Servetkienė, Vaida

Straipsnyje analizuojami dviejų reprezentatyvių Lietuvos visuomenės nuomonės apie sveikatos priežiūros paslaugų (SPP) kokybę ir prieinamumą tyrimų rezultatai ir jų pokytis per 10 metų. Atskleidžiama, kaip buvo įgyvendinama SPP kokybės politika ir kuriama vertė pacientui, taip pat aiškinamasi, kaip ji veikia SPP kokybę.

The success of health policy and the healthcare sector is increasingly measured in terms of the dynamics and changes in public trust in the healthcare system, the quality of services provided by healthcare facilities matching people’s expectations, and the fulfilment of patient needs. In order to ensure the required efficiency of public services and to provide better-quality and more accessible healthcare services that match the expectations of the population, it is necessary that the recipients of these services (patients) themselves are actively engaged in improvement processes. Therefore, increasing importance and value is placed on the engagement of the patient in the process of improving healthcare services as an active and informed participant of the healthcare system.

Patient-centered care is considered to be one of the essential pillars of a modern healthcare system. Thus, quality assessment based on patients’ perceptions, views and experiences in their journey through the healthcare system is recognized as one of the key principles for quality improvement initiatives. Measuring patient satisfaction can be confounded by expectations and prior experiences, which can be at least partly overcome by evaluating patient-perceived healthcare quality (PPHQ). Understanding the principal constituents of PPHQ may aid healthcare professionals and decision makers in the healthcare management process and help in creating instruments to meaningfully measure patient feedback. Herein, we aimed to analyze the primary determinants of PPHQ and their interactions, with a focus on patient experiences and healthcare accessibility, using the example of Lithuanian primary healthcare. For this purpose, we conducted a cross-sectional representative telephone survey that included a total of 1033 respondents (48% male) who had encountered primary healthcare during last 3 years. Survey questions consisted of sociodemographic characteristics, patient perceptions of healthcare service provision, patient experiences, self-reported health status and overall PPHQ ranked with a 5-point Likert scale as the primary outcome. The classification-regression tree (CRT) technique was used to analyze the relationship between different explanatory variables and PPHQ, as well as their relative importance and interactions. The majority of respondents (89%) evaluated PPHQ as acceptable or good. CRT analysis identified staff behavior, organizational accessibility and financial accessibility as the most important factors affecting PPHQ. Importantly, the latter factors surpassed the effect of other known PPHQ determinants, such as sociodemographic characteristics or health status. Further analysis has revealed that the relative importance of staff behavior, including understanding, attention and empathy, increased when more problems with organizational accessibility were encountered. In conclusion, our study suggests that PPHQ in primary healthcare may primarily be determined by organizational and financial accessibility and staff behavior, which may also act as an important mediating factor.

Straipsnyje aptariami reprezentatyvaus Lietuvos visuomenės nuomonės tyrimo apie sveikatos priežiūros paslaugų (SPP) kokybę ir atitiktį pacientų lūkesčiams rezultatai. Tyrimo tikslas – įvertinti, kaip pacientų požiūriu tiriamu laiko- tarpiu veikė SPP teikimo sistema, ir nustatyti SPP atitiktį pacientų lūkesčiams tam tikruose sveikatos sistemos lygiuose. Tyrimo metodai. Apklausa vykdyta 2021 m., joje dalyvavo 1 033 respondentai. Tyrimo imties pasiskirstymo repre- zentatyvumas pagal lytį, amžių ir gyvenamąją vietą ne mažesnis nei 95 proc., lyginant su Lietuvos statistikos departamen- to 2020 m. duomenimis. Tyrimui atlikti buvo parengta apklausos anketa, ją sudarė bendrieji (socialiniai, demografiniai) klausimai bei klausimų grupės, kuriomis buvo vertinama pacientų patirtis kreipiantis į sveikatos priežiūros įstaigas, ati- tiktis jų lūkesčiams tam tikruose sveikatos sistemos lygiuose, pasitelkiant paciento kelionės etapų diskretizaciją, SPP prieinamumas ir kokybė, taip pat identifikuojami sunkumai, su kuriais pacientai dažniausiai susiduria, jų elgsena pajutus negalavimus, gydytojų ir pacientų bendravimas. Tyrimo dalyviai apibendrintai įvertino, kaip teikiamos pirminio, antrinio ir tretinio lygio SPP. Tyrimo rezultatai ir išvados. Tyrimo metu nustatyta, kad didžiosios dalies pacientų patirtis, susijusi su sveikatos priežiūros sistemos veikimu, atitinka jų lūkesčius. Pagal paciento kelionės stoteles analizuojant, kaip teikiamos SPP, mažiausiai atitinkančiomis lūkesčius laikytinos šios paslaugos: registracija ir patekimas pas gydytojus, slaugytojų ir gy- dytojų specialistų (antrinio lygio) paslaugos. Stebimi didesni pacientų lūkesčiai ir empatijos bei jų įtraukimo į sprendimų priėmimo procesą poreikiai vizitų pas gydytojus metu. Pirminio, antrinio ir tretinio lygio SPP kokybės vertinimų vidurkis varijuoja nuo 3,4 iki 3,6 balo (iš maksimalių 5). Galima teigti, kad Lietuvoje SPP sistema pacientų požiūriu vertinama kaip funkcionuojanti nepakankamai kokybiškai ir yra taisytina.

Improving health care quality is a continuous goal that requires constant attention and innovative solutions. One of the sources from which we can learn about what quality changes are needed is patient experience. "Collaboration" is one way to develop instruments and use them to gather knowledge about patient needs related to the patient journey and measures to improve the quality of services, such as service collaboration. The direction, in terms of the identification of patient needs and relatively urgent changes to the system, depends on the organizational culture determined by leadership. Different approaches towards leadership initiate different outcomes and consequences. Collaborative health care leadership comes with the decision to strengthen collaboration between health professionals and patients, thus addressing service quality gaps. Therefore, it becomes important to understand patients’ expectations in terms of such cooperation. The study aim is to investigate whether patient satisfaction barriers can be linked to shortages in collective leadership. All three dimensions of collaborative leadership (horizontal collaboration, interorganizational (vertical) collaboration, and collaboration with patients) demonstrate the link between leadership and accepted health care quality.

Improving health care quality is a continuous goal that requires constant attention and innovative solutions. One of the sources from which we can learn about what quality changes are needed is patient experience. "Collaboration" is one way to develop instruments and use them to gather knowledge about patient needs related to the patient journey and measures to improve the quality of services, such as service collaboration. The direction, in terms of the identification of patient needs and relatively urgent changes to the system, depends on the organizational culture determined by leadership. Different approaches towards leadership initiate different outcomes and consequences. Collaborative health care leadership comes with the decision to strengthen collaboration between health professionals and patients, thus addressing service quality gaps. Therefore, it becomes important to understand patients’ expectations in terms of such cooperation. The study aim is to investigate whether patient satisfaction barriers can be linked to shortages in collective leadership. All three dimensions of collaborative leadership (horizontal collaboration, interorganizational (vertical) collaboration, and collaboration with patients) demonstrate the link between leadership and accepted health care quality.

Moterų ir vyų darbo užmokesčio bei pajamų atotrūkio tema yra nagrinėta daugelio autorių pasaulyje ir Lietuvoje. Tačiau monografijoje išryškintos Lietuvoje gana nelauktos tendencijos ir pokyčiai bei pateikti nauji tyrimų rezultatai lyčių lygybės srityje. Remiantis autorių atlikto tyrimo išvadomis, žvelgiant iš rinkos ekonomikos 30 metų laikotarpio retrospektyvos, Lietuvoje lyčių lygybės srityje pasiekti įspūdingi rezultatai. Svarbiausi pasiekimai lyčių lygybės srityje – per 30 metų pasikeitė lyčių lygybės stereotipai, pastebima sparti moterų dalyvavimo darbo rinkoje pažanga, pasikeitė darbdavių požiūris į moterį – darbuotoją: darbdaviai aukštai vertina moterų darbo potencialą, jų išsilavinimą ir profesines savybes. Tačiau, nepaisant pasiektos pažangos, atlikto tyrimo rezultatai leidžia iškelti Lietuvoje naują akcentą ir iššūkį lyčių lygybės srityje – didelę moterų diskriminaciją pagal amžių, ypač priešpensinio ir pensinio amžiaus moterų. Ši problematika nors ir buvo nagrinėjama Lietuvoje, tačiau dažnai suvokiama kaip savaime suprantama, kad pajamos, sulaukus pensinio amžiaus, ir turi mažėti. Autorių pozicija yra kita – vyresnio amžiaus žmonių profesinis potencialas yra didžiulis neišnaudotas šalies ekonomikos resursas ir tikslinga jį efektyviai panaudoti šalies darbo rinkoje. Sparčiai didėjant visuomenės senėjimo ir emigracijos iš Lietuvos rodikliams, turėtų didėti vyresnio amžiaus žmonių paklausa darbo rinkoje. Sukaupta vyresnio amžiaus žmonių darbo patirtis, žinios, profesinis potencialas turėtų būti panaudoti Lietuvos ekonomikoje, ypač sparčiai mažėjant darbo jėgai dėl didelio masto emigracijos iš šalies. Autorių atlikti darbuotojų ir darbdavių sociologiniai tyrimai leido atskleisti gilumines lyčių, ypač vyresnio amžiaus žmonių pajamų skirtumų priežastis. Kaip vieną iš svarbių monografijos privalumų galima pažymėti ir tai, kad darbas turi ne tik teorinę, bet ir praktinę reikšmę darbuotojams ir darbdaviams vertinant moterų ir vyrų darbo užmokesčio skirtumus. Pasiūlytas LOGIB metodas leidžia palyginti, greitai ir paprastai įvertinti moterų ir vyrų padėtį darbo užmokesčio srityje visoje Lietuvoje ir bet kurioje verslo įmonėje ar įstaigoje. Tai – naujas žingsnis lyčių ekonomikos mokslinių tyrimų srityje. Darbas yra inovacinis, turi mokslinę ir praktinę vertę, jis būtų naudingas mokslo bendruomenės atstovams, politikams, ekonomistams, verslininkams, darbdaviams, darbuotojams, studentams, nevyriausybinių organizacijų atstovams, besidomintiems lyčių lygybės klausimais.

The high level of income and wealth distribution in the world is recognized as a phenomenon that leads to negative economic and social consequences. The imperfection of redistribution levers in the economy has created conditions for the concentration of resources, material goods and wealth in small population groups. Today, the economic system is not focused on majority of the population, and therefore the high level of inequality and its consequences for economic growth, well-being and human development cannot be ignored. In this context, too high economic inequality in Lithuania is one of the most sensitive problems of the country; Lithuania is an anti-leader in the European Union according to economic inequality. Conventionally, economic inequality is measured using such methods as distribution of income and consumption of the population, however, to find out the real level of inequality, wealth diversity should be studied as well. The main purpose of this article is to identify and emphasise wealth diversity as an inseparable part of economic inequality in Lithuania and, as a result, the poor quality of life and obstacles in the way of economic progress as well as to compare wealth inequality with income inequality in Lithuania. The authors organised a representative poll of Lithuanian citizens and used a certain survey to collect information about the dwelling-places or other types of assets owned by the respondents as well as to evaluate wealth diversity in the country. The results show that the edge value of the assets owned by the representatives between I and X deciles differs by 16.9 times. However, comparing the average prices of dwelling-places in deciles I and X, the difference amounts to 7.2 times. Assessing all types of assets, including accommodation, land, durable goods, etc., it has been revealed that the distribution of wealth exceeds the limit of income and consumption distribution established by various statistical organisations and by the authors themselves. The decile ratio (in relation to deciles I and X) equals to 40.8, thus, it considerably exceeds the level of income and consumption inequality.

In Lithuania, socio-economic inequality (hereinafter: 'SEI') has recently overstepped the threshold of economic security and has become an impediment to economic development and the source of social tension. As the global research shows, firstly, excessive inequality impedes economic growth; secondly, distribution of the products created in defiance of social justice also has a negative impact on the population's quality of life. The object of the present research is interdisciplinary, it encompasses economics and psychology and is examined at the macro(state) and micro-(individual) levels. The methodology of the assessment of SEI adapted to Lithuania is developed, the factors determining SEI in Lithuania are explored at the macro-and micro-levels, social and economic inequality (income, consumption, material standard of living) of various groups of Lithuanian society and its consequences for the country's economic and social development and the population's quality of life are analyzed. The research pursues the aim of examining SEI in Lithuania as the essential factor of the quality of life of the population, basing the factors determining SEI and consequences for the population's quality of life by means of scientific research and providing possible methods and tools for the reduction of SEI.