Healthcare Delivery and Stakeholder’s Satisfaction under Social Health Insurance Schemes in India : An Evaluation of Central Government Health Scheme (CGHS) and Ex- servicemen Contributory Health Scheme (ECHS)

This study attempted to evaluate the working of the Central Government Health Scheme (CGHS) and Ex-servicemen Contributory Health Scheme (ECHS) by assessing patient satisfaction as well as the issues and concerns of empanelled private healthcare providers. The study is based on a primary survey of 1,204 CGHS and 640 ECHS principal beneficiaries, 100 empanelled private healthcare providers and 100 officials of the schemes across 12 Indian cities. We have found that patients are reasonably well satisfied with the healthcare services of both empanelled private healthcare providers and the dispensaries-polyclinics but are relatively more satisfied with the former than the latter. We also found that beneficiaries are willing to pay more for better quality services. Though the schemes provide comprehensive healthcare services, the beneficiaries incur some out-of- pocket health expenditure while seeking healthcare. Furthermore, beneficiaries are not in favour of the recent proposal to replace the schemes with health insurance for several reasons. The empanelled private healthcare providers are dissatisfied with the terms and conditions of empanelment, especially the low tariffs for their services as compared to prevailing market rates and the delays in reimbursements from the schemes. We suggest that appropriate efforts be undertaken to enhance the quality of healthcare service provided in the dispensaries-polyclinics of the CGHS and ECHS as well as to address the issues and concerns of empanelled private healthcare providers to ensure better healthcare delivery and for a long-term, sustainable public-private partnership.CGHS, ECHS, patient satisfaction, willingness to pay, empanelled private healthcare providers

Healthcare providers' views on the acceptability of financial incentives for breastfeeding:a qualitative study

BACKGROUND: Despite a gradual increase in breastfeeding rates, overall in the UK there are wide variations, with a trend towards breastfeeding rates at 6–8 weeks remaining below 40% in less affluent areas. While financial incentives have been used with varying success to encourage positive health related behaviour change, there is little research on their use in encouraging breastfeeding. In this paper, we report on healthcare providers’ views around whether using financial incentives in areas with low breastfeeding rates would be acceptable in principle. This research was part of a larger project looking at the development and feasibility testing of a financial incentive scheme for breastfeeding in preparation for a cluster randomised controlled trial. METHODS: Fifty–three healthcare providers were interviewed about their views on financial incentives for breastfeeding. Participants were purposively sampled to include a wide range of experience and roles associated with supporting mothers with infant feeding. Semi-structured individual and group interviews were conducted. Data were analysed thematically drawing on the principles of Framework Analysis. RESULTS: The key theme emerging from healthcare providers’ views on the acceptability of financial incentives for breastfeeding was their possible impact on ‘facilitating or impeding relationships’. Within this theme several additional aspects were discussed: the mother’s relationship with her healthcare provider and services, with her baby and her family, and with the wider community. In addition, a key priority for healthcare providers was that an incentive scheme should not impact negatively on their professional integrity and responsibility towards women. CONCLUSION: Healthcare providers believe that financial incentives could have both positive and negative impacts on a mother’s relationship with her family, baby and healthcare provider. When designing a financial incentive scheme we must take care to minimise the potential negative impacts that have been highlighted, while at the same time recognising the potential positive impacts for women in areas where breastfeeding rates are low

Tamiah N. McCoy - African American Women’s Birth Stories as Told To African American Women Interviewers

Background: A woman’s birth story allows each woman to tell her own perspectives about her experience of bringing a child into the world. As healthcare providers, it is always important to value listening to and learning from our clients. Researchers systematically analyzing birth stories can yield insights on ways to improve birthing experiences for women. This is especially important for African American women, who differentially encounter the most numerous health disparities of any racial group, with twice as much infant mortality than other groups. Purpose: This study examined birth stories of African American women in order to gain insights from them to better meet their needs. In this way, healthcare providers may learn strategies to address health disparities. Methods: A secondary analysis of five African American birth stories was conducted. Findings: Three themes were identified from the women’s stories: (a) desire for continuous labor support, (b) preference for certain characteristics of healthcare providers (such as gender and race), and (c) reliance on spirituality for coping. Conclusions: These findings highlight the importance of listening to and learning from women. Clinical Relevance: Healthcare providers can likely improve the care of their patients by incorporating these themes into their methods of care. Understanding and taking action towards the unsaid needs of African American women experiencing childbirth can ultimately help health disparities get addressed.https://epublications.marquette.edu/mcnair_2013/1014/thumbnail.jp

Promoting Cultural Humility: LGBTQIA+ Education for Healthcare Providers

Abstract: Purpose: LGBTQIA+ patients experience devastating mental health and substance abuse disparities. While our organization has a broad non-discrimination statement that includes gender identity and sexual orientation, there is no guidance for how to best serve these patients. Evidence suggests training sessions are a successful means of increasing LGBTQIA+ cultural competency, with “Safe Zone” identified as being especially successful on college campuses. The Healthcare Equality Index also calls for education to demonstrate healthcare organizations’ commitment to LGBTQIA+ patients. Intervention: We developed an educational workshop - Safe Zone – with university psychologists. This workshop included interactive exercises that focused on increasing empathy and cultural humility. Implementation: A formal pilot was completed with inpatient psychiatric nurses. Results demonstrated increased comfort interacting with and advocating for LGBTQIA+ patients, as well as increased knowledge of health disparities and terminology. The workshop, along with pre-and post-education survey data, was presented to key stakeholders in the organization. Outcomes: Safe Zone is now in the early stages of dissemination across the organization. This will give all staff the opportunity to increase their knowledge of LGBTQIA+ patients. We are consulting on clinical information changes happening within our organization. These include creating specific education bulletins to assist staff with asking patients about their LGBTQIA+ identity. Future Implications: We will examine if and how Safe Zone improves experiences for LGBTQIA+ patients. Safe Zone will inspire staff to advocate for their organization to be more inclusive of LGBTQIA+ patients. Education is one aspect of the Healthcare Equality Index, but also a critical step to creating an equitable LGBTQIA+ environment

Accessing Patient Records in Virtual Healthcare Organisations

The ARTEMIS project is developing a semantic web service based P2P interoperability infrastructure for healthcare information systems that will allow healthcare providers to securely share patient records within virtual healthcare organisations. Authorisation decisions to access patient records across organisation boundaries can be very dynamic and must occur within a strict legislative framework. In ARTEMIS we are developing a dynamic authorisation mechanism called PBAC that provides a means of contextual and process oriented access control to enforce healthcare business processes. PBAC demonstrates how healthcare providers can dynamically share patient records for care pathways across organisation boundaries

Social capital and burnout among mental healthcare providers

Background: Provider burnout is a critical problem in mental health services. Contributing factors have been explicated across three domains: personal, job and organizational characteristics. Of these, organizational characteristics, including workplace environment, appear to be particularly important given that most interventions addressing burnout via the other domains (e.g. bolstering personal coping skills) have been modestly effective at best. Aims: This study builds on previous research by using social capital as a framework for the experience of work social milieu, and aims to provide a richer understanding of how workplace social environment might impact burnout and help create more effective ways to reduce burnout. Methods: Providers (n = 40) taking part in a larger burnout intervention study were randomly selected to take part in interviews regarding their workplace environment and burnout. Participant responses were analyzed thematically. Results: Workplace social milieu revolved around two primary themes: workplace social capital in provider burnout and the protective qualities of social capital in cohesive work teams that appear to mitigate burnout. Conclusions: These results imply that work environments where managers support collaboration and social interaction among work teams may reduce burnout

Bilingual Proficiency Among California's Health Care Professionals

Explores the policy options for encouraging and measuring second-language competence among healthcare providers in California

Harsh Truth: Do Healthcare Providers Silence Women Who Experience Intimate Partner Violence

Background: Globally, one-third of women experience abuse from their intimate partners. Since intimate partner violence (IPV) creates a chronic stress environment, affected women suffer from several physical and mental stress-related disorders for which they seek healthcare services in higher proportion to that of non-abused women. Although affected women seek help for the consequences of IPV, addressing the cause, is an important responsibility of healthcare providers. This study aimed to explore how healthcare providers may contribute to silencing of women who have experienced IPV. Subjects and Methods: This was an integrative review. We performed a systematic search of eight databases for articles published between 2007 and 2018. We identified 4507 publications. We included the English language articles that focused on adult women between 18 and 49 years of age, explored the issue of silencing of women who have experienced IPV, and followed a primary research study design. Two reviewers screened the articles using the web application, Rayyan. Quality was assessed using Joanna Briggs Institute Critical Appraisal tools. Results: Five articles were selected for analysis. The findings revealed that healthcare providers might play a significant role in silencing women’s suffering from abuse. Affected women’s unwillingness to act as their own agent in healthcare settings or disclose experiences of IPV was associated with healthcare provider’s inadequate or inappropriate response. Lack of affirmation, validation, and inability to make women feel accepted were the main factors which silenced women who experienced IPV. Both individual-level factors, such as shame, fear, humiliation, hope, and relationship dynamics, and community-level factors, such as cultural norms, and values, seemed to precede the factors related to healthcare providers. Conclusion:A socioecological understanding of the factors influencing silencing of women who have experienced IPV is required. A health care model which takes into consideration the contributing factors at various ecological levels of influence is imperative to guide healthcare providers towards the development of best practices in caring with women who have experienced violence in their intimate relationships. Keywords: intimate, partner, violence, health care, provide