1.Contracting out of health services for province-level integration of healthcare system: Effect on equity
Theo Prudencio Juhani Z. Capeding ; Ma-Ann M. Zarsuelo ; Hilton Y. Lam ; Ma. Esmeralda C. Silva ; Michael Antonio F. Mendoza
Acta Medica Philippina 2020;54(6):734-741
Background:
The recently enacted Universal Health Care (UHC) Act prioritizes the provision of a comprehensive set of quality and accessible services. However, the devolution of health services has led to inequitable investments in healthcare resulting to disparities in health outcomes between areas. One of the strategies considered that could minimize these differences is the contracting out of health services to the private sector. This review focuses on mapping equity-related issues and concerns with regard to contracting out health services.
Methods:
A modified systematic search of literature using published journal articles through PubMed and Google Scholar and other pertinent reports and manuals was conducted on issues of equity and health service contracting.
Results and Discussion:
There is currently a dearth of literature on the effect of contracting services on health equity outcomes, particularly on the impact of contracting out on equity. Limited studies showed that contracting out can potentially improve equity by increasing service utilization. Mechanisms on how contracting out could potentially affect equity were also found.
Results mainly suggest that concrete steps should be taken to ensure equitable access and improvement in health outcomes among population subgroups. To provide a framework in applying possible insights from the review, discussion of the literature review was framed in the context of establishing performance-based contracting. It was emphasized that including representatives from the underserved populations and patient groups during stakeholder consultations were crucial to provide localized context for the inclusive development of contracting arrangements. Other strategies that were highlighted included: establishing monitoring systems that disaggregate data between groups, selecting contractors that have the capacity to reach and provide services to the underserved, and making sure that these contractors are also open to data sharing for economic evaluation of services.
Conclusion and Recommendations
Despite the paucity of data on the impact of contracting out services on equity, mechanisms explaining the effect of contracting on equity were put forward and illustrated. These findings can be considered by policy makers and program developers in the operationalization of service agreements between the public and private sectors.
Health Equity
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Contract Services
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Health Services
3.Civil competence assessment of the mental disorders involved in contract dispute.
Qin-Ting ZHANG ; Yan-Xia PANG ; Wei-Xiong CAI ; Tao TANG ; Jian-Jun WANG
Journal of Forensic Medicine 2009;25(2):95-101
OBJECTIVE:
To search the criteria for evaluating the civil competence of the mental disorders involved in contract dispute.
METHODS:
Data on the interviewee's mental status and the forensic expertise were collected retrospectively. And 6 indexes were selected and graded: awareness of situation, factual understanding of issues, appreciation of likely consequences, rational manipulation of information, functioning in one's own environment and communication of choice. All of the data were analyzed by SPSS.
RESULTS:
Fifty six cases were included and interviewee's civil competence was graded to three levels: full civil competence, diminished civil competence, and no civil competence. These cases included two types of contract: the real estate related contract (38 cases) and the labor related contract (14 cases). All of the 6 indexes were well correlated to the forensic expertise. The related coefficient was from 0.703 to 0.834, and the interrelated coefficient of the 6 items was also high, from 0.712 to 0.877.
CONCLUSION
It is feasible to divide the civil competence of the mental disorders into three grades. As the basis, these 6 indexes mentioned above are representative and can be applied in further standardized and quantified assessment of civil competence.
Contract Services/legislation & jurisprudence*
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Dissent and Disputes
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Expert Testimony
;
Female
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Forensic Psychiatry
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Humans
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Informed Consent
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Male
;
Mental Competency/psychology*
;
Mental Disorders/psychology*