1.The fast pace by which technology is evolving creates a competitive challenge to health care services providers, furthermore, the complexity of healthcare processes and the autonomy of healthcare independent practitioners blended with the stringent need to provided a patient centered care shapes the need to develop a careful, comprehensive and flexible healthcare planning mechanism to ensure a satisfactory healthcare system.
a.Identify these determinants as well as other factors that may play an influential role in shaping an effective health care planning. Discuss as well the influences of these determinants on the outcomes of healthcare care planning process.
b.Propose strategies to address two challenges that you had identified in the course of your synthesis
2.Health Pro is a regional professional enterprise that owns a chain of hospitals. As being a central corporation supervising the overall operations, the company had formulated a health care plan in response to a recent decline in its profits and operational efficiency. The plan focused on addressing the rising number of complaints and sentinel events resulting in a series of malpractice lawsuits. As a result of the scope of the formulated plan, the corporate initially began to achieve improvements in patient safety while the financial performance remained unchanged despite tremendous efforts to solve these issues. However the pattern of rising events of serious patient safety issues returned to emerge in the course of the year.
a.Discuss the main focus of this plan (problem based or goal oriented) and critique its efficiency.
3.Referring to a recently published article (Koornneef, Robben & Blair, 2017) Between 2011 and 2015 healthcare spending in the UAE grew by 10% to US$ 11 billion, as a result of this fact, this stressing strategy mandates the government’s commitment to patient safety. While the published review serves as the basis of the scope of this query, other literature sources are recommended to be sought to answer the following questions:
b.Discuss the Abu Dhabi health reform system in terms of its planning efficiency and scope of focus. Is this reform program problem based or population oriented?
c.Describe and evaluate the strategies that have been implemented as part of the health system reform program in UAE?
1.a.With the introduction of fast paced technology and complexity of healthcare processes and preference for patient centered care, there is a need to engage in careful and flexible healthcare planning process (Butler et al. 2014). Certain determinants will play an important role in engaging in effective health care planning process. One of the determinants is the skills of health workforce and the availability of adequate health care staffs. This is because a flexible and accessible health service requires diverse range of skillful workers to fulfill the health needs of the population. Nancarrow (2015) argues that health workforce failed to respond effectively to health care demands because of several restrictions imposed by professional boundaries and funding models. These issues reduce workforce flexibility as well as contribute to additional medical cost and inefficiencies. Hence, workforce flexibility is a major determinant while shaping the effective health care planning process. Current health workforce are bound to traditional role boundaries and flexible workforce can address health care accessibility issues by eliminating the need for training all staffs and the time lost in training. Health workforce is major challenges for health care system today and embracing policies related to workforce flexibility can help to address workplace shortage as well as increase the opportunity to provide patient-centered care (Humphreys et al. 2017).
Clinical governance structure is also one of the determinants needed for planning an effective health care system. Government plays a vital role in intervening at the right and implementing action to improve equity and governance. Hence, to strengthen the function of the health care system, focusing on governance and service delivery is necessary. They can influence outcome of the health care planning process by the generation of human resources and strengthening the health care systems. Therefore, government can play a role in addressing health inequalities, promoting health care financing and responding to the needs of the population. The values and effective integration of patient centered care is also necessary to increase the quality of care and promote patient satisfaction. The main advantage of patient centered care is that it can promote patient-staff partnership, enhance flexibility in health care provisions and denounce traditional approach to care.
Presence of appropriate resources determines the quality of health service and effectiveness of the health care system. The most common gap in hospital setting is that health care resources are limited, but the patient expectation is high (Mosadeghrad 2014). Current, clinical leaders focus on getting all advanced medical technology and equipments to achieve positive health outcomes. However, despite introduction of medical technologies, efficacy of the health care is hampered because of lack of collaboration of care. The study by O'connor et al. (2016) has revealed that poor collaboration with team results in poor team function and high level of risk to patient. The study investigated about the situations that lead to poor team work and found that poor quality of collaboration was the most commonly identified reason for poor teamwork. Hence, level of collaboration can be regarded as one of the factor that can influence effective health care planning process. To move ahead with the goal of flexible and effective health care system, there is a need to focus on factors that improve collaboration process between health care team. Morley and Cashell (2017) gave an insight into the structural, psychological and educational determinants of collaboration. Structural determinants include the physical and organization environment such as physical structure, functionality and communication mode. Psychological determinants include presence of mutual trust and respect, willingness to collaborate and communication process. Educational determinants include skills training and giving clear understanding regarding roles and expectations in care.
Communication and efficient care coordination among multi-disciplinary team and health consumers is also a necessary element for promoting efficiency during care planning. This is also necessary considering the importance and preference for patient-centered care currently. Clinicians or health workers work in a stressful environment often working overtime to provide care to patient. However, main reason for dissatisfaction with the job and poor quality of care is the poor alignment of the organizational culture and poor preparedness to accurately respond to patient needs. This signifies that communication structure and organizational culture is a necessary determinant affecting the efficiency of the health care system (Smith et al. 2013). Current research evidence pays special emphasis to enhance the multi-disciplinary care coordination protocol as it is associated with improved measures of care quality. Development of a standardized protocol can play a role in improving patient assessment, care coordination and length of hospital stay. Lau and Dhamoon (2017) also gave the evidence that when a multidisciplinary round protocol was implemented in an academic medical center, improvements in the care coordination and patient outcome is seen. Therefore, to realize the goals of an efficient and flexible health care system, implementation of new communication and decision making paradigms particularly for vulnerable population group such as low income group and racial minority group is essential.
b.While conducting search on the determinants that play a role in shaping an effective health care planning process, two challenges has been identified in using addressing those determinants during the planning process. Firstly, maintaining workforce flexibility will be a difficult task particularly in low-density setting. One of the objectives of the World Health Organization is to maintain sufficient number of health workers to achieve Millennium Development Goal. However, in low resource setting, getting appropriate finance and support for addressing health care shortage is difficult. Furthermore, retention will also be a tedious process as human resource is effective only when the following activities are done in the health organization:
- Educate health workers
- Make arrangements for financing salaries, transportation and supplies
- Establish effective physical infrastructure and delivery models
- Maintain safe working condition (Jimba and Reidy 2009)
Maintaining all the above requires great financial support as well as extra critical insight from clinical administrators. Bringing improvement in how the health system is created is a demanding task. However, these can be addressed by looking at evidence regarding how countries suffering from such issues have managed to come out of the crisis. For example, a program implemented in sub-Saharan Africa in response to human resource shortages paid attention to retention, recruitment and incentives for health care workers. The agencies involved strengthened the monitoring system and revealed positive impact of the program (Palmer 2006). WHO has also recommended indicators for the evaluating finance, education and management element of the health care system. This gives implication to use political strategies to gain the required support for the reforms.
The second challenge that has been identified is regarding the challenges in implemented care coordination between different types of care provider. This issue is most likely to occur as evidenced by the research by Tomasone et al. (2017). Tomasone et al. (2017) reported about the state of care coordination for the health care system of Canada. The author indicated that various method was implemented to improve care coordination between oncology staffs and the primary health staff. Some of these included developing program material and clinical pathways and designing referral pathways. Latest technology like medical record was also utilized to incorporate evidence based recommendation. The study gave evidence about challenges that may come up when engaging in large scale implementation process. For example, program organizer has to face budget constraints related issues and issues in adhering to standardized protocols. Another challenge during large scale implementation was variation in medical practices. Hence, this evidence gives evidence the implication to take additional effort to standardize practice and make it flexible to accommodate all types of changes and variation. This would help in promoting effective and efficiency of the health care system.
a:In response to the decline in profits and operational efficiency, Health Pro, a regional professional enterprise took the step to address the increase in number of complaints and sentinel events in the chain of hospitals. The review of the intervention implemented in the scenario shows that Health Pro has taken a goal based approach to manage the issues. This is because HealthPro has considered only the goals to achieve health efficiency. However, unlike problem oriented approach, it has not considered the context in which the sentinel event has occurred. and the factors that contribute to problems. For this reason, many inherent problems present within the heath care system was ignored. Although Health Pro took the step to enhance operational efficiency, however it lacked wider focus. The decision regarding ways to address was not done by critically evaluating research problems and then interpreting the links between the problem and the sentinel event. Hence, goal oriented approach helps to formulate goals in relation to the increase in sentinel events. However, it lacked focus as it was not enough critical planning was done to identify the main element that caused the problem and resulted in return of patient safety issues. The advantage of relying on problem based approach is understood from the review of one research. In response to the problem of challenges faced by clinicians and others staffs in using medical records, Buchanan (2017) adapted problem-oriented approach to develop progress note regarding inefficiency in the creation of the tool. After analyzing user’s experience of challenges, the author technical vendor added an electronic chronological index in the medical records. This utility of this form of change was that user got the opportunity to focus on most recent data. Hence, the problem oriented focus offered a user-friendly record that displayed on-demand aggregated data and notes relevant to a particular problem. Similar type of approach could have been taken by Health Pro too to enhance the
3.a .UAE is a country consisting of 7 emirates and known for self-sufficiency in managing all health care funding requirements. The health care system of UAE can be defined as a mix of public-private system. This is said because public system with centralized management exists for Emiratis and large private sector exists in urban areas. Primary care is mainly provided through primary health care system and hospital care is delivered through specialized hospitals (Malik et al. 2016). The main issue with the use of public health facilities in UAE is that consumers have low level of trust in the system because of high cost of care and poor clinical expertise. In contrast, the number of private health services in UAE is increasing and there are more number of private hospitals compared to public hospitals in UAE. There is also an increase in the number of private health insurance companies and the total number of claims in 2016 were 28.9 million claims (Department of Health, 2018). Therefore, private health care system is playing a major role in providing high standard of care to the population.
The review of the population statistics of UAE suggest that the population structure is shaped by young population and equal ratio of male to females exists. However, unequal distribution exists among UAE nationals and expatriates. The demographic characteristics have a major impact on distribution and delivery of health care services. The review of the mortality statistics gives an insight into the health of the population. Chronic disease like cardiovascular disease, cancer and disease of the circulatory system are some of the major burden for UAE health care system (Paulo, Loney and Lapão, 2017). According to the health statistics of UAE in 2016, cardiovascular disease is the leading cause of death followed by injuries and cancer (Department of Health 2018). High rate of chronic disease related to lifestyle such as diabetes, obesity and cardiovascular disease is prevalent in UAE. The analysis of chronic disease by HAAD revealed that obesity rate is high both for national population and expatriate population. Hence, review of this population health statistics for UAE suggest that lifestyle diseases are major burden in the country and diagnosis of these diseases like cancer and diabetes is the reason for increase in volume of patients and hospital admission rates. The country is dealing with escalating crisis of chronic conditions and in this respect, obesity is considered as one of the major health burden (Bell 2016).
There are many regulatory companies too involved in administering different type of health service. Some of the authorities that manage public health care system include the Dubai Health Authority (DHA), the Emirates Health Authority (EHA), the Ministry of Health and Prevention, and the Health Authority-Abu Dhabi (HAAD). Compared to other countries, the life expectancy of people living in UAE is high evidenced by a life-expectancy of 77.7 years in 2017 (Rizvi, 2016). Advances in the health care system is the main reason for increase in life expectancy and it also indicates resolution of access issues by adding more health facilities and more number of skilled workers. The report by Bell (2016) states that UAE women will live longer than the male counterpart. However, obesity is one major risk for women in UAE and large numbers of UAE women are likely to develop diabetes, hypertension and associated illness. However, the analysis of the current state of health in UAE suggests that well-being of citizens has been prioritized and the health care sector is paying attention to both quality and quantity of health care services in the UAE. This kind of changes in the health care system will help to meet the medical needs of Emiratis and expatriates and reduce the burden of chronic disease too.
b.U.A.E is a union of seven emirates and the Health Authority-Abu Dhabi (HAAD) is one statutory agency that has taken health care regulation responsibility. Since 2007, HAAD has set many regulatory requirements for health care professionals, insurance companies and care providers. It monitors compliance to regulatory standards across hospitals in Abu Dhabi and also plays a role in influencing the health care system. Much of the health system reform has been shaped by HAAD. The main goal of the health system reform Abu Dhabi is to improve the quality of care, increase the access to care and promote affordability. The three important component of the health system reform in UAE includes mandatory health insurance, introduction of centralized regulatory system and enhance competition (Paulo, Loney and Lapão 2017). Abu Dhabi health system reform cannot be termed as an efficient plan has not yet achieved the desired goal. The cost of health care is still rising and disparities in health outcome exist even today. However, this might also be possible because the health system reform in U.A.E is very young and it has been implemented in 2007 only. Hence, analyzing the activities implemented as part of the reform is important to comment on the efficiency of the planning process and the scope of focus.
The introduction of the mandatory health insurance system is one of the core components of the reform and according to this scheme, all employers had the responsibility to fund insurance for all eligible expatriate employees. This plan was relevant to fulfill the goal of access to health care. However, inefficiency in the plan is understood from the fact that no strategies was taken to ensure even distribution of the insurance schemes. The main behind the underutilization of scheme is that members of the basic insurance group had high level of health co-payment, but they accessed the services less frequently (Paulo, Loney and Lapão 2017). To ensure efficiency in health care planning, getting the best value for the money was important. However, failure in improving access rate even after the introduction of the mandatory health insurance scheme suggests the inefficiency in the planning process. Awofeso (2017) argues that fraud and corruption are some of factors that contribute to inefficiency of the health care system. By analyzing the Abu Dhabi Mandatory health insurance program, the author revealed that Dubai’s health insurance coverage relied mainly on enrollment through employment. Therefore, equity in access was not achieved as many expatriates favored getting treatment in their country during severe illness. Hence, low rate of utilization in the Basic plan depicts major flaws in the planning process of the health system reform (Paulo, Loney and Lapão 2017).
Another important characteristic of the Abu Dhabi health system reform is the development of a centralized regulatory system. HAAD got involved in the regulation of the key stakeholders. The main advantage of the regulatory mechanism was that it looked to create a pathway to control cost and implement effective reimbursement mechanism. In the area of improving the quality of the care, HAAD took the step to promote transparency and consumer trust by developing a rating system for all hospitals. This rating system would play a role in giving trustworthy information about care and not misleading health consumers. Successful use of the rating system is an element that can enhance the efficiency of the health care system because by improving the health seeking behavior of consumers. In the past, expatriates coming in the country have been misguided about the quality of care and this has lead to poor utilization of health care services. Hence, the introduction of the rating system would play a role in increasing access to care and promoting transparency in relation to the quality of care. Federal system ranking is the need of the hour and paying attention to the ranking system is the positive part of the planning process as it would help to understand the factors that would provide transparent choices about hospitals to health care consumers too (National Editorial 2014).
Another initiative that was implemented as part of the health system reform was that a mechanism was created to promote delivery of critical care to external companies. This was needed to appropriately respond to growing competition and privatization of the health care system. For example, in Abu Dhabi, established health care institutes such as John Hopkins hospital got the contract for providing high quality critical care. The management of contracted providers was started by Abu Dhabi Health Services Company (SEHA) and the agency was mainly involved in monitoring agreed key performance indicators (Latif et al. 2015). Research on day to day work commissioning within health care system has revealed that such initiatives has also been implemented in English primary care trust for the management of long term conditions like diabetes, stroke and dementia. Porter et al. (2013) mainly aimed to explore how NHS (National Health Service) commissioning can improve care for patients suffering from long-term conditions. The unique element of this commissioning was that it provided a structure which provided choice to consumers both on the basis of cost as well as value. The significance of this evidence was that it described factors that would not have any effect on the implementation and operation of the competition. These included having clear idea about provider’s cost, facilitating a pathway for clear accountability of provider performance and making decisions more clear to the patients and providers (Porter et al. 2013). Hence, these elements can be considered while providing critical care contracts to other agencies.
Increasing the number of health care facilities was also included in the Abu Dhabi health system reform. Based on the review of current challenges in the health care system, staff shortage and inadequate distribution of care is a major factor affecting the efficiency of the health care system. Aluttis, Bishaw and Frank (2014) explains that crisis in human resource is one of the significant global health issue. However, adequately increasing the flows and number of health worker is a very difficult endeavour which cannot be easily done. One of the hurdle in proceeding with this pathway includes lack of registration data and poor definition regarding the migrating worker’s health status. Therefore, unless clear picture of the diverse workforce pattern is found, developing most relevant action is difficult. To find a solution to this issue, finding evidence regarding agencies or leaders who have taken innovative strategy to quantify health worker flow is important. For example, the Organization for Economic Cooperation and Development (OECD) took this approach. The main lessons coming from the experience was that making distinction between foreign born and foreign trained worker was important to determine training needs. All European countries mostly rely on expatriate workers to overcome their health workforce shortage (Wurie, Samai and Witter 2016). Hence, before recruiting expatriate workers, the pros and cons need to be critically analyzed. Hence, taking steps to consider cost-benefit analysis would have enhance the efficiency of the Abu Dhabi health system.
The review of the flaws in the Abu Dhabi health reform system suggest that it is mainly a problem based plan instead of being a population oriented plan. For this reason, inequities in health care access and poor utilization of the insurance scheme remain even after the implementation of the mandatory insurance scheme. Abu Dhabi’s reform system would be referred as a problem oriented health reform system as it took steps to address the problem of rising health care cost and poor quality of care. However, it cannot be regarded as a population oriented system because during the planning process, the Dubai did not considered ways to equally distribute insurance scheme among national citizens as well as expatriates. Population health disparities still remain thus suggesting that proper mechanism has not been implemented to promote overall health of the population. Creating value based payment system was necessary to reduce disparities in health coverage (Burwell 2015).
On the whole, summing up details related to the goals of the Abu Dhabi health system reform and evaluating the characteristics of the reform system, it can be said that lack of considered of health equity and equal distribution of resource is one of the major flaws in the planning process. The goals set by HAAD in relation to health system reform is suitable as high quality and affordability can be the pathway for achieving successful health outcome. However, additional planning and critical consideration is needed in the future to improve outcomes in different areas such as health insurance and health care quality. For example, mandatory health insurance in Abu Dhabi has been successful in improving the utilizing rate, however some of the major challenges seen in the program is that utilization of the scheme significantly differs in different group. Lower income group do not utilize the service suggesting major gaps in the reform system. Hence, these findings suggest that major flaws exist in the area of all the three goals of the health reform system (quality, affordability and accessibility). In the long term, creating transparency in health care access and adapting models for responsive delivery of new initiative is critical to reduce burden and achieve the set goals. This would also create pathways for increasing the likelihood of compliance with the regulatory requirements and achieving desired excellence.
c.As part of the health system reform program, many changes have been seen across the arrangements for insurance and utilization of health services. To achieve the objective of universal access and quality health care provision, the Emirate of Abu Dhabi took many concrete steps to reform health insurance and improve access to health providers. The introduction of the mandatory health insurance is one of the strategies that was developed as part of the health system reform in the UAE. The mandatory health insurance scheme was fully launched in 2013 after the enactment of the mandatory health insurance law. This law mainly stated that all residents and visitors to Dubai must have a minimum of basic insurance coverage. Hence, this coverage was mainly available through employment and the funding arrangement is mainly looked after by the Dubai Government (Koornneef et al. 2012). Although the strength of the plan is understood from the fact that it took steps to assure coverage for both citizens and the expatriates, however one limitation of the strategy was that no special consideration was done for low income earners. For this reason, people in basic scheme did not utilized the program. Awofeso (2017) reviewed several health insurance schemes implemented in UAE and revealed that health insurance scheme has not been well-established in UAE. This has also happened because efficient system does not exist for fraud detection and the plan failed to mitigate the gaps in health insurance payment for white collar expatriate as they are often misguided during treatment planning and they end up paying much more than what they are required to pay (Paulo, Loney and Lapão 2017). Hence, factors leading to health insurance frauds needs to be considered in future.
Commission of the health system was also one of the strategies implemented for health system reform in UAE. This was done to included specialized agencies that could tackle the burden of acute care. Many international institutes were recruited for this purpose. However, this move is not considered effective because the attention was only to increase the number of facilities. However, increasing the number cannot guarantee access to care. It requires much wider focus. The review of evidence on strategies to increase access to health service suggests that several factors need to be considered while engaging in improving health access process. The four components were defined to overcome barriers to care. The first component included reduces geographical barriers by concentrating services in poor and rural areas. The next is the ethical element where the focus is to promote the ability to provide the right care at the right time. Affordability is also an important component and more attention should be given to indirect cost that influences health seeking behavior. Behavioral intervention suggest using acceptability as a component to align health service and match the expectation of users (Bright et al. 2017). Similar consideration would have promote achieved desired outcomes for UAE.
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