A cost and performance comparison of Public Private Partnership and public hospitals in Spain

© 2016 Caballer-Tarazona and Vivas-Consuelo. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.The Erratum to this article has been published in Health Economics Review 2016 6:20[EN] Public-private partnership (PPP) initiatives are extending around the world, especially in Europe, as an innovation to traditional public health systems, with the intention of making them more efficient. There is a varied range of PPP models with different degrees of responsibility from simple public sector contracts with the private, up to the complete privatisation of the service. As such, we may say the involvement of the private sector embraces the development, financing and provision of public infrastructures and delivery services. In this paper, one of the oldest PPP initiatives developed in Spain and transferred to other European and Latin American countries is evaluated for first time: the integrated healthcare delivery Alzira model. Through a comparison of public and PPP hospital performance, cost and quality indicators, the efficiency of the PPP experience in five hospitals is evaluated to identify the influence of private management in the results. Regarding the performance and efficiency analysis, it is seen that the PPP group obtains good results, above the average, but not always better than those directly managed. It is necessary to conduct studies with a greater number of PPP hospitals to obtain conclusive results.Caballer Tarazona, M.; Vivas Consuelo, DJJ. (2016). 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Human resources: the Cinderella of health sector reform in Latin America

Human resources are the most important assets of any health system, and health workforce problems have for decades limited the efficiency and quality of Latin America health systems. World Bank-led reforms aimed at increasing equity, efficiency, quality of care and user satisfaction did not attempt to resolve the human resources problems that had been identified in multiple health sector assessments. However, the two most important reform policies – decentralization and privatization – have had a negative impact on the conditions of employment and prompted opposition from organized professionals and unions. In several countries of the region, the workforce became the most important obstacle to successful reform. This article is based on fieldwork and a review of the literature. It discusses the reasons that led health workers to oppose reform; the institutional and legal constraints to implementing reform as originally designed; the mismatch between the types of personnel needed for reform and the availability of professionals; the deficiencies of the reform implementation process; and the regulatory weaknesses of the region. The discussion presents workforce strategies that the reforms could have included to achieve the intended goals, and the need to take into account the values and political realities of the countries. The authors suggest that autochthonous solutions are more likely to succeed than solutions imported from the outside

Dual practice in the health sector: review of the evidence

This paper reports on income generation practices among civil servants in the health sector, with a particular emphasis on dual practice. It first approaches the subject of public–private overlap. Thereafter it focuses on coping strategies in general and then on dual practice in particular. To compensate for unrealistically low salaries, health workers rely on individual coping strategies. Many clinicians combine salaried, public-sector clinical work with a fee-for-service private clientele. This dual practice is often a means by which health workers try to meet their survival needs, reflecting the inability of health ministries to ensure adequate salaries and working conditions. Dual practice may be considered present in most countries, if not all. Nevertheless, there is surprisingly little hard evidence about the extent to which health workers resort to dual practice, about the balance of economic and other motives for doing so, or about the consequences for the proper use of the scarce public resources dedicated to health. In this paper dual practice is approached from six different perspectives: (1) conceptual, regarding what is meant by dual practice; (2) descriptive, trying to develop a typology of dual practices; (3) quantitative, trying to determine its prevalence; (4) impact on personal income, the health care system and health status; (5) qualitative, looking at the reasons why practitioners so frequently remain in public practice while also working in the private sector and at contextual, personal life, institutional and professional factors that make it easier or more difficult to have dual practices; and (6) possible interventions to deal with dual practice

The management of acute venous thromboembolism in clinical practice. Results from the European PREFER in VTE Registry

Venous thromboembolism (VTE) is a significant cause of morbidity and mortality in Europe. Data from real-world registries are necessary, as clinical trials do not represent the full spectrum of VTE patients seen in clinical practice. We aimed to document the epidemiology, management and outcomes of VTE using data from a large, observational database. PREFER in VTE was an international, non-interventional disease registry conducted between January 2013 and July 2015 in primary and secondary care across seven European countries. Consecutive patients with acute VTE were documented and followed up over 12 months. PREFER in VTE included 3,455 patients with a mean age of 60.8 ± 17.0 years. Overall, 53.0 % were male. The majority of patients were assessed in the hospital setting as inpatients or outpatients (78.5 %). The diagnosis was deep-vein thrombosis (DVT) in 59.5 % and pulmonary embolism (PE) in 40.5 %. The most common comorbidities were the various types of cardiovascular disease (excluding hypertension; 45.5 %), hypertension (42.3 %) and dyslipidaemia (21.1 %). Following the index VTE, a large proportion of patients received initial therapy with heparin (73.2 %), almost half received a vitamin K antagonist (48.7 %) and nearly a quarter received a DOAC (24.5 %). Almost a quarter of all presentations were for recurrent VTE, with >80 % of previous episodes having occurred more than 12 months prior to baseline. In conclusion, PREFER in VTE has provided contemporary insights into VTE patients and their real-world management, including their baseline characteristics, risk factors, disease history, symptoms and signs, initial therapy and outcomes

Percepciones de gestores de salud y facilitadores de la estrategia Atención Integrada a las Enfermedades Prevalentes (AIEPI) en una zona del Noreste de Brasil y Perú

El objetivo del estudio fue explorar las percepciones sobre la estrategia de Atención Integrada a las Enfermedades Prevalentes en la Infancia (AIEPI) de gestores de salud y facilitadores de la estrategia. Se realizó una investigación de tipo cualitativo mediante entrevistas semiestructuradas. Se llevaron a cabo 14 entrevistas entre mayo y junio del 2011, ocho en el Estado de Ceará-Brasil y seis en el Perú. En general los profesionales manifestaron una buena percepción de la estrategia AIEPI, observándose una predominancia del componente clínico, en comparación con el componente comunitario y de servicios de salud. A diferencia de Brasil, en el Perú hubo una promoción gubernamental para la adopción estrategia. En conclusión, este estudio muestra una intervención compleja de la estrategia AIEPI, con predominancia del componente clínico poniendo en evidencia las limitaciones en la integración de los componentes de la estrategia

Significados das hierarquias no trabalho em hospitais públicos brasileiros a partir de estudos empíricos

OBJETIVO: Compreender como as estruturas hierárquicas presentes na cultura organizacional de hospitais públicos brasileiros significam no trabalho hospitalar. MÉTODOS: O corpus da pesquisa originou-se em quatro teses e seis dissertações e foi organizado, analisado e interpretado sob a perspectiva da antropologia simbólica-interpretativa. RESULTADOS: Hospitais estão calcados na burocracia profissional e mecanicista, e as hierarquias, decorrentes dessas estruturas, produzem significados que interpretados indicam fragmentação das relações, disputas profissionais e distanciamentos, bem como conflitos e comportamentos subversivos no trabalho, respectivamente. CONCLUSÃO: As hierarquias em cada uma das burocracias encaminham diferentes enfrentamentos que desestabilizam os trabalhadores e seus processos de trabalho. Estratégias de reorientação e conscientização dos limites hierárquicos devem ser equacionadas, para que o trabalho seja otimizado.Objective: Understand the meaning, in hospital work, of hierarchical structures present in the organizational culture of Brazilian public hospitals. Methods: The corpus of research was originated in four theses and six dissertations, and was organized, analyzed and interpreted from the perspective of symbolic anthropology interpretation. Results: Hospitals copied the professional mechanistic bureaucracy and hierarchies, from these structures, produce meanings that indicate a fragmentation of relationships, professional disputes and separations, as well as conflicts and subversive behavior at work. Conclusion: The hierarchies in each of the bureaucracies created several clashes that disrupt the workers and their work processes. Reorientation strategies and awareness of the hierarchical boundaries should be studied so that the work is optimized.Objetivo: Comprender que significan, en el trabajo hospitalario, las estructuras jerárquicas presentes en la cultura organizacional de hospitales públicos brasileños. Métodos: El corpus de la investigación se originó en cuatro tesis y seis disertaciones y fue organizado, analizado y interpretado bajo la perspectiva de la antropología simbólica interpretativa. Resultados: Los Hospitales copian la burocracia profesional y mecanicista, y las jerarquías, provenientes de esas estructuras, producen significados que indican una fragmentación de las relaciones, disputas profesionales y distanciamientos, así como conflictos y comportamientos subversivos en el trabajo. Conclusión: Las jerarquías en cada una de las burocracias crean diferentes enfrentamientos que desestabilizan a los trabajadores y a sus procesos de trabajo. Estrategias de reorientación y concientización de los límites jerárquicos deben ser estudiadas, para que el trabajo sea optimizado