Linking health system inputs, processes and outputs to identify medical deserts in Serbia

Abstract Background Medical deserts (regions where the population does not have adequate access to health care) indicate the failure of the health system to achieve the goals of improving the health of the population. Identifying medical deserts (MD) is far from simple. The aim of this study is to describe the approach to identification of medical deserts in Serbia using indicators for the health system inputs, processes and outputs. Methods We investigated the basic healthcare-related medical deserts using the indicators of primary health care centers’ inputs (accessibility: annual number of patients per physician), processes (performance: annual workload of patient visits per physician) and outputs (unmet needs: percentage of patients unable to access health services) in all 25 Serbian districts in 2020, using data of the Health Statistical Yearbook of the Republic of Serbia and the National Patient Satisfaction Survey of the Institute of Public Health. We developed a Multiple Criteria Scoring System (MCSS) incorporating the weighting and scoring of accessibility and performance for four types of physicians (general practitioners, pre-school pediatricians, youth pediatricians, and gynecologists) and five dimensions of unmet needs (financial reasons, waiting times, lack of personal time, long-distance and COVID-19). MCSS final scores 0 (none) - 100% (MDs on all indicators) are assessed using the regulatory norms. Results MDs partially overlap by different criteria: accessibility, 4-10 districts; performance, three districts; unmet needs: 2-5 districts. Top five medical deserts identified according to the MCSS are Mačvanski, Šumadijski, Moravički, Srednjebanatski, and Podunavski district. Conclusions Serbia has at least one MD per administrative region according to the objective normative indicators and patients’ subjective experiences. The study findings can be used to inform district stakeholders on how to use health workforce policy and planning to address medical deserts. Key messages • MCSS indicates potential medical deserts in 20% of all districts in the Republic of Serbia. • Evidence on poor health workforce accessibility and performance in light of the patient unmet healthcare needs could be used to inform stakeholders on medical deserts in the country.


Background:
During the COVID-19 pandemic surges, healthcare stakeholders were concerned with the sufficiency of available health workforce capacity. In this study we examined the changes in the supply and demand of physicians, nurses and care workers in Serbia over the period 2011-2021.

Methods:
The National Employment Service (NES) data on total number of unemployed physicians, nurses and care workers, and vacancy data in health sector were described using the annualized % change for the period 2011-2021. The longterm duration of unemployed female physicians and nurses was further analyzed.

Results:
In 2021, NES has registered total of 13,332 unemployed physicians, nurses and care workers, out of which the majority were females (79%), and nurses and care workers (88%). 2021 data on vacancies showed that only 16% of unemployed workers were needed. The peak of health workers unemployment was in 2016, highlighting the period of unemployment rise (2011)(2012)(2013)(2014)(2015)(2016) at an annualized rate of 3.7% for medical doctors' specialists, 6.4% for medical doctors without specialization, and 3.2% for nurses and care workers, and the period of unemployment decline (2017)(2018)(2019)(2020)(2021) at an annualized rate of -7.9% for medical doctors' specialists, -10.9% for medical doctors without specialization, and -5.9% for nurses and care workers. The annualized rate of decline was the lowest for female nurses and care workers. On average 53% of all long term unemployed medical doctors, nurses and care workers were women. In comparison to 2019, during the COVID-19 epidemic in 2020 and 2021 the number of vacancies for specialists and nurses and care workers has increased by one-third.

Conclusions:
The study indicated a continuous mismatch between the supply and demand of physicians and nurses in Serbia (a surplus of some categories of nurse-specialists versus a shortage of some doctor specialists). The Serbian stakeholders need to urgently intervene regarding the long-term unemployment of female health workers. Key messages: NES data imply a low capacity of the Serbian health sector to absorb the huge numbers of (long-term) unemployed health workers.
It is necessary to thoroughly examine and counteract the causes of the dramatic number of unemployed health workers on the NES records in Serbia.
system to achieve the goals of improving the health of the population. Identifying medical deserts (MD) is far from simple. The aim of this study is to describe the approach to identification of medical deserts in Serbia using indicators for the health system inputs, processes and outputs.

Methods:
We investigated the basic healthcare-related medical deserts using the indicators of primary health care centers' inputs (accessibility: annual number of patients per physician), processes (performance: annual workload of patient visits per physician) and outputs (

Conclusions:
The systematic application of the break-even analysis will allow defining over time the right distribution of robotic, laparoscopic and laparotomy surgeries' volumes to perform in order to ensure both quality and economic-financial balance and therefore value of uterine oncological surgery in the University Hospital. Key messages: The value-based healthcare approach, defined as the measured improvement in a patient's health outcomes in relation to its cost, finds effective application in uterine cancer surgery. The use of the break-even approach allows to promote the value-based view by identifying a useful criterion for the planning and governance of interventions for uterine malignancies.

Background:
The delivery of high quality health and social care services is a fundamental goal for health systems worldwide. Quality is variable in services and settings. One response to variation in quality is a regulatory framework that looks to set minimum standards that are enforced by an independent public authority. This systematic review seeks to identify and describe determinants of regulatory compliance in health and social care services.

Methods:
Systematic searches were carried out on five electronic databases and grey literature sources. Titles and abstracts were screened by two reviewers independently. Determinants evaluated in studies were identified, extracted and allocated to constructs in the Consolidated Framework for Implementation Research (CFIR). The included studies were quality appraised by two reviewers independently. The results were synthesised narratively under each CFIR domain.

Results:
The search yielded 6,515 articles for screening, of which 148 were included. Most studies were quantitative designs focused on specific exposures (e.g. staffing levels, size, for-profit status). Qualitative studies were sparse, limiting investigation of the processes underlying regulatory compliance. Most of the determinants identified fit within the inner and outer setting domains of the CFIR, many with mixed findings in terms of an association with compliance. There were fewer determinants identified in the intervention characteristics, characteristics of individuals, and process domains of the CFIR.

Conclusions:
The literature in this field focuses on the broader concept of quality and appears to neglect the more nuanced issues 15th European Public Health Conference 2022