Making a Cross-Country Comparison of Health Systems: What Are the Possible Study Design Frameworks?

2.50
Hdl Handle:
http://hdl.handle.net/10755/621632
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Making a Cross-Country Comparison of Health Systems: What Are the Possible Study Design Frameworks?
Other Titles:
Cross-Country Health Systems
Author(s):
Zlotnick, Cheryl; Anderson, Sue A.; Heaslip, Vanessa
Lead Author STTI Affiliation:
Phi Gamma
Author Details:
Cheryl Zlotnick, DrPH, MPH, MS, RN, Professional Experience: Cheryl Zlotnick is an Associate Professor at the Cheryl Spencer Department of Nursing, in the Department of Public Health and Welfare Sciences at the University of Haifa. In the past, she has held positions as a clinician, evaluator, program developer and researcher to reduce inequity in health care access and services for vulnerable and at-risk populations. Prof. Zlotnick's studies focus on health status, risk, and services for children, adults and families living in impoverished and transitional situations (i.e., new immigrants, homeless individuals, and youth in foster care/group homes). Author Summary: Cheryl Zlotnick is an Associate Professor at the University of Haifa. Her studies focus on developing culturally-appropriate interventions, and examining inequities in service utilization and health status for vulnerable populations including children, adults and families living in impoverished and transitional situations (i.e., immigrants, homeless individuals/youth in foster care/group homes) within institutions, across communities, between countries and globally.
Abstract:

Purpose:   Health care systems form the framework and context through which countries provide health care services to their populations. They are comprised of an amalgam of culturally- and often economically-driven structures (e.g., facilities, personnel, policies, processes) to attain optimal health outcomes. No single health system is precisely like another. However, when studies explore differences in population health status or outcomes across countries, often the comparison focuses solely on health outcomes, completely omitting the effects and influences of the health system. This omission is problematic, since as several health care provision models suggest, health care outcome inequities may be connected to or even originate from the health system's context and approach; but this topic has been explored by very few studies. With increasing globalization, nurses comprising the largest health professional labor force in the world must employ the most rigorous study design frameworks when conducting cross-country comparisons of health outcomes. Thus, the goal of this research project is to examine study design frameworks used to make cross-country comparisons of health care outcomes taking into account the health care system context.  

Methods: To address this goal, this study examined study design frameworks using a scoping review methodology with the following steps: the identification of the domains of the health care system that must be explored; search and selection of relevant studies; charting the studies’ findings; and summarization of the results.

Results: Study design frameworks for cross-country comparisons of health care outcomes within the health system context varied by: (1) use of country selection criteria as a basis for country selection, (2) use of a guiding theory to govern the elements for comparison, (3) the decision of the data type (i.e., quantitative, qualitative, mixed-methods), (4) ascertainment and validation of measurements, (5) synthesis of findings employed a wide versus narrow focus, (6) inclusion of countries' cultures and population composition, and (7) contribution to other countries' health systems. 

Conclusion: A grid denoting a variety of cross-country study design frameworks depicts a variety of strengths and weaknesses. Countries' health care systems are culturally-linked, but criteria exploring or explicating cultural influences within the health system context were sparse or absent. Moreover, cross-country comparison frameworks were inconsistent in their abilities to delineate and define approaches that resulted in inequitable health service outcomes for different population groups. Design frameworks failing to include the cultural context limit our ability to fully examine differences in health care outcomes. Nurses and other health professionals must choose a study design framework that is systematic, comprehensive and sufficiently robust to meet the challenge of conducting cross-country comparisons so that study results are able to assist countries' policymakers and administrators to make improvements that promote better and more equitable health outcomes for their population.

Keywords:
Cross-Country Comparisons; Health Outcomes; Research Designs
Repository Posting Date:
3-Jul-2017
Date of Publication:
3-Jul-2017
Other Identifiers:
INRC17S07
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleMaking a Cross-Country Comparison of Health Systems: What Are the Possible Study Design Frameworks?en_US
dc.title.alternativeCross-Country Health Systemsen
dc.contributor.authorZlotnick, Cherylen
dc.contributor.authorAnderson, Sue A.en
dc.contributor.authorHeaslip, Vanessaen
dc.contributor.departmentPhi Gammaen
dc.author.detailsCheryl Zlotnick, DrPH, MPH, MS, RN, Professional Experience: Cheryl Zlotnick is an Associate Professor at the Cheryl Spencer Department of Nursing, in the Department of Public Health and Welfare Sciences at the University of Haifa. In the past, she has held positions as a clinician, evaluator, program developer and researcher to reduce inequity in health care access and services for vulnerable and at-risk populations. Prof. Zlotnick's studies focus on health status, risk, and services for children, adults and families living in impoverished and transitional situations (i.e., new immigrants, homeless individuals, and youth in foster care/group homes). Author Summary: Cheryl Zlotnick is an Associate Professor at the University of Haifa. Her studies focus on developing culturally-appropriate interventions, and examining inequities in service utilization and health status for vulnerable populations including children, adults and families living in impoverished and transitional situations (i.e., immigrants, homeless individuals/youth in foster care/group homes) within institutions, across communities, between countries and globally.en
dc.identifier.urihttp://hdl.handle.net/10755/621632-
dc.description.abstract<p><strong><strong>Purpose: </strong> </strong><span> Health care systems form the framework and context through which countries provide health care services to their populations. They are comprised of an amalgam of culturally- and often economically-driven structures (e.g., facilities, personnel, policies, processes) to attain optimal health outcomes. No single health system is precisely like another. However, when studies explore differences in population health status or outcomes across countries, often the comparison focuses solely on health outcomes, completely omitting the effects and influences of the health system. This omission is problematic, since as several health care provision models suggest, health care outcome inequities may be connected to or even originate from the health system's context and approach; but this topic has been explored by very few studies. With increasing globalization, nurses comprising the largest health professional labor force in the world must employ the most rigorous study design frameworks when conducting cross-country comparisons of health outcomes. Thus, the goal of this research project is to examine study design frameworks used to make cross-country comparisons of health care outcomes taking into account the health care system context. </span><strong> </strong></p> <p><strong>Methods: </strong>To address this goal, this study examined study design frameworks using a scoping review methodology with the following steps: the identification of the domains of the health care system that must be explored; search and selection of relevant studies; charting the studies’ findings; and summarization of the results.<strong></strong></p> <p><strong>Results: </strong>Study design frameworks for cross-country comparisons of health care outcomes within the health system context varied by: (1) use of country selection criteria as a basis for country selection, (2) use of a guiding theory to govern the elements for comparison, (3) the decision of the data type (i.e., quantitative, qualitative, mixed-methods), (4) ascertainment and validation of measurements, (5) synthesis of findings employed a wide versus narrow focus, (6) inclusion of countries' cultures and population composition, and (7) contribution to other countries' health systems. <strong></strong></p> <p><strong>Conclusion: </strong>A grid denoting a variety of cross-country study design frameworks depicts a variety of strengths and weaknesses. Countries' health care systems are culturally-linked, but criteria exploring or explicating cultural influences within the health system context were sparse or absent. Moreover, cross-country comparison frameworks were inconsistent in their abilities to delineate and define approaches that resulted in inequitable health service outcomes for different population groups. Design frameworks failing to include the cultural context limit our ability to fully examine differences in health care outcomes. Nurses and other health professionals must choose a study design framework that is systematic, comprehensive and sufficiently robust to meet the challenge of conducting cross-country comparisons so that study results are able to assist countries' policymakers and administrators to make improvements that promote better and more equitable health outcomes for their population.</p>en
dc.subjectCross-Country Comparisonsen
dc.subjectHealth Outcomesen
dc.subjectResearch Designsen
dc.date.available2017-07-03T15:10:06Z-
dc.date.issued2017-07-03-
dc.date.accessioned2017-07-03T15:10:06Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
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