| Child Health | Diagnostics | Hospitals | Maternal & Rep. Health | Pharmacy | Primary Care | Public Health | Traditional Healer Definition The provision of beds, meals, and constant nursing care for patients while they undergo medical therapy at the hands of professional physicians. In carrying out these services, the aim is to restore patients to health. Top Status of Hospital Services Hospital-based care directly improves the overall health of a population by providing care to people of all ages that are needy and infirm. Indirectly, hospitals increase overall health of a population through many venues, including teaching and research. Hospitals also impose a substantial financial burden on nations. For example, in terms of a nation's health care budget, hospitals account for:  ·70% or more of overall health care expenditures in countries of the former Soviet Union
·50% of overall health care expenditures in Europe Furthermore, hospital-based care is very costly for households. When payment is made out-of-pocket, it generates a large burden and creates risk for households in entering poverty. Protection from these "catastrophic" costs requires insurance or risk-pooling or public payment. Voices of the Poor recorded the case of a 26 year old man in Vietnam, who, as a result of his daughter's hospital costs, moved from being the richest man in the community to one of the poorest. Top Issues in Hospital Services Generally, several issues undermine the quality and efficiency of public hospitals services. These issues are hospital structures related to technology, management, and payment. Refer to Preker (2003) and Jakab (2002) for detailed information. - Technology -- Hospitals often have a high prevalence of broken medical equipment and primitive or nonexistent management information systems.
- Management -- Hospitals often have poor managers that lack in decision-making skills.
- Payment -- Hospitals often have poor payment structures that have weak incentives, leading to low quality and efficiency of services.
In addition, politics also influence the effectiveness of hospital services because elite members of the medical profession use their connections to oppose changes that threaten their interests. Thus, hospitals inadequately respond to the actual health needs of a population, especially for the marginalized populations. Furthermore, accountability is another issue because most often there are ineffective mechanisms to hold hospitals responsible for their behaviors and actions. In particular, the ability of the government to assert direct accountability diminishes when hospitals are given more autonomy. Top Trends in Hospital Services Developing country governments have applied and proposed several mechanisms to improve the efficiency and quality of public hospital services. Trends show that there are broadly four types of mechanisms: Technological Reform, Management Reform, Payment Reform, and Organization Reform. Policy makers interested in reforming their hospitals should review these mechanisms. Refer to Preker (2003), Jakab (2002), or McKee (2000) for more information. - Technological Reform: This approach attempts to enhance the technological capacity of hospitals by investing in viable medical equipment and maintaining equipment.
- Management Reform: This approach attempts to strengthen managerial expertise through training and recruitment policies.
- Payment Reform: This reform approach attempts to alter the payment mechanisms to create financial incentives that promote efficiency and quality.
- Organization Reform: This approach attempts to change the degree of decision rights, residual claim, market exposure, accountability, and social function. Adjustments to these five elements introduce different incentives to hospitals and promote efficiency and quality of services.
Another reform towards improving public hospital services is the application of "report cards," which uses citizen feedback to assess the performance of services. Paul (1998) describes the positive effects of the "report cards" on hospital services in Bangalore, India. For example, "report cards" led two leading public hospitals in Bangalore to be more responsive to patient needs through the establishment of "help desks." Top Key References World Bank - Jakab, M., A. S. Preker, A. Harding and L. Hawkins (2002). The Introduction of Market Forces in the Public Hospital Sector: From New Public Sector Management to Organizational Reform. HNP Discussion Series. Washington.
Provides insight into recent hospital reforms, with an emphasis on organizational changes, including autonomization and corporatization. Specfically, it addresses the questions of 1)what problems did these types of reform try to address, 2)what are the core elements of their designs, and 3)is there any evidence that this type of reform is successful in addressing the intended problems. - Preker, A. S. and A. Harding (2003). Innovations in Health Service Delivery: The Corporatization of Public Hospitals. Washington, World Bank.
Examines the design, implementation, and impact of reforms in the public hospital sector. The book offers case studies on the analysis of autonomization in several countries, including the UK, New Zealand, and Hong Kong. In addition, Singapore and Malaysia are analyzed as case studies of corporatization. - Harding, A. and A.S. Preker (2000). Understanding Organizational Reform: The Corporatization of Public Hospitals. HNP Discussion Series. Washington, World Bank.
Establishes a conceptual framework for introducing autonomization and coporatization as mechanisms to improve hospitals services in developing countries.
Top External - Barnum, H. and J. Kutzin (1993). Public Hospitals in Developing Countries. Baltimore, Johns Hopkins University Press.Erikson,
- P., D. V, et al. (2002). Health Sector Reforms: What about Hospitals? Gotenberg, The Nordic School ofPublic Health.
- McKee, M. and J. Healy (2000). "The role of the hospital in a changing environment." Bulletin of the World Health Organization 78(6): 803-810.
- McKee, M. and J. Healy (2002). Hospitals in a changing Europe. Buckingham, Open University Press.World_Health_Organization (1990). The Role of the hospital in the district: delivering or supporting primary health care? Geneva, World Health Organization.
Top Resource People World Bank: - Alexander S. Preker: Chief Economist in the Health, Nutrition, and Population Dpt. at the World Bank
- April Harding: Senior Economist in the Health, Nutrition, and Population Dpt. at the World Bank
External: - Syed Al-Funid: Profesor of health economics and health of the Department of Community Health, Faculty of Medicine, Universiti Kebangsaan, Malaysia
- Willy De Geyndt: President of the InterHealth Institute, adjunct professor of health services management and policy at the George Washington University
- Chris Ham: Professor of health policy and management at the University of Birmingham, England.
- William Hsiao: K.T. Li Professor of Economics at Harvard School of Public Health.
- Barbara McPake: Senior Lecturer in Health Economics. London School of Hygiene and Tropical Medicine.
- Winnie Yip: Associate professor of international health economics and policy at the Harvard School of Public Health.
Top Useful Websites Additional References Brolly, E. H. (1982). "Health care data recording system for developing countries." Trop Doct 12(3): 105-9.Halbwachs, H. (1994). "Health care equipment management." Health Estate J 48(10): 14, 17-9, 22. Halbwachs, H. (1999). "The technical and financial impact of systematic maintenance and repair services within health systems of developing countries." HealthEstate 53(4): 6-8, 10-1. Jakab, M., A. S. Preker, A. Harding and L. Hawkins (2002). The Introduction of Market Forces in the Public Hospital Sector: From New Public Sector Management to Organizational Reform. HNP Discussion Series. Washington. Kotilainen, H. (2001). "Rehabilitation of the hospital infrastructure in a developing country." World Hosp Health Serv 37(2): 25-8, 34, 36. Mckee, M. and J. Healy (2001). "Implementing hospital reform in central and eastern Europe and central Asia." Eurohealth 7(3). Paul, S. (1998). Making Voice Work: The Report Card on Bangalore's Public Service. Washington, DC, World Bank. Piachaud, D. (1982). "Medical equipment in Third World countries." J Trop Med Hyg 85(5): 183-5. Roemer, M. (1973). Hospital legislation and hospital systems. Geneva, World Health Organization.Shaw, J. (1998). Hospital Management: Training and Professional Development. Geneva, World Health Organization. World Health Organization (1992). The Hospital in rural and urban districts: report of a WHO Study Group on the Functions of Hospitals at the First Referral Level. Geneva, World Health Organization. Top |
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