Shedding Light on the Main Characteristics and Perspectives of Romanian Medicinal Oxygen Market

Medicinal oxygen plays an important role in healthcare, being essential for the existence and maintenance of the health of millions of people, who depend on medicinal oxygen every day, both in hospitals and at home. Medicinal oxygen is the primary treatment administrated to the majority of patients suffering from respiratory problems and low levels of oxygen in the blood, and in the context of the actual health crisis caused by the new COVID-19, the challenge is represented by increasing the supply of medicinal oxygen while reducing cost so that it is accessible where it is needed most, free at the point of use. It will take increased investment and commitment to put oxygen at the center of strategies for universal health coverage. In this context, it becomes essential to investigate the main characteristics of the Romanian market of medicinal oxygen, highlighting top key players, market development, key driving factors, types of products, market perspectives as well as shedding light on the segmentation of this particular market based on considerations regarding regions, hospital competence class and hospital specialization. Also, the research aims to explore the regional disparities in the decision of using O93%medicinal oxygen, revealing the main factors related to the usage of this type of product among Romanian public hospitals. The research relies on the first quantitative survey regarding medicinal oxygen usage among 121 public hospital units from a total of 461 public hospitals in 2018, which meet the specific requirements: includes the entire population according to the list published on the website of the Ministry of Health, is the most recent data and does not show repetition. The sampling was of probabilistic stage-type stratification, with the following sampling layers: hospital county distribution, hospital competence class officially assigned by the Ministry of Health and also area of residence (urban/rural). In order to analyze the main characteristics of the Romanian oxygen market, the following methods have been used: analysis of variance (ANOVA) together with Kruskal–Wallis, Pearson correlation coefficient as well as Goodman and Kruskal gamma, Kendall’s tau-b and Cramer’s V, as well as multilevel logistic regression analysis using hierarchical data (hospitals grouped in regions). The Romanian market of medicinal oxygen is rather an oligopoly market characterized by the existence of a small number of producers and two types of products currently used for the same medical purpose and having a substitutable character: medicinal oxygen O99.5%, and medicinal oxygen O93%. An overwhelming proportion of public hospitals agree that both types of medicinal oxygen serve the same therapeutic purpose. The Romanian market of medicinal oxygen highlighted a significant segmentation on considerations based on regions, hospital competence class and hospital specialization. Regarding the main perspectives, the Romanian market of medical oxygen keeps the growth trend registered globally, with development perspectives for competitors. Exploring the regional disparities in the decision of using O93 medicinal oxygen, the empirical results acknowledged the important role of unitary price, hospital capacity and the relevance of this product seen as a medicine. Medicinal oxygen is vital in sustaining life, proving its utility mainly in the context of the actual health crisis. In this context, the Romanian local market exhibits prospects for further development, being characterized by an important segmentation depending on regions, hospital competence class and hospital specialization.

Resource Partitioning and Hospital Specialization

Background: Organizational scholars have been debating over specialism and generalism, and which environment is better for specialists and for generalists. Methods: This study relies heavily on the work of Okasha (Okasha, 1995, Modeling the determinants of hospital services differentiation and specialization (Dissertation). Virginia Commonwealth University, Richmond) and enhances it with available current literature on the topic. Okasha’s ( Modeling the determinants of hospital services differentiation and specialization (Dissertation). Virginia Commonwealth University, Richmond) study tested the use of resource partitioning theory to explain the conversion of generalists to specialists under competitive environments. Results: The anticipated effect of buyers of care on hospital specialization was evident. Recent work on specialization (Eastaugh, 2014, Journal of Healthcare Finance) confirmed the trend. Conclusion: Buyer-related factors and organizational factors were the most important predictors of the positive change in hospital specialization between 1987 and 1993. High competition, the increased pressure from buyers of care, and organizational factors were the most important predictors of the positive change in the hospital specialization measures during that time period.

The Impact of Hospital Specialization on Congestion and Efficiency

The purpose of this study is to verify the existence of congestion in Korean hospitals, to identify the causes of congestion, and to suggest directions for efficiency improvement of hospitals. The result showed that congestion occurred in 71.90% of 1185 hospitals. In addition, it was found that hospital specialization has a negative effect on congestion. In other words, the higher the hospital specialization, the lower the overall congestion rate of the hospital. More specifically, the specialization of hospitals also showed a negative effect on congestion of nurses. On the other hand, hospital specialization was found to have a positive effect on the congestion of the number of doctors, but it does not have a significant effect on the congestion of hospital beds. It was also found that hospital size has an effect on the relationship between hospital specialization and congestion, but the location of the hospital and the type of ownership did not act as a moderator.

An Organizational Guideline for Gynecologic Oncology Services

ObjectivesDocumented variations in practice compelled the need to establish a network that would facilitate the flow of patients through the care continuum of a provincial health care system in accordance with best practices. Therefore, a guideline was developed to provide recommendations for the optimal organization of gynecologic oncology services in this higher resource location to improve access to multidisciplinary care and appropriate treatment.MethodsA systematic review was conducted of Web sites of international guideline developers, relevant cancer agencies, and Medline and EMBASE from 1996 to 2011 using search terms related to gynecologic malignancies, combined with organization of services, patterns of care, and various facility and physician characteristics. The results of the review were combined with expert consensus and stakeholder consultation to develop a gynecologic oncology services organizational guideline.ResultsThe evidence review yielded a lower quality evidence base; therefore, recommendations were determined through consensus, including guidance for physician and hospital specialization, and other domains including human and physical resources. Definitive surgical treatment of most invasive cancers by subspecialist gynecologic oncologists is recommended. In addition, it is recommended that these subspecialists provide care within designated gynecologic oncology centers. The recommendations also outline which services, such as radiation therapy, may be provided in other affiliated centers. Multidisciplinary team management is also endorsed.ConclusionsThese recommendations are intended to allow a collaborative community of practice, supported by formal interorganizational processes, to evolve to facilitate adherence to guidelines and best practices at a system-wide level.