Healthcare Investments for Sustainability of Care

Rising healthcare costs are increasingly becoming a threat to the sustainability of healthcare. Many organizations have been passing the healthcare costs to the consumers, thereby increasing disparities in financial access to care. There is need for healthcare organizations and hospitals to find ways to finance their services without creating undesirable social effects on the access to care. Healthcare organizations can achieve this by making investment decisions that generate additional funds for sustaining healthcare services.

Aging population

With the increasing population of the aged, this population segment can offer opportunities for investment on their unique needs. This population segment needs more rehabilitative care. Health organizations can invest in nursing centers for the aged, providing a comprehensive range of services for the aged.

Cosmetic health services

Cosmetic health services have been facing a rising demand in the recent times. Reconstructive surgeries, dental formula restructuring, and other cosmetic services can be a good source of income for investors in healthcare. Health organizations can take advantage of these social needs, and invest in these to provide finance for core health services.

Funeral homes

Changing population needs and innovations can see funeral homes generating very good revenue for health organizations. This is an investment with a huge potential and many opportunities. An in-depth analysis of this investment option will be posted here soon.

Personalized medicine

Personalized care and home-care services are investment opportunities worth keen consideration. The provision of these services is done at premium rates. The Health Services Manager has to ensure a balance in provision of these services in order to offer core services without human resource constraints.

Technological innovations

Investment in technology has a positive influence on cost reduction. Although initial investment cost is usually high, the long run cost effect is desirable. These savings from application of advanced technologies can be reinvested back in sustaining healthcare services.

Sustainability of care is important. Achievement of this is possible in application of innovative healthcare related investment options without relying on donor or government funding. 

Occupational Health Hazards Facing Mortuary Attendants

Mortuary attendants play a crucial role in the health system, though they are in most cases put at the periphery in human resource matters. Their role in preparation of cadavers is very important in ensuring the safe disposal of human remains and helping the bereaved to send off their loved ones in an honorable way. Health Systems Mangers need to ensure fairness in treatment of all health workforce. Mortuary attendants have been overlooked in many policy issues and in resource allocation, which actually demotivates them. Researchers on occupational health and safety in hospitals have been keen to focus on the clinical staff, with very few reaching out to the morticians. The few who have done research on the occupational health of mortuary attendants, have put more emphasis on the exposures to biological hazards without consideration of other many hazards mortuary attendants are to face.

Needle pricks, cuts, and lacerations

Mortuary workers usually use needles and surgical blades in the process of embalming. These tools may result to pricks and cuts if not well handled. Proper training of the mortuary attendant especially in the developing countries is unsatisfactory, because of the poor perception of this job. Since most of these workers have no formal training, they are at a higher risk of handling these tools improperly, leading to injuries.

Formalin

Formalin is the main preservative used in most mortuaries. This liquid is highly volatile and therefore, most mortuaries have formalin vapor in the air. Poorly ventilated mortuaries, and use of high concentrations of formalin, results in more formalin concentration in the air. Inhalation of formalin has negative health effects on the nervous, reproductive, and circulatory/breathing systems. Formalin also has an irritating effect on the eyes and nasal membranes.

Musculo-skeletal conditions

Mortuary work usually involves movement of bodies from one place to another, sometimes involving movement in different heights. Most morgues have inadequate equipment to aid the attendants in moving these bodies. The mortuary attendants end up with back, neck, or arm pains because of moving these bodies. This can be made worse when the movements are done under wrong postures.

Spillage of body fluids

Cadavers usually come in different conditions, some with various leaking fluids. As the mortuary attendants work on these bodies, they face the risk of getting in contact with these fluids and that may contain disease-causing microorganisms. These fluids may lead to slips and falls if they spill on the floor and the floor is not cleaned to dry. Other hazards include psychological stress as a result of interaction with the bereaved, noise, electrical hazards, and ergonomic hazards.

Recommendations

Mortuary attendants of most mortuaries are faced with various occupational hazards, and there are inadequate preventive measures in place. The public mortuaries should institute surveillance systems for occupational risks and hazards. Mortuary attendants should be provided with safety devices of appropriate quality and quantity, and training on their safety. Managers should adequately supervise the work in the morgues, develop safety procedures, and adequately communicate such procedures to the mortuary attendants.

Proper Management Practices for Drugs and Other Health Commodities

Drugs, vaccines, and non-pharmaceutical commodities form a large percentage of most health organization's budgets, in most cases going up to half of the proposed annual expenditure. These costs usually go higher due to inadequate management practices of these commodities, leading to wastage. Wastage may result from poor handling of the health commodities, improper storage, improper usage, and fraudulent practices within the organization.

Quantification

The estimation of the annual demand for the commodities is the first point that determines the cost to be incurred. A careful analysis of the previous consumption data and morbidity patterns is important in developing estimates that are more accurate. Under or over estimation have their associated costs.

Procurement

In procuring these commodities, proper management starts with the proper choice of the supplier. There is a high tendency of selecting the lowest bidder in procurement, but this is not a sufficient basis of selection for a supplier. Other important variables to put into consideration are quality of product, reliability of a supplier, and volume of transactions the potential supplier can provide. Consideration of the offer price is key, but there also needs to be compliance checks on all the other variables since they affect the organization’s operations and costs.

Documentation

There needs to be adequate and accurate documentation of transactions.  These transactions include acquisition, acceptance, disposal, rejects, and dispensation of commodities. Proper documentation helps to avoid errors and fraudulent acts. The LPOs/LSOs, invoices, receipt notes, delivery notes, payments, CRIVs, bin cards, stock control ledgers, cash book, credit notes, debit notes, bank statements, and other records need to be reconciled to reflect the authenticity of the transactions done.

Transportation and delivery

Placement of orders is done well in advance, considering the lead-time and stock level. The ordered commodities need transportation under the right conditions with proper handling. Those that require cold chain maintenance need transport facilities that ensure maintenance of the cold chain. The delivered commodities are inspected in order to ensure they are in the right condition and quantity. The organization can return to the supplier, or accept damaged goods at a lower price depending on nature of the commodity under consideration. The relevant documents should accompany the goods on deliveries and returns.

Storage and dispensation

Right conditions are necessary in storage of health commodities based on their specific requirements on temperature, lighting, humidity, security, spacing among other conditions. This avoids further wastage because of damages, pilferage, and theft. The dispensation of commodities should consider demand of the user department. Application of the appropriate stocking system is also crucial in dispensation to avoid wastage as a result of expiries. The most commonly advocated stock management system is FIFO (First In First Out), although there also has been recent ideologies on FEFO (First to Expire First Out).

Careful consideration of these practices ensures cost saving strategies have been put in place to minimize wastage.

Preventive Health Taken Too Far

A proposal by some civil society groups to cub teenage pregnancy cases in Kenya spiraled into a national debate on the role of some preventive health initiatives on the societal well-being. The groups were proposing the distribution of contraceptives to school going children/teenagers in order to minimize the rising cases of early pregnancies. This proposal has led stakeholders in the health sector to assess the overall impact of some preventive health interventions and re-assessment of health priorities.

Behavioral characteristics of teenagers

Teenagers are in a stage of development characterized by curiosity and this can be destructive especially under peer pressure. These young people are in the process of discovering their bodies and yearn to be ‘adults’. Ease of access and approval by the government will ‘open’ the minds of those children who had no idea of these things, thereby developing interest among all the children. Gone will be the days when our children will be playing football, the focus will be more on the consumption of contraceptives. One can only imagine how peer pressure can accelerate consumption rates. Why should they expire anyway?

Health priorities

There is need for a review of our health priorities. A program on distribution of contraceptives among school going children will require sustainability since it cannot be a one-time intervention. Alternatively, many school going children from poor families lack sanitary towels and therefore end up using homemade materials that may be unhygienic and uncomfortable. This goes a long way to affect the health and education of the girl child. A program for distribution of sanitary towels also requires long-term sustainability, but it will be addressing a higher priority public health condition as compared to distribution of contraceptives.

Gap between knowledge and practice

Availability of the contraceptives is one thing; their proper usage is the other thing. Some crucial stakeholders (especially the teaching fraternity), are against this intervention. These people would have played the role of teaching the children on how to use these contraceptives properly. The resistance shown by the teachers will put the children at greater risk since these contraceptives will be experimental use. There was inadequate involvement of stakeholders in coming up with the proposal.

Reality of the modern society

Although most people are faulting the proposal, some practitioners defend the proposal as the best way to deal with the reality that children become sexually active at a lower age than before and therefore, there is need for their protection in their adventures. Unavailability of these prophylactic devices may expose them to obvious risks, and this justifies the need to avoid taking chances, by providing the contraceptives to the children.

Innovative Marketing of Health Services for Public Facilities

There has been growing demand for healthcare services in the recent past, and this has contributed to a growth in investments in the health sector. Healthcare services are increasingly being commercialized than it was the case some time back, and therefore an element of competition is becoming a reality in the health sector, just like in the general corporate world. Therefore, every health institution is striving to stand out in the provision of its services in order to maintain and grow its market segments. Public health institutions in Kenya and most other countries lack incentive to market the various services they offer. This can be attributed to their nature of operation as not-for-profit, as influenced by government policies to ensure affordable healthcare to its citizens. The hospitals therefore in most cases have insufficient funds not only to sustain their services, but also to market their services to the level of their private peers. Although successful marketing in any sector comes with a high financial cost, the element of cost is not a hindrance especially in marketing of health services. Public health institutions can still go ahead and compete effectively in the health sector by employing the following strategies at minimal or no cost;

Quality care

This may be seen as an obvious strategy, but public health facilities need to make quality of care and satisfaction of their clients a number one priority since this is really what drives their clients away. Quality is the most valued attribute in the health sector, and therefore it’s an area that needs careful consideration. Quality issues range from the effectiveness of treatment provided (the patient’s role being constant), suitability of materials used, client waiting time, courtesy, adherence to SOPs (Standard Operating Procedures) and the general ambiance of the institution. The institution can set up an active and functional committee to check on quality issues.

Point of convergence for corporate social responsibility

Public facilities play a crucial role in the lives of people in their respective catchment areas due to the high poverty levels especially in third world countries. Therefore, these facilities have a great influence on the local population. The facilities can take this as an advantage in reaching out to the population through other organizations and still gain an edge in marketing. The facilities can achieve this by seeking to carry out joint community health related projects with multinational companies (e.g. Coca-Cola) or other leading national companies. In most cases, the companies will be willing to provide all the resources for the outreach, while the hospital can provide expertise, site space and access to the population. As the company seeks to market its activities and products to the local population and beyond, the public hospital will also gain limelight as a contributor/partner to the success of the outreach. These outreaches may combine the efforts of several organizations, or they may be bilateral between the hospital and a company depending on the practicality, economic viability and willingness of the companies involved.

Specialization while ensuring diversification

Successful companies like Samsung, initially had specialized in making cell phones and was ranked lower than Nokia. On diversification to other household electronics (like televisions, refrigerators etc.), Samsung gained higher ranks than Nokia and became a market leader in 2012. There is need for health facilities in the public sector to identify their strengths in service delivery and put a keen focus on these in order to gain much authority in those categories, just the way Samsung focused initially on cellphones. On identification of this area of specialty (guided by feasibility of implementation and demand for the service), the hospital should also diversify its services to widen its market. For example, Mathari Level 5 Hospital has specialized in mental health which has made it gain popularity in Kenya and beyond, although it still offers other services like dental care and thus serving a wider market.

Collaborations with institutions of learning

Most hospitals miss out on the marketing opportunities that come along with collaborations with medical training schools. These collaborations are usually seen in an abstract manner without deeper insights on possible opportunities for marketing. Hospitals can gain a lot through joint researches with medical training institutions usually at no cost. In most cases, the hospitals usually provide access to the subjects but at the end of the day, the name of the hospital dominates the research work. Isn’t this marketing without a sweat that?

Publicity

In the year 2012, Webuye Level 4 Hospital was awarded as the best maternity services provider among all the public health facilities in Kenya. Hospitals should strive to seek positive publicity in various ways, outstanding performance being one of them. Public hospitals can also take part in celebrations like the World AIDS Day and do these in unique ways that elicit media/public admiration and interest.

In conclusion:

It is now quite clear that public health institutions need to be at par with the reality of commercialization of healthcare, and thereby strive to stand out against competition that is increasing with time. This calls for innovative marketing strategies since these institutions are faced with financial constraints.

Future Challenges for Health Systems Management

Healthcare/system management is one of the professional practices that are rapidly changing with time. This dynamic practice therefore has experienced various uncertainties and challenges with changing times in the past. Some of the future challenges healthcare managers are likely to face, are analyzed in the following sections.

Escalating healthcare costs

Health care management will be faced with the challenge of minimizing healthcare expenditure which has been brought about by the trend of rising health care costs annually (Walshe & Smith, 2011). Research has shown that, for example, in the year 2001, the United States of America (U.S.A) had 14.1% of its Gross Domestic Product (G.D.P.) committed to covering health care costs. Going by the upward trend, this expenditure had been predicted to rise to 17.7% of G.D.P.in the year 2012 and continued increase in the subsequent years. This poses a great challenge to healthcare management professionals on how to contain these rising costs and increase efficiency in health care delivery.

Social disparities/inequities in health

One of the goals in health care management is to increase the access to quality health care in a fair way. Health care management is faced with the challenge of enhancing fairness and access in healthcare provision, due to the rising pressure on the public to pay for the healthcare services as a cost containment measure. This has limited the financial access of the poor to quality health care services, thus creating disparities in health status on the basis of income/social status. These disparities are likely to increase in the future as long as the cost of care is still being passed on to the consumers.

New healthcare technologies

Development of new drugs and technologies has been instrumental in improving the health of the population, although, it has also had its share of challenges in the health care industry. Many of these new technologies are expensive and may receive partial insurance coverage (Geisler, Krabbendam, & Schuring, 2003). Insured persons are thus quite often required to cover the high costs of these new technologies and prescription drugs. As the number of new technologies increase with time, healthcare managers are likely to be faced in the future by a conflict of interest between the benefits of new technologies to the society, and the need to minimize coverage of such new technologies in a bid to reduce healthcare expenditure

Emergence and re-emergence of diseases

The increasing burden of disease is another challenge that is currently facing healthcare management and is likely to be worse in the future. This will put a lot of pressure on healthcare managers to continuously review their healthcare priorities for the population. Emerging and re-emerging of conditions is proving a challenge in relation to frequent diversion of attention and action, which is likely to negatively influence overall health outcomes. An initial focus on infectious diseases in the 1960s was diverted to an increased focus on non-communicable diseases in the 1990s. A rise of the number of drug-resistant bacterial infections has been experienced in the past, and the trend is set to continue in the future. Health care management is thus faced with an additional challenge of investing more in research under its already constrained budget.

Complex client-provider relationship

The increasing complexity of the relationship between patients/clients with providers of healthcare will present a great challenge in the future. This relationship has been shifting from patient-provider to customer-provider, where patients/clients are insisting on their choice of treatment/care, confidentiality of information and informed consent. This continued empowerment of clients on health matters may result in increased risks of litigation against providers. Health care management will therefore be faced with the challenge of enhancing ethical practices among its providers in order to minimize ligation costs, and enhance patient/client satisfaction.

In conclusion;

Health care management being a dynamic field, is likely to be faced with various challenges ranging from rising expenditure, increased disparities in access to care, introduction of new technologies, increased burden of disease, to developing complexities in patient-provider relationships. These challenges need careful strategic planning to achieve the desired health care outcomes in the future.