How do hospital‐specialty characteristics influence health system responsiveness? An empirical evaluation of in‐patient care in the Italian region of Emilia‐Romagna

Fiorentini, Gianluca; Robone, Silvana; Verzulli, Rossella

doi:10.1002/hec.3540

Cited by 10 publications

(13 citation statements)

References 58 publications

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“…Additionally, our findings of lower levels of positive opinions about the emergency care department post-reform may reinforce those of Fiorentini et al (2017), who recorded a strong association between subjective and objective measures of health care satisfaction. Therefore, we corroborate previous findings that patients' self-reported measures can be considered valid predictors of more objective measures of responsiveness and could be used as tools to evaluate the performance of health systems.…”

Section: Discussionsupporting

confidence: 85%

“…While the primary focus of the reform is health care utilization, a parameter that can be directly determined, the impact of the law on user perceptions about the health system, or on health status, is less straightforward. Taking a recent study (Fiorentini et al, 2017) reporting a strong correlation between objective and subjective opinions about health system responsiveness, we offer the conjecture that the 2012 reform may have had a negative effect on the perceived quality of care on the part of undocumented persons. However, it is also plausible that, in times of restricted access to health care, individual expectations may be lower (Gallo and Gené-Badía, 2013) and thus positive opinions about the health system may even increase as a result.…”

Section: Datamentioning

confidence: 99%

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Limiting health‐care access to undocumented immigrants: A wise option?

Jiménez-Rubio

Castelló

2020

Health Economics

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The number of undocumented migrants in high income countries has increased in recent decades, imposing considerable political, fiscal and social pressures on governments. This has fostered discussions on whether and to what extent undocumented migrants should get access to public programs and public benefits.Looking at the 2012 Spanish health reform, this is the first paper to document the impacts of a restriction on access to the health care system for undocumented migrants on health care utilization, health care system perceptions and self-reported health in a high income country.We show that such restrictions may significantly reduce planned care for undocumented migrants and result in sharp fall in positive opinions about the health care services still left available to them. We also exploit the heterogeneity in implementing the policy across regions and report stronger effects in regions that enforced the national ban more fully. Furthermore, in the first three years since the implementation of the reform, we find suggestive evidence of a worsening in self-assessed health. This study is relevant for policymakers in the developed world, especially in countries which have recently implemented initiatives aimed at reducing the health care coverage for targeted groups, such as the UK and the US.

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Section: Discussionsupporting

confidence: 85%

Section: Datamentioning

confidence: 99%

Limiting health‐care access to undocumented immigrants: A wise option?

Jiménez-Rubio

Castelló

2020

Health Economics

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“…Such surveys have not been repeated since, so there is no way of knowing whether countries have improved/ regressed in relation to their national responsiveness assessment. More recent studies have applied the tool to measure responsiveness at the meso-level (organization/ facility) or for specific services or programs [70][71][72]. There are also responsiveness assessments for the health system building blocks.…”

Section: Description Of Categorization 1: 'Unidirectional User-service Interface'mentioning

confidence: 99%

Health system responsiveness: a systematic evidence mapping review of the global literature

Khan

Kagwanja

Whyle

et al. 2021

Int J Equity Health

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Background The World Health Organisation framed responsiveness, fair financing and equity as intrinsic goals of health systems. However, of the three, responsiveness received significantly less attention. Responsiveness is essential to strengthen systems’ functioning; provide equitable and accountable services; and to protect the rights of citizens. There is an urgency to make systems more responsive, but our understanding of responsiveness is limited. We therefore sought to map existing evidence on health system responsiveness. Methods A mixed method systemized evidence mapping review was conducted. We searched PubMed, EbscoHost, and Google Scholar. Published and grey literature; conceptual and empirical publications; published between 2000 and 2020 and English language texts were included. We screened titles and abstracts of 1119 publications and 870 full texts. Results Six hundred twenty-one publications were included in the review. Evidence mapping shows substantially more publications between 2011 and 2020 (n = 462/621) than earlier periods. Most of the publications were from Europe (n = 139), with more publications relating to High Income Countries (n = 241) than Low-to-Middle Income Countries (n = 217). Most were empirical studies (n = 424/621) utilized quantitative methodologies (n = 232), while qualitative (n = 127) and mixed methods (n = 63) were more rare. Thematic analysis revealed eight primary conceptualizations of ‘health system responsiveness’, which can be fitted into three dominant categorizations: 1) unidirectional user-service interface; 2) responsiveness as feedback loops between users and the health system; and 3) responsiveness as accountability between public and the system. Conclusions This evidence map shows a substantial body of available literature on health system responsiveness, but also reveals evidential gaps requiring further development, including: a clear definition and body of theory of responsiveness; the implementation and effectiveness of feedback loops; the systems responses to this feedback; context-specific mechanism-implementation experiences, particularly, of LMIC and fragile-and conflict affected states; and responsiveness as it relates to health equity, minority and vulnerable populations. Theoretical development is required, we suggest separating ideas of services and systems responsiveness, applying a stronger systems lens in future work. Further agenda-setting and resourcing of bridging work on health system responsiveness is suggested.

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“…In the report, the WHO developed a framework for assessing the overall performance of a health system taking into account the following items: level and distribution of health, level and distribution of responsiveness, and fairness in financial contribution. Of these items, those related to responsiveness have received increasing attention in the literature [2][3][4][5]. Health system responsiveness concerns the way individuals are treated and the environment in which they are treated by the health system.…”

Section: Introductionmentioning

confidence: 99%

“…Therefore, the experiences that people report with regard to non-clinical factors have typically been used to quantify the level of health system responsiveness in these domains. Some authors have shown that subjective measures may be a good proxy of the real responsiveness of health systems [2].…”

Section: Introductionmentioning

confidence: 99%

Improving People’s Self-Reported Experience with the Health Services: The Role of Non-Clinical Factors

Fernández-Pérez

Sánchez

2019

IJERPH

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The main aim of this study was to analyse the association between non-clinical factors and the self-reported experience of people with the main health services of the Spanish public healthcare system. Specifically, we analysed whether factors such as the treatment received from health staff, the confidence transmitted to the patient by the doctor, or waiting time for a diagnostic test had an influence on people reporting a more satisfactory experience with primary, specialised, and hospital care services. We used cross-sectional microdata from the Spanish Healthcare Barometer survey of 2015 comprising a sample of 7800 individuals. We applied a probit-adapted ordinary least squares estimation, which is one of the most widely used methods in recent studies on subjective well-being. Our findings suggest that individuals’ interaction with non-clinical factors was positively correlated with the overall health services experience. Treatment received from health staff was one of the most relevant factors to ensure that individuals report a more satisfactory experience with primary care. Time devoted by physicians to each patient and waiting time for a non-emergency admission were the most correlated factors in specialised and hospital care services, respectively. This study could have implications for public policies. First, it shows policy-makers the influence of non-clinical factors when individuals rate their overall experience with the main health services in Spain. Second, it identifies the key factors where the health system could reallocate more public resources to improve people’s experience and thus the health system responsiveness.

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How do hospital‐specialty characteristics influence health system responsiveness? An empirical evaluation of in‐patient care in the Italian region of Emilia‐Romagna

Cited by 10 publications

References 58 publications

Limiting health‐care access to undocumented immigrants: A wise option?

Limiting health‐care access to undocumented immigrants: A wise option?

Health system responsiveness: a systematic evidence mapping review of the global literature

Improving People’s Self-Reported Experience with the Health Services: The Role of Non-Clinical Factors

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