It adds to the existing literature by characterising problems encountered at transition points in care and contextualises these findings in the resources allocated to these high cost, low volume services.
Since these services (i.e. Email and M2M-SV) are low-volume services, even the total violation of their capacity cannot cover the shortage of network capacity; therefore, interactive services, the ones with the second lowest violation weights, have also to be subject of capacity violations.
This relatively low volume of service demand is a dilemma faced by health facilities serving smaller, remote and more dispersed low income populations as reported in a multi-country study where the majority of PHC facilities were found to be under-utilized and under-resourced especially in terms of staffing [ 22].
Such cut offs are recommended for use in measures of physician performance to improve the reliability of estimated performance while ensuring that potential poor-performers who provide a low volume of service are not excluded from evaluations [ 22, 24].
They pursued social rather than traditional marketing, partnerships with government, low cost/high volume services and cross-subsidization between different market segments.
Bhattacharaya et al [ 9] found many similar practices to those in our study, including social rather than traditional marketing, partnerships with government, low cost/high volume services and cross-subsidization.
The hospital also is the location for three of altogether 41 nationally centralised low volume, highly specialised services, namely advanced prenatal invasive treatment, neonatal surgery and photophoresis, These services account for less than 100 admissions per year.
Differences in patient characteristics between low and high volume hospitals in our analysis suggest the suspension of services at low volume hospitals may disproportionately affect minorities and patients with Medicaid insurance, groups with historically limited access to cardiovascular care.
The study results indicate that geosynthetics can be used to enhance the pavement service life for low volume roads with optimized cost and minimum environmental impacts.
