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Healthcare
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Healthcare Management and Health Economics
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Healthcare Management and Health Economics

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Health Policy".

Deadline for manuscript submissions: closed (29 February 2024) | Viewed by 32784

Special Issue Editors

Prof. Dr. Steffen Flessa

E-Mail Website
Guest Editor
Department of General Business Administration and Healthcare Management, University of Greifswald, Friedrich-Loeffler-Str. 70, 17487 Greifswald, Germany
Interests: healthcare management; health economics; hospital administration; health care in low-income countries; rural health; cross-border healthcare
Prof. Dr. Manuela De Allegri

E-Mail Website
Guest Editor
Research Unit "Health Economics and Health Financing", University Hospital of Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
Interests: healthcare management; health economics; healthcare financing; healthcare in low-income countries

Special Issue Information

Dear Colleagues,

Health economics and healthcare management are essential for service providers, managers, as well as policy- and decision-makers in the healthcare sector to protect and improve patient and population health. However, until today, the value and relevance of health economics and healthcare management are often underestimated, and sometimes they may even be perceived as stumbling stones on the path towards achieving effective, equitable, and sustainable healthcare systems. In this Special Issue, we would like to publish papers which clearly indicate the relevance of health economics and healthcare management for population health in order to demonstrate its relevance for public health and medicine.

Health economics can be defined as the art of describing, explaining, and reducing scarcity of health. It is the obligation of a health economist to provide recommendations on how to use scarce healthcare resources efficiently in order to ensure the best possible health promotion, disease prevention, cure, and care.

Consequently, this Special Issue of Healthcare invites research from very different healthcare fields, from high- and low-income countries, including theoretical health economics, practical healthcare management, and service provision. We welcome papers adopting different methodological approaches, including research on modelling, econometrics, conceptional, qualitative, and mixed methods. Each paper will demonstrate that methods and approaches of health economics and healthcare management are highly relevant for public health and medicine.

Prof. Dr. Steffen Flessa
Prof. Dr. Manuela De Allegri
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • health economics
  • healthcare management
  • hospital care
  • hospital management
  • healthcare services
  • quality
  • sustainability
  • efficiency
  • effectiveness
  • public health
  • health systems

Published Papers (20 papers)

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Editorial

Jump to: Research, Review

3 pages, 406 KiB  
Editorial
Healthcare Management and Health Economics
by Steffen Flessa and Manuela De Allegri
Healthcare 2022, 10(10), 1879; https://doi.org/10.3390/healthcare10101879 - 27 Sep 2022
Cited by 1 | Viewed by 3024
Abstract
The Universal Declaration of Human Rights stipulates that, “recognition of the inherent dignity and of the equal and inalienable rights of all members of the human family is the foundation of freedom, justice and peace in the world” (Preamble) [...] Full article
(This article belongs to the Special Issue Healthcare Management and Health Economics)
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Research

Jump to: Editorial, Review

12 pages, 254 KiB  
Article
Assessment of Knowledge of Health Economics among Healthcare Professionals in the Kingdom of Saudi Arabia: A Cross-Sectional Study
by Esraa Dhaif Allah Algharibi, Bodour Ayman Fadel and Mohammed Khaled Al-Hanawi
Healthcare 2024, 12(2), 185; https://doi.org/10.3390/healthcare12020185 - 12 Jan 2024
Viewed by 965
Abstract
Addressing the ongoing challenge of rising healthcare spending is crucial for ensuring the health quality of a population. At the core of healthcare systems, health professionals play a vital role in patient care and resource utilization. Despite healthcare cost concerns, health professionals often [...] Read more.
Addressing the ongoing challenge of rising healthcare spending is crucial for ensuring the health quality of a population. At the core of healthcare systems, health professionals play a vital role in patient care and resource utilization. Despite healthcare cost concerns, health professionals often lack an understanding of health economics for optimal decision making. Accordingly, the aim of this study was to assess the knowledge of health economics among healthcare professionals in the Kingdom of Saudi Arabia. The broader goal was to identify knowledge gaps crucial for developing targeted interventions to maintain quality healthcare within the context of resource constraints. We used cross-sectional data collected from January to June 2023 and employed univariate, bivariate, and multivariable techniques for analysis. Univariate analyses were used to compare respondent proportions in socio-economic and demographic categories, bivariate analysis was used to examine the frequencies of independent variables related to the dependent variable, and a multivariate logistic regression model was used to identify the factors associated with knowledge of health economics among healthcare professionals. A total of 1056 responses were included for analysis. Approximately 35.35% of the sample possessed optimal knowledge of healthcare economics. Additionally, 58.14% of respondents considered health economics knowledge essential in their job practice, 16.95% regularly read articles on health economics, 22.06% engage in economic decision making at work, and 20.17% apply health economics techniques in their decision making. Health economics knowledge varied according to profession status, work experience, perceptions about health economics, and involvement in management tasks and decision-making processes. Generally, knowledge of health economics tended to increase with experience, positive perceptions, and engagement in administrative or management tasks. Nevertheless, knowledge of health economics is largely limited among health professionals in Saudi Arabia. Policymakers should address disparities in knowledge and perceptions of health economics through ongoing training courses and workshops. These interventions will ensure the presence of highly skilled professionals capable of implementing effective healthcare decisions and managing the increasing costs of healthcare. Full article
(This article belongs to the Special Issue Healthcare Management and Health Economics)
23 pages, 2985 KiB  
Article
The Epidemiological and Economic Impact of COVID-19 in Kazakhstan: An Agent-Based Modeling
by Berik Koichubekov, Aliya Takuadina, Ilya Korshukov, Marina Sorokina and Anar Turmukhambetova
Healthcare 2023, 11(22), 2968; https://doi.org/10.3390/healthcare11222968 - 16 Nov 2023
Viewed by 768
Abstract
Background: Our study aimed to assess how effective the preventative measures taken by the state authorities during the pandemic were in terms of public health protection and the rational use of material and human resources. Materials and Methods: We utilized a stochastic agent-based [...] Read more.
Background: Our study aimed to assess how effective the preventative measures taken by the state authorities during the pandemic were in terms of public health protection and the rational use of material and human resources. Materials and Methods: We utilized a stochastic agent-based model for COVID-19’s spread combined with the WHO-recommended COVID-ESFT version 2.0 tool for material and labor cost estimation. Results: Our long-term forecasts (up to 50 days) showed satisfactory results with a steady trend in the total cases. However, the short-term forecasts (up to 10 days) were more accurate during periods of relative stability interrupted by sudden outbreaks. The simulations indicated that the infection’s spread was highest within families, with most COVID-19 cases occurring in the 26–59 age group. Government interventions resulted in 3.2 times fewer cases in Karaganda than predicted under a “no intervention” scenario, yielding an estimated economic benefit of 40%. Conclusion: The combined tool we propose can accurately forecast the progression of the infection, enabling health organizations to allocate specialists and material resources in a timely manner. Full article
(This article belongs to the Special Issue Healthcare Management and Health Economics)
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21 pages, 1927 KiB  
Article
Hospital Resource Planning for Mass Casualty Incidents: Limitations for Coping with Multiple Injured Patients
by Daniel Staribacher, Marion Sabine Rauner and Helmut Niessner
Healthcare 2023, 11(20), 2713; https://doi.org/10.3390/healthcare11202713 - 11 Oct 2023
Cited by 1 | Viewed by 981
Abstract
Using a discrete-event simulation (DES) model, the current disaster plan regarding the allocation of multiple injured patients from a mass casualty incident was evaluated for an acute specialty hospital in Vienna, Austria. With the current resources available, the results showed that the number [...] Read more.
Using a discrete-event simulation (DES) model, the current disaster plan regarding the allocation of multiple injured patients from a mass casualty incident was evaluated for an acute specialty hospital in Vienna, Austria. With the current resources available, the results showed that the number of severely injured patients currently assigned might have to wait longer than the medically justifiable limit for lifesaving surgery. Furthermore, policy scenarios of increasing staff and/or equipment did not lead to a sufficient improvement of this outcome measure. However, the mean target waiting time for critical treatment of moderately injured patients could be met under all policy scenarios. Using simulation-optimization, an optimal staff-mix could be found for an illustrative policy scenario. In addition, a multiple regression model of simulated staff-mix policy scenarios identified staff categories (number of radiologists and rotation physicians) with the highest impact on waiting time and survival. In the short term, the current hospital disaster plan should consider reducing the number of severely injured patients to be treated. In the long term, we would recommend expanding hospital capacity—in terms of both structural and human resources as well as improving regional disaster planning. Policymakers should also consider the limitations of this study when applying these insights to different areas or circumstances. Full article
(This article belongs to the Special Issue Healthcare Management and Health Economics)
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9 pages, 913 KiB  
Article
Analysis of the Health Examination Service Process Using Service Blueprint: Focus on the Older Adult Patient in South Korea
by Donghee Kim and Jungeun Cho
Healthcare 2023, 11(20), 2709; https://doi.org/10.3390/healthcare11202709 - 10 Oct 2023
Viewed by 961
Abstract
As the older adult population grows, the paradigm of aging is shifting from simply living longer to living longer while maintaining health. This shift has led to a transformation in healthcare from passive to proactive approaches, emphasizing disease prevention. Health examination services have [...] Read more.
As the older adult population grows, the paradigm of aging is shifting from simply living longer to living longer while maintaining health. This shift has led to a transformation in healthcare from passive to proactive approaches, emphasizing disease prevention. Health examination services have seen significant growth as they transition from being solely diagnostic processes to crucial tools for disease prevention. This study focuses on the health examination service industry, particularly in the context of the older adult population, and aims to develop a service blueprint to identify challenges and solutions in utilizing these services. The research employs the service blueprint methodology to map out the health examination service process comprehensively. The distinction is made between customer interactions and internal procedures that are observable and those that are not. Through a comprehensive analysis of the service process, it is possible to identify potential instances of customer unhappiness. These instances primarily occur during the initial interaction between older clients and the service, as well as when they receive their examination findings. There are several factors that contribute to discontent among individuals, namely the insufficient comprehension of the needs of the aged by service providers and the provision of substandard facilities. The study suggests strategies to improve customer satisfaction, such as dedicated personnel for older adult assistance, specialized education for staff, and better facilities tailored for older adult patients. Furthermore, the research highlights the significance of effectively addressing both areas of critical discontent and elements that enhance satisfaction in the process of service design. This research provides a detailed analysis of health examination services for the older adult, highlighting opportunities for improvement through enhanced customer experiences and specialized services. Full article
(This article belongs to the Special Issue Healthcare Management and Health Economics)
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16 pages, 313 KiB  
Article
Effects of Servicescapes on Interaction Quality, Service Quality, and Behavioral Intention in a Healthcare Setting
by Sohyun An, Pyoungsoo Lee and Choong Ho Shin
Healthcare 2023, 11(18), 2498; https://doi.org/10.3390/healthcare11182498 - 08 Sep 2023
Viewed by 1967
Abstract
This study develops a conceptual framework that encompasses servicescapes and customer perceptions and behaviors, and conducts an empirical investigation of healthcare service facilities. Structural equation modeling is performed using a sample of 271 patients who received treatment within one year at hospitals and [...] Read more.
This study develops a conceptual framework that encompasses servicescapes and customer perceptions and behaviors, and conducts an empirical investigation of healthcare service facilities. Structural equation modeling is performed using a sample of 271 patients who received treatment within one year at hospitals and clinics located in the metropolitan area of Seoul, South Korea. The results of the empirical analysis show that service quality improvements and patient revisits to healthcare facilities can be induced through servicescape improvements and interaction quality. These results make theoretical contributions to the service management literature and have practical implications for the operations of healthcare facilities. Full article
(This article belongs to the Special Issue Healthcare Management and Health Economics)
13 pages, 259 KiB  
Article
How Managed Entry Agreements Influence the Patients’ Affordability to Biological Medicines—Bulgarian Example
by Zornitsa Mitkova, Ivan Manev, Konstantin Tachkov, Vladimira Boyadzhieva, Nikolay Stoilov, Miglena Doneva and Guenka Petrova
Healthcare 2023, 11(17), 2427; https://doi.org/10.3390/healthcare11172427 - 30 Aug 2023
Viewed by 837
Abstract
Managed entry agreements are applied in almost all European countries in order to improve patients’ access to therapy. The current study aims to evaluate the changes in the affordability of biological medicines for patients in Bulgaria during 2019–2022. The study is a top-down [...] Read more.
Managed entry agreements are applied in almost all European countries in order to improve patients’ access to therapy. The current study aims to evaluate the changes in the affordability of biological medicines for patients in Bulgaria during 2019–2022. The study is a top-down macroeconomic analysis of the key economic indicators and reimbursed costs of biologic therapies. Affordability was determined as the number of working hours needed to pay for monthly therapy. The average NHIF budget for pharmaceuticals increased significantly along with inflation in the healthcare sector. Bulgarian patients had to devote a large part of their income to buying medicines if a co-payment existed. The percentage of the monthly income of pensioners needed for therapy co-payment varied between 10% and 280%. The hours of work required to purchase a package of biologicals varied between 7 and 137 working hours. The global economic crisis has affected Bulgaria and led to worsening economic parameters. There are still no well-established practices to control public spending, as the measures taken to reduce the final cost of medicines mainly affect the pharmaceutical companies. This type of cost-containment policy provides an opportunity for innovative treatment with biologicals for patients with inflammatory diseases. Most of the therapies cost more than the patients’ monthly income. Full article
(This article belongs to the Special Issue Healthcare Management and Health Economics)
17 pages, 2379 KiB  
Article
Drug Expenditure, Price, and Utilization in US Medicaid: A Trend Analysis for New Multiple Myeloma Medications from 2016 to 2022
by Marwan Alrasheed, Abdulrahman Alsuhibani, Bander Balkhi and Jeff Jianfei Guo
Healthcare 2023, 11(16), 2265; https://doi.org/10.3390/healthcare11162265 - 11 Aug 2023
Viewed by 1432
Abstract
Introduction: Multiple myeloma (MM) is the most common plasma cell tumor type. In late 2015, the FDA approved three new medications for MM. These medications were ixazomib, daratumumab, and elotuzumab. However, their utilization, reimbursement, and price in the Medicaid program have not been [...] Read more.
Introduction: Multiple myeloma (MM) is the most common plasma cell tumor type. In late 2015, the FDA approved three new medications for MM. These medications were ixazomib, daratumumab, and elotuzumab. However, their utilization, reimbursement, and price in the Medicaid program have not been analyzed before. Methods: A retrospective drug utilization study using the national Medicaid pharmacy claims data from 2016 to 2022 in the US. The primary metrics of analysis were utilization (number of prescriptions), reimbursement (total spending), and price (reimbursement per prescription). Results: The overall Medicaid utilization of MM medications increased from 1671 prescriptions in 2016 to 34,583 prescriptions in 2022 (1970% increase). Moreover, the overall Medicaid reimbursement for the new MM medications increased from USD 9,250,000 in 2016 to over USD 214,449,000 in 2022 (2218% increase). Daratumumab had much higher utilization, reimbursement, and market shares than its competitors. Ixazomib was the most expensive medication compared to daratumumab and elotuzumab. Conclusion: The results of this study demonstrate that CMS utilization and spending on MM medications have significantly grown since 2016. Daratumumab has by far the highest utilization, spending, and market share. The utilization of and spending on specific pharmaceuticals are clearly impacted by policy and clinical guideline recommendations. Full article
(This article belongs to the Special Issue Healthcare Management and Health Economics)
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13 pages, 504 KiB  
Article
Efficiency Improvement Strategies for Public Health Systems: Developing and Evaluating a Taxonomy in the Australian Healthcare System
by James Kenneth Walters, Anurag Sharma and Reema Harrison
Healthcare 2023, 11(15), 2177; https://doi.org/10.3390/healthcare11152177 - 31 Jul 2023
Cited by 1 | Viewed by 894
Abstract
Introduction: As demand for healthcare continues to grow, public health systems are increasingly required to drive efficiency improvement (EI) to address public service funding challenges. Despite this requirement, evidence of EI strategies that have been successful applied at the whole-of-system level is limited. [...] Read more.
Introduction: As demand for healthcare continues to grow, public health systems are increasingly required to drive efficiency improvement (EI) to address public service funding challenges. Despite this requirement, evidence of EI strategies that have been successful applied at the whole-of-system level is limited. This study reports the development, implementation and evaluation of a novel taxonomy of EI strategies used in public health systems to inform systemwide EI models. Materials and methods: The public health system in New South Wales, Australia, operates a centralised EI model statewide and was the setting for this study. An audit of EI strategies implemented in the NSW Health system between July 2016 and June 2019 was used to identify all available EI strategies within the study timeframe. A content management approach was applied to audit the strategies, with each strategy coded to an EI focus area. Codes were clustered according to similarity, and category names were assigned to each cluster to form a preliminary taxonomy. Each category was defined and examples were provided. The resulting taxonomy was distributed and evaluated by user feedback survey and pre–post study to assess the impact on EI strategy distribution. Results: A total of 1127 EI strategies were identified and coded into 263 unique strategies, which were clustered into nine categories to form the taxonomy of EI strategies. Categories included the following: non-clinical contracts and supplies; avoided and preventable activity; clinical service delivery and patient outcomes; finance and operations; recruitment, vacancies and FTE; staffing models; leave management; staff engagement and development; premium staffing; and clinical contracts and supplies. Evaluative findings revealed a perceived reduction in the duplication of EI work, improved access to EI knowledge and improved engagement with EI processes when using the taxonomy. The taxonomy was also associated with wider use of EI strategies. Conclusions: Whole-of-system EI is an increasing requirement. Using a taxonomy to guide systemwide practice appears to be advanta-geous in reducing duplication and guiding practice, with implications for use in health systems internationally. Full article
(This article belongs to the Special Issue Healthcare Management and Health Economics)
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12 pages, 303 KiB  
Article
Cost Analysis of Magnetic Resonance Imaging and Computed Tomography in Cardiology: A Case Study of a University Hospital Complex in the Euro Region
by Francisco Reyes-Santias, Carlos García-García, Beatriz Aibar-Guzmán, Ana García-Campos, Octavio Cordova-Arevalo, Margarita Mendoza-Pintos, Sergio Cinza-Sanjurjo, Manuel Portela-Romero, Pilar Mazón-Ramos and Jose Ramon Gonzalez-Juanatey
Healthcare 2023, 11(14), 2084; https://doi.org/10.3390/healthcare11142084 - 21 Jul 2023
Cited by 1 | Viewed by 1129
Abstract
Introduction: In recent years, several hospitals have incorporated MRI equipment managed directly by their cardiology departments. The aim of our work is to determine the total cost per test of both CT and MRI in the setting of a Cardiology Department of a [...] Read more.
Introduction: In recent years, several hospitals have incorporated MRI equipment managed directly by their cardiology departments. The aim of our work is to determine the total cost per test of both CT and MRI in the setting of a Cardiology Department of a tertiary hospital. Materials and Methods: The process followed for estimating the costs of CT and MRI tests consists of three phases: (1) Identification of the phases of the testing process; (2) Identification of the resources consumed in carrying out the tests; (3) Quantification and assessment of inputs. Results: MRI involves higher personnel (EUR 66.03 vs. EUR 49.17) and equipment (EUR 89.98 vs. EUR 33.73) costs, while CT consumes higher expenditures in consumables (EUR 93.28 vs. EUR 22.95) and overheads (EUR 1.64 vs. EUR 1.55). The total cost of performing each test is higher in MRI (EUR 180.60 vs. EUR 177.73). Conclusions: We can conclude that the unit cost of each CT and MRI performed in that unit are EUR 177.73 and EUR 180.60, respectively, attributable to consumables in the case of CT and to amortization of equipment and staff time in the case of MRI. Full article
(This article belongs to the Special Issue Healthcare Management and Health Economics)
11 pages, 1183 KiB  
Article
Identifying the Drivers of Inter-Regional Patients’ Mobility: An Analysis on Hospital Beds Endowment
by Giovanni Guarducci, Gabriele Messina, Simona Carbone and Nicola Nante
Healthcare 2023, 11(14), 2045; https://doi.org/10.3390/healthcare11142045 - 17 Jul 2023
Viewed by 700
Abstract
Background: In a Beveridgean decentralized healthcare system, like the Italian one, where regions are responsible for their own health planning and financing, the analysis of patients’ mobility appears very interesting as it has economic and social implications. The study aims to analyze both [...] Read more.
Background: In a Beveridgean decentralized healthcare system, like the Italian one, where regions are responsible for their own health planning and financing, the analysis of patients’ mobility appears very interesting as it has economic and social implications. The study aims to analyze both patients’ mobility for hospital rehabilitation and if the beds endowment is a driver for these flows; Methods: From 2011 to 2019, admissions data were collected from the Hospital Discharge Cards database of the Italian Ministry of Health, population data from the Italian National Institute of Statistics and data on beds endowment from the Italian Ministry of Health website. To evaluate patients’ mobility, we used Gandy’s Nomogram, while to assess if beds endowments are mobility drivers, we created two matrices, one with attraction indexes (AI) and one with escape indexes (EI). The beds endowment, for each Italian region, was correlated with AI and EI. Spearman’s test was carried out through STATA software; Results: Gandy’s Nomogram showed that only some northern regions had good hospital planning for rehabilitation. A statistically significant correlation between beds endowment and AI was found for four regions and with EI for eight regions; Conclusions: Only some northern regions appear able to satisfy the care needs of their residents, with a positive attractions minus escapes epidemiological balance. The beds endowment seems to be a driver of patients’ mobility, mainly for escapes. Certainly, the search for mobility drivers needs further investigation given the situation in Molise and Basilicata. Full article
(This article belongs to the Special Issue Healthcare Management and Health Economics)
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12 pages, 386 KiB  
Article
Do Out-of-Pocket Payments for Care for Children under 5 Persist Even in a Context of Free Healthcare in Burkina Faso? Evidence from a Cross-Sectional Population-Based Survey
by Ludovic D. G. Tapsoba, Mimbouré Yara, Meike I. Nakovics, Serge M. A. Somda, Julia Lohmann, Paul J. Robyn, Saidou Hamadou, Hervé Hien and Manuela De Allegri
Healthcare 2023, 11(10), 1379; https://doi.org/10.3390/healthcare11101379 - 10 May 2023
Viewed by 1246
Abstract
Background: In April 2016, Burkina Faso began free healthcare for children aged from 0 to 5 years. However, its implementation faces challenges, and the goal of this study is to estimate the fees paid for this child care and to determine the causes [...] Read more.
Background: In April 2016, Burkina Faso began free healthcare for children aged from 0 to 5 years. However, its implementation faces challenges, and the goal of this study is to estimate the fees paid for this child care and to determine the causes of these direct payments. Methods: Data gathering involved 807 children aged from 0 to 5 years who had contact with the public healthcare system. The estimation of the determinants of out-of-pocket health payments involved the application of a two-part regression model. Results: About 31% of the children made out-of-pocket payments for healthcare (an average of 3407.77 CFA francs per case of illness). Of these, 96% paid for medicines and 24% paid for consultations. The first model showed that out-of-pocket payments were positively associated with hospitalization, urban area of residence, and severity of illness, were made in the East-Central and North-Central regions, and were negatively associated with the 7 to 23 month age range. The second model showed that hospitalization and severity of illness increased the amount of direct health payments. Conclusion: Children targeted by free healthcare still make out-of-pocket payments. The dysfunction of this policy needs to be studied to ensure adequate financial protection for children in Burkina Faso. Full article
(This article belongs to the Special Issue Healthcare Management and Health Economics)
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18 pages, 1948 KiB  
Article
Aspects Regarding Sustainability among Private Dental Practitioners from Bucharest, Romania: A Pilot Study
by Ana Maria Cristina Țâncu, Andreea Cristiana Didilescu, Mihaela Pantea, Ruxandra Sfeatcu and Marina Imre
Healthcare 2023, 11(9), 1326; https://doi.org/10.3390/healthcare11091326 - 05 May 2023
Viewed by 1198
Abstract
Oral health professionals’ knowledge of sustainability is essential for promoting environmental protection in dental healthcare. This pilot study involved an online survey addressed to 70 dental private practitioners from Bucharest, Romania, to evaluate their awareness of the concept of sustainability in dentistry. The [...] Read more.
Oral health professionals’ knowledge of sustainability is essential for promoting environmental protection in dental healthcare. This pilot study involved an online survey addressed to 70 dental private practitioners from Bucharest, Romania, to evaluate their awareness of the concept of sustainability in dentistry. The performed statistical analysis revealed that 41.4% of the participants were well aware of sustainability in dentistry, with older participants demonstrating significantly higher levels of such awareness (p = 0.001). Sustainability awareness among participants correlates positively with their knowledge of the negative environmental impacts of dental activity (p < 0.001) and with the concern for sustainable dentistry implementation in their workplace (p = 0.037). Improper biohazardous waste disposal was identified as the primary cause of negative environmental impact of dental practices by 87.1% of participants. Installing high energy-efficient dental equipment was selected as the most important action to implement sustainability in participants’ dental practices (64.3%). Overall, 51.4% of the participants reported that the COVID-19 pandemic had a medium impact on their dental activity in terms of sustainability. Our study found that participants have a moderate level of awareness regarding sustainability in dentistry, highlighting the need for education on sustainability for oral health professionals. Full article
(This article belongs to the Special Issue Healthcare Management and Health Economics)
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16 pages, 3598 KiB  
Article
The Link between HRM Practices and Performance in Healthcare: The Mediating Role of the Organizational Change Process
by Cristina Claudia Rotea, Andra-Nicoleta Ploscaru, Claudiu George Bocean, Anca Antoaneta Vărzaru, Mădălina Giorgiana Mangra and Gabriel Ioan Mangra
Healthcare 2023, 11(9), 1236; https://doi.org/10.3390/healthcare11091236 - 26 Apr 2023
Cited by 2 | Viewed by 2555
Abstract
The role of human resources as a change agent in the organizational change process holds great importance. Hence, it is crucial to identify ways human resources can support change. This paper investigates the direct and indirect relationships between human resource management (HRM) practices [...] Read more.
The role of human resources as a change agent in the organizational change process holds great importance. Hence, it is crucial to identify ways human resources can support change. This paper investigates the direct and indirect relationships between human resource management (HRM) practices and organizational performance, as well as the mediating role of the organizational change process in these relationships. The proposed model integrates primary HRM practices, organizational change components, organizational performance, employee retention, and organizational abandonment. We collected data to evaluate the relationships between the model variables through a survey questionnaire applied to 441 Romanian employees in the healthcare industry. The paper used structural equation modeling to test the model’s validity and hypotheses. The results show that HRM practices directly impact organizational performance and have a mediated impact through the organizational change process. Additionally, the direct and mediating effects are consistent, and healthcare employers consider appropriate HRM practices and effective management of the organizational change process as essential drivers to achieve superior performance. The empirical findings provide valuable insights for government policymakers, stakeholders, and health managers on how suitable HRM practices can influence organizational performance. Full article
(This article belongs to the Special Issue Healthcare Management and Health Economics)
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11 pages, 250 KiB  
Article
Vial Sharing of High-Cost Drugs to Decrease Leftovers and Costs: A Retrospective Observational Study on Patisiran Administration in Bologna, Italy
by Margherita Cozzio, Alessandro Melis, Giusy La Fauci, Pietro Guaraldi, Rosaria Caputo, Flavia Lioi, Giulia Sangiorgi Cellini, Giuseppina Santilli, Donatella Scarlattei, Pasquale Siravo, Paola Zuccheri, Andrea Ziglio and Marco Montalti
Healthcare 2023, 11(7), 1013; https://doi.org/10.3390/healthcare11071013 - 02 Apr 2023
Cited by 1 | Viewed by 1287
Abstract
Waste of high-cost medicines, such as orphan drugs, is a major problem in healthcare, which leads to excessive costs for treatments. The main objective of this study was to evaluate the impact of a vial-sharing strategy for patisiran, an orphan drug used for [...] Read more.
Waste of high-cost medicines, such as orphan drugs, is a major problem in healthcare, which leads to excessive costs for treatments. The main objective of this study was to evaluate the impact of a vial-sharing strategy for patisiran, an orphan drug used for the treatment of hereditary transthyretin-mediated amyloidosis, in terms of a reduction in the discarded drug amount and cost savings. The retrospective observational study was conducted in a tertiary referral center (Emilia-Romagna, Italy), between February 2021 and November 2022. Data on drug waste were calculated as “(mg used–mg prescribed)/mg prescribed” for each session. We found a statistically significant (−9.14%, p < 0.001, 95% CI 5.87–12.41) absolute difference in mean discarded drug rates per session based on the study phase (before and after vial-sharing introduction) at the two-sample t-test. The absolute difference corresponded to a percentage decrease in the average reduction in the discarded drug rate with vial sharing of 82.96% per session. On an annual scale, the estimated cost savings was EUR 26,203.80/year for a patient with a standard body weight of 70 kg. In conclusion, we demonstrated that a patisiran vial-sharing program undoubtedly offsets some of the high costs associated with this treatment. We suggest that this easy-to-introduce and cost-effective approach can be applied to the administration of other high-cost drugs. Full article
(This article belongs to the Special Issue Healthcare Management and Health Economics)
13 pages, 2242 KiB  
Article
Depression in Central and Eastern Europe: How Much It Costs? Cost of Depression in Romania
by Miorita Melina Iordache, Costin Octavian Sorici, Kamer Ainur Aivaz, Elena Carmen Lupu, Andrei Dumitru, Cristina Tocia and Eugen Dumitru
Healthcare 2023, 11(6), 921; https://doi.org/10.3390/healthcare11060921 - 22 Mar 2023
Cited by 3 | Viewed by 1896
Abstract
Objective: The present study aims to estimate the public cost of depression in Romania during a seven-year time span to complement existing papers with data from Central and Eastern Europe and to identify and propose measures that allow efficient use of funds. Methods: [...] Read more.
Objective: The present study aims to estimate the public cost of depression in Romania during a seven-year time span to complement existing papers with data from Central and Eastern Europe and to identify and propose measures that allow efficient use of funds. Methods: We used data collected from the National Health Insurance System to analyze the main components of the cost. Findings: Indirect costs exceed direct costs. Within the direct costs, hospitalization and medicines still have an important share but are decreasing due to the intervention of outpatient services such as psychiatrists and psychotherapists. Conclusion: Since the goal is mental health, it is necessary to act early and quickly to decrease the burden in the long run. Annually, the mean direct cost of depression per patient is EUR 143 (part of it is represented by hospitalization, i.e., EUR 67, and psychotherapy, i.e., EUR 5), the mean cost of sick leaves per patient is EUR 273, and the total cost per patient is EUR 5553. Indirect costs (cost of disability and lost productive years) represent 97.17% of the total cost. An integrated approach to early diagnosis, effective treatment, monitoring, and prevention as well as included economic and social programs are needed to optimize indirect costs. Full article
(This article belongs to the Special Issue Healthcare Management and Health Economics)
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21 pages, 901 KiB  
Article
Green Operation Strategies in Healthcare for Enhanced Quality of Life
by Albi Thomas, Suresh Ma, Ateekh Ur Rehman and Yusuf Siraj Usmani
Healthcare 2023, 11(1), 37; https://doi.org/10.3390/healthcare11010037 - 22 Dec 2022
Cited by 5 | Viewed by 2337
Abstract
Healthcare services have now become a fundamental requirement for all individuals owing to rising pollution levels and shifting lifestyles brought on by fast modernization. The hospital is a specialized healthcare facility where doctors, nurses, and other medical professionals offer their services. Academics and [...] Read more.
Healthcare services have now become a fundamental requirement for all individuals owing to rising pollution levels and shifting lifestyles brought on by fast modernization. The hospital is a specialized healthcare facility where doctors, nurses, and other medical professionals offer their services. Academics and professionals have emphasized green operation initiatives such as green design, green purchasing, green supply chain, and green manufacturing to increase public awareness of environmental problems affecting company operations associated with healthcare for the quality of life. The purpose of this research is to use total interpretive structural modeling and MICMAC (matrix cross multiplication applied to a classification) analysis to investigate and analyze the elements impacting green operations strategies in healthcare. The data are gathered using a closed-ended questionnaire together with a scheduled interview. The components’ interactions are explored using the total interpretive structural modeling technique, and the MICMAC analysis is used to rank and categorize the green operation strategy variables. The study is a novel effort to address and focus on stakeholders, vision and structure, resources, and capabilities. Green operations strategies have only been the subject of a small number of studies in the past, and those studies were mostly addressed at manufacturing-specific green strategies. Thus, by promoting energy efficiency programs, green building design, alternative sources of energy, low-carbon transportation, local food, waste reduction, and water conservation, the health sector can develop multiple key strategies to become more climate-friendly with significant health, environmental, and social co-benefits for quality of life. Full article
(This article belongs to the Special Issue Healthcare Management and Health Economics)
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15 pages, 1455 KiB  
Article
Cataract Surgery in Low-Income Countries: A Good Deal!
by Steffen Flessa
Healthcare 2022, 10(12), 2580; https://doi.org/10.3390/healthcare10122580 - 19 Dec 2022
Cited by 3 | Viewed by 1511
Abstract
Cataract is a major cause of blindness worldwide. In particular, in low-income countries, the burden of disease as well as its direct and indirect economic cost are a major challenge for the population and economy. In many cases, it would be possible to [...] Read more.
Cataract is a major cause of blindness worldwide. In particular, in low-income countries, the burden of disease as well as its direct and indirect economic cost are a major challenge for the population and economy. In many cases, it would be possible to prevent or cure blindness with a comparably simple cataract surgery, but many countries lack the resources to strengthen healthcare systems and implement broad cataract surgery programs reaching, in particular, the rural poor. In this paper, we analyse whether such an intervention could be cost-effective or even cost-saving for the respective health systems. We calculate the net value of the lifelong costs of cataract with and without surgery. This calculation includes direct costs (e.g., treatment, glasses, surgery) as well as indirect cost of the caregiver and the patient. We total all costs from the year of onset of cataract until death and discount the respective values to the year of onset. We define the surgery as cost-saving if the net-value of costs with surgery is lower than without surgery. If the cost per quality adjusted life year is lower than one gross national product per capita, we define the intervention as highly cost-effective. We find that the cost-effectiveness of cataract surgery depends on the age of onset of the disease and the age of surgery. If the surgery is performed with the beginning of severe impairment, even surgery of a 78-year-old patient is still cost-saving. Almost all possible constellations are highly cost-effective, only for the very old it is questionable whether the surgery should be performed. The simulations show that cataract surgery is one of the most cost-effective interventions. However, millions of people in low-income countries still have no chance to prevent or cure blindness due to limited resources. The findings of this paper clearly call for a stronger effort to reach poor and rural populations with this cost-effective service. Full article
(This article belongs to the Special Issue Healthcare Management and Health Economics)
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15 pages, 600 KiB  
Article
Catholic Ownership, Physician Leadership and Operational Strategies: Evidence from German Hospitals
by Sandra Sülz, Ludwig Kuntz, Helena Sophie Müller and Michael Wittland
Healthcare 2022, 10(12), 2538; https://doi.org/10.3390/healthcare10122538 - 14 Dec 2022
Viewed by 1168
Abstract
Previous research has revealed that Catholic hospitals are more likely follow a strategy of horizontal diversification and maximization of the number of patients treated, whereas Protestant hospitals follow a strategy of horizontal specialization and focus on vertical differentiation. However, there is no empirical [...] Read more.
Previous research has revealed that Catholic hospitals are more likely follow a strategy of horizontal diversification and maximization of the number of patients treated, whereas Protestant hospitals follow a strategy of horizontal specialization and focus on vertical differentiation. However, there is no empirical evidence pertaining to this mechanism. We conduct an empirical study in a German setting and argue that physician leadership mediates the relationship between ownership and operational strategies. The study includes the construction of a model combining data from a survey and publicly available information derived from the annual quality reports of German hospitals. Our results show that Catholic hospitals opt for leadership structures that ensure operational strategies in line with their general values, i.e., operational strategies of maximizing volume throughout the overall hospital. They prefer part-time positions for chief medical officers, as chief medical officers are identified to foster strategies of maximizing the overall number of patients treated. Hospital owners should be aware that the implementation of part-time and full-time leadership roles can help to support their strategies. Thus, our results provide insights into the relationship between leadership structures at the top of an organization, on the one hand, and strategic choices, on the other. Full article
(This article belongs to the Special Issue Healthcare Management and Health Economics)
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Review

Jump to: Editorial, Research

11 pages, 282 KiB  
Review
Analysis of the Healthcare System in Romania: A Brief Review
by Ion Petre, Flavia Barna, Daniela Gurgus, Laurentiu Cezar Tomescu, Adrian Apostol, Izabella Petre, Cristian Furau, Miruna Lucia Năchescu and Anca Bordianu
Healthcare 2023, 11(14), 2069; https://doi.org/10.3390/healthcare11142069 - 19 Jul 2023
Cited by 5 | Viewed by 2527
Abstract
This manuscript provides a brief review and analysis of the healthcare system in Romania. This study aims to comprehensively analyse the healthcare system in Romania, evaluating its strengths, weaknesses, and impact on the population’s access to quality healthcare services. Within the framework of [...] Read more.
This manuscript provides a brief review and analysis of the healthcare system in Romania. This study aims to comprehensively analyse the healthcare system in Romania, evaluating its strengths, weaknesses, and impact on the population’s access to quality healthcare services. Within the framework of the Romanian healthcare system, a multitude of pressing challenges endure. These encompass insufficient funding, shortages of medical personnel, and ineffectiveness in the provisioning of services. These impediments substantially hinder the accessibility of healthcare services, particularly in outlying and pastoral regions, thereby rendering the system susceptible and underserving certain demographics. Our investigation presents three hypotheses. The opening conjecture proposes that inadequate funding has a negative impact on the availability and standard of healthcare facilities in Romania. In addition, another hypothesis assumes that insufficient medical staff plays a considerable role in inequalities in access to and delivery of healthcare. Moreover, the existence of inadequacies in service provision serves as a significant barrier, obstructing the timely and efficient delivery of healthcare to those who need it. Our research encompasses a comprehensive analysis of key aspects of the Romanian healthcare system, ranging from healthcare infrastructure and financing mechanisms to service delivery and healthcare outcomes. Through a blend of qualitative and quantitative data sources, including government reports, academic studies, and statistical data, we have endeavoured to provide an in-depth evaluation. The analysis encompasses various aspects, including healthcare infrastructure, financing mechanisms, service delivery, and healthcare outcomes. Romania has a mixed healthcare system with both public and private providers. The primary level of care is delivered by family doctors, while hospitals and specialised medical centres provide secondary and tertiary care services. This research underlines the criticality of significant alterations being implemented in the healthcare system of Romania to address the issues arising from insufficient funding, a shortage of medical personnel, and shortcomings in service delivery. It is vital to tackle the obstacles presented by insufficient funding, the dearth of healthcare staff, and inadequacies in service delivery to attain impartial and reachable healthcare. By implementing these essential transformations, Romania can pave the way towards a healthcare system that efficaciously caters to the diverse requirements of its populace and guarantees the provision of prompt and superior healthcare services. Full article
(This article belongs to the Special Issue Healthcare Management and Health Economics)
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