The cost of healthcare for children with mental health difficulties

Objective: Childhood mental health difficulties affect one in every seven children in Australia, posing a potential financial burden to society. This paper reports on the early lifetime individual and population non-hospital healthcare costs to the Australian Federal Government for children experiencing mental health difficulties. It also reports on the use and cost of particular categories of service use, including the Medicare Benefits Schedule (MBS) mental health items introduced in 2006.

Medical tourism: a conceptual framework for an innovation in global healthcare provision

The purpose of this chapter is to establish a conceptual model that can potentially fill research gaps in the literature about medical tourism as an innovative concept in global healthcare provision by developing emerging economies as they are providing low cost alternatives in medical treatment at internationally accredited medical facilities to treat patients from developed countries. Major databases such as Ebscohost and Emerald have been used to search relevant literature. The literature on medical tourism is reviewed so as to understand the key drivers of medical tourism as well as research gaps in the existing literature. Three major drivers of medical tourism have been identified, namely cost, waiting time, and perceived quality. Further empirical research is needed to test the conceptual model in order to better understand what drives a decision to engage in medical tourism. This chapter makes three major contributions; firstly, the identification of the medical tourism literature from the service marketing and management perspectives; secondly, to propose a conceptual model representing innovation in medical tourism for global healthcare by developing emerging economies; thirdly, the identification of research gaps in the medical tourism literature through which future research can further the knowledge of why people travel to developing countries for medical treatment.

Demographic and socio-cultural correlates of medical mistrust in two Australian states:Victoria and South Australia

Studies on medical mistrust have mainly focused on depicting the association between medical mistrust and access/utilization of healthcare services. The effect of broader socio-demographic and psycho-social factors on medical mistrust remains poorly documented. The study examined the effect of broader socio-demographic factors, acculturation, and discrimination on medical mistrust among 425 African migrants living in Victoria and South Australia, Australia. After adjusting for socio-demographic factors, low medical mistrust scores (i.e., more trusting of the system) were associated with refugee (β=−4.27, p<0.01) and family reunion (β=−4.01, p<0.01) migration statuses, being Christian (β=−2.21, p<0.001), and living in rural or village areas prior to migration (β=−2.09, p<0.05). Medical mistrust did not vary by the type of acculturation, but was positively related to perceived personal (β=0.43, p<0.001) and societal (β=0.38, p<0.001) discrimination. In order to reduce inequalities in healthcare access and utilisation and health outcomes, programs to enhance trust in the medical system among African migrants and to address discrimination within the community are needed.

Habitat utilization by juvenile hawksbill turtles (Eretmochelys imbricata, Linnaeus, 1766) around a shallow water coral reef

Contemporary studies of sea turtle diving behaviour are generally based upon sophisticated techniques such as the attachment of time depth recorders. However, if the risks of misinterpretation are to be minimized, it is essential that electronic data are analysed in the light of first-hand observations. To this aim, we set out to make observations of juvenile hawksbill turtles (Eretmochelys imbricata, Linnaeus, 1766) foraging and resting in a shallow water coral reef habitat around the granitic Seychelles (4°'S, 55°'E). Data were collected from six study sites characterized by a shallow reef plateau (<5 m) and a flat sandy area at the base of the reef face (<10 m). Observation data were categorized into the following behaviours: (1) stationary foraging; (2) active foraging; (3) resting; and (4) assisted resting. Central to this investigation was the development of a technique for accurately estimating the size of sea turtles in situ based upon previously tested techniques for reef fishes. This revealed that through calibration, the curved carapace length (CCL) of marine turtles can be consistently estimated to within 10 cm of their actual size. Although rudimentary, this has advantages for assessing the residency or absence of specific life history stages from particular environments. Indeed, our data supported previous claims that following the reproductive season, adult hawksbills in the region may move away from the nesting beaches to alternative foraging grounds whilst immature turtles (following the pelagic juvenile stage) may opt to reside in areas close to their natal beaches. With regards to habitat utilization, juvenile hawksbills displayed an alternating pattern of short, shallow foraging dives followed by deeper, longer resting dives. These findings are consistent with previous electronic studies of free-range diving in this species and suggest that the maximization of resting duration may be an important factor driving this behaviour.

A systematic review of the extent and measurement of healthcare provider racism

Background
Although considered a key driver of racial disparities in healthcare, relatively little is known about the extent of interpersonal racism perpetrated by healthcare providers, nor is there a good understanding of how best to measure such racism.

Objectives
This paper reviews worldwide evidence (from 1995 onwards) for racism among healthcare providers; as well as comparing existing measurement approaches to emerging best practice, it focuses on the assessment of interpersonal racism, rather than internalized or systemic/institutional racism.

Methods
The following databases and electronic journal collections were searched for articles published between 1995 and 2012: Medline, CINAHL, PsycInfo, Sociological Abstracts. Included studies were published empirical studies of any design measuring and/or reporting on healthcare provider racism in the English language. Data on study design and objectives; method of measurement, constructs measured, type of tool; study population and healthcare setting; country and language of study; and study outcomes were extracted from each study.

Results
The 37 studies included in this review were almost solely conducted in the U.S. and with physicians. Statistically significant evidence of racist beliefs, emotions or practices among healthcare providers in relation to minority groups was evident in 26 of these studies. Although a number of measurement approaches were utilized, a limited range of constructs was assessed.

Conclusion
Despite burgeoning interest in racism as a contributor to racial disparities in healthcare, we still know little about the extent of healthcare provider racism or how best to measure it. Studies using more sophisticated approaches to assess healthcare provider racism are required to inform interventions aimed at reducing racial disparities in health.

Evaluation of building performance for strategic facilities management in healthcare : a case study of a public hospital in Australia

Purpose - This paper evaluates the main elements of building performance namely building function, building impact and building quality in order to promote strategic facilities management in healthcare organisation to improve core (health) business activities. Design/methodology/approach - Based on current available toolkits, a questionnaire is issued to healthcare users (staff) in a public hospital about their level of agreement in relation to these elements. Statistical analysis is conducted to regroup the elements. These regrouped elements and their inter relationships are used to develop a framework for measuring building performance in healthcare buildings. Findings - The analysis helped to clarify the understanding and agreement of users in Australian healthcare organisation with regards to building performance. Based on the survey results, 11 new elements were regrouped into three groups. These new regrouped elements will be used to develop a reliable framework for measuring performance of Australian healthcare buildings. Originality/value - Currently there is no building performance toolkit available for Australian healthcare organisation. The framework developed in this paper will help healthcare organisations with a reliable performance tool for their buildings and this will promote strategic facilities management.

Utilization of a population health survey in policy and practice: a case study

Background
There is growing interest by funding bodies and researchers in assessing the impact of research on real world policy and practice. Population health monitoring surveys provide an important source of data on the prevalence and patterns of health problems, but few empirical studies have explored if and how such data is used to influence policy or practice decisions. Here we provide a case study analysis of how the findings from an Australian population monitoring survey series of children’s weight and weight-related behaviors (Schools Physical Activity and Nutrition Survey (SPANS)) have been used, and the key facilitators and barriers to their utilization.

Methods
Data collection included semi-structured interviews with the chief investigators (n = 3) and end-users (n = 9) of SPANS data to explore if, how and under what circumstances the survey findings had been used, bibliometric analysis and verification using documentary evidence. Data analysis involved thematic coding of interview data and triangulation with other data sources to produce case summaries of policy and practice impacts for each of the three survey years (1997, 2004, 2010). Case summaries were then reviewed and discussed by the authors to distil key themes on if, how and why the SPANS findings had been used to guide policy and practice.

Results
We found that the survey findings were used for agenda setting (raising awareness of issues), identifying areas and target groups for interventions, informing new policies, and supporting and justifying existing policies and programs across a range of sectors. Reported factors influencing use of the findings were: i) the perceived credibility of survey findings; ii) dissemination strategies used; and, iii) a range of contextual factors.

Conclusions
Using a novel approach, our case study provides important new insights into how and under what circumstances population health monitoring data can be used to influence real world policy and practice. The findings highlight the importance of population monitoring programs being conducted by independent credible agencies, researchers engaging end-users from the inception of survey programs and utilizing existing policy networks and structures, and using a range of strategies to disseminate the findings that go beyond traditional peer review publications.

Influence of high performance work systems on employee subjective well-being and job burnout: empirical evidence from the Chinese healthcare sector

Over the last two decades, high performance work systems (HPWSs) research has been dominated by examining the effects of these systems on firm performance. Research on the impact of HPWSs on employees has been marginalised. This study examines the impact of HPWSs on two psychological outcomes for employees, namely, subjective well-being (SWB) and workplace burnout, by utilising data collected from 1488 physicians and nurses in 25 Chinese hospitals. It also examines the moderating effects of employees' organisational based self-esteem (OBSE), as an individual intervention and physician–nurse relationships, as an organisational intervention, on the relationship between HPWSs and employee outcomes. HPWS is found to increase employees' SWB and decrease burnout. Such well-being-enhancing and burnout-relieving effects are stronger when employees have high OBSE. The positive effect of HPWS on SWB is also stronger when there is a collaborative relationship among employees in an organisation. The major contribution of this study is to unpack the ‘black box’ of how HPWS influences employee well-being in the Chinese healthcare sector context.