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Objective: With the participation of private hospitals in the health system, improving hospital efficiency becomes more important. This study aimed to evaluate the technical efficiency of public and private hospitals in Beijing, China, and analyze the influencing factors of hospitals’ technical efficiency, and thus provide policy implications to improve the efficiency of public and private hospitals. Method: This study used a data set of 154–232 hospitals from “Beijing’s Health and Family Planning Statistical Yearbooks” in 2012–2017. The data envelopment analysis (DEA) model was employed to measure technical efficiency. The propensity score matching (PSM) method was used for matching “post-randomization” to directly compare the efficiency of public and private hospitals, and the Tobit regression was conducted to analyze the influencing factors of technical efficiency in public and private hospitals. Results: The technical efficiency, pure technical efficiency and scale efficiency of public hospitals were higher than those of private hospitals during 2012–2017. After matching propensity scores, although the scale efficiency of public hospitals remained higher than that of their private counterparts, the pure technical efficiency of public hospitals was lower than that of private hospitals. Panel Tobit regression indicated that many hospital characteristics such as service type, level, and governance body affected public hospitals’ efficiency, while only the geographical location had an impact on private hospitals’ efficiency. For public hospitals in Beijing, those with lower average outpatient and inpatient costs per capita had better performance in technical efficiency, and bed occupancy rate, annual visits per doctor, and the ratio of doctors to nurses also showed a positive sign with technical efficiency. For private hospitals, the average length of stay was negatively associated with technical efficiency, but the bed occupancy rate, annual visits per doctor, and average outpatient cost were positively associated with technical efficiency. Conclusions: To improve technical efficiency, public hospitals should focus on improving the management standards, including the rational structure of doctors and nurses as well as appropriate reduction of hospitalization expenses. Private hospitals should expand their scale with proper restructuring, mergers, and acquisitions, and pay special attention to shortening the average length of stay and increasing the bed occupancy rate.

\"Madness in the Family explores how colonial families coped with insanity through a trans-colonial study of the relationships between families and public colonial hospitals for the insane in New South Wales, Victoria, Queensland and New Zealand between 1860 and 1914\"--Provided by publisher.

China's 3 year, CN¥850 billion (US$125 billion) reform plan, launched in 2009, marked the first phase towards achieving comprehensive universal health coverage by 2020. The government's undertaking of systemic reform and its affirmation of its role in financing health care together with priorities for prevention, primary care, and redistribution of finance and human resources to poor regions are positive developments. Accomplishing nearly universal insurance coverage in such a short time is commendable. However, transformation of money and insurance coverage into cost-effective services is difficult when delivery of health care is hindered by waste, inefficiencies, poor quality of services, and scarcity and maldistribution of the qualified workforce. China must reform its incentive structures for providers, improve governance of public hospitals, and institute a stronger regulatory system, but these changes have been slowed by opposition from stakeholders and lack of implementation capacity. The pace of reform should be moderated to allow service providers to develop absorptive capacity. Independent, outcome-based monitoring and evaluation by a third-party are essential for mid-course correction of the plans and to make officials and providers accountable.

Where does one go without health insurance, when turned away by hospitals, clinics, and doctors? In this volume, Nuila follows the lives of five uninsured Houstonians as their struggle for survival leads them to a hospital where insurance comes second to genuine care. Each patient eventually lands at Ben Taub, the county hospital where Dr. Nuila has worked for over a decade. Nuila delves with empathy into the experiences of his patients, braiding their dramas into a singular narrative that contradicts the established idea that the only way to receive good healthcare is with good insurance. As readers follow twists and turns in each patient's story, it's impossible to deny that our system is broken--and that Ben Taub's innovative model, which emphasizes people over payments, could help light the path forward. -- Provided by publisher.

Background Emergency department (ED) serve as critical entry points in healthcare systems, particularly in tertiary care hospitals where complex medical emergencies are managed. In Pakistan, both public and private sector tertiary care hospitals provide emergency care services; however, systematic evidence comparing their quality in terms of service availability and readiness remains limited. The World Health Organization’s Harmonized Health Facility Assessment (HHFA) tool is one such approach that offers a framework to evaluate the quality of health care facilities in terms of service availability and readiness. The current exploratory comparative study was conducted to compare the quality of emergency care services in terms of service availability and readiness between public and private tertiary care hospitals in Rawalpindi, Pakistan. Methods This exploratory comparative cross-sectional study was conducted in six tertiary care hospitals (three public and three private sector hospitals) in Rawalpindi, Pakistan, from September 2024 to December 2024. The availability and readiness of emergency care services were evaluated using an adapted WHO HHFA tool addressing multiple domains: emergency service availability, site condition readiness, equipment readiness, medicines and commodities, diagnostic readiness, and support and quality services. The indicators were scored as available or unavailable, and scores were aggregated to form domain-specific percentage scores. Results were reported as median (IQR), and comparisons between public and private-sector hospitals were performed using the Mann-Whitney U test due to the small sample size. The data were analyzed via a scoring system formulated by HHFA in SPSS version 27. Results The median daily ED patient volume was 320 (IQR: 300–340) for public hospitals and 210 (IQR: 195–225) for private hospitals, while the median for the number of ED beds was 28 (IQR: 26–30) and 15 (IQR: 15-17.5), respectively. No statistically significant difference was observed between hospital characteristics ( p  > 0.05). The median overall emergency service availability and readiness score was 76.47 (IQR: 75.29–80.59) for public hospitals and 76.47 (IQR: 75.00-77.06) for private hospitals ( p  = 0.658). In both sectors, the median readiness for emergency medicines and surgical equipment was 100. The median diagnostic readiness score in public hospitals was 42.86 (IQR: 28.57–64.29), compared to 14.29 (IQR: 14.29-50.00) in private hospitals. However, this difference did not attain statistical significance ( p  = 0.637). No statistically significant differences were observed between public and private hospitals for all observed domains. Conclusion This exploratory study found no statistically significant differences in emergency care service availability and readiness between public and private tertiary care hospitals in Rawalpindi. Although minor numerical variations were observed, both sectors demonstrated comparable availability and readiness for emergency care. Persistent deficiencies in diagnostic readiness and support services across both sectors indicate the need for system-level improvements to strengthen emergency care delivery.

Background Studies have shown that poor sleep could result in many unpleasant consequences and is prevalent in nurses. Considering the fact of high stress, overwhelming workload and many night shifts in the emergency department in China, this study aimed to evaluate the current status of emergency nurses’ sleep quality in public hospitals in Shandong, China and explored its influencing factors. Methods A self-administered questionnaire incorporating the Job Content Questionnaire and Pittsburgh Sleep Quality Index (PSQI) was conducted among 4856 emergency nurses in five randomly selected city emergency command systems in Shandong, China. The association of potential influencing factors, including occupational, psychosocial and individual factors, with poor sleep (PSQI> 5) was quantified by multivariate logistic regression analysis. Results The average PSQI score of 4730 emergency nurses in public hospitals was 8.2 ± 3.9, including 3114 (65.8%) subjects with PSQI > 5 and 2905 (61.4%) > 8; these figures were found highest for 337 emergency nurses in 14 tertiary hospitals with 11.8 ± 4.3, 257 (76.3%) and 232 (68.8%), followed by 1044 emergency nurses in 43 secondary hospitals with 9.5 ± 3.9, 725 (69.4%) and 675 (64.7%) and 3349 emergency nurses in 167 primary hospitals with 7.4 ± 3.5, 2132 (63.7%) and 1998 (59.7%). The following factors were associated with poor sleep: hospital level (tertiary vs. primary, secondary vs. primary), female sex, less of exercise, long work hours per week, many patients in the charge of at night, high monthly night shift frequency (4–6 vs. never, ≥7 vs. never) and high occupational stress. Conclusions The sleep quality of emergency nurses in public hospitals in China was poor, especially in tertiary hospitals. Many factors as listed above, especially occupational stress, night shift taking and workload at night, should be considered when improving emergency nurses’ sleep quality.

Background The Covid-19 pandemic stretched health systems globally including in Iran. Hospital demand and performance was affected both directly and indirectly as a result of the pandemic. Analyzing hospital indicators can provide insights to deal with the consequences and challenges related to various aspects of future pandemics. Objective This study aimed to investigate the impact of the Covid-19 pandemic on key performance indicators of public hospitals in Iran. Methods In this quasi-experimental study, we used time-series analysis to examine eight key indicators of hospital performance: number of outpatient visits, number of elective hospitalization, average length of stay, hospital mortality rate, number of surgeries, hospitalization rate, emergency visits, bed occupancy rate, and hospitals’ revenue. Data were extracted from four public hospitals in Yazd at two time intervals, 15 months before and after the outbreak of COVID-19. Data were analysed using interrupted time series analysis models with STATA 17 . Results Average length of stay ( p  = 0.02) and hospital mortality rate ( p  < 0.01) increased significantly following the outbreak of COVID-19, while the mean of other indicators such as number of outpatient visits ( p  < 0.01), number of elective hospitalization ( p  < 0.01), number of surgeries ( p  = 0.01), hospitalization rate ( p  < 0.01), emergency visits ( p  < 0.01) and bed occupancy rate ( p  < 0.01) decreased significantly. The Covid-19 pandemic had an immediately reverse significant impact on the level changes of “outpatient visits”, “elective hospitalization”, “hospitalization rate”, “emergency visits” and “bed occupancy rate” indicators ( p  < 0.05). Although the trend of surgeries indicator was affected significantly ( p  = 0.01) after the covid-19 outbreak. Conclusion We showed significant changes in most hospital indicators after the Covid-19 pandemic, reflecting the effect of this pandemic on the performance of hospitals. Understanding the impact of a pandemic on hospital indicators is necessary for decision-makers to effectively plan an effective pandemic response and to inform resource allocation decisions.