetric care is not universal across all districts in Ghana. The lived experiences of 3 stakeholder groups on maternity care shortcomings in 3 rural Ghanaian districts are examined in this study. We applied an ethnographic study approach where field data were collected between March to May 2015 in 3 rural districts of northern Ghana. Data were collected among women with recent births experiences (n = 90), health care providers (n = 16), and policy actors (n = 6). Transcripts were read through to identify similar and divergent stakeholders' views. Significant expressions and experiences of stakeholders on maternity care shortcomings were extracted and evaluated to define key themes. Four themes emerged: social/community factors, payments for health care, facility level factors, and policy level factors. The results show that traditional women's roles divest time for maternity care. Poor transport arrangements, insufficient health workforce, health funding gaps, insurance reimbursements delays, and catastrophic health expenditures on travel and drugs are attested as major barriers across all stakeholder groups in all districts studied. The discussion of the study findings suggests it is important to ascertain the scale of informal payments and their impacts on health access. Investments in health workforce and reliable ambulatory service systems could help address poor referral difficulties in rural areas of the country. Social support for community initiatives that pool funds could provide extra resources and relieve cost access‐related challenges for using maternity care in rural settings in Ghana.
    April 06, 2017   doi: 10.1002/hpm.2411   open full text
  • The empirical Bayes estimators of fine‐scale population structure in high gene flow species.
    Shuichi Kitada, Reiichiro Nakamichi, Hirohisa Kishino.
    The International Journal of Health Planning and Management. April 05, 2017
    An empirical Bayes (EB) pairwise FST estimator was previously introduced and evaluated for its performance by numerical simulation. In this study, we conducted coalescent simulations and generated genetic population structure mechanistically, and compared the performance of the EBFST with Nei's GST, Nei and Chesser's bias‐corrected GST (GST_NC), Weir and Cockerham's θ (θWC) and θ with finite sample correction (θWC_F). We also introduced EB estimators for Hedrick’ G’ST and Jost’ D. We applied these estimators to publicly available SNP genotypes of Atlantic herring. We also examined the power to detect the environmental factors causing the population structure. Our coalescent simulations revealed that the finite sample correction of θWC is necessary to assess population structure using pairwise FST values. For microsatellite markers, EBFST performed the best among the present estimators regarding both bias and precision under high gene flow scenarios (FST≤0.032). For 300 SNPs, EBFST had the highest precision in all cases, but the bias was negative and greater than those for GST_NC and θWC_F in all cases. GST_NC and θWC_F performed very similarly at all levels of FST. As the number of loci increased up to 10 000, the precision of GST_NC and θWC_F became slightly better than for EBFST for cases with FST≥0.004, even though the size of the bias remained constant. The EB estimators described the fine‐scale population structure of the herring and revealed that ~56% of the genetic differentiation was caused by sea surface temperature and salinity. The R package finepop for implementing all estimators used here is available on CRAN.
    April 05, 2017   doi: 10.1111/1755-0998.12663   open full text
  • treespace: statistical exploration of landscapes of phylogenetic trees.
    Thibaut Jombart, Michelle Kendall, Jacob Almagro‐Garcia, Caroline Colijn.
    The International Journal of Health Planning and Management. April 04, 2017
    The increasing availability of large genomic datasets as well as the advent of Bayesian phylogenetics facilitate the investigation of phylogenetic incongruence, which can result in the impossibility of representing phylogenetic relationships using a single tree. While sometimes considered as a nuisance, phylogenetic incongruence can also reflect meaningful biological processes as well as relevant statistical uncertainty, both of which can yield valuable insights in evolutionary studies. We introduce a new tool for investigating phylogenetic incongruence through the exploration of phylogenetic tree landscapes. Our approach, implemented in the R package treespace, combines tree metrics and multivariate analysis to provide low dimensional representations of the topological variability in a set of trees, which can be used for identifying clusters of similar trees and group‐specific consensus phylogenies. treespace also provides a user‐friendly web interface for interactive data analysis. treespace is integrated alongside existing standards for phylogenetics and is easily accessible through a web interface. It fills a gap in the current phylogenetics toolbox in R and will facilitate the investigation of phylogenetic results. This article is protected by copyright. All rights reserved.
    April 04, 2017   doi: 10.1111/1755-0998.12676   open full text
  • The impact of change from copayment to coinsurance on medical care usage and expenditure in outpatient setting in older Koreans.
    Byoungjun Bae, Bo Ram Choi, Inmyung Song.
    The International Journal of Health Planning and Management. April 03, 2017
    Patient cost‐sharing change was implemented on August 1, 2007, for outpatient care in the clinic setting in Korea from copayment to coinsurance. This study aims to estimate the effect of the policy change on medical care usage and expenditure in older Koreans. By using national health insurance claims data from the Health Insurance Reimbursement Assessment Service, this study analyzed the entire 137 million claims for a total of approximately 4.1 million patients aged 60 to 69 years who had been diagnosed and/or treated for outpatient care in clinics from January 1, 2007, to December 31, 2008. Medical care usage was defined as the proportion of all beneficiaries in each group who visited clinics and the mean number of visit days per beneficiary. Medical care expenditure per visit day was expressed as total costs, reimbursed amount, and patient's out‐of‐pocket payment. Data on January through June of 2008 were analyzed as compared with the same months of 2007. Raw difference‐in‐difference and multiple regression analyses were performed. The interaction coefficients, which measured the impact of cost‐sharing change, was −0.078 in model 1 and −0.039 in model 2 (P < .0001). In conclusion, a cost‐sharing change from copayment to coinsurance reduced medical care usage and expenditure.
    April 03, 2017   doi: 10.1002/hpm.2416   open full text
  • Graphics for relatedness research.
    Iván Galván‐Femenía, Jan Graffelman, Carles Barceló‐i‐Vidal.
    The International Journal of Health Planning and Management. April 03, 2017
    Studies of relatedness have been crucial in molecular ecology over the last decades. Good evidence of this is the fact that studies of population structure, evolution of social behaviours, genetic diversity and quantitative genetics all involve relatedness research. The main aim of this article is to review the most common graphical methods used in allele sharing studies for detecting and identifying family relationships. Both IBS and IBD based allele sharing studies are considered. Furthermore, we propose two additional graphical methods from the field of compositional data analysis: the ternary diagram and scatterplots of isometric log‐ratios of IBS and IBD probabilities. We illustrate all graphical tools with genetic data from the HGDP‐CEPH diversity panel, using mainly 377 microsatellites genotyped for 25 individuals from the Maya population of this panel. We enhance all graphics with convex hulls obtained by simulation and use these to confirm the documented relationships. The proposed compositional graphics are shown to be useful in relatedness research, as they also single out the most prominent related pairs. The ternary diagram is advocated for its ability to display all three allele sharing probabilities simultaneously. The log‐ratio plots are advocated as an attempt to overcome the problems with the Euclidean distance interpretation in the classical graphics. This article is protected by copyright. All rights reserved.
    April 03, 2017   doi: 10.1111/1755-0998.12674   open full text
  • Unlocking the story in the swab: A new genotyping assay for the amphibian chytrid fungus Batrachochytrium dendrobatidis.
    Allison Q. Byrne, Andrew P. Rothstein, Thomas J. Poorten, Jesse Erens, Matthew L. Settles, Erica Bree Rosenblum.
    The International Journal of Health Planning and Management. April 02, 2017
    One of the most devastating emerging pathogens of wildlife is the chytrid fungus, Batrachochytrium dendrobatidis (Bd), which affects hundreds of amphibian species around the world. Genomic data from pure Bd cultures has advanced our understanding of Bd phylogenetics, genomic architecture, and mechanisms of virulence. However pure cultures are laborious to obtain and whole genome sequencing is comparatively expensive, so relatively few isolates have been genetically characterized. Thus we still know little about the genetic diversity of Bd in natural systems. The most common non‐invasive method of sampling Bd from natural populations is to swab amphibian skin. Hundreds of thousands of swabs have been collected from amphibians around the world, but Bd DNA collected via swabs is often low in quality and/or quantity. In this study, we developed a custom Bd genotyping assay using the Fluidigm Access Array platform to amplify 192 carefully‐selected regions of the Bd genome. We obtained robust sequence data for pure Bd cultures and field‐collected skin swabs. This new assay has the power to accurately discriminate among the major Bd clades, recovering the basic tree topology previously revealed using whole genome data. Additionally, we established a critical value for initial Bd load for swab samples (150 Bd genomic equivalents) above which our assay performs well. By leveraging advances in microfluidic multiplex PCR technology and the globally distributed resource of amphibian swab samples, non‐invasive skin swabs can now be used to address critical spatial and temporal questions about Bd and its effects on declining amphibian populations. This article is protected by copyright. All rights reserved.
    April 02, 2017   doi: 10.1111/1755-0998.12675   open full text
  • Sequencing historical specimens: successful preparation of small specimens with low amounts of degraded DNA.
    John S. Sproul, David R. Maddison.
    The International Journal of Health Planning and Management. March 30, 2017
    Despite advances that allow DNA sequencing of old museum specimens, sequencing small‐bodied, historical specimens can be challenging and unreliable as many contain only small amounts of fragmented DNA. Dependable methods to sequence such specimens are especially critical if the specimens are unique. We attempt to sequence small‐bodied (3–6 mm) historical specimens (including nomenclatural types) of beetles that have been housed, dried, in museums for 58–159 years, and for which few or no suitable replacement specimens exist. To better understand ideal approaches of sample preparation and produce preparation guidelines, we compared different library preparation protocols using low amounts of input DNA (1–10 ng). We also explored low‐cost optimizations designed to improve library preparation efficiency and sequencing success of historical specimens with minimal DNA, such as enzymatic repair of DNA. We report successful sample preparation and sequencing for all historical specimens despite our low‐input DNA approach. We provide a list of guidelines related to DNA repair, bead handling, reducing adapter dimers and library amplification. We present these guidelines to facilitate more economical use of valuable DNA and enable more consistent results in projects that aim to sequence challenging, irreplaceable historical specimens.
    March 30, 2017   doi: 10.1111/1755-0998.12660   open full text
  • Polymorphism‐aware protein databases – a prerequisite for an unbiased proteomic analysis of natural populations.
    Kathrin A. Otte, Christian Schlötterer.
    The International Journal of Health Planning and Management. March 30, 2017
    Recent technological advances have increased the throughput of proteomics, facilitating the characterization of molecular phenotypes on the population level, thus bearing the potential to complement transcriptomic analyses. Reference protein databases are crucial for the analysis and quantification, because only peptides in the protein database can be identified. Any peptide carrying an amino acid variant cannot be identified. Because most proteomic studies, even of natural populations, do not account for polymorphisms, we analysed the influence of variant peptides on quantitative proteomic analyses. We used transcriptomic and proteomic data of two Drosophila melanogaster genotypes and identified genotype‐specific variants from RNA‐seq data. We introduce a simple pipeline to include these variants in a polymorphism‐aware protein database and compared the results to an unmodified reference database. The polymorphism‐aware database not only identifies more peptides, but the quantitative values also changed when peptide variants were included. We conclude that proteomic quantification is likely to be biased, in particular for small genes, when polymorphisms are being ignored. Polymorphism‐aware databases may be therefore a key step towards improved proteomic data analyses, especially for the analysis of pooled individuals and the comparison of population samples.
    March 30, 2017   doi: 10.1111/1755-0998.12656   open full text
  • Estimating mating rates in wild Drosophila melanogaster females by decay rates of male reproductive proteins in their reproductive tracts.
    Thomas J. Giardina, Andrew G. Clark, Anthony C. Fiumera.
    The International Journal of Health Planning and Management. March 24, 2017
    Female Drosophila melanogaster frequently mate with multiple males in nature as shown through parentage analysis. Although polyandry is well documented, we know little about the timing between mating events in wild Drosophila populations due to the challenge of following behaviours of individual females. In this study, we used the presence of a male reproductive protein that is transferred to the female during mating (Sex Peptide, SP) to determine whether she had recently mated. We sampled females throughout the day, conducted control matings to determine the decay rate of SP within the female reproductive tract and performed computer simulations to fit the observed proportion of mated females to a nonhomogenous Poisson process that defined the expected time between successive matings for a given female. In our control matings, 100% of mated females tested positive for SP 0.5 h after the start of mating (ASM), but only 24% tested positive 24 h ASM. Overall, 35% of wild‐caught females tested positive for the presence of SP. Fitting our observed data to our simple nonhomogenous Poisson model provided the inference that females are mating, on average, approximately every 27 h (with 95% credibility interval 23–31 h). Thus, it appears that females are mating a bit less frequently that once per day in this natural population and that mating events tend to occur either early in the morning or late in the afternoon.
    March 24, 2017   doi: 10.1111/1755-0998.12661   open full text
  • Design of Character‐based DNA Barcode Motif for species identification: A computational approach and its validation in fishes.
    Mohua Chakraborty, Bishal Dhar, Sankar Kumar Ghosh.
    The International Journal of Health Planning and Management. March 23, 2017
    The DNA barcodes are generally interpreted using distance‐based and character‐based methods. The former uses clustering of comparable groups, based on the relative genetic distance, while the latter is based on the presence or absence of discrete nucleotide substitutions. The distance‐based approach has a limitation in defining a universal species boundary across the taxa since the rate of mtDNA evolution is not constant throughout the taxa. However, character‐based approach more accurately defines this using a unique set of nucleotide characters. The character‐based analysis of full‐length barcode has some inherent limitations, like sequencing of the full‐length barcode, use of a sparse data matrix and lack of a uniform diagnostic position for each group. A short continuous stretch of a fragment can be used to resolve the limitations. Here, we observe that a 154 bp fragment, from the transversion rich domain of 1367 COI barcode sequences can successfully delimit species in the three most diverse orders of freshwater fishes. This fragment is used to design species‐specific barcode motifs for 109 species by the character‐based method, which successfully identifies the correct species using a pattern‐matching program. The motifs also correctly identify geographically isolated population of the Cypriniformes species. Further, this region is validated as a species‐specific mini‐barcode for freshwater fishes by successful PCR amplification and sequencing of the motif (154 bp) using the designed primers. We anticipate that use of such motifs will enhance the diagnostic power of DNA barcode, and the mini‐barcode approach will greatly benefit the field‐based system of rapid species identification. This article is protected by copyright. All rights reserved.
    March 23, 2017   doi: 10.1111/1755-0998.12671   open full text
  • Change management in an environment of ongoing primary health care system reform: A case study of Australian primary health care services.
    Sara Javanparast, Janny Maddern, Fran Baum, Toby Freeman, Angela Lawless, Ronald Labonté, David Sanders.
    The International Journal of Health Planning and Management. March 22, 2017
    Introduction/Background Globally, health reforms continue to be high on the health policy agenda to respond to the increasing health care costs and managing the emerging complex health conditions. Many countries have emphasised PHC to prevent high cost of hospital care and improve population health and equity. The existing tension in PHC philosophies and complexity of PHC setting make the implementation and management of these changes more difficult. This paper presents an Australian case study of PHC restructuring and how these changes have been managed from the viewpoint of practitioners and middle managers. Methods As part of a 5‐year project, we interviewed PHC practitioners and managers of services in 7 Australian PHC services. Findings Our findings revealed a policy shift away from the principles of comprehensive PHC including health promotion and action on social determinants of health to one‐to‐one disease management during the course of study. Analysis of the process of change shows that overall, rapid, and top‐down radical reforms of policies and directions were the main characteristic of changes with minimal communication with practitioners and service managers. The study showed that services with community‐controlled model of governance had more autonomy to use an emergent model of change and to maintain their comprehensive PHC services. Conclusions Change is an inevitable feature of PHC systems continually trying to respond to health care demand and cost pressures. The implementation of change in complex settings such as PHC requires appropriate change management strategies to ensure that the proposed reforms are understood, accepted, and implemented successfully.
    March 22, 2017   doi: 10.1002/hpm.2413   open full text
  • The effect of mobile phone short message service on maternal health in south‐west Nigeria.
    Oluwatosin Omole, Macellina Y. Ijadunola, Ezeomu Olotu, Olorunfemi Omotoso, Bamidele Bello, Olalekan Awoniran, Abimbola Phillips, Adesegun Fatusi.
    The International Journal of Health Planning and Management. March 22, 2017
    Background The maternal mortality ratio in Nigeria is estimated to be about 814 per 100,000 live births, and deliveries taken outside a health facility have been implicated as a major factor for this high number. Mobile phones interventions are continually being explored in the health field but its usefulness in maternal health in Nigeria has not been widely explored. Objective To determine the impact of SMS (text messages) on maternal health behaviour in Ife‐Ijesa zone of Osun State, Nigeria. Methods We conducted an experimental study involving 2 groups of pregnant women and sent text messages to both groups. The control group was sent general health messages while the intervention group was sent specific pregnancy related messages and both groups were followed up till 6 weeks after delivery. Results An increase in facility delivery rates among both groups, between the index pregnancy and their last pregnancies, were recorded for both groups with a higher percentage increase recorded in the intervention group (29%) compared with the control group 13%. Crude and adjusted linear regression coefficients were done to estimate the effect of the intervention on the change in proportion of deliveries in health facilities. After adjusting for other variables, the difference obtained was a significant value of 14% (regression coefficient = 0.14, 95% CI = 0.08–0.20, P value = .005). Most participants in the intervention group (96.6%) expressed support for the use of text message for maternal health promotion. Conclusion The SMS‐based intervention has a positive effect on facility delivery, and mothers welcome its use in pregnancy.
    March 22, 2017   doi: 10.1002/hpm.2404   open full text
  • The health policy pendulum: Cost control vs activity growth.
    Trond Tjerbo, Terje P. Hagen.
    The International Journal of Health Planning and Management. March 20, 2017
    Background Cost containment is a major policy challenge and one of the key drivers of health care reform. In this article, we focus on the role cost control has played as a reform driver in the Norwegian hospital sector between 1980 and 2014. Methods We use data on aggregate expenditure as well as on activity changes from year to year. We also use qualitative data for illustrative purposes. Results We identify 4 phases in the period 1980 to 2014: two where activity increases have dominated the agenda and 2 where cost control has been emphasized. The desire to either increase activity or improve cost control has been important reform drivers. Conclusion Cost control has been a major reform motivator in the period, and some of the policies aimed towards achieving cost control have been successful. But as cost control is achieved, waiting lists and popular dissatisfaction increase and new policies are implemented to increase activity.
    March 20, 2017   doi: 10.1002/hpm.2407   open full text
  • Analysis and determination the efficiency of the European health systems.
    María Moreno‐Enguix, Juan Cándido Gómez‐Gallego, María Gómez Gallego.
    The International Journal of Health Planning and Management. March 20, 2017
    The current economic crisis has increased the interest in analyzing the efficiency of health care systems, as their funding is a very important part of the budgets for different countries. In this work determines the efficiency in the health services in European countries applying data envelopment analysis. In addition, the combined application of data envelopment analysis methods and ACP can provide an evaluation of the efficiency with respect to differently oriented productive health systems in the different countries. The results show that models with a lower level of efficiency are those whose input is beds, followed by the models whose input is physicians. Finally, we apply the AD to select a few simple indicators that facilitate control of the level of operational efficiency of a health system.
    March 20, 2017   doi: 10.1002/hpm.2412   open full text
  • Detecting Alternatively Spliced Transcript Isoforms from Single‐Molecule Long‐Read Sequences without a Reference Genome.
    Xiaoxian Liu, Wenbin Mei, Pamela S. Soltis, Douglas E. Soltis, W. Brad Barbazuk.
    The International Journal of Health Planning and Management. March 18, 2017
    Alternative splicing (AS) is a major source of transcript and proteome diversity, but examining AS in species without well‐annotated reference genomes remains difficult. Research on both human and mouse has demonstrated the advantages of using Iso‐Seq™ data for isoform‐level transcriptome analysis, including the study of AS and gene fusion. We applied Iso‐Seq™ to investigate AS in Amborella trichopoda, a phylogenetically pivotal species that is sister to all other living angiosperms. Our data show that, compared with RNA‐Seq data, the Iso‐Seq™ platform provides better recovery on large transcripts, new gene locus identification, and gene model correction. Reference‐based AS detection with Iso‐Seq™ data identifies AS within a higher fraction of multi‐exonic genes than observed for published RNA‐Seq analysis (45.8% vs. 37.5%). These data demonstrate that the Iso‐Seq™ approach is useful for detecting AS events. Using the Iso‐Seq‐defined transcript collection in Amborella as a reference, we further describe a pipeline for detection of AS isoforms from PacBio Iso‐Seq™ without using a reference sequence (de novo). Results using this pipeline show a 66‐76% overall success rate in identifying AS events. This de novo AS detection pipeline provides a method to accurately characterize and identify bona fide alternatively spliced transcripts in any non‐model system that lacks a reference genome sequence. Hence, our pipeline has huge potential applications and benefits to the broader biology community. This article is protected by copyright. All rights reserved.
    March 18, 2017   doi: 10.1111/1755-0998.12670   open full text
  • Detection of individual ploidy levels with genotyping‐by‐sequencing (GBS) analysis.
    Zachariah Gompert, Karen E. Mock.
    The International Journal of Health Planning and Management. March 09, 2017
    Ploidy levels sometimes vary among individuals or populations, particularly in plants. When such variation exists, accurate determination of cytotype can inform studies of ecology or trait variation and is required for population genetic analyses. Here, we propose and evaluate a statistical approach for distinguishing low‐level ploidy variants (e.g. diploids, triploids and tetraploids) based on genotyping‐by‐sequencing (GBS) data. The method infers cytotypes based on observed heterozygosity and the ratio of DNA sequences containing different alleles at thousands of heterozygous SNPs (i.e. allelic ratios). Whereas the method does not require prior information on ploidy, a reference set of samples with known ploidy can be included in the analysis if it is available. We explore the power and limitations of this method using simulated data sets and GBS data from natural populations of aspen (Populus tremuloides) known to include both diploid and triploid individuals. The proposed method was able to reliably discriminate among diploids, triploids and tetraploids in simulated data sets, and this was true for different levels of genetic diversity, inbreeding and population structure. Power and accuracy were minimally affected by low coverage (i.e. 2×), but did sometimes suffer when simulated mixtures of diploids, autotetraploids and allotetraploids were analysed. Cytotype assignments based on the proposed method closely matched those from previous microsatellite and flow cytometry data when applied to GBS data from aspen. An R package (gbs2ploidy) implementing the proposed method is available from CRAN.
    March 09, 2017   doi: 10.1111/1755-0998.12657   open full text
  • High‐throughput mining of E‐genome‐specific SNPs for characterizing Thinopyrum elongatum introgressions in common wheat.
    Haijuan Lou, Lingli Dong, Kunpu Zhang, Da‐Wei Wang, Maolin Zhao, Yiwen Li, Chaowu Rong, Huanju Qin, Aimin Zhang, Zhenying Dong, Daowen Wang.
    The International Journal of Health Planning and Management. March 06, 2017
    Diploid Thinopyrum elongatum (EE, 2n = 2x = 14) and related polyploid species constitute an important gene pool for improving Triticeae grain and forage crops. However, the genomic and molecular marker resources are generally poor for these species. To aid the genetic, molecular, breeding and ecological studies involving Thinopyrum species, we developed a strategy for mining and validating E‐genome‐specific SNPs using Th. elongatum and common wheat (Triticum aestivum, AABBDD, 2n = 6x = 42) as experimental materials. By comparing the transcriptomes between Chinese Spring (CS, a common wheat variety) and the CS‐Th. elongatum octoploid, 35,193 candidate SNPs between E genome genes and their common wheat orthologs were computed. Through comparative genomic analysis, these SNPs were putatively assigned to the seven individual E genome chromosomes. Among 420 randomly selected SNPs, 373 could be validated. Thus, approximately 89% of the mined SNPs may be authentic with respect to their polymorphism and chromosomal location. Using 14 such SNPs as molecular markers, complex E genome introgressions were reliably identified in 78 common wheat‐Th. elongatum hybrids, and the structural feature of a novel recombinant chromosome formed by 6E and 7E was revealed. Finally, based on testing 33 SNPs assigned to chromosome 3E in multiple genotypes of Th. elongatum, Pseudoroegneria stipifolia (carrying the St genome related to E) and common wheat, we suggest that some of the SNP markers may also be applicable for genetic studies within and among the Thinopyrum species (populations) carrying E and/or St genomes in the future.
    March 06, 2017   doi: 10.1111/1755-0998.12659   open full text
  • The Bandung neurosurgery patient outcomes project, Indonesia (Part I): Methods, participant characteristics, and pre‐discharge outcomes.
    Susan McAllister, Amelia Ganefianty, Ahmad Faried, Agung Budi Sutiono, Kalih Sarjono, Regina Melia, Sheila Sumargo, Muhammad Zafrullah Arifin, Sarah Derrett.
    The International Journal of Health Planning and Management. March 02, 2017
    Introduction Little is known about neurosurgery patient outcomes in Indonesia. Our study sought to describe patient characteristics, health care pathways, health‐related quality of life, and health/rehabilitation care needs of patients admitted to, and discharged from, a major neurosurgery department. Methods Eligible patients were aged ≥18 years admitted to the Neurosurgery Department in a regional referral hospital in Bandung, Indonesia. Baseline data was collected on admission. An in‐person interview (in the Indonesian language) was held 1 to 2 days pre‐discharge. Sociodemographic along with clinical characteristics, Glasgow Coma Scale (GCS), and EQ‐5D‐5L data were collected. Results A total of 217 patients were admitted, 37 died before discharge, and a pre‐discharge interview was undertaken by 178 (82%). Almost half (48%) were admitted because of injury, 38% brain tumour, 10% acute illness, and 4% other conditions. The mean age was 41 years. On admission, 63% had a mild Glasgow Coma Scale, 31% moderate, and 3% severe. The average hospital stay was 8 days for injury and 24 days for illness patients. Prior to discharge, one‐third, or less, of the 178 patients interviewed reported “no problems” in the EQ‐5D dimensions of mobility (32%), self‐care (27%), usual activities (16%), and pain/discomfort (32%), whereas 70% reported “no problems” with anxiety/depression. Conclusion A large proportion of patients are being discharged with considerable levels of difficulty in four of the five EQ‐5D dimensions. This stresses the importance of providing good follow‐up and support of patients and their families.
    March 02, 2017   doi: 10.1002/hpm.2408   open full text
  • The Bandung neurosurgery patient outcomes project, Indonesia (Part II): Patient pathways and feasibility and acceptability of telephone follow‐up.
    Agung Budi Sutiono, Ahmad Faried, Susan McAllister, Amelia Ganefianty, Kalih Sarjono, Muhammad Zafrullah Arifin, Sarah Derrett.
    The International Journal of Health Planning and Management. March 02, 2017
    Introduction Support of neurosurgery patients following discharge from hospital is important. Currently, little is known about patients' in low‐ and middle‐income countries before and after their hospital treatment. This companion paper reports patients' pathways before and after hospital admission and the feasibility of following up this ill‐patient population by telephone. Methods Eligible patients were aged ≥18 years admitted to the Neurosurgery Department in Dr. Hasan Sadikin Hospital—a regional referral hospital in Bandung City, Indonesia. Clinical data were collected on admission by clinicians. In‐person interviews were undertaken with a clinical research nurse 1 to 2 days pre‐discharge, and telephone follow‐up interviews at 1, 2, and 3 months post‐discharge. Information was also collected on pathways prior to admission and following discharge. The number of contact attempts for each patient interview was documented, as was the overall acceptability of undertaking a telephone interview. Results Of 178 patients discharged from hospital, 12 later died. Of the remaining 166 patients, 95% were able to be followed up to 3 months. Two‐thirds of patients had been referred from another hospital. Patients came from, and were discharged to, locations throughout the West Java region. At the 1‐month interview, 84% participants reported that they had had a follow‐up consultation with a health professional—mostly with a neurosurgeon. Conclusion This study has shown that, with a neurosurgery nurse delegated to the role, it is feasible to conduct follow‐up telephone interviews with patients after discharge from a neurosurgery ward and that in fact such follow‐up was appreciated by patients.
    March 02, 2017   doi: 10.1002/hpm.2406   open full text
  • Detecting invertebrate species in archived collections using next‐generation sequencing.
    Melissa E. Carew, Leon Metzeling, Rosalind St Clair, Ary A. Hoffmann.
    The International Journal of Health Planning and Management. February 27, 2017
    Invertebrate biodiversity measured at mostly family level is widely used in biological monitoring programmes to assess anthropogenic impacts on ecosystems. However, next‐generation sequencing (NGS) could allow development of new more sensitive biomonitoring tools by allowing rapid species identification. This could be accelerated if archived invertebrate collections and environmental information from past programmes are used to understand species distributions and their environmental responses. In this study, we take archived macroinvertebrate samples from two sites collected on multiple occasions and test whether NGS can successfully detect species. Samples had been stored in 70% ethanol at room temperature for up to 12 years. Three amplicons ranging from 197 to 274 bps within the DNA barcode region were amplified from samples and compared to DNA barcoding libraries to identify species. We were able to amplify partial DNA barcodes from most samples, and species were often detected with multiple amplicons. However, some singletons and taxa poorly covered by DNA barcoding were missed. This suggests additional DNA barcodes will be required to fill ‘gaps’ in current DNA barcode libraries for aquatic macroinvertebrates and/or that it may not be possible to detect all taxa in a sample. Furthermore, older samples often detected fewer taxa and were less reliable for amplification, suggesting NGS is best used on samples within 8 years of collection. Nevertheless, many common taxa with existing DNA barcodes were reliably identified with NGS and were often present at sites across multiple years, showing the potential of NGS for detecting common and abundant species in archived material.
    February 27, 2017   doi: 10.1111/1755-0998.12644   open full text
  • Cryptic diversity and discordance in single‐locus species delimitation methods within horned lizards (Phrynosomatidae: Phrynosoma).
    Christopher Blair, Robert W. Bryson.
    The International Journal of Health Planning and Management. February 27, 2017
    Biodiversity reduction and loss continues to progress at an alarming rate, and thus, there is widespread interest in utilizing rapid and efficient methods for quantifying and delimiting taxonomic diversity. Single‐locus species delimitation methods have become popular, in part due to the adoption of the DNA barcoding paradigm. These techniques can be broadly classified into tree‐based and distance‐based methods depending on whether species are delimited based on a constructed genealogy. Although the relative performance of these methods has been tested repeatedly with simulations, additional studies are needed to assess congruence with empirical data. We compiled a large data set of mitochondrial ND4 sequences from horned lizards (Phrynosoma) to elucidate congruence using four tree‐based (single‐threshold GMYC, multiple‐threshold GMYC, bPTP, mPTP) and one distance‐based (ABGD) species delimitation models. We were particularly interested in cases with highly uneven sampling and/or large differences in intraspecific diversity. Results showed a high degree of discordance among methods, with multiple‐threshold GMYC and bPTP suggesting an unrealistically high number of species (29 and 26 species within the P. douglasii complex alone). The single‐threshold GMYC model was the most conservative, likely a result of difficulty in locating the inflection point in the genealogies. mPTP and ABGD appeared to be the most stable across sampling regimes and suggested the presence of additional cryptic species that warrant further investigation. These results suggest that the mPTP model may be preferable in empirical data sets with highly uneven sampling or large differences in effective population sizes of species.
    February 27, 2017   doi: 10.1111/1755-0998.12658   open full text
  • Spatial detection of outlier loci with Moran eigenvector maps.
    Helene H. Wagner, Mariana Chávez‐Pesqueira, Brenna R. Forester.
    The International Journal of Health Planning and Management. February 18, 2017
    The spatial signature of microevolutionary processes structuring genetic variation may play an important role in the detection of loci under selection. However, the spatial location of samples has not yet been used to quantify this. Here, we present a new two‐step method of spatial outlier detection at the individual and deme levels using the power spectrum of Moran eigenvector maps (MEM). The MEM power spectrum quantifies how the variation in a variable, such as the frequency of an allele at a SNP locus, is distributed across a range of spatial scales defined by MEM spatial eigenvectors. The first step (Moran spectral outlier detection: MSOD) uses genetic and spatial information to identify outlier loci by their unusual power spectrum. The second step uses Moran spectral randomization (MSR) to test the association between outlier loci and environmental predictors, accounting for spatial autocorrelation. Using simulated data from two published papers, we tested this two‐step method in different scenarios of landscape configuration, selection strength, dispersal capacity and sampling design. Under scenarios that included spatial structure, MSOD alone was sufficient to detect outlier loci at the individual and deme levels without the need for incorporating environmental predictors. Follow‐up with MSR generally reduced (already low) false‐positive rates, though in some cases led to a reduction in power. The results were surprisingly robust to differences in sample size and sampling design. Our method represents a new tool for detecting potential loci under selection with individual‐based and population‐based sampling by leveraging spatial information that has hitherto been neglected.
    February 18, 2017   doi: 10.1111/1755-0998.12653   open full text
  • Phylogenomics using formalin‐fixed and 100+ year‐old intractable natural history specimens.
    Sara Ruane, Christopher C. Austin.
    The International Journal of Health Planning and Management. February 13, 2017
    Museum specimens provide a wealth of information to biologists, but obtaining genetic data from formalin‐fixed and fluid‐preserved specimens remains challenging. While DNA sequences have been recovered from such specimens, most approaches are time‐consuming and produce low data quality and quantity. Here, we use a modified DNA extraction protocol combined with high‐throughput sequencing to recover DNA from formalin‐fixed and fluid‐preserved snakes that were collected over a century ago and for which little or no modern genetic materials exist in public collections. We successfully extracted DNA and sequenced ultraconserved elements (x¯ = 2318 loci) from 10 fluid‐preserved snakes and included them in a phylogeny with modern samples. This phylogeny demonstrates the general use of such specimens in phylogenomic studies and provides evidence for the placement of enigmatic snakes, such as the rare and never‐before sequenced Indian Xylophis stenorhynchus. Our study emphasizes the relevance of museum collections in modern research and simultaneously provides a protocol that may prove useful for specimens that have been previously intractable for DNA sequencing.
    February 13, 2017   doi: 10.1111/1755-0998.12655   open full text
  • Minimum sample sizes for population genomics: an empirical study from an Amazonian plant species.
    Alison G. Nazareno, Jordan B. Bemmels, Christopher W. Dick, Lúcia G. Lohmann.
    The International Journal of Health Planning and Management. February 10, 2017
    High‐throughput DNA sequencing facilitates the analysis of large portions of the genome in nonmodel organisms, ensuring high accuracy of population genetic parameters. However, empirical studies evaluating the appropriate sample size for these kinds of studies are still scarce. In this study, we use double‐digest restriction‐associated DNA sequencing (ddRADseq) to recover thousands of single nucleotide polymorphisms (SNPs) for two physically isolated populations of Amphirrhox longifolia (Violaceae), a nonmodel plant species for which no reference genome is available. We used resampling techniques to construct simulated populations with a random subset of individuals and SNPs to determine how many individuals and biallelic markers should be sampled for accurate estimates of intra‐ and interpopulation genetic diversity. We identified 3646 and 4900 polymorphic SNPs for the two populations of A. longifolia, respectively. Our simulations show that, overall, a sample size greater than eight individuals has little impact on estimates of genetic diversity within A. longifolia populations, when 1000 SNPs or higher are used. Our results also show that even at a very small sample size (i.e. two individuals), accurate estimates of FST can be obtained with a large number of SNPs (≥1500). These results highlight the potential of high‐throughput genomic sequencing approaches to address questions related to evolutionary biology in nonmodel organisms. Furthermore, our findings also provide insights into the optimization of sampling strategies in the era of population genomics.
    February 10, 2017   doi: 10.1111/1755-0998.12654   open full text
  • Haplotyping RAD loci: an efficient method to filter paralogs and account for physical linkage.
    Stuart C. Willis, Christopher M. Hollenbeck, Jonathan B. Puritz, John R. Gold, David S. Portnoy.
    The International Journal of Health Planning and Management. February 09, 2017
    Next‐generation sequencing of reduced‐representation genomic libraries provides a powerful methodology for genotyping thousands of single‐nucleotide polymorphisms (SNPs) among individuals of nonmodel species. Utilizing genotype data in the absence of a reference genome, however, presents a number of challenges. One major challenge is the trade‐off between splitting alleles at a single locus into separate clusters (loci), creating inflated homozygosity, and lumping multiple loci into a single contig (locus), creating artefacts and inflated heterozygosity. This issue has been addressed primarily through the use of similarity cut‐offs in sequence clustering. Here, two commonly employed, postclustering filtering methods (read depth and excess heterozygosity) used to identify incorrectly assembled loci are compared with haplotyping, another postclustering filtering approach. Simulated and empirical data sets were used to demonstrate that each of the three methods separately identified incorrectly assembled loci; more optimal results were achieved when the three methods were applied in combination. The results confirmed that including incorrectly assembled loci in population‐genetic data sets inflates estimates of heterozygosity and deflates estimates of population divergence. Additionally, at low levels of population divergence, physical linkage between SNPs within a locus created artificial clustering in analyses that assume markers are independent. Haplotyping SNPs within a locus effectively neutralized the physical linkage issue without having to thin data to a single SNP per locus. We introduce a Perl script that haplotypes polymorphisms, using data from single or paired‐end reads, and identifies potentially problematic loci.
    February 09, 2017   doi: 10.1111/1755-0998.12647   open full text
  • The computer program structure for assigning individuals to populations: easy to use but easier to misuse.
    Jinliang Wang.
    The International Journal of Health Planning and Management. February 07, 2017
    The computer program Structure implements a Bayesian method, based on a population genetics model, to assign individuals to their source populations using genetic marker data. It is widely applied in the fields of ecology, evolutionary biology, human genetics and conservation biology for detecting hidden genetic structures, inferring the most likely number of populations (K), assigning individuals to source populations and estimating admixture and migration rates. Recently, several simulation studies repeatedly concluded that the program yields erroneous inferences when samples from different populations are highly unbalanced in size. Analysing both simulated and empirical data sets, this study confirms that Structure indeed yields poor individual assignments to source populations and gives frequently incorrect estimates of K when sampling is unbalanced. However, this poor performance is mainly caused by the adoption of the default ancestry prior, which assumes all source populations contribute equally to the pooled sample of individuals. When the alternative ancestry prior, which allows for unequal representations of the source populations by the sample, is adopted, accurate individual assignments could be obtained even if sampling is highly unbalanced. The alternative prior also improves the inference of K by two estimators, albeit the improvement is not as much as that in individual assignments to populations. For the difficult case of many populations and unbalanced sampling, a rarely used parameter combination of the alternative ancestry prior, an initial ALPHA value much smaller than the default and the uncorrelated allele frequency model is required for Structure to yield accurate inferences. I conclude that Structure is easy to use but is easier to misuse because of its complicated genetic model and many parameter (prior) options which may not be obvious to choose, and suggest using multiple plausible models (parameters) and K estimators in conducting comparative and exploratory Structure analysis.
    February 07, 2017   doi: 10.1111/1755-0998.12650   open full text
  • A qualitative study on human resources for primary health care in Iran.
    Mahmood Nekoei Moghadam, Mohammadreza Amiresmaili, Vahideh Sadeghi, Ali‐Hossein Zeinalzadeh, Mahmud Tupchi, Sahar Parva.
    The International Journal of Health Planning and Management. February 03, 2017
    Background According to World Bank Group report, while Primary Health Care (PHC) services in Iran were appropriate to the needs of the population in the late 1970s and 1980s, the changing burden of diseases and shifting demand patterns have rendered the existing PHC system no longer suitable to meet current and emergent needs. Based on previous studies, one of the main PHC challenges in Iran relates to human resources issues. Methods This study was conducted in 2012 at 3 scales of local (Tabriz city), provincial (East Azerbaijan), and national levels. Two qualitative methods were used in the study: free–focus group discussions and in‐depth interviews. Framework analysis was used to analyze collected data. Categories of analysis were developed using framework analysis approach, and main themes were emerged. Results Four themes were developed and finalized out of focus group discussions and interviews: availability of health workers in PHC, competency, PHC health workers' motivation, and PHC managerial issues. Conclusion Based on findings and issues discovered in this study, several suggestions can be made, including development, implementation, and evaluation of needs assessment strategies for various vocational posts, promotion of educational courses and PHC‐based training, strengthening of relationships and coordination between practical and scientific bodies, application of incentive programs in PHC, and strengthening of system management capacity through use of qualified managers.
    February 03, 2017   doi: 10.1002/hpm.2405   open full text
  • Reconstructing the plant mitochondrial genome for marker discovery: a case study using Pinus.
    Kevin Donnelly, Joan Cottrell, Richard A. Ennos, Giovanni Giuseppe Vendramin, Stuart A'Hara, Sarah King, Annika Perry, Witold Wachowiak, Stephen Cavers.
    The International Journal of Health Planning and Management. February 03, 2017
    Whole‐genome‐shotgun (WGS) sequencing of total genomic DNA was used to recover ~1 Mbp of novel mitochondrial (mtDNA) sequence from Pinus sylvestris (L.) and three members of the closely related Pinus mugo species complex. DNA was extracted from megagametophyte tissue from six mother trees from locations across Europe, and 100‐bp paired‐end sequencing was performed on the Illumina HiSeq platform. Candidate mtDNA sequences were identified by their size and coverage characteristics, and by comparison with published plant mitochondrial genomes. Novel variants were identified, and primers targeting these loci were trialled on a set of 28 individuals from across Europe. In total, 31 SNP loci were successfully resequenced, characterizing 15 unique haplotypes. This approach offers a cost‐effective means of developing marker resources for mitochondrial genomes in other plant species where reference sequences are unavailable.
    February 03, 2017   doi: 10.1111/1755-0998.12646   open full text
  • DNA metabarcoding reveals that 200‐μm‐size‐fractionated filtering is unable to discriminate between planktonic microbial and large eukaryotes.
    Lemian Liu, Min Liu, David M. Wilkinson, Huihuang Chen, Xiaoqing Yu, Jun Yang.
    The International Journal of Health Planning and Management. February 03, 2017
    Microeukaryotic plankton (0.2–200 μm) are critical components of aquatic ecosystems and key players in global ecological processes. High‐throughput sequencing is currently revolutionizing their study on an unprecedented scale. However, it is currently unclear whether we can accurately, effectively and quantitatively depict the microeukaryotic plankton communities using traditional size‐fractionated filtering combined with molecular methods. To address this, we analysed the eukaryotic plankton communities both with, and without, prefiltering with a 200 μm pore‐size sieve –by using SSU rDNA‐based high‐throughput sequencing on 16 samples with three replicates in each sample from two subtropical reservoirs sampled from January to October in 2013. We found that ~25% reads were classified as metazoan in both size groups. The species richness, alpha and beta diversity of plankton community and relative abundance of reads in 99.2% eukaryotic OTUs showed no significant changes after prefiltering with a 200 μm pore‐size sieve. We further found that both >0.2 μm and 0.2–200 μm eukaryotic plankton communities, especially the abundant plankton subcommunities, exhibited very similar, and synchronous, spatiotemporal patterns and processes associated with almost identical environmental drivers. The lack of an effect on community structure from prefiltering suggests that environmental DNA from larger metazoa is introduced into the smaller size class. Therefore, size‐fractionated filtering with 200 μm is insufficient to discriminate between the eukaryotic plankton size groups in metabarcoding approaches. Our results also highlight the importance of sequencing depth, and strict quality filtering of reads, when designing studies to characterize microeukaryotic plankton communities.
    February 03, 2017   doi: 10.1111/1755-0998.12652   open full text
  • Meeting the challenge of DNA barcoding Neotropical amphibians: polymerase chain reaction optimization and new COI primers.
    Mariana L. Lyra, Célio F. B. Haddad, Ana Maria L. Azeredo‐Espin.
    The International Journal of Health Planning and Management. January 31, 2017
    Amphibians are one of the most threatened vertebrate classes, yet at the same time new species are being described every year, demonstrating that the number of existing species is grossly underestimated. In groups such as amphibians, with high extinction rates and poorly known species boundaries, DNA barcoding is a tool that can rapidly assess genetic diversity and estimate species richness for prioritizing conservation decisions. However, reliable recovery of the 5′ region of the cytochrome c oxidase subunit 1 (COI) gene is critical for the ongoing effort to gather DNA barcodes for all amphibian species. Here, we provide new PCR conditions and tested new primers that increase the efficiency of barcode recovery in amphibians. We found that a low extension temperature for PCR cycles significantly improves the efficiency of amplification for all combinations of primers. Combining low PCR extension temperature and primers AnF1 + AnR1, we were able to recover COI sequences for 100% of the species analysed (N = 161), encompassing ~15% of the species known from Brazil (representing 77 genera and 23 families), which is an important improvement over previous studies. The preliminary assessment of species diversity suggested that number of species might be underestimated by about 25%. We conclude that DNA barcoding is an efficient, simple, and standardized protocol for identifying cryptic diversity in amphibians and advocate for its use in biodiversity inventories and across widespread populations within known species.
    January 31, 2017   doi: 10.1111/1755-0998.12648   open full text
  • Level of genetic differentiation affects relative performances of expressed sequence tag and genomic SSRs.
    Aurélie Khimoun, Anthony Ollivier, Bruno Faivre, Stéphane Garnier.
    The International Journal of Health Planning and Management. January 29, 2017
    Microsatellites, also called simple sequence repeats (SSRs), are markers of choice to estimate relevant parameters for conservation genetics, such as migration rates, effective population size and kinship. Cross‐amplification of SSRs is the simplest way to obtain sets of markers, and highly conserved SSRs have recently been developed from expressed sequence tags (EST) to improve SSR cross‐species utility. As EST‐SSRs are located in coding regions, the higher stability of their flanking regions reduces the frequency of null alleles and improves cross‐species amplification. However, EST‐SSRs have generally less allelic variability than genomic SSRs, potentially leading to differences in estimates of population genetic parameters such as genetic differentiation. To assess the potential of EST‐SSRs in studies of within‐species genetic diversity, we compared the relative performance of EST‐ and genomic SSRs following a multispecies approach on passerine birds. We tested whether patterns and levels of genetic diversity within and between populations assessed from EST‐ and from genomic SSRs are congruent, and we investigated how the relative efficiency of EST‐ and genomic SSRs is influenced by levels of differentiation. EST‐ and genomic SSRs ensured comparable inferences of population genetic structure in cases of strong genetic differentiation, and genomic SSRs performed slightly better than EST‐SSRs when differentiation is moderate. However and interestingly, EST‐SSRs had a higher power to detect weak genetic structure compared to genomic SSRs. Our study attests that EST‐SSRs may be valuable molecular markers for conservation genetic studies in taxa such as birds, where the development of genomic SSRs is impeded by their low frequency.
    January 29, 2017   doi: 10.1111/1755-0998.12642   open full text
  • Identifying the plant‐associated microbiome across aquatic and terrestrial environments: the effects of amplification method on taxa discovery.
    Sara L. Jackrel, Sarah M. Owens, Jack A. Gilbert, Catherine A. Pfister.
    The International Journal of Health Planning and Management. January 25, 2017
    Plants in terrestrial and aquatic environments contain a diverse microbiome. Yet, the chloroplast and mitochondria organelles of the plant eukaryotic cell originate from free‐living cyanobacteria and Rickettsiales. This represents a challenge for sequencing the plant microbiome with universal primers, as ~99% of 16S rRNA sequences may consist of chloroplast and mitochondrial sequences. Peptide nucleic acid clamps offer a potential solution by blocking amplification of host‐associated sequences. We assessed the efficacy of chloroplast and mitochondria‐blocking clamps against a range of microbial taxa from soil, freshwater and marine environments. While we found that the mitochondrial blocking clamps appear to be a robust method for assessing animal‐associated microbiota, Proteobacterial 16S rRNA binds to the chloroplast‐blocking clamp, resulting in a strong sequencing bias against this group. We attribute this bias to a conserved 14‐bp sequence in the Proteobacteria that matches the 17‐bp chloroplast‐blocking clamp sequence. By scanning the Greengenes database, we provide a reference list of nearly 1500 taxa that contain this 14‐bp sequence, including 48 families such as the Rhodobacteraceae, Phyllobacteriaceae, Rhizobiaceae, Kiloniellaceae and Caulobacteraceae. To determine where these taxa are found in nature, we mapped this taxa reference list against the Earth Microbiome Project database. These taxa are abundant in a variety of environments, particularly aquatic and semiaquatic freshwater and marine habitats. To facilitate informed decisions on effective use of organelle‐blocking clamps, we provide a searchable database of microbial taxa in the Greengenes and Silva databases matching various n‐mer oligonucleotides of each PNA sequence.
    January 25, 2017   doi: 10.1111/1755-0998.12645   open full text
  • A new sequence data set of SSU rRNA gene for Scleractinia and its phylogenetic and ecological applications.
    Roberto Arrigoni, Benoît Vacherie, Francesca Benzoni, Fabrizio Stefani, Eric Karsenti, Olivier Jaillon, Fabrice Not, Flavia Nunes, Claude Payri, Patrick Wincker, Valérie Barbe.
    The International Journal of Health Planning and Management. January 23, 2017
    Scleractinian corals (i.e. hard corals) play a fundamental role in building and maintaining coral reefs, one of the most diverse ecosystems on Earth. Nevertheless, their phylogenies remain largely unresolved and little is known about dispersal and survival of their planktonic larval phase. The small subunit ribosomal RNA (SSU rRNA) is a commonly used gene for DNA barcoding in several metazoans, and small variable regions of SSU rRNA are widely adopted as barcode marker to investigate marine plankton community structure worldwide. Here, we provide a large sequence data set of the complete SSU rRNA gene from 298 specimens, representing all known extant reef coral families and a total of 106 genera. The secondary structure was extremely conserved within the order with few exceptions due to insertions or deletions occurring in the variable regions. Remarkable differences in SSU rRNA length and base composition were detected between and within acroporids (Acropora, Montipora, Isopora and Alveopora) compared to other corals. The V4 and V9 regions seem to be promising barcode loci because variation at commonly used barcode primer binding sites was extremely low, while their levels of divergence allowed families and genera to be distinguished. A time‐calibrated phylogeny of Scleractinia is provided, and mutation rate heterogeneity is demonstrated across main lineages. The use of this data set as a valuable reference for investigating aspects of ecology, biology, molecular taxonomy and evolution of scleractinian corals is discussed.
    January 23, 2017   doi: 10.1111/1755-0998.12640   open full text
  • Specifying a State Guaranteed Health Benefits package for Kazakhstan: lessons for emerging economies and middle‐income countries.
    Michael Jones, Tata Chanturidze, Sam Franzen, Alex Manu, Mike Naylor.
    The International Journal of Health Planning and Management. January 12, 2017
    The Government of Kazakhstan is engaged in a “root and branch” modernisation of the health care sector. One aspect of the raft of modernisation programmes was to revisit the State Guaranteed Health Benefits Package, with the aim to review citizen entitlements to healthcare. This paper reviews the ongoing evolution of the planning of the health benefits package in Kazakhstan, with the main challenges encountered, and critical lessons learned, to be considered for similar attempts elsewhere. The main conclusions are that: the design process requires a blend of technical and socio‐political analysis, because it attracts public interest, and therefore political risks; the scale and burden of analysis need to be kept to manageable proportions; and the relationship between the benefits package and funding modalities needs to be carefully managed by the State, to ensure access to declared entitlements to all members, including the most vulnerable, while keeping the package financially feasible. © 2017 The Authors. International Journal of Health Planning and Management published by John Wiley & Sons, Ltd.
    January 12, 2017   doi: 10.1002/hpm.2359   open full text
  • Why do they care? Narratives of physician volunteers on motivations for participation in short‐term medical missions abroad.
    Paul H. Caldron, Ann Impens, Milena Pavlova, Wim Groot.
    The International Journal of Health Planning and Management. January 12, 2017
    Background Short‐term medical missions (STMMs) refer to the provision of direct pro bono medical services in lower and middle income countries for periods ranging from days to a few weeks by physicians from rich countries. Survey data have provided limited information on demographic and professional profiles of physicians as well as monetary and manpower inputs. Understanding why physicians participate, however, remains incomplete. The study's objective was to elicit physicians' motivations directly. Methods Semi‐structured interviews of physicians identified through snowball recruiting were conducted to explore motivational themes and then analyzed using narrative software employing directed content analysis methodology. Results Twenty physicians from varying backgrounds and specialties were interviewed. Responses identified aspects of the decision to participate and the relative influence of economic, diplomatic, value‐related, and emotive constructs. Conclusion Personality traits may be more influential to participation than demographic, professional, or socioeconomic determinants. Word‐of‐mouth recruitment appears to underlie the increase in STMM activity, facilitated by information technology. Reported key motivators for physician participation in STMMs tend to parallel schools of thought regarding philanthropy and volunteering and include satisfaction from helping in challenging conditions of limited resources, learning experiences, appreciation from patients, sense of renewal, and the legacy effect of teaching.
    January 12, 2017   doi: 10.1002/hpm.2402   open full text
  • Implementation of the redesigned Community Health Fund in the Dodoma region of Tanzania: A qualitative study of views from rural communities.
    Albino Kalolo, Lara Gautier, Ralf Radermacher, Manfred Stoermer, Albrecht Jahn, Menoris Meshack, Manuela De Allegri.
    The International Journal of Health Planning and Management. January 08, 2017
    The need to understand how an intervention is received by the beneficiary community is well recognised and particularly neglected in the micro–health insurance (MHI) domain. This study explored the views and reactions of the beneficiary community of the redesigned Community Health Fund (CHF) implemented in the Dodoma region of Tanzania. We collected data from focus group discussions with 24 groups of villagers (CHF members and nonmembers) and in‐depth interviews with 12 key informants (enrolment officers and health care workers). The transcribed material was analysed thematically. We found that participants highly appreciate the scheme, but to be resolved are the challenges posed by the implementation strategies adopted. The responses of the community were nested within a complex pathway relating to their interaction with the implementation strategies and their ongoing reflections regarding the benefits of the scheme. Community reactions ranged from accepting to rejecting the scheme, demanding the right to receive benefit packages once enrolled, and dropping out of the scheme when it failed to meet their expectations. Reported drivers of the responses included intensity of CHF communication activities, management of enrolment procedures, delivery of benefit packages, critical features of the scheme, and contextual factors (health system and socio‐political context). This study highlights that scheme design and implementation strategies that address people's needs, voices, and values can improve uptake of MHI interventions. The study adds to the knowledge base on implementing MHI initiatives and could promote interests in assessing the response to interventions within the MHI domain and beyond.
    January 08, 2017   doi: 10.1002/hpm.2403   open full text
  • eDNA metabarcoding: a promising method for anuran surveys in highly diverse tropical forests.
    Carla M. Lopes, Thais Sasso, Alice Valentini, Tony Dejean, Marcio Martins, Kelly R. Zamudio, Célio F. B. Haddad.
    The International Journal of Health Planning and Management. January 05, 2017
    Understanding the geographical distribution and community composition of species is crucial to monitor species persistence and define effective conservation strategies. Environmental DNA (eDNA) has emerged as a powerful noninvasive tool for species detection. However, most eDNA survey methods have been developed and applied in temperate zones. We tested the feasibility of using eDNA to survey anurans in tropical streams in the Brazilian Atlantic forest and compared the results with short‐term visual and audio surveys. We detected all nine species known to inhabit our focal streams with one single visit for eDNA sampling. We found a higher proportion of sequence reads and larger number of positive PCR replicates for more common species and for those with life cycles closely associated with the streams, factors that may contribute to increased release of DNA in the water. However, less common species were also detected in eDNA samples, demonstrating the detection power of this method. Filtering larger volumes of water resulted in a higher probability of detection. Our data also show it is important to sample multiple sites along streams, particularly for detection of target species with lower population densities. For the three focal species in our study, the eDNA metabarcoding method had a greater capacity of detection per sampling event than our rapid field surveys, and thus, has the potential to circumvent some of the challenges associated with traditional approaches. Our results underscore the utility of eDNA metabarcoding as an efficient method to survey anuran species in tropical streams of the highly biodiverse Brazilian Atlantic forest.
    January 05, 2017   doi: 10.1111/1755-0998.12643   open full text
  • A novel method to infer the origin of polyploids from Amplified Fragment Length Polymorphism data reveals that the alpine polyploid complex of Senecio carniolicus (Asteraceae) evolved mainly via autopolyploidy.
    Manuela Winkler, Pedro Escobar García, Andreas Gattringer, Michaela Sonnleitner, Karl Hülber, Peter Schönswetter, Gerald M. Schneeweiss.
    The International Journal of Health Planning and Management. January 05, 2017
    Despite its evolutionary and ecological relevance, the mode of polyploid origin has been notoriously difficult to be reconstructed from molecular data. Here, we present a method to identify the putative parents of polyploids and thus to infer the mode of their origin (auto‐ vs. allopolyploidy) from Amplified Fragment Length Polymorphism (AFLP) data. To this end, we use Cohen's d of distances between in silico polyploids, generated within a priori defined scenarios of origin from a priori delimited putative parental entities (e.g. taxa, genetic lineages), and natural polyploids. Simulations show that the discriminatory power of the proposed method increases mainly with increasing divergence between the lower‐ploid putative ancestors and less so with increasing delay of polyploidization relative to the time of divergence. We apply the new method to the Senecio carniolicus aggregate, distributed in the European Alps and comprising two diploid, one tetraploid and one hexaploid species. In the eastern part of its distribution, the S. carniolicus aggregate was inferred to comprise an autopolyploid series, whereas for western populations of the tetraploid species, an allopolyploid origin involving the two diploid species was the most likely scenario. Although this suggests that the tetraploid species has two independent origins, other evidence (ribotype distribution, morphology) is consistent with the hypothesis of an autopolyploid origin with subsequent introgression by the second diploid species. Altogether, identifying the best among alternative scenarios using Cohen's d can be straightforward, but particular scenarios, such as allopolyploid origin vs. autopolyploid origin with subsequent introgression, remain difficult to be distinguished.
    January 05, 2017   doi: 10.1111/1755-0998.12641   open full text
  • Resolving microsatellite genotype ambiguity in populations of allopolyploid and diploidized autopolyploid organisms using negative correlations between allelic variables.
    Lindsay V. Clark, Andrea Drauch Schreier.
    The International Journal of Health Planning and Management. January 05, 2017
    A major limitation in the analysis of genetic marker data from polyploid organisms is non‐Mendelian segregation, particularly when a single marker yields allelic signals from multiple, independently segregating loci (isoloci). However, with markers such as microsatellites that detect more than two alleles, it is sometimes possible to deduce which alleles belong to which isoloci. Here, we describe a novel mathematical property of codominant marker data when it is recoded as binary (presence/absence) allelic variables: under random mating in an infinite population, two allelic variables will be negatively correlated if they belong to the same locus, but uncorrelated if they belong to different loci. We present an algorithm to take advantage of this mathematical property, sorting alleles into isoloci based on correlations, then refining the allele assignments after checking for consistency with individual genotypes. We demonstrate the utility of our method on simulated data, as well as a real microsatellite data set from a natural population of octoploid white sturgeon (Acipenser transmontanus). Our methodology is implemented in the R package polysat version 1.6.
    January 05, 2017   doi: 10.1111/1755-0998.12639   open full text
  • SNPs selected by information content outperform randomly selected microsatellite loci for delineating genetic identification and introgression in the endangered dark European honeybee (Apis mellifera mellifera).
    Irene Muñoz, Dora Henriques, Laura Jara, J. Spencer Johnston, Julio Chávez‐Galarza, Pilar De La Rúa, M. Alice Pinto.
    The International Journal of Health Planning and Management. December 26, 2016
    The honeybee (Apis mellifera) has been threatened by multiple factors including pests and pathogens, pesticides and loss of locally adapted gene complexes due to replacement and introgression. In western Europe, the genetic integrity of the native A. m. mellifera (M‐lineage) is endangered due to trading and intensive queen breeding with commercial subspecies of eastern European ancestry (C‐lineage). Effective conservation actions require reliable molecular tools to identify pure‐bred A. m. mellifera colonies. Microsatellites have been preferred for identification of A. m. mellifera stocks across conservation centres. However, owing to high throughput, easy transferability between laboratories and low genotyping error, SNPs promise to become popular. Here, we compared the resolving power of a widely utilized microsatellite set to detect structure and introgression with that of different sets that combine a variable number of SNPs selected for their information content and genomic proximity to the microsatellite loci. Contrary to every SNP data set, microsatellites did not discriminate between the two lineages in the PCA space. Mean introgression proportions were identical across the two marker types, although at the individual level, microsatellites' performance was relatively poor at the upper range of Q‐values, a result reflected by their lower precision. Our results suggest that SNPs are more accurate and powerful than microsatellites for identification of A. m. mellifera colonies, especially when they are selected by information content.
    December 26, 2016   doi: 10.1111/1755-0998.12637   open full text
  • Combining bleach and mild predigestion improves ancient DNA recovery from bones.
    Sanne Boessenkool, Kristian Hanghøj, Heidi M. Nistelberger, Clio Der Sarkissian, Agata T. Gondek, Ludovic Orlando, James H. Barrett, Bastiaan Star.
    The International Journal of Health Planning and Management. December 15, 2016
    The feasibility of genome‐scale studies from archaeological material remains critically dependent on the ability to access endogenous, authentic DNA. In the majority of cases, this represents a few per cent of the DNA extract, at most. A number of specific pre‐extraction protocols for bone powder aimed to improve ancient DNA recovery before library amplification have recently been developed. Here, we test the effects of combining two of such protocols, a bleach wash and a predigestion step, on 12 bone samples of Atlantic cod and domestic horse aged 750–1350 cal. years before present. Using high‐throughput sequencing, we show that combined together, bleach wash and predigestion consistently yield DNA libraries with higher endogenous content than either of these methods alone. Additionally, the molecular complexity of these libraries is improved and endogenous DNA templates show larger size distributions. Other library characteristics, such as DNA damage profiles or the composition of microbial communities, are little affected by the pre‐extraction protocols. Application of the combined protocol presented in this study will facilitate the genetic analysis of an increasing number of ancient remains and will reduce the cost of whole‐genome sequencing.
    December 15, 2016   doi: 10.1111/1755-0998.12623   open full text
  • DNA barcoding of crickets, katydids and grasshoppers (Orthoptera) from Central Europe with focus on Austria, Germany and Switzerland.
    O. Hawlitschek, J. Morinière, G. U. C. Lehmann, A. W. Lehmann, M. Kropf, A. Dunz, F. Glaw, M. Detcharoen, S. Schmidt, A. Hausmann, N. U. Szucsich, S. A. Caetano‐Wyler, G. Haszprunar.
    The International Journal of Health Planning and Management. December 05, 2016
    We present a DNA barcoding study on the insect order Orthoptera that was generated in collaboration between four barcoding projects in three countries, viz. Barcoding Fauna Bavarica (Germany), German Barcode of Life, Austrian Barcode of Life and Swiss Barcode of Life. Our data set includes 748 COI sequences from 127 of the 162 taxa (78.4%) recorded in the three countries involved. Ninety‐three of these 122 species (76.2%, including all Ensifera) can be reliably identified using DNA barcodes. The remaining 26 caeliferan species (families Acrididae and Tetrigidae) form ten clusters that share barcodes among up to five species, in three cases even across different genera, and in six cases even sharing individual barcodes. We discuss incomplete lineage sorting and hybridization as most likely causes of this phenomenon, as the species concerned are phylogenetically young and hybridization has been previously observed. We also highlight the problem of nuclear mitochondrial pseudogenes (numts), a known problem in the barcoding of orthopteran species, and the possibility of Wolbachia infections. Finally, we discuss the possible taxonomic implications of our barcoding results and point out future research directions.
    December 05, 2016   doi: 10.1111/1755-0998.12638   open full text
  • DNA barcoding of tuberous Orchidoideae: a resource for identification of orchids used in Salep.
    Abdolbaset Ghorbani, Barbara Gravendeel, Sugirthini Selliah, Shahin Zarré, Hugo Boer.
    The International Journal of Health Planning and Management. November 28, 2016
    Tubers of terrestrial orchids are harvested and traded from the eastern Mediterranean to the Caspian Sea for the traditional product Salep. Overexploitation of wild populations and increased middle‐class prosperity have escalated prices for Salep, causing overharvesting, depletion of native populations and providing an incentive to expand harvesting to untapped areas in Iran. Limited morphological distinctiveness among traded Salep tubers renders species identification impossible, making it difficult to establish which species are targeted and affected the most. In this study, a reference database of 490 nrITS, trnL‐F spacer and matK sequences of 133 taxa was used to identify 150 individual tubers from 31 batches purchased in 12 cities in Iran to assess species diversity in commerce. The sequence reference database consisted of 211 nrITS, 158 trnL‐F and 121 matK sequences, including 238 new sequences from collections made for this study. The markers enabled unambiguous species identification with tree‐based methods for nrITS in 67% of the tested tubers, 58% for trnL‐F and 59% for matK. Species in the genera Orchis (34%), Anacamptis (27%) and Dactylorhiza (19%) were the most common in Salep. Our study shows that all tuberous orchid species in this area are threatened by this trade, and further stresses the urgency of controlling illegal harvesting and cross‐border trade of Salep tubers.
    November 28, 2016   doi: 10.1111/1755-0998.12615   open full text
  • High performance computation of landscape genomic models including local indicators of spatial association.
    S. Stucki, P. Orozco‐terWengel, B. R. Forester, S. Duruz, L. Colli, C. Masembe, R. Negrini, E. Landguth, M. R. Jones, , M. W. Bruford, P. Taberlet, S. Joost.
    The International Journal of Health Planning and Management. November 28, 2016
    With the increasing availability of both molecular and topo‐climatic data, the main challenges facing landscape genomics – that is the combination of landscape ecology with population genomics – include processing large numbers of models and distinguishing between selection and demographic processes (e.g. population structure). Several methods address the latter, either by estimating a null model of population history or by simultaneously inferring environmental and demographic effects. Here we present samβada, an approach designed to study signatures of local adaptation, with special emphasis on high performance computing of large‐scale genetic and environmental data sets. samβada identifies candidate loci using genotype–environment associations while also incorporating multivariate analyses to assess the effect of many environmental predictor variables. This enables the inclusion of explanatory variables representing population structure into the models to lower the occurrences of spurious genotype–environment associations. In addition, samβada calculates local indicators of spatial association for candidate loci to provide information on whether similar genotypes tend to cluster in space, which constitutes a useful indication of the possible kinship between individuals. To test the usefulness of this approach, we carried out a simulation study and analysed a data set from Ugandan cattle to detect signatures of local adaptation with samβada, bayenv, lfmm and an FST outlier method (FDIST approach in arlequin) and compare their results. samβada – an open source software for Windows, Linux and Mac OS X available at – outperforms other approaches and better suits whole‐genome sequence data processing.
    November 28, 2016   doi: 10.1111/1755-0998.12629   open full text
  • Strategies for complete plastid genome sequencing.
    Alex D. Twyford, Rob W. Ness.
    The International Journal of Health Planning and Management. November 28, 2016
    Plastid sequencing is an essential tool in the study of plant evolution. This high‐copy organelle is one of the most technically accessible regions of the genome, and its sequence conservation makes it a valuable region for comparative genome evolution, phylogenetic analysis and population studies. Here, we discuss recent innovations and approaches for de novo plastid assembly that harness genomic tools. We focus on technical developments including low‐cost sequence library preparation approaches for genome skimming, enrichment via hybrid baits and methylation‐sensitive capture, sequence platforms with higher read outputs and longer read lengths, and automated tools for assembly. These developments allow for a much more streamlined assembly than via conventional short‐range PCR. Although newer methods make complete plastid sequencing possible for any land plant or green alga, there are still challenges for producing finished plastomes particularly from herbarium material or from structurally divergent plastids such as those of parasitic plants.
    November 28, 2016   doi: 10.1111/1755-0998.12626   open full text
  • Resources for phylogenomic analyses of Australian terrestrial vertebrates.
    Jason G. Bragg, Sally Potter, Ke Bi, Renee Catullo, Stephen C. Donnellan, Mark D. B. Eldridge, Leo Joseph, J. Scott Keogh, Paul Oliver, Kevin C. Rowe, Craig Moritz.
    The International Journal of Health Planning and Management. November 25, 2016
    High‐throughput sequencing methods promise to improve our ability to infer the evolutionary histories of lineages and to delimit species. These are exciting prospects for the study of Australian vertebrates, a group comprised of many globally unique lineages with a long history of isolation. The evolutionary relationships within many of these lineages have been difficult to resolve with small numbers of loci, and we now know that many lineages also exhibit substantial cryptic diversity. Here, we present a set of phylogenetically diverse transcriptome resources to enable exon‐based sequence capture studies of Australian vertebrates, including transcriptome sequences for four species of birds, four frogs, seven lizards and seven mammals. We also use exon data from the marsupial transcriptomes we generated to examine an approach for choosing a moderate number (dozens or hundreds) of phylogenetically informative exons based on a single transcriptome sequence, and a relatively distant reference genome.
    November 25, 2016   doi: 10.1111/1755-0998.12633   open full text
  • Controlling for P‐value inflation in allele frequency change in experimental evolution and artificial selection experiments.
    Petri Kemppainen, Bernt Rønning, Thomas Kvalnes, Ingerid J. Hagen, Thor Harald Ringsby, Anna M. Billing, Henrik Pärn, Sigbjørn Lien, Arild Husby, Bernt‐Erik Sæther, Henrik Jensen.
    The International Journal of Health Planning and Management. November 25, 2016
    Experimental evolution studies can be used to explore genomic response to artificial and natural selection. In such studies, loci that display larger allele frequency change than expected by genetic drift alone are assumed to be directly or indirectly associated with traits under selection. However, such studies report surprisingly many loci under selection, suggesting that current tests for allele frequency change may be subject to P‐value inflation and hence be anticonservative. One factor known from genomewide association (GWA) studies to cause P‐value inflation is population stratification, such as relatedness among individuals. Here, we suggest that by treating presence of an individual in a population after selection as a binary response variable, existing GWA methods can be used to account for relatedness when estimating allele frequency change. We show that accounting for relatedness like this effectively reduces false‐positives in tests for allele frequency change in simulated data with varying levels of population structure. However, once relatedness has been accounted for, the power to detect causal loci under selection is low. Finally, we demonstrate the presence of P‐value inflation in allele frequency change in empirical data spanning multiple generations from an artificial selection experiment on tarsus length in two free‐living populations of house sparrow and correct for this using genomic control. Our results indicate that since allele frequencies in large parts of the genome may change when selection acts on a heritable trait, such selection is likely to have considerable and immediate consequences for the eco‐evolutionary dynamics of the affected populations.
    November 25, 2016   doi: 10.1111/1755-0998.12631   open full text
  • ITS all right mama: investigating the formation of chimeric sequences in the ITS2 region by DNA metabarcoding analyses of fungal mock communities of different complexities.
    Anders Bjørnsgaard Aas, Marie Louise Davey, Håvard Kauserud.
    The International Journal of Health Planning and Management. November 24, 2016
    The formation of chimeric sequences can create significant methodological bias in PCR‐based DNA metabarcoding analyses. During mixed‐template amplification of barcoding regions, chimera formation is frequent and well documented. However, profiling of fungal communities typically uses the more variable rDNA region ITS. Due to a larger research community, tools for chimera detection have been developed mainly for the 16S/18S markers. However, these tools are widely applied to the ITS region without verification of their performance. We examined the rate of chimera formation during amplification and 454 sequencing of the ITS2 region from fungal mock communities of different complexities. We evaluated the chimera detecting ability of two common chimera‐checking algorithms: perseus and uchime. Large proportions of the chimeras reported were false positives. No false negatives were found in the data set. Verified chimeras accounted for only 0.2% of the total ITS2 reads, which is considerably less than what is typically reported in 16S and 18S metabarcoding analyses. Verified chimeric ‘parent sequences’ had significantly higher per cent identity to one another than to random members of the mock communities. Community complexity increased the rate of chimera formation. GC content was higher around the verified chimeric break points, potentially facilitating chimera formation through base pair mismatching in the neighbouring regions of high similarity in the chimeric region. We conclude that the hypervariable nature of the ITS region seems to buffer the rate of chimera formation in comparison with other, less variable barcoding regions, due to shorter regions of high sequence similarity.
    November 24, 2016   doi: 10.1111/1755-0998.12622   open full text
  • varver: a database of microsatellite variation in vertebrates.
    Akiko Sato Yashima, Hideki Innan.
    The International Journal of Health Planning and Management. November 21, 2016
    Understanding how genetic variation is maintained within a species is important in ecology, evolution, conservation and population genetics. Tremendous efforts have been made to evaluate the patterns of genetic variation in natural populations of various species. For this purpose, microsatellites have played a major role since the 1990s. Here we describe a comprehensive database, varver (Variation in Vertebrates) that provides complete information regarding microsatellite variation in natural populations of vertebrates. For each species, varver includes basic information of the species, a list of publications reporting the microsatellite variation, and tables of genetic variation within and between populations (heterozygosity and FST). The geographic location and rough sampling range are also shown for each sampled population. The database should be useful for researchers interested in not only specific species but also comparing multiple species. We discuss the utility of microsatellite data, particularly for meta‐analyses that involve multiple microsatellite loci from various species. We show that in such analyses, it is extremely important to correct for biases caused by differences in mutation rate, mainly due to repeat unit and number.
    November 21, 2016   doi: 10.1111/1755-0998.12625   open full text
  • Evaluating and optimizing the performance of software commonly used for the taxonomic classification of DNA metabarcoding sequence data.
    Rodney T. Richardson, Johan Bengtsson‐Palme, Reed M. Johnson.
    The International Journal of Health Planning and Management. November 21, 2016
    The taxonomic classification of DNA sequences has become a critical component of numerous ecological research applications; however, few studies have evaluated the strengths and weaknesses of commonly used sequence classification approaches. Further, the methods and software available for sequence classification are diverse, creating an environment in which it may be difficult to determine the best course of action and the trade‐offs made using different classification approaches. Here, we provide an in silico evaluation of three DNA sequence classifiers, the rdp Naïve Bayesian Classifier, rtax and utax. Further, we discuss the results, merits and limitations of both the classifiers and our method of classifier evaluation. Our methods of comparison are simple, yet robust, and will provide researchers a methodological and conceptual foundation for making such evaluations in a variety of research situations. Generally, we found a considerable trade‐off between accuracy and sensitivity for the classifiers tested, indicating a need for further improvement of sequence classification tools.
    November 21, 2016   doi: 10.1111/1755-0998.12628   open full text
  • Detection limits of quantitative and digital PCR assays and their influence in presence–absence surveys of environmental DNA.
    Margaret E. Hunter, Robert M. Dorazio, John S. S. Butterfield, Gaia Meigs‐Friend, Leo G. Nico, Jason A. Ferrante.
    The International Journal of Health Planning and Management. November 20, 2016
    A set of universal guidelines is needed to determine the limit of detection (LOD) in PCR‐based analyses of low‐concentration DNA. In particular, environmental DNA (eDNA) studies require sensitive and reliable methods to detect rare and cryptic species through shed genetic material in environmental samples. Current strategies for assessing detection limits of eDNA are either too stringent or subjective, possibly resulting in biased estimates of species’ presence. Here, a conservative LOD analysis grounded in analytical chemistry is proposed to correct for overestimated DNA concentrations predominantly caused by the concentration plateau, a nonlinear relationship between expected and measured DNA concentrations. We have used statistical criteria to establish formal mathematical models for both quantitative and droplet digital PCR. To assess the method, a new Grass Carp (Ctenopharyngodon idella) TaqMan assay was developed and tested on both PCR platforms using eDNA in water samples. The LOD adjustment reduced Grass Carp occupancy and detection estimates while increasing uncertainty—indicating that caution needs to be applied to eDNA data without LOD correction. Compared to quantitative PCR, digital PCR had higher occurrence estimates due to increased sensitivity and dilution of inhibitors at low concentrations. Without accurate LOD correction, species occurrence and detection probabilities based on eDNA estimates are prone to a source of bias that cannot be reduced by an increase in sample size or PCR replicates. Other applications also could benefit from a standardized LOD such as GMO food analysis and forensic and clinical diagnostics.
    November 20, 2016   doi: 10.1111/1755-0998.12619   open full text
  • Paralogs are revealed by proportion of heterozygotes and deviations in read ratios in genotyping‐by‐sequencing data from natural populations.
    Garrett J. McKinney, Ryan K. Waples, Lisa W. Seeb, James E. Seeb.
    The International Journal of Health Planning and Management. November 20, 2016
    Whole‐genome duplications have occurred in the recent ancestors of many plants, fish, and amphibians, resulting in a pervasiveness of paralogous loci and the potential for both disomic and tetrasomic inheritance in the same genome. Paralogs can be difficult to reliably genotype and are often excluded from genotyping‐by‐sequencing (GBS) analyses; however, removal requires paralogs to be identified which is difficult without a reference genome. We present a method for identifying paralogs in natural populations by combining two properties of duplicated loci: (i) the expected frequency of heterozygotes exceeds that for singleton loci, and (ii) within heterozygotes, observed read ratios for each allele in GBS data will deviate from the 1:1 expected for singleton (diploid) loci. These deviations are often not apparent within individuals, particularly when sequence coverage is low; but, we postulated that summing allele reads for each locus over all heterozygous individuals in a population would provide sufficient power to detect deviations at those loci. We identified paralogous loci in three species: Chinook salmon (Oncorhynchus tshawytscha) which retains regions with ongoing residual tetrasomy on eight chromosome arms following a recent whole‐genome duplication, mountain barberry (Berberis alpina) which has a large proportion of paralogs that arose through an unknown mechanism, and dusky parrotfish (Scarus niger) which has largely rediploidized following an ancient whole‐genome duplication. Importantly, this approach only requires the genotype and allele‐specific read counts for each individual, information which is readily obtained from most GBS analysis pipelines.
    November 20, 2016   doi: 10.1111/1755-0998.12613   open full text
  • A combined field survey and molecular identification protocol for comparing forest arthropod biodiversity across spatial scales.
    Brent C. Emerson, Juliane Casquet, Heriberto López, Pedro Cardoso, Paulo A. V. Borges, Noémy Mollaret, Pedro Oromí, Dominique Strasberg, Christophe Thébaud.
    The International Journal of Health Planning and Management. November 20, 2016
    Obtaining fundamental biodiversity metrics such as alpha, beta and gamma diversity for arthropods is often complicated by a lack of prior taxonomic information and/or taxonomic expertise, which can result in unreliable morphologically based estimates. We provide a set of standardized ecological and molecular sampling protocols that can be employed by researchers whose taxonomic skills may be limited, and where there may be a lack of robust a priori information regarding the regional pool of species. These protocols combine mass sampling of arthropods, classification of samples into parataxonomic units (PUs) and selective sampling of individuals for mtDNA sequencing to infer biological species. We sampled ten lowland rainforest plots located on the volcanic oceanic island of Réunion (Mascarene archipelago) for spiders, a group with limited taxonomic and distributional data for this region. We classified adults and juveniles into PUs and then demonstrated the reconciliation of these units with presumed biological species using mtDNA sequence data, ecological data and distributional data. Because our species assignment protocol is not reliant upon prior taxonomic information, or taxonomic expertise, it minimizes the problem of the Linnean shortfall to yield diversity estimates that can be directly compared across independent studies. Field sampling can be extended to other arthropod groups and habitats by adapting our field sampling protocol accordingly.
    November 20, 2016   doi: 10.1111/1755-0998.12617   open full text
  • Identification of sawflies and horntails (Hymenoptera, ‘Symphyta’) through DNA barcodes: successes and caveats.
    Stefan Schmidt, Andreas Taeger, Jérôme Morinière, Andrew Liston, Stephan M. Blank, Katja Kramp, Manfred Kraus, Olga Schmidt, Erik Heibo, Marko Prous, Tommi Nyman, Tobias Malm, Julie Stahlhut.
    The International Journal of Health Planning and Management. November 19, 2016
    The ‘Symphyta’ is a paraphyletic assemblage at the base of the order Hymenoptera, comprising 14 families and about 8750 species. All have phytophagous larvae, except for the Orussidae, which are parasitoids. This study presents and evaluates the results of DNA barcoding of approximately 5360 specimens of ‘Symphyta’, mainly adults, and 4362 sequences covering 1037 species were deemed of suitable quality for inclusion in the analysis. All extant families are represented, except for the Anaxyelidae. The majority of species and specimens are from Europe, but approximately 38% of the species and 13% of the specimens are of non‐European origin. The utility of barcoding for species identification and taxonomy of ‘Symphyta’ is discussed on the basis of examples from each of the included families. A significant level of cryptic species diversity was apparent in many groups. Other attractive applications include the identification of immature stages without the need to rear them, community analyses based on metabarcoding of bulk samples and association of the sexes of adults.
    November 19, 2016   doi: 10.1111/1755-0998.12614   open full text
  • High phylogenetic utility of an ultraconserved element probe set designed for Arachnida.
    James Starrett, Shahan Derkarabetian, Marshal Hedin, Robert W. Bryson, John E. McCormack, Brant C. Faircloth.
    The International Journal of Health Planning and Management. November 19, 2016
    Arachnida is an ancient, diverse and ecologically important animal group that contains a number of species of interest for medical, agricultural and engineering applications. Despite their importance, many aspects of the arachnid tree of life remain unresolved, hindering comparative approaches to arachnid biology. Biologists have made considerable efforts to resolve the arachnid phylogeny; yet, limited and challenging morphological characters, as well as a dearth of genetic resources, have hindered progress. Here, we present a genomic toolkit for arachnids featuring hundreds of conserved DNA regions (ultraconserved elements or UCEs) that allow targeted sequencing of any species in the arachnid tree of life. We used recently developed capture probes designed from conserved regions of available arachnid genomes to enrich a sample of loci from 32 diverse arachnids. Sequence capture returned an average of 487 UCE loci for all species, with a range from 170 to 722. Phylogenetic analysis of these UCEs produced a highly resolved arachnid tree with relationships largely consistent with recent transcriptome‐based phylogenies. We also tested the phylogenetic informativeness of UCE probes within the spider, scorpion and harvestman orders, demonstrating the utility of these markers at shallower taxonomic scales and suggesting that these loci will be useful for species‐level differences. This probe set will open the door to phylogenomic and population genomic studies across the arachnid tree of life, enabling systematics, species delimitation, species discovery and conservation of these diverse arthropods.
    November 19, 2016   doi: 10.1111/1755-0998.12621   open full text
  • Modified low‐salt CTAB extraction of high‐quality DNA from contaminant‐rich tissues.
    Jean‐René Arseneau, Royce Steeves, Mark Laflamme.
    The International Journal of Health Planning and Management. November 18, 2016
    The increasing use of high‐throughput sequencing platforms has made the isolation of pure, high molecular weight DNA a primary concern for studies of a diverse range of organisms. Purification of DNA remains a significant challenge in many tissue and sample types due to various organic and inorganic molecules that coprecipitate with nucleic acids. Molluscs, for example, contain high concentrations of polysaccharides which often coprecipitate with DNA and can inhibit downstream enzymatic reactions. We modified a low‐salt CTAB (MoLSC) extraction protocol to accommodate contaminant‐rich animal tissues and compared this method to a standard CTAB extraction protocol and two commercially available animal tissue DNA extraction kits using oyster adductor muscle. Comparisons of purity and molecular integrity showed that our in‐house protocol yielded genomic DNA generally free of contaminants and shearing, whereas the traditional CTAB method and some of the commercial kits yielded DNA unsuitable for some applications of massively parallel sequencing. Our open‐source MoLSC protocol provides a cost‐effective, scalable, alternative DNA extraction method that can be easily optimized and adapted for sequencing applications in other contaminant‐rich samples.
    November 18, 2016   doi: 10.1111/1755-0998.12616   open full text
  • Testing genotyping strategies for ultra‐deep sequencing of a co‐amplifying gene family: MHC class I in a passerine bird.
    Aleksandra Biedrzycka, Alvaro Sebastian, Magdalena Migalska, Helena Westerdahl, Jacek Radwan.
    The International Journal of Health Planning and Management. November 18, 2016
    Characterization of highly duplicated genes, such as genes of the major histocompatibility complex (MHC), where multiple loci often co‐amplify, has until recently been hindered by insufficient read depths per amplicon. Here, we used ultra‐deep Illumina sequencing to resolve genotypes at exon 3 of MHC class I genes in the sedge warbler (Acrocephalus schoenobaenus). We sequenced 24 individuals in two replicates and used this data, as well as a simulated data set, to test the effect of amplicon coverage (range: 500–20 000 reads per amplicon) on the repeatability of genotyping using four different genotyping approaches. A third replicate employed unique barcoding to assess the extent of tag jumping, that is swapping of individual tag identifiers, which may confound genotyping. The reliability of MHC genotyping increased with coverage and approached or exceeded 90% within‐method repeatability of allele calling at coverages of >5000 reads per amplicon. We found generally high agreement between genotyping methods, especially at high coverages. High reliability of the tested genotyping approaches was further supported by our analysis of the simulated data set, although the genotyping approach relying primarily on replication of variants in independent amplicons proved sensitive to repeatable errors. According to the most repeatable genotyping method, the number of co‐amplifying variants per individual ranged from 19 to 42. Tag jumping was detectable, but at such low frequencies that it did not affect the reliability of genotyping. We thus demonstrate that gene families with many co‐amplifying genes can be reliably genotyped using HTS, provided that there is sufficient per amplicon coverage.
    November 18, 2016   doi: 10.1111/1755-0998.12612   open full text
  • Identifying homomorphic sex chromosomes from wild‐caught adults with limited genomic resources.
    Alan Brelsford, Guillaume Lavanchy, Roberto Sermier, Anna Rausch, Nicolas Perrin.
    The International Journal of Health Planning and Management. November 18, 2016
    We demonstrate a genotyping‐by‐sequencing approach to identify homomorphic sex chromosomes and their homolog in a distantly related reference genome, based on noninvasive sampling of wild‐caught individuals, in the moor frog Rana arvalis. Double‐digest RADseq libraries were generated using buccal swabs from 30 males and 21 females from the same population. Search for sex‐limited markers from the unfiltered data set (411 446 RAD tags) was more successful than searches from a filtered data set (33 073 RAD tags) for markers showing sex differences in heterozygosity or in allele frequencies. Altogether, we obtained 292 putatively sex‐linked RAD loci, 98% of which point to male heterogamety. We could map 15 of them to the Xenopus tropicalis genome, all but one on chromosome pair 1, which seems regularly co‐opted for sex determination among amphibians. The most efficient mapping strategy was a three‐step hierarchical approach, where R. arvalis reads were first mapped to a low‐coverage genome of Rana temporaria (17 My divergence), then the R. temporaria scaffolds to the Nanorana parkeri genome (90 My divergence), and finally the N. parkeri scaffolds to the X. tropicalis genome (210 My). We validated our conclusions with PCR primers amplifying part of Dmrt1, a candidate sex determination gene mapping to chromosome 1: a sex‐diagnostic allele was present in all 30 males but in none of the 21 females. Our approach is likely to be productive in many situations where biological samples and/or genomic resources are limited.
    November 18, 2016   doi: 10.1111/1755-0998.12624   open full text
  • A framework for developing and validating taxon‐specific primers for specimen identification from environmental DNA.
    Anna J. MacDonald, Stephen D. Sarre.
    The International Journal of Health Planning and Management. November 16, 2016
    Taxon‐specific DNA tests are applied to many ecological and management questions, increasingly using environmental DNA (eDNA). eDNA facilitates noninvasive ecological studies but introduces additional risks of bias and error. For effective application, PCR primers must be developed for each taxon and validated in each system. We outline a nine step framework for the development and validation of taxon‐specific primers for eDNA analysis in ecological studies, involving reference database construction, phylogenetic evaluation of the target gene, primer design, primer evaluation in silico, and laboratory evaluation of primer specificity, sensitivity and utility. Our framework makes possible a rigorous evaluation of likely sources of error. The first five steps can be conducted relatively rapidly and (where reference DNA sequences are available) require minimal laboratory resources, enabling assessment of primer suitability before investing in further work. Steps six to eight require more costly laboratory analyses but are essential to evaluate risks of false‐positive and false‐negative results, while step 9 relates to field implementation. As an example, we have developed and evaluated primers to specifically amplify part of the mitochondrial ND2 gene from Australian bandicoots. If adopted during the early stages of primer development, our framework will facilitate large‐scale implementation of well‐designed DNA tests to detect specific wildlife from eDNA samples. This will provide researchers and managers with an understanding of the strengths and limitations of their data and the conclusions that can be drawn from them.
    November 16, 2016   doi: 10.1111/1755-0998.12618   open full text
  • A comparison of DNA extraction methods for high‐throughput DNA analyses.
    Lauren M. Schiebelhut, Sarah S. Abboud, Liza E. Gómez Daglio, Holly F. Swift, Michael N Dawson.
    The International Journal of Health Planning and Management. November 16, 2016
    The inclusion of next‐generation sequencing technologies in population genetic and phylogenetic studies has elevated the need to balance time and cost of DNA extraction without compromising DNA quality. We tested eight extraction methods – ranging from low‐ to high‐throughput techniques – and eight phyla: Annelida, Arthropoda, Cnidaria, Chordata, Echinodermata, Mollusca, Ochrophyta and Porifera. We assessed DNA yield, purity, efficacy and cost of each method. Extraction efficacy was quantified using the proportion of successful polymerase chain reaction (PCR) amplification of two molecular markers for metazoans (mitochondrial COI and nuclear histone 3) and one for Ochrophyta (mitochondrial nad6) at four time points – 0.5, 1, 2 and 3 years following extraction. DNA yield and purity were quantified using NanoDrop absorbance ratios. Cost was estimated in terms of time and material expense. Results show differences in DNA yield, purity and PCR success between extraction methods and that performance also varied by taxon. The traditional time‐intensive, low‐throughput CTAB phenol–chloroform extraction performed well across taxa, but other methods also performed well and provide the opportunity to reduce time spent at the bench and increase throughput.
    November 16, 2016   doi: 10.1111/1755-0998.12620   open full text
  • swinger: a user‐friendly computer program to establish captive breeding groups that minimize relatedness without pedigree information.
    Jonathan Sandoval‐Castillo, Catherine R. M. Attard, Shashikanth Marri, Chris J. Brauer, Luciana M. Möller, Luciano B. Beheregaray.
    The International Journal of Health Planning and Management. November 14, 2016
    Captive breeding programmes are often a necessity for the continued persistence of a population or species. They typically have the goal of maintaining genetic diversity and minimizing inbreeding. However, most captive breeding programmes have been based on the assumption that the founding breeders are unrelated and outbred, even though in situ anthropogenic impacts often mean these founders may have high relatedness and substantial inbreeding. In addition, polygamous group‐breeding species in captivity often have uncertain pedigrees, making it difficult to select the group composition for subsequent breeding. Molecular‐based estimates of relatedness and inbreeding may instead be used to select breeding groups (≥two individuals) that minimize relatedness and filter out inbred individuals. swinger constructs breeding groups based on molecular estimates of relatedness and inbreeding. The number of possible combinations of breeding groups quickly becomes intractable by hand. swinger was designed to overcome this major issue in ex situ conservation biology. The user can specify parameters within swinger to reach breeding solutions that suit the mating system of the target species and available resources. We provide evidence of the efficiency of the software with an empirical example and using simulations. The only data required are a typical molecular marker data set, such as a microsatellite or SNP data set, from which estimates of inbreeding and pairwise relatedness may be obtained. Such molecular data sets are becoming easier to gather from non‐model organisms with next‐generation sequencing technology. swinger is an open‐source software with a user‐friendly interface and is available at and
    November 14, 2016   doi: 10.1111/1755-0998.12609   open full text
  • Draft genome of the American Eel (Anguilla rostrata).
    Scott A. Pavey, Martin Laporte, Eric Normandeau, Jérémy Gaudin, Louis Letourneau, Sébastien Boisvert, Jacques Corbeil, Céline Audet, Louis Bernatchez.
    The International Journal of Health Planning and Management. November 14, 2016
    Freshwater eels (Anguilla sp.) have large economic, cultural, ecological and aesthetic importance worldwide, but they suffered more than 90% decline in global stocks over the past few decades. Proper genetic resources, such as sequenced, assembled and annotated genomes, are essential to help plan sustainable recoveries by identifying physiological, biochemical and genetic mechanisms that caused the declines or that may lead to recoveries. Here, we present the first sequenced genome of the American eel. This genome contained 305 043 contigs (N50 = 7397) and 79 209 scaffolds (N50 = 86 641) for a total size of 1.41 Gb, which is in the middle of the range of previous estimations for this species. In addition, protein‐coding regions, including introns and flanking regions, are very well represented in the genome, as 95.2% of the 458 core eukaryotic genes and 98.8% of the 248 ultra‐conserved subset were represented in the assembly and a total of 26 564 genes were annotated for future functional genomics studies. We performed a candidate gene analysis to compare three genes among all three freshwater eel species and, congruent with the phylogenetic relationships, Japanese eel (A. japanica) exhibited the most divergence. Overall, the sequenced genome presented in this study is a crucial addition to the presently available genetic tools to help guide future conservation efforts of freshwater eels.
    November 14, 2016   doi: 10.1111/1755-0998.12608   open full text
  • Characterizing restriction enzyme‐associated loci in historic ragweed (Ambrosia artemisiifolia) voucher specimens using custom‐designed RNA probes.
    Fátima Sánchez Barreiro, Filipe G. Vieira, Michael D. Martin, James Haile, M. Thomas P. Gilbert, Nathan Wales.
    The International Journal of Health Planning and Management. November 07, 2016
    Population genetic studies of nonmodel organisms frequently employ reduced representation library (RRL) methodologies, many of which rely on protocols in which genomic DNA is digested by one or more restriction enzymes. However, because high molecular weight DNA is recommended for these protocols, samples with degraded DNA are generally unsuitable for RRL methods. Given that ancient and historic specimens can provide key temporal perspectives to evolutionary questions, we explored how custom‐designed RNA probes could enrich for RRL loci (Restriction Enzyme‐Associated Loci baits, or REALbaits). Starting with genotyping‐by‐sequencing (GBS) data generated on modern common ragweed (Ambrosia artemisiifolia L.) specimens, we designed 20 000 RNA probes to target well‐characterized genomic loci in herbarium voucher specimens dating from 1835 to 1913. Compared to shotgun sequencing, we observed enrichment of the targeted loci at 19‐ to 151‐fold. Using our GBS capture pipeline on a data set of 38 herbarium samples, we discovered 22 813 SNPs, providing sufficient genomic resolution to distinguish geographic populations. For these samples, we found that dilution of REALbaits to 10% of their original concentration still yielded sufficient data for downstream analyses and that a sequencing depth of ~7m reads was sufficient to characterize most loci without wasting sequencing capacity. In addition, we observed that targeted loci had highly variable rates of success, which we primarily attribute to similarity between loci, a trait that ultimately interferes with unambiguous read mapping. Our findings can help researchers design capture experiments for RRL loci, thereby providing an efficient means to integrate samples with degraded DNA into existing RRL data sets.
    November 07, 2016   doi: 10.1111/1755-0998.12610   open full text
  • DNA barcodes of the native ray‐finned fishes in Taiwan.
    Chia‐Hao Chang, Kwang‐Tsao Shao, Han‐Yang Lin, Yung‐Chieh Chiu, Mao‐Ying Lee, Shih‐Hui Liu, Pai‐Lei Lin.
    The International Journal of Health Planning and Management. November 02, 2016
    Species identification based on the DNA sequence of a fragment of the cytochrome c oxidase subunit I gene in the mitochondrial genome, DNA barcoding, is widely applied to assist in sustainable exploitation of fish resources and the protection of fish biodiversity. The aim of this study was to establish a reliable barcoding reference database of the native ray‐finned fishes in Taiwan. A total of 2993 individuals, belonging to 1245 species within 637 genera, 184 families and 29 orders of ray‐finned fishes and representing approximately 40% of the recorded ray‐finned fishes in Taiwan, were PCR amplified at the barcode region and bidirectionally sequenced. The mean length of the 2993 barcodes is 549 bp. Mean congeneric K2P distance (15.24%) is approximately 10‐fold higher than the mean conspecific one (1.51%), but approximately 1.4‐fold less than the mean genetic distance between families (20.80%). The Barcode Index Number (BIN) discordance report shows that 2993 specimens represent 1275 BINs and, among them, 86 BINs are singletons, 570 BINs are taxonomically concordant, and the other 619 BINs are taxonomically discordant. Barcode gap analysis also revealed that more than 90% of the collected fishes in this study can be discriminated by DNA barcoding. Overall, the barcoding reference database established by this study reveals the need for taxonomic revisions and voucher specimen rechecks, in addition to assisting in the management of Taiwan's fish resources and diversity.
    November 02, 2016   doi: 10.1111/1755-0998.12601   open full text
  • Development of genomic tools in a widespread tropical tree, Symphonia globulifera L.f.: a new low‐coverage draft genome, SNP and SSR markers.
    Sanna Olsson, Pedro Seoane‐Zonjic, Rocío Bautista, M. Gonzalo Claros, Santiago C. González‐Martínez, Ivan Scotti, Caroline Scotti‐Saintagne, Olivier J. Hardy, Myriam Heuertz.
    The International Journal of Health Planning and Management. October 27, 2016
    Population genetic studies in tropical plants are often challenging because of limited information on taxonomy, phylogenetic relationships and distribution ranges, scarce genomic information and logistic challenges in sampling. We describe a strategy to develop robust and widely applicable genetic markers based on a modest development of genomic resources in the ancient tropical tree species Symphonia globulifera L.f. (Clusiaceae), a keystone species in African and Neotropical rainforests. We provide the first low‐coverage (11X) fragmented draft genome sequenced on an individual from Cameroon, covering 1.027 Gbp or 67.5% of the estimated genome size. Annotation of 565 scaffolds (7.57 Mbp) resulted in the prediction of 1046 putative genes (231 of them containing a complete open reading frame) and 1523 exact simple sequence repeats (SSRs, microsatellites). Aligning a published transcriptome of a French Guiana population against this draft genome produced 923 high‐quality single nucleotide polymorphisms. We also preselected genic SSRs in silico that were conserved and polymorphic across a wide geographical range, thus reducing marker development tests on rare DNA samples. Of 23 SSRs tested, 19 amplified and 18 were successfully genotyped in four S. globulifera populations from South America (Brazil and French Guiana) and Africa (Cameroon and São Tomé island, FST = 0.34). Most loci showed only population‐specific deviations from Hardy–Weinberg proportions, pointing to local population effects (e.g. null alleles). The described genomic resources are valuable for evolutionary studies in Symphonia and for comparative studies in plants. The methods are especially interesting for widespread tropical or endangered taxa with limited DNA availability.
    October 27, 2016   doi: 10.1111/1755-0998.12605   open full text
  • Genome assembly and annotation of Arabidopsis halleri, a model for heavy metal hyperaccumulation and evolutionary ecology.
    Roman V. Briskine, Timothy Paape, Rie Shimizu‐Inatsugi, Tomoaki Nishiyama, Satoru Akama, Jun Sese, Kentaro K. Shimizu.
    The International Journal of Health Planning and Management. October 26, 2016
    The self‐incompatible species Arabidopsis halleri is a close relative of the self‐compatible model plant Arabidopsis thaliana. The broad European and Asian distribution and heavy metal hyperaccumulation ability make A. halleri a useful model for ecological genomics studies. We used long‐insert mate‐pair libraries to improve the genome assembly of the A. halleri ssp. gemmifera Tada mine genotype (W302) collected from a site with high contamination by heavy metals in Japan. After five rounds of forced selfing, heterozygosity was reduced to 0.04%, which facilitated subsequent genome assembly. Our assembly now covers 196 Mb or 78% of the estimated genome size and achieved scaffold N50 length of 712 kb. To validate assembly and annotation, we used synteny of A. halleri Tada mine with a previously published high‐quality reference assembly of a closely related species, Arabidopsis lyrata. Further validation of the assembly quality comes from synteny and phylogenetic analysis of the HEAVY METAL ATPASE4 (HMA4) and METAL TOLERANCE PROTEIN1 (MTP1) regions using published sequences from European A. halleri for comparison. Three tandemly duplicated copies of HMA4, key gene involved in cadmium and zinc hyperaccumulation, were assembled on a single scaffold. The assembly will enhance the genomewide studies of A. halleri as well as the allopolyploid Arabidopsis kamchatica derived from A. lyrata and A. halleri.
    October 26, 2016   doi: 10.1111/1755-0998.12604   open full text
  • tipdatingbeast: an r package to assist the implementation of phylogenetic tip‐dating tests using beast.
    Adrien Rieux, Camilo E. Khatchikian.
    The International Journal of Health Planning and Management. October 25, 2016
    Molecular tip dating of phylogenetic trees is a growing discipline that uses DNA sequences sampled at different points in time to coestimate the timing of evolutionary events with rates of molecular evolution. In this context, beast, a program for Bayesian analysis of molecular sequences, is the most widely used phylogenetic tool. Here, we introduce tipdatingbeast, an r package built to assist the implementation of various phylogenetic tip‐dating tests using beast. tipdatingbeast currently contains two main functions. The first one allows preparing date‐randomization analyses, which assess the temporal signal of a data set. The second function allows performing leave‐one‐out analyses, which test for the consistency between independent calibration sequences and allow pinpointing those leading to potential bias. We apply those functions to an empirical data set and supply practical guidance for results interpretation.
    October 25, 2016   doi: 10.1111/1755-0998.12603   open full text
  • PSMC (pairwise sequentially Markovian coalescent) analysis of RAD (restriction site associated DNA) sequencing data.
    Shenglin Liu, Michael M. Hansen.
    The International Journal of Health Planning and Management. October 24, 2016
    The pairwise sequentially Markovian coalescent (PSMC) method uses the genome sequence of a single individual to estimate demographic history covering a time span of thousands of generations. Although originally designed for whole‐genome data, we here use simulations to investigate its applicability to reference genome‐aligned restriction site associated DNA (RAD) data. We find that RAD data can potentially be used for PSMC analysis, but at present with limitations. The key factor is the proportion (p) of the genome that the RAD data covers. In our simulations, a proportion of 10% can still retain a substantial amount of coalescent information, whereas for 1% estimation becomes unreliable. The performance depends strongly on mutation rate (μ) and recombination rate (r) and is proportional to μ*p/r. When the value of this term is low, increasing the amount of data and number of iterations helps restoring the power of the estimation. We subsequently analyse one whole‐genome‐sequenced and 17 RAD‐sequenced three‐spined sticklebacks (Gasterosteus aculeatus) from a lake in Greenland. The whole‐genome sequence suggests a relatively recent expansion and decline within ca. 4000–40 000 generations ago, possibly reflecting postglacial expansion and founding of the lake population. RAD data, where chromosomes from 10 individuals are combined, identify a similar pattern. Our study provides guidance about the use of PSMC analysis and suggests measures that can improve its utility for RAD data. Finally, the study shows that RAD loci in general contain coalescent information that can be used for developing more targeted methods.
    October 24, 2016   doi: 10.1111/1755-0998.12606   open full text
  • Can positive inquiry strengthen obstetric referral systems in Cambodia?
    Gillian Le, Molyaneth Heng, Keosothea Nou, Phina So, Tim Ensor.
    The International Journal of Health Planning and Management. October 24, 2016
    Maternal death remains high in low resource settings. Current literature on obstetric referral that sets out to tackle maternal death tends to focus on problematization. We took an alternative approach and rather asked what works in contemporary obstetric referral in a low income setting to find out if positive inquiry could generate original insights on referral that could be transformative. We documented and analysed instances of successful referral in a rural province of Cambodia that took place within the last year. Thirty women, their families, healthcare staff and community volunteers were purposively sampled for in‐depth interviews, conducted using an appreciative inquiry lens. We found that referral at its best is an active partnership between families, community and clinicians that co‐constructs care for labouring women during referral and delivery. Given the short time frame of the project we cannot conclude if this new understanding was transformative. However, we can show that acknowledging positive resources within contemporary referral systems enables health system stakeholders to widen their understanding of the kinds of resources that are available to them to direct and implement constructive change for maternal health. Copyright © 2016 John Wiley & Sons, Ltd.
    October 24, 2016   doi: 10.1002/hpm.2385   open full text
  • Explaining the accreditation process from the institutional isomorphism perspective: a case study of Jordanian primary healthcare centers.
    Mohammad Alyahya, Heba Hijazi, Heather Harvey.
    The International Journal of Health Planning and Management. October 20, 2016
    Background While the main focus of accreditation initiatives has been on hospitals, the implementation of these programs is a relatively new notion among other types of healthcare facilities. Correspondingly, this study aims to understand how accreditation is perceived among primary public healthcare centers using an isomorphic institutional theory. Design/Methodology Semi‐structured, in‐depth interviews were conducted with 56 healthcare professionals and administrative staff from seven non‐profit healthcare centers in Jordan using an explanatory case‐study approach. Results The informants' narratives revealed that all three components of institutional theory: coercive, mimetic, and normative pressure, were drivers for institutional change in seeking accreditation. There was an overlapping and blending between the three various types of pressure. While participants perceived that healthcare centers faced formal and informal pressures to achieve accreditation, health centers were reluctant about the time, amount of effort, and their ability to achieve the accreditation. Ambiguity and fear of failure forced them to model successful ones. Moreover, the findings revealed that normative values of health professionals enhanced institutional isomorphism and influenced the accreditation process. Conclusion Identifying these isomorphic changes may help key stakeholders to develop plans, policies, and procedures that could improve the quality of healthcare and enhance accreditation as an organizational strategic plan. Moreover, the study provided explanations of why and how organizations move to adopt new interventions and grow over time. Copyright © 2016 John Wiley & Sons, Ltd.
    October 20, 2016   doi: 10.1002/hpm.2397   open full text
  • High‐resolution melt analysis without DNA extraction affords rapid genotype resolution and species identification.
    Paul F. Rugman‐Jones, Richard Stouthamer.
    The International Journal of Health Planning and Management. October 18, 2016
    Extracting and sequencing DNA from specimens can impose major time and monetary costs to studies requiring genotyping, or identification to species, of large numbers of individuals. As such, so‐called direct PCR methods have been developed enabling significant savings at the DNA extraction step. Similarly, real‐time quantitative PCR techniques (qPCR) offer very cost‐effective alternatives to sequencing. High‐resolution melt analysis (HRM) is a qPCR method that incorporates an intercalating dye into a double‐stranded PCR amplicon. The dye fluoresces brightly, but only when it is bound. Thus, after PCR, raising the temperature of the amplicon while measuring the fluorescence of the reaction results in the generation of a sequence‐specific melt curve, allowing discrimination of genotypes. Methods combining HRM (or other qPCR methods) and direct PCR have not previously been reported, most likely due to concerns that any tissue in the reaction tube would interfere with detection of the fluorescent signal. Here, we couple direct PCR with HRM and, by way of three examples, demonstrate a very quick and cost‐effective method for genotyping large numbers of specimens, using Rotor‐Gene HRM instruments (QIAGEN). In contrast to the heated‐block design of most qPCR/HRM instruments, the Rotor‐Gene's centrifugal rotor and air‐based temperature‐regulation system facilitate our method by depositing tissues away from the pathway of the machine's fluorescence detection optics.
    October 18, 2016   doi: 10.1111/1755-0998.12599   open full text
  • Residual eDNA detection sensitivity assessed by quantitative real‐time PCR in a river ecosystem.
    Katherine D. Balasingham, Ryan P. Walter, Daniel D. Heath.
    The International Journal of Health Planning and Management. October 12, 2016
    Several studies have demonstrated that environmental DNA (eDNA) can be used to detect the presence of aquatic species, days to weeks after the target species has been removed. However, most studies used eDNA analysis in lentic systems (ponds or lakes), or in controlled laboratory experiments. While eDNA degrades rapidly in all aquatic systems, it also undergoes dilution effects and physical destruction in flowing systems, complicating detection in rivers. However, some eDNA (i.e. residual eDNA) can be retained in aquatic systems, even those subject to high flow regimes. Our goal was to determine residual eDNA detection sensitivity using quantitative real‐time polymerase chain reaction (qRT–PCR), in a flowing, uncontrolled river after the eDNA source was removed from the system; we repeated the experiment over 2 years. Residual eDNA had the strongest signal strength at the original source site and was detectable there up to 11.5 h after eDNA source removal. Residual eDNA signal strength decreased as sampling distance downstream from the eDNA source site increased, and was no longer detectable at the source site 48 h after the eDNA source water was exhausted in both experiments. This experiment shows that residual eDNA sampled in surface water can be mapped quantitatively using qRT–PCR, which allows a more accurate spatial identification of the target species location in lotic systems, and relative residual eDNA signal strength may allow the determination of the timing of the presence of target species.
    October 12, 2016   doi: 10.1111/1755-0998.12598   open full text
  • Complete mitochondrial genomes of eleven extinct or possibly extinct bird species.
    Jarl A. Anmarkrud, Jan T. Lifjeld.
    The International Journal of Health Planning and Management. October 11, 2016
    Natural history museum collections represent a vast source of ancient and historical DNA samples from extinct taxa that can be utilized by high‐throughput sequencing tools to reveal novel genetic and phylogenetic information about them. Here, we report on the successful sequencing of complete mitochondrial genome sequences (mitogenomes) from eleven extinct bird species, using de novo assembly of short sequences derived from toepad samples of degraded DNA from museum specimens. For two species (the Passenger Pigeon Ectopistes migratorius and the South Island Piopio Turnagra capensis), whole mitogenomes were already available from recent studies, whereas for five others (the Great Auk Pinguinis impennis, the Imperial Woodpecker Campehilus imperialis, the Huia Heteralocha acutirostris, the Kauai Oo Moho braccathus and the South Island Kokako Callaeas cinereus), there were partial mitochondrial sequences available for comparison. For all seven species, we found sequence similarities of >98%. For the remaining four species (the Kamao Myadestes myadestinus, the Paradise Parrot Psephotellus pulcherrimus, the Ou Psittirostra psittacea and the Lesser Akialoa Akialoa obscura), there was no sequence information available for comparison, so we conducted blast searches and phylogenetic analyses to determine their phylogenetic positions and identify their closest extant relatives. These mitogenomes will be valuable for future analyses of avian phylogenetics and illustrate the importance of museum collections as repositories for genomics resources.
    October 11, 2016   doi: 10.1111/1755-0998.12600   open full text
  • Setting the scene for the future: implications of key legal regulations for the development of e‐health interoperability in the EU.
    Marcin Kautsch, Mateusz Lichoń, Natalia Matuszak.
    The International Journal of Health Planning and Management. September 30, 2016
    E‐health has experienced a dynamic development across the European Union in the recent years and enjoys support from the European Commission that seeks to achieve interoperability of national healthcare systems in order to facilitate free movement. Differences that can be observed between the member states in legal regulations, cultural approaches and technological solutions may hinder this process. This study compares the legal standing of e‐health in Denmark, Poland, Spain and the UK, along with key legal acts and their implications. The academic literature review along with an analysis of materials found through the desk study research (reports, legal acts, press articles, governmental web pages and so on) was performed in order to identify aspects relevant to e‐health interoperability. The approach to legal regulation of e‐health substantially differs by country. So do the procedures that they have developed regarding the requirement for patient's consent for the processing of their data, their rights to access to the medical data, to change the data, data confidentiality and types of electronic health records. The principles governing the assignment of responsibility for data protection are also different. These legal and technological differences must be reconciled if interoperability of European national e‐health systems is to be achieved. Copyright © 2016 John Wiley & Sons, Ltd.
    September 30, 2016   doi: 10.1002/hpm.2384   open full text
  • Understanding implementation of comprehensive geriatric care programs: a multiple perspective approach is preferred.
    Annemarie Vos, Jane‐Murray Cramm, Jeroen D. H. Wijngaarden, Ton J. E. M. Bakker, Johan P. Mackenbach, Anna P. Nieboer.
    The International Journal of Health Planning and Management. September 29, 2016
    Background The Prevention and Reactivation Care Program (PReCaP) provides a novel approach targeting hospital‐related functional decline among elderly patients. Despite the high expectations, the PReCaP was not effective in preventing functional decline (ADL and iADL) among older patients. Although elderly PReCaP patients demonstrated slightly better cognitive functioning (Mini Mental State Examination; 0.4 [95% confidence interval (CI) 0.2–0.6]), lower depression (Geriatric Depression Scale 15; –0.9 [95% –1.1 to –0.6]), and higher perceived health (Short‐form 20; 5.6 [95% CI 2.8–8.4]) 1 year after admission than control patients, the clinical relevance was limited. Therefore, this study aims to identify factors impacting on the effectiveness of the implementation of the PReCaPand geriatric care ‘as usual’. Methods We conducted semi‐structured interviews with 34 professionals working with elderly patients in three hospitals, selected for their comparable patient case mix and different levels of geriatric care. Five non‐participatory observations were undertaken during multidisciplinary meetings. Patient files (n = 42), hospital protocols, and care plans were screened for elements of geriatric care. Clinical process data were analysed for PReCaP components. Results The establishment of a geriatric unit and employment of geriatricians demonstrates commitment to geriatric care in hospital A. Although admission processes are comparable, early identification of frail elderly patients only takes place in hosptial A. Furthermore, nursing care in the hospital A geriatric unit excels with regard to maximizing patient independency, an important predictor for hospital‐related functional decline. Transfer nurses play a key role in arranging post‐discharge geriatric follow‐up care. Geriatric consultations are performed by geriatricians, geriatric nurses, and PReCaP case managers in hospital A. Yet hospital B consultative psychiatric nurses provide similar consultation services. The combination of standardized procedures, formalized communication channels, and advanced computerization contributes significantly to geriatric care in hospital B. Nevertheless, a small size hospital (hospital C) provides informal opportunities for information sharing and decision making, which are essential in geriatric care, given its multidisciplinary nature. Conclusions Geriatric care for patients with multimorbidity requires a multidisciplinary approach in a geriatric unit. Geriatric care, which integrates medical and reactivation treatment, by means of early screening of risk factors for functional decline, promotion of physical activity, and adequate discharge planning, potentially reduces the incidence of functional decline in elderly patients. Yet low treatment fidelity played a major role in the ineffective implementation of the PReCaP. Treatment fidelity issues are caused by various factors, including the complexity of projects, limited attention for implementation, and inadequate interdisciplinary communication. © 2016 The Authors The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd.
    September 29, 2016   doi: 10.1002/hpm.2383   open full text
  • The influence of fiscal rules on healthcare policy in the United States and the Netherlands.
    H. Christiaan Schakel, Patrick Jeurissen, Sherry Glied.
    The International Journal of Health Planning and Management. September 28, 2016
    Governments use fiscal rules to put a framework and limits on how budgetary challenges are addressed, but the rules themselves are still an understudied area among health policy scholars. For a long time, healthcare held a somewhat separate status because of the reliance on entitlements and dedicated revenue streams. However, the combined forces of advocates for integral decision‐making, central budget control and the increasing costs might shift healthcare towards budgetary frameworks that currently apply to other spending categories. In this paper, we study fiscal rules that the US and the Netherlands have adopted since 2010 and their impact on healthcare policy. Our analysis shows that fiscal rules can have an impact on the rationing of healthcare. In the studied timeframe, the rules seem to have more impact on budget outcomes than on the budget process itself. In addition, the convergence of fiscal and program policy objectives seems to be better accomplished in a budgetary system that applies enforceable budget ceilings. Budgeting for health entitlements requires a comprehensive and tailor‐made approach and the composition of traditional rules might not fully answer to the complexities of healthcare policy. This paper aims to contribute to that debate and the way we think about healthcare budgeting. Copyright © 2016 John Wiley & Sons, Ltd.
    September 28, 2016   doi: 10.1002/hpm.2382   open full text
  • The role of global public health strategy in non‐profit organisational change at country level: lessons from the joining of Save the Children and Merlin in Myanmar.
    Fiona M. Campbell, Dina Balabanova, Natasha Howard.
    The International Journal of Health Planning and Management. September 28, 2016
    Introduction The paper presents a case study that critically assesses the role of global strategy ‘Public Health on the Frontline 2014–2015’ (‘the Strategy’) in supporting Merlin and Save the Children's organisational change and future programme of the combined organisation in Myanmar. Materials and methods Research was undertaken in 2014 in Myanmar. Twenty‐six individual and three group interviews were conducted with stakeholders, and 10 meetings relevant to the country organisational transition process were observed. A conceptual framework was developed to assess the role of the global strategy in supporting the country change process. Results Several positive aspects of the global strategy were found, as well as critical shortcomings in its support to the organisational change process at country level. The strategy was useful in signalling Save the Children's intention to scale up humanitarian health provision. However, it had only limited influence on the early change process and outcomes in Myanmar. Conclusions Results highlight several aspects that would enhance the role of a global strategy at country level. Lessons can be applied by organisations undertaking a similar process. Copyright © 2016 John Wiley & Sons, Ltd.
    September 28, 2016   doi: 10.1002/hpm.2386   open full text
  • Evidence‐based HMO care for prostate specific antigen testing.
    Daniel J. Merenstein, Frank J. D'Amico, Shlomo Vinker, Stephen Petterson, Amnon Lahad.
    The International Journal of Health Planning and Management. September 20, 2016
    Background There is pressure in the U.S. system to move away from fee‐for‐service models to a more pre‐paid system, which may result in decreased costs, but the impact on evidence‐based care is unclear. We examined a large pre‐paid Health Maintenance Organizations (HMO) in Israel to see if evidence‐based guidelines are followed for prostate specific antigen (PSA) testing. Methods A retrospective cohort of ambulatory visits from 2002 to 2011 of patients age >75 receiving care from Clalit Health Services was conducted. Historically reported U.S. cohorts were used for comparison. The main measure was the percent of patients who had at least one PSA after age 75. Results In each of the 10 years of follow‐up, 22% of the yearly Israeli cohort, with no known malignancy or benign prostatic hyperplasia, had at least one PSA, while for the total 10 years, 30% of the men had at least one PSA. These rates are considerably lower than previously reported U.S. rates. Conclusions In a pre‐paid system in which physicians have no incentive to order tests, they appear to order PSA tests at a lower rate than has been observed in the U.S. system. Additional quality of measures should continue to be examined as the U.S. shifts away from a fee‐for‐service model. Copyright © 2016 John Wiley & Sons, Ltd.
    September 20, 2016   doi: 10.1002/hpm.2388   open full text
  • Perceptions of the first family physicians to adopt advanced access in the province of Quebec, Canada.
    Mylaine Breton, Lara Maillet, Isabelle Paré, Sabina Abou Malham, Nassera Touati.
    The International Journal of Health Planning and Management. September 08, 2016
    In Quebec, several primary care physicians have made the transition to the advanced access model to address the crisis of limited access to primary care. The objectives are to describe the implementation of the advanced access model, as perceived by the first family physicians; to analyze the factors influencing the implementation of its principles; and to document the physicians' perceptions of its effects on their practice, colleagues and patients. Qualitative methods were used to explore, through semi‐structured interviews, the experiences of 21 family physicians who had made the transition to advanced access. Of the 21 physicians, 16 succeeded in adopting all five advanced access principles to varying degrees. Core implementation issues revolved around the dynamics of collaboration between physicians, nurses and other colleagues. Secretaries' functions, in particular, had to be expanded. Facilitating factors were mainly related to the physicians' leadership and the professional resources available in the organizations. Impediments related to resource availability and team functioning were also encountered. This is the first exploratory study to examine the factors influencing the adoption of the advanced access model conducted with early‐adopter family physicians. The lessons drawn will inform discussions on scaling up to other settings experiencing the same problems. Copyright © 2016 John Wiley & Sons, Ltd.
    September 08, 2016   doi: 10.1002/hpm.2380   open full text
  • Nuclear internal transcribed spacer‐1 as a sensitive genetic marker for environmental DNA studies in common carp Cyprinus carpio.
    Toshifumi Minamoto, Kimiko Uchii, Teruhiko Takahara, Takumi Kitayoshi, Satsuki Tsuji, Hiroki Yamanaka, Hideyuki Doi.
    The International Journal of Health Planning and Management. August 31, 2016
    The recently developed environmental DNA (eDNA) analysis has been used to estimate the distribution of aquatic vertebrates by using mitochondrial DNA (mtDNA) as a genetic marker. However, mtDNA markers have certain drawbacks such as variable copy number and maternal inheritance. In this study, we investigated the potential of using nuclear DNA (ncDNA) as a more reliable genetic marker for eDNA analysis by using common carp (Cyprinus carpio). We measured the copy numbers of cytochrome b (CytB) gene region of mtDNA and internal transcribed spacer 1 (ITS1) region of ribosomal DNA of ncDNA in various carp tissues and then compared the detectability of these markers in eDNA samples. In the DNA extracted from the brain and gill tissues and intestinal contents, CytB was detected at 95.1 ± 10.7 (mean ± 1 standard error), 29.7 ± 1.59 and 24.0 ± 4.33 copies per cell, respectively, and ITS1 was detected at 1760 ± 343, 2880 ± 503 and 1910 ± 352 copies per cell, respectively. In the eDNA samples from mesocosm, pond and lake water, the copy numbers of ITS1 were about 160, 300 and 150 times higher than those of CytB, respectively. The minimum volume of pond water required for quantification was 33 and 100 mL for ITS1 and CytB, respectively. These results suggested that ITS1 is a more sensitive genetic marker for eDNA studies of C. carpio.
    August 31, 2016   doi: 10.1111/1755-0998.12586   open full text
  • wisepair: a computer program for individual matching in genetic tracking studies.
    Andrew P. Rothstein, Ryan McLaughlin, Alejandro Acevedo‐Gutiérrez, Dietmar Schwarz.
    The International Journal of Health Planning and Management. August 29, 2016
    Individual‐based data sets tracking organisms over space and time are fundamental to answering broad questions in ecology and evolution. A ‘permanent’ genetic tag circumvents a need to invasively mark or tag animals, especially if there are little phenotypic differences among individuals. However, genetic tracking of individuals does not come without its limits; correctly matching genotypes and error rates associated with laboratory work can make it difficult to parse out matched individuals. In addition, defining a sampling design that effectively matches individuals in the wild can be a challenge for researchers. Here, we combine the two objectives of defining sampling design and reducing genotyping error through an efficient Python‐based computer‐modelling program, wisepair. We describe the methods used to develop the computer program and assess its effectiveness through three empirical data sets, with and without reference genotypes. Our results show that wisepair outperformed similar genotype matching programs using previously published from reference genotype data of diurnal poison frogs (Allobates femoralis) and without‐reference (faecal) genotype sample data sets of harbour seals (Phoca vitulina) and Eurasian otters (Lutra lutra). In addition, due to limited sampling effort in the harbour seal data, we present optimal sampling designs for future projects. wisepair allows for minimal sacrifice in the available methods as it incorporates sample rerun error data, allelic pairwise comparisons and probabilistic simulations to determine matching thresholds. Our program is the lone tool available to researchers to define parameters a priori for genetic tracking studies.
    August 29, 2016   doi: 10.1111/1755-0998.12590   open full text
  • Practical low‐coverage genomewide sequencing of hundreds of individually barcoded samples for population and evolutionary genomics in nonmodel species.
    Nina Overgaard Therkildsen, Stephen R. Palumbi.
    The International Journal of Health Planning and Management. August 29, 2016
    Today most population genomic studies of nonmodel organisms either sequence a subset of the genome deeply in each individual or sequence pools of unlabelled individuals. With a step‐by‐step workflow, we illustrate how low‐coverage whole‐genome sequencing of hundreds of individually barcoded samples is now a practical alternative strategy for obtaining genomewide data on a population scale. We used a highly efficient protocol to generate high‐quality libraries for ~6.5 USD from each of 876 Atlantic silversides (a teleost fish with a genome size ~730 Mb) that we sequenced to 1–4× genome coverage. In the absence of a reference genome, we developed a bioinformatic pipeline for mapping the genomic reads to a de novo assembled reference transcriptome. This provides an ‘in silico’ method for exome capture that avoids the complexities and expenses of using wet chemistry for target isolation. Using novel tools for analysis of low‐coverage data, we extracted population allele frequencies, individual genotype likelihoods and polymorphism data for 2 504 335 SNPs across the exome for the 876 fish. To illustrate the use of the resulting data, we present a preliminary analysis of geographical patterns in the exome data and a comparison of complete mitochondrial genome sequences for each individual (constructed from the low‐coverage data) that show population colonization patterns along the US east coast. With a total cost per sample of less than 50 USD (including sequencing) and ability to prepare 96 libraries in only 5 h, our approach adds a viable new option to the population genomics toolbox.
    August 29, 2016   doi: 10.1111/1755-0998.12593   open full text
  • A comparative assessment of SNP and microsatellite markers for assigning parentage in a socially monogamous bird.
    Sara A. Kaiser, Scott A. Taylor, Nancy Chen, T. Scott Sillett, Eliana R. Bondra, Michael S. Webster.
    The International Journal of Health Planning and Management. August 29, 2016
    Single‐nucleotide polymorphisms (SNPs) are preferred over microsatellite markers in many evolutionary studies, but have only recently been applied to studies of parentage. Evaluations of SNPs and microsatellites for assigning parentage have mostly focused on special cases that require a relatively large number of heterozygous loci, such as species with low genetic diversity or with complex social structures. We developed 120 SNP markers from a transcriptome assembled using RNA‐sequencing of a songbird with the most common avian mating system—social monogamy. We compared the effectiveness of 97 novel SNPs and six previously described microsatellites for assigning paternity in the black‐throated blue warbler, Setophaga caerulescens. We show that the full panel of 97 SNPs (mean Ho = 0.19) was as powerful for assigning paternity as the panel of multiallelic microsatellites (mean Ho = 0.86). Paternity assignments using the two marker types were in agreement for 92% of the offspring. Filtering individual samples by a 50% call rate and SNPs by a 75% call rate maximized the number of offspring assigned with 95% confidence using SNPs. We also found that the 40 most heterozygous SNPs (mean Ho = 0.37) had similar power to assign paternity as the full panel of 97 SNPs. These findings demonstrate that a relatively small number of variable SNPs can be effective for parentage analyses in a socially monogamous species. We suggest that the development of SNP markers is advantageous for studies that require high‐throughput genotyping or that plan to address a range of ecological and evolutionary questions.
    August 29, 2016   doi: 10.1111/1755-0998.12589   open full text
  • discomark: nuclear marker discovery from orthologous sequences using draft genome data.
    Sereina Rutschmann, Harald Detering, Sabrina Simon, Jakob Fredslund, Michael T. Monaghan.
    The International Journal of Health Planning and Management. August 23, 2016
    High‐throughput sequencing has laid the foundation for fast and cost‐effective development of phylogenetic markers. Here we present the program discomark, which streamlines the development of nuclear DNA (nDNA) markers from whole‐genome (or whole‐transcriptome) sequencing data, combining local alignment, alignment trimming, reference mapping and primer design based on multiple sequence alignments to design primer pairs from input orthologous sequences. To demonstrate the suitability of discomark, we designed markers for two groups of species, one consisting of closely related species and one group of distantly related species. For the closely related members of the species complex of Cloeon dipterum s.l. (Insecta, Ephemeroptera), the program discovered a total of 78 markers. Among these, we selected eight markers for amplification and Sanger sequencing. The exon sequence alignments (2526 base pairs) were used to reconstruct a well‐supported phylogeny and to infer clearly structured haplotype networks. For the distantly related species, we designed primers for the insect order Ephemeroptera, using available genomic data from four sequenced species. We developed primer pairs for 23 markers that are designed to amplify across several families. The discomark program will enhance the development of new nDNA markers by providing a streamlined, automated approach to perform genome‐scale scans for phylogenetic markers. The program is written in Python, released under a public licence (GNU GPL version 2), and together with a manual and example data set available at:
    August 23, 2016   doi: 10.1111/1755-0998.12576   open full text
  • Species diversity can be overestimated by a fixed empirical threshold: insights from DNA barcoding of the genus Cletus (Hemiptera: Coreidae) and the meta‐analysis of COI data from previous phylogeographical studies.
    Hai‐Guang Zhang, Min‐Hua Lv, Wen‐Bo Yi, Wei‐Bing Zhu, Wen‐Jun Bu.
    The International Journal of Health Planning and Management. August 20, 2016
    The use of genetic distances to identify species within the framework of DNA barcoding has to some extent improved the development of biodiversity studies. However, using a fixed empirical threshold to delimit species may lead to overestimating species diversity. In this study, we use a new data set of COI sequences for 366 specimens within the genus of Cletus as well as conduct an analysis on the same genetic data for collected morphologically defined species from previous phylogeographical studies, to test whether high intraspecific genetic divergences are common with the premises of comprehensive sampling. The results indicate C. graminis Hsiao & Cheng , is the same species with C. punctiger (Dallas, 1852) and should be synonymized and that the distributional record of C. pugnator (Fabricius, 1787) in China is correct. High intraspecific genetic differentiations (0%–4.35%) were found in C. punctiger. Furthermore, as to the mined data, the maximum intraspecific K2P distances of 186 species (48.44% of 384) exceed 3%, and 101 species (26.30%) can be divided into two or more clusters with a threshold of 3% in cluster analysis. If genetic distance is used to delimit species boundaries, the minimum interspecific K2P distance of the congeneric species should be considered rather than only using the fixed empirical value; otherwise, the species richness may be overestimated in some cases.
    August 20, 2016   doi: 10.1111/1755-0998.12571   open full text
  • Achieving value for money in health: a comparative analysis of OECD countries and regional countries.
    Yusuf Çelik, Mahmud Khan, Neşet Hikmet.
    The International Journal of Health Planning and Management. August 11, 2016
    Objective To measure efficiency gains in health sector over the years 1995 to 2013 in OECD, EU, non‐member European countries. Methods An output‐oriented DEA model with variable return to scale, and residuals estimated by regression equations were used to estimate efficiencies of health systems. Slacks for health care outputs and inputs were calculated by using DEA multistage method of estimating country efficiency scores. Results Better health outcomes of countries were related with higher efficiency. Japan, France, or Sweden were found to be peer‐efficient countries when compared to other developed countries like Germany and United States. Increasing life expectancy beyond a certain high level becomes very difficult to achieve. Despite declining marginal productivity of inputs on health outcomes, some developed countries and developing countries were found to have lowered their inefficiencies in the use of health inputs. Although there was no systematic relationship between political system of countries and health system efficiency, the objectives of countries on social and health policy and the way of achieving these objectives might be a factor increasing the efficiency of health systems. Conclusions Economic and political stability might be as important as health expenditure in improving health system goals. A better understanding of the value created by health expenditures, especially in developed countries, will require analysis of specific health interventions that can increase value for money in health. Copyright © 2016 John Wiley & Sons, Ltd.
    August 11, 2016   doi: 10.1002/hpm.2375   open full text
  • Tracer methodology: an appropriate tool for assessing compliance with accreditation standards?
    Chantal Bouchard, Olivier Jean.
    The International Journal of Health Planning and Management. August 10, 2016
    Objectives Tracer methodology has been used by Accreditation Canada since 2008 to collect evidence on the quality and safety of care and services, and to assess compliance with accreditation standards. Given the importance of this methodology in the accreditation program, the objective of this study is to assess the quality of the methodology and identify its strengths and weaknesses. Method A mixed quantitative and qualitative approach was adopted to evaluate consistency, appropriateness, effectiveness and stakeholder synergy in applying the methodology. An online questionnaire was sent to 468 Accreditation Canada surveyors. Results According to surveyors' perceptions, tracer methodology is an effective tool for collecting useful, credible and reliable information to assess compliance with Qmentum program standards and priority processes. The results show good coherence between methodology components (appropriateness of the priority processes evaluated, activities to evaluate a tracer, etc.). The main weaknesses are the time constraints faced by surveyors and management's lack of cooperation during the evaluation of tracers. Conclusion The inadequate amount of time allowed for the methodology to be applied properly raises questions about the quality of the information obtained. This study paves the way for a future, more in‐depth exploration of the identified weaknesses to help the accreditation organization make more targeted improvements to the methodology. Copyright © 2016 John Wiley & Sons, Ltd.
    August 10, 2016   doi: 10.1002/hpm.2376   open full text
  • Combined hybridization capture and shotgun sequencing for ancient DNA analysis of extinct wild and domestic dromedary camel.
    Elmira Mohandesan, Camilla F. Speller, Joris Peters, Hans‐Peter Uerpmann, Margarethe Uerpmann, Bea De Cupere, Michael Hofreiter, Pamela A. Burger.
    The International Journal of Health Planning and Management. August 01, 2016
    The performance of hybridization capture combined with next‐generation sequencing (NGS) has seen limited investigation with samples from hot and arid regions until now. We applied hybridization capture and shotgun sequencing to recover DNA sequences from bone specimens of ancient‐domestic dromedary (Camelus dromedarius) and its extinct ancestor, the wild dromedary from Jordan, Syria, Turkey and the Arabian Peninsula, respectively. Our results show that hybridization capture increased the percentage of mitochondrial DNA (mtDNA) recovery by an average 187‐fold and in some cases yielded virtually complete mitochondrial (mt) genomes at multifold coverage in a single capture experiment. Furthermore, we tested the effect of hybridization temperature and time by using a touchdown approach on a limited number of samples. We observed no significant difference in the number of unique dromedary mtDNA reads retrieved with the standard capture compared to the touchdown method. In total, we obtained 14 partial mitochondrial genomes from ancient‐domestic dromedaries with 17–95% length coverage and 1.27–47.1‐fold read depths for the covered regions. Using whole‐genome shotgun sequencing, we successfully recovered endogenous dromedary nuclear DNA (nuDNA) from domestic and wild dromedary specimens with 1–1.06‐fold read depths for covered regions. Our results highlight that despite recent methodological advances, obtaining ancient DNA (aDNA) from specimens recovered from hot, arid environments is still problematic. Hybridization protocols require specific optimization, and samples at the limit of DNA preservation need multiple replications of DNA extraction and hybridization capture as has been shown previously for Middle Pleistocene specimens.
    August 01, 2016   doi: 10.1111/1755-0998.12551   open full text
  • What can the Canadians and Americans learn from each other's health care systems?
    Thomas P. Weil.
    The International Journal of Health Planning and Management. July 29, 2016
    Numerous papers have been written comparing the Canadian and US healthcare systems, and a number of health policy experts have recommended that the Americans implement their single‐payer system to save 12–20% of its healthcare expenditures. This paper is different in that it assumes that neither country will undertake a significant philosophic or structural change in their healthcare system, but there are lessons to be learned that are inherent in one that could be a major breakthrough for the other. Following the model in Canada and in Western Europe, the USA could implement universal health insurance so that the 32.0 million (2015) Americans still uninsured would have at least minimal coverage when incurring medical expenditures. Also, the USA could use smart cards to evaluate eligibility and to process health insurance claims; these changes resulting in an estimated 15% reduction in US health expenditures without adversely effecting access or quality of care. Such a strategy would result in the eventual loss of 2.5 million white‐collar jobs at hospitals, physician offices and insurance companies, a long‐term economic gain. Only a few would agree with the statement that Canada already functions with a multi‐payer reimbursement system as evidenced by (1) a federal‐provincial, tax‐supported plan, administered by each of the provinces, providing universal coverage for hospital and physician services and (2) roughly 60% of its residents receiving employer‐paid health insurance benefits, underwritten primarily by investor‐owned plans, that are less than effective to reimburse for pharmaceuticals, dental and other healthcare services. What could be learned from the USA and particularly from Western European countries is possibly implementing an approach, whereby at least upper‐income Canadians could opt out of their federal‐provincial plan and purchase private insurance coverage — being eligible for far more comprehensive “private” benefits for hospital, physician, pharmaceutical, dental and other healthcare services. Aside from generating billions of additional needed revenues from the private sector, it could (1) help eliminate long waits for non‐emergent physicians' care by appointing newly minted specialists to their medical staffs; (2) offer prompt admissions for elective cases to “private” wings of hospitals; (3) increase available funding for what is currently an undercapitalized system; (4) enhance the system's sluggish operations; and (5) encourage more competition among various providers. Although such a two‐tier approach, such as available in the USA and elsewhere, is politically dead on arrival in Canada today, private insurance being already legal and commonly available there. Interestingly, this recommended solution is utilized in most western European countries where there is a higher percentage than in Canada of public (versus private) funding of their total health expenditures. Because of various vested interests, attempts to implement any of the aforementioned proposals will undoubtedly result in considerable political rancor. There is greater likelihood, however, that the Canadians because their need to be more effective and efficient in their delivery of care, and their overall long‐term fiscal outlook will agree to the further privatization of their healthcare system before the Americans will mandate universal access, use the smart card to process insurance eligibility and claims or will impose price controls on high‐tech services and on pharmaceuticals. Copyright © 2016 John Wiley & Sons, Ltd.
    July 29, 2016   doi: 10.1002/hpm.2374   open full text
  • The evolution of the cancer formulary review in Canada: Can centralization improve the use of economic evaluation?
    W. Dominika Wranik, Liesl Gambold, Natasha Hanson, Adrian Levy.
    The International Journal of Health Planning and Management. July 29, 2016
    Public reimbursement of drugs is a costly proposition for health care systems. Decisions to add drugs to the public formulary are often guided by review processes and committees. The evolution of the formulary review process in Canada's publicly funded health system is characterized by increased centralization and systematization. In the past, the review of evidence and recommendation was conducted at the regional level, but was replaced with the pan‐Canadian Oncology Drug Review in 2011. We assess the extent to which centralization and systematization of the review process have responded to past challenges, focusing on the use of economic evaluation in the process. Past challenges with economic evaluation experienced by regionalized review committees were identified from literature and qualitative data collected in the province of Nova Scotia. We categorize these using a typology with a macro‐, meso, and micro‐level hierarchy, which provides a useful framework for understanding at which level change is required, and who has the authority to influence change. Using grounded theory methods, we identify approaches used by Nova Scotia past committee members to compensate for perceived shortcomings of the process. These include an undue reliance on other committee members, on the multidisciplinarity of the committee, and on past decisions. Using a policy analysis approach, we argue that centralization and systematization of the review process only partially address the shortcomings of the previous regionalized process. Lessons from Canada can inform policy discussions across all health systems, where similar challenges with the formulary review process have been identified. © 2016 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.
    July 29, 2016   doi: 10.1002/hpm.2372   open full text
  • megasat: automated inference of microsatellite genotypes from sequence data.
    Luyao Zhan, Ian G. Paterson, Bonnie A. Fraser, Beth Watson, Ian R. Bradbury, Praveen Nadukkalam Ravindran, David Reznick, Robert G. Beiko, Paul Bentzen.
    The International Journal of Health Planning and Management. July 19, 2016
    megasat is software that enables genotyping of microsatellite loci using next‐generation sequencing data. Microsatellites are amplified in large multiplexes, and then sequenced in pooled amplicons. megasat reads sequence files and automatically scores microsatellite genotypes. It uses fuzzy matches to allow for sequencing errors and applies decision rules to account for amplification artefacts, including nontarget amplification products, replication slippage during PCR (amplification stutter) and differential amplification of alleles. An important feature of megasat is the generation of histograms of the length–frequency distributions of amplification products for each locus and each individual. These histograms, analogous to electropherograms traditionally used to score microsatellite genotypes, enable rapid evaluation and editing of automatically scored genotypes. megasat is written in Perl, runs on Windows, Mac OS X and Linux systems, and includes a simple graphical user interface. We demonstrate megasat using data from guppy, Poecilia reticulata. We genotype 1024 guppies at 43 microsatellites per run on an Illumina MiSeq sequencer. We evaluated the accuracy of automatically called genotypes using two methods, based on pedigree and repeat genotyping data, and obtained estimates of mean genotyping error rates of 0.021 and 0.012. In both estimates, three loci accounted for a disproportionate fraction of genotyping errors; conversely, 26 loci were scored with 0–1 detected error (error rate ≤0.007). Our results show that with appropriate selection of loci, automated genotyping of microsatellite loci can be achieved with very high throughput, low genotyping error and very low genotyping costs.
    July 19, 2016   doi: 10.1111/1755-0998.12561   open full text
  • Setting standards and monitoring quality in the NHS 1999–2013: a classic case of goal conflict.
    Peter Littlejohns, Alec Knight, Anna Littlejohns, Tara‐Lynn Poole, Katharina Kieslich.
    The International Journal of Health Planning and Management. July 19, 2016
    2013 saw the National Health Service (NHS) in England severely criticized for providing poor quality despite successive governments in the previous 15 years, establishing a range of new institutions to improve NHS quality. This study seeks to understand the contributions of political and organizational influences in enabling the NHS to deliver high‐quality care through exploring the experiences of two of the major new organizations established to set standards and monitor NHS quality. We used a mixed method approach: first a cross‐sectional, in‐depth qualitative interview study and then the application of principal agent modeling (Waterman and Meier broader framework). Ten themes were identified as influencing the functioning of the NHS regulatory institutions: socio‐political environment; governance and accountability; external relationships; clarity of purpose; organizational reputation; leadership and management; organizational stability; resources; organizational methods; and organizational performance. The organizations could be easily mapped onto the framework, and their transience between the different states could be monitored. We concluded that differing policy objectives for NHS quality monitoring resulted in central involvement and organizational change. This had a disruptive effect on the ability of the NHS to monitor quality. Constant professional leadership, both clinical and managerial, and basing decisions on best evidence, both technical and organizational, helped one institution to deliver on its remit, even within a changing political/policy environment. Application of the Waterman–Meier framework enabled an understanding and description of the dynamic relationship between central government and organizations in the NHS and may predict when tensions will arise in the future. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd.
    July 19, 2016   doi: 10.1002/hpm.2365   open full text
  • The impact of Saudi hospital accreditation on quality of care: a mixed methods study.
    Mohammed Almasabi, Shane Thomas.
    The International Journal of Health Planning and Management. July 19, 2016
    In 2005, the Central Board for Accreditation of Healthcare Institutions (CBAHI) was launched in Saudi Arabia in order to improve the quality of care. By 2010, the first hospital was accredited by CBAHI, followed by many hospitals in following years. The aim of this study is to examine the impact of CBAHI on quality of care. In this study we used a mixed methods approach involving surveys, documentary analyses and semi‐structure interviews. Surveys data were collected from 669 staff. Documentary analyses included mortality, infection and length of stay. The semi‐structure interview data were gathered from 12 senior managers. Data were collected from three accredited public hospitals. Although some improvements in procedure were recognised, CBAHI does not monitor the continuity of health care delivery and had no effect on quality outcomes in our analysis. This study illustrates a need to sustain improvements over time in the accreditation cycle. Copyright © 2016 John Wiley & Sons, Ltd.
    July 19, 2016   doi: 10.1002/hpm.2373   open full text
  • Effects of Per‐diem payment on the duration of hospitalization and medical expenses according to the palliative care demonstration project in Korea.
    J. Y. Shin, S. J. Yoon, H. S. Ahn, Y. H. Yun.
    The International Journal of Health Planning and Management. July 13, 2016
    Objectives The aim of this study was to examine the impacts of a government‐directed palliative care demonstration (PCD) project, Per‐diem Payment System (PDPS), on length of stay (LOS), hospital costs, resource usage and healthcare quality during the searched period from January in 2009 to December in 2010. Study Design A retrospective claim data review. Methods Individuals who had been eligible for the palliative care payment policy, PDPS, during 2 years (from 2009 to 2010) were assigned to the case group including seven hospitals (n = 3117). Those (seven hospitals) who were not come eligible for the palliative care payment policy were assigned to the control group (n = 2347) with fee for service. The data used in this study were electronically submitted requests of payment to the Health Insurance Review Agency during the period January 2009 to December 2010. Results After the PCD project, the length of stay for palliative patients with cancer diseases decreased by 2.56% (β = −0.026; p‐value = 0.0001) among patients hospitalized in a PCD project compared with patients hospitalized in seven hospitals that was not designed as a PCD project. Compared with costs before the PCD project, costs decreased by 0.76% (β = 0.013; p‐value = 0.0001). Conclusions We provided evidence regarding the change in the societal burden due to palliative care. Although there was a reduction of direct medical costs reported in limited number of hospitals, in the long term, we can anticipate an expanding impact on medical costs in all palliative hospitals. Copyright © 2016 John Wiley & Sons, Ltd.
    July 13, 2016   doi: 10.1002/hpm.2366   open full text
  • ddradseqtools: a software package for in silico simulation and testing of double‐digest RADseq experiments.
    F. Mora‐Márquez, V. García‐Olivares, B. C. Emerson, U. López de Heredia.
    The International Journal of Health Planning and Management. July 12, 2016
    Double‐digested RADseq (ddRADseq) is a NGS methodology that generates reads from thousands of loci targeted by restriction enzyme cut sites, across multiple individuals. To be statistically sound and economically optimal, a ddRADseq experiment has a preliminary design stage that needs to consider issues related to the selection of enzymes, particular features of the genome of the focal species, possible modifications to the library construction protocol, coverage needed to minimize missing data, and the potential sources of error that may impact upon the coverage. We present ddradseqtools, a software package to help ddRADseq experimental design by (i) the generation of in silico double‐digested fragments; (ii) the construction of modified ddRADseq libraries using adapters with either one or two indexes and degenerate base regions (DBRs) to quantify PCR duplicates; and (iii) the initial steps of the bioinformatics preprocessing of reads. ddradseqtools generates single‐end (SE) or paired‐end (PE) reads that may bear SNPs and/or indels. The effect of allele dropout and PCR duplicates on coverage is also simulated. The resulting output files can be submitted to pipelines of alignment and variant calling, to allow the fine‐tuning of parameters. The software was validated with specific tests for the correct operability of the program. The correspondence between in silico settings and parameters from ddRADseq in vitro experiments was assessed to provide guidelines for the reliable performance of the software. ddradseqtools is cost‐efficient in terms of execution time, and can be run on computers with standard CPU and RAM configuration.
    July 12, 2016   doi: 10.1111/1755-0998.12550   open full text
  • Vector soup: high‐throughput identification of Neotropical phlebotomine sand flies using metabarcoding.
    Arthur Kocher, Jean‐Charles Gantier, Pascal Gaborit, Lucie Zinger, Helene Holota, Sophie Valiere, Isabelle Dusfour, Romain Girod, Anne‐Laure Bañuls, Jerome Murienne.
    The International Journal of Health Planning and Management. July 12, 2016
    Phlebotomine sand flies are haematophagous dipterans of primary medical importance. They represent the only proven vectors of leishmaniasis worldwide and are involved in the transmission of various other pathogens. Studying the ecology of sand flies is crucial to understand the epidemiology of leishmaniasis and further control this disease. A major limitation in this regard is that traditional morphological‐based methods for sand fly species identifications are time‐consuming and require taxonomic expertise. DNA metabarcoding holds great promise in overcoming this issue by allowing the identification of multiple species from a single bulk sample. Here, we assessed the reliability of a short insect metabarcode located in the mitochondrial 16S rRNA for the identification of Neotropical sand flies, and constructed a reference database for 40 species found in French Guiana. Then, we conducted a metabarcoding experiment on sand flies mixtures of known content and showed that the method allows an accurate identification of specimens in pools. Finally, we applied metabarcoding to field samples caught in a 1‐ha forest plot in French Guiana. Besides providing reliable molecular data for species‐level assignations of phlebotomine sand flies, our study proves the efficiency of metabarcoding based on the mitochondrial 16S rRNA for studying sand fly diversity from bulk samples. The application of this high‐throughput identification procedure to field samples can provide great opportunities for vector monitoring and eco‐epidemiological studies.
    July 12, 2016   doi: 10.1111/1755-0998.12556   open full text
  • De novo assembly of a tadpole shrimp (Triops newberryi) transcriptome and preliminary differential gene expression analysis.
    Rebekah L. Horn, Thiruvarangan Ramaraj, Nicholas P. Devitt, Faye D. Schilkey, David E. Cowley.
    The International Journal of Health Planning and Management. July 12, 2016
    Next‐generation sequencing techniques, such as RNA sequencing, have provided a wealth of genomic information for nonmodel species. Transcriptomic information can be used to quantify the patterns of gene expression, which can identify how environmental differences invoke organismal stress responses and provide a gauge in predicting species adaptability. In our study, we used RNA sequencing to characterize the first transcriptome from a naupliar tadpole shrimp (Triops newberryi) to identify the genes expressed during the early life history stages and which could be important for future genomic studies. RNA was extracted from naupliar T. newberryi that were reared in a laboratory‐controlled setting and in two different water types, a native and a non‐native condition. A total of six replicates, three per condition, were sequenced with the Illumina Hi‐Seq 2000 achieving 365 M 50‐nt reads. High‐quality reads were produced and de novo assembly was used to construct a T. newberryi transcriptome that was approximately 24.8 M base pairs. More than 10 000 peptides were predicted from the assembly, and genes were sorted into gene ontology categories. The use of different water conditions allowed for a preliminary differential gene expression analysis in order to compare the changes in gene expression between conditions. There were 299 differentially expressed genes between water conditions that might serve as a focal point for future genomic studies of Triops acclimation to different environments. The Triops transcriptome could serve as vital genomic information for additional studies on Branchiopod crustaceans.
    July 12, 2016   doi: 10.1111/1755-0998.12555   open full text
  • Sex determination in the wild: a field application of loop‐mediated isothermal amplification successfully determines sex across three raptor species.
    A. Centeno‐Cuadros, I. Abbasi, R. Nathan.
    The International Journal of Health Planning and Management. June 30, 2016
    PCR‐based methods are the most common technique for sex determination of birds. Although these methods are fast, easy and accurate, they still require special facilities that preclude their application outdoors. Consequently, there is a time lag between sampling and obtaining results that impedes researchers to take decisions in situ and in real time considering individuals’ sex. We present an outdoor technique for sex determination of birds based on the amplification of the duplicated sex‐chromosome‐specific gene Chromo‐Helicase‐DNA binding protein using a loop‐mediated isothermal amplification (LAMP). We tested our method on Griffon Vulture (Gyps fulvus), Egyptian Vulture (Neophron percnopterus) and Black Kite (Milvus migrans) (family Accipitridae). We introduce the first fieldwork procedure for sex determination of animals in the wild, successfully applied to raptor species of three different subfamilies using the same specific LAMP primers. This molecular technique can be deployed directly in sampling areas because it only needs a voltage inverter to adapt a thermo‐block to a car lighter and results can be obtained by the unaided eye based on colour change within the reaction tubes. Primers and reagents are prepared in advance to facilitate their storage at room temperature. We provide detailed guidelines how to implement this procedure, which is simpler (no electrophoresis required), cheaper and faster (results in c. 90 min) than PCR‐based laboratory methods. Our successful cross‐species application across three different raptor subfamilies posits our set of markers as a promising tool for molecular sexing of other raptor families and our field protocol extensible to all bird species.
    June 30, 2016   doi: 10.1111/1755-0998.12540   open full text
  • Reconfiguration of acute care hospitals in post‐socialist Serbia: spatial distribution of hospital beds.
    Marko Matejic.
    The International Journal of Health Planning and Management. June 21, 2016
    In the context of healthcare reforms in post‐socialist Serbia, this research analyses the reconfiguration of acute care hospitals from the aspect of the spatial distribution of hospital beds among and within state‐owned hospitals. The research builds a relationship between the macro or national level and the micro or hospital level of the spatial distribution of hospital beds. The aim of the study is to point out that a high level of efficiency in hospital functionality is difficult to achieve within the current hospital network and architectural‐urban patterns of hospitals, and to draw attention to the necessity of a strategically planned hospital spatial reconfiguration, conducted simultaneously with other segments of the healthcare system reform. The research analyses published and unpublished data presented in tables and diagrams. The theoretical platform of the research covers earlier discussions of the Yugoslav healthcare system, its post‐socialist reforms and the experiences of developed countries. The results show that the hospital bed distribution has not undergone significant changes, while the hospital spatial reconfiguration has either not been carried out at all or, if it has, only on a small scale. All this has contributed to overall inadequate, inflexible, inefficient, defragmented and unequal bed distribution. Copyright © 2016 John Wiley & Sons, Ltd.
    June 21, 2016   doi: 10.1002/hpm.2364   open full text
  • Organizational learning capability and organizational citizenship behaviour in the health sector: examining the role of happiness at work from a gender perspective.
    Andrés Salas‐Vallina, Joaquin Alegre, Rafael Fernández.
    The International Journal of Health Planning and Management. June 21, 2016
    Both researchers and managers are interested in finding the factors that raise organizational citizenship behaviour (OCB), particularly in the health sector. In this complex context, characterized by a high workload, it becomes essential that physicians voluntarily contribute beyond their official job description. Our research aims to evidence the working conditions that promote OCB, considering the role of organizational learning capability through happiness at work. Our research was based on a sample of 167 allergists at Spanish public hospitals, and by means of structural equation models, interesting results were found. We offer to hospital managers both a tool and an explanation for the fostering of OCB. Physicians that progress through learning, under positive attitudes at work, may indeed behave more civically, going beyond their job description. Copyright © 2016 John Wiley & Sons, Ltd.
    June 21, 2016   doi: 10.1002/hpm.2363   open full text
  • Improving performance of long‐term care networks at their initial stage: an empirical study of factors affecting results.
    Nunzio Angiola, Piervito Bianchi.
    The International Journal of Health Planning and Management. June 10, 2016
    Until now very little research has been carried out on the performance of health and human services networks in evolution. In particular, previous studies mainly referred to “centrally governed services networks” in the US context. According to Provan and Kenis (2008), these networks are “lead organization‐governed”, and are different from the “participant‐governed” model or the “network administrative organization (NAO)” solution. We focused our attention on the Apulia region care services networks (Italy). In the last few years, the governance of these networks has passed from the “participant‐governed” model to the NAO approach. We examined how the integration mechanisms work in this type of networks, and if there were challenges to tackle in order to improve their overall performance. These networks were examined at their initial stage, exactly when their governance model moved to a more integrated solution. We collected survey data from 17 health and human services networks out of 45 (38%). The research is carried out by means of statistical methods (OLS). The analysis is cross sectional. The implementation of “rational/technocratic” factors is important but not sufficient to enhance collaboration. The integration at the “professional level” should be kept in mind. In particular, the role of network (case) managers is paramount. Copyright © 2016 John Wiley & Sons, Ltd.
    June 10, 2016   doi: 10.1002/hpm.2361   open full text
  • Epidemiological and financial indicators of hypertension in older adults in Mexico: challenges for health planning and management in Latin America.
    Armando Arredondo, Maria Beatriz Duarte, Silvia Magali Cuadra.
    The International Journal of Health Planning and Management. May 30, 2016
    This study estimated the epidemiological and financial indicators of hypertension in order to identify challenges in strategic planning and management for health systems in Latin America. This is a longitudinal study with a population base of 187 326 reported cases of older adults with hypertension, diagnosed at public health institutions in Mexico. The cost‐evaluation method that was used was based on the instrumentation and consensus techniques. To estimate the epidemiological changes and financial consequences for 2015–2017, time series analyses and probabilistic models were constructed according to the Box–Jenkins technique. Regarding epidemiological changes for 2015 versus 2017, an increase of 8–12% is expected (p < 0.001). Comparing the economic impact in 2015 versus 2017 (p < 0.001), there is a 22% increase in financial requirements. The total amount estimated for hypertension in 2015 (in US dollars) was $1 575 671 330. It included $747 527 259 as direct costs and $829 144 071 as indirect costs. If the risk factors and the different healthcare services for older adults remain as they are currently, the financial consequences of epidemiological changes in older adults will have a major impact on the users' pockets, following in order of importance, on social security providers and on public assistance providers. The challenges and implications of our findings in the context of universal coverage reforms in Latin America reinforce the urgent need to develop more and better strategic planning for the prevention of chronic diseases. Copyright © 2016 John Wiley & Sons, Ltd.
    May 30, 2016   doi: 10.1002/hpm.2362   open full text
  • Continuous improvement, burnout and job engagement: a study in a Dutch nursing department.
    Jos Benders, Hans Bleijerveld, Roel Schouteten.
    The International Journal of Health Planning and Management. May 27, 2016
    Continuous improvement (CI) programs are potentially powerful means to improve the quality of care. The more positive nurses perceive these programs' effects, the better they may be expected to cooperate. Crucial to this perception is how nurses' quality of working life is affected. We studied this in a nursing department, using the job demands‐resources model. We found that two job demands improved, and none of the job resources. Job engagement did not change significantly, while the burnout risk decreased slightly. Overall, the nurses felt the impact to be small yet the changes were in a positive direction. CI can thus be used to improve nurses' working lives and, by restructuring the work processes, the quality of care. Copyright © 2016 John Wiley & Sons, Ltd.
    May 27, 2016   doi: 10.1002/hpm.2355   open full text
  • Community governance in primary health care: towards an international Ideal Type.
    Geoffrey Meads, Grant Russell, Amanda Lees.
    The International Journal of Health Planning and Management. May 27, 2016
    Against a global background of increased resource management responsibilities for primary health care agencies, general medical practices, in particular, are increasingly being required to demonstrate the legitimacy of their decision making in market oriented environments. In this context a scoping review explores the potential utility for health managers in primary health care of community governance as a policy concept. The review of recent research suggests that applied learning from international health systems with enhanced approaches to public and patient involvement may contribute to meeting this requirement. Such approaches often characterise local health systems in Latin America and North West Europe where innovative models are beginning to respond effectively to the growing demands on general practice. The study design draws on documentary and secondary data analyses to identify common components of community governance from the countries in these regions, supplemented by other relevant international studies and sources where appropriate. Within a comprehensive framework of collaborative governance the components are aggregated in an Ideal Type format to provide a point of reference for possible adaptation and transferable learning across market oriented health systems. Each component is illustrated with international exemplars from recent organisational practices in primary health care. The application of community governance is considered for the particular contexts of GP led Clinical Commissioning Groups in England and Primary Health Networks in Australia. Some components of the Ideal Type possess potentially powerful negative as well as positive motivational effects, with PPI at practice levels sometimes hindering the development of effective local governance. This highlights the importance of careful and competent management of the growing resources attributed to primary health care agencies, which possess an increasingly diverse range of non‐governmental status. Future policy and research priorities are outlined. Copyright © 2016 John Wiley & Sons, Ltd.
    May 27, 2016   doi: 10.1002/hpm.2360   open full text
  • Medical mall founders' satisfaction and integrated management requirements.
    Atsushi Ito.
    The International Journal of Health Planning and Management. May 24, 2016
    Medical malls help provide integrated medical services and the effective and efficient independent management of multiple clinics, pharmacies and other medical facilities. Primary care in an aging society is a key issue worldwide and the establishment of a new model for primary care in Japanese medical malls is needed. Understanding the requirements of integrated management that contribute to the improvement of medical mall founders' satisfaction levels will help provide better services. We conducted a questionnaire survey targeting 1840 medical facilities nationwide; 351 facilities responded (19.1%). We performed comparative analyses on founders' satisfaction levels according to years in business, department/area, founder's relationship, decision‐making system and presence/absence of liaison role. A total of 70% of medical malls in Japan have adjacent relationships with no liaison role in most cases; however, 60% of founders are satisfied. Integrated management requirements involve establishing the mall with peers from the same medical office unit or hospital, and establishing a system in which all founders can participate in decision‐making (council system) or one where each general practitioner (GP) independently runs a clinic without communicating with others. The council system can ensure the capability of general practitioners to treat many primary care patients in the future. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd
    May 24, 2016   doi: 10.1002/hpm.2352   open full text
  • Selection of asset investment models by hospitals: examination of influencing factors, using Switzerland as an example.
    Bernhard Eicher.
    The International Journal of Health Planning and Management. May 20, 2016
    Hospitals are responsible for a remarkable part of the annual increase in healthcare expenditure. This article examines one of the major cost drivers, the expenditure for investment in hospital assets. The study, conducted in Switzerland, identifies factors that influence hospitals' investment decisions. A suggestion on how to categorize asset investment models is presented based on the life cycle of an asset, and its influencing factors defined based on transaction cost economics. The influence of five factors (human asset specificity, physical asset specificity, uncertainty, bargaining power, and privacy of ownership) on the selection of an asset investment model is examined using a two‐step fuzzy‐set Qualitative Comparative Analysis. The research shows that outsourcing‐oriented asset investment models are particularly favored in the presence of two combinations of influencing factors: First, if technological uncertainty is high and both human asset specificity and bargaining power of a hospital are low. Second, if assets are very specific, technological uncertainty is high and there is a private hospital with low bargaining power, outsourcing‐oriented asset investment models are favored too. Using Qualitative Comparative Analysis, it can be demonstrated that investment decisions of hospitals do not depend on isolated influencing factors but on a combination of factors. Copyright © 2016 John Wiley & Sons, Ltd.
    May 20, 2016   doi: 10.1002/hpm.2341   open full text
  • Impact assessment of a maternal health project in a megacity, Nigeria: toward a future with more demand for maternal health services.
    Sadatoshi Matsuoka, Sumiko Koga, Emiko Suzui, Yoshiko Tsukada, Kazutomo Ohashi, Taiwo Johnson.
    The International Journal of Health Planning and Management. May 20, 2016
    To improve the quantity and quality of maternal health services in Lagos State, Nigeria having a maternal mortality ratio of 555 per 100 000 live births, a four‐year project was implemented since February 2010. The major activity of the project was training for both the service supply and demand sides. This study aimed to examine the impact of the project on coverages and quality of the services in target areas, and guide statewide policies. The Cochran–Armitage test for trend was applied to understand trends in the service coverages during 2009–2013. The same test was performed to analyse trends in the proportions of perineal conditions (i.e. intact or tear) and to evaluate variations in midwives' snkill during 2011–2013. The paired t‐test was used to analyse changes in midwives' knowledge. The project interventions contributed to a significant increase in the overall service coverages, including improvements in midwifery knowledge and possibly in their skills. However, the service coverage was still limited as of the termination of the project. To instal the interventions and maximise the effect of them state‐wide, it is recommended to undertake five tasks: (i) establishment of public primary health centres offering 24‐h maternal health services; (ii) redeployment and recruitment of public health personnel; (iii) expansion of midwifery trainings and continuous education by the local trainers; (iv) review of grass‐roots level activities; and (v) scrutiny of barriers to maternal health services. Copyright © 2016 John Wiley & Sons, Ltd.
    May 20, 2016   doi: 10.1002/hpm.2354   open full text
  • Where there is no policy: governing the posting and transfer of primary health care workers in Nigeria.
    Seye Abimbola, Titilope Olanipekun, Marta Schaaf, Joel Negin, Stephen Jan, Alexandra L. C. Martiniuk.
    The International Journal of Health Planning and Management. May 04, 2016
    The posting and transfer of health workers and managers receives little policy and research attention in global health. In Nigeria, there is no national policy on posting and transfer in the health sector. We sought to examine how the posting and transfer of frontline primary health care (PHC) workers is conducted in four states (Lagos, Benue, Nasarawa and Kaduna) across Nigeria, where public sector PHC facilities are usually the only form of formal health care service providers available in many communities. We conducted in‐depth interviews with PHC workers and managers, and group discussions with community health committee members. The results revealed three mechanisms by which PHC managers conduct posting and transfer: (1) periodically moving PHC workers around as a routine exercise aimed at enhancing their professional experience and preventing them from being corrupted; (2) as a tool for improving health service delivery by assigning high‐performing PHC workers to PHC facilities perceived to be in need, or posting PHC workers nearer their place of residence; and (3) as a response to requests for punishment or favour from PHC workers, political office holders, global health agencies and community health committees. Given that posting and transfer is conducted by discretion, with multiple influences and sometimes competing interests, we identified practices that may lead to unfair treatment and inequities in the distribution of PHC workers. The posting and transfer of PHC workers therefore requires policy measures to codify what is right about existing informal practices and to avert their negative potential. © 2016 The Authors The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd
    May 04, 2016   doi: 10.1002/hpm.2356   open full text
  • Robust analysis of the determinants of healthcare expenditure growth: evidence from panel data for low‐, middle‐ and high‐income countries.
    Moheddine Younsi, Mohamed Chakroun, Amine Nafla.
    The International Journal of Health Planning and Management. May 03, 2016
    This paper examines the determinants of healthcare expenditure for low‐, middle‐ and high‐income countries, and it quantifies their influences in order to assess policies for achieving universal health coverage. We elaborate two models, a fixed‐effect model and the dynamic panel model, to estimate the factors associated with the total health expenditure growth as well as its major components for 167 countries over the period of 1993–2013. The panel data on total health expenditure per capita and its components were taken from the World Development Indicators. Overall, our results showed that total health expenditure per capita is rising in all countries over time as a result of rising incomes. However, our estimates showed that the income elasticity of health expenditure ranged from 0.75 to 0.96 in the fixed‐effect static panel model, while in the dynamic panel model, it was smaller and ranged from 0.16 to 0.47. Our empirical findings indicate that development assistance for health reduced government domestic spending on health but increased total government health spending. Our results also indicate that the trend in health expenditure growth is significantly depending with the country's economic development. In addition, out‐of‐pocket expenditure is powerfully influenced by a country's capacity to increase general government revenues and social insurance contributions. Knowledge of factors associated to health expenditure might help policy makers to make wise judgments, plan health reforms and allocate resources efficiently. Copyright © 2016 John Wiley & Sons, Ltd.
    May 03, 2016   doi: 10.1002/hpm.2358   open full text
  • A comparison of experiences, competencies and development needs of doctor managers in Kenya and the United Kingdom (UK).
    Salome Kathomi Ireri, Kieran Walshe, Lawrence Benson, Mutuku Mwanthi.
    The International Journal of Health Planning and Management. May 02, 2016
    Purpose The purpose of the research was to explore and compare the experiences, leadership and management competencies and development needs of doctor managers in Kenya and the UK. Design/methodology A comparative study d258esign involving fieldwork in Kenya and the UK was adopted. Data were collected using a multi‐method approach: qualitative interviews and a survey with doctor managers. The template method was used for qualitative data analysis while appropriate statistical tests in SPSS were used for quantitative data analysis. Findings The findings of the study add to the knowledge on experiences of doctor managers, competencies and development needs. Ways of addressing some of the difficulties are proposed. Research limitations/implications The study highlights issues of a comparative study across different cultures and the issue of bias that is associated with self reports. Practical and social Implications It is assumed that management decisions have much in common and the training and socialisation of doctors as professionals is somewhat similar. This paper explores if there are any experiences that are transferable and if competency frameworks in healthcare used in developed countries are transferable to a developing country. Originality/value The study gives baseline knowledge and insight into the experiences, competencies and development needs of doctor managers in a developing country and adds to existing knowledge on doctor managers in the UK. This study has also provided currently the only international study comparing the experiences, competencies and development needs of doctors in management.
    May 02, 2016   doi: 10.1002/hpm.2357   open full text
  • The atlas network: a “strategic ally” of the tobacco industry.
    Julia Smith, Sheryl Thompson, Kelley Lee.
    The International Journal of Health Planning and Management. April 28, 2016
    Amid growing academic and policy interest in the influence of think tanks in public policy processes, this article demonstrates the extent of tobacco industry partnerships with think tanks in the USA, and analyzes how collaborating with a network of think tanks facilitated tobacco industry influence in public health policy. Through analysis of documents from tobacco companies and think tanks, we demonstrate that the Atlas Economic Research Foundation, a network of 449 free market think tanks, acted as a strategic ally to the tobacco industry throughout the 1990s. Atlas headquarters, while receiving donations from the industry, also channeled funding from tobacco corporations to think tank actors to produce publications supportive of industry positions. Thirty‐seven per cent of Atlas partner think tanks in the USA received funding from the tobacco industry; the majority of which were also listed as collaborators on public relations strategies or as allies in countering tobacco control efforts. By funding multiple think tanks, within a shared network, the industry was able to generate a conversation among independent policy experts, which reflected its position in tobacco control debates. This demonstrates a coherent strategy by the tobacco industry to work with Atlas to influence public health policies from multiple directions. There is a need for critical analysis of the influence of think tanks in tobacco control and other health policy sectors, as well as greater transparency of their funding and other links to vested interests. © 2016 The Authors The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd
    April 28, 2016   doi: 10.1002/hpm.2351   open full text
  • Revisiting the ichthyodiversity of Java and Bali through DNA barcodes: taxonomic coverage, identification accuracy, cryptic diversity and identification of exotic species.
    Hadi Dahruddin, Aditya Hutama, Frédéric Busson, Sopian Sauri, Robert Hanner, Philippe Keith, Renny Hadiaty, Nicolas Hubert.
    The International Journal of Health Planning and Management. April 19, 2016
    Among the 899 species of freshwater fishes reported from Sundaland biodiversity hotspot, nearly 50% are endemics. The functional integrity of aquatic ecosystems is currently jeopardized by human activities, and landscape conversion led to the decline of fish populations in several part of Sundaland, particularly in Java. The inventory of the Javanese ichthyofauna has been discontinuous, and the taxonomic knowledge is scattered in the literature. This study provides a DNA barcode reference library for the inland fishes of Java and Bali with the aim to streamline the inventory of fishes in this part of Sundaland. Owing to the lack of available checklist for estimating the taxonomic coverage of this study, a checklist was compiled based on online catalogues. A total of 95 sites were visited, and a library including 1046 DNA barcodes for 159 species was assembled. Nearest neighbour distance was 28‐fold higher than maximum intraspecific distance on average, and a DNA barcoding gap was observed. The list of species with DNA barcodes displayed large discrepancies with the checklist compiled here as only 36% (i.e. 77 species) and 60% (i.e. 24 species) of the known species were sampled in Java and Bali, respectively. This result was contrasted by a high number of new occurrences and the ceiling of the accumulation curves for both species and genera. These results highlight the poor taxonomic knowledge of this ichthyofauna, and the apparent discrepancy between present and historical occurrence data is to be attributed to species extirpations, synonymy and misidentifications in previous studies.
    April 19, 2016   doi: 10.1111/1755-0998.12528   open full text
  • Primary health care workers' views of motivating factors at individual, community and organizational levels: a qualitative study from Nasarawa and Ondo states, Nigeria.
    Aarushi Bhatnagar, Shivam Gupta, Olakunle Alonge, Asha S. George.
    The International Journal of Health Planning and Management. April 06, 2016
    Background Current efforts to motivate primary health workers in Nigeria focus on better financial incentives, and the role of other motivating factors has received less attention. The aim of this study is to explore individual and organizational determinants, their interactions and effects on motivation. Methods Exploratory qualitative research, involving semi‐structured interviews with 29 primary health workers (doctors, nurses, midwives and community health workers), was conducted in Nasarawa and Ondo states in Nigeria. Nine key informant interviews were conducted with government officials. Interviews were digitally recorded, transcribed and coded. Thematic analysis was conducted to identify common themes, as well as unique narratives. Results Results from this study suggest that health workers are motivated by individual (vocation, religion, humanity and self‐efficacy) and organizational (monetary incentives, good working environment) factors and community recognition. Supervision and leadership provided by the officer in charge as compared with that by external agencies appeared to have a positive effect on motivation. Conclusions Policy makers and donor agencies should take into account a broader range of factors while designing strategies to motivate the health workforce. The study also underscores how officer in charges with enhanced skills are likely to motivate health workers by creating a more supportive environment.
    April 06, 2016   doi: 10.1002/hpm.2342   open full text
  • Not very NICE: deviance, stigma and nutritional guidelines related to healthy weight and obesity.
    Alison Hann, Ashley Frawley, Gillian Spedding.
    The International Journal of Health Planning and Management. April 06, 2016
    This paper critically examines the current National Institute for Health and Clinical Excellence and National Health Service guidelines on weight management and the avoidance of obesity (NG7). We demonstrate that the guidance is unlikely to produce the desired effect of enabling people to reduce or control their weight through the twin strategies of dieting (primarily using the calories‐in, calories‐out approach) and increasing their levels of exercise. The paper provides a critical examination of these guidelines and concludes that they are unlikely to encourage maintenance of ‘healthy’ weights or prevent obesity, are not based upon particularly strong evidence and are misguided in maintaining a persistent focus upon weight rather than other indicators of health. Moreover, we suggest their promotion may produce a number of unintended consequences, including perpetuating body‐related stigmatisation and anxieties. Copyright © 2016 John Wiley & Sons, Ltd.
    April 06, 2016   doi: 10.1002/hpm.2350   open full text
  • Costs of hospital services in Jordan.
    Eman A Hammad, Taissir Fardous, Ibrahim Abbadi.
    The International Journal of Health Planning and Management. April 01, 2016
    Background Policy makers are on quest for estimates of health costs to achieve maximum efficiency and sustainability. In Jordan, there is a scarcity of information on hospital service costs. Aim The purpose of this study was to estimate the direct cost of hospital services in one of the biggest public hospitals in Amman, Jordan. Methods A retrospective analysis forms a 400‐bed public urban hospital. Costs were estimated in Jordanian dinars (JD) (exchange rate was US$1.41). Results Inpatient costs contributed to 50% of all costs whilst outpatient clinics consumed 17%. Average cost per admission was JD 481.6 (US$674.2), JD 106.7 (US$149.3) per inpatient day and JD 63.1 (US$88.3) per bed day. The average cost per visit to emergency room was JD 14.1 s (US$19.7). Cost per visit to ambulatory care services ranged between JD 37.3 and 473 (US$52.6–662.2). The average cost per surgery was JD 322.1 (US$454.2). Conclusions With high health costs, areas for improvements in efficiency and cost savings must be identified and discussed with managers and policy makers. A larger‐scale study is advocated to understand the costs of various health providers such as military, teaching and private hospitals.
    April 01, 2016   doi: 10.1002/hpm.2343   open full text
  • The effect of health transformation policies on the resident physicians' perception of the medical profession in Turkey.
    Ferda Erdem, Murat Atalay.
    The International Journal of Health Planning and Management. March 21, 2016
    Although the new changes in the health system in Turkey has resulted in positive implications with respect to the groups that use the healthcare services, it has been singled out for criticism by the professional associations because of its erosive consequences particularly for the medical profession as a whole. The purpose of this study is to explain how the health transformation policies and practices influenced the working conditions and perceptions of the resident physicians in Turkey with regard to the medical profession. A qualitative research design was employed, and the data was collected through document analysis and focus group interview. The common findings highlight that the new practices have had an aggravated effect on the working conditions of the resident physicians, which has resulted in several contentious issues. These include the increased workload, insufficient training and development, economic and social conditions and a heightened number of violent acts against physicians. Negatively, these influence the motivation of the physicians and their perception of the medical profession. This finding suggests that the medical profession is able to be studied as an appropriate case for the phenomenon of deprofessionalization. Copyright © 2016 John Wiley & Sons, Ltd.
    March 21, 2016   doi: 10.1002/hpm.2340   open full text
  • Effects of healthcare reform on health resource allocation and service utilization in 1110 Chinese county hospitals: data from 2006 to 2012.
    Pengqian Fang, Ruirong Hu, Qiuxia Han.
    The International Journal of Health Planning and Management. March 14, 2016
    The central government of China launched a large‐scale, expensive health reform in April 2009 because of the serious health‐related problems in the country. This reform aims to re‐establish a universal healthcare system, which is expected to provide affordable basic healthcare. Independent two‐sample t‐test, one‐way ANOVA and chi‐squared test were conducted to analyze the effect of the health reform on health resource allocation and service utilization in Chinese county hospitals. First, we described the hospitals' financial performance in terms of funding sources, balances and fiscal compensations (for personnel expenditure). Second, we discussed the total number of health personnel as well as the structure (number of medical personnel per thousand population and ratio of doctors and nurses) and quality of the health personnel. Lastly, we investigated the county hospitals' health resource utilization, bed occupancy and average medical expense per visit. Then, we probed different reasons and provided multiple approaches to existing problems. Copyright © 2016 John Wiley & Sons, Ltd.
    March 14, 2016   doi: 10.1002/hpm.2344   open full text
  • Exploring the barriers to rigorous monitoring and evaluation of health systems strengthening activities: qualitative evidence from international development partners.
    Janna M. Wisniewski, Valerie A. Yeager, Mark L. Diana, David R. Hotchkiss.
    The International Journal of Health Planning and Management. February 29, 2016
    The number of health systems strengthening (HSS) programs has increased in the last decade. However, a limited number of studies providing robust evidence for the value and impact of these programs are available. This study aims to identify knowledge gaps and challenges that impede rigorous monitoring and evaluation (M&E) of HSS, and to ascertain the extent to which these efforts are informed by existing technical guidance. Interviews were conducted with HSS advisors at United States Agency for International Development‐funded missions as well as senior M&E advisors at implementing partner and multilateral organizations. Findings showed that mission staff do not use existing technical resources, either because they do not know about them or do not find them useful. Barriers to rigorous M&E included a lack suitable of indicators, data limitations, difficulty in demonstrating an impact on health, and insufficient funding and resources. Consensus and collaboration between international health partners and local governments may mitigate these challenges. Copyright © 2016 John Wiley & Sons, Ltd.
    February 29, 2016   doi: 10.1002/hpm.2339   open full text
  • Health services utilization of people having and not having a regular doctor in Canada.
    Nguyen Xuan Thanh, John Rapoport.
    The International Journal of Health Planning and Management. February 10, 2016
    Canada having a universal health insurance plan that provides hospital and physician benefits offers a natural experiment of whether continuity of care actually provides lower or higher utilization of services. The question we are evaluating is whether Canadians, who have a regular physician, use more health resources than those who do not have one? Using two statistical methods, including propensity score matching and zero‐inflated negative binomial regression, we analyzed data from the 2010 and 2007/2008 Canadian Community Health Surveys separately to document differences between people self‐reportedly having and not having a regular doctor in the utilization of general practitioner, specialist, and hospital services. The results showed, consistently for all two statistical methods and two datasets used, that people reportedly having a regular doctor used more healthcare services than a matched group of people who was self‐reportedly not having a regular doctor. For specialist and hospital utilization, the statistically significant differences were in the likelihood if the service was used but not in the number of specialist visits or hospital nights among users. Copyright © 2016 John Wiley & Sons, Ltd.
    February 10, 2016   doi: 10.1002/hpm.2338   open full text
  • Private capital investments in health care provision through mergers and acquisitions: from long‐term to acute care.
    Federica Angeli, Hans Maarse.
    The International Journal of Health Planning and Management. January 27, 2016
    Objectives This work aims to test whether different segments of healthcare provision differentially attract private capital and thus offer heterogeneous opportunities for private investors' diversification strategies. Methods Thomson Reuter's SDC Platinum database provided data on 2563 merger and acquisition (M&A) deals targeting healthcare providers in Western Europe between 1990 and 2010. Longitudinal trends of industrial and geographical characteristics of M&As' targets and acquirers are examined. Results Our analyses highlight: (i) a relative decrease of long‐term care facilities as targets of M&As, replaced by an increasing prominence of general hospitals, (ii) a shrinking share of long‐term care facilities as targets of financial service organizations' acquisitions, in favor of general hospitals, and (iii) an absolute and relative decrease of long‐term care facilities' role as target of cross‐border M&As. Conclusions We explain the decreasing interest of private investors towards long‐term care facilities along three lines of reasoning, which take into account the saturation of the long‐term care market and the liberalization of acute care provision across Western European countries, regulatory interventions aimed at reducing private ownership to ensure resident outcomes and new cultural developments in favor of small‐sized facilities, which strengthen the fragmentation of the sector. These findings advance the literature investigating the effect of private ownership on health outcomes in long‐term facilities. Market, policy and cultural forces have emerged over two decades to jointly regulate the presence of privately owned, large‐sized long‐term care providers, seemingly contributing to safeguard residents' well‐being. Copyright © 2016 John Wiley & Sons, Ltd.
    January 27, 2016   doi: 10.1002/hpm.2327   open full text
  • Health service utilization and access to medicines among Syrian refugee children in Jordan.
    Shannon Doocy, Emily Lyles, Laila Akhu‐Zaheya, Ann Burton, William Weiss.
    The International Journal of Health Planning and Management. January 22, 2016
    Background With over one million Syrian refugee children in the region, we undertook this study to characterize care‐seeking behaviors and health service utilization for child refugees with the aim of informing humanitarian programming for non‐camp settings in Jordan. Methods A survey of Syrian refugees living outside of camps in Jordan was conducted using a 125 × 12 cluster design with probability proportional to size sampling to obtain a representative sample. The questionnaire focused on access to health services, including a module on care seeking for children. Results Care seeking was high with 90.9% of households with a child less than 18 years seeking medical care the last time it was needed. Households most often sought care for children in the public sector (54.6%), followed by private (36.5%) and charity sectors (8.9%). Among child care seekers, 88.6% were prescribed medication during the most recent visit, 90.6% of which obtained the medication. Overall, 49.4% of households reported out‐of‐pocket expenditures for either the consultation or prescribed medications at the most recent visit (mean $US21.1 and median $US0). Conclusions Syrian refugees had good access to care for their sick children at the time of the survey; however, this has likely deteriorated since the survey because of the withdrawal of free access for refugees. The number of refugees in Jordan and relative accessibility of care has resulted in a large burden on the health system; the Jordanian government will require additional support if current levels of health access are to be maintained for Syrian refugees. © 2016 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.
    January 22, 2016   doi: 10.1002/hpm.2336   open full text
  • Values and strategies: management of radical organizational change in a university hospital.
    Arne Orvik.
    The International Journal of Health Planning and Management. January 17, 2016
    Managers' experiences of radical change were studied in a Norwegian university hospital, which was relocated from a traditional building to a new, high‐tech building. The university hospital was also accredited as a health promoting hospital. Thirteen managers at different levels in the organization and a personnel safety representative were interviewed as part of a trailing research project. The aim of the study was to elucidate the managers' value orientation and strategies for dealing with value tensions. A combination of a hermeneutical, reflective method and a template for quality, efficiency and integrity guided the analysis. The template was based not only on the main findings but also on the core values of a model of organizational health. The results show that clinical managers focus on quality and top managers, not unexpectedly, focus on efficiency. Managers at both levels were concerned about their own integrity, and also about the integrity of their clinician colleagues, as well as showing concern for the hospital's mission, in terms of organizational effectiveness. The discussion was conducted in terms of dominance, cycling and balancing strategies, of which the last was the most prevalent. However, sustainable strategies for dealing with value tensions also call for value‐based management and value‐conscious leadership. Copyright © 2016 John Wiley & Sons, Ltd.
    January 17, 2016   doi: 10.1002/hpm.2332   open full text
  • Factors associated with job satisfaction among district hospital health workers in Northern Vietnam: a cross‐sectional study.
    Huy Van Nguyen, Huong Thao Duong, Toan Thinh Vu.
    The International Journal of Health Planning and Management. January 17, 2016
    Background In many developing countries, including Vietnam, little is known about job satisfaction among lower level‐health staff. The purpose of this study was to assess job satisfaction and its determinants among district hospital health staff. Methods In a cross‐sectional quantitative study, 128 health staff from a rural district hospital in Northern Vietnam were approached for data collection. Regression techniques were adopted to assess factors associated with several types of job satisfaction. Results Overall job satisfaction was moderately high, ranging from 69% to 91%. Across all dimensions, health workers showed their highest satisfaction with co‐worker relationships, while, in comparison, it was much lower for their supervisor's style and relationship. However, they claimed their lowest satisfaction with compensation and benefits. In final multivariate models, females and those satisfied with knowledge, skills and job performance were most likely to be satisfied with relationships with co‐workers. Staff who were married, received a low pay, who were not satisfied with supervisor style and relationships and who were not satisfied with staff training, development opportunities were least likely to be satisfied with compensation and benefits. Conclusions The study findings highlight an important need for designing an intervention program that considers organizational factors. Copyright © 2016 John Wiley & Sons, Ltd.
    January 17, 2016   doi: 10.1002/hpm.2337   open full text
  • Implementing root cause analysis in Iranian hospitals: challenges and benefits.
    Zhaleh Abdi, Hamid Ravaghi.
    The International Journal of Health Planning and Management. January 12, 2016
    Root cause analysis (RCA) has been widely used for retrospective investigations of patient safety incidents. To increase patient safety competencies, RCA has recently been introduced in Iranian hospitals. The aims of the current study were to explore team members' experiences and perceptions of RCA and to identify the challenges and benefits of using it in Iranian hospitals from their perspective. A qualitative study was conducted consisting of 32 semi‐structured interviews with health professionals who participated in the national training programme and were involved in RCA investigations. Data were analysed using the thematic analysis method. The participants encountered a range of obstacles while conducting RCA, including time constraints, a lack of resources, the blame culture and unsupportive colleagues. They stressed the need for further leadership support and cultural change within the Iranian healthcare system to facilitate the application of RCA. RCA was perceived as a beneficial analytical tool that improved patient care, fostered teamwork and communication among staff and promoted safety culture. This study concluded that applying RCA in the Iranian healthcare setting has had a significant impact on improving commitment to safety. However, the general adoption of this method is hindered by the lack of workplace and system supports. To maximize profits from RCA, clinical leaders must assign a high priority to RCA investigations and support RCA team efforts. Copyright © 2016 John Wiley & Sons, Ltd.
    January 12, 2016   doi: 10.1002/hpm.2335   open full text
  • Use of Lean methodology to improve operating room efficiency in hospitals across the Kingdom of Saudi Arabia.
    Mazen Hassanain, Mohammed Zamakhshary, Ghada Farhat, Ahmed Al‐Badr.
    The International Journal of Health Planning and Management. January 12, 2016
    Objective The objective of this study was to assess whether an intervention on process efficiency using the Lean methodology leads to improved utilization of the operating room (OR), as measured by key performance metrics of OR efficiency. Design A quasi‐experimental design was used to test the impact of the intervention by comparing pre‐intervention and post‐intervention data on five key performance indicators. Setting The ORs of 12 hospitals were selected across regions of the Kingdom of Saudi Arabia (KSA). Participants The participants were patients treated at these hospitals during the study period. Intervention(s) The intervention comprised the following: (i) creation of visual dashboards that enable starting the first case on time; (ii) use of computerized surgical list management; (iii) optimization of time allocation; (iv) development of an operating model with policies and procedures for the pre‐anesthesia clinic; and (iv) creation of a governance structure with policies and procedures for day surgeries. Main outcome measure(s) The following were the main outcome measures: on‐time start for the first case, room turnover times, percent of overrun cases, average weekly procedure volume and OR utilization. Results The hospital exhibited statistically significant improvements in the following performance metrics: on‐time start for the first case, room turnover times and percent of overrun cases. A statistically significant difference in OR utilization or average weekly procedure volumes was not detected. Conclusions The implementation of a Lean‐based intervention targeting process efficiency applied in ORs across various KSA hospitals resulted in encouraging results on some metrics at some sites, suggesting that the approach has the potential to produce significant benefit in the future. Copyright © 2016 John Wiley & Sons, Ltd.
    January 12, 2016   doi: 10.1002/hpm.2334   open full text
  • Productivity changes in OECD healthcare systems: bias‐corrected Malmquist productivity approach.
    Younhee Kim, Dong‐hyun Oh, Minah Kang.
    The International Journal of Health Planning and Management. January 11, 2016
    This study evaluates productivity changes in the healthcare systems of 30 Organization for Economic Co‐operation and Development (OECD) countries over the 2002–2012 periods. The bootstrapped Malmquist approach is used to estimate bias‐corrected indices of healthcare performance in productivity, efficiency and technology by modifying the original distance functions. Two inputs (health expenditure and school life expectancy) and two outputs (life expectancy at birth and infant mortality rate) are used to calculate productivity growth. There are no perceptible trends in productivity changes over the 2002–2012 periods, but positive productivity improvement has been noticed for most OECD countries. The result also informs considerable variations in annual productivity scores across the countries. Average annual productivity growth is evenly yielded by efficiency and technical changes, but both changes run somewhat differently across the years. The results of this study assert that policy reforms in OECD countries have improved productivity growth in healthcare systems over the past decade. Countries that lag behind in productivity growth should benchmark peer countries' practices to increase performance by prioritizing an achievable trajectory based on socioeconomic conditions. For example, relatively inefficient countries in this study indicate higher income inequality, corresponding to inequality and health outcomes studies. Although income inequality and globalization are not direct measures to estimate healthcare productivity in this study, these issues could be latent factors to explain cross‐country healthcare productivity for future research. Copyright © 2016 John Wiley & Sons, Ltd.
    January 11, 2016   doi: 10.1002/hpm.2333   open full text
  • Lean healthcare in developing countries: evidence from Brazilian hospitals.
    Luana Bonome Message Costa, Moacir Godinho Filho, Antonio Freitas Rentes, Thiago Moreno Bertani, Ronaldo Mardegan.
    The International Journal of Health Planning and Management. December 17, 2015
    The present study evaluates how five sectors of two Brazilian hospitals have implemented lean healthcare concepts in their operations. The main characteristics of the implementation process are analyzed in the present study: the motivational factor for implementation, implementation time, form (consultancy or internal), team (hospital and consultants), lean implementation continuity/sustainability, lean healthcare tools and methods implemented, problems/improvement opportunities, lean healthcare barriers faced during the implementation process, and critical factors that affected the implementation and the results obtained in each case. The case studies indicate that reducing patient lead times and costs and making financial improvements were the primary factors that motivated lean healthcare implementation in the hospitals studied. Several tools and methods were used in the cases studied, especially value stream mapping and DMAIC. The barriers found in both hospitals are primarily associated with the human factor. Additionally, the results obtained after implementation were analyzed and improvements in financial aspects, productivity and capacity, and lead time reduction of the analyzed sectors were observed. Further, this study also exhibited four propositions elaborated from the results obtained from the cases that highlighted barriers and challenges to lean healthcare implementation in developing countries. Two of these barriers are hospital organizational structure (and, consequently, how the senior management works with medical staff), and outsourcing hospital activities. This study also concluded that the initialization and maintenance of lean healthcare implementation rely heavily on external support because lean healthcare subject knowledge is not yet available in the healthcare organization, which represents a challenge. Copyright © 2015 John Wiley & Sons, Ltd.
    December 17, 2015   doi: 10.1002/hpm.2331   open full text
  • Great expectations ‐ introduction of flow managers in a university hospital.
    Runo Axelsson, Susanna Bihari Axelsson, Jeppe Gustafsson, Janne Seemann.
    The International Journal of Health Planning and Management. December 08, 2015
    A major reorganization of a university hospital included the clinical structure as well as the administrative structure of the hospital. The focus of the reorganization was to improve the coordination of patient flows through the hospital. An important part of the organizational change was the introduction of flow managers. The aim of the article is to describe and analyze the challenges of the flow managers in the implementation of the reorganization. The description is based on a number of individual and focus group interviews with professionals and managers on different organizational levels. The analysis is guided by a broad conceptual framework, focusing on the processes of change in a professional organization like a hospital. The results show that the flow managers started with a lot of uncertainty regarding their responsibilities. There was also a lot of resistance to the reorganization, which the flow managers came to personify. They proceeded by building relationships and shaping their role and tasks. They tried to balance proactive and reactive strategies of change. There were some positive results, but they felt that that the expectations placed on them had been unrealistic. The introduction of flow managers in a university hospital has touched upon many elements of the conceptual framework. There were a number of structural, cultural, financial and strategic barriers influencing the change process. The main conclusion of the analysis is that the flow managers need more power and legitimacy in the organization to deal with these barriers. Copyright © 2015 John Wiley & Sons, Ltd.
    December 08, 2015   doi: 10.1002/hpm.2328   open full text
  • The impact of regional policies on emergency department management and performance: the case of the regional government of Sicily.
    Simone Fanelli, Marco Ferretti, Antonello Zangrandi.
    The International Journal of Health Planning and Management. December 08, 2015
    Background Improvement in healthcare, seeking the correct balance between quality and costs, is an ongoing concern in many countries. Many countries have developed and implemented improvement programmes in health care, particularly in emergency departments (ED), which play a key role in terms of hospital resources and planning. The regional government of Sicily implemented a project 2010–2012 to improve ED care quality and patient safety. Purpose This paper aims to evaluate improvements implemented by the Regional Health Authority of Sicily in the 20 main EDs. Method Performance analysis of EDs was conducted on three levels: care quality (standard Joint Commission International evaluation), efficiency in terms of resources and output (by way of interviews and document analysis) and the role of management in efficiently promoting change (presence of a performance monitoring system). Findings The results show improvements in all areas and improved performance in all EDs. There is, however, room for improvement in certain areas, and improvement was not uniformly distributed. Practical implications The quality of local policy and management are key aspects of efficient promotion of performance improvement. Copyright © 2015 John Wiley & Sons, Ltd.
    December 08, 2015   doi: 10.1002/hpm.2329   open full text
  • Building political will for HIV response: an operational model and strategy options.
    Derick W. Brinkerhoff.
    The International Journal of Health Planning and Management. December 08, 2015
    As global programs for HIV response look to transfer responsibility and financing increasingly to country governments, the political will to take on these responsibilities becomes increasingly prominent. However, defining and assessing political will are problematic; it involves intent and motivation, and thus is inherently difficult to observe. It is intimately connected to capacity and is contextually embedded. This article describes an operational model of political will comprised of seven components that are observable and measurable. Two case studies illustrate the application of the model and shed light on the interconnections among commitment, capacity and context: South Africa and China. Strategy options to build political will for HIV response identify possible actions for both government and civil society. Political will as a concept is most usefully viewed as integrated within larger political and bureaucratic processes, as a product of the complex array of incentives and disincentives that those processes create. However, this conclusion is not a recipe for discouragement or inaction. Agent‐based conceptualizations of policy change offer a solid grounding for building political will that supports HIV policy and programs. Copyright © 2015 John Wiley & Sons, Ltd.
    December 08, 2015   doi: 10.1002/hpm.2330   open full text
  • Preferences of Bulgarian consumers for quality, access and price attributes of healthcare services—result of a discrete choice experiment.
    Thijs Schoot, Milena Pavlova, Elka Atanasova, Wim Groot.
    The International Journal of Health Planning and Management. November 18, 2015
    Objective The aim of the study is to determine the preferences of Bulgarian citizens regarding the provision of healthcare services. Method A survey was carried out in Bulgaria among a nationally representative sample of 1003 respondents. Both a discrete choice experiment and a self‐explicated ranking of outpatient and inpatient service attributes were included in the survey. The data are analyzed to elicit the preferences of Bulgarian healthcare consumers for service attributes and to compare them with previous studies in Bulgaria and other countries in Central and Eastern Europe. Results The reputation and skills of the care provider appear to be relatively most important to the respondents, followed by the state of the equipment, the condition of the facility and the attitude of the staff. The fee‐level and access‐related attributes (waiting and traveling time) emerged as less important. Overall, consumers in Bulgaria value the quality of healthcare provision very highly. Yet, there are some statistically significant differences between socio‐demographic groups. Conclusion In general, Bulgarian healthcare consumers are willing to accept higher prices for the services they use, when this comes with improved quality of services. These findings comply with findings in previous studies in Bulgaria and in the region. Given the quality problems in the Bulgarian healthcare sector, our findings indicate that priority has to be given to the improvement of healthcare quality when the Bulgarian government invests in this sector. Copyright © 2015 John Wiley & Sons, Ltd.
    November 18, 2015   doi: 10.1002/hpm.2325   open full text
  • Why were doctors unable to accomplish their rural‐aid mission in China? A qualitative study.
    Hongxing Yu, Jie Luo, Lan Yao, Bo Qian, Tianwei Shi, Youmei Feng.
    The International Journal of Health Planning and Management. November 09, 2015
    Background To alleviate the difficulties of rural residents in receiving timely healthcare, the Chinese government launched a medical rural‐aid program that solicited urban medical professionals to go to rural hospitals for a 1‐year tenure. However, many of urban doctors did not accomplish this task. In this study, we attempted to investigate the reasons behind the failure to fulfill this program and to explore a more feasible solution. Methods Eleven doctors and nurses participated in the focus group discussions. Twenty‐five interviewees, including health administrative officials, doctors and managers from both urban tertiary hospitals and county‐level hospitals, participated in semi‐structured in‐depth telephone interviews. The interview data were summarized and analyzed using the grounded theory. Results The failure of this program was attributed to multiple causes, such as problems with the recipient hospitals, the support hospitals and the participating doctors, and overall defects in the program strategy itself. One major reason is the competition between the recipient hospitals and the support hospitals, which distorted the original purpose of this rural‐aid program. Conclusion The rural‐aid program strategy should be adjusted. The recipient hospitals should be township‐level health centers rather than county‐level hospitals. In addition, the relevant policies should be amended and improved accordingly. Copyright © 2015 John Wiley & Sons, Ltd.
    November 09, 2015   doi: 10.1002/hpm.2324   open full text
  • Regulating self‐selection into private health insurance in Chile and the United States.
    Arturo Vargas Bustamante, Claudio A. Méndez.
    The International Journal of Health Planning and Management. November 02, 2015
    In the 1980s, Chile adopted a mixed (public and private) model for health insurance coverage similar to the one recently outlined by the Affordable Care Act in the United States (US). In such a system, a mix of public and private health plans offer nearly universal coverage using a combined approach of managed competition and subsidies for low‐income individuals. This paper uses a “most different” case study design to compare policies implemented in Chile and the US to address self‐selection into private insurance. We argue that the implementation of a mixed health insurance system in Chile without the appropriate regulations was complex, and it generated a series of inequities and perverse incentives. The comparison of Chile and the US healthcare reforms examines the different approaches that both countries have used to manage economic competition, address health insurance self‐selection and promote solidarity. Copyright © 2015 John Wiley & Sons, Ltd.
    November 02, 2015   doi: 10.1002/hpm.2321   open full text
  • Towards a non‐ethics‐based consensual public policy on abortion.
    David Alvargonzález.
    The International Journal of Health Planning and Management. November 02, 2015
    The absence of agreement on the ethical legitimacy of abortion does not entail the impossibility of finding a consensus on the best policy on abortion. This consensus is affordable because nobody doubts that, regarding the methods of birth control, contraception is better than abortion, abortion is better than infanticide and abortion is worse the later and the less safe it is performed. Because the complete elimination of abortion is not possible, the most relevant realistic political objectives that can be proposed are reducing the abortion rate, reducing the gestational age of abortions and making the remaining abortions safer. Restrictive policies do not contribute to lowering the abortion rate while are associated with unsafe abortions and higher women's morbidity and mortality. Copyright © 2015 John Wiley & Sons, Ltd.
    November 02, 2015   doi: 10.1002/hpm.2320   open full text
  • Effect of TV and radio family planning messages on the probability of modern contraception utilization in post‐Soviet Central Asia.
    Nazim Habibov, Hakim Zainiddinov.
    The International Journal of Health Planning and Management. October 21, 2015
    This study evaluates the effects of family planning message broadcast on radio and TV on the probability of modern contraception utilization in post‐Soviet Central Asia. Viewing family planning messages on TV improves the chances of using modern contraception for a woman who actually saw the messages by about 11 and 8 per cent in Kyrgyzstan and Tajikistan, respectively. If every woman in Kyrgyzstan and Tajikistan had an opportunity to watch a family planning message on TV, then the likelihood of using modern contraception would have improved by 10 and 7 per cent in Kyrgyzstan and Tajikistan, respectively. By contrast, the effect of hearing family planning messages on radio is not significant in both countries. © 2015 The Authors. International Journal of Health Planning and Management published by John Wiley & Sons, Ltd. Key Messages Viewing family planning messages on TV improves the chances of using modern contraception for a woman who actually saw the messages by about 11 and 8 per cent in Kyrgyzstan and Tajikistan, respectively. If every woman in Kyrgyzstan and Tajikistan had an opportunity to watch a family planning message on TV, then the probability of using modern contraception would have improved by 10 and 7 per cent in Kyrgyzstan and Tajikistan, respectively. Consequently, using TV family planning messages in both countries should be encouraged. In comparison, the effect of hearing family planning messages on radio is not significant in both countries.
    October 21, 2015   doi: 10.1002/hpm.2318   open full text
  • Health information systems and disability in the Lao PDR: a qualitative study.
    Jo Durham, Vanphanom Sychareun, Anna Rodney, Hebe N. Gouda, Nicola Richards, Rasika Rampatige, Maxine Whittaker.
    The International Journal of Health Planning and Management. October 21, 2015
    The Convention on the Rights of Persons with Disabilities provides an opportunity to strengthen disability‐related health information. This study analysed the health information system in Lao PDR and sought evidence of interventions to improve disability‐related health information. The study was based on a literature review and key informant interviews (N = 17) informed by the Health Metrics Network's Framework and Standards and the Performance of Routine Information System Management framework. The Lao health information system is in an embryonic stage with health data often incomplete, inaccurate and poorly used. Indicators related to disability or functioning are not included, and capacity to diagnose the health condition of disability is limited. No studies of health information interventions were found. As a State Party to the CRPD, the Lao PDR has a legal obligation to collect health‐related information on people with disabilities. Given the nascent stage of development of the health information system in the Lao PDR and diagnostic capacity, indicators related to basic functioning and access to services should be integrated into household level surveys. As the health information system further develops, small, incremental changes in the type of disability information and rehabilitation and the way it is collected can be implemented. Copyright © 2015 John Wiley & Sons, Ltd.
    October 21, 2015   doi: 10.1002/hpm.2319   open full text
  • Developing hospital accreditation standards in Uganda.
    Moses Galukande, Achilles Katamba, Noeline Nakasujja, Rhona Baingana, Moses Bateganya, Amy Hagopian, Paula Tavrow, Scott Barnhart, Sam Luboga.
    The International Journal of Health Planning and Management. October 06, 2015
    Background Whereas accreditation is widely used as a tool to improve quality of healthcare in the developed world, it is a concept not well adapted in most developing countries for a host of reasons, including insufficient incentives, insufficient training and a shortage of human and material resources. The purpose of this paper is to describe refining use and outcomes of a self‐assessment hospital accreditation tool developed for a resource‐limited context. Methods We invited 60 stakeholders to review a set of standards (from which a self‐assessment tool was developed), and subsequently refined them to include 485 standards in 7 domains. We then invited 60 hospitals to test them. A study team traveled to each of the 40 hospitals that agreed to participate providing training and debrief the self‐assessment. The study was completed in 8 weeks. Results Hospital self‐assessments revealed hospitals were remarkably open to frank rating of their performance and willing to rank all 485 measures. Good performance was measured in outreach programs, availability of some types of equipment and running water, 24‐h staff calls systems, clinical guidelines and waste segregation. Poor performance was measured in care for the vulnerable, staff living quarters, physician performance reviews, patient satisfaction surveys and sterilizing equipment. Conclusion We have demonstrated the feasibility of a self‐assessment approach to hospital standards in low‐income country setting. This low‐cost approach may be used as a good precursor to establishing a national accreditation body, as indicated by the Ministry's efforts to take the next steps. Copyright © 2015 John Wiley & Sons, Ltd.
    October 06, 2015   doi: 10.1002/hpm.2317   open full text
  • Is globalization really good for public health?
    Arno Tausch.
    The International Journal of Health Planning and Management. September 22, 2015
    Objectives In the light of recent very prominent studies, especially that of Mukherjee and Krieckhaus (), one should be initially tempted to assume that nowadays globalization is a driver of a good public health performance in the entire world system. Most of these studies use time series analyses based on the KOF Index of Globalization. We attempt to re‐analyze the entire question, using a variety of methodological approaches and data. Our re‐analysis shows that neoliberal globalization has resulted in very important implosions of public health development in various regions of the world and in increasing inequality in the countries of the world system, which in turn negatively affect health performance. Design We use standard ibm/spss ordinary least squares (OLS) regressions, time series and cross‐correlation analyses based on aggregate, freely available data. Main outcomes Different components of the KOF Index, most notably actual capital inflows, affect public health negatively. The “decomposition” of the available data suggests that for most of the time period of the last four decades, globalization inflows even implied an aggregate deterioration of public health, quite in line with globalization critical studies. We introduce the effects of inequality on public health, widely debated in global public health research. Our annual time series for 99 countries show that globalization indeed leads to increased inequality, and this, in turn, leads to a deteriorating public health performance. In only 19 of the surveyed 99 nations with complete data (i.e., 19.1%), globalization actually preceded an improvement in the public health performance. Far from falsifying globalization critical research, our analyses show the basic weaknesses of the new “pro‐globalization” literature in the public health profession. Copyright © 2015 John Wiley & Sons, Ltd.
    September 22, 2015   doi: 10.1002/hpm.2315   open full text
  • The unannounced patient in the corridor: trust, friction and person‐centered care.
    Eric D. Carlström, Elisabeth Hansson Olofsson, Lars‐Eric Olsson, Jan Nyman, Inga‐Lill Koinberg.
    The International Journal of Health Planning and Management. September 14, 2015
    In this study, a Swedish cancer clinic was studied where three to four unscheduled patients sought support from the hospital on a daily basis for pain and nutrition problems. The clinic was neither staffed nor had a budget to handle such return visits. In order to offer the patients a better service and decrease the workload of the staff in addition to their everyday activities, a multidisciplinary team was established to address the unscheduled return visits. The team was supposed to involve the patient, build trust, decrease the friction, and contribute to a successful rehabilitation process. Data were collected from the patients and the staff. Patients who encountered the team (intervention) and patients who encountered the regular ad hoc type of organization (control) answered a questionnaire measuring trust and friction. Nurses in the control group spent 35% of their full‐time employment, and the intervention group staffed with nurses spent 30% of their full‐time employment in addressing the needs of these return patients. The patients perceived that trust between them and the staff was high. In summary, it was measured as being 4.48 [standard deviation (SD) = 0.82] in the intervention group and 4.41 (SD = 0.79) in the control group using the 5‐point Likert scale. The data indicate that using a multidisciplinary team is a promising way to handle the problems of unannounced visits from patients. Having a team made it cost effective for the clinic and provided a better service than the traditional ad hoc organization. Copyright © 2015 John Wiley & Sons, Ltd.
    September 14, 2015   doi: 10.1002/hpm.2313   open full text
  • Determinants of physician's office visits and potential effects of co‐payments: evidence from Austria.
    Philipp Hafner, Jörg C. Mahlich.
    The International Journal of Health Planning and Management. September 11, 2015
    Objective The objective of this study is to analyse determinants of physician office visits and potential effects of co‐payments in Austria. Methods Based on survey data, the number of annual physician office visits is regressed on a set of explanatory variable such as income, communication behaviour in waiting room, travel time, gender, age, presence of chronic diseases and connectedness to family members. It was then examined how those determinants are affected by hypothetical co‐payments in the range of €5 to €200. Results Our results suggest a negative impact of income and family connectedness on doctor's visits. On the other hand, age, morbidity and active communication behaviour in the waiting room are positively associated with office visits. The significant impact of both income and active communication behaviour on the number of doctor's visits disappears when significant co‐payments greater than €50 are introduced. Conclusions Higher co‐payments would reduce healthcare service utilization in Austria mainly because of a demand reduction of poorer patients. Another key finding of our study is that the desire to chat with peers in the waiting room is another significant driver of physician office visits. Copyright © 2015 John Wiley & Sons, Ltd.
    September 11, 2015   doi: 10.1002/hpm.2316   open full text
  • Is the introduction of an accreditation program likely to generate organization‐wide quality, change and learning?
    Gilles Lanteigne, Chantal Bouchard.
    The International Journal of Health Planning and Management. September 11, 2015
    Objective This research assesses whether integration of Accreditation Canada's program brings about change and organizational learning. Methods Two health organizations, the Health Authority of Anguilla and the Ca' Foncella Opetale di Treviso, are studied on three levels: (1) members; (2) accreditation teams; and (3) organization. The methods used to collect data consisted of individual questionnaires administered to team members, semi‐formal interviews with team leaders and quality coordinators, a documentation review and periodic assessments of compliance with the standards. Results The findings indicate that the organizations made strategic, organizational and relational changes. They improved their systems and management practices as well as their internal and external communications. There was also useful learning by individuals, teams and the organizations. Individual learning involved quality practice, client‐focused approach, risk management, ethics, participatory management and assessment of services. The “self‐assessment” and “make improvements and follow up on recommendations” stages of the accreditation cycle contributed the most to change and organizational learning. The interdisciplinary accreditation teams were the preferred vehicle for achieving these changes and this learning. Conclusions The Health Authority of Anguilla and Ca' Foncella Opetale di Treviso have gradually improved their level of compliance with the standards in all quality dimensions. However, improvement in the overall compliance level was below the program's minimum requirements to obtain accreditation status without major restrictions. The scope of the changes and learning achieved raises the issue of the capacity of organizations to formalize this new knowledge throughout the organization. Copyright © 2015 John Wiley & Sons, Ltd.
    September 11, 2015   doi: 10.1002/hpm.2314   open full text
  • Impact of patients' healthcare payment methods on hospital discharge process: evidence from India.
    Brendan Drew, Federica Angeli, Karan Dave, Milena Pavlova.
    The International Journal of Health Planning and Management. September 09, 2015
    This study investigates the impact of patients' payment methods on hospitals' discharge process. Patients' payment methods, particularly the use of third‐party payers, are documented to impact hospitals' behavior. However, evidence is still missing on how differences across payment categories affect hospital discharge, a complicated and poorly standardized process. Data are derived from a single case study carried out in 2014 at the Mazumdar Shaw Medical Center at the Narayana Health City Campus in Bangalore, India. A mixed‐method approach has been adopted. First, process mapping for different payment categories was conducted using unstructured interviews with staff and on‐the‐floor observations. Second, linear regression analysis was applied on a sample of 1000 discharges that occurred in January 2014 to investigate the impact of patients' payment categories on discharge turnaround time. The qualitative evidence highlights substantial variation in the discharge process across payment categories. Regression analyses reveal that the sequential process used to discharge community health insurance patients results in a significantly shorter discharge turnaround time and that cash‐paying patients do not experience any significantly shorter discharge duration. For hospital managers, this study provides important evidence that patient utilization of a third‐party payer does not hamper hospital efficiency. This finding should also encourage policy makers and third‐party payers to work towards expanding the medical insurance system, particularly in India and particularly community‐based schemes. At the same time, our findings document a strong fragmentation of discharge processes, which should spur hospitals and third‐party payers to cooperate in order to set standards and minimize disruptions to patient flows. Copyright © 2015 John Wiley & Sons, Ltd.
    September 09, 2015   doi: 10.1002/hpm.2310   open full text
  • When community reintegration is not the best option: interethnic violence and the trauma of parental loss in South Sudan.
    Brigitte Muller, Barry Munslow, Tim O'Dempsey.
    The International Journal of Health Planning and Management. August 26, 2015
    The magnitude of violence and human loss in conflict settings often exceeds the caring capacity of traditional support systems for orphans. The aim of this study is to understand the developmental context for children experiencing armed conflict, parental loss, extreme poverty, violence and social exclusion in a setting affected by interethnic violence. This article challenges the received wisdom that community reintegration is always better than institutional provision. Using a case study employing interviews, focus groups, workshops and observations, we examined how children's experiences of armed violence and parental loss affected their mental well‐being, and their relationships within their community. Emerging findings such as experienced violence and psychological distress were further investigated using a cross‐sectional survey design to explore the generalisability or transferability of theories or conclusions drawn from qualitative data. Findings showed that parental loss had a major impact on children's lives in the context of armed violence. Four main outcomes of orphanhood emerged: (i) facing the situation and evading harm (feelings of rejection and stigmatisation); (ii) trauma exposure and mental health effects (associations of orphanhood with adverse mental health outcomes and the number and type of experienced trauma); (iii) dealing with psychological distress (seeking caring connections and decreased feelings of isolation); and (iv) education and acceptance (increasing knowledge, skills and attitude and being respected in their community). We discuss the role that contexts such as armed violence, parental loss and social exclusion play for children's mental well‐being and their implications for psychosocial interventions and orphan care in humanitarian settings. Copyright © 2015 John Wiley & Sons, Ltd.
    August 26, 2015   doi: 10.1002/hpm.2311   open full text
  • NRCMS capitation reform and effect evaluation in Pudong New Area of Shanghai.
    Limei Jing, Jie Bai, Xiaoming Sun, David Zakus, Jiquan Lou, Ming Li, Qunfang Zhang, Yuehong Zhuang.
    The International Journal of Health Planning and Management. August 18, 2015
    The Rural Cooperative Medical Scheme (RCMS) had played an important role in guaranteeing the acquisition of basic medical healthcare of China's rural populations, being an innovative model of the medical insurance system for so many years here in China. Following the boom and bust of RCMS, the central government rebuilt the New Rural Cooperative Medical Scheme (NRCMS) in 2003 across the whole country. Shanghai, one of the developed cities in China, has developed its RCMS and NRCMS as an advanced and exemplary representative of Chinese rural health insurance. But in the past 10 years, its NRCMS has encountered such challenges as a spiral of medical expenditures and a decrease of insurance participants. Previous investigations showed that the capitation and general practitioner (GP) system had great effect on medical cost containment. Thus, the capitation reform combined with GP system reform of NRCMS, based on a system design, was implemented in Pudong New Area of Shanghai as of 1 August 2012. The aim of the current investigation was to present how the reform was designed and implemented, evaluating its effect by analyzing the data acquired from 12 months before and after the reform. This was an empirical study; we made a conceptual design of the reform to be implemented in Pudong New Area. Most data were derived from the institution‐based surveys and supplemented by a questionnaire survey, qualitative interviews and policy document analysis. We found that most respondents held an optimistic attitude towards the reform. We employed a structure–process–outcome evaluation index system to evaluate the effect of the reform, finding that the growth rate of the insured population's total medical costs and NRCMS funds slowed down significantly after the reform; that the total medical expenditure of the insured rural population decreased by 3.60%; and that the total expenditure of NRCMS decreased by 3.99%. The capitation was found to help the medical staff build active cost control consciousness. Approximately 2.3% of the outpatients flowed to the primary hospitals from the secondary hospitals; and farmers' annual medical burden was relieved to a certain degree. Meanwhile, it did not affect farmers' utilization and benefits of healthcare. However, further reform still faces new challenges: The capitation reform should be well combined with the primary healthcare system to realize the “dual gatekeeper” of GPs; a variety of payment methods should be mixed on the basis of capitation to avoid possible mistakes by one single approach; and the supervision of medical institutions should be strengthened. A long‐term follow‐up study need to be carried out to evaluate the effects of the capitation reform so as to improve the design of the program. Copyright © 2015 John Wiley & Sons, Ltd.
    August 18, 2015   doi: 10.1002/hpm.2302   open full text
  • The changing role of health‐oriented international organizations and nongovernmental organizations.
    Kieke G.H. Okma, Adrian Kay, Shelby Hockenberry, Joanne Liu, Susan Watkins.
    The International Journal of Health Planning and Management. August 03, 2015
    Apart from governments, there are many other actors active in the health policy arena, including a wide array of international organizations (IOs), public‐private partnerships and non‐governmental organizations (NGOs) that state as their main mission to improve the health of (low‐income) populations of low‐income countries. Despite the steady rise in numbers and prominence of NGOs, however, there is lack of empirical knowledge about their functioning in the international policy arena, and most studies focus on the larger organizations. This has also caused a somewhat narrow focus of theoretical studies. Some scholars applied the ‘principal‐agent’ theory to study the origins of IOs, for example, other focus on changing power relations. Most of those studies implicitly assume that IOs, public‐private partnerships and large NGOs act as unified and rational actors, ignoring internal fragmentation and external pressure to change directions. We assert that the classic analytical instruments for understanding the shaping and outcome of public policy: ideas, interests and institutions apply well to the study of IOs. As we will show, changing ideas about the proper role of state and non‐state actors, changing positions and activities of major stakeholders in the (international) health policy arena, and shifts in political institutions that channel the voice of diverging interests resulted in (and reflected) the changing positions of the health‐oriented organizations‐and also affect their future outlook. Copyright © 2015 John Wiley & Sons, Ltd.
    August 03, 2015   doi: 10.1002/hpm.2298   open full text
  • An alternative way of understanding exit, voice and loyalty: the case of informal payments for health care in Israel.
    Nissim Cohen, Dani Filc.
    The International Journal of Health Planning and Management. July 31, 2015
    This study examines Hirschman's model of exit, voice and loyalty with regard to informal payments in the Israeli healthcare system. Based on a national survey, we investigate the extent of “black” payments, its characteristics and its correlated factors. We find that informal payments do exist in Israel—although it seems that there has been a decline in the phenomenon. Contrary to the literature, we find no relationship between the option of voice or dissatisfaction with healthcare services and informal payments. However, we do find a negative correlation between trust and the use of such payments. This finding is consistent with Hirschman's insight that a lack of loyalty may lead people to strategies of exit. We suggest that given the fact that health care in Israel is a public service, the exit option may actually be a quasi‐exit behavior. Copyright © 2015 John Wiley & Sons, Ltd.
    July 31, 2015   doi: 10.1002/hpm.2309   open full text
  • The consumers' social media use in choosing physicians and hospitals: the case study of the province of Izmir.
    Dilaver Tengilimoglu, Nilgün Sarp, Cemre Eda Yar, Meral Bektaş, Mehmet Nil Hidir, Esin Korkmaz.
    The International Journal of Health Planning and Management. July 22, 2015
    Manifested as a reflection of the Internet technology progress, web 2.0 has transformed communication among people to different dimensions while increasing the social use of Internet. Thus, the concept of social media has entered our lives. Blogs, forums, Facebook, Twitter and YouTube applications are but few of the social media platforms with active users exceeding millions. As in many other subjects, these and others are also environments where people share information and their positive or negative experiential views with respect to healthcare issues and services. Hence, the social media communication and exchange of information are deemed influential on the process of receiving health services. In the present study that aims to determine social media use of individuals in their choice of physicians, dentists and hospitals, a survey, as a data collection instrument, has been carried out to 947 residents of the province of Izmir. Individuals participating in the study have stated that they have used social media in choosing a physician (41.9% of the participants), dentist (34.1% of the participants) and hospitals (41.7% of the participants). The study has revealed that individuals are affected by social media in their healthcare choices. Copyright © 2015 John Wiley & Sons, Ltd.
    July 22, 2015   doi: 10.1002/hpm.2296   open full text
  • Catalyzing the scale‐up of community‐based primary healthcare in a rural impoverished region of northern Ghana.
    John Koku Awoonor‐Williams, James F. Phillips, Ayaga A. Bawah.
    The International Journal of Health Planning and Management. July 19, 2015
    Ghana's Community‐based Health Planning and Services (CHPS) initiative develops accessible healthcare with participatory community support, using strategies developed and tested by a project of the Navrongo Health Research Centre. In 1996, the project was expanded to a district‐wide four‐celled trial. In response to evidence that strategies could reduce fertility and childhood mortality, a replication project was launched to develop methods for scale‐up. Based on experience gained, CHPS scale‐up was launched in 2000. Although CHPS now reaches all of Ghana's districts, the pace of scale‐up within districts has been slow. In response, the Ministry of Health conducted a review of factors that constrain CHPS scale‐up and problems that detract from its original evidence‐based design. To resolve problems that were identified, a project was launched in 2010 to test means of accelerating CHPS scale‐up and expand its range of care. Known as the Ghana Essential Health Interventions Program (GEHIP), the project provided catalytic revenue to four treatment district managers for 3 years, in conjunction with implementation of strategies for comprehensive leadership development and community partnership. Monitoring systems were developed to gauge CHPS coverage time trends in all nine study districts. GEHIP successfully accelerated CHPS implementation, producing 100% of its targeted community coverage within 5 years of implementation. Coverage in comparison districts also improved. However, the rate of coverage and per cent of the population reached by CHPS in comparison districts was only half that of GEHIP districts. GEHIP success in completing CHPS coverage represents the initial stage of a national program for strengthening community health systems in Ghana. Copyright © 2015 John Wiley & Sons, Ltd.
    July 19, 2015   doi: 10.1002/hpm.2304   open full text
  • Singapore's regional health systems—a data‐driven perspective on frequent admitters and cross utilization of healthcare services in three systems.
    Nakul Saxena, Alex Xiaobin You, Zhecheng Zhu, Yan Sun, Pradeep Paul George, Kiok Liang Teow, Phui‐Nah Chong, Joe Sim, John Eu Li Wong, Benjamin Ong, Hee Jug Foo, Eugene Fidelis Soh, Linus Tham, Bee Hoon Heng, Philip Choo.
    The International Journal of Health Planning and Management. June 29, 2015
    Introduction With population health management being a priority in the Singapore, this paper aims to provide a data‐driven perspective of the population health management initiatives to aid program planning and serves as a baseline for evaluation of future implemented programs. Methods A database with information on patient demographics, health services utilization, cost, diagnoses and chronic disease information from 2008 to 2013 for three regional health systems in Singapore was used for analysis. Patients with three or more inpatient admissions were considered as “Frequent Admitters.” Health service utilization was quantified, and cross utilization of services was studied. One‐year readmission rate for inpatients was studied, and a predictive model for readmission or death was developed. Results There were a total of 2.8 M patients in the database. Frequent admitters accounted for 0.9% of all patients with an average cost per patient of S$29 547. Of these, 89% had chronic diseases. Cross utilization of health services showed that 8.2% of the patients utilized services from more than one hospital with 19.6% utilizing hospital and polyclinic services in 2013. The highest risk of readmission or death was for those patients who had five or more inpatient episodes in each of the preceding 2 years. Conclusion By understanding the profile of the patients and their utilization patterns in the three regional health systems, our study will help clinicians and decision makers design appropriate integrated care programs for patients with the aim of covering the healthcare needs for the enitre population across the healthcare spectrum in Singapore. Copyright © 2015 John Wiley & Sons, Ltd.
    June 29, 2015   doi: 10.1002/hpm.2300   open full text
  • Can performance‐based financing help reaching the poor with maternal and child health services? The experience of rural Rwanda.
    Laurence Lannes, Bruno Meessen, Agnes Soucat, Paulin Basinga.
    The International Journal of Health Planning and Management. June 29, 2015
    More than 20 countries in Africa are scaling up performance‐based financing (PBF), but its impact on equity in access to health services remains to be documented. This paper draws on evidence from Rwanda to examine the capacity of PBF to ensure equal access to key health interventions especially in rural areas where most of the poor live. Specifically, it focuses on maternal and child health services, distinguishing two wealth groups, and uses data from a rigorous impact evaluation. Difference‐in‐difference technique is used, and different model specifications are tested: control for unobserved heterogeneity and common random error using linear probability model, seemingly unrelated regression equations, and clustering and fixed effects. Results suggest that in Rwanda, PBF improved efficiency rather than equity for most health services. We find that PBF achieved efficiency gains by improving access to health services for those easier to reach, generally the relatively more affluent. It turns out to be less effective in reaching the poorest. Our results illustrate the advantages of rigorous randomized impact evaluation data as results published earlier using a nationally representative survey (Demographic and Health Survey) were not able to capture the pro‐rich nature of the PBF scheme in Rwanda. Our paper advocates for building mechanisms targeting the vulnerable groups in PBF strategies. It also highlights the need to understand the impact of PBF together with the specific development of health insurance coverage and the organization of the health system.
    June 29, 2015   doi: 10.1002/hpm.2297   open full text
  • Integrated care in action: opening the “black box” of implementation.
    Federica Segato, Cristina Masella.
    The International Journal of Health Planning and Management. June 29, 2015
    The aim of this contribution is to explain how healthcare professionals implement policies for integrated care. More specifically, we aim to understand how these policies are received, interpreted and executed by primary care professionals. By opening the “black box” of policy implementation, we also explain how and why the process of implementation of the same policy diverges in practice. The research is framed according to both the neo‐institutional and the change management perspectives. The empirical investigation is conducted through a documental analysis and a multiple‐embedded case study. The results show that three forces affect and explain differences in the implementation processes: the unstable level of internal communication among the professionals involved, the limited use of power to resist to change and the poor learning process on the part of both the professionals and policy makers. The pressure of external institutions does not play a role in shaping the process. Through our study, we further knowledge about how healthcare professionals implement policies for integrated care, and we believe this is interesting, according to emerging evidence that variations in the effectiveness of policy outcomes may be explained by choices and potential distortions made during the initial stages of the policy implementation process. Copyright © 2015 John Wiley & Sons, Ltd. StartCopTextCopyright © 2015 John Wiley & Sons, Ltd.
    June 29, 2015   doi: 10.1002/hpm.2306   open full text
  • Corruption costs lives: a cross‐country study using an IV approach.
    Mon‐Chi Lio, Ming‐Hsuan Lee.
    The International Journal of Health Planning and Management. June 29, 2015
    This study quantitatively estimates the effects of corruption on five major health indicators by using recent cross‐country panel data covering 119 countries for the period of 2005–2011. The corruption indicators provided by the World Bank and Transparency International are used, and both the two‐way fixed effect and the two‐stage least squares approaches are employed for our estimation. The estimation results show that, in general, corruption is negatively associated with a country's health outcomes. A lower level of corruption or a better control of corruption in a country can lead to longer life expectancy, a lower infant mortality rate and a lower under‐five mortality rate for citizens. However, our estimation finds no significant association between corruption and individual diseases including human immunodeficiency virus prevalence and tuberculosis incidence. The findings suggest that corruption reduction itself is an effective method to promote health. Copyright © 2015 John Wiley & Sons, Ltd.
    June 29, 2015   doi: 10.1002/hpm.2305   open full text
  • Community participation in the decentralised district health systems in Tanzania: why do some health committees perform better than others?
    Stephen Oswald Maluka, Godfrey Bukagile.
    The International Journal of Health Planning and Management. June 05, 2015
    Over the past two decades, community participation has emerged as an important dimension within decentralised district healthcare systems. In Tanzania, initiatives to strengthen community participation have focused on the formation of the health committees. Studies have reported variations in the performance of the committees. An exploratory case study design focusing on two districts was adopted to explore the differences in practice of the health facility committees in a well‐functioning district and one that is not. In both study districts, the committees were in place. The most common activities of the health committees were assisting the clinic in day‐to‐day running. The health committees' influence on policy, planning and budgeting was limited. Managerial and leadership practices of the district health managers, including effective supervision and personal initiatives of the top‐district health officials coupled with incentives, are the major factors for the good performance of the health facility committees and the boards. Inadequate training and low public awareness affected the performance of the committees. A greater role in governance and oversight is essential for effective and meaningful health committees. To achieve impact, health committees will require adequate training on the following: roles and functions of the health facility committees and the boards; interaction between the committees and the communities and the health workers; development of health plans and budgets at the local and district level; and monitoring and tracking. Copyright © 2015 John Wiley & Sons, Ltd.
    June 05, 2015   doi: 10.1002/hpm.2299   open full text
  • A hybrid health service accreditation program model incorporating mandated standards and continuous improvement: interview study of multiple stakeholders in Australian health care.
    David Greenfield, Reece Hinchcliff, Anne Hogden, Virginia Mumford, Deborah Debono, Marjorie Pawsey, Johanna Westbrook, Jeffrey Braithwaite.
    The International Journal of Health Planning and Management. June 05, 2015
    The study aim was to investigate the understandings and concerns of stakeholders regarding the evolution of health service accreditation programs in Australia. Stakeholder representatives from programs in the primary, acute and aged care sectors participated in semi‐structured interviews. Across 2011–12 there were 47 group and individual interviews involving 258 participants. Interviews lasted, on average, 1 h, and were digitally recorded and transcribed. Transcriptions were analysed using textual referencing software. Four significant issues were considered to have directed the evolution of accreditation programs: altering underlying program philosophies; shifting of program content focus and details; different surveying expectations and experiences and the influence of external contextual factors upon accreditation programs. Three accreditation program models were noted by participants: regulatory compliance; continuous quality improvement and a hybrid model, incorporating elements of these two. Respondents noted the compatibility or incommensurability of the first two models. Participation in a program was reportedly experienced as ranging on a survey continuum from “malicious compliance” to “performance audits” to “quality improvement journeys”. Wider contextual factors, in particular, political and community expectations, and associated media reporting, were considered significant influences on the operation and evolution of programs. A hybrid accreditation model was noted to have evolved. The hybrid model promotes minimum standards and continuous quality improvement, through examining the structure and processes of organisations and the outcomes of care. The hybrid model appears to be directing organisational and professional attention to enhance their safety cultures. Copyright © 2015 John Wiley & Sons, Ltd.
    June 05, 2015   doi: 10.1002/hpm.2301   open full text
  • How to attract health students to remote areas in Indonesia: a discrete choice experiment.
    Ferry Efendi, Ching‐Min Chen, Nursalam Nursalam, Nurul Wachyu Fitriyah Andriyani, Anna Kurniati, Susan Alison Nancarrow.
    The International Journal of Health Planning and Management. May 25, 2015
    Background Remote areas of Indonesia lack sufficient health workers to meet the health‐care needs of the population. There is an urgent need for evidence regarding interventions to attract health workers and specifically health students to serve in remote areas. The aim of this research was to analyze the job preferences of health students to develop effective policies to improve the recruitment and retention of health students in remote areas. Methods A discrete choice experiment was conducted to investigate health students' preferences regarding job characteristics. This study was conducted in three different regions of Indonesia, with a total included 400 health students. Mixed logit models were used to explore the stated preferences for each attribute. Results Data were collected from 150 medical, 150 nursing and 100 midwifery students. Medical students gave the highest preference for receiving study assistance, while nursing students viewed salary as the most important. Midwifery students valued advanced quality facilities as an important attribute. Conclusions This study confirmed the importance of combination interventions in attracting and retaining health workers in remote areas of Indonesia. Money is not the only factor affecting student preferences to take up a rural post; good management and better facilities were viewed as important by all health students. Addressing health student preferences, which are the candidate of future health workforce, would help the nation solve the recruitment and retention issues. Copyright © 2015 John Wiley & Sons, Ltd.
    May 25, 2015   doi: 10.1002/hpm.2289   open full text
  • An assessment of fiscal space for health in Bhutan.
    Jayendra Sharma.
    The International Journal of Health Planning and Management. May 18, 2015
    Several factors are expected to put a strain on health financing in Bhutan. In a predominantly public‐financed healthcare, ensuring that the health system gains sufficient fiscal space to ensure the sustainability of its financing is a critical policy concern. This fiscal space assessment bases its analysis on national surveys and statistics, international databases and review of official documents and reports. Assuming that the government health spending will continue to respond in the same way to growth as in the period 2002–2012, Bhutan can expect to see a robust increase in government investments in health. If elasticity of health expenditure with respect to GDP does not change significantly, projections indicate that per‐capita government spending for health could more than double in the period 2012 to 2019. This increase from Ngultrum 2632 in 2012 to Ngultrum 6724 in 2019 could correspond to government health spending from 2.65% of GDP to 3.98% of GDP in the respective years. The country, however, needs to closely monitor and ensure that government investment in healthcare keeps pace with the growth of the national economy. Along with this, supplementary resources for healthcare could be explored through earmarked taxes and by generating efficiency gains. Copyright © 2015 John Wiley & Sons, Ltd.
    May 18, 2015   doi: 10.1002/hpm.2295   open full text
  • Saving for delivery through technology: an inquiry into an electronic commitment savings product for maternal healthcare in Kenya.
    Thierry Bastelaer, Benjamin Woodman, Minki Chatterji, David Long.
    The International Journal of Health Planning and Management. April 28, 2015
    Many women in low‐income countries cannot afford maternal healthcare services. Changamka, a Kenyan company, developed an electronic, stored‐value card to help pregnant women save for maternal healthcare at a Nairobi hospital. This paper reports results from a mixed‐methods process evaluation of the card's implementation. The study found high levels of uptake and identified several benefits of the program, such as facilitating payment for services. The evaluation also identified several challenges. Most users completed only one transaction before discontinuing card use; only 6% of women who acquired the card used it to pay for delivery, and slightly less than 1% used it as it was originally intended—to pay for several antenatal care visits and for delivery. According to respondents, the main reason for this discontinuation was a lack of understanding about how to use the card. Users were, on average, of a higher socioeconomic and educational status than non‐card users. Most users obtained the card in their third trimester, and among those who used the card to save for delivery, most started to do so too late in pregnancy to accumulate sufficient savings to pay for that service. Copyright © 2015 John Wiley & Sons, Ltd.
    April 28, 2015   doi: 10.1002/hpm.2292   open full text
  • Addressing health system barriers to access to and use of skilled delivery services: perspectives from Ghana.
    John Kuumuori Ganle, Raymond Fitzpatrick, Easmon Otupiri, Michael Parker.
    The International Journal of Health Planning and Management. March 30, 2015
    Poor access to and use of skilled delivery services have been identified as a major contributory factor to poor maternal and newborn health in sub‐Saharan African countries, including Ghana. However, many previous studies that examine norms of childbirth and care‐seeking behaviours have focused on identifying the norms of non‐use of services, rather than factors, that can promote service use. Based on primary qualitative research with a total of 185 expectant and lactating mothers, and 20 healthcare providers in six communities in Ghana, this paper reports on strategies that can be used to overcome health system barriers to the use of skilled delivery services. The strategies identified include expansion and redistribution of existing maternal health resources and infrastructure, training of more skilled maternity caregivers, instituting special programmes to target women most in need, improving the quality of maternity care services provided, improving doctor–patient relationships in maternity wards, promotion of choice, protecting privacy and patient dignity in maternity wards and building partnerships with traditional birth attendants and other non‐state actors. The findings suggest the need for structural changes to maternity clinics and routine nursing practices, including an emphasis on those doctor–patient relational practices that positively influence women's healthcare‐seeking behaviours. Copyright © 2015 John Wiley & Sons, Ltd.
    March 30, 2015   doi: 10.1002/hpm.2291   open full text
  • Health sector operational planning and budgeting processes in Kenya—“never the twain shall meet”.
    Benjamin Tsofa, Sassy Molyneux, Catherine Goodman.
    The International Journal of Health Planning and Management. March 18, 2015
    Operational planning is considered an important tool for translating government policies and strategic objectives into day‐to‐day management activities. However, developing countries suffer from persistent misalignment between policy, planning and budgeting. The Medium Term Expenditure Framework (MTEF) was introduced to address this misalignment. Kenya adopted the MTEF in the early 2000s, and in 2005, the Ministry of Health adopted the Annual Operational Plan process to adapt the MTEF to the health sector. This study assessed the degree to which the health sector Annual Operational Plan process in Kenya has achieved alignment between planning and budgeting at the national level, using document reviews, participant observation and key informant interviews. We found that the Kenyan health sector was far from achieving planning and budgeting alignment. Several factors contributed to this problem including weak Ministry of Health stewardship and institutionalized separation between planning and budgeting processes; a rapidly changing planning and budgeting environment; lack of reliable data to inform target setting and poor participation by key stakeholders in the process including a top‐down approach to target setting. We conclude that alignment is unlikely to be achieved without consideration of the specific institutional contexts and the power relationships between stakeholders. In particular, there is a need for institutional integration of the planning and budgeting processes into a common cycle and framework with common reporting lines and for improved data and local‐level input to inform appropriate and realistic target setting. © 2015 The Authors. International Journal of Health Planning and Management published by John Wiley & Sons, Ltd.
    March 18, 2015   doi: 10.1002/hpm.2286   open full text
  • Acceptability of programme budgeting and marginal analysis as a tool for routine priority setting in Indigenous health.
    Michael E. Otim, Augustine D. Asante, Margaret Kelaher, Ian P. Anderson, Stephen Jan.
    The International Journal of Health Planning and Management. March 11, 2015
    Objective This study aimed to examine the acceptability of programme budgeting and marginal analysis (PBMA) as a tool for priority setting in the Indigenous health sector. Methods The study uses a mix of quantitative and qualitative methods. A survey of key decision makers in Indigenous health in Victoria was conducted to assess the acceptability of PBMA as a potential tool for priority setting. Respondents comprised 24 bureaucrats from the Victorian Department of Human Services (DHS) and 26 senior executives from the aboriginal community controlled health sector (ACCHS) in Victoria. The survey instrument included both closed‐ended and open‐ended questions and was administered face‐to‐face by a trained researcher in 2007–2008. Closed‐ended questions were analysed using descriptive statistics, and content analysis was used for the open‐ended ones. Results The PBMA was well received as having the potential to improve priority setting processes in Indigenous health. Sixty‐nine percent of the DHS respondents felt that PBMA was acceptable as a routine decision‐making tool, and nearly 80% of ACCHS respondents thought that PBMA was intuitively appealing and would most probably be an acceptable priority setting approach in their organisations. The challenges of using PBMA were related to resource constraints and data intensity. Conclusion Programme budgeting and marginal analysis is potentially acceptable within the ACCHS and was perceived as useful in terms of assisting the decision maker to maximise health outcomes, but data systems need to be re‐oriented to address its significant data needs. Implication Proper guidelines need to be developed to facilitate PBMA application within the Indigenous‐controlled community health sector. Copyright © 2015 John Wiley & Sons, Ltd.
    March 11, 2015   doi: 10.1002/hpm.2287   open full text
  • Can managers empower nurse‐midwives to improve maternal health care? A comparison of two resource‐poor hospitals in Tanzania.
    Paula Tibandebage, Tausi Kida, Maureen Mackintosh, Joyce Ikingura.
    The International Journal of Health Planning and Management. February 24, 2015
    Maternal mortality is very high in Tanzania. Competent hospital care is key to improving maternal outcomes, but there is a crisis of availability and performance of health workers in maternal care. This article uses interviews with managers, nurse‐midwives, and women who had given birth in two hospitals providing virtually all the emergency maternal care in one Tanzania city. It contrasts women's experience in the two hospitals, and analyses interconnections with nurse‐midwives' and managers' experiences of working conditions. The conceptual literature on nurse empowerment identifies some key explanatory variables for these contrasts. Staff experienced less frustration and constraint in one of the hospitals; had more access to structurally empowering resources; and experienced greater congruence between job commitment and working culture, resulting in better work engagement. Conversely, nurse‐midwives in the other hospital were constrained by supply shortages and recurrent lack of support. Contrasting management styles and their impacts demonstrate that even in severely resource‐constrained environments, there is room for management to empower staff to improve maternal care. Empowering management practices include participatory management, supportive supervision, better incentives, and clear leadership concerning ward culture. Structural constraints beyond the capacity of health facility managers must however also be addressed. © 2015 The Authors. International Journal of Health Planning and Management published by John Wiley & Sons, Ltd.
    February 24, 2015   doi: 10.1002/hpm.2279   open full text
  • Ambulance services as part of the district health system in low‐income countries: a feasibility study from Cambodia.
    Bart Jacobs, Cheanrithy Men, Oeun Sam Sam, Sjoerd Postma.
    The International Journal of Health Planning and Management. February 10, 2015
    Background Emergency referral care is considered an essential component of the district health system. Nevertheless, the establishment of effective and durable transport arrangements of such referral care by use of an ambulance is considered controversial in low‐income countries. Objective We aim to assess the extent to which an ambulance service as part of the district health system is feasible in rural Cambodia. Methods In a rural health district, we assessed the population's perception of the ambulance service, its recurrent costs requirements, government financial contribution to its operations, profile and medical conditions of ambulance (non)users, reasons for (non)use of the ambulance and contextual factors required for the ambulance services to operate. This observation was obtained through nine key informant interviews, five focus group discussions, structured interviews with 225 caretakers of admitted patients, a 1‐month census of admitted emergency cases and assessment of annual recurrent costs for the ambulance services. Results The ambulance services were well received by the population and authorities and appeared to reinforce an appreciation of the hospital. Ambulance services were mainly used by the poor and by women, especially for emergency obstetric care. Less than half the number of transported patients, 44%, was considered a medical emergency. The direct cost to the hospital per collected emergency case was $34.4. Conclusion When certain conditions are met, effective ambulance services can be an integral part of the district health system and positively contribute to the population's appreciation of the hospital services and respective district health system. Copyright © 2015 John Wiley & Sons, Ltd.
    February 10, 2015   doi: 10.1002/hpm.2285   open full text
  • Preparing for the introduction of hospital autonomy in Laos: an assessment of current situation and suggestions for policy‐making.
    Jinsong Geng, Hao Yu, Yingyao Chen.
    The International Journal of Health Planning and Management. February 10, 2015
    The National Assembly of Lao People's Democratic Republic (Laos) approved the Health Sector Reform Strategy in 2012, which called for an assessment as to whether Laos should introduce hospital autonomy, and if so, in which ways. The purpose of this study is to assess the status quo of hospital governance in Laos and propose policy suggestions for hospital autonomy in the country. We formulated an analytic framework for hospital autonomy based on previous work by other researchers, collected qualitative data through key informant interviews and focus group discussions, and also performed secondary data analysis. Public hospitals in Laos enjoyed some informal autonomy with little accountability and Laos is facing key challenges of hospital governance. As a result, introducing hospital autonomy in Laos could bring risks, benefits and debates. Before Laos decides on granting autonomy to its public hospitals, we strongly suggest that the government do pilot in selected public hospitals with well‐regulated governance framework first and conduct rigorous evaluations to examine whether the granted autonomy leads to the intended social goals of equity, quality, efficiency and sustainability. We recommend residual claimants should be monitored by the government and by the society with open and transparent approach, and active measures should be taken to improve performance and ensure social functions. The study findings may also provide some suggestions for low‐ and middle‐income countries, which are contemplating the introduction of hospital autonomy in the public sector. Copyright © 2015 John Wiley & Sons, Ltd.
    February 10, 2015   doi: 10.1002/hpm.2283   open full text
  • The state of collaborative work with nurses in Israel: a mixed method study.
    Sigalit Warshawski.
    The International Journal of Health Planning and Management. February 02, 2015
    Effective collaboration among health professionals is associated with patient safety, quality of care and professionals' satisfaction. Nurse–physician collaboration has been a topic of substantial research worldwide. In Israel, few studies have examined this subject, but none has explored health professionals' collaborative practice with nurses, although nursing in Israel is experiencing significant professional changes. The aim of this study was to explore health professionals' attitudes toward collaboration with nurses and how these attitudes relate to their perceptions of role overlap, role clarity and feeling of threat. Research data were collected employing both quantitative and qualitative methods. A structured questionnaire was fulfilled by 262 participants, following which 12 personal interviews and 12 observations were conducted in hospital wards. Participants' attitudes toward collaboration with nurses were found statistically related to their perception of role overlap, role clarity and feeling of professional threat. Interviews and observations indicated immediate mutual assistance among professionals instead of collaborative practice. Interactions were brief and purposeful. The results highlight the absence of an organized procedure for collaborative practice with nurses. Therefore, it is necessary to act at the organization and departments, to assimilate nurses' role and the importance of collaborative practice. Nurse leaders and nurse educators must consider pragmatic and effective means to promote and articulate nurses' role in inter‐professional clinical settings. Copyright © 2015 John Wiley & Sons, Ltd.
    February 02, 2015   doi: 10.1002/hpm.2281   open full text
  • Power to the people? An international review of the democratizing effects of direct elections to healthcare organizations.
    Ellen A. Stewart, Scott L. Greer, Iain Wilson, Peter D. Donnelly.
    The International Journal of Health Planning and Management. January 26, 2015
    Ensuring that publicly funded health systems are democratically accountable is an enduring challenge in policy and practice. One strategy for enhancing public officials' accountability is to elect members of the public to oversee their performance. Several countries have experimented with direct elections to healthcare organizations. The most directly comparable examples involve some Canadian regional health authorities, New Zealand district health boards, foundation trusts in England and health boards in Scotland. We propose three aspects of the process by which the democratizing effects of elections should be judged: authorization, accountability and influence. Evidence from these countries suggests that the democratization of health systems is a complex task, which cannot be completed simply by introducing elections. Copyright © 2015 John Wiley & Sons, Ltd.
    January 26, 2015   doi: 10.1002/hpm.2282   open full text
  • Public trust in the healthcare system in a developing country.
    Dexnell Peters, Farid F. Youssef.
    The International Journal of Health Planning and Management. December 23, 2014
    Broadly defined, trust in the healthcare system is concerned with how the public perceives the system and the actors therein as it pertains to their ability to both deliver services and seek the best interests of their clientele. Trust is important because it impacts upon a range of health behaviors including compliance and ultimately affects the ability of the healthcare system to meet its goals. While several studies exist on public trust within the developed world, few studies have explored this issue in developing countries. This paper therefore assesses public trust in the healthcare system of a developing small island nation, Trinidad and Tobago. A cross‐sectional survey of adults was conducted using a questionnaire that has been successfully used across Europe. We report that trust levels in the healthcare system in Trinidad and Tobago are relatively low with less than 50% of persons indicating fair trust in the healthcare system. In addition, individual health professionals also did not score highly with lowest scores found for nurses and complementary therapists. Results on four out of five dimensions of trust also demonstrated scores significantly lower than those reported in more developed nations. Open‐ended comments supported these findings with the majority of persons indicating a lack of confidence in the healthcare system. These results may reflect the reality in the wider developing world, and we suggest that bolstering trust is a needed area of focus in the delivery of healthcare services throughout the nation. Copyright © 2014 John Wiley & Sons, Ltd.
    December 23, 2014   doi: 10.1002/hpm.2280   open full text
  • What if implementation is not the problem? Exploring the missing links between knowledge and action.
    Sara A. Kreindler.
    The International Journal of Health Planning and Management. November 25, 2014
    Given all the available knowledge about effective implementation, why do many organizations continue to have—or appear to have—an implementation problem? Analysis of a 7‐year corpus of reports by a Canadian health region's “embedded” research and evaluation unit sought to discover the source of the region's intractable difficulty implementing improvement. Findings suggested that the problem was neither a lack of knowledge (decision‐makers displayed sophisticated understanding of fundamental issues) nor an inability to take action (there existed sufficient capacity to implement change). However, managers' high‐level knowledge was not made actionable, and micro‐level decision‐making often produced piecemeal actions inadequately informed by existing knowledge. The problem arose at the stage of “operationalization”—the identification of concrete, executable actions fully informed by knowledge of complex, system‐level issues. Yet this crucial phase is a focus of neither the implementation nor knowledge translation (KT) literatures. The organizational decision‐making literature reveals how decision‐makers initiate operationalization (i.e., by setting the direction for a discovery approach) but not how they can ensure its successful completion. The focus of KT research and practice should expand to explicating and improving decision‐making, lest KT become an exercise of infusing content into a broken process. Copyright © 2014 John Wiley & Sons, Ltd.
    November 25, 2014   doi: 10.1002/hpm.2277   open full text
  • Redesigning a Ministry of Health's organizational structure: exploring implementation challenges through Botswana's experiences.
    Onalenna Seitio‐Kgokgwe, Robin D. C. Gauld, Philip C. Hill, Pauline Barnett.
    The International Journal of Health Planning and Management. November 13, 2014
    Introduction The Botswana's Ministry of Health redesigned and adopted a new organizational structure in 2005, which was poorly implemented. This article explores factors that influenced the implementation of this organizational structure. Methods This article draws from data collected through in‐depth interviews with 54 purposively selected key informants comprising policy makers, senior managers and staff of the Ministry of Health (N = 40) and senior officers from various stakeholder organizations (N = 14). Findings Participants generally felt that the review of the Ministry of Health organizational structure was important. The previous structure was considered obsolete with fragmented functions that limited the overall performance of the health system. The new organizational structure was viewed to be aligned to current national priorities with potential to positively influence performance. Some key weaknesses identified included lack of consultation and information sharing with workers during the restructuring process, which affected the understanding of their new roles, failure to mobilize key resources to support implementation of the new structure and inadequate monitoring of the implementation process. Conclusion Redesigning an organizational structure is a major change. There is a need for effective and sustained leadership to plan, direct, coordinate, monitor and evaluate the implementation phase of the reform. Copyright © 2014 John Wiley & Sons, Ltd.
    November 13, 2014   doi: 10.1002/hpm.2275   open full text
  • Perspective: lessons from the past.
    Walter W. Holland.
    The International Journal of Health Planning and Management. October 23, 2014
    A considered analysis of some factors used in the past 50–70 years in medical education, care on a hospital ward, organisation of health services, medical research and the attitudes of media and politics to health services is described. The possible reasons for changes in these areas over time are considered, and recommendations are made in each area on how current practice could be improved in the light of past experience. Copyright © 2014 John Wiley & Sons, Ltd.
    October 23, 2014   doi: 10.1002/hpm.2271   open full text
  • Social determinants of health in selected slum areas in Jordan: challenges and policy directions.
    Musa T. Ajlouni.
    The International Journal of Health Planning and Management. October 03, 2014
    Background The unplanned urbanization in Jordan has over time created many informal settlements “slums” around big cities as Amman, Zerka and Aqaba. The purpose of this study was to highlight the most common challenges related to social determinants of health in two selected slum areas in Amman and Aqaba and suggest policy directions and interventions to meet these challenges. Methods In addition to a prestructured interview with all household heads living in the two slum sites, focus group meetings with a purposefully selected sample of 12 slum dwellers in each site were used to assess the structural and intermediary determinants of health as perceived by slum residents in the two study locations. Results The study found that slum residents in the two locations suffer from many challenges as severe poverty; unemployment; illiteracy and low education attainments; gender discrimination; insufficient and poor diet; social and official exclusion; unhealthy environment; lack of water supply, electricity and basic sanitation facilities; high prevalence of diseases; and insufficient and inappropriate health services. Specific policy directions to meet these challenges were recommended and grouped into three main clusters: social protection, social inclusion and empowerment. Conclusion New plans and tools should be developed by local authorities in Jordan to understand, protect, include and empower those vulnerable people who are forced to live in these unhealthy and inhuman environments. Copyright © 2014 John Wiley & Sons, Ltd.
    October 03, 2014   doi: 10.1002/hpm.2267   open full text
  • Introducing diagnosis‐related groups: is the information system ready?
    Weiyan Jian, Ming Lu, Wei Han, Mu Hu.
    The International Journal of Health Planning and Management. August 11, 2014
    Diagnosis‐related group (DRG) system is a classification system widely used in health managements, the foundation of which lies in the medical information system. A large effort had been made to improve the quality of discharge data before the introduction of DRGs in Beijing. We extract discharge data from 108 local hospitals spanning 4 years before and after standardization to evaluate the impact of standardization on DRG grouping performance. The data was grouped on an annual basis in accordance with Beijing's local DRG system. Proportion of ungrouped data, coefficient of variation (CV) and reduction in variance (RIV) were used to measure the performance of the DRG system. Both the descriptive and regression analysis indicate a significant reduction in terms of ungrouped data and CV for expenditure, increase of RIV for expenditure and length of stay. However, when there was no intervention, that is, between 2005 and 2006 and between 2008 and 2009, changes in these indicators were all insignificant. Therefore, the standardization of discharge data did improve data quality and consequently enhanced the performance of DRGs. Developing countries with a relatively weak information infrastructure should strengthen their medical information system before the introduction of the DRG system. Copyright © 2014 John Wiley & Sons, Ltd.
    August 11, 2014   doi: 10.1002/hpm.2270   open full text
  • How do supply‐side factors influence informal payments for healthcare? The case of HIV patients in Cameroon.
    Hyacinthe Tchewonpi Kankeu, Sylvie Boyer, Raoul Fodjo Toukam, Mohammad Abu‐Zaineh.
    The International Journal of Health Planning and Management. August 11, 2014
    Direct out‐of‐pocket payments for healthcare continue to be a major source of health financing in low‐income and middle‐income countries. Some of these direct payments take the form of informal charges paid by patients to access the needed healthcare services. Remarkably, however, little is known about the extent to which these payments are exercised and their determinants in the context of Sub‐Saharan Africa. This study attempts therefore to shed light on the role of supply‐side factors in the occurrence of informal payments while accounting for the demand‐side factors. The study relies on data taken from a nationally representative survey conducted among people living with HIV/AIDS in Cameroon. A multilevel mixed‐effect logistic model is employed to identify the factors associated with the incidence of informal payments. Results reveal that circa 3.05% of the surveyed patients incurred informal payments for the consultations made on the day of the survey. The amount paid informally represents up to four times the official tariff. Factors related to the following: (i) human resource management of the health facilities (e.g., task shifting); (ii) health professionals' perceptions vis‐à‐vis the remunerations of HIV care provision; and (iii) reception of patients (e.g., waiting time) significantly influence the probability of incurring informal payments. Also of note, the type of healthcare facilities is found to play a role: informal payments appear to be significantly lower in private non‐profit facilities compared with those belonging to public sector. Our findings allude to some policy recommendations that can help reduce the incidence of informal payments. Copyright © 2014 John Wiley & Sons, Ltd.
    August 11, 2014   doi: 10.1002/hpm.2266   open full text
  • Identifying barriers to move to better health coverage: preferences for health insurance benefits among the rural poor population in La Guajira, Colombia.
    Jeannette Liliana Amaya, Fernando Ruiz, Antonio J. Trujillo, Christine Buttorff.
    The International Journal of Health Planning and Management. August 11, 2014
    Even though access to health insurance in Colombia has improved since the implementation of the 1993 health reforms (Law 100), universal coverage has not yet been accomplished. There is still a segment of the population under the low‐income (subsidized) health insurance policy or without health insurance altogether. The purpose of this research was to identify preferences and behavior regarding health insurance among the subsidized rural population in La Guajira, Colombia, and to understand why that population remains under the subsidized health insurance policy. The field experiment gathered information from 400 households regarding their socioeconomic situation, health conditions, and preferences for health insurance characteristics. Results suggest that the surveyed population gives priority to expanded family coverage, physician and hospital choice, and access to specialists, rather than to attributes associated with co‐payments or premiums. That indicates that people value healthcare benefits and family coverage more than health insurance expenses, and policy makers could use these preferences to enroll subsidized population into the contributory regime. Copyright © 2014 John Wiley & Sons, Ltd.
    August 11, 2014   doi: 10.1002/hpm.2268   open full text
  • Towards medicines regulatory authorities' quality performance improvement: value for public health.
    Gordana Pejović, Jovan Filipović, Ljiljana Tasić, Valentina Marinković.
    The International Journal of Health Planning and Management. July 02, 2014
    The purpose of this article is to explore the possibility of implementing total quality management (TQM) principles in national medicines regulatory authorities in Europe to achieve all public health objectives. Bearing in mind that medicines regulation is a governmental function that serves societal objectives to protect and promote public health, measuring the effective achievement of quality objectives related to public health is of utmost importance. A generic TQM model for meeting public health objectives was developed and was tested on 10 European national medicines regulatory authorities with different regulatory performances. Participating national medicines regulatory authorities recognised all TQM factors of the proposed model in implemented systems with different degrees of understanding. An analysis of responses was performed within the framework of two established criteria—the regulatory authority's category and size. The value of the paper is twofold. First, the new generic TQM model proposes to integrate four public health objectives with six TQM factors. Second, national medicines regulatory authorities were analysed as public organisations and health authorities to develop a proper tool for assessing their regulatory performance. The paper emphasises the importance of designing an adequate approach to performance measurement of quality management systems in medicines regulatory authorities that will support their public service missions. Copyright © 2014 John Wiley & Sons, Ltd.
    July 02, 2014   doi: 10.1002/hpm.2265   open full text
  • Community programmes for coronary heart disease in Spanish primary care.
    Eva Frigola‐Capell, Jan Lieshout, Miguel A. Muñoz, Jose Verdú‐Rotellar, Francesc Orfila, Rosa Suñol, Michel Wensing.
    The International Journal of Health Planning and Management. June 10, 2014
    Objective To explore the added value of community‐orientated programmes aimed at enhancing healthy lifestyles associated with the key components of cardiovascular risk management (CVRM) in coronary heart disease (CHD) patients. Methods Observational study in Spain, including 36 practices, 36 health professionals, and 722 CHD patients (mean (SD) age 72 (11.73)). Our predictor variable of interest was reported deliveries from primary care practices (PCPs) concerning community‐orientated programmes such as physical exercise and smoking cessation groups. Data were obtained through structured questionnaires administered to PCP health professionals. Our CVRM outcome measures were as follows: recorded risk factors, drug prescriptions, and intermediate patient outcomes (blood pressure levels, low‐density lipoprotein cholesterol, and body mass index). Results Thirty practices delivered community programmes: most delivered one [17 (47.2%) practices] or two [11 (30.5%) practices]. These educational programmes aimed to encourage enhanced healthy lifestyles through group counselling sessions, mailed print material, and one‐to‐one counselling. In PCPs delivering community programmes, more patients received antihypertensives (89.7%), antiplatelet therapy (80.5%), and statins (70.8%) than those PCPs without programmes, although there were no statistically significant differences between them. Conclusions No evidence was found for the added value of community‐orientated CVRM programmes that could help health professionals refine criteria when including CHD patients in preventive programmes. Copyright © 2014 John Wiley & Sons, Ltd.
    June 10, 2014   doi: 10.1002/hpm.2262   open full text
  • The influence of medical cost controls implemented by Taiwan's national health insurance program on doctor–patient relationships.
    Jhih‐Ling Chiu.
    The International Journal of Health Planning and Management. May 30, 2014
    To prevent medical costs from rising, the National Health Insurance administration implemented the global budget system for financial reform, effective 1 July 2004. Since the implementation of this system, patients have been required to pay for some medicines to limit costs to the system. More recently, as they have faced constant increases in health insurance fees and also faced an increase in the number of medical expenses they must pay during an economic recession and a rise in unemployment, would the economic burden on the people of Taiwan not be increased? Even though National Health Insurance is a form of social insurance, does it guarantee social equality? The value of the healthcare industry is irreplaceable, so the most critical concern is whether worsening doctor–patient relationships will worsen healthcare quality. In short, while the global budget system saves on National Health Insurance costs, whether its implementation has affected healthcare quality is also worth exploring. This commentary also hopes to serve as a reference for the implementation of national health insurance in the United States. Copyright © 2014 John Wiley & Sons, Ltd.
    May 30, 2014   doi: 10.1002/hpm.2256   open full text
  • The impact of expanded health system reform on governmental contributions and individual copayments in the new Chinese rural cooperative medical system.
    Hengjin Dong, Shengnan Duan, Lennart Bogg, Yuan Wu, Hua You, Jianhua Chen, Xujun Ye, Karen Seccombe, Hai Yu.
    The International Journal of Health Planning and Management. May 22, 2014
    In 2002, the Chinese central government created a new rural cooperative medical system (NCMS), ensuring that both central and local governments partner with rural residents to reduce their copayments, thus making healthcare more affordable. Yet, significant gaps in health status and healthcare utilization persisted between urban and rural communities. Therefore, in 2009, healthcare reform was expanded, with (i) increased government financing and (ii) sharply reduced individual copayments for outpatient and inpatient care. Analyzing data from China's Ministry of Health, the Rural Cooperative Information Network, and Statistical Yearbooks, our findings suggest that healthcare reform has reached its preliminary objectives—government financing has grown significantly in most rural provinces, especially those in poorer western and central China, and copayments in most rural provinces have been reduced. Significant intraprovincial inequality of support remains. The central government contributes more money for poor provinces than for rich ones; however, NCMS schemes operate at the county level, which vary significantly in their level of economic development and per capital gross domestic products (GDP) within a province. Data reveal that the compensation ratios for both outpatient and inpatient care are not adjusted to compensate for a rural county's level of economic development or per capita GDP. Consequently, a greater financial burden for healthcare persists among persons in the poorest rural regions. A recommendation for next step in healthcare reform is to pool resources at prefectural/municipal level and also adjust central government contributions according to the GDP level at prefectural/municipal level. Copyright © 2014 John Wiley & Sons, Ltd.
    May 22, 2014   doi: 10.1002/hpm.2259   open full text
  • Bayreuth Productivity Analysis—a method for ascertaining and improving the holistic service productivity of acute care hospitals.
    Mario Alexander Pfannstiel.
    The International Journal of Health Planning and Management. May 19, 2014
    The healthcare sector is lacking a method with which hospitals can measure the extent to which they achieve their goals in terms of aggregate productivity from both patients' and employees' perspectives. The Bayreuth Productivity Analysis (BPA) provides a solution to this problem because it uses two standardized questionnaires—one for patients and one for employees—to ascertain productivity at hospitals. These questionnaires were developed in several steps according to the principles of classical test theory, and they consist of six dimensions (information, organization, climate, methods, infrastructure and equipment) of five items each. One item describes a factual situation relevant to productivity and services so that it makes a contribution to the overall productivity of a hospital. After individualized evaluation of these items, the dimensions are subjectively weighted in the two questionnaires. The productivity index thus ascertained can be considered “holistic” when all patients and employees in a hospital make a differentiated assessment and weigh off each of the dimensions. In conclusion, the BPA constitutes a simple yet practicable method to ascertain and improve the holistic service productivity of hospitals. Copyright © 2014 John Wiley & Sons, Ltd.
    May 19, 2014   doi: 10.1002/hpm.2250   open full text
  • Effects of decentralisation and health system reform on health workforce and quality‐of‐care in Indonesia, 1993–2007.
    Aly Diana, Samantha A. Hollingworth, Geoffrey C. Marks.
    The International Journal of Health Planning and Management. May 14, 2014
    The impact of decentralisation, socioeconomic changes and healthcare reforms in Indonesia on type and distribution of healthcare providers and quality‐of‐care has been unclear. We examined workforce trends for healthcare facilities from 1993 to 2007 using the Indonesian Family Life Surveys. Each included a sample of public and private healthcare facilities, used standardised interviews for numbers and composition of staffing, and quality‐of‐care vignettes. There was an increase in multiprovider facilities and shift in profile of solo providers—increasing proportions of midwives and drop in doctors in rural areas (including facilities with doctors) and nurses in urban areas. Quality‐of‐care scores were low, particularly for nurses as solo providers. Despite increased numbers of healthcare workers and growth of the private sector, outer Java‐Bali and rural areas continued to be disadvantaged in workforce capacity and quality‐of‐care. The results have implications for accreditation and in‐service training requirements, the legal status of nurses and private sector regulation. Copyright © 2014 John Wiley & Sons, Ltd.
    May 14, 2014   doi: 10.1002/hpm.2255   open full text
  • The regulation of private hospitals in Asia.
    Rosemary Morgan, Tim Ensor.
    The International Journal of Health Planning and Management. May 13, 2014
    Private providers play a significant role in the provision of health services in low and middle income countries (LMICs), and the number of private hospitals is increasing rapidly. The growth of the sector has drawn attention to the many problems that are often associated with this sector and the need for effective regulation if private providers are to contribute to the effective provision of healthcare. This paper outlines three main regulatory strategies—command and control, incentives, and self‐regulation, providing examples of each approach in Asia. Traditionally, command and control regulatory instruments have dominated the regulation of private hospitals in Asia; however, when deciding on which approach is most appropriate, it is important to consider the goal of the regulation, the context in which it is to be implemented, and the advantages and disadvantages of each approach. This paper concludes that regulation needs to extend beyond command and control to include a full range of mechanisms. Doing so will help address many of the challenges found within individual approaches, in addition to helping address the regulatory challenges particular to many LMICs. Copyright © 2014 John Wiley & Sons, Ltd.
    May 13, 2014   doi: 10.1002/hpm.2257   open full text
  • Service providers' views of community participation at six Australian primary healthcare services: scope for empowerment and challenges to implementation.
    Toby Freeman, Frances E. Baum, Gwyneth M. Jolley, Angela Lawless, Tahnia Edwards, Sara Javanparast, Anna Ziersch.
    The International Journal of Health Planning and Management. April 30, 2014
    Community participation is a key principle of comprehensive primary health care (PHC). There is little literature on how community participation is implemented at Australian PHC services. As part of a wider study conducted in partnership with five South Australian PHC services, and one Aboriginal community controlled health service in the Northern Territory, 68 staff, manager, regional health executives, and departmental funders were interviewed about community participation, perceived benefits, and factors that influenced implementation. Additional data were collected through analysis of policy documents, service reports on activity, and a web‐based survey completed by 130 staff. A variety of community participation strategies was reported, ranging from consultation and participation as a means to improve service quality and acceptability, to substantive and structural participation strategies with an emphasis on empowerment. The Aboriginal community controlled health service in our study reported the most comprehensive community participation. Respondents from all services were positive about the benefits of participation but reported that efforts to involve service users had to compete with a centrally directed model of care emphasising individual treatment services, particularly at state‐managed services. More empowering substantive and structural participation strategies were less common than consultation or participation used to achieve prescribed goals. The most commonly reported barriers to community participation were budget and lack of flexibility in service delivery. The current central control of the state‐managed services needs to be replaced with more local management decision making if empowering community participation is to be strengthened and embedded more effectively in the culture of services. Copyright © 2014 John Wiley & Sons, Ltd.
    April 30, 2014   doi: 10.1002/hpm.2253   open full text
  • Coordination pays off: a comparison of two models for organizing hip fracture care, outcomes and costs.
    Susanne Löfgren, Clas Rehnberg, Gunnar Ljunggren, Mats Brommels.
    The International Journal of Health Planning and Management. April 30, 2014
    Background and purpose With the “graying” of the population, hip fractures place an increasing burden on health systems and call for efficient forms of care. The aim was to compare two models of organizing hip fracture care at one university hospital working at two sites. The differences in organization were coordinated care provided in one of the sites and traditional care, divided between different institutions, in the other. Material and methods The study was conducted at a Swedish university hospital and included all 503 hip fracture patients, admitted during the 1‐year period of February 2009 through January 2010. Patient gender, age, type of fracture, admission and discharge dates were documented. The patients were surveyed of their health‐related quality of life at the time of admission and at 4 and 12 months after discharge. The costs for the inpatient care episode were estimated using three costing methods. Results The coordinated care model resulted in a shorter hospital stay and consistently lower costs. There was no difference between patient‐reported quality of life. Interpretation The care of hip fracture patients coordinated by a geriatric ward throughout the whole care episode is more cost‐efficient than uncoordinated where patients are transferred to other institutions for rehabilitation. © 2014 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.
    April 30, 2014   doi: 10.1002/hpm.2249   open full text
  • Drug pricing and control of health expenditures: a comparison between a proportional decision rule and a cost‐per‐QALY rule.
    Afschin Gandjour.
    The International Journal of Health Planning and Management. April 30, 2014
    Background and aims In Germany, the Institute for Quality and Efficiency in Health Care (IQWiG) makes recommendations for reimbursement prices of drugs on the basis of a proportional relationship between costs and health benefits. This paper analyzed the potential of IQWiG's decision rule to control health expenditures and used a cost‐per‐quality‐adjusted life year (QALY) rule as a comparison. Methods A literature search was conducted, and a theoretical model of health expenditure growth was built. Results The literature search shows that the median incremental cost‐effectiveness ratio of German cost‐effectiveness analyses was €7650 per QALY gained, thus yielding a much lower threshold cost‐effectiveness ratio for IQWiG's rule than an absolute rule at €30 000 per QALY. The theoretical model shows that IQWiG's rule is able to contain the long‐term growth of health expenditures under the conservative assumption that future health increases at a constant absolute rate and that the threshold incremental cost‐effectiveness ratio increases at a smaller rate than health expenditures. In contrast, an absolute rule offers the potential for manufacturers to raise drug prices in response to the threshold, thus resulting in an initial spike in expenditures. Conclusions Results suggest that IQWiG's proportional rule will lead to lower drug prices and a slower growth of health expenditures than an absolute cost‐effectiveness threshold at €30 000 per QALY. This finding is surprising as IQWiG's rule—in contrast to a cost‐per‐QALY rule—does not start from a fixed budget. Copyright © 2014 John Wiley & Sons, Ltd.
    April 30, 2014   doi: 10.1002/hpm.2247   open full text
  • Power and trust in organizational relations: an empirical study in Turkish public hospitals.
    Tuba Bozaykut, F. Gulruh Gurbuz.
    The International Journal of Health Planning and Management. April 25, 2014
    Given the salience of the interplay between trust and power relations in organizational settings, this paper examines the perceptions of social power and its effects on trust in supervisors within the context of public hospitals. Following the theoretical background from which the study model is developed, the recent situation of hospitals within Turkish healthcare system is discussed to further elucidate the working conditions of physicians. Sample data were collected employing a structured questionnaire that was distributed to physicians working at seven different public hospitals. The statistical analyses indicate that perceptions of supervisors' social power affect subordinates' trust in supervisors. Although coercive power is found to have the greatest impact on trust in supervisors, the influence of the power base is weak. In addition, the results show that perceptions of social power differ between genders. However, the results do not support any of the hypotheses regarding the relations between trust in supervisors and the examined demographic variables. Copyright © 2014 John Wiley & Sons, Ltd.
    April 25, 2014   doi: 10.1002/hpm.2251   open full text
  • Implementing hospital innovation in Taiwan: the perspectives of institutional theory and social capital.
    Chen‐Wei Yang.
    The International Journal of Health Planning and Management. April 16, 2014
    The main purpose of this study is to develop an innovation model for hospital organisations. For this purpose, this study explores and examines the determinants, capabilities and performance in the hospital sector. First, this discusses three categories of determinants that affect hospitals' innovative capability studies: (1) knowledge stock; (2) social ties; and (3) institutional pressures. Then, this study examines the idea of innovative hospital capabilities, defined as the ability of the hospital organisation to innovate their knowledge. Finally, the hospital evaluation rating, which identifies performance in the hospital sector, was examined. This study empirically tested the theoretical model at the organisation level. The findings suggest that a hospital's innovative capabilities are influenced by its knowledge stock, social ties, institutional pressures and the impact of hospital performance. However, in attempts to keep hospitals aligned with their highly institutionalised environments, it may prove necessary for hospital administrators to pay more attention to both existing knowledge stock and the process of innovation if the institutions are to survive. Finally, implications for theory and practitioners complete this study. Copyright © 2014 John Wiley & Sons, Ltd.
    April 16, 2014   doi: 10.1002/hpm.2248   open full text
  • Optimal administrative scale for planning public services: a social cost model applied to Flemish hospital care.
    Jos L.T. Blank, Bart Hulst.
    The International Journal of Health Planning and Management. April 10, 2014
    In choosing the scale of public services, such as hospitals, both economic and public administrative considerations play important roles. The scale and the corresponding spatial distribution of public institutions have consequences for social costs, defined as the institutions' operating costs and the users' travel costs (which include the money and time costs). Insight into the relationship between scale and spatial distribution and social costs provides a practical guide for the best possible administrative planning level. This article presents a purely economic model that is suitable for deriving the optimal scale for public services. The model also reveals the corresponding optimal administrative planning level from an economic perspective. We applied this model to hospital care in Flanders for three different types of care. For its application, we examined the social costs of hospital services at different levels of administrative planning. The outcomes show that the social costs of rehabilitation in Flanders with planning at the urban level (38 areas) are 11% higher than those at the provincial level (five provinces). At the regional level (18 areas), the social costs of rehabilitation are virtually equal to those at the provincial level. For radiotherapy, there is a difference of 88% in the social costs between the urban and the provincial level. For general care, there are hardly any cost differences between the three administrative levels. Thus, purely from the perspective of social costs, rehabilitation should preferably be planned at the regional level, general services at the urban level and radiotherapy at the provincial level. Copyright © 2014 John Wiley & Sons, Ltd.
    April 10, 2014   doi: 10.1002/hpm.2246   open full text
  • Evolving social health scheme for workers in unorganized sector: key evidences from study of cycle rickshaw pullers in Delhi, India.
    Nishant Kumar, Vijay Kumar Tiwari, Kuldeep Kumar, Kesavan Sreekantan Nair, Sherin Raj, Deoki Nandan.
    The International Journal of Health Planning and Management. March 27, 2014
    Background In view of high out‐of‐pocket costs and low spending even for basic healthcare for the poor employed in the unorganized sector, policy makers in India have turned their attention to developing a financing mechanism for social health insurance with the desire to provide quality care to the poor and economically disadvantaged. Objectives This study aims to assess and determine the disease profile, treatment expenditure and willingness to pay for health insurance among rickshaw pullers in Delhi. Methods The study was conducted among 500 rickshaw pullers from five zones of the Municipal Corporation of Delhi, taking a sample of 100 from each zone. Results The average cost of treatment was Rs.505 for outpatient and Rs. 3200 for inpatient care. To finance the treatment expenditure, 27.5% of the respondents spent from their household savings, and 43% had to borrow funds. Any “spell of sickness” and “total expenditure on acute illness” were significantly (p < 0.01) associated with the willingness to pay for health insurance. Overall, the majority (83%) of participants were willing to pay for health insurance. Conclusion The study provides the evidence for the need for urgent policy development by introducing a social health insurance package including wage losses for the vulnerable groups such as rickshaw pullers in the unorganized sector in India, which significantly contribute to pollution free and cheap transportation of community, tourists and commercial goods as well. Copyright © 2014 John Wiley & Sons, Ltd.
    March 27, 2014   doi: 10.1002/hpm.2244   open full text
  • Whither the elephant?: the continuing development of clinical leadership in the UK National Health Services.
    John Duncan Edmonstone.
    The International Journal of Health Planning and Management. March 17, 2014
    The paper revisits the theme of clinical leadership in UK countries, following an earlier (2009) review. It examines the competency‐based approach; considers the emerging voices of clinical leaders; explores the results of evaluation research studies; identifies learning from intra‐UK and international comparisons and considers the issue of leader development versus leadership development. It concludes that there is little conceptual clarity; that there continues to be a major disconnect between clinicians and managers; that different approaches to developing clinical leaders are emerging in different parts of the UK and that the major challenge remains to develop leadership, rather than leaders. Copyright © 2014 John Wiley & Sons, Ltd.
    March 17, 2014   doi: 10.1002/hpm.2245   open full text
  • Article Withdrawal: “Perceptions of the use of complementary therapy and Siddha medicine among rural patients with HIV/AIDS: a case study from India” by Maria Costanza Torri.

    The International Journal of Health Planning and Management. March 04, 2014
    The above article from the International Journal of Health Planning and Management, published online in Wiley Online Library on July 4th 2012, has been withdrawn by agreement between the author, the journal Editor‐in‐Chief and John Wiley & Sons Ltd. The withdrawal has been agreed owing to an error at the publishers and subsequent dual publication in the journal. The journal Editor‐in‐Chief and John Wiley & Sons Ltd. would like to emphasise that there is no suggestion of a breach of publication ethics by Dr Torri. REFERENCE Torri MC. 2012. Perceptions of the use of complementary therapy and Siddha medicine among rural patients with HIV/AIDS: a case study from India. Int J Health Plann Mgmt. doi: 10.1002/hpm.2242
    March 04, 2014   doi: 10.1002/hpm.2242   open full text
  • Developing a national framework of quality indicators for public hospitals.
    Effie Simou, Paraskevi Pliatsika, Eleni Koutsogeorgou, Anastasia Roumeliotou.
    The International Journal of Health Planning and Management. January 28, 2014
    Background The current study describes the development of a preliminary set of quality indicators for public Greek National Health System (GNHS) hospitals, which were used in the “Health Monitoring Indicators System: Health Map” (Ygeionomikos Chartis) project, with the purpose that these quality indicators would assess the quality of all the aspects relevant to public hospital healthcare workforce and services provided. Methods A literature review was conducted in the MEDLINE database to identify articles referring to international and national hospital quality assessment projects, together with an online search for relevant projects. Studies were included if they were published in English, from 1980 to 2010. A consensus panel took place afterwards with 40 experts in the field and tele‐voting procedure. Results Twenty relevant projects and their 1698 indicators were selected through the literature search, and after the consensus panel process, a list of 67 indicators were selected to be implemented for the assessment of the public hospitals categorized under six distinct dimensions: Quality, Responsiveness, Efficiency, Utilization, Timeliness, and Resources and Capacity. Conclusion Data gathered and analyzed in this manner provided a novel evaluation and monitoring system for Greece, which can assist decision‐makers, healthcare professionals, and patients in Greece to retrieve relevant information, with the long‐term goal to improve quality in care in the GNHS hospital sector. Copyright © 2014 John Wiley & Sons, Ltd.
    January 28, 2014   doi: 10.1002/hpm.2237   open full text
  • Factors impacting the use of antenatal care and hospital child delivery services: a case study of rural residents in the Enshi Autonomous Prefecture, Hubei Province, China.
    Yin Zhang, Minxing Chen, Jun Lu, Mo Hao, Changli Zhang, Mei Sun, Xiaohong Li, Fengshui Chang.
    The International Journal of Health Planning and Management. January 21, 2014
    This study was undertaken to understand the factors that impact whether rural women obtain antenatal care (ANC) and choose to use hospital delivery services in central and western China. We chose to conduct field research with the rural residents in Hubei Province through a combination of random sampling and purposive sampling methods. A mixed method approach was taken to analyze the factors impacting the use of ANC and hospital delivery services from the perspective of the villagers. Our results indicate that the quality of the available ANC services is poor. In particular, women who have special circumstances and unplanned pregnancies or who become pregnant prior to marriage are confronted with inadequate ANC and hospital child delivery services. The factors that impact whether women use or not use ANC and hospital delivery services and that cause women to choose hospital or home delivery can be understood at three levels: macro, middle, and micro. We strongly suggest that the policies and projects that promote maternal healthcare in rural areas be sustained with an added focus on including women with special circumstances. Village doctors can be enlisted to regularly visit pregnant women at home and to provide extra explanation about the ANC services available and the purpose of maternal healthcare. These findings and suggestions can be used by local health providers and decision‐makers to improve the quality of ANC and hospital delivery services. Copyright © 2014 John Wiley & Sons, Ltd.
    January 21, 2014   doi: 10.1002/hpm.2238   open full text
  • Preferences for physician services in Ukraine: a discrete choice experiment.
    Andriy Danyliv, Milena Pavlova, Irena Gryga, Wim Groot.
    The International Journal of Health Planning and Management. January 08, 2014
    Evidence on preferences of Ukrainian consumers for healthcare improvements can help to design reforms that correspond to societal priorities. This study aims to elicit and to place monetary values on public preferences for out‐patient physician services in Ukraine. The method of discrete choice experiment is used on a sample of 303 respondents, representative of the adult Ukrainian population. The random effect logit model with interactions provides the best fit for the data and is used to calculate the marginal willingness to pay (MWTP) for quality and access improvements. At a sample level, there is no clear preference to pay formally rather than informally or vice versa. We also do not find that visiting a general practitioner is preferred over direct access to a medical specialist. However, there are differences between population groups. Quality‐related attributes of physician services appear important to respondents, especially the attitude of medical staff. Thus, interpersonal aspects of out‐patient care should be given priority in decisions about investments in quality improvements. Other aspects, that is social quality and access, are important as well but their improvement brings fewer social gains. Measures should be taken to eradicate the informal payment channels and to strengthen the gate‐keeping role of primary care. Copyright © 2014 John Wiley & Sons, Ltd.
    January 08, 2014   doi: 10.1002/hpm.2239   open full text
  • Healthcare program for sex workers: a public health priority.
    Gustavo Marin, Martin Silberman, Susana Martinez, Carlos Sanguinetti.
    The International Journal of Health Planning and Management. December 26, 2013
    Objective The objective of this study was to propose a model of health care for sexual workers (SWs) and transvestites (Ts) groups who were historically excluded from health services. Materials and methods A prospective descriptive/analytical study with an intervention stage was performed, focusing on the health status of SWs and Ts. Access to health system, inclusion into social programs, beneficiaries' participation, and rate of risk behaviors were variables measured before and after intervention that consist in a program based on promotion/prevention activities and complete health care service suitable to SW–T needs. Results Nine hundred and fifty SW–Ts were included. At baseline, 99.7% lacked health insurance and 90.1% had no access to the health care. These data were compared with those obtained after attention quadruplicated among SW because of the implementation of the program. Risky sexual behaviors were reduced by 25 times. SWs have their own leader of health institutions and coordinate themselves with the program's activities. Conclusion Responsibility of the state's authorities on vulnerable groups must focus on their inclusion. To this end, health services must adapt themselves in order to attend those community groups with special needs. Active participation of the target population contributes to viability of this type of proposals, and it is essential for the project's success. Copyright © 2013 John Wiley & Sons, Ltd.
    December 26, 2013   doi: 10.1002/hpm.2234   open full text
  • Bend the healthcare cost curve without pain? The health outcome after the Medicare reimbursement cut in 1997.
    Jing Hua Zhang.
    The International Journal of Health Planning and Management. December 03, 2013
    Objective This study examines whether the hospital‐acquired infection (HAI) rates in hospitals in Pennsylvania of the USA have increased after reimbursement reductions, based on the Balance Budget Act of 1997. Methods This study used patient discharge data from 1994 to 2002 from the Pennsylvania Health Care Cost Containment Council and analyzed the pre‐post changes of the HAI rates in a hospital group, which had received a high level of reimbursement cuts, comparing this with a control group, using ordinary least squares regression analysis. Results Seven hundred six hospital‐year records from 89 different hospitals in Pennsylvania during 1994–2002 were examined. No statistically significant changes in the difference of the HAI rates were found between the hospital groups with high and low levels of financial impacts from the reimbursement cut in the short or long run. Conclusions After the implementation of the Medicare reimbursement cut by the Balance Budget Act of 1997, the HAI rates among hospitals in Pennsylvanian in the USA did not statistically significantly increase. The results suggest that, in cost‐saving healthcare reform, hospitals may not operate a simple cost‐quality trade‐off. Copyright © 2013 John Wiley & Sons, Ltd.
    December 03, 2013   doi: 10.1002/hpm.2221   open full text
  • Evolution of European Union legislation of herbal medicinal products and its transposition to national legislation in 1965–2007: case Finland.
    Sari M. Koski, Pirjo Laitinen‐Parkkonen, Marja Airaksinen.
    The International Journal of Health Planning and Management. December 03, 2013
    Objectives The study aim was to explore the progress of legislation relating to herbal medicinal products in the European Union and compare it with the corresponding progress of the legislation in Finland in 1965−2007. Methods The study was carried out using content analysis. Data were searched from publicly available European Union directives and national acts. All definitions and safety‐related requirements for herbal medicinal products were identified. The transposition of safety‐related requirements into the national legislation was studied. Results Medicinal products from plant origins have been part of the European Union legislation since 1965. Most plant‐based products have not initially been regarded as medicinal products but rather as some kind of medicine‐like products. The official definition of herbal medicinal products was introduced in Directive 2004/24/EC and implemented into the Finnish legislation with the terminology to recognise herbal medicinal products as part of medicinal products. The current safety‐related requirements of medicinal products concern analogously herbal medicinal products. Conclusions Herbal medicinal products have had different definitions in pharmaceutical legislation over the study period in the European Union and Finland. The current definition places herbal medicinal products more clearly under the medicinal products' legislation. Safety‐related requirements are now practically identical for all medicinal products. Transposition of the European Union legislation into the national legislation in Finland is apparent. Copyright © 2013 John Wiley & Sons, Ltd.
    December 03, 2013   doi: 10.1002/hpm.2233   open full text
  • Financing healthcare in Gulf Cooperation Council countries: a focus on Saudi Arabia.
    Abdulwahab Alkhamis, Amir Hassan, Peter Cosgrove.
    The International Journal of Health Planning and Management. August 28, 2013
    Background This paper presents an analysis of the main characteristics of the Gulf Cooperation Council's (GCC) health financing systems and draws similarities and differences between GCC countries and other high‐income and low‐income countries, in order to provide recommendations for healthcare policy makers. The paper also illustrates some financial implications of the recent implementation of the Compulsory Employment‐based Health Insurance (CEBHI) system in Saudi Arabia. Methods Employing a descriptive framework for the country‐level analysis of healthcare financing arrangements, we compared expenditure data on healthcare from GCC and other developing and developed countries, mostly using secondary data from the World Health Organization health expenditure database. The analysis was supported by a review of related literature. Results There are three significant characteristics affecting healthcare financing in GCC countries: (i) large expatriate populations relative to the national population, which leads GCC countries to use different strategies to control expatriate healthcare expenditure; (ii) substantial government revenue, with correspondingly high government expenditure on healthcare services in GCC countries; and (iii) underdeveloped healthcare systems, with some GCC countries' healthcare indicators falling below those of upper‐middle‐income countries. Conclusion Reforming the mode of health financing is vital to achieving equitable and efficient healthcare services. Such reform could assist GCC countries in improving their healthcare indicators and bring about a reduction in out‐of‐pocket payments for healthcare. © 2013 The Authors. International Journal of Health Planning and Management published by John Wiley & Sons, Ltd.
    August 28, 2013   doi: 10.1002/hpm.2213   open full text
  • Identifying health insurance predictors and the main reported reasons for being uninsured among US immigrants by legal authorization status.
    Arturo Vargas Bustamante, Jie Chen, Hai Fang, John A. Rizzo, Alexander N. Ortega.
    The International Journal of Health Planning and Management. August 27, 2013
    This study identifies differences in health insurance predictors and investigates the main reported reasons for lacking health insurance coverage between short‐stayed (≤10 years) and long‐stayed (>10 years) US immigrant adults to parse the possible consequences of the Affordable Care Act among immigrants by length of stay and documentation status. Foreign‐born adults (18‐64 years of age) from the 2009 California Health Interview Survey are the study population. Health insurance coverage predictors and the main reasons for being uninsured are compared across cohorts and by documentation status. A logistic‐regression two‐part multivariate model is used to adjust for confounding factors. The analyses determine that legal status is a strong health insurance predictor, particularly among long‐stayed undocumented immigrants. Immigration status is the main reported reason for lacking health insurance. Although long‐stayed documented immigrants are likely to benefit from the Affordable Care Act implementation, undocumented immigrants and short‐stayed documented immigrants may encounter difficulties getting health insurance coverage. Copyright © 2013 John Wiley & Sons, Ltd.
    August 27, 2013   doi: 10.1002/hpm.2214   open full text
  • Reflecting on the efficacy of cognitive mapping for decision‐making in intellectual disability care: a case study.
    Meri Duryan, Dragan Nikolik, Godefridus Merode, Leopold M. G. Curfs.
    The International Journal of Health Planning and Management. August 16, 2013
    The central aspect of this study is a set of reflections on the efficacy of soft operational research techniques in understanding the dynamics of a complex system such as intellectual disability (ID) care providers. Organizations providing services to ID patients are complex and have many interacting stakeholders with often different and competing interests. Understanding the causes for failures in complex systems is crucial for appreciating the multiple perspectives of the key stakeholders of the system. Knowing the factors that adversely affect delivery of a patient‐centred care by ID provider organizations offers the potential for identifying more effective resource‐allocation solutions. The authors suggest cognitive mapping as a starting point for system dynamics modelling of optimal resource‐allocation projects in ID care. The application of the method is illustrated via a case study in one of the ID care providers in the Netherlands. The paper discusses some of the practical implications of applying problem‐structuring methods that support gathering feedback from vulnerable service users and front‐line workers. The authors concluded that cognitive mapping technique can assist the management of healthcare organizations in strategic decision‐making. Copyright © 2013 John Wiley & Sons, Ltd.
    August 16, 2013   doi: 10.1002/hpm.2215   open full text
  • Advancing universal coverage of healthcare in China: translating political will into policy and practice.
    Shenglan Tang, Hana Brixi, Henk Bekedam.
    The International Journal of Health Planning and Management. July 23, 2013
    China launched its new health system reform plan in 2009 to advance its universal coverage of healthcare, after more than 4 years' consultations and discussions with various stakeholders including the public. This paper aims to introduce and discuss the context and process of China's current health system reform and analyse how political will in China has been translated into policy practice over the past decade. The paper also shares the insights of World Health Organization's contribution to China's health system reform, as the authors advised the Chinese government on the reform options and process. Furthermore, the paper describes and discusses key challenges in the implementation of the reform plan over the past 3 years and draws lessons for other countries. Copyright © 2013 John Wiley & Sons, Ltd.
    July 23, 2013   doi: 10.1002/hpm.2207   open full text
  • User cost of Caesarean section: case study of Bunia, Democratic Republic of Congo.
    Danielle Deboutte, Tim O'Dempsey, Gillian Mann, Brian Faragher.
    The International Journal of Health Planning and Management. July 17, 2013
    The study estimated the user cost of Caesarean section (CS), a major component of emergency obstetric care (EmOC), in a post conflict situation in Bunia, DR Congo, 2008. A case control study used a structured questionnaire to compare women who had a CS (cases) with women who had a vaginal delivery (controls). Service information was recorded in 20 facilities providing obstetric care. Maternal and perinatal deaths, including those outside health facilities, were recorded and verified. The user cost of CS was estimated at four hospitals, one of them managed by an international non‐governmental organization offering EmOC free of charge, compared to the user cost of women who had a vaginal delivery. Among paying users, the mean healthcare cost was $US68.0 for CS and $US12.1 for vaginal delivery; mean transport cost to and from the hospital was $US11.7 for cases and $US3.2 for controls. The mean monthly family income was $US75.5. The user cost of CS placed an important financial burden on patients and their families. During transition from humanitarian to developmental assistance, donors and the State should shore up the EmOC budget to avoid an increase in maternal and perinatal mortality. Copyright © 2013 John Wiley & Sons, Ltd.
    July 17, 2013   doi: 10.1002/hpm.2208   open full text
  • Cultural camouflage—a critical study of how artefacts are camouflaged and mental health policy subverted.
    Johan M. Berlin, Eric D. Carlström.
    The International Journal of Health Planning and Management. July 17, 2013
    This study identifies hidden artefacts in a public organisation. In contrast to earlier studies, it focuses on artefacts as concealing rather than conveying meaning. Negligent behaviour caused by an unpopular culture was recognised in five psychiatric wards at a Swedish university hospital. Data comprising observations (87 h) and interviews (n = 60) were collected over a period of 48 months (2008–2011). Four different items used in everyday work representing a deeper meaning of the organisation were identified during the observations. The items selected were work attire, nametags, keys and restraint beds. These were considered particularly promising when it came to the aim of the study, namely, to find out how artefacts are camouflaged. The observations and the interviews revealed that these were controversial and contested artefacts in the organisation. The study uses the term ‘cultural camouflage’ for behaviour that ignores and consciously conceals symbols that have negative values. This concept contrasts with previous research that shows how artefacts are emphasised and how they contribute to the character of the activity in a transparent way. Conservative and backward‐looking behaviour among staff provided one explanation as to why artefacts were concealed. Another was the need to establish harmonious internal interactions. Copyright © 2013 John Wiley & Sons, Ltd.
    July 17, 2013   doi: 10.1002/hpm.2210   open full text
  • Liberalising trade in health services: constraints and prospects for South Asian countries.
    Fahmida Khatun, Mazbahul Ahamad.
    The International Journal of Health Planning and Management. July 12, 2013
    This paper attempts to examine the prospects and challenges associated with liberalising trade in health services in five South Asian countries, namely Bangladesh, India, Nepal, Pakistan and Sri Lanka. Country‐specific secondary information, a brief literature review of empirical studies and debriefing sessions with key stakeholders are employed to explore the issues related to liberalising health services trade. The health sectors in India, Nepal and Pakistan are scheduled under General Agreement on Trade in Services (GATS) classification, whereas those in Bangladesh and Sri Lanka are not. In Bangladesh, there is opportunity for investment in joint venture hospitals under Mode 3. Nonetheless, India is the largest trader in health services under all four modes. In Sri Lanka, cross‐border trade in healthcare services is found to be insignificant. Moreover, expertise in eye treatment in Nepal could also attract foreign investment in medical services under Mode 3. In contrast, Pakistan exhibits no potential under Mode 4, because of a lack of healthcare professionals. In this view, the prospects of trade in health services within the South Asian region under the four GATS modes are constrained by infrastructural, regulatory, perception‐related, logistical and cultural problems. Considering the level of development and commercial opportunities, regional integration in the health sector could be explored in such areas as telemedicine, medical tourism, cross‐border investment and capacity building of health personnel. These developments call for stronger and pro‐active government‐to‐government collaboration in the South Asian Association of Regional Cooperation (SAARC) region in a transparent and accountable manner. Copyright © 2013 John Wiley & Sons, Ltd.
    July 12, 2013   doi: 10.1002/hpm.2205   open full text
  • Long‐term care services expenditure projection in South Korea from 2015 to 2050.
    Nayoung Kim.
    The International Journal of Health Planning and Management. July 12, 2013
    South Korea has been undergoing significant change in its population structure over the past three decades. Within 10 years, South Korean baby‐boomers will reach the age of 65 years and accelerate this change. This trend in population structure is crucial, because an aging population may increase medical demand, especially that for long‐term care (LTC) services, which would create a financial burden on society. This study estimates total LTC expenditure in South Korea from 2015 to 2050 by modifying the method proposed by the UK Personal Social Science Research Unit, the seminal study on projecting costs of LTC services. Using population data from the projections of the Korean Statistical Information Service, I stratify the projected population by gender and age, using the groups 65–69, 70–74, 75–79 and 80 or over and divide LTC services into two categories, namely facility and home care. South Korea's total LTC expenditure is predicted to continuously increase and then reach 4.2% of GDP in 2050. Expenditure on LTC services for women is higher than that for men. Moreover, the increase in total expenditure is dramatic after 2040 for home‐based services but is constant for facility services. This study shows that the presence of baby‐boomers heavily influences LTC expenditure in South Korea. Copyright © 2013 John Wiley & Sons, Ltd.
    July 12, 2013   doi: 10.1002/hpm.2204   open full text
  • The pursuit of political will: politicians' motivation and health promotion.
    Yair Zalmanovitch, Nissim Cohen.
    The International Journal of Health Planning and Management. July 02, 2013
    The health promotion literature points out a significant gap between declared health promotion policy and practice. The common assumption is that one of the main obstacles to progress is “political will” and the intersectoral action necessary to create healthy environments. The concept of political will is most frequently invoked to explain a lack of action usually rooted in politicians' lack of personal courage or good sense. While stressing the fact that health and its promotion are profoundly political, we claim that the lack of political will is usually not because politicians have shown insufficient personal courage or good sense. Rather, we suggest that one of the reasons for the gap between the need for health promotion policies and political will derives from politicians' lack of attraction to several aspects associated with this policy area. In many cases, politicians are not attracted to the issue of health promotion because of the unique structural conditions usually associated with this policy domain. Using tools related to public policy theory, we suggest a conceptual framework that explains what those conditions are and answers the question of why politicians seem to lack the political will to undertake the design of health promotion policies. Copyright © 2013 John Wiley & Sons, Ltd.
    July 02, 2013   doi: 10.1002/hpm.2203   open full text
  • Public hospital autonomy in China in an international context.
    Pauline Allen, Qi Cao, Hufeng Wang.
    The International Journal of Health Planning and Management. July 01, 2013
    Following decades of change in health care structures and modes of funding, China has recently been making pilot reforms to the governance of its public hospitals, primarily by increasing the autonomy of public hospitals and redefining the roles of the health authorities. In this paper, we analyse the historical evolution and current situation of public hospital governance in China, focussing the range of governance models being tried out in pilot cities across China. We then draw on the experiences of public hospital governance reform in a wide range of other countries to consider the nature of the Chinese pilots. We find that the key difference in China is that the public hospitals in the pilot schemes do not receive sufficient funding from government and are able to distribute profits to staff. This creates incentives to charge patients for excessive treatment. This situation has undermined public service orientation in Chinese public hospitals. We conclude that the pilot reforms of governance will not be sufficient to remedy all the problems facing these hospitals, although they are a step in the right direction. Copyright © 2013 John Wiley & Sons, Ltd.
    July 01, 2013   doi: 10.1002/hpm.2200   open full text
  • How do hospitalization experience and institutional characteristics influence inpatient satisfaction? A multilevel approach.
    Anna Maria Murante, Chiara Seghieri, Adalsteinn Brown, Sabina Nuti.
    The International Journal of Health Planning and Management. July 01, 2013
    Over the last several years, interest in benchmarking health services' quality—particularly patient satisfaction (PS)—across organizations has increased. Comparing patient experiences of care across hospitals requires risk adjustment to control for important differences in patient case‐mix and provider characteristics. This study investigates the individual‐level and organizational‐level determinants of PS with public hospitals by applying hierarchical models. The analysis focuses on the effect of hospital characteristics, such as self‐discharges, on overall evaluations and on across hospital variation in scores. Sociodemographics, admission mode, place of residence, hospitalization ward and continuity of care were statistically significant predictors of inpatient satisfaction. Interestingly, it was observed that hospitals with a higher percentage of Patients Leaving Against Medical Advice (PLAMA) received lower scores. The latter result suggests that the percentage of PLAMA may provide a useful measure of a hospital's inability to meet patient needs and a proxy indicator of PS with hospital care. © 2013 The Authors. International Journal of Health Planning and Management published by John Wiley & Sons, Ltd.
    July 01, 2013   doi: 10.1002/hpm.2201   open full text
  • Reforms and emerging noncommunicable disease: some challenges facing a conflict‐ridden country—the case of the Syrian Arab Republic.
    Kasturi Sen, Waleed Al‐Faisal.
    The International Journal of Health Planning and Management. June 25, 2013
    The past year witnessed considerable turbulence in the Arab world—in this case, Syria, a lower middle‐income country with a record of a strong public health infrastructure. This paper explores the current challenges facing its health system from reforms, civil strife and international sanctions all of which we argue have serious implications for population health. The health sector in Syria was little known, and until recently, it was well integrated to provide preventive and specialized care when needed. Regionally, it was one of the few countries ready and capable of addressing the challenges of demographic and epidemiologic transition with a long‐standing emphasis on primary care and prevention, unlike most countries of the region. This context has changed dramatically through the recent implementation of reforms and the current civil war. Changes to financing, management and the delivery of health service placed access to services in jeopardy, but now, these are compounded by the destruction from an intractable and violent conflict and international sanctions. This paper explores some of the combined effects of reforms, conflict and sanctions on population health. Copyright © 2013 John Wiley & Sons, Ltd.
    June 25, 2013   doi: 10.1002/hpm.2193   open full text
  • Development of a methodology for the detection of hospital financial outliers using information systems.
    Sachiko Okada, Keisuke Nagase, Ayako Ito, Fumihiko Ando, Yoshiaki Nakagawa, Kazuya Okamoto, Naoto Kume, Tadamasa Takemura, Tomohiro Kuroda, Hiroyuki Yoshihara.
    The International Journal of Health Planning and Management. June 20, 2013
    Comparison of financial indices helps to illustrate differences in operations and efficiency among similar hospitals. Outlier data tend to influence statistical indices, and so detection of outliers is desirable. Development of a methodology for financial outlier detection using information systems will help to reduce the time and effort required, eliminate the subjective elements in detection of outlier data, and improve the efficiency and quality of analysis. The purpose of this research was to develop such a methodology. Financial outliers were defined based on a case model. An outlier‐detection method using the distances between cases in multi‐dimensional space is proposed. Experiments using three diagnosis groups indicated successful detection of cases for which the profitability and income structure differed from other cases. Therefore, the method proposed here can be used to detect outliers. Copyright © 2013 John Wiley & Sons, Ltd.
    June 20, 2013   doi: 10.1002/hpm.2194   open full text
  • The establishment and expansion of an innovative centre for rational pharmacotherapy—determinants and challenges.
    Therese Kardakis, Göran Tomson, Björn Wettermark, Mats Brommels, Brian Godman, Pia Bastholm‐Rahmner.
    The International Journal of Health Planning and Management. June 20, 2013
    Introduction The regional Board of Health in Stockholm, Sweden, established the Pharmacotherapy Centre (PTC) to enhance the rational use of medicines. The PTC initiated computerised decision support systems and developed a range of electronic service products to sustain rational prescribing. However, knowledge about which determinants have supported or hindered the sustainability of this type of healthcare organisation is limited. Objective This study aims to identify and explore determinants that support or challenge the development and sustainability of the PTC organisation, as well as investigate the key elements of their implementation efforts. Methods An in‐depth interview study among key informants involved in the establishment of the PTC organisation was conducted. Data were analysed using qualitative content analysis. Results Findings suggest that determinants enabling the development and expansion of this organisation include the presence of innovative characteristics among the PTC leadership and the ability of leaders to nurture visionary innovation in others, as well as the instigation of informal social networks and to identify end‐user needs. Challenges included an ambiguous relationship to the pharmaceutical industry, an underestimation of the innovation‐system fit and to undertake systematic evaluation of created impact by the organisation. Although prescriber use of electronic service products and adherence to an essential drug list increased over time, it remains difficult to identify methods required for demonstrating patient effects. Conclusion Whereas some determinants enabled the successful expansion of the PTC organisation, others served to substantially hinder it. The determinants identified can pave the way for systematic investigations into organisational change and development research in the pharmaceutical field. Copyright © 2013 John Wiley & Sons, Ltd.
    June 20, 2013   doi: 10.1002/hpm.2202   open full text
  • Out‐of‐pocket payments for public healthcare services by selected exempted groups in Serbia during the period of post‐war healthcare reforms.
    Jelena Arsenijevic, Milena Pavlova, Wim Groot.
    The International Journal of Health Planning and Management. June 20, 2013
    This paper focuses on the exemption mechanism that accompanies patient co‐payments for outpatient and inpatient hospital care in Serbia. The objective was to investigate the level and dynamics of out‐of‐pocket payments for this type of services by exempted groups (older than 65 years, younger than 15 years, unemployed, disabled and individuals with low family income) compared with that by other groups. For this purpose, we use empirical household data collected in the Serbian Living Standards Measurement Study carried out in 2002, 2003 and 2007. These years correspond to the start of the recent reforms in the Serbian healthcare sector and 1 and 5 years after the start of the reform. Our results show that people who belong to exempted groups were paying for healthcare in 2002, 2003 and 2007. They report different types of out‐of‐pocket payments for outpatient and inpatient hospital care. Thus, despite the ambition of the Ministry of Health in Serbia to promote equity in healthcare as a leading aim of the reforms, the implementation of the exemption mechanism fails to protect the targeted groups. Future exemption mechanism should be pro‐poor oriented but should also exempt those whose health status requires a frequent healthcare use. Copyright © 2013 John Wiley & Sons, Ltd.
    June 20, 2013   doi: 10.1002/hpm.2188   open full text
  • Healthcare priority setting in Kenya: a gap analysis applying the accountability for reasonableness framework.
    Salome A. Bukachi, Washington Onyango‐Ouma, Jared Maaka Siso, Isaac K. Nyamongo, Joseph K. Mutai, Anna Karin Hurtig, Øystein Evjen Olsen, Jens Byskov.
    The International Journal of Health Planning and Management. June 15, 2013
    In resource‐poor settings, the accountability for reasonableness (A4R) has been identified as an important advance in priority setting that helps to operationalize fair priority setting in specific contexts. The four conditions of A4R are backed by theory, not evidence, that conformance with them improves the priority setting decisions. This paper describes the healthcare priority setting processes in Malindi district, Kenya, prior to the implementation of A4R in 2008 and evaluates the process for its conformance with the conditions for A4R. In‐depth interviews and focus group discussions with key players in the Malindi district health system and a review of key policy documents and national guidelines show that the priority setting process in the district relies heavily on guidelines from the national level, making it more of a vertical, top‐down orientation. Multilateral and donor agencies, national government, budgetary requirements, traditions and local culture influence the process. The four conditions of A4R are present within the priority setting process, albeit to varying degrees and referred to by different terms. There exists an opportunity for A4R to provide a guiding approach within which its four conditions can be strengthened and assessed to establish whether conformance helps improve on the priority setting process. Copyright © 2013 John Wiley & Sons, Ltd.
    June 15, 2013   doi: 10.1002/hpm.2197   open full text
  • Submerged discontent and patterns of accommodation: a case study of doctors' pay in two public hospitals in China.
    Xuebing Cao.
    The International Journal of Health Planning and Management. June 04, 2013
    The article evaluates submerged discontent among Chinese public hospital doctors (Note1) regarding their pay and patterns of accommodation, including doctors' responses through formal and informal actions in the context of health service marketization. On the basis of a case study of two public hospitals, the article illustrates the dynamical impact of marketization on Chinese doctors' pay‐related dissatisfaction and health service employment relationship. Because of the authoritarian management and compliant trade unions, the conflict between doctors and hospitals is unable to be accommodated through collective methods. Instead, doctors' discontent is often channelled through informal, individual and subtle activities. Meanwhile, doctors' professional society is gradually influential, showing its potential of developing doctors' group identity and protecting members' interests in future. Copyright © 2013 John Wiley & Sons, Ltd.
    June 04, 2013   doi: 10.1002/hpm.2196   open full text
  • Exploring the impacts of personal factors on self‐leadership in a hospital setting.
    Ozgur Ugurluoglu, Meltem Saygılı, Ozlem Ozer, Fatih Santas.
    The International Journal of Health Planning and Management. June 04, 2013
    Self‐leadership may be defined as a self‐effecting process that individuals experience by maintaining the motivation they require for fulfilling their roles and duties. The self‐leadership process comprises three key strategies: behaviour‐oriented strategies, natural reward strategies and constructive thought pattern strategies. What is intended herein is to inquire about the implementation of self‐leadership within organisations and to examine the effects of such variables as age, gender, total terms of employment, marital status and education on self‐leadership strategies. The primary data collection instrument was a survey distributed to 450 personnel working at a state hospital in Kırıkkale, Turkey, and feedback thereto was received from 308 (68.4%) of those surveyed. As a result of the findings taken from the analyses, age, total terms of employment and receipt of education in leadership affect the use of self‐leadership strategies. Although age and total terms of employment display a negative‐directional correlation with the self‐leadership strategies, female employees and those who receive education in leadership are more inclined towards self‐leadership strategies. Copyright © 2013 John Wiley & Sons, Ltd.
    June 04, 2013   doi: 10.1002/hpm.2199   open full text
  • Responsiveness of Lebanon's primary healthcare centers to non‐communicable diseases and related healthcare needs.
    Rami Yassoub, Suha Hashimi, Siham Awada, Fadi El‐Jardali.
    The International Journal of Health Planning and Management. June 03, 2013
    Lebanon currently faces a rise in non‐communicable diseases (NCD) that is stressing the population's health and financial well‐being. Preventive care is recognized as the optimal health equitable, cost‐effective solution. The study aims to assess the responsiveness of primary health care centers (PHCs) to NCD, and identify the needed health arrangements and responsibilities of PHCs, the Ministry Of Public Health and other healthcare system entities, for PHCs to purse a more preventive role against NCD. Single and group interviews were conducted via a semi‐structured questionnaire with 10 PHCs from Lebanon's primary health care network that have undergone recent pilot accreditation and are recognized for having quality services and facilities. This manifested administrative aspects and NCD‐related services of PHCs and generated information regarding the centers' deficiencies, strengths and areas needing improvement for fulfilling a more preventive role. Administrative features of PHCs varied according to number and type of health personnel employed. Variations and deficiencies within and among PHCs were manifested specifically at the level of cardiovascular and respiratory diseases and cancer. PHCs identified the pilot accreditation as beneficial at the administrative and clinical levels; however, various financial and non‐financial resources, in addition to establishing a strong referral system with secondary care settings and further arrangements with MOPH, are necessary for PHCs to pursue a stronger preventive role. The generated results denote needed changes within the healthcare system's governance, financing and delivery. They involve empowering PHCs and increasing their breadth of services, allocating a greater portion of national budget to health and preventive care, and equipping PHCs with personnel skilled in conducting community‐wide preventive activities. Copyright © 2013 John Wiley & Sons, Ltd.
    June 03, 2013   doi: 10.1002/hpm.2192   open full text
  • The equity lens in the health care performance evaluation system.
    Sara Barsanti, Sabina Nuti.
    The International Journal of Health Planning and Management. May 30, 2013
    The main objective of this paper is to describe how indicators of the equity of access to health care according to socioeconomic conditions may be included in a performance evaluation system (PES) in the regional context level and in the planning and strategic control system of healthcare organisations. In particular, the paper investigates how the PES adopted, in the experience of the Tuscany region in Italy, indicators of vertical equity over time. Studies that testify inequality of access to health services often remain just a research output and are not used as targets and measurements in planning and control systems. After a brief introduction to the concept of horizontal and vertical equity in health care systems and equity measures in PES, the paper describes the ‘equity process’ by which selected health indicators declined by socioeconomic conditions were shared and used in the evaluation of health care institutions and in the CEOs' rewarding system, and subsequently analyses the initial results. Results on the maternal and child path and the chronicity care path not only show improvements in addressing health care inequalities, but also verify whether the health system responds appropriately to different population groups. Copyright © 2013 John Wiley & Sons, Ltd.
    May 30, 2013   doi: 10.1002/hpm.2195   open full text
  • The long and bumpy road to outcome‐oriented management of long‐term care in Germany: implementation of the Resident Assessment Instrument in home‐care services.
    Günter Roth, Annika Wolter, Claudia Stolle, Heinz Rothgang.
    The International Journal of Health Planning and Management. May 14, 2013
    Objective Although the quality of long‐term care has improved, many problems still remain, and better processes seem to be necessary. Hence, outcome‐oriented management is of particular importance. The Resident Assessment Instrument (RAI) is a tool that has been used successfully in many countries to improve quality of care. However, there are problems of implementation and it lacks information on the conditions of successful or failing information of the RAI. The aim of this article is to find out to what extent technical/qualification requirements help to introduce or lead to failure of the implementation of an assessment instrument like RAI. Methods Therefore, a cluster randomized controlled trial showed services using RAI intensively tend to have better outcomes after 12 months. But the effects depend on the success of the implementation. Using a factor analysis, an index was built to divide the care providers into “optimal” and “suboptimal” RAI users. Results Some factors that seem to lead to a rather successful implementation could be detected: A higher proportion of qualified staff, a lower perceived quantitative workload, a small size of care providers, the type of ownership (for‐profit) and a late entry in study [Correction made here after initial online publication.]. Conclusion The success or failure of the implementation of an outcome‐oriented control instrument is determined by professional, organizational restrictions. The results show that a better implementation leads to better outcomes for clients. Copyright © 2013 John Wiley & Sons, Ltd.
    May 14, 2013   doi: 10.1002/hpm.2186   open full text
  • Cost effectiveness of enhanced recovery after surgery programme for vaginal hysterectomy: a comparison of pre and post‐implementation expenditures.
    Sophie Relph, Alice Bell, Viswapriya Sivashanmugarajan, Kerry Munro, Kelly Chigwidden, Sue Lloyd, Abiodun Fakokunde, Wai Yoong.
    The International Journal of Health Planning and Management. May 10, 2013
    Enhanced Recovery After Surgery programmes were first conceived to optimise perioperative patient care and have been delivered by surgical specialities in the UK for over a decade. Although their safety and acceptability have been ratified in many surgical fields including gynaecology and colorectal surgery, the cost effectiveness of its implementation in benign vaginal surgery remains unclear. In this case‐control study, the perioperative expenditure for 45 women undergoing vaginal hysterectomy at a North London teaching hospital after implementation of an enhanced recovery pathway was compared with 45 matched controls prior to implementation. Frequency of catheter use (84.4% vs. 95.6%) and median length of stay (23.5 vs. 42.9 h) were significantly lower following implementation of pathway (both p < 0.05). Although enhanced recovery patients were more likely to attend the accident and emergency department for minor symptoms following discharge (15.6% vs. 0%, p < 0.05), the inpatient readmission rate (6.7% vs. 0.0%, p > 0.05) was similar in both groups. Establishing the programme incurred additional expenditures including delivering a patient‐orientated gynaecology ‘school’ and employing a specialist enhanced recovery nurse, but despite these, we demonstrated a saving of 15.2% (or £164.86) per patient. The cost efficiency savings, coupled with increased satisfaction and no rise in morbidity, offers a very attractive means of managing women undergoing vaginal hysterectomy. We believe that our data can be reproduced in other centres and recommend that the pathway be used routinely in women undergoing these procedures. Copyright © 2013 John Wiley & Sons, Ltd.
    May 10, 2013   doi: 10.1002/hpm.2182   open full text
  • Positioning matrix of economic efficiency and complexity: a case study in a university hospital.
    Adelaide Ippolito, Vincenzo Viggiani.
    The International Journal of Health Planning and Management. April 25, 2013
    At the end of 2010, the Federico II University Hospital in Naples, Italy, initiated a series of discussions aimed at designing and applying a positioning matrix to its departments. This analysis was developed to create a tool able to extract meaningful information both to increase knowledge about individual departments and to inform the choices of general management during strategic planning. The name given to this tool was the positioning matrix of economic efficiency and complexity. In the matrix, the x‐axis measures the ratio between revenues and costs, whereas the y‐axis measures the index of complexity, thus showing “profitability” while bearing in mind the complexity of activities. By using the positioning matrix, it was possible to conduct a critical analysis of the characteristics of the Federico II University Hospital and to extract useful information for general management to use during strategic planning at the end of 2010 when defining medium‐term objectives. Copyright © 2013 John Wiley & Sons, Ltd.
    April 25, 2013   doi: 10.1002/hpm.2189   open full text
  • Healthcare reform in Italy: an analysis of efficiency based on nonparametric methods.
    Arianna De Nicola, Simone Gitto, Paolo Mancuso, Vivian Valdmanis.
    The International Journal of Health Planning and Management. April 25, 2013
    Over the past twenty years, important changes in the Italian health system have led to different approaches in organizing, delivering and financing health services throughout the country's regions. In this paper, we assess the impacts that such changes have had on health efficiency. The analysis performed here is in two stages. In the first stage, healthcare efficiency is measured via bootstrapped Data Envelopment Analysis. In the second stage, the impacts of organizational and environmental variables on efficiency are investigated. Our results highlight that the organizational model adopted by the Lombardia region allows for the best results in healthcare efficiency in Italy. A process of administrative decentralization from the regional governments to local health units appears to be a source of inefficiency. Finally, patient mobility has a significant impact on healthcare efficiency. Copyright © 2013 John Wiley & Sons, Ltd.
    April 25, 2013   doi: 10.1002/hpm.2183   open full text
  • Bringing antiretroviral therapy (ART) closer to the end‐user through mobile clinics and home‐based ART: systematic review shows more evidence on the effectiveness and cost effectiveness is needed.
    Noreen Dadirai Mdege, Stanley Chindove.
    The International Journal of Health Planning and Management. April 22, 2013
    Background Home‐based antiretroviral therapy (ART) and ART through mobile clinics can potentially increase access to ART for large numbers of people, including hard‐to‐reach populations. We reviewed literature on the effectiveness and cost implications of the home‐based ART and mobile clinic ART models. Methods We searched Medline, Embase, PsycInfo, CINAHL, Cochrane Library, Web of Knowledge and Current Controlled Trials Register for articles published up to March 2012. We included non‐randomised and randomised controlled clinical trials that recruited HIV/AIDS positive adults with or without prior exposure to ART. Results Six studies were included in the review, with only four effectiveness studies (all evaluating home‐based ART and none for mobile clinic ART) and four studies reporting on the cost implications. The evidence suggests home‐based ART is as effective as health facility‐based ART, including on clinical outcomes, viral load and CD4+ count. However, three of these studies were very small. Studies suggest health facility‐based ART is the most cost‐effective, followed by mobile‐clinic ART, with home‐based ART being the least cost‐effective. Conclusions Evidence on the effectiveness and cost implications of mobile clinic and home‐based ART is currently limited. Although the few available studies suggest home‐based ART can potentially be as effective as health facility‐based ART, there is need for more research before robust conclusions can be made. Results from the few available studies also suggest that health facility‐based ART is the most cost‐effective. Copyright © 2013 John Wiley & Sons, Ltd.
    April 22, 2013   doi: 10.1002/hpm.2185   open full text
  • Experiences with primary healthcare in Fuzhou, urban China, in the context of health sector reform: a mixed methods study.
    Rosalind McCollum, Lieping Chen, Tang ChenXiang, Xiaoyun Liu, Barbara Starfield, Zheng Jinhuan, Rachel Tolhurst.
    The International Journal of Health Planning and Management. April 09, 2013
    China has recently placed increased emphasis on the provision of primary healthcare services through health sector reform, in response to inequitably distributed health services. With increasing funding for community level facilities, now is an opportune time to assess the quality of primary care delivery and identify areas in need of further improvement. A mixed methodology approach was adopted for this study. Quantitative data were collected using the Primary Care Assessment Tool‐Chinese version (C‐PCAT), a questionnaire previously adapted for use in China to assess the quality of care at each health facility, based on clients' experiences. In addition, qualitative data were gathered through eight semi‐structured interviews exploring perceptions of primary care with health directors and a policy maker to place this issue in the context of health sector reform. The study found that patients attending community health and sub‐community health centres are more likely to report better experiences with primary care attributes than patients attending hospital facilities. Generally low scores for community orientation, family centredness and coordination in all types of health facility indicate an urgent need for improvement in these areas. Healthcare directors and policy makers perceived the need for greater coordination between levels of health providers, better financial reimbursement, more formal government contracts and recognition/higher status for staff at the community level and more appropriate undergraduate and postgraduate training. Copyright © 2013 John Wiley & Sons, Ltd.
    April 09, 2013   doi: 10.1002/hpm.2165   open full text
  • Changes in healthcare use across the transition from civilian to military life.
    Stephanie K. McWhorter, Valerie A. Stander, Cynthia J. Thomsen, Lex L. Merrill, Joel S. Milner.
    The International Journal of Health Planning and Management. April 08, 2013
    Patterns of healthcare use in a sample of young adults entering the US Navy (N = 1137) were examined in a longitudinal survey study. Baseline data provided information about healthcare use as a civilian, whereas follow‐up data were used to examine changes in patterns of use over time following entry into the Military Health System (MHS). Entrance into the MHS was marked by increased use of preventive care. Although few systematic differences were noted with respect to socioeconomic status or race/ethnicity, women consistently used more healthcare than did men, and women's use increased more over time; however, this increase was largely driven by pregnancy during military service. Findings suggest that individuals with access to universal healthcare are likely to increase their overall use of services. However, these effects were quite small in absolute terms, and they were strongest for preventive care rather than more intensive and expensive services. Published 2013. This article is a US Government work and is in the public domain in the USA.
    April 08, 2013   doi: 10.1002/hpm.2176   open full text
  • Beyond feedback control: the interactive use of performance management systems. Implications for process innovation in Italian healthcare organizations.
    Chiara Demartini, Piero Mella.
    The International Journal of Health Planning and Management. April 08, 2013
    This paper shows how the use of performance management systems affects managers' perception of satisfaction, the effectiveness of the control system and the performance related to process innovation. An exploratory empirical research has been conducted on 85 managers operating in Italian healthcare organizations. Empirical findings put forward that the interactive—as opposed to diagnostic—use of performance management systems enhances managerial satisfaction with the control system and managerial perception of effectiveness. The present study then showed that it is not the control itself that is an obstacle to innovation in organizations in general (and in health organizations in particular) but the diagnostic use of the control mechanisms, which impedes the interaction between the control personnel and those subject to the control. Finally, this paper addresses managerial implications and further research avenues. Copyright © 2013 John Wiley & Sons, Ltd.
    April 08, 2013   doi: 10.1002/hpm.2177   open full text
  • Hospital decentralisation in Romania: stakeholders' perspectives in the newsprint media.
    Adela Elena Popa.
    The International Journal of Health Planning and Management. April 05, 2013
    In the summer of 2010, Romania undertook a process of hospital decentralisation as part of the reform in the healthcare sector. The national newsprint media covered the process thoroughly. This paper is a study of how key stakeholders' views, attitudes, beliefs and attitudes towards decentralisation are represented in print media. 106 articles, published between June and September 2010, retrieved from the online databases of six leading national dailies were analysed. A mixed methodology was used in the data analysis stage. The qualitative data exploration identified five voices belonging to stakeholders involved directly or indirectly in the process: the representatives of central government, the local authorities (district and local councils, municipal mayors), health professionals (managers and physicians in hospitals), the media (journalists, analysts) and finally voices from civil society, professional associations and advocacy groups. These were the main actors negotiating the subjective meanings of the decentralisation process. An imbalance between these key actors were observed in the frequency, content and tone of the messages delivered in media during the four months. Central government and the local authorities were the most active voices, but the respective discourses differed significantly. An analysis of the accounts identified three main themes: the financial problem (hospitals liabilities and future spending), human resource in hospitals (the impact of decentralisation upon it) and the political character of the decentralisation. Copyright © 2013 John Wiley & Sons, Ltd.
    April 05, 2013   doi: 10.1002/hpm.2168   open full text
  • Implementation of pro‐poor exemption policy in Tanzania: policy versus reality.
    Aisha Idd, Odongo Yohana, Stephen Oswald Maluka.
    The International Journal of Health Planning and Management. April 04, 2013
    Like many other African countries, Tanzania has been implementing user fee policy in its health sector since the early 1990s. Accompanying user fee, mechanisms were designed that exempted the poor and vulnerable groups of the society from paying user charges. Although studies on the implementation of exemption policies in Tanzania exist, very few have documented the actual process of translating exemption policies into actions—the process of implementation. Drawing from policy analysis and implementation theories, this paper documents the implementation of the waiver (need‐based exemptions) policy in Tanzania. The findings indicate that waiver systems, while potentially effective in principle, were ineffective in implementation. Lack of specification of criteria by which the poor could be identified made policy implementers at different levels to implement the policy in their own style. Low level of public awareness about the existence of waiver mechanisms hindered the poor to demand exemptions. Furthermore, fear of loss of revenue at the health facilities and ineffective enforcement mechanisms provided little incentives for local government leaders and health workers to communicate the policy to beneficiaries. It is concluded from this study that to better achieve the objectives of the pro‐poor exemption policy, it is important to engage policy implementers more actively in the management and implementation of policies. Additionally, it is imperative to understand the behaviour and practices of policy implementers, especially district health managers, health workers and village and ward leaders, who may react negatively to new policies and implement the policies in ways contrary to what policy makers had intended. Copyright © 2013 John Wiley & Sons, Ltd.
    April 04, 2013   doi: 10.1002/hpm.2174   open full text
  • Describing the primary care system capacity for the prevention and management of non‐communicable diseases in rural Vietnam.
    Hoang Van Minh, Young Kyung Do, Mary Ann Cruz Bautista, Tran Tuan Anh.
    The International Journal of Health Planning and Management. April 04, 2013
    Background The primary care system in Vietnam has been shown to play a crucial role in disease prevention and health promotion. This study described the primary care system in a selected rural area in Vietnam in terms of its capacity for prevention and control of non‐communicable diseases (NCDs). Methods The study was conducted in 2011 in Dong Hy district, Thai Nguyen province—a rural community located in northern Vietnam. Mixed methods were used, including quantitative and qualitative and literature review approaches, to collect data on the current status of the six building blocks of the primary care system in Dong Hy district. Selected health workers and stakeholders in the selected healthcare facilities were surveyed. Results A description of Dong Hy district's primary care capacity for NCD prevention and control is reported. (i) Service delivery: The current practice in NCD prevention and treatment is mainly based on a single risk factor rather than a combination of cardiovascular disease risks. (ii) Governance: At the primary care level, multi‐sectoral collaborations are limited, and there is insufficient integration of NCD preventive activities. (iii) Financing: A national budget for NCD prevention and control is lacking. The cost of treatment and medicines is high, whereas the health insurance scheme limits the list of available medicines and the reimbursement ceiling level. Health workers have low remuneration despite their important roles in NCD prevention. (iv) Human resources: The quantity and quality of health staff working at the primary care level, especially those in preventive medicine, are insufficient. (v) Information and research: The health information system in the district is weak, and there is no specific information system for collecting population‐based NCD data. (vi) Medical products and technology: Not all essential equipment and medicines recommended by the WHO are always available at the commune health centre. Conclusion The capacity of the primary care system in Vietnam is still inadequate to serve the NCD‐related health needs of the population. There is an urgent need to improve the primary care capacity for NCD prevention and management in Vietnam. Copyright © 2013 John Wiley & Sons, Ltd.
    April 04, 2013   doi: 10.1002/hpm.2179   open full text
  • Motivating health workers for the provision of directly observed treatment to TB patients in rural China: does cash incentive work? A qualitative study.
    Tao Tao, Qi Zhao, Shiwen Jiang, Liping Ma, Liya Wan, Yongcheng Ma, Biao Xu.
    The International Journal of Health Planning and Management. April 02, 2013
    As a key component of DOTS (directly observed treatment, short course) strategy, DOT is essential in the prevention of drug‐resistant tuberculosis. However, DOT had very poor implementation in rural areas of China. One major reason to this problem was the lack of incentives for DOT providers. In 2005, the Chinese Minister of Health released an incentive strategy that aimed to improve the DOT performance of rural health workers by providing allowances. Our study used a qualitative method to explore the practical impact of this incentive strategy in motivating rural DOT providers, and searched for other potential incentive measures as well. A total of 16 focus group discussions were carried out among 102 rural health workers in eight counties of China. A semi‐structured theme outline was used to collect the perception, attitude and experiences of health workers toward the DOT implementation as well as the cash incentive strategy. Findings showed that DOT allowance had some incentive effect to DOT providers, but its extent was circumscribed by the small amount and operational problems. Raising DOT allowance and removing existing barriers to DOT provision might result in a greater motivational impact, particularly in less developed areas of China, where health workers were more likely to encounter financial and other obstacles in delivering DOT services to TB patients in rural areas. Copyright © 2013 John Wiley & Sons, Ltd.
    April 02, 2013   doi: 10.1002/hpm.2175   open full text
  • Improving primary healthcare through accreditation: baseline assessment of readiness and challenges in lebanese context.
    Fadi El‐Jardali, Walid Ammar, Randa Hemadeh, Diana Jamal, Maha Jaafar.
    The International Journal of Health Planning and Management. March 20, 2013
    The quality of primary healthcare (PHC) has become of high importance. In 2009, the Lebanese Ministry of Public Health launched the PHC accreditation program to expand and improve quality across the continuum of care. This study will explore the readiness of PHC centers in Lebanon to implement the newly developed accreditation standards including challenges and required actions/strategies. Seventy‐two centers were sampled, and respondents were asked to complete a 65‐item questionnaire adapted from the national PHC accreditation standards and two open‐ended questions. Descriptive analysis was conducted to assess responses to each item. Thematic analysis was used to analyze open‐ended questions. Scale scores were considerably low, particularly for areas that relate to quality of service delivery. Most respondents (59.8%) indicated not having a strategic plan on the basis of community needs. Close to 70% of respondents indicated that they do not monitor and investigate trends in rates of sentinel events, near misses, and adverse events. Moreover, 76.2% indicated not having a system for incident and accident‐reporting, and only 22.3% reported using one. The PHC accreditation in Lebanon can potentially reform this essential health system component. Results provide insights for policymakers and managers to consider in their efforts to improve quality and performance of PHC centers in Lebanon. Copyright © 2013 John Wiley & Sons, Ltd.
    March 20, 2013   doi: 10.1002/hpm.2170   open full text
  • Evaluation of Taiwan's National Health Insurance policy: an importance–satisfaction analysis.
    I‐Chun Liu.
    The International Journal of Health Planning and Management. March 14, 2013
    The hypothesis that policy performance affects citizens' satisfaction with public policies could be considered a well‐worn topic. However, this paper shows that the extant literature has not adequately conceptualized nor addressed the relationship, which could exist between citizens' satisfaction and importance of the evaluation's indicators. The findings of most previous studies reflect elite perspectives on Taiwan's National Health Insurance (NHI) policy evaluation, and the importance of the evaluation's indicators may not be recognized by the public. In addition, previous satisfaction studies have not provided information on the level of evaluative indicator importance. This study utilized importance–satisfaction analysis to examine public preferences of the NHI policy and assigned weights for NHI policy evaluation indicators by administering a national phone survey in October 2009. A total of 1103 telephone interviews were conducted with people aged 20 years and older, comprising a sample that was representative of the Taiwanese population according to age, gender, and area of residence. Furthermore, to explore the difference between expected importance and perceived satisfaction, this study calculated a reconceptualized performance gap. To obtain the gap value for an indicator, the mean value for importance was subtracted from the mean value for satisfaction. The findings imply that public recognition and support constitute the premise for the successful operation and reform of the NHI policy. The study concludes that policy adjustment is needed in several areas where importance outweighed satisfaction, including access to medical care services and NHI efficiency. The results suggest public recognition of and satisfaction with the evaluation indicators in use and the need for policy adjustment in areas where importance outweighs satisfaction. Copyright © 2013 John Wiley & Sons, Ltd.
    March 14, 2013   doi: 10.1002/hpm.2173   open full text
  • Effect of travel distance on household demand for typhoid vaccines: implications for planning.
    Dohyeong Kim, Donald T. Lauria, Christine Poulos, Baiqing Dong, Dale Whittington.
    The International Journal of Health Planning and Management. March 12, 2013
    Typhoid fever causes millions of illnesses and hundreds of thousands of deaths yearly. Vaccinations would mitigate this problem, but the users would probably have to pay some or most of the cost. Several willingness‐to‐pay studies have assessed the effect of price on private demand to provide a basis for financial planning of campaigns, but the effect of travel distance, which is a potentially important determinant of demand, has not been studied. This paper thus has two objectives: (i) conduct a willingness‐to‐pay survey to assess the effects of distance, price and other variables on the private demand for typhoid vaccinations in a rural township of China where a campaign is under consideration; and (ii) embed the demand function in a mathematical model to address three planning questions; should each village have its own clinic, would one clinic be best or should the number of clinics be something in‐between? Private vaccine demand was found to depend on and be inelastic with respect to both price and travel distance. A 1‐km increase in distance caused the number of vaccinations demanded to decrease the same as a $0.5 increase in price. Thus, the marginal rate of substitution was $0.5 per km. A single clinic would be best for the township only if diseconomies of scale in supplying vaccinations exceeded the marginal rate of substitution. Otherwise, multiple clinics close to users would be optimal. Thus, deciding the number, location and capacities of clinics for vaccination planning is as important as deciding what price(s) to charge. Copyright © 2013 John Wiley & Sons, Ltd.
    March 12, 2013   doi: 10.1002/hpm.2172   open full text
  • The impact of total quality service (TQS) on healthcare and patient satisfaction: An empirical study of Turkish private and public hospitals.
    Ismail Bakan, Tuba Buyukbese, Burcu Ersahan.
    The International Journal of Health Planning and Management. March 12, 2013
    This paper attempts to measure patients' perceptions of the quality of services in public and private healthcare centers in Turkey. The main aim was to examine the impact of the dimensions of patient‐perceived total quality service (TQS) on patients' satisfaction. The research framework and hypotheses are derived from a literature review of service quality and quality in the healthcare industry. The research data were collected through questionnaires and then statistically analyzed using descriptive statistics, Pearson product moment correlation and linear regression. The results suggest that service quality perceptions positively influence patient satisfaction with overall hospital care (SOHC). The most important factors identified in the regression model regarding patient SOHC are the quality of the hospital's social responsibility, administrative processes and overall experience of medical care received. These factors explain 74% of the variance in SOHC. The findings of the study can be used to improve TQS in both private and public hospitals. Copyright © 2013 John Wiley & Sons, Ltd.
    March 12, 2013   doi: 10.1002/hpm.2169   open full text
  • Health care expenditures from living longer—how much do they matter.
    Afschin Gandjour.
    The International Journal of Health Planning and Management. February 18, 2013
    Health interventions have two major downstream cost effects, savings from reducing morbidity and expenditures from living longer. Anecdotal evidence suggests that many economic evaluations, particularly those that are trial‐based, do not include health care costs from living longer. The purpose of this study was therefore to determine the bias from excluding life extension costs in economic evaluations. To this end, the impact of health changes on savings from preventing disease and costs of living longer was examined in the US Medicare population between 1998 and 2004. A state transition decision model with two health states (alive and dead) was built from an extended payer's perspective. It used Medicare expenditure data on survivors and decedents. Health changes were measured in terms of both morbidity and mortality reduction. The analysis shows that life extension costs cancel out savings from reducing morbidity. Users of economic evaluations may use this finding to estimate the bias when life extensions costs are not included in the analysis. Copyright © 2013 John Wiley & Sons, Ltd.
    February 18, 2013   doi: 10.1002/hpm.2164   open full text
  • Financing incidence analysis of household out‐of‐pocket spending for healthcare: getting more health for money in Nigeria?
    Obinna Onwujekwe, Kara Hanson, Hyacinth Ichoku, Benjamin Uzochukwu.
    The International Journal of Health Planning and Management. February 07, 2013
    The study examined the burden of out‐of‐pocket spending (OOPS) to households, because available data showed that OOPS dominates household expenditure on health in Nigeria. The study took place in rural and urban districts in Nigeria. A household questionnaire was used to collect data from 4873 households on their healthcare expenditures and payment mechanisms by using a 1‐month expenditure recall period. Financing incidence analysis was assessed at the household level on the basis of socio‐economic status (SES) groups and rural–urban location of the households. Concentration curves of OOPS were plotted with the Lorenz curve of total household expenditures to show the distribution of the burden of OOPS by SES compared with total household expenditure. The Kakwani index was computed to examine the overall progressivity or regressivity of OOPS. There was lack of financial risk protection for healthcare in the study area. The results showed that 3150 (98.8%) of payments were made using OOPS, nine (0.3%) using reimbursement by employers, one (0.03%) through private voluntary health insurance (PVHI), nine (0.3%) using instalment and 14 (0.44%) through ‘others’. The average monthly household OOPS was 2219.1 Naira. The Kakwani index for financing incidence of OOPS was −0.18, showing that OOPS was regressive. The most‐poor SES groups and rural dwellers experienced the highest burden of health expenditure. Urgent steps should be taken by the government to increase or enhance universal coverage in the country with financial protection mechanisms such as the National Health Insurance Scheme in addition to possibly abolishing some of the user fees that cause high incidence and burden of OOPS. Copyright © 2013 John Wiley & Sons, Ltd.
    February 07, 2013   doi: 10.1002/hpm.2166   open full text
  • Using the nominal group technique to engage people with chronic pain in health service development.
    David Wainwright, Charlotte Boichat, Lance M. McCracken.
    The International Journal of Health Planning and Management. January 14, 2013
    In this methodological paper, we discuss the use of the nominal group technique to facilitate the involvement of people with chronic pain and other stakeholder groups in the design of a community‐based pain management programme. On the basis of our experiences of using the technique in a study conducted in the south‐west region of the UK, we explore conceptual and logistical issues relating to patient involvement in health service development, discuss political issues relating to the articulation and synthesis of different stakeholder perspectives, and provide a description of how the technique can be applied in the aforementioned context. We conclude that although the nominal group technique is not a panacea for the difficulties encountered in patient involvement, it does offer advantages over other approaches. Copyright © 2013 John Wiley & Sons, Ltd.
    January 14, 2013   doi: 10.1002/hpm.2163   open full text
  • Do prevailing theories sufficiently explain perceptions and health‐seeking behavior of Ghanaians?
    Christine J. Fenenga, Kwasi Boahene, Daniel Arhinful, Tobias Rinke Wit, Inge Hutter.
    The International Journal of Health Planning and Management. January 10, 2013
    The challenges faced by African countries that have pioneered a national health insurance scheme (NHIS) and the lessons learned can be of great value to other countries, contemplating the introduction of such a health financing system. In 2003, Ghana initiated the NHIS to provide access to healthcare for people in both the formal and informal sectors. The paper assesses the applicability of four theoretical models to explain the perceptions and decisions of Ghanaians to participate in the NHIS. To contextualize these models, we used qualitative data from individual and group interviews of Ghanaians. These interviews form part of the study “towards a client‐oriented health insurance system in Ghana” to explain the uptake of the Ghanaian social health insurance. The paper argues for a new integrated model to provide a better understanding of clients' perceptions on illness, healthcare and health insurance. Such a model should highlight trust as a fundamental factor influencing the decision of Ghanaians to enroll in the NHIS. Copyright © 2013 John Wiley & Sons, Ltd.
    January 10, 2013   doi: 10.1002/hpm.2159   open full text
  • Regional inequity in financing New Cooperative Medical Scheme in Jiangsu, China.
    Baozhen Dai, Lulin Zhou, Y. John Mei, Changchun Zhan.
    The International Journal of Health Planning and Management. January 08, 2013
    This study examined the regional inequity in the New Cooperative Medical Scheme (NCMS) financing in Jiangsu, China. Counties were classified into three categories according to socio‐economic development level: South Jiangsu, Middle Jiangsu and North Jiangsu. Five counties (Changshu, Danyang, Gaoyou, Jiangyan and Ganyu) were selected on the basis of the following criteria: (i) NCMS had been implemented before 2005; (ii) county governments were willing and able to collaborate with the research team; and (iii) counties had different socio‐economic development status representing the low, medium and high level of socio‐economic development in Jiangsu. As shown in this study, local governments in Jiangsu took the major NCMS financing responsibilities (75.2% in 2009), and local governments (county and lower) subsidies ranged from 220 RMB per capita in South Jiangsu to 18 RMB per capita in North Jiangsu in 2009, with a larger contribution (73.3%) in South than that in Middle (40.0%) and North Jiangsu (18.0%). For achieving more equity in NCMS financing and carrying NCMS forward, we propose that provincial and municipal governments should increase their contribution to NCMS for balancing the regional inequity in subsidies from county and lower‐level governments, and the risk pool of NCMS should be promoted to a higher level (e.g., provincial). Copyright © 2013 John Wiley & Sons, Ltd.
    January 08, 2013   doi: 10.1002/hpm.2162   open full text
  • Mental health in France, policies and actors: developing administrative knowledge in a segmented world.
    Philippe Mossé, Caroline Maury, Nicolas Daumerie, Jean‐Luc Roelandt.
    The International Journal of Health Planning and Management. December 28, 2012
    The new mental health care policy, which has been set up in France, involves a change of paradigm, which has been going on since the 2000s: the emphasis is shifting from psychiatry to mental health care. This shift mainly concerns the knowledge about mental health is produced and circulates among an increasingly large number of bodies. Mainly grounded on actor interview analysis, official reports and blueprints, this study shows that the results of this process are numerous. They include the development of ambulatory care and strong moves towards decentralization. More data and knowledge are therefore to be shared in this more complex system. However, the French State, in the form of the central administration, is taking advantage of this move and is still contributing significantly to the definition and implementation of the new policy. On the other hand, the new governance dynamic is not leading to standardization of medical practices, as the mental health field remains highly heterogeneous. Copyright © 2012 John Wiley & Sons, Ltd.
    December 28, 2012   doi: 10.1002/hpm.2158   open full text
  • Evaluation of a changed model of care delivery in a Canadian province using outcome mapping.
    Gail Tomblin Murphy, Adrian MacKenzie, Rob Alder, Cindy Cruickshank.
    The International Journal of Health Planning and Management. December 28, 2012
    Background Collaboration between the Nova Scotia Department of Health and Wellness, the province's District Health Authorities (DHAs) and the Izaak Walton Killam (IWK) Health Center led to the development and implementation of a new collaborative model of patient‐centered care delivery in the province. Objective The objective was to determine the effectiveness of the initiative in arriving at the envisioned care model by investigating its impacts (if any) on patient, system, and providers outcomes. Methods A repeated surveys study design with mixed methods in an outcome mapping framework was used to measure process and outcome indicators for patients and families, providers, and the system. Results Almost all outcomes at the patient and family, provider, and system level improved following the implementation of the model, and these effects were stronger on units where the model was more fully implemented. Conclusions The efforts of the province, DHAs and IWK to improve patient care through the new care model have been successful. This evaluation is unique in the broad range of indicators it incorporates. Comprehensive monitoring and evaluation of health system changes is critical to system effectiveness. Copyright © 2012 John Wiley & Sons, Ltd.
    December 28, 2012   doi: 10.1002/hpm.2157   open full text
  • An analysis of relationships among transformational leadership, job satisfaction, organizational commitment and organizational trust in two Turkish hospitals.
    Mehmet Top, Menderes Tarcan, Sabahattin Tekingündüz, Neşet Hikmet.
    The International Journal of Health Planning and Management. December 14, 2012
    The purpose of this study was to investigate the relationships among employee organizational commitment, organizational trust, job satisfaction and employees' perceptions of their immediate supervisors' transformational leadership behaviors in Turkey. First, this study examined the relationships among organizational commitment, organizational trust, job satisfaction and transformational leadership in two Turkish public hospitals. Second, this investigation examined how job satisfaction, organizational trust and transformational leadership affect organizational commitment. Moreover, it was aimed to investigate how organizational commitment, job satisfaction and transformational leadership affect organizational trust. A quantitative, cross‐sectional method, self‐administered questionnaire was used for this study. Eight hundred four employees from two public hospitals in Turkey were recruited for collecting data. The overall response rate was 38.14%. The measurement instruments of survey were the Job Satisfaction Survey (developed by P. Spector), the Organizational Commitment Questionnaire (developed by J. Meyer and N. Allen), the Organizational Trust Inventory‐short form (developed by L. Cummings and P. Bromiley) and the Transformational Leadership Inventory (TLI) (developed by P. M. Podsakoff). Five‐point Likert scales were used in these measurement instruments. Correlation test (the Pearson's rank test) was used to examine relationships between variables. Also, multiple regression analysis was used to determine the regressors for organizational commitment and organizational trust. There were significant relationships among overall job satisfaction, overall transformational leadership and organizational trust. Regression analyses showed that organizational trust and two job satisfaction dimensions (contingent rewards and communication) were significant predictors for organizational commitment. It was found that one transformational leadership dimension (articulating a vision), two job satisfaction dimensions (pay and supervision) and two organizational commitment dimensions (affective commitment and normative commitment) were significant regressors for organizational trust. There is a lack of research in the health organizations regarding organizational commitment, organizational trust, job satisfaction and transformational leadership. The investigator of the proposed study intends to add to the literature and intends to prove that the proposed study would be important for healthcare organizations. A number of specific measures should be undertaken to reduce factors that negatively affect organizational commitment, organizational trust and job satisfaction of hospital personnel and to improve transformational leadership behaviors of hospital administrators. Copyright © 2012 John Wiley & Sons, Ltd.
    December 14, 2012   doi: 10.1002/hpm.2154   open full text
  • Barriers to and facilitators of the implementation of health promoting hospitals in Taiwan: a top‐down movement in need of ground support.
    Chiachi Bonnie Lee, Michael S. Chen, Ying Wei Wang.
    The International Journal of Health Planning and Management. December 10, 2012
    This study investigates barriers to and facilitators of health promoting hospitals (HPH) in Taiwan. The findings are based on a cross‐sectional questionnaire survey involving 55 hospitals committed to health promotion (HP) as of the end of 2009, and 52 of them completed the questionnaire. The five most reported barriers are inadequate national health insurance coverage of HP, staff detachment, incoherence of government policies, weak inter‐sectoral link and resistance to change. The five most reported facilitators are support from hospital superintendents, support from unit/department directors, HP‐inclusive hospital development mission and goals, funding from the government, founding of HP‐related committees, resources and healthy policies. The study also found that organizational capacity building (OCB) had a significantly negative association with the number of barriers and a positive association with the number of facilitators. Stepwise linear regressions further found that OCB in structure was a significant predictor of the fewer number of barriers and that in‐staff participation was a significant predictor of the more perceived facilitators. It also confirmed the significant role of organizational capacity building and that of coordinators in the effective implementation of HPH. The transformational factors as well as transactional factors are very much at work as facilitators, but the transactional factors are trapped in a less‐than‐friendly environment. Comprehensive support from transformational factors as well as transactional factors is essential and further support for daily routine operations and staff participation are required to sustain the implementation of HPH in Taiwan. Copyright © 2012 John Wiley & Sons, Ltd.
    December 10, 2012   doi: 10.1002/hpm.2156   open full text
  • Management characteristics of successful public health programs: “Avahan” HIV prevention program in India.
    Shunsuke Mabuchi, Suneeta Singh, Rituparna Bishnu, Sara Bennett.
    The International Journal of Health Planning and Management. December 05, 2012
    Objectives This paper analyzes Avahan, an HIV prevention program in India, that achieved very rapid scale‐up. The paper aims to (i) define the distinctive features of the management of Avahan, (ii) examine how the distinctive features relate to key constructs in management frameworks and (iii) investigate how the management approaches of Avahan contributed to the program's ability to scale‐up rapidly while maintaining service quality. Design, setting and participants The Delphi method was used to identify the distinctive features of Avahan. Through three rounds of questions, 38 participants closely associated with Avahan were asked to identify and develop consensus on its distinctive features. These features were then mapped against the Baldrige Health Care Criteria for Performance Excellence to investigate how they related to important dimensions of management. Results A total of 17 distinctive features of Avahan were identified. These distinctive features emphasized the importance of data use and performance monitoring at all levels, especially combined with a flexible management style that facilitated local responsiveness to community, innovation and learning. The distinctive features comprehensively addressed the criteria for management excellence in the Baldridge framework. Conclusions In the case of Avahan, the rigorous application of known management techniques to public health programs appears to have been an important factor in the successful scale‐up of the program. Also, the Baldrige criteria seem applicable to health programs in low‐income and middle‐income countries; further applications would help test their robustness and utility in such contexts. Copyright © 2012 John Wiley & Sons, Ltd.
    December 05, 2012   doi: 10.1002/hpm.2153   open full text
  • The level of consumer information about health insurance in Nanjing, China.
    Weiwei Xu, Wynand P. M. M. Ven.
    The International Journal of Health Planning and Management. November 21, 2012
    The Chinese government is considering a (regulated) competitive healthcare system. Sufficient consumer information is a crucial pre‐condition to benefit from such a change. We conducted a survey on the level of consumer information regarding health insurance among the insured population in Nanjing, China in 2009. The results from descriptive analysis and binary logistic regression demonstrate that the current level of consumer information about health insurance is low. The level of consumer information is positively correlated with the subscribers' motivation to obtain the information and its availability. The level of searching for health insurance information is also low; moreover, even upon searching, the chance of finding relevant information is less than 25%. We conclude that the level of consumer information is currently insufficient in China. If the Chinese government is determined to adopt market mechanisms in the healthcare sector, it should take the lead in making valid and reliable information publicly available and easily accessible. Copyright © 2012 John Wiley & Sons, Ltd.
    November 21, 2012   doi: 10.1002/hpm.2138   open full text
  • Forty years of USAID health cooperation in Bolivia. A lose–lose game?
    Herland Tejerina, Marie‐Christine Closon, Pierre De Paepe, Christian Darras, Patrick Van Dessel, Jean‐Pierre Unger.
    The International Journal of Health Planning and Management. November 20, 2012
    The present article proposes an analysis of the USA–Bolivia relationships in the health sector between 1971 and 2010 based on a grey and scientific literature review and on interviews. We examined United States Agency for International Development (USAID) interventions, objectives, consistency with Bolivian needs, and impact on health system integration. USAID operational objectives—decentralization, fertility and disease control, and maternal and child health—may have worked against each other while competing for limited Ministry of Health resources. They largely contributed to the segmentation and fragmentation of the Bolivian health system. US cooperation in health did not significantly improve health status while the USAID failed to properly tackle anti‐drugs, political, and economic US interests in Bolivia. Copyright © 2012 John Wiley & Sons, Ltd.
    November 20, 2012   doi: 10.1002/hpm.2149   open full text
  • Estimating the unit costs of public hospitals and primary healthcare centers.
    Mustafa Z. Younis, Samer Jaber, Anthony R. Mawson, Michael Hartmann.
    The International Journal of Health Planning and Management. November 05, 2012
    Background Many factors have affected the rise of health expenditures, such as high‐cost medical technologies, changes in disease patterns and increasing demand for health services. All countries allocate a significant portion of resources to the health sector. In 2008, the gross domestic product of Palestine was estimated to be at $6.108bn (current price) or about $1697 per capita. Health expenditures are estimated at 15.6% of the gross domestic product, almost as much as those of Germany, Japan and other developed countries. The numbers of hospitals, hospital beds and primary healthcare centers in the country have all increased. The Ministry of Health (MOH) currently operates 27 of 76 hospitals, with a total of 3074 beds, which represent 61% of total beds of all hospitals in the Palestinian Authorities area. Also, the MOH is operating 453 of 706 Primary Health Care facilities. By 2007, about 40 000 people were employed in different sectors of the health system, with 33% employed by the MOH. Aim This purpose of this study was to develop a financing strategy to help cover some or all of the costs involved in operating such institutions and to estimate the unit cost of primary and secondary programs and departments. Methods A retrospective study was carried out on data from government hospitals and primary healthcare centers to identify and analyze the costs and output (patient‐related services) and to estimate the unit cost of health services provided by hospitals and PHCs during the year 2008. All operating costs are assigned and allocated to the departments at MOH hospitals and primary health care centers (PPHCs) and are identified as overhead departments, intermediate‐service and final‐service departments. Intermediate‐service departments provide procedures and services to patients in the final‐service departments. The costs of the overhead departments are distributed to the intermediate‐service and final‐service departments through a step‐down method, according to allocation criteria devised to resemble as closely as possible the actual use of resources by each of the departments. The data were analyzed using spss. Data cleaning was carried out by cross‐validating the results through conducting cross‐tabulations between the hospital/center and section/program to identify errors from the data collection or entry process. Depreciation of assets and the consumption of capital costs are ignored in this study, as it is difficult to evaluate the MOH facilities owing to a lack of recording of depreciation of assets or other costs of servicing capital assets. Results Inpatient costs contributed about 75% of all costs, whereas outpatient services contributed the remaining 25% of total costs. The average cost per visit was $13.00 for outpatient departments, whereas the average cost per patient day for inpatient departments was $90.00. As for the unit cost for each department, intensive care unit and intermediate care unit services were the highest among all categories of daily hospital services ($208.00). This is in contrast to surgical operations ($124.00), specialized surgeries ($106.00), delivery department ($99.00), orthopedics ($98.50) and general surgery ($85.00). The lowest unit cost was found in the neonatology department ($72.00). In PHCs, the unit cost per visit was highest for psychiatry programs ($26.00), followed by other programs ($21.50), chronic diseases ($21.00), maternal and child health ($11.50), preventive programs ($9.00) and general medicine ($6.50). The exchange rate listed by The Wall Street Journal as of Wednesday August 25, 2010 is 1 US dollar = 3.82 new Israeli shekel (NIS). Conclusion The findings have implications for policy and decision making in the health sector in Palestine concerning the cost of services provided by hospitals and PHCs. The availability of a standardized data set for cost assessment would greatly enhance and improve the quality of financial information as well as efficiency in the use of scarce resources. Copyright © 2012 John Wiley & Sons, Ltd.
    November 05, 2012   doi: 10.1002/hpm.2147   open full text
  • A mixed‐methods assessment of sexual and gender‐based violence in eastern Democratic Republic of Congo to inform national and international strategy implementation.
    Jennifer Scott, Suzanne Polak, Michael Kisielewski, Mary McGraw‐Gross, Kirsten Johnson, Miel Hendrickson, Lynn Lawry.
    The International Journal of Health Planning and Management. October 29, 2012
    Context National and international strategies were implemented in eastern Democratic Republic of Congo (DRC) to address sexual and gender‐based violence (SGBV). Objectives The objective was to assess community attitudes of SGBV and health facility capacity to address SGBV in eastern DRC. Design and setting The design and setting are as follows: a cross‐sectional, population‐based cluster survey of 998 adults in eastern DRC territories, a convenience sample of 27 adults using semi‐structured directed interviews, qualitative data from 37 focus groups conducted in three health zones, assessment of 64 health facilities and a comparative analysis of SGBV strategies. Main outcome measures The main outcome measures opinions regarding SGBV prevention and justice and health facility capacity to address SGBV. Results The majority of respondents favored the legal system over community mediation to obtain justice for SGBV. However, 61.1% (95% CI, 51.8–70.5%) of SGBV survivors reported being forced to accept community mediation. Among SGBV survivors, 81.2% (95% CI, 74.5–87.8%) reported no available mental health care. Less than half of all respondents reported access to a hospital, clinic or pharmacy. The analyses and facility assessment reinforce the need to improve SGBV care. Conclusions Mixed methodologies point to the complexities of addressing SGBV, assess key elements of SGBV prevention, justice and response, and may ultimately inform national and international strategies. Copyright © 2012 John Wiley & Sons, Ltd.
    October 29, 2012   doi: 10.1002/hpm.2144   open full text
  • Thinking through health capacity development for Fragile States.
    Annabelle Mark, Mike Jones.
    The International Journal of Health Planning and Management. October 10, 2012
    The purpose of this paper is to consider capacity development for healthcare in Fragile States and its roles, for example, in securing civil and political stability, as well as improved health, within the various contexts prevailing in fragile settings across the world. As a precursor to this, however, it is important to understand how, in rapidly changing environments, the role and contribution of different donors will have an impact in different ways. This paper sets out to interpret these issues, and what becomes apparent is the need to develop an understanding of the value base of donors, which we demonstrate through the development of a value‐based framework. This highlights the separate motivations and choices made by donors, but what is apparent is that all remain within the positivist perspective perhaps for reasons of accountability and transparency. However, the emergence of new interpretations drawing on systems thinking, and followed by complexity theory more recently, in understanding contexts, suggests that the favouring of any one of these perspective can be counterproductive, without a consideration of the contexts in which they occur. In seeking an explanation of these environmental contexts, which also address the perspectives in use, we suggest the use of wider multi‐ontology sense‐making framework such as Cynefin. Through this approach, analytical insights can be given into the interpretation, decision and intervention processes available in these different and often changing environments, thus enabling greater coherence between donor values and recipient contexts. Copyright © 2012 John Wiley & Sons, Ltd.
    October 10, 2012   doi: 10.1002/hpm.2140   open full text
  • “Diagnosing” Saudi health reforms: is NHIS the right “prescription”?
    Omar Zayan Al‐Sharqi, Muhammad Tanweer Abdullah.
    The International Journal of Health Planning and Management. October 10, 2012
    This paper outlines the health context of the Kingdom of Saudi Arabia (KSA). It reviews health systems development in the KSA from 1925 through to contemporary New Health Insurance System (NHIS). It also examines the consistency of NHIS in view of the emerging challenges. This paper identifies the determinants and scope of contextual consistency. First, it indicates the need to evolve an indigenous, integrated, and comprehensive insurance system. Second, it highlights the access and equity gaps in service delivery across the rural and remote regions and suggests how to bring these under insurance coverage. Third, it suggests how inputs from both the public and private sectors should be harmonized – the “quality” of services in the private healthcare industry to be regulated by the state and international standards, its scope to be determined primarily by open‐market dynamics and the public sector welfare‐model to ensure “access” of all to essential health services. Fourth, it states the need to implement an evidence‐based public health policy and bridge inherent gaps in policy design and personal‐level lifestyles. Fifth, it points out the need to produce a viable infrastructure for health insurance. Because social research and critical reviews in the KSA health scenario are rare, this paper offers insights into the mainstream challenges of NHIS implementation and identifies the inherent weaknesses that need attention. It guides health policy makers, economists, planners, healthcare service managers, and even the insurance businesses, and points to key directions for similar research in future. Copyright © 2012 John Wiley & Sons, Ltd.
    October 10, 2012   doi: 10.1002/hpm.2148   open full text
  • Barriers to implementing WHO's exclusive breastfeeding policy for women living with HIV in sub‐Saharan Africa: an exploration of ideas, interests and institutions.
    Gwendolen G. Eamer, Glen E. Randall.
    The International Journal of Health Planning and Management. September 03, 2012
    The vertical transmission of HIV occurs when an HIV‐positive woman passes the virus to her baby during pregnancy, delivery or breastfeeding. The World Health Organization's (WHO) Guidelines on HIV and infant feeding 2010 recommends exclusive breastfeeding for HIV‐positive mothers in resource‐limited settings. Although evidence shows that following this strategy will dramatically reduce vertical transmission of HIV, full implementation of the WHO Guidelines has been severely limited in sub‐Saharan Africa. This paper provides an analysis of the role of ideas, interests and institutions in establishing barriers to the effective implementation of these guidelines by reviewing efforts to implement prevention of vertical transmission programs in various sub‐Saharan countries. Findings suggest that WHO Guidelines on preventing vertical transmission of HIV through exclusive breastfeeding in resource‐limited settings are not being translated into action by governments and front‐line workers because of a variety of structural and ideological barriers. Identifying and understanding the role played by ideas, interests and institutions is essential to overcoming barriers to guideline implementation. Copyright © 2012 John Wiley & Sons, Ltd.
    September 03, 2012   doi: 10.1002/hpm.2139   open full text
  • Distance to hospital and utilization of surgical services in Haiti: do children, delivering mothers, and patients with emergent surgical conditions experience greater geographical barriers to surgical care?
    James M. Friedman, Lars Hagander, Christopher D. Hughes, Katherine A. Nash, Allison F. Linden, Jeff Blossom, John G. Meara.
    The International Journal of Health Planning and Management. August 31, 2012
    Background An inverse relationship between healthcare utilization and distance to care has been previously described. The purpose of this study was to evaluate this effect related to emergency and essential surgical care in central Haiti. Methods We conducted a retrospective review of operative logbooks from the Clinique Bon Sauveur in Cange, Haiti, from 2008 to 2010. We used Geographic Information Systems to map the home locations of all patients. Spearman's correlation was used to determine the relationship between surgical utilization and distance, and a multivariate linear regression model identified characteristics associated with differences in distances traveled to care. Results The highest annual surgical utilization rate was 184 operations/100 000 inhabitants. We found a significant inverse correlation between surgical utilization rate and distance from residence to hospital (rs = −0.68, p = 0.02). The median distance from residence to hospital was 55.9 km. Pediatric patients lived 10.1% closer to the hospital than adults (p < 0.01), and distance from residence to hospital was not significantly different between men and women (p = 0.25). Patients who received obstetric or gynecologic surgery originated 7.8% closer to the hospital than patients seeking other operations (p < 0.01), and patients who received emergent surgical care originated 24.8% closer to the hospital than patients who received elective surgery (p < 0.01). Conclusions Utilization of surgical services was low and inversely related to distance from residence to hospital in rural areas of central Haiti. Children and patients receiving obstetric, gynecologic or emergent surgery lived significantly closer to the hospital, and these groups may need special attention to ensure adequate access to surgical care. Copyright © 2012 John Wiley & Sons, Ltd.
    August 31, 2012   doi: 10.1002/hpm.2134   open full text
  • Diffusion of new technology, health services and information after a crisis: a focus group study of the Sichuan “5.12” Earthquake.
    Hong Zhou, Lu Shi, Yuping Mao, Juan Tang, Yu Zeng.
    The International Journal of Health Planning and Management. August 02, 2012
    Introduction The Sichuan “5.12” Earthquake in 2008 occurred in a relatively underdeveloped area in China. The rainy weather, the mountainous environment and the local languages all posed major challenges to the dissemination of information and services after the disaster. By adopting a communication perspective, this study applies the diffusion of innovations theory to investigate how healthcare professionals diffused health technologies, health information and services during the rescue and relief operation. Method The authors conducted three focus group sessions with the health professionals who had attended to the rescue and relief work of the Sichuan “5.12” Earthquake in 2008. A range of questions regarding the diffusion of innovations were asked during these sessions. Results The health professionals used their cell phones to communicate with other healthcare providers, disseminated knowledge of health risks and injuries to affected residents with pamphlets and posters and attended daily meetings at the local government offices. They reported on the shortage of maritime satellite cell phones and large‐size tents for medical use, and the absence of fully equipped ambulances. Volunteers, local health professionals and local officials provided health information and services in different ways. However, the diffusion of health information and services was less likely to reach those living next to transportation centers, in remote areas and in disaster areas neglected by the media. Discussion New communication devices such as cell phones and the mobile Internet enabled medical professionals to coordinate the rescue and relief work after this major natural disaster, at a time when the country's emergency response system still had plenty of room for improvement. In future, the mobile Internet should be used as a means of collecting bottom‐up disaster reports so that the media will not neglect any disaster areas as they did during the Sichuan Earthquake. Rescue relief work would have been substantially easier if medical teams had been equipped with advanced appliances such as maritime satellite cell phones. “Disaster medicine” should be treated as a separate discipline in medical schools and receive more investment. Moreover, a stronger public health emergency response system is needed for more efficient dispatch and coordination. Copyright © 2012 John Wiley & Sons, Ltd.
    August 02, 2012   doi: 10.1002/hpm.2137   open full text
  • Perceptions of the use of complementary therapy and Siddha medicine among rural patients with HIV/AIDS: a case study from India.

    The International Journal of Health Planning and Management. July 04, 2012
    Article Withdrawal: “Perceptions of the use of complementary therapy and Siddha medicine among rural patients with HIV/AIDS: a case study from India” by Maria Costanza Torri The above article from the International Journal of Health Planning and Management, published online in Wiley Online Library on July 4th 2012, has been withdrawn by agreement between the author, the journal Editor‐in‐Chief and John Wiley & Sons Ltd. The withdrawal has been agreed owing to an error at the publishers and subsequent dual publication in the journal. The journal Editor‐in‐Chief and John Wiley & Sons Ltd. would like to emphasise that there is no suggestion of a breach of publication ethics by Dr Torri. REFERENCE Torri MC. 2012. Perceptions of the use of complementary therapy and Siddha medicine among rural patients with HIV/AIDS: a case study from India. Int J Health Plann Mgmt. doi: 10.1002/hpm.2121
    July 04, 2012   doi: 10.1002/hpm.2121   open full text