According to Folland, Goodman, and Stano (2007, p.1), health economics involves health economists who examine the field and draw various disciplines such as economics training. These training may include industrial organisation, labour finance, cost-benefit analysis and public finance. Also, health economics are dependent on the cost-effectiveness of the system applied which may involve technology costs. Smith, Mossialos, and Papanicolas (2008, p.2) state that the performance measures in healthcare improvement seek to monitor, communicate and evaluate the extent that various health system aspects meet their key objectives. Moreover, health system performance gets measured with different entities (stakeholders) such as clinicians, patients, purchaser organisation, healthcare providers and the government. Therefore, the main role of identifying and analysing the performance of healthcare improvement is to help in holding the various entities into account by involving the stakeholders in making decisions. The purpose of this article is to identify and analyse how various stakeholders are involved in providing improved health care and the structure of the healthcare sector.
Various methods have got used in task 1 and task 2 in analysing the measures of healthcare improvement which influenced by the effectiveness of the health program. The four evaluation stages may help the Senior Manager in constructing measures that influence healthcare improvement.
The research report details the various studies that got made while per taking task 1 and task 2 of the assignment. In task 1, the report analyses the various inputs and outputs of data sources which help in healthcare improvement. In spite of that, task 2 analyses the structure of the demand in healthcare provision and how demand of medicine is rarely affected by the price of the price of healthcare. Also, in task 2 there is the structure of the health sector and how it influences demand and supply of health care.
According to Parsons, Gokey, and Thornton (2013, p.13), when assessing the performance of health information systems and data quality generated it is important to consider whether they are input or output data sources. Input data sources monitor the availability of essential resources providing early warning of various challenges during healthcare improvement. Parsons et al. states, “For example, as part of a project to address problems of pretrial detention in South Sudan, the United Nations provided computerised case management systems to prisons across the country” (p.14). On the other hand, output data sources explain the delivery of products though they are not limited to providing training and technical assistance. Furthermore, they also create standards and relevant legislative documents required for investing in a building and other infrastructure. Moreover, Tinker (n.d) states that the importance of output sources of data is to improve the patient’s experience of healthcare, improving health in its population and reduce the cost per capita of the healthcare.
According to Darby, Valentine, De Silva, Murray, and World Health Organization (2003, p.6), the WHO strategy gets drawn from the research approach which provides reliable information and valid measurements. Some of these measurements that improve health include the use of rating scales and reports in combination with field tests acquired and cognition. For instance, the reliable and valid measures in improving health care performance measures provide an assessment of responsive distribution. Darby et al. (2003) states, “WHO in its responsiveness strategy is implementing measurement tools that provide as close a report of what happened as possible. The strategy includes reports from those who are served by the health system and methods for assessing how those reports compare with other observations of what happens” (p.7). Furthermore, WHO uses the reporting and rating strategy in measuring consumer’s reports and their experience ratings.
Also, the World Health Organization uses cognitive and field testing to get a responsive survey in various countries with health systems and cultures. WHO uses this strategic approach together in providing credible evidence on the validity and reliability of the instruments that measure health improvement. The essence of this design is to survey data collected cost-effectively and ensuring that measurement errors get addressed such as sampling (Darby et al., 2003, p.8). The cognitive testing may get used by WHO in assessing respondents understanding and interpreting questionnaire items presented to them. The assessment of the respondents gets done by the ability of them to recall information that applied to the question asked and the various judgements they may make regarding which information to use. According to Darby et al. (2003), “The two most frequently used cognitive testing techniques are the ‘think aloud’ interview and debriefing. In the think-aloud procedure, respondents say out loud what they are thinking about with regard to the questions they are answering what the questions mean to them, what information they are drawing upon to answer the questions and how they are forming their responses as they complete the questionnaire. Interviewers may probe to get the respondents to elaborate or clarify. In debriefing, interviewers ask respondents to provide similar information; but after they have completed the questionnaire” (p.8).
According to Johansen, Mangolini, Chan, and Peacock (2001, p.33), irrespective of the techniques used in evaluating measures of health improvement it should get noted that they get based on efficiency and effectiveness of the health program. Therefore, the healthcare performance can get measured depending on the supply and demand and the study design which assesses the efficiency, acceptability and effectiveness of health care (Asteraye, 2002, p.90). Patient satisfaction, experience and patient reports act as perfect measures for healthcare improvement. Some of the tried and tested surveys done on patients got carried out by the Picker Institute and Care Quality Commission to analyse national monitoring performance (HealthKnowledge, n.d). Moreover, the quality of healthcare may also get improved by guideline implementation and treatment criteria. The quality assessment may also get carried out by external organisations (Care Quality Commission) which will help in monitoring and inspecting the process. Also, the productivity of the healthcare organisation help in measuring health improvement through bed occupancy and waiting time. Another crucial measure is a financial performance which helps in determining the healthcare performance (HealthKnowledge, n.d).
Johasen et al. (2003, p. 34) state that four evaluation stages may help the Senior Manager in creating appropriate measures for healthcare improvement. There are four stages which include; identifying the study perspective and question, determining the ideal way to identify and measure benefits and costs, comparing costs and benefits and deriving the decision rule. During the economic evaluation, the research question helps in identifying the specific set of healthcare programs which assist in addressing current programs. Also, the perspective of the research helps in creating a measure for healthcare improvement by decision making on what it may cause and consequences concerned (Johansen et al., 2003, p.34). The second step on the evaluation stage involves identifying and measuring costs and benefits which relate to the therapeutic effects, resource savings on health programs and changes in life quality for patients.
Furthermore, the consequences and costs may get measured inappropriate physical units which allow generalisation and replication of resources. Some of the cost units may include nursing time, pharmaceuticals used and some physician units. The third stage of the evaluation may involve analysing benefits and costs where the analysis gets made on the cost period incurred and benefits it may bring in the future. The third stage helps in the evaluation of the decision-making process which helps in assessing the distribution benefits of the improved health care system.
Shri Guru Ram Rai Institute of Technology and Science (n.d, p.1) states that health care demand involves the allocation of resources which enable consumption and production of health. The extent and nature of demand depending on the changing factors in resources and supply of health demand. Therefore, the healthcare price and its services play a crucial role in the demand and supply of health economics. Though, the demand for health care may be an urgent life necessity its price does not necessarily determine it since sometimes it may be a matter of life or death which may cause one to borrow. In spite of that, when the type of medical care is relatively expensive, consumers may opt for more affordable medical care which results in a decline of original medical products. When some consumers expect prices of health care to drop in the future, they may postpone the purchase of certain medical items. Such actions may lead to health care demand to drop resulting in the prices decreasing relatively. Therefore the health care demand is directly related to the pricing of the quality health care item. Also, the demand for quality healthcare items may also rise from diseases and medical problems that consumers may face. Also, the demand for proper health care items and services may not get affected by expected future or a sudden drop in the prices of quality healthcare items. The reason that keeps this constant demand for health care services and items is that consumers do not use stock medicines for any future low price drops. Figure 1, gives the structure of the demand curve which has the price of health care along with its vertical axis and the quantity of health care services and items get located on the horizontal axis.
Figure 1: The demand curve shifts its position to the right
According to Sengupta, (2015), “when the price of the medical service is P4 the quantity of the health services demanded and consumed was Q4 when the consumers are at the demand curve D1. However, at the same price of P4, when consumers demand an increased quantum of medical services of Q5 they move to a demand curve to the right which is now D2 instead of being on the original demand curve D1 as the quantity of Q5 and price P4 cannot be accommodated on the demand curve D1 but can be accommodated only on a demand curve to the right at D2” (p.28).
Figure 2: Shift in demand for healthcare and services with no price change
Figure 2, also identifies that a decline in the incidences of malaria or any other illness may result in a decline in the demand and consumption of health care services and items. Sengupta (2015) states, “The result of this will be a shift of the demand curve to the left from D2 to D1 when the demand decreases from Q6 to Q3 at the same price of P3. Under such circumstances, the government department, health sector as well as the health industry has to gear itself up accordingly. Being guided only by the price of health service in such a situation will bring about distortion in the sector, which would result in a misallocation of scarce resources in the health sector. These features associated with principals of the demand side of health” (p.29).
According to Doheny (2015, p.2), the National Health Service (NHS) focuses on care provision which gets delivered by using resources requiring maintenance, management and development. The importance of the health care sector seeks to evaluate which inputs in the healthcare system are essential in ensuring a credible performance of the health program (Smith, Papanicolas, and Cylus, 2016, p.1). Furthermore, the system structure shapes how specialists relate with each other and their patients. Another point to note is that the health care systems can either lever types in the market (competition, relying on pricing and contracts) or bureaucratic levers (performance management, direct control and standards). The use of these levers relates to the structure of the health sector and how they interact. For instance, the bureaucratic system flows its operation down the health care system and service providers and holds them accountable for their work. A market system separates health care service providers into various entities that offer services in the market. Furthermore, the market system also facilitates the competing of customers solely based on price and quality. Doheny (2015) states, “So whereas in a bureaucracy, providers are made accountable to the Minister through managers, a market encourages providers to be more accountable to patients” (p.2).
According to the Care Quality Commission (2016, p.55), some of the trends in health care expenditure include; adult social care, primary medical services and health equality. In adult social care the quality of care still varies though the good health care systems and management support staff delivering better health services. Some of the health services got rated as inadequate Moreover, some of the health services performed better compared to others, for instance, services that specialise in hospices and community social care performed better. The community social care and hospices scored 84 per cent and 94 per cent respectively. In spite of that, domiciliary care services and residential homes had a similar performance while nursing homes which had a relatively bad score of 41 per cent. The reason for this conclusion in the assessment is that nursing homes did not have sufficient staff and experienced mismanagement of medicine (Care Quality Commission, 2016, p.59). From figure 3, small care homes had a generally better performance compared to medium and large care homes. However, the pattern was partly due to the attribution of smaller services getting dominated by health care providers for all ages who experience learning disability.
Figure 3: Current overall ratings by size and service type as at 31st July 2016
Conclusion
This article explains the various measures used in healthcare improvement and how various World Health Organizations use different strategies to identify appropriate approaches which are reliable and valid. In spite of that, the article also explains the recent trends in health care expenditure that involve adult social care and primary health services. There is an analysis regarding the demand curve and how it influences the demand for and supply of medication. An analysis also got done regarding outputs and input data sources that influence healthcare improvement.
According to Parry, Carson-Stevens, Luff, McPherson, and Goldmann (2013, p.S26), the Kirkpatrick Framework got used in evaluating programs, and it can get recommended as a considerable approach. It describes four levels which include experience, learning, behaviour and results. For improvement initiative, the framework helps in describing a program theory which involves changing processes and outputs expected. Also, it can get recommended that every evaluation intended to improve healthcare should seek clarity on the contents and execution of their health programs.
References
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