Abstract from article: The Dutch healthcare system has changed towards a system of regulated competition to contain costs and to improve efficiency and quality of care. This paper provides: (1) a brief as-is overview of the changes for primary care, based on explorative literature reviews; (2) provides noteworthy remarks as for the way primary and secondary healthcare is organised; (3) an example of an E-health portal illustrating implemented processes within the Dutch context and (4) a proposed research agenda on various e-health topics. Noteworthy remarks are: (1) government, insurer, healthcare provider and patient are main actors within the Dutch healthcare system; (2) general practitioners (GP’s) are gatekeepers to secondary and other care providers; (3) the illustrated portal with a patient oriented design, provides access to applications implemented at care providers resulting in increased electronic availability and increased patient satisfaction; (4) a variety of fragmented information systems at health care providers exists, which leaves room for standardisation and increased efficiency. We end with suggestions for future research.
DOCUMENT
Purpose - This paper provides an overview on the technical and vocational education and training (TVET) program components/mechanisms and their overall effect on learning outcomes in a developing country context. Design/methodology/approach - Using secondary data, this descriptive case study integrates the realistic evaluation framework of Pawson and Tilley (1997) with Total Quality Management (TQM) frameworks. Findings - Ethiopia's TVET system adopts/adapts international best practices. Following the implementation of the 2008 TVET strategy, the proportion of formal TVET graduates who were recognized as competent by the assessment and certification system increased from 17.42 percent in 2009/2010 to 40.23 percent in 2011/2012. Nevertheless, there is regional variation. Research limitations/implications - Outcome-based TVET reforms that are based on TQM frameworks could improve learning outcome achievements in developing countries by enhancing awareness, coordination, integration, flexibility, participation, empowerment, accountability and a quality culture. Nevertheless, this research is limited by lack of longitudinal data on competency test results. There is also a need for further investigation into the practice of TQM and the sources of differences in internal effectiveness across TVET institutions. Practical implications - Our description of the Ethiopian reform experience, which is based on international best experience, could better inform policy makers and practitioners in TVETelsewhere in Africa. Originality/value - A realistic evaluation of TVET programs, the articulation of the mechanisms, especially based on TQM, that affect TVET effectiveness would add some insight into the literature. The evidence we have provided from the Ethiopian case is also fresh. Keywords TVET reform, TVET quality, Total quality management, Internal effectiveness, Realistic evaluation, Developing countries, Ethiopia
MULTIFILE
Abstract Background: Many countries in Europe have implemented managed competition and patient choice during the last decade. With the introduction of managed competition, health insurers also became an important stakeholder. They purchase services on behalf of their customers and are allowed to contract healthcare providers selectively. It has, therefore, become increasingly important to take one's insurance into account when choosing a provider. There is little evidence that patients make active choices in the way that policymakers assume they do. This research aims to investigate, firstly, the role of patients in choosing a healthcare provider at the point of referral, then the role of the GP and, finally, the influence of the health insurer/insurance policies within this process. Methods: We videotaped a series of everyday consultations between Dutch GPs and their patients during 2015 and 2016. In 117 of these consultations, with 28 GPs, the patient was referred to another healthcare provider. These consultations were coded by three observers using an observation protocol which assessed the role of the patient, GP, and the influence of the health insurer during the referral. Results: Patients were divided into three groups: patients with little or no input, patients with some input, and those with a lot of input. Just over half of the patients (56%) seemed to have some, or a lot of, input into the choice of a healthcare provider at the point of referral by their GP. In addition, in almost half of the consultations (47%), GPs inquired about their patients' preferences regarding a healthcare provider. Topics regarding the health insurance or insurance policy of a patient were rarely (14%) discussed at the point of referral. Conclusions: Just over half of the patients appear to have some, or a lot of, input into their choice of a healthcare provider at the point of referral by their GP. However, the remainder of the patients had little or no input. If more patient choice continues to be an important aim for policy makers, patients should be encouraged to actively choose the healthcare provider who best fits their needs and preferences.
DOCUMENT
