Objectives: The purpose of the study is to determine the level of rationing of nursing care and its relationship to nurses' perception of their practice environment.

Methods: The study employed a descriptive, cross-sectional study design. The Basel Extent of Rationing of Nursing Care (BERNCA) was administered to assess the level of care rationing while the Practice Environment Scale of the Nursing Work Index (PES-NWI) was used to describe nurses' practice environment. A total of 147 nurses participated in the study. Multiple regression analysis was conducted to determine the effect of various respondent characteristics and nurse practice environment on care rationing.

Results: Only practice environment total score was significantly associated with rationing of care total scores (B = -0.20, p < 0.05). Results of the regression show that for every unit increase in nurse practice environment total score, indicating a better work environment, there is a 0.20 unit decrease in rationing of nursing care total score, which indicated less rationing of care. Respondent characteristics are not significantly related.

Conclusion: Nurses most frequently rationed tasks in the areas of caring/support and monitoring. The less frequently rationed tasks involved medical, technical, and therapeutic aspects of care. The identification of rationing predictors can aid in determining starting points for hospital policy reforms. Prevalence levels can indicate when care rationing exceeds identified thresholds, if any. Nursing administrators can use implicit rationing of nursing care as a crucial indicator of the impact of strategies and changes in the nurse practice environment (e.g., changes in staffing levels, skill mix, and other resources).

Key Words: Health Care Rationing, Health Facility Environment, Nursing Care

Health Care Rationing ; Health Facility Environment ; Nursing Care

COVID-19/prevention & control* ; Communicable Disease Control ; General Surgery/organization & administration* ; Guidelines as Topic ; Health Care Rationing ; Health Services Needs and Demand ; Health Workforce ; Humans ; Practice Guidelines as Topic ; SARS-CoV-2 ; Singapore/epidemiology* ; Surgical Procedures, Operative ; Triage

COVID-19 has spread globally, infecting and killing millions of people worldwide. The use of operating rooms (ORs) and the post-anaesthesia care unit (PACU) for intensive care is part of surge response planning. We aim to describe and discuss some of the practical considerations involved in a large tertiary hospital in Singapore. Firstly, considerations for setting up a level III intensive care unit (ICU) include that of space, staff, supplies and standards. Secondly, oxygen supply of the entire hospital is a major determinant of the number of ventilators it can support, including those on non-invasive forms of oxygen therapy. Thirdly, air flows due to positive pressure systems within the OR complex need to be addressed. In addition, due to the worldwide shortage of ICU ventilators, the US Food and Drug Administration has granted temporary approval for the use of anaesthesia gas machines for patients requiring mechanical ventilation. Lastly, planning of logistics and staff deployment needs to be carefully considered during a crisis. Although OR and PACU are not designed for long-term care of critically ill patients, they may be adapted for ICU use with careful planning in the current pandemic.
COVID-19/therapy* ; Critical Care/organization & administration* ; Critical Illness ; Health Care Rationing/organization & administration* ; Health Resources/organization & administration* ; Health Services Accessibility/organization & administration* ; Humans ; Intensive Care Units/organization & administration* ; Operating Rooms/organization & administration* ; Pandemics ; Respiration, Artificial ; Singapore/epidemiology* ; Tertiary Care Centers/organization & administration*

COVID-19/psychology* ; Child ; Child Health ; Health Care Rationing ; Health Policy ; Health Services Accessibility ; Humans ; Pandemics ; Parents/psychology* ; Patient Acceptance of Health Care ; Singapore/epidemiology*

PURPOSE: The purpose of this study was to analyze the migration patterns of new nurses and experienced nurses and to identify the factors influencing inter-regional migration for solving regional imbalances of clinical nurses in South Korea. METHODS: This study involved a secondary analysis of data from the Health Insurance Review and Assessment Service (HIRA). Data were analyzed using descriptive statistics and multiple logistic regression analysis. RESULTS: New nurses tended to migrate from Kyunggi to Seoul. However, experienced nurses tended to migrate from Seoul and Chungchung to Kyunggi. Significant predictors of inter-regional migration among new nurses were location and nurse staffing grade of hospitals. Significant predictors of inter-regional migration among experienced nurses were location, hospital type, nurse staffing grade, ownership of hospitals and age of nurses. CONCLUSION: Inter-regional migration occupied a small portion of total hospital movement among clinical nurses. The regional imbalances of nurses were not caused by the migration from non-metropolitan areas to Seoul. Nurse shortage problems in the small and medium hospitals of the non-metropolitan area can be solved only through improvement of work environment.
Geography ; Gyeonggi-do ; Health Care Rationing ; Human Migration ; Insurance, Health ; Korea ; Logistic Models ; Ownership ; Personnel Turnover ; Seoul

Against the backdrop of population aging, this paper presents the analysis of need-standardised health care utilization among elderly in India. Based on nationally representative morbidity and health care survey 2004, we demonstrate that the need for health care utilization is indeed pro-poor in nature. However, the actual health care utilization is concentrated among richer sections of the population. Further, the decomposition analysis reveals that income has a very strong role in shifting the distribution of health care away from the poor elderly. The impact of income on utilization is well-demonstrated even at the ecological-level as states with higher per capita incomes have higher elderly health care utilization even as the levels of need-predicted distribution across these states are similar. We also find that the distribution of elderly across social groups and their educational achievements favours the rich and significantly contributes to overall inequality. Nevertheless, contribution of need-related self-assessed health clearly favours pro-poor inequality. In concluding, we argue that to reduce such inequities in health care utilization it is necessary to increase public investments in health care infrastructure including geriatric care particularly in rural areas and underdeveloped regions to enhance access and quality of health care for the elderly.
Aged ; Aged, 80 and over ; *Cultural Characteristics ; Evidence-Based Medicine ; Female ; Health Care Rationing/*statistics & numerical data ; Health Equity/*statistics & numerical data ; Health Services for the Aged/*utilization ; Humans ; Income/*statistics & numerical data ; India/epidemiology ; Male ; Middle Aged ; Socioeconomic Factors ; *Utilization Review

OBJECTIVETo conduct a cost utility study on the HIV/AIDS 'one-stop service' at county level.

METHODSFinancial records and questionnaires were used to collect the information about the resource allocation and the effectiveness of antivirus treatment (ART) during the two period which were January 2012-June 2013 and July 2013-December 2013 in the three pilot counties providing 'one-stop service'. Treeage Pro 2009 was used to build the Markov model to simulate the evolution of 5 different HIV statuses, including HIV infection, AIDS, HIV infection receiving ART, AIDS receiving ART and death. And compared the cost-utility ratios between current ART process and 'one-stop service' process. National and local epidemic data and literature review were used to provide the parameters in the model, including prior probabilities of each status, transferring probabilities among each status, health utility values and investments of each status and discount rate.

RESULTSThe expenditures related with 'one-stop service' in the three counties were 2 627 339, 209 969, and 191 658 RMB, respectively between July and December, 2013. The average periods from HIV infection confirmation to ART initiation was reduced from 8 weeks to 18, 10 and 16 days, respectively. The percentage of receiving ART within 30 d among those qualified were increased from 46.7% (63/135) to 64.3% (45/70) in county A, from 40.0% (16/40) to 69.4% (25/36) in county B, and from 9.5% (4/42) to 50.0% (19/38) in county C. If current process was applied, the CUR in three counties would be 10 391.89 RMB/quality adjusted life years (QALY), 6 271.42 RMB/QALY and 3 515.94 RMB/QALY, and these would be 10 825.08 RMB/QALY, 8 522.30 RMB/QALY and 10 414.65 RMB/QALY with application of 'one-stop service'.

CONCLUSION'one-stop service' could decrease the interval between HIV infection confirmation and ART initiation and increase the percentage of receiving ART among people living with HIV(PLHIV), more QALYs would be obtained with more resources invested.

Acquired Immunodeficiency Syndrome ; Anti-HIV Agents ; Cost-Benefit Analysis ; Epidemics ; HIV Infections ; Health Care Rationing ; Humans ; Quality-Adjusted Life Years ; Survival Rate ; Time-to-Treatment

OBJECTIVETo analyze the allocation and trend of central government AIDS special funding in 4 priority sites of HIV/AIDS prevention and control across calendar years.

METHODSInformation about the allocation of central government special AIDS funding and cumulative HIV/AIDS survivor numbers of Z city, D prefecture, L prefecture and D prefecture were collected until 2013. Data were collected from 2004-2013 for Z city and D prefecture, and data from 2009-2013 were collected for L and Y prefecture. Funding allocation among all working areas and their trend over time were analyzed.

RESULTSFrom 2004-2013, the total amount of special funding in Z prefecture was 110.15 million RMB. The largest three areas of allocation were key population response (29%, 3 190/11 015), surveillance and testing (23%, 2 535/11 015) and human resource (13%, 1 498/11 015). The least area of allocation was follow-up and prevention of discordant couple transmission (2%, 251/11 015). The total amount of special funding in D prefecture from 2004-2013 was 109.77 million RMB. The largest three areas of allocation were treatment and care (25%, 2 691/10 977), follow-up and prevention of discordant couple transmission (17%, 1 843/10 977) and surveillance and testing (15%, 1 656/10 977). The least area was blood safety (1%, 135/10 977). From 2009 to 2013, the total amount of special funding in L prefecture was 55 million RMB. The largest three areas of allocation were surveillance and testing (60%, 3 298/5 500), high risk population intervention (14%, 768/5 500) and follow up and prevention of discordant couple transmission (12%, 675/5 500). The least area was blood safety (0.1%, 8/5 500). From 2009-2013, the total amount of special funding in Y prefecture was 55 million RMB and the largest three areas of allocation were project management and others (28%, 1 527/5 500), key population response (19%, 1 046/5 500) and high risk population intervention (17%, 922/5 500). The least area of special funding was blood safety (2%, 106/5 500). Among three HIV/AIDS epidemic related key areas (surveillance and testing, follow-up and prevention of discordant couple transmission, treatment and care), 2004-2013, allocated funds were between 2.96-3.36, 0-0.37, 0.37-1.97 million RMB in Z city; 0.64-2.35, 0.00-3.00, 2.00-4.70 million RMB in D prefecture; 2009-2013, allocated funds were between 2.67-8.85, 0.41-2.39, 0.35-1.84 million RMB in L prefecture, 1.18-2.84, 0.70-1.05, 0.46-0.89 million RMB in Y prefecture.

CONCLUSIONThe allocation patterns of central government AIDS special funding among key working areas were different across 4 different sites; in each individual site, the trend of special funding allocation was stable among HIV epidemic related key areas over calendar years.

Acquired Immunodeficiency Syndrome ; epidemiology ; prevention & control ; therapy ; Communicable Diseases ; Epidemiological Monitoring ; Government ; HIV Infections ; epidemiology ; prevention & control ; therapy ; Health Care Rationing ; Humans ; Mass Screening ; National Health Programs ; Survival Rate

Probably more than any country, Singapore has made significant investment into the biomedical enterprise as a proportion of its economy and size. This focus recently witnessed a shift towards a greater emphasis on translational and clinical development. Key to the realisation of this strategy will be Academic Medical Centres (AMCs), as a principal tool to developing and applying useful products for the market and further improving health outcomes. Here, we explore the principal value proposition of the AMC to Singapore society and its healthcare system. We question if the values inherent within academic medicine--that of inquiry, innovation, pedagogy and clinical exceptionalism--can be compatible with the seemingly paradoxical mandate of providing cost-effective or rationed healthcare.
Academic Medical Centers ; economics ; organization & administration ; Cost-Benefit Analysis ; Financing, Government ; Health Care Costs ; Health Care Rationing ; Quality of Health Care ; Singapore

OBJECTIVETo assess the extent and relative changes of the equities in prenatal care utilization among women with different educational attainment in some areas of China.

METHODSData were collected in 13 counties/cities covered by Perinatal Health Care Surveillance System established by Institute of Reproductive and Child Health, Peking University. The study population consisted of 103 704 women who delivered single live births in 1994 and 2000. Chi-square and multiple logistic regression were employed to compare the systematic management rates and relative risks. Concentration index was used to assess the relative changes of equities in prenatal care utilization. SPSS 11.5 and Microsoft Excel 2003 were used for analysis.

RESULTSThe total systematic management rate was 22.1% in 1994 and 57.4% in 2000. The concentration index was -0.046 in 1994 and 0.066 in 2000. In northern areas, the concentration index increased from 0.015 in 1994 to 0.295 in 2000, while it increased from -0.015 in 1994 to 0.062 in 2000 in southern areas. In rural areas, the concentration index increased from 0.002 in 1994 to 0.026 in 2000, while it decreased from 0.042 in 1994 to 0.019 in 2000 in urban areas.

CONCLUSIONInequities in prenatal care utilization in 2000 become more obvious than in 1994, especially in northern areas. More attention should be paid to solve the inequities.

China ; Culture ; Female ; Health Care Rationing ; Healthcare Disparities ; Humans ; Prenatal Care ; statistics & numerical data ; utilization ; Rural Population