Hospital Competition and Physician Prices (Economics, Health Care)

92 p.Thesis (Ph.D.)--University of Illinois at Urbana-Champaign, 1984.This study investigates the relationship between physicians and hospitals. Physicians are modeled as purchasing hospital affiliation. The affiliation fee is in the form of donated services, restrictions on physician behavior and other means by which the physician is made to bear hospital costs. The affiliation fee increases as the hospital's quality increases. Perfectly competitive physicians offer consumers a bundled good of office and hospital characteristics. There is a market clearing hedonic price function which relates physician attributes to price. Physicians affiliate with that hospital which offers the physician his/her profit maximizing combination of affiliation fee and hospital characteristics. Competition among hospitals reduces the affiliation fee and increases hospital characteristics. This allows physicians to lower their prices, inducing consumers to enter the market which results in higher physician density.The model is tested empirically using data collected in a survey of 1500 physicians in 1978. The price of a follow-up office visit is regressed on a set of demand variables, variables reflecting hospital and office characteristics and variables reflecting the level of competition in the hospital market. The results demonstrate that physician price is significantly related to hospital characteristics and that hospital competition lowers physician prices.A second set of regressions on physician density confirmed the theoretical prediction that market wide hospital characteristics have a significant effect on physician density.U of I OnlyRestricted to the U of I community idenfinitely during batch ingest of legacy ETD

Understanding the impact of subsidizing artemisinin-based combination therapies (ACTs) in the retail sector--results from focus group discussions in rural Kenya.

BACKGROUND: There is considerable interest in the potential of private sector subsidies to increase availability and affordability of artemisinin-based combination therapies (ACTs) for malaria treatment. A cluster randomized trial of such subsidies was conducted in 3 districts in Kenya, comprising provision of subsidized packs of paediatric ACT to retail outlets, training of retail staff, and community awareness activities. The results demonstrated a substantial increase in ACT availability and coverage, though patient counselling and adherence were suboptimal. We conducted a qualitative study in order to understand why these successes and limitations occurred. METHODOLOGY/PRINCIPAL FINDINGS: Eighteen focus group discussions were conducted, 9 with retailers and 9 with caregivers, to document experiences with the intervention. Respondents were positive about intervention components, praising the focused retailer training, affordable pricing, strong promotional activities, dispensing job aids, and consumer friendly packaging, which are likely to have contributed to the positive access and coverage outcomes observed. However, many retailers still did not stock ACT, due to insufficient supplies, lack of capital and staff turnover. Advice to caregivers was poor due to insufficient time, and poor recall of instructions. Adherence by caregivers to dosing guidelines was sub-optimal, because of a wish to save tablets for other episodes, doses being required at night, stopping treatment when the child felt better, and the number and bitter taste of the tablets. Caregivers used a number of strategies to obtain paediatric ACT for older age groups. CONCLUSIONS/SIGNIFICANCE: This study has highlighted that important components of a successful ACT subsidy intervention are regular retailer training, affordable pricing, a reliable supply chain and community mobilization emphasizing patient adherence and when to seek further care

Malaria case management in Papua New Guinea following the introduction of a revised treatment protocol

This paper reports on the availability of diagnostic tools and recommended anti-malarials in the 12-month period immediately following the implementation of a new national malaria treatment protocol (NMTP) in Papua New Guinea (PNG). Health worker adherence to the new NMTP is also examined and comparisons made with previously reported pre-implementation findings.; A countrywide cross-sectional survey in randomly selected primary health care facilities (n = 88). Data were collected via passive observation of the clinical case management of fever or suspected malaria patients and via an interviewer administered questionnaire completed with the officer in charge of each participating health care facility.; Malaria rapid diagnostic tests (RDTs) and the new first-line anti-malarial medication, artemether-lumefantrine (AL), were available in 53.4% and 51.1% of surveyed heath facilities, respectively. However, they were more widely available in the larger health centres as compared to the smaller aid-posts (90.2% vs. 21.3% and 87.8% vs. 19.2%, respectively). Overall, 68.3% of observed fever cases (n = 445) were tested for malaria by RDT and 39% prescribed an anti-malarial, inclusive of 98.2% of RDT positive patients and 19.8% of RDT negative cases. The availability and use of malaria RDTs was greater in the current survey as compared to pre-implementation of the new NMTP (8.9% vs. 53.4% & 16.2% vs. 68.3%, respectively) as was the availability of AL (0% vs. 51.1%). The percentage of fever patients prescribed anti-malarials decreased substantially post implementation of the new NMTP (96.4% vs. 39.0%).; PNG has achieved high coverage of malaria RDTs and AL at the health centre level, but these resources have yet to reach the majority of aid-posts. Malaria case management practice has substantially changed in the 12-month period immediately following the new NMTP, although full protocol adherence was rarely observed