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 ; Contract Services ; Health Services

China ; Contract Services ; legislation & jurisprudence ; Delivery of Health Care ; legislation & jurisprudence ; Dental Caries ; therapy ; Dentists ; legislation & jurisprudence ; Female ; Humans ; Liability, Legal ; Middle Aged ; Pulpitis ; therapy ; Tooth Extraction ; Treatment Failure

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* ; Dissent and Disputes ; Expert Testimony ; Female ; Forensic Psychiatry ; Humans ; Informed Consent ; Male ; Mental Competency/psychology* ; Mental Disorders/psychology*

The purpose of this study was to compare the usage of beef and foodservice managers' perceptions of beef quality by foodservice type. A survey was conducted on 546 dietitians, and 499 acceptable responses were used for data analysis. By weight, pork was the most used meat in foodservice institutions, followed by poultry and beef. More than half of the foodservices selected meat suppliers by competitive bidding. Approximately 85.8% of the respondents used Hanwoo beef, followed by Australian beef and Youku beef. Beef type differed significantly by foodservice type (P<0.001): most of the schools and social welfare facilities used Hanwoo beef, whereas most hospitals and business/industry operations used Australian beef. When purchasing beef, safety of beef was rated the most important, while eco-friendliness was rated the least important. Most of the dietitians understood that marbling is one of the determinants of the beef quality, but were not aware of other components. Dietitians that selected Hanwoo and Youku beef were more satisfied with quality, taste, nutrition, freshness, country of origin, package, customer, preference, and availability for various menus than those who used imported beef. Dietitians who used Hanwoo beef were the most satisfied with country of origin, whereas the others were the most satisfied with safety. Since the dietitians are in charge of planning menus and selecting meat suppliers at foodservice institutions, they should make knowledgeable decisions by understanding meat supply systems and quality of beef.
Competitive Bidding ; Humans ; Meat ; Nutritionists ; Poultry ; Red Meat* ; Social Welfare ; Statistics as Topic ; Surveys and Questionnaires

The purposes of this study were to investigate the current status of contracted hospital food services and to find out the difference in accordance with the number of beds in hospitals. Thirty six hospitals having more than 100beds in Seoul, Inchon and Kyungkido were the subjects of this study. Data was collected through surveys. The survey was conducted during March and April in 2002. The Questionnaires were mailed to the 36 directors of dietetic departments of the hospitals and 36 managers of contracting patient food services. Statistical analysis was completed using SPSS Win(11.0) for descriptive analysis and t-test. The results of the study are summerized as follows; I. Hospital perspective : The range covered by contract food service was 63.3% and 36.7% in hospital food services, and medical nutrition services. The patient and employee food services were in 83.3%, and patient food services were in 6.7%. The methods selecting contractors are general, limited, selected and competitive biddings, and private contracts. The responsibility for supervision of contract food services was the dietetic department (51.7%) in most cases. Hospitals having personnel responsible for contracting affairs were in 75.9% of the cases and 24.1% did not have personnel. The biggest reason for contracting was facilitation of personnel management. The most important criteria on selecting food services contractors was the professionality of the contractor. II. Contractor's perspective : The cost per meal in the year 2001 was composed of 1,905 won for food cost, 1,081 won for labor cost, 222 won for expenses, 114 won for VAT, 14 won for rent and 146 won for miscellaneous or controllable expense, representing 109 won loss per meal. The profit-and-loss contract cost is higher than the fee-contract cost. The ratios of food cost, labor cost and expenses are higher and the ratios of miscellaneous or controllable expense, VAT, rent and profit are lower in hospitals with more than 400 beds compared with those less than 400 beds. However, no significant differences are present between these two groups of hospitals. The actual contract period was 2.2 years upon initial contract and 1.2 years upon renewal. The initial investment cost was 53 million won and the cost of renovation and repair was 8.5 million won. Significant differences were present between two groups of hospitals. The conditions of employment and number of personnel hired by contractors for contract patient food services were significantly different according to the number of beds.
Competitive Bidding ; Employment ; Food Service, Hospital* ; Food Services ; Gyeonggi-do ; Humans ; Incheon ; Investments ; Meals ; Organization and Administration ; Personnel Management ; Postal Service ; Surveys and Questionnaires ; Seoul

The purposes of this study were to investigate the current status of contracted hospital food services and to find out the difference in accordance with the number of beds in hospitals. Thirty six hospitals having more than 100beds in Seoul, Inchon and Kyungkido were the subjects of this study. Data was collected through surveys. The survey was conducted during March and April in 2002. The Questionnaires were mailed to the 36 directors of dietetic departments of the hospitals and 36 managers of contracting patient food services. Statistical analysis was completed using SPSS Win(11.0) for descriptive analysis and t-test. The results of the study are summerized as follows; I. Hospital perspective : The range covered by contract food service was 63.3% and 36.7% in hospital food services, and medical nutrition services. The patient and employee food services were in 83.3%, and patient food services were in 6.7%. The methods selecting contractors are general, limited, selected and competitive biddings, and private contracts. The responsibility for supervision of contract food services was the dietetic department (51.7%) in most cases. Hospitals having personnel responsible for contracting affairs were in 75.9% of the cases and 24.1% did not have personnel. The biggest reason for contracting was facilitation of personnel management. The most important criteria on selecting food services contractors was the professionality of the contractor. II. Contractor's perspective : The cost per meal in the year 2001 was composed of 1,905 won for food cost, 1,081 won for labor cost, 222 won for expenses, 114 won for VAT, 14 won for rent and 146 won for miscellaneous or controllable expense, representing 109 won loss per meal. The profit-and-loss contract cost is higher than the fee-contract cost. The ratios of food cost, labor cost and expenses are higher and the ratios of miscellaneous or controllable expense, VAT, rent and profit are lower in hospitals with more than 400 beds compared with those less than 400 beds. However, no significant differences are present between these two groups of hospitals. The actual contract period was 2.2 years upon initial contract and 1.2 years upon renewal. The initial investment cost was 53 million won and the cost of renovation and repair was 8.5 million won. Significant differences were present between two groups of hospitals. The conditions of employment and number of personnel hired by contractors for contract patient food services were significantly different according to the number of beds.
Competitive Bidding ; Employment ; Food Service, Hospital* ; Food Services ; Gyeonggi-do ; Humans ; Incheon ; Investments ; Meals ; Organization and Administration ; Personnel Management ; Postal Service ; Surveys and Questionnaires ; Seoul

OBJECTIVES: This study aimed to reveal the multiple factors that are related to the work-related musculoskeletal disorders (WMSDs) of shipbuilding workers, and to elucidate the relationship between musculoskeletal symptoms and factors such as the change of working conditions, job stress and physical workload. METHODS: The study sample comprised 1,059 shipbuilding workers. A structured-questionnaire was used to assess the general characteristics, job stress, psychosocial well-being index (PWI), physical workload, change of working conditions and information concerning musculoskeletal symptoms. We estimated the relations of job stress, physical workload and intensity of labour to musculoskeletal symptoms using univariate and multiple logistic regression analyses. RESULTS: The symptom prevalence of musculoskeletal disorders in any part of the body was 89.5% by 'criteria 1'in the order of back (58.6%) and shoulder (56.3%). After adjustment for sociodemographic factors, posture factor (Odds ratio [OR]=1.06, 95% confidence interval [ C I ] = 1 . 0 0~1.12), non-posture factor (OR=1.17, CI=1.05~1.31), Borg scale (OR=1.15, C I = 1 . 0 0~1.32), relative work intensity increase (OR=1.92, CI=1.08~3.41), labor flexibility increase (OR=2.04, CI=1.04~4.01), high job demand (OR=2.68, CI=1.48~4.88), and high risk stress group (OR=13.50, CI=3.15~57.97) were all found to be significantly associated with musculoskeletal disorders. CONCLUSION: These results suggest that WMSDs have multiple risk factors such as stress, physical workload and change of working conditions. High job demand, increased relative intensification of work and increased flexibility, especially such as subcontract, outsourcing and importing of contingent work, were very important factors associated with increasing WMSDs.
Logistic Models ; Outsourced Services ; Pliability ; Posture ; Prevalence ; Risk Factors ; Shoulder

OBJECTIVE: This study aims to describe the basic features of Electronic Medical Records at the Seoul National University Hospital and Seoul National University Bundang Hospital and to discuss the process we developed and adopted the system. We also aim to suggest potential risks and success factors in our processes. METHODS: Seoul National University Hospital, a tertiary teaching hospital with 100-year-old history, 1000 medical staffs, and 1700 in-patient beds has successfully adopted Electronic Medical Records system from October 2004 and runs very well for more than one year. Our system is fully integrated with Computerized Physician's Order Entry (CPOE) and Picture Archiving and Communication System (PACS). RESULTS: We identified that the key step for the successful adoption of the full system was to overcome physicians' resistance to their use of Electronic Medical Records and to help their earlier accommodation to new practice environment. We then found that five important success factors were the clinical leadership, adoption strategy, young doctors' participation, outsourcing of the department of information technology and the accumulated domain knowledge. Our experience shows it is important to expose young medical staffs to the change before the main Electronic Medical Records system opens and "patient-centered" was the most important concept to make these reform processes successful. CONCLUSION: Development and adoption of Electronic Medical Records at large teaching hospital are not easy but are very important and powerful tool for patient-centered medical practice.
Electronic Health Records* ; Hospitals, Teaching ; Humans ; Leadership ; Medical Staff ; Outsourced Services ; Seoul*

Clinical Competence ; Humans ; Outsourced Services ; Radiology ; education ; trends ; Radiology Information Systems

OBJECTIVES: The purpose of this study was to identify the effects of hospitals' innovativeness on outsourcing decision-making regarding four information system (IS) functions, namely, software programs, network maintenance, hardware systems, and PC/printer maintenance. METHODS: Using the 2011 roster of the Korean Hospital Association, this study selected 311 general hospitals as a study population. After identifying the managers who were in charge of outsourcing, this study administered questionnaires. A total of 103 hospitals responded. RESULTS: Of the responding hospitals, 55.34% outsourced at least one IS function, whereas 88.35% outsourced at least one managerial function. IS outsourcing was motivated by the need for outside experts, but other managerial functions were outsourced for cost savings. Innovative and early adopter hospitals were 4.52 and 4.91 times more likely to outsource IS functions related with work processes (i.e., software and network maintenance) than early and late majority hospitals, respectively. IT outsourcing effectiveness significantly influenced the outsourcing decisions regarding four IS functions. Hospitals that had perceived more risks of outsourcing significantly preferred non-outsourcing on their hardware systems, but the risks of outsourcing were not significant for outsourcing decisions regarding the other IS functions. Hospitals' innovativeness also significantly explained the quantity of innovation adoptions. Innovative and early adopter hospitals did more outsourcing than early and late majority hospitals. CONCLUSIONS: Hospitals' innovativeness influences decision-making regarding outsourcing. Innovative hospitals are more likely to outsource their work-process-related IS functions. Thus, organizational traits, especially hospitals' innovativeness, should be considered as a key success factor for IS management.
Cost Savings ; Hospitals, General ; Information Systems* ; Organizational Innovation ; Outsourced Services* ; Surveys and Questionnaires