Public vs private administration of rural health insurance schemes: a comparative study in Zhejiang of China.

: Since 2003, China has experimented in some of the country's counties with the private administration of the New Cooperative Medical Scheme (NCMS), a publicly subsidized health insurance scheme for rural populations. Our study compared the effectiveness and efficiency of private vs public administration in four counties in one of China's most affluent provinces in the initial stage of the NCMS's implementation. The study was undertaken in Ningbo city of Zhejiang province. Out of 10 counties in Ningbo, two counties with private administration for the NCMS (Beilun and Ninghai) were compared with two others counties with public administration (Zhenhai and Fenghua), using the following indicators: (1) proportion of enrollees who were compensated for inpatient care; (2) average reimbursement-expense ratio per episode of inpatient care; (3) overall administration cost; (4) enrollee satisfaction. Data from 2004 to 2006 were collected from the local health authorities, hospitals and the contracted insurance companies, supplemented by a randomized household questionnaire survey covering 176 households and 479 household members. In our sample counties, private administration of the NCMS neither reduced transaction costs, nor improved the benefits of enrollees. Enrollees covered by the publicly administered NCMS were more likely to be satisfied with the insurance scheme than those covered by the privately administered NCMS. Experience in the selected counties suggests that private administration of the NCMS did not deliver the hoped-for results. We conclude that caution needs to be exercised in extending private administration of the NCMS

Barriers and facilitators to a health information exchange system for general practitioners

Background Health information exchange (HIE) systems, that are computer-based tools used by healthcare providers for secure access to share patient's medical information electronically, seem to help reduce the use of specific resources and improve the quality of care. This highlights the importance of this issue in the Public Health sector. This research goal is to identify barriers and facilitators perceived by general practitioners (GPs) when using an HIE system in a Southern Switzerland area. Methods we performed a qualitative study using semi-structured interviews, interviewed 10 GPs, randomly selected among some 500 HIE system local users and analysed interview transcripts using thematic content analysis with an abductive approach (a mix of deductive and inductive approaches). Results findings showed the following key facilitators: a) perception of dealing with a secure system; b) possibility of delegating management to secretaries and healthcare assistants; c) technical support and training; d) high quality of the information exchange; e) positive impact on clinical practice; and f) regional context. However, major challenges persist, and GPs reported the following main barriers to using an HIE system: a) frequent lack of all patient information needed; b) no effective workflow improvements; c) lack of some technical features. Conclusions We propose four recommendations based on findings: 1. Future initiatives should focus on developing HIE systems giving GPs access to all possible patient medical information; 2. Crucial data privacy and security issues should never be overlooked; 3. Technical and workflow improvements should particularly consider the socio-technical nature of HIE systems; 4. Much attention needs to be paid to the importance of relationships between health care providers and between these and local health institutions when implementing HIE systems. Key messages This study filled a research gap as it is the first that tackles HIE system barriers and facilitators in Ticino. When information sharing for clinical practice focuses on improving the quality and costs of healthcare, GP's trust in HIE system security is crucial

Utilization of health care services by migrants in Europe-a systematic literature review.

Introduction: Our study reviewed the empirical evidence on the utilization of health care services by migrants in Europe, and on differences in health service utilization between migrants and non-migrants across European countries. Sources of data: A systematic literature review was performed, searching the databases Medline, Cinahl and Embase and covering the period from January 2009 to April 2016. The final number of articles included was 39. Areas of agreement: Utilization of accident and emergency services and hospitalizations were higher among migrants compared with non-migrants in most countries for which evidence was available. In contrast, screening and outpatient visits for specialized care were generally used less often by migrants. Areas of controversy: Utilization of general practitioner services among migrants compared with non-migrants presents a diverging picture. Growing points: Compared with previous systematic reviews, the results indicate a clearer picture of the differences in health service utilization between migrants and non-migrants in Europe. Areas timely for developing research: A comprehensive comparison across European countries is impossible because the number of studies is still limited. Further research should also help to identify barriers regarding the utilization of health care services by migrants