disadvantages of specialization for patients include all but
was used only in 4% of cases of choosing a specialist and in only 0.5% cases of choosing a hospital. 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Federalniy zakon Rossiyskoy Federatsii. Motivation, Agency, and Public Policy. 0000036886 00000 n For example, a patient who does not require hospitalization may use inpatient care while his illness could be successfully treated in an ambulatory setting. Therefore, promoting patient choice by the Government should be accompanied by managing health care and making choice less enforced and more manageable. For example, an individual with asthma can freely go to any physician, and each would treat the patient according to his specialty, while none is held responsible for the worsening of the symptoms and the subsequent hospitalization, which raises the overall medical care expenditures. nursing homes? 1289 0 obj<> endobj Only 25% of district physicians respond that they receive information about all hospital admissions of their chronic cases; 57% receive this information only rarely and 18% do not receive at all. New inefficiencies arise from duplication and the lack of co-ordination. The law establishes the right to choose a primary healthcare facility once a year and then to choose a district physician or a general practitioner within that facility. The list of specialists with open enrolment could include the specialists who deal with specific chronic conditions. Specialization. Benefits of Specialization. These findings indicate that the incidence of choice in Russia is much lower than the available figures on the incidence of choice for the UK (share of patients that was offered a choice of hospital), mentioned earlier from the Dixon (2009) study. Therefore, patients may end up choosing the providers who have higher costs of obtaining similar clinical outcomes. The search process has a greater likelihood than choice to result in the loss of the proper sequence of care at different stages. Publishing House of the Higher School of Economics. 2 The Semashko model was the primary structure of the healthcare system in the USSR, named after its founder, Nikolai Semashko. 0000001430 00000 n It addresses most of the common health problems of individuals Understanding medical corruption in China: a mixed-methods study, Feasibility and sustainability of a school-based platform for integrated delivery of HPV vaccination with adolescent health services in Tanzania: qualitative insights from stakeholders, An empirically validated framework for measuring patients acceptability of health care in Multi-Island Micro States, How to do (or not to do)how to embed equity in the conduct of health research: lessons from piloting the 8Quity tool, Capacity of the Ethiopian Primary Health Care System for Achieving Universal Health Coverage: A Primary Health Care Progression Approach, About the London School of Hygiene and Tropical Medicine, Government of the Russian Federation (2008), http://www.rg.ru/2011/11/23/zdorovie-dok.html, http://www.economy.gov.ru/minec/activity/sections/fcp/rasp_2008_n1662_red_08.08.2009, http://www.hse.ru/data/2011/12/05/1271846229/WP8_2011_12f.pdf, http://base.consultant.ru/cons/cgi/online.cgi?req=doc;base=LAW;n=89957, Receive exclusive offers and updates from Oxford Academic, Copyright 2023 The London School of Hygiene and Tropical Medicine and Oxford University Press. Changing Medicaid eligibility criteria so that more people Some of the countries in this group, such as France, are gradually moving away from too much choice as the way to enhance integration of care, make duplication of services lower, and, thereby, to curb cost escalation (Ettelt et al. Research generally finds that telemedicine works, even for serious medical conditions. In our discussion of the contradictory results of promoting greater choice, we emphasize that patient choice can lead to the misallocation of resources emanating from three main factors. Local monopolies, particularly in the hospital sector, and limitations to cross-border flows of patients also create barriers for patient choice (Gaynor 2006). 0000015153 00000 n In the Russian context, it is reasonable to assume that the non-clinical indicators will play a greater role than the clinical information that is less trusted and understood. 0 The final section presents health policy options to facilitate choice and enhance its positive impact. 0000004078 00000 n Professional healthcare providers can see more patients, improve performance, and reduce medical errors. 12. xref Empirical findings from Germany Witten/Herdecke University. The implementation of the policies to enhance patient choice in the Western countries brought about ambivalent results. Hospitals can be classified by a variety of criteria, including: An estimated 80% to 95% of health problems are never brought forward to a physician or. The main advantage of specialization is that an expert person is less likely to make an error in performing a particular task than a non-expert performing the same task, thus reducing the risk of error. The philosophical limits of evidence-based medicine. Expanding patient choice in health care is justified by economic theory, but in practice does not always lead to efficient resource allocation if it is not accompanied by appropriate structural changes. Belonged to minority racial and ethnic groups a. Medicaid Finally, to conclude the discussions of the conceptual foundations of patient choice, we make one final observation. Le Grand 2003, 2007; Porter and Teisberg 2004). Out of those choosing a hospital for elective admission, 41% ended up choosing a regional hospital and 9% went to a federal medical centre. These changes created some opportunities for patient choice of the medical facility and the provider. Physician Specialization had advantages and disadvantages for patients. common inpatient diagnoses occurred between 2005 and 2014 as a Among sources of information about physicians, recommendations from relatives, friends and acquaintances who are not part of the medical profession is the most common40% of respondents use this source when choosing a specialist, and 20% when choosing a hospital. The first type of process, specialization, is a mainstream aspect of the healthcare system development and thus becomes a long-term factor that creates the areas of inefficient choice. First, there was a weakening in the requirements of professional qualifications of the primary care physicians and their co-ordinating role in the system of medical care. In addition, general practitioners in their role of guides of health care can make the choice more appropriate if it is based on their awareness of the best providers of specialty care. True, What entity grants medical licenses? On the one hand, these policies created new opportunities for patients to receive medical care and make providers more responsive to the patients needs. Which of these paintings should be considered a primary source? Described below are some important preconditions. In addition, patients can choose only a clinically justified provider, taking into consideration the correspondence of the nature and complexity of his condition to the profile of the chosen medical organization (Department of Health 2008a,b). Inefficient choice is more likely to occur in this context. - 30279844 Which rights determine who is responsible for managing the resources? The competency of such physicians is questioned by many residents, particularly, in urban areas. Finally, the choice of providers made by patients independently may lead to the difficulty in co-ordinating the care received by the patient from different providers involved in treating his particular condition, and thus to the weakening or loss of the appropriate sequencing of care. 7 Federalniy zakon Rossiyskoy Federatsii Ob osnovakh okhrany zdorovia grazhdan v Rossiykoy Federatsii' (2011). More often, the respondents were choosing a provider, looking for free care if possible, but willing to pay if need be44% and 46%, respectively, for outpatient and inpatient care. It should be noted that in this research project there was no differentiation between the situations of choice and situations of search for a medical provider. Thus, additional information on the performance of alternative providers and the outcomes of services is needed not only for the patient but also for the physician as the agent of the patient. They will lead to higher costs and inefficient care. Le Grand 2003, 2007; Porter and Teisberg 2004). The number of general practitioners is only 0.7 per 10 000 residents in 2010 (Rosstat 2011) compared with the average of 8.2 for the EU (WHO 2012). Which of the following is a trend for physicians in the US? 2011 Ob osnovakh okhranyzdorovia grazhdan v Rossiyskoy Federatsii. (The Federal Law On the Fundamentals of Health Protection in the Russian Federation) N 323-FZ. Nurses (APRNs)? Advantages of telehealth. In group practices, physicians can share ideas and develop professionally. Lessons from the reform of the U.K. National Health Service, Are health problems systemic? Chapters Two, Three, and Seven Quiz forward to a physician or otherwise involve professional medical care The key element of the traditional Semashko model2 is the correspondence of the level of treatment with a patients health status at each stage of care: primary healthcare providers refer a patient to a chain of hospitals of various technical capacities, intensities and levels of healthcare specialization (i.e. This programme significantly contributed to the reduction in waiting periods for some medical services, such as elective knee replacements, hip replacements and cataract surgeries (Cooper et al. However, the availability of even the non-clinical data would make the choice more justified compared with the current situation revealed by the survey. The functions of district physicians are much narrower compared with a GP: they deal with a very limited scope of simple conditions and are not allowed to provide specialty care even if they can. The higher these costs are, the lower the potential for choice and competition among providers is (Dranove and Satterthwaite 2000). Rigid administrative dividers between territorial units limit the expansion of cross-border flows of medical services, and thus constrain patient choice. Disadvantages of Specialization for patients include all but: a. Choice of providers and mutual healthcare purchasers: can the English National Health Service learn from the Dutch reforms? For example, a 2017 meta-analysis and systematic review of the use of telemedicine for treating . trailer Dixon and Le Grand (2006) show that extending patient choice may increase inequity, decrease it or leave it unchanged, depending on various parameters of demand and supply of health care; they propose a package of supported choice whereby individuals from lower income groups would receive assistance in making choices (Dixon and Le Grand 2006). Thus, in most cases, the choice was based not on reliable sources of information, but on the informal channels of hearsay. There is the evidence that the number of physician visits per capita, hospital admission rates and share of health expenditure in GDP are substantially higher in the countries with no GP gate-keeping function and no specialist care control (Sheiman et al. Patients tend to choose based on the available resources (rather than quality), which are easier to assess in a country with a highly hierarchical health system. The sample included 1598 respondents, including 791 physicians, 761 nurses and 46 directors of health facilities of various types (polyclinics, local, city and regional hospitals). Based on past experience and, The ABC Toy Company makes a few types of toy cars on one of its production line. ), in any imaging direction. Benefits. Disadvantages of Specialization for patients include all but: A. On average, FNPs have 9.8 years of experience. the social health insurance systems) already had substantial choice of provider for patients and the inefficiencies that come with these. b. Such informational base for patient choice may lead to inefficient choice and misallocation of resources. a. a. rural, central rayon3, city, regional and federal hospitals, plus numerous specialty care facilities). The choice of an inpatient care facility to a large extent is focused on getting into a regional or a federal hospital, which provide mostly tertiary care. . Important details from your medical history may not be considered. chose a hospital with similar functions and capacity levels. The policies of expanding choice may have ambivalent impact on access to health care and equity in the utilization of medical services. E-mail: Search for other works by this author on: What are Advantages and Disadvantages of Restructuring a Health System to Be More Focused on Primary Care Services? Disadvantages of Specialization for patients include all but : 9 . This article explores these controversial developments by using empirical evidence from the Russian Federation. Better educated people are more likely to choose a provider. 0000023134 00000 n 2003). Hospitals are increasingly making available the information about the positive outcomes of their services, highlighting the aspects that are most understandable to the patients and especially the general practitioners who are the ones prescribing the hospital services. To triage patients in the emergency department Physician Specialization has advantages and disadvantages for patients. The weakening of the healthcare governance systems, accompanied by the expansion of patient choicetogether, these processes may lead to the breakdown in the co-ordination structures that oversee the activities of various providers such as referral systems from one stage of medical care to another and information exchange between different medical specialties. The computer-driven model used to make decisions may not be right for you if you have a complex medical history. Neurologists also take care of patients who have common problems such as migraine headaches and . The concept of inefficient patient choice, as understood in this article, is presented. In the last three decades, evidence-based medicine (EBM) has become the gold standard for clinical practice. <<8ef883c1e49c5e4cbacaaab76f466059>]>> This research project showed that the right to choose a practitioner and healthcare facility is valued by the Russian population overall. 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