While hospital-based Palliative Care services are usually covered through the main funding healthcare framework, traditional reimbursement methods have been criticized for their appropriateness. The present study investigates for the first time the case of treating end-of-life cancer patients in a Greek public hospital in terms of cost and reimbursement.
This retrospective observational study used health administrative data of 135 deceased cancer patients who were hospitalized in the end of their lives. Following the cost estimation procedure, which indentified both the individual patient and overhead costs, we compared the relevant billing data and reimbursement requests to the estimated costs.
The average total cost per patient per day was calculated to be 97 EUR, with equal participation of individual patient\'s and overhead costs. Length of stay was identified as the main cost driver. Reimbursement was performed either by per-diem fees or by Diagnosis Related Groups\' (DRGs), which were correspondingly associated with under or over reimbursement risks. In the case of the combined use of the two available reimbursement alternatives a cross-subsidization phenomenon was described.
Although the cost of end-of-life care proved to be quite low, the national per-diem rate fails to cover it. DRGs designed for acute care needs are rather unsuitable for such sub acute hospitalizations.
There is a concrete need for reconsidering the current reimbursement schemes for this group of patients as part of any national plan concerning the integration and reformation of Palliative Care services. Otherwise, there is a serious danger for public institutions\' reluctance to admit them with a serious impact on access and equity of end-of-life cancer care.

OBJECTIVE: This study aimed to examine mobbing in the health sector based on the Supreme Court case law.
METHODS: The data were accessed on the website of the Supreme Court. Searches were made using mobbing and health-related keywords and filters. As a result, 43 lawsuits were included.
CONCLUSIONS: Most of the cases occurred in private hospitals. Hospital managers were accused of mobbing in 88% of cases. In 30% of cases, nurses were plaintiffs. Also, 45% of cases involved an attack on the occupational situation of employees.
CONCLUSIONS: It is important to develop policies specific to mobbing behavior in the workplace at the macro level and to consider legislation and management monitoring by health managers and especially nurse managers at the micro level.

Institutional conflicts of interest (ICOIs) with pharmaceutical companies can bias internal operation of healthcare organizations. Naturally, a scholarship donation-which is a donation scheme unique to Japan, provided to healthcare organizations and their subunits to encourage educational and academic activities related to the development of new drugs-fall into the ICOI category. While anecdotal evidence exists that scholarship donations have been used as bribes by pharmaceutical companies, there has been little case study research that would illuminate the workings of this \"gray area\" mechanism. From this perspective, we offer an in-depth analysis of a recent scandal involving the Department of Clinical Anesthesiology, Mie University and Ono Pharmaceutical, where a scholarship donation was used by a pharmaceutical company to increase the prescription of one of its key drugs at a hospital department. Available evidence also suggests that a professor based within the department originally requested a scholarship donation from the company, which became an initial trigger of the scandal. We argue that by scrutinizing scholarship donations we can gain insight into problems specific to ICOIs between the pharmaceutical companies and the healthcare sector in Japan. In addition, scholarship donations can be understood as a form of \"gifts\" which have been found to underpin certain forms of pharmaceutical companies\' promotional activities in Japan but also in other countries. We conclude by highlighting potential institutional remedies, which may alleviate ICOIs and corrupt behavior affecting the healthcare sector.

BACKGROUND: Political and managerial reforms affect the health sector by translating into governance tensions. As identified in the public management literature, these tensions come from the diffusion of management principles and practices from the business world. These tensions manifest at four levels: institutional, organisational, managerial and instrumental. The aim of this research is to understand how these tensions are expressed in healthcare organisations of different status.
METHODS: We conduct a contrasting case study exploring the cases of two French healthcare organisations, one private for-profit (clinic) and one public not-for-profit (cancer treatment centre). Our analyses are mainly based on the content analysis of 32 semi-structured interviews conducted with staff (nurses, doctors, management and administrative staff) of these two organisations.
RESULTS: Our results show that these tensions can be distinguished into three categories (tensions on professional values, standards and practices) which are expressed differently depending on the type of healthcare organisation and its main management characteristics.
CONCLUSIONS: Unexpectedly, in the for-profit organisation, the most intense tensions concern professional standards, whereas they concern professional practices in the not-for-profit organisation. These analyses can help guide policy makers and healthcare managers to better integrate these tensions into their political and managerial decisions.

Social sustainability is the much emphasized organizational phenomenon in Western literature; however, in emerging economies, its importance has only been realized in the recent past. Social sustainability is the amiability of the relationship between employees and the organizations on a relatively permanent basis. Social sustainability is the key determinant of organizational sustainability and organizational effectiveness. As healthcare organizations are labor-intensive, the role of social sustainability in hospitals is more crucial. The purpose of the present study is to understand the role of work safety in improving social sustainability in public sector hospitals. To this effect, we collected data from 431 healthcare professionals of a large public sector tertiary and teaching hospital in the city of Lahore Pakistan and analyzed the data using structural equation modeling (SEM). The results uncovered certain important facts, which were not expected per se. Job design, coworkers\' behavior towards work safety, and supervisors\' role in ensuring work safety are the key factors that influence social sustainability. However, surprisingly, in the eyes of employees, management practices and safety programs/policies do not contribute to the work safety of the hospital under study. Keeping in view the findings, we suggest that management must participate in work safety affairs directly and formulate indigenous policies and programs according to local needs. Job analysis is needed to redesign job structures to meet workplace safety requirements. Formal and informal training will be beneficial to make workers and supervisors more aware, more sensitive, and more responsible regarding work safety.

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Hypertension is a major risk factor of cardiovascular disease and a leading cause of morbidity and mortality globally. In Kenya, the rise of hypertension strains an already stretched health care system that has traditionally focused on the management of infectious diseases. Health care provision in this country remains fragmented, and little is known about the role of health information technology in care coordination. Furthermore, there is a dearth of literature on the experiences, challenges, and solutions for improving the management of hypertension and other noncommunicable diseases in the Kenyan private health care sector.
The aim of this study is to assess stakeholders\' perspectives on the challenges associated with the management of hypertension in the Kenyan private health care sector and to derive recommendations for the design and functionality of a digital health solution for addressing the care continuity and quality challenges in the management of hypertension.
We conducted a qualitative case study. We collected data using in-depth interviews with 18 care providers and 8 business leads, and direct observations at 18 private health care institutions in Nairobi, Kenya. We analyzed the data thematically to identify the key challenges and recommendations for technology-enabled solutions to support the management of hypertension in the Kenyan private health sector. We subsequently used the generated insights to derive and describe the design and range of functions of a digital health wallet platform for enabling care quality and continuity.
The management of hypertension in the Kenyan private health care sector is characterized by challenges such as high cost of care, limited health care literacy, lack of self-management support, ineffective referral systems, inadequate care provider training, and inadequate regulation. Care providers lack the tools needed to understand their patients\' care histories and effectively coordinate efforts to deliver high-quality hypertension care. The proposed digital health platform was designed to support hypertension care coordination and continuity through clinical workflow orchestration, decision support, and patient-mediated data sharing with privacy preservation, auditability, and trust enabled by blockchain technology.
The Kenyan private health care sector faces key challenges that require significant policy, organizational, and infrastructural changes to ensure care quality and continuity in the management of hypertension. Digital health data interoperability solutions are needed to improve hypertension care coordination in the sector. Additional studies should investigate how patients can control the sharing of their data while ensuring that care providers have a holistic view of the patient during any encounter.

Big Data technologies can contribute to medical fraud detection. The aim of this paper is to present the methodological approach of the Hellenic National Organization for the Provision of Health Services (EOPYY) in data analysis to detect financial or medical fraud. To analyze the data for fraud detection, a selection of prescription data from the year 2018 were examined. The Local Correlation Integral algorithm was applied to detect any outliers on the dataset. The results revealed that 7 out of 879 cases could be characterized as outliers. These outliers must be further investigated to determine if they have been associated with fraud. According to the results of this study, this outliers\' detection approach can support and help the fraud detection process conducted by the auditing services in Healthcare sector.

Medical waste generation is rapidly rising, which may cause a serious risk for both humans and environment if it is not properly managed. Designing an efficient and reliable medical waste reverse supply chain (MWRSC) is extremely beneficial to society. Most studies on this issue have only considered the generated waste and have not reported the uncertainty in the amount of medical waste generation and other MWRSC parameters. Sustainability criteria and environmental issues in choosing treatment technology are rarely considered as well. In this research, a linear programming model under uncertainty is developed to design an MWRSC. The proposed model is multi-item and multi-period with three objective functions. The first objective function minimizes total costs, the second objective function is relevant to the best treatment technology selection and the third objective function minimizes the total medical waste stored. A robust possibilistic programming approach is utilized to handle imprecise parameters in the model and a fuzzy goal programming method is employed to build up a multi-objective model. A real case study is conducted to illustrate the potential of the proposed model which involves different attributes and problems, such as the location and capacity of facilities, and the type of treatment technology. Furthermore, the transferring amount of medical waste among different nodes is calculated.

Purpose: Mexico\'s public hospitals are experiencing major operational problems which seriously affect the care of Mexican citizens. Some hospitals have initiated efforts to apply the Kaizen philosophy to improve this situation. Therefore, the purpose of this article is to analyze the methodological impact of Kaizen-Kata implementation in Mexican public hospitals that have tried to solve operational problems using this improvement approach. Design/Methodology/Approach: The service organization implemented Kaizen-Kata methodology in order to improve one operational problem-process in health care. A case-study approach was used in this research in order to understand the effects of the Kaizen-Kata methodology in solving problems in their operational procedures. Findings: Six specific drivers were identified when applying the Kaizen-Kata methodology. Furthermore, the impact on the levels of implementation of the Kaizen-Kata methodology in each of the improvement teams studied was also identified. Research Limitations: The main limitation of the research is that only three case-studies are presented thus it is not possible to generalize its results. Practical Implications (Where Possible): Other public hospitals can use this specific example as a working guide to solve the operational problems of health systems. Originality/Value: A methodology of continuous improvement in manufacturing was imported from the industry sector for application in an operational health care process. The Kaizen-Kata methodology contributed significantly to improving issues involving delays, customer complaints, process reworks and extra-cost, among other effects of operational problems.