Benchmark of patient& provider autonomy

Some of who do not know the term think that autonomy means leave the patient alone or in funny way do not disturb and interrupt. Actually the opposite is the correct by autonomy. Share the care responsibility between the healthcare providers and the patients considered and form the real core and concept of autonomy. But in this post not for autonomy and interpretation of term itself, moreover the direct impact of autonomy over society segments and patients mindsets significantly appeared in their awareness and active responsiveness toward modern solutions and shared medical integrations. The point here how would be better from professional perspective to measure the patient autonomy for every community segment professionals are going to deal with and modify or adjust the self and mind control to improve such degree of patients care contributions, there is a question here that easy and possible?, the answer yes possible for sure but not easy at all.

The matter of adaptation of public interest begins with scoring and measuring where exactly the benchmark applied to build reforms. Dealing with human nature differ greatly according to personal, community and even national interest and coherent or deviated according to lifestyle and capabilities to embrace the change dogma. Service autonomy is much better in certain situations depending on hazards enclosed and around; in remote service and in case following the patients those are hard to keep them on monitoring most of time. Also in acute medical cases and chronic follow up, autonomy plays direct impact on patient life and can protect them away from harm complications. Below there is a simple Benchmark of patient and provider autonomy;

1. Degree of consumer choice

Of primary care providers

Of specialized care providers

Of alternative providers

Of procedures

2. Degree of practitioner autonomy

Provider autonomy is the degree of given authority to make patient related decisions and freedom to act according to one’s professional knowledge base. And the level of authority differs with care services of each provider; means general practitioner differs in autonomy strength than specialist and emergency care professionals. Moreover; at some point of provider autonomy needed written agreement in order to be able to exceed certain level of autonomy restrictions with patients especially in surgery. This benchmark can be stretched and divided to cover both categories of autonomy whether patient or provider use to achieve and analysis the proper measurement of reforms. Full health J

Benchmark of democratic accountability and empower

For creation good management atmosphere serve the main target of work supply toward end value receivers. That for sure needs favourable standards lead to build compact management concept, the standards should applied over medical workers and nurses. It means there is no way to train the employees and nurses to know and understand these standards. Own perspective considered a good management scheme base of any successful business and even with the most brilliant business process without can easily lead to unbearable problems. Here would like to give one example describe the significance of management quality; pharmaceutical firms worldwide are most profitable industry whether on the level of manufacture or distribution channels. How did I know that?; simply because of experience for years in pharmaceutical industry and business.

Anyway; there is no doubts about their huge profits annually they get from different market segments and in over population countries word millions repeatedly touch your ears in every sales meeting you attended. But the point here not talking about the industry but refer to quality management which be always the cause of success of business cycle. Many of those companies could not tolerate the matter of success and huge revenue daily and after few years they naively increase their expenses and business stopped at such point with no extension or creation. At the end; their business retreat till found themselves have to pay additional bonuses and in worst condition they have to offer bribe for physicians to prescribe the company items. This not ever because of anything else than inferior mindset of business and focusing only on revenues than working to increase them, many of these companies declined to disappear couple of years later because their inappropriate management concept. In coming Benchmark does explain fair and acceptable skeleton of productive management pathway of healthcare:

1. Explicit, public, detailed procedures for evaluating services with full public reports

Use reports

Performance reports

Compliance reports

Use of adequately qualified consultants

2. Explicit deliberative procedures for resource allocation with transparency and rationales for decisions based on reasons all ‘‘stakeholders’’ can agree are relevant.

3. Global budgeting

4. Fair grievance procedures

Legal procedures (malpractice)

Non-legal dispute resolution procedures

5. Adequate privacy protection

6. Measures for enforcement of compliance with rules and laws

7. Strengthening civil society

Enabling environment for advocacy groups

Stimulating public debate, including participation of vulnerable groups, full health J

Benchmark of administrative efficiency

Administrative work of healthcare is the raw material desktop and without many of work preparation and tabulation will be scattered and become useless. But the truth about administrative work is like a watery unites of management; there are no demarcations in order to define the borders and boundaries for checking and further development. In this benchmark we are going to draw some sort of demarcation lines to be in mind account when medical professionals work with healthcare systems and other management supportive unites. The importance of this benchmark lied in being the first line of patients dealing platform and also data management platform. You can remember when you visited last time a hospital with supposed professional integrated employees; what you felt at that time and what was your impression about the service and other neglecting signs!. Exactly; this is the main aim of administration efficiency to reach point of good impression and build subconscious loyalty lead the patient to feel comfortable when they get their medical care and get their demands. Exhaustion and drained effort of patient is repellent in medical care systems, indirectly even build loyalty not only with medical care but exceed that to reach loyalty to government and country sometimes.  One hint here I like much to mention that when country enemies like to destruct loyalty atmosphere of public toward the home country, they easily working to ruin education quality and healthcare loyalty through implanting less qualified or agenda oriented employees to build repellent living standards for most of citizens then forcing them implicitly to move and leave the country and there are many examples prove this plan. Please look below to find the main work skeleton of administrative efficiency and benchmark for further development and progress:

1. Minimize administrative overheads

Appropriate technology acquisition (Purchase- Maintenance- Training)

Reduce excessive marketing costs (hospitals or plans)

Efficient use of personnel (Reduction of excess- Appointments and promotions based on competence)

Appropriate economies of scale adequate risk pools for insurers

Reduction of duplicate structures, including integration of vertically organized programmes

Minimize transaction costs (Enrolment and non enrolment costs)

Oversupply of some services in some areas:

2. Cost-reducing purchasing

Reduce price variation

Drug cost reduction through large scale purchasing

Reliance on (quality) generics where possible

3. Minimize cost shifting

Cost shifting from PC to tertiary

Cost shifting to patients

Cost shifting to public sector or insurance from other types

Cost shifting between schemes

4. Minimize abuse and fraud and inappropriate incentives

Shadow providers, partial and total

Practitioner auto-referral

Drug sales at profit by rural doctor

Billing practices

Unqualified practitioners in rural areas

Inappropriate promotion of drugs and devices. Full health J

Comprehensiveness of healthcare benefits and tiering

There are many business model of healthcare system worldwide and certain achieve minimum level of value satisfaction while many still on the threshold of basics and only few could reach to be good and acceptable according to fairness standards of medical provision and value community coverage. The worst level of fairness lack among society individuals is called ‘Tiering’; which means inequality and considerable deviation of value coverage delivery and quality care to certain community segments. The real problem of Tiering is not about meaning and explanation but more touch the medical system mechanisms and way of value management between different insurance holders. Tiering can be found in rich societies and also in middle and poor societies. Moreover; there is Tiering inside the same category of insurance whether public and private sector, and so on. I would like here to highlight point of understanding to get the whole idea about Tiering; actually Tiering is not new and most of healthcare systems textbooks took about in details and the core meaning of such term lied in creating and building parallel layers of society segments could not get proper and achieve minimum threshold of healthcare whether if they public insured or in private one.

One of relapsed key leads to Tiering in healthcare increased successive interest toward certain customers segment and neglecting others according to their ability to pay more for their extra or additional values gained.  Private sector in UK is clear example about Tiering in rich countries and much interest in wealthy clients whereas there are many could not reach to only the minimum of the same care. Levels of the same service are important and quality improvements in compliance with budget disbursed for each value good to apply but the weird is when you found highest standards for certain group of customers depending on their living capabilities and neglecting the rest of society. And for that reason applying fairness standards among community segments considered urgent to remove Tiering layers and dependent gaps.

The other example regarding Tiering in rich country; failing to provide proper insurance to the poor population and worker in USA is common. Moreover; it is not a secret for anyone to reach how many millions medical insured uncovered in 2017 and number existed already online, that if we consider USA is as a rich country with $ 20. 453 Trillions National Debit.  In Colombia is the same Tiering problem of medical care regarding massive interest toward wealthy segment of population which almost represent 5 % of the whole society and neglecting others or/and keep them on minimum medical benefits while population masses of them not insured covered indeed. Before we are leaving the term would like to refer to types and degrees of Tiering among communities, hard to build zero Tiering medical system but to keep satisfied level of medical benefits and insurance package to majority of the society is not that impossible.

The direct sequences of Tiering in healthcare system is decrease fairness standards and increase service deficiency gaps among members of community and clearly noticed in chronic value receivers and elderly patients service. As I said before medical business cycle is most profitable cycle ever you can meet and work with and rarely to find any medical institution or service provider suffer from lack of customers and that everywhere from Alaska to New Zealand. Because of that highest demand surge forms irresistible dynamic business cycle with unlimited rewards. Full health J

Nonfinancial barriers to healthcare access 

We discussed the definition of benchmark formerly and what the best approach for analysis and reform policy identification. As we know now that the benchmark is the measurement of improvement and progress indicator than threshold of reforms. In our series about reform benchmarks and associated indicators is really useful to highlight a bit over the matter of access which was the first post of this blog. Matter of access is one word but indeed represented to the first mirror of the healthcare system everywhere; it means when someone able to enter the healthcare system smoothly and elegantly without inconveniences. That reflects how far this system well designed and much coherent to the core role of medical value delivery. Also matter of system accessibility subjected to many other parameters indirectly related to the end user values such as tradition and local community customs. In some country level of web use is limited to certain nature of work and public organization; in that case when I talk about mobile app for diagnosis and mobile data entry never make sense with society traditions and behavioural lifestyle. 

Some researchers defined the local community culture and work traditions as a source of medical care success and others top them on the peak of work move and improvements. To get my idea in simple way imagine some investors would like to sell winter  blankets in tropical countries than air condition, you can imagine the result depending on the same concept with healthcare systems. Put the matter of society traditions as a matter of priority to describe the key of medical care success with any system model wanted to be applied. In coming paragraph we will reveal third benchmark in our series regarding the matter of healthcare access suited and adaptable to numerous community segments and suited also to different strategic policy of medical values. There is hint here describe and summarize the coming Benchmark; the core of work depends mainly on addressing the poor distribution of drugs, supplies and facilities as follow:

1. Reduction of geographical mal-distribution

Family and services

Personnel (mix and training)

 Supplies

Drugs

Clinic hours (appropriate to village routines, work schedules)

Transportation for medical purposes

2. Gender

Status in family regarding decision-making

Mobility

Access to resources

Reproductive autonomy

Gender sensitive provision of services, involvement of community political groups to address gender barriers

3. Cultural

Language

Attitude and practices relevant to disease and health

Uninformed reliance on untrained traditional practitioners (some healers, midwives, dentists, pharmacists)

Perception of public sector quality

4. Discrimination by race, religion, class, sexual orientation, disease

Include stigmatization of groups receiving public care. Full health J