The objective of this paper is to evaluate the long-term development of main health system inputs and outputs and to evaluate the development of the efficiency of the Czech health system. We evaluate the health system efficiency by two indices of efficiency, which contain 4 inputs and 2, respectively 3 outputs of the health system. The weights of inputs and outputs were obtained by a questionnaire survey among experts. The developed efficiency indices show that the efficiency of the Czech health system has a downward trend.

• Klíčová slova
• health system, efficiency, international comparison,
• MeSH
• efektivita organizační MeSH
• lidé MeSH
• poskytování zdravotní péče * organizace a řízení   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH
• Geografické názvy
• Česká republika MeSH

BACKGROUND: An international comparison of health system performance is a popular tool of health policy analysis. However, the efficiency evaluation of health systems is a practical example of an international comparison in which non-homogeneity is expected. The objective of this paper is to evaluate the efficiency of health systems by models in which a degree of non-homogeneity among countries is considered. METHODS: We study the problem of non-homogeneity of health systems in the theoretical framework of the data envelopment analysis (DEA), which is a popular method of efficiency evaluation with hundreds of applications from various fields. DEA assume the homogeneity of production units and the homogeneity of the environment in which the production units operate. Hence, we compiled a summary of 14 recommendations on how to deal with the non-homogeneity in the DEA models. The analysed sample includes 38 OECD member countries. The data are from the year 2019. RESULTS: As an example, we evaluated the health system efficiency of the Czech Republic. We used the DEA models with the neighbourhood measure of distance and the constraint limiting the comparison of countries with different levels of economic development. The health system inputs were the numbers of physicians, nurses, and hospital beds. In the production of the intermediate outputs (doctor consultations, inpatient care discharges), the Czech Republic should look at Poland, Slovakia and Slovenia. In the production of health outcomes (life expectancy), the peer countries are France, Italy and Switzerland. CONCLUSIONS: The results of the DEA analysis are only indicative because no single analytical method can determine whether a health system is better or worse than others. We need to combine different methods, and DEA is one of them. We consider DEA as an exploratory method, not a method providing definitive answers.

• Klíčová slova
• Data envelopment analysis, Efficiency evaluation, Health systems, Non-homogeneity,
• MeSH
• efektivita organizační * MeSH
• lidé MeSH
• vládní programy MeSH
• výkonnost * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Francie MeSH
• Polsko MeSH

Healthcare is a highly sophisticated segment of the public sector, which requires not only highly professional and competent staff, but also a properly set ratio of healthcare professionals. In the Czech Republic, the state, as the main guarantor of health care, applied strong control through price and volume control. The aim of the paper is to define the differences in the technical efficiency of public hospitals, with regard to the size of hospitals and partial types of human resources. An input-oriented Data Envelopment Analysis model (DEA model) was chosen for modeling the technical efficiency of 47 public hospitals. The personnel performance concept of the evaluation of technical efficiency was further implemented in eight specific models, from the perspective of individual input variables relative to output variables and according to different assumptions regarding the character of economies of scale. The results of technical efficiency were analyzed using correlation, regression analysis, and the Bootstrap method. The least efficient hospitals in terms of hospital size are large hospitals, and the most balanced results have been achieved by medium-sized hospitals. The average efficiency rate in models that include all selected input and output variables is highest in medium-sized hospitals, with a value of 0.866 for CRS and an efficiency rate of 0.926 for VRS. The rationalization of human resources should be implemented in order not to reduce the quality of care provided.

• Klíčová slova
• bootstrap, data envelopment analysis model, hospital efficiency, hospitals in public ownership, human resources in healthcare, performance,
• MeSH
• efektivita organizační * MeSH
• lidé MeSH
• nemocnice veřejné * MeSH
• pracovní síly MeSH
• veřejný sektor MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

In recent years, most countries around the world have struggled with the consequences of budget cuts in health expenditure, obliging them to utilize their resources efficiently. In this context, performance evaluation facilitates the decision-making process in improving the efficiency of the healthcare system. However, the performance evaluation of many sectors, including the healthcare systems, is, on the one hand, a challenging issue and on the other hand a useful tool for decision- making with the aim of optimizing the use of resources. This study proposes a new methodology comprising two well-known analytical approaches: (i) data envelopment analysis (DEA) to measure the efficiencies and (ii) data science to complement the DEA model in providing insightful recommendations for strategic decision making on productivity enhancement. The suggested method is a first attempt to combine two DEA extensions: flexible measure and cross-efficiency. We develop a pair of benevolent and aggressive scenarios aiming at evaluating cross-efficiency in the presence of flexible measures. Next, we perform data mining cluster analysis to create groups of homogeneous countries. Organizing the data in similar groups facilitates identifying a set of benchmarks that perform similarly in terms of operating conditions. Comparing the benchmark set with poorly performing countries we can obtain attainable goals for performance enhancement which will assist policymakers to strategically act upon it. A case study of healthcare systems in 120 countries is taken as an example to illustrate the potential application of our new method.

• Klíčová slova
• Clustering, Cross-efficiency, Data envelopment analysis, Data science, Flexible measure, Healthcare,
• MeSH
• alokace zdrojů metody   MeSH
• celosvětové zdraví MeSH
• efektivita organizační * MeSH
• lidé MeSH
• poskytování zdravotní péče * metody   organizace a řízení   MeSH
• rozhodování MeSH
• shluková analýza MeSH
• statistické modely * MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

Case management is generally seen as a way to provide efficient, cost-saving person-centred care for people with dementia by connecting together fragmented services, but the available evidence in favour of its merits is often considered inconclusive, unclear and sketchy. This discussion paper investigates the evidence of the benefit of case management for people with dementia and explores the complexity of the concept and the experiences of its implementation. It offers a comprehensive framework for conceptualising various types of case management and asks the question: who can be a case manager? Building on examples from three European countries it addresses the problem of the expansion and adoption of the case management method. It compares the conventional model of diffusion of innovation with the ideas of interessement and co-constitution and envisions a successful model of case management as a fluid technology that is both friendly and flexible, allowing it to adapt to different settings and systems.

• Klíčová slova
• case management, dementia, fluid technology, interessement, translation of case management,
• MeSH
• demence * ošetřování   MeSH
• efektivita organizační MeSH
• koordinovaný terapeutický postup ekonomika   MeSH
• lidé MeSH
• péče orientovaná na pacienta * MeSH
• primární zdravotní péče metody   MeSH
• rozšiřování inovací MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH

BACKGROUND: In addition to cost-effectiveness, national guidelines often include other factors in reimbursement decisions. However, weights attached to these are rarely quantified, thus decisions can depend strongly on decision-maker preferences. OBJECTIVE: To explore the preferences of policymakers and healthcare professionals involved in the decision-making process for different efficiency and equity attributes of interventions and to analyse cross-country differences. METHOD: Discrete choice experiments (DCEs) were carried out in Austria, Hungary, and Norway with policymakers and other professionals working in the health industry (N = 153 respondents). Interventions were described in terms of different efficiency and equity attributes (severity of disease, target age of the population and willingness to subsidise others, potential number of beneficiaries, individual health benefit, and cost-effectiveness). Parameter estimates from the DCE were used to calculate the probability of choosing a healthcare intervention with different characteristics, and to rank different equity and efficiency attributes according to their importance. RESULTS: In all three countries, cost-effectiveness, individual health benefit and severity of the disease were significant and equally important determinants of decisions. All countries show preferences for interventions targeting young and middle aged populations compared to those targeting populations over 60. However, decision-makers in Austria and Hungary show preferences more oriented to efficiency than equity, while those in Norway show equal preferences for equity and efficiency attributes. CONCLUSION: We find that factors other than cost-effectiveness seem to play an equally important role in decision-making. We also find evidence of cross-country differences in the weight of efficiency and equity attributes.

• Klíčová slova
• Discrete choice experiment, Equity-efficiency trade-off, Priority setting, Reimbursement,
• MeSH
• analýza nákladů a výnosů MeSH
• efektivita organizační * MeSH
• lidé MeSH
• přidělování zdravotní péče ekonomika   organizace a řízení   MeSH
• rozhodování * MeSH
• směrnice jako téma MeSH
• stupeň závažnosti nemoci MeSH
• věkové faktory MeSH
• výběrové chování MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Evropa MeSH

Trends such as aging populations, excess costs, rising public expectations, and progress in medical science and technologies point out the necessity of adaptation and development of innovation in the healthcare systems particularly in developed countries. The main objective of this article is to review diffusion of innovation in the healthcare sector. Different types of innovation, diffusion characteristics, and adoption mechanisms are the subjects that are discussed in the selected case study, Finland. Finally, the key items of innovation management in the Finnish health system are introduced. The results can be implemented in other countries as well.

• MeSH
• efektivita organizační MeSH
• lidé MeSH
• organizační inovace * MeSH
• pracovní síly MeSH
• primární zdravotní péče ekonomika   organizace a řízení   MeSH
• případové studie organizací MeSH
• rozšiřování inovací MeSH
• státní lékařství ekonomika   organizace a řízení   MeSH
• výdaje na zdravotnictví MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Finsko MeSH

BACKGROUND: This contribution is a response to the current issue of corporate governance in hospitals in the Czech Republic, which draw a significant portion of funds from public health insurance. This not only has a significant impact on the economic efficiency of hospitals, but ultimately affects the whole system of healthcare provision in the Czech Republic. Therefore, the effectiveness of the corporate governance of hospitals might affect the fiscal stability of the health system and, indirectly, health policy for the whole country. OBJECTIVES: The main objective of this paper is to evaluate the success of the transformation in connection with the performance of corporate governance in hospitals in the Czech Republic. Specifically, there was an examination of the management differences in various types of hospitals, which differed in their ownership structure and legal form. METHODOLOGY/APPROACH: A sample of 100 hospitals was investigated in 2009, i.e., immediately after the transformation had been completed, and then three years later in 2012. With regard to the different public support of individual hospitals, the operating subsidies were removed from the economic results of the corporations in the sample. The adjusted economic results were first of all examined in relationship to the type of hospital (according to owner and legal form), and then in relation to its size, the size of the supervisory board and the education level of the senior hospital manager. A multiple median regression was used for the evaluation. FINDINGS: One of the basic findings was the fact that the hospital's legal form had no influence on economic results. Successful management in the form of adjusted economic results is only associated with the private type of facility ownership. From the perspective of our concept of corporate governance other factors were under observation: the size of the hospital, the size of the supervisory board and the medical qualifications of the senior manager had no statistically verifiable influence on the efficiency of the hospital management, though we did record certain developments as a result of the transformation process. The economic results that were reported were significantly distorted by the operating subsidies from the founder. PRACTICAL IMPLICATIONS: The results can be used immediately on several practical levels: on the macro level as part of the state's formulation of health policy, particularly in the optimization of the structure of healthcare providers, as well as for the completion of reforms in legal forms and hospital founders, and on the micro level as part of the effective administration and governance of hospitals through corporate governance regardless of the form of ownership.

• Klíčová slova
• Corporate governance, Hospitals, Legal form transformation, Management,
• MeSH
• efektivita organizační ekonomika   MeSH
• ekonomika nemocniční zákonodárství a právo   organizace a řízení   MeSH
• financování vládou MeSH
• lidé MeSH
• nemocnice soukromé ekonomika   zákonodárství a právo   organizace a řízení   MeSH
• nemocnice veřejné ekonomika   zákonodárství a právo   organizace a řízení   MeSH
• řízení nemocnice zákonodárství a právo   metody   MeSH
• vládní výbor ekonomika   organizace a řízení   MeSH
• vlastnictví * zákonodárství a právo   organizace a řízení   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika MeSH

The results of the study Benchmarking Regional Health Management II suggest that compulsory measles immunisation is a good practice in public health management. Yet, the potential achievement of the desired health outcome alone is not a sufficient reason to make the immunisation obligatory. Rather, compulsory measles immunisation is a morally challenging measure. In this article, compulsory measles immunisation is critically evaluated from a public health ethics point of view. For this evaluation, a set of ethical criteria is proposed: respect for autonomy, health maximisation, efficiency, proportionality and social justice. The authors suggest it should not be taken for granted that compulsory measles immunisation should be championed, rather, health policy makers in the European Union should try to raise immunisation rates with non-compulsory means.

• MeSH
• benchmarking etika   metody   MeSH
• důstojnost lidského života MeSH
• efektivita organizační MeSH
• kvalita zdravotní péče MeSH
• lidé MeSH
• očkovací programy etika   MeSH
• sociální spravedlnost MeSH
• spalničková vakcína aplikace a dávkování   MeSH
• veřejné zdravotnictví - praxe etika   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• spalničková vakcína MeSH