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PubMed2001

Service quality in public and private pharmacies in the city of Kragujevac, fr Yugoslavia.

AIM: To compare the service quality in public and private pharmacies in the city of Kragujevac by measuring patient care and health facility indicators. METHODS: The patient care indicators and health facility indicators, established by the World Health Organization in 1995, were measured prospectively in 7 public and 7 private pharmacies in Kragujevac, Yugoslavia, during November and December 1999. A sample of 100 patient-visits was analyzed in each pharmacy. RESULTS: Our study showed that the average drug dispensing time ranged from 20.5 to 48.2 seconds, being significantly longer in private (21.1-48.2 s) than in public pharmacies (20.5-33.7 s) (F=13.12, p<0.001). The percentage of actually dispensed drugs ranged from 29% to 63%, and no significant difference was found between public and private pharmacies. Patients' knowledge of a correct dosage ranged from 30% to 74% and the availability of key drugs ranged from 67% to 93% with no significant difference between public and private pharmacies. There was serious negligence in labeling the dispensed drugs in both public and private pharmacies: not a single drug package was labeled according to the World Health Organization recommendations. Key drugs were highly available in both public and private pharmacies. CONCLUSION: The average drug dispensing time was too short for a proper interaction between a pharmacist and a patient in both public and private pharmacies. The results of our study suggest that there was no real difference in the service quality between the public and the private pharmacies.

Croatia↗
PubMed1989

Nursery privileges of the private attending pediatrician in the care of critically sick neonates in New York state.

To determine the role of the private attending pediatrician in caring for newborns who require intensive, intermediate, or continuing care in New York state, a request was sent to New York state institutions to select the statement best describing private attending pediatrician privileges. Privileges were graded from 1 to 6 with category 1 allowing the private attending pediatrician to care for all newborns and category 6 not allowing the private attending pediatrician to care for any newborns. Nurseries were classified (per New York State Department of Health) as regional, nonregional intensive care, intermediate care, and continuing care centers. A total of 97% (88/90) of institutions responded, representing 2,040 private attending pediatricians. In 95% (79/83) of the New York state institutions with staff private attending pediatricians, the pediatricians' privileges were limited. In 18% (15/83), the private attending pediatrician does not supervise any newborns receiving special care, whereas in an additional 77%, pediatricians' privileges have been limited. Despite this, the majority of institutions encourage the private attending pediatrician to continue communication with the family. Limited hospital privileges coupled with continued family communication may be the future trend for private attending pediatricians in the hospital setting.

Communication↗
PubMed2006

Private or public? An empirical analysis of the importance of work values for work sector choice among Norwegian medical specialists.

In the aftermath of the Norwegian hospital reform of 2002, the private supply of specialized healthcare has increased substantially. This article analyses the likelihood of medical specialists working in the private sector. Sector choice is operationalized in two ways: first, as the likelihood of medical specialists working in the private sector at all (at least 1% of the total work hours), and second, as the likelihood of working full-time (90-100%) privately. The theoretical framework is embedded in work values theory and the results suggest that work values are important predictors of sector choice. All analyses are based on a postal questionnaire survey of medical specialists working in private contract practices and for-profit hospitals and a control group of specialists selected from the Norwegian Medical Association's member register. The analyses revealed that while autonomy values impact positively on the propensity for allocating any time at all to the private sector, professional values have a negative effect. Given that the medical specialist already works in the private sector, a high valuation of professional values and payment and benefit values increases the likelihood of having a dual sector job rather than a full-time private position. However, due to the cross-sectional structure of the data and limitations in the dataset, causality questions cannot be fully settled on the basis of the analyses. The relationship between work values and sector choice should, therefore, be regarded as associations rather than causality links. Finally, the likelihood of working in the private sector varies significantly at the municipality level, suggesting that medical specialist's location is important for sector choice.

Adult↗
PubMed2006

Are private school students more likely to smoke than public school students in China?

BACKGROUND: Tobacco use is prevalent among adolescents in China in general, however, little is known about tobacco use among students in private schools with an enrollment of 1.5 million. METHOD: In 2001, cross-sectional survey data from 2725 students in grades seven and eight (1307 sampled from private schools and 1418 sampled from public schools) were included. Smoking measures (risk of susceptibility to smoking, smoking onset, ever smoking, smoking in the past 7 days and past 30 days, established smoking) were compared between private and public school students using chi-square test, logistic regression, and survival analysis. RESULTS: Cigarette smoking was more prevalent among private school students than among public school students (private vs. public: 21.9% vs. 12.3% for susceptibility to smoking, 53.9% vs. 38.2% for ever smoking, 22% vs. 12.0% for 30-day smoking, 15.9% vs. 4.0% for 7-day smoking, 4.5% vs. 1.2% for established smoking). Students in private schools are 3.4 to 3.8 times more likely to smoke than students in public schools after the adjustment of important covariates (gender, grade, peer smoking, parental smoking, and parents' occupation). Risk of smoking onset by age was also greater for private school students than for public school students. CONCLUSIONS: Being in private schools was associated with three to four times increases in the likelihood of current cigarette smoking and heightened risk of smoking onset by age. Findings from this study suggest the urgent need to collect additional data on risk and protective factors as well as the willingness to participate in effective tobacco use intervention prevention among private school students.

Adolescent↗
PubMed1996

Private attending physician status and the withdrawal of life-sustaining interventions in a medical intensive care unit population.

OBJECTIVE: To assess the influence of private attending physician status on the withdrawal of life-sustaining interventions among patients dying within a medical intensive care unit (ICU). DESIGN: Retrospective cohort analysis. SETTING: An academic tertiary care center. PATIENTS: One hundred fifty-nine consecutive patient deaths occurring in the medical ICU during a 12-month period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Withdrawal of life-sustaining interventions (i.e., mechanical ventilation, dialysis, and/or vasopressors), duration of mechanical ventilation, length of intensive care unit stay, medical care costs, and patient charges were recorded. Life sustaining interventions were actively withdrawn from 69 (43.4%) patients prior to death. Patients without a private attending physician were significantly more likely to undergo the withdrawal of life-sustaining interventions compared with patients having a private attending physician (odds ratio = 2.5; 95% confidence interval = 1.8, 3.6, respectively; p = .005). A correlation was found between the possession of private health insurance and private attending physician status (r2 = .39, p < .001). Multiple logistic regression analysis was subsequently used to control for demographic factors and severity of illness. Three independent predictors for the withdrawal of life-sustaining interventions were identified in this patient cohort (p < .05) having a planned therapeutic trial of life-sustaining interventions outlined in the medical record (adjusted odds ratio 9.4; 95% confidence interval = 5.6 to 15.6; p < .001); lack of a private attending physician (adjusted odds ratio = 4.4; 95% confidence interval = 2.9 to 6.5; p < .001); and the presence of clearly defined advance directives regarding patient preferences for medical care (adjusted odds ratio = 3.6; 95% confidence interval = 2.3 to 5.7; p. = .005). Patients with private attending physicians had significantly greater medical care costs and medical care charges compared with patients without a private attending physician. CONCLUSION: Among patients dying within a medical ICU, those patients without a private attending physician are more likely to undergo the active withdrawal of life-sustaining interventions.

APACHE↗
PubMed1996

U.S. hospital care for HIV-infected persons and the role of public, private, and Veterans Administration hospitals.

Hospitals are a major provider of medical care for human immunodeficiency virus (HIV)-infected persons. Although utilization and patterns of care profiles in public and private hospitals have been evaluated for acquired immunodeficiency syndrome (AIDS)-related Pneumocystis carinii pneumonia (PCP), one of the most costly and common severe complications of AIDS, information from Veterans Administration (VA) hospitals has not been reported previously. This article reports on inpatient care for PCP patients by obtaining data from VA, private, and public hospitals. Cost and resource utilization data were obtained from reviews of medical records, claims, and provider bills from 26 non-VA hospitals and 18 VA hospitals in 10 cities in the United States. Data on severity of illness, patterns of care, and outcomes for PCP were obtained from medical record reviews from 2,174 PCP cases treated in 82 non-VA and 14 VA hospitals in five U.S. cities. Estimates were made of the average costs and the rates of use of diagnostic tests, anti-PCP medications, and intensive care units for samples of public hospital, private hospital, and VA patients with PCP. With mean charges for a single PCP episode of $14,500 to $16,060, PCP remains one of thea most costly complications of AIDS. Although the severity of PCP illness at admission was greatest at public hospitals, the intensity of care was lowest: for frequency of cytologic diagnosis (48% at public, 62% at VA, and 66% at private hospitals), bronchoscopy (45% at public, 60% at VA, and 66% at private hospitals), and intensive care unit use (11% at public, 22% at VA, and 19% at private hospitals). In-hospital mortality rates for PCP also differed in the three types of hospitals (20% at public, 24% at VA, and 18% at private hospitals). Patterns of PCP care differ among VA, public, and private hospitals. Future studies on the HIV epidemic should include data collected from uniform data sources from VA hospitals, in addition to public and private hospitals, to provide insight on the processes of care and outcomes for HIV-infected persons.

AIDS-Related Opportunistic Infections↗
PubMed2005

Colorectal cancer surgical care and survival: do private health insurance, socioeconomic and locational status make a difference?

BACKGROUND: The purpose of the present paper was to examine patterns of surgical care and the likelihood of death within 5 years after a diagnosis of colorectal cancer, including the effects of demographic, locational and socioeconomic disadvantage and the possession of private health insurance. METHODS: The Western Australian Data Linkage System was used to extract all hospital morbidity, cancer and death records for people with a diagnosis of colorectal cancer from 1982 to 2001. Demographic, hospital and private health insurance information was available for all years and measures of socioeconomic and locational disadvantage from 1991. A logistic regression model estimated the probability of receiving colorectal surgery. A Cox regression model estimated the likelihood of death from any cause within 5 years of diagnosis. RESULTS: People were more likely to undergo colorectal surgery if they were younger, had less comorbidity and were married/defacto or divorced. People with a first admission to a private hospital (odds ratio (OR) 1.31, 95% confidence interval (CI): 1.16-1.48) or with private health insurance (OR 1.27, 95% CI: 1.14-1.42) were more likely to undergo surgery. Living in a rural or remote area made little difference, but a first admission to a rural hospital reduced the likelihood of surgery (OR 0.76, 95% CI: 0.66-0.87). Residency in lower socioeconomic areas also made no difference to the likelihood of having surgical treatment. The likelihood of death from any cause was lower in those who were younger, had less comorbidity, were elective admissions and underwent surgery. Residency in lower socioeconomic status and rural areas, admission to a rural hospital or a private hospital and possession of private health insurance had no effect on the likelihood of death. CONCLUSIONS: The present study demonstrates that socioeconomic and locational status and access to private health care had no significant effects on surgical patterns of care in people with colorectal cancer. However, despite the higher rates of surgery in the private hospitals and among those with private health insurance, their survival was no better.

Age Factors↗
PubMed1986

Private nursing homes: contribution to long stay care of the elderly in the Brighton Health District.

Two surveys of private nursing homes, designated geriatric wards, and a sample of social service part III homes were carried out in the Brighton Health District using questionnaires supplemented (in the second survey) by some interviews. The dependency of old people in the private nursing homes was more like that of long stay hospital patients rather than that of residents in social services homes. In the private nursing homes, however, a smaller proportion of patients were in the medium to heavy nursing category (178 (31%) compared with 158 (63%) in the hospital long stay wards) and a larger proportion in the heavy nursing category (170 (30%) compared with 44 (17%) in the long stay wards). Of the patients in private nursing homes, 401 (82%) were local residents, 488 (86%) were long stay, and 459 (88%) were women; their mean age was 88 years. Two thirds of the patients were over 80. There were no significant differences between the private nursing homes and the wards in nursing workloads or staffing, except for a slightly higher provision of state registered nurses in the private sector. In the private nursing homes 348 (63%) of the patients had fees paid by private funds, 26 (5%) were in contract beds paid for by the National Health Service, and 176 (32%) were subsidized by the Department of Health and Social Security. Private nursing homes make a substantial contribution to the care of the elderly in the Brighton Health District, and the health authority should develop a more active partnership with this sector.

Aged↗
PubMed2001

Public and private providers' quality of care for tuberculosis patients in Kampala, Uganda.

SETTING: The role of the private sector in tuberculosis treatment in developing countries in sub-Saharan Africa is largely unknown. In recent years, many fee-for-service clinics have opened up in Kampala, Uganda. Little is known about the tuberculosis caseload seen in private clinics or the standard of care provided to the patients. OBJECTIVE: To compare the appropriateness of tuberculosis care in private and public clinics, and the extent of the tuberculosis burden handled in the private sector. DESIGN: Cross-sectional survey in private and public clinics treating tuberculosis patients in Kampala, Uganda, during June to August 1999. MEASUREMENTS: Clinics were evaluated for appropriateness of care. This was defined as provision of proper diagnosis (sputum smear microscopy as the primary means of diagnosis), treatment (short-course chemotherapy, with or without directly observed therapy), outcome evaluation (smear microscopy at 6 or 7 months) and case notification in accordance with the Uganda National Tuberculosis and Leprosy Programme. RESULTS: A total of 114 clinics (104 private, 10 public) were surveyed. Forty-one per cent of the private clinics saw three or more new tuberculosis patients each month. None of the public or private clinics met all standards for appropriate tuberculosis care. Only 24% of all clinics adhered to WHO-recommended treatment guidelines. Public clinics, younger practitioners and practitioners with advanced degrees were most likely to provide appropriate care for tuberculosis. CONCLUSION: The private sector cares for many tuberculosis cases in Kampala; however, a new programme that offers continuing medical education is needed to improve tuberculosis care and to increase awareness of national guidelines for tuberculosis care.

Adult↗
PubMed1994

Private speech in adolescents.

The main objective of this study was to investigate the occurrence of private speech in adolescents. The data supported the theory that private speech continues to occur during adolescence. Indications were found that prior studies of older children may not have detected private speech due to observer effects. In this study the observer attempted to appear uninterested in the subject's actions to alleviate self-consciousness. Thirty-three female and fourteen male high school upperclassmen and college freshmen took an exam one at a time with a confederate subject who was trained to use private speech. An experimenter recorded all speech produced during the thirty-minute period. The subjects worked in the presence of a confederate who exhibited private speech for the last twenty minutes of the testing session in order to help them believe they could use private speech if they wished to. The relationship found between private speech and observer effects indicates that social situations may have a profound effect upon its occurrence. Private speech was found to be negatively correlated with task performance when uttered before the confederates had begun to speak to themselves. No such correlation was found between private speech and score during the period in which the confederates talked to themselves. The final hypothesis was that the speech emitted would fit into the same categories defined by Berk and Garvin (1984); all but one of their categories were observed. Of the observed categories description of activity and self guidance was correlated with high test scores.

Adolescent↗
PubMed2004

Impact of private health insurance incentives on obstetric outcomes in NSW hospitals.

The purpose of this study is to analyse the impact of changes in Australian private health insurance coverage as seen in NSW public and private hospital birth profies, and identify trends in obstetric outcomes from 1997-2001. NSW Midwives Data Collection unit record data is analysed for women who gave birth to a live singleton baby of term gestation (> or = 37 weeks) and cephalic presentation in NSW hospitals during 1997- 2001. Use of private hospitals for childbirth has increased in conjunction with increases in private health insurance coverage. Although some obstetric interventions have increased for both public and private hospitals over time, clinical factors do not explain the large differences in birth interventions and outcomes between NSW public and private hospitals. Incentives to increase private health insurance coverage appear to be having a negative impact on childbirth, in terms of higher birth intervention and operative birth rates in NSW private hospitals.

Anesthesia, Obstetrical↗
PubMed1999

The influence of access to a private attending physician on the withdrawal of life-sustaining therapies in the intensive care unit.

OBJECTIVE: To assess the influence of patient access to a private attending physician on the withdrawal of life-sustaining therapies in a medical intensive care unit (ICU). DESIGN: Prospective cohort study. SETTING: A university-affiliated teaching hospital. PATIENTS: A total of 501 consecutive patients admitted to the medical ICU during a 5-month period. INTERVENTIONS: None MEASUREMENTS AND MAIN RESULTS: Among patients dying in the medical ICU, those without a private attending physician (n = 26) were statistically more likely to undergo the active withdrawal of life-sustaining therapies than patients with a private attending physician (n = 87) (80.8% vs. 29.9%; relative risk = 2.70; 95% confidence interval = 1.86-3.92; p < .001). Despite having similar predicted mortality rates by Acute Physiology and Chronic Health Evaluation II score (60.5% +/- 27.0% vs. 66.1% +/- 21.3%; p = .280), patients dying in the medical ICU without a private attending physician had statistically shorter hospital and ICU lengths of stay, a shorter duration of mechanical ventilation, and fewer total hospital costs and charges compared with patients with access to a private attending physician. Multiple logistic regression analysis, controlling for severity of illness, demographic characteristics, and patient diagnoses, demonstrated that lack of access to a private attending physician (adjusted odds ratio = 23.10; 95% confidence interval = 9.10-58.57; p < .001) and the presence of a do-not-resuscitate order while in the ICU (adjusted odds ratio = 7.33; 95% confidence interval = 3.69-14.54; p = .004) were the only variables independently associated with the withdrawal of life-sustaining therapies before death. CONCLUSIONS: Patients dying in a medical ICU setting without access to a private attending physician are more likely to undergo the active withdrawal of life-sustaining therapies before death than patients with a private attending physician. Health care providers should be aware of possible variations in the practice of withdrawal of life-sustaining therapies in their ICUs based on this patient characteristic.

Adolescent↗
PubMed2005

Private health insurance: implications for developing countries.

Private health insurance is playing an increasing role in both high- and low-income countries, yet is poorly understood by researchers and policy-makers. This paper shows that the distinction between private and public health insurance is often exaggerated since well regulated private insurance markets share many features with public insurance systems. It notes that private health insurance preceded many modern social insurance systems in western Europe, allowing these countries to develop the mechanisms, institutions and capacities that subsequently made it possible to provide universal access to health care. We also review international experiences with private insurance, demonstrating that its role is not restricted to any particular region or level of national income. The seven countries that finance more than 20% of their health care via private health insurance are Brazil, Chile, Namibia, South Africa, the United States, Uruguay and Zimbabwe. In each case, private health insurance provides primary financial protection for workers and their families while public health-care funds are targeted to programmes covering poor and vulnerable populations. We make recommendations for policy in developing countries, arguing that private health insurance cannot be ignored. Instead, it can be harnessed to serve the public interest if governments implement effective regulations and focus public funds on programmes for those who are poor and vulnerable. It can also be used as a transitional form of health insurance to develop experience with insurance institutions while the public sector increases its own capacity to manage and finance health-care coverage.

Developing Countries↗
PubMed2003

Variation in public and private supply of pneumococcal conjugate vaccine during a shortage.

CONTEXT: In late August 2001, a serious shortage of the heptavalent pneumococcal conjugate vaccine (PCV7) developed in 34 state immunization programs. In September 2001, the Centers for Disease Control and Prevention published revised recommendations advising physicians to prioritize PCV7 to specific groups of children. The effect of the shortage at the practice level is unknown. OBJECTIVE: To determine the variation between public and private markets in the supply of PCV7 and the nature and extent of the PCV7 shortage at the practice level. DESIGN, SETTING, AND PARTICIPANTS: Semistructured interviews with office staff responsible for ordering vaccines at private practices in 12 states were conducted between October 19 and November 2, 2001. MAIN OUTCOME MEASURES: Variation in supply of PCV7 obtained from public sources and through purchase on the private market. Supply was characterized into 3 categories: "no problem," "problem obtaining a consistent supply," and "out of stock." RESULTS: Interviews were completed at 405 practices, representing a response rate of 74%. Overall, 51% of practices reported at least 1 episode of being out of stock of public PCV7 and 64% of private PCV7, with significant state-to-state variation. Only 2 of 12 study states had a substantially higher proportion of practices experiencing out-of-stock episodes for public compared with private PCV7, while in 6 states public PCV7 was less frequently out of stock than private PCV7. Only 23% of practices in this study altered their administration policy for private PCV7, while 27% altered their policy for public PCV7. CONCLUSIONS: The distribution and supply of PCV7 varied between public and private supplies and between states during the shortage. Few practices changed their administration schedules in response to revised recommendations.

Pneumococcal Vaccines↗
PubMed2007

Public versus private health care in a national health service.

This paper studies the interaction between public and private health care provision in a National Health Service (NHS), with free public care and costly private care. The health authority decides whether or not to allow private provision and sets the public sector remuneration. The physicians allocate their time (effort) in the public and (if allowed) in the private sector based on the public wage income and the private sector profits. We show that allowing physician dual practice 'crowds out' public provision, and results in lower overall health care provision. While the health authority can mitigate this effect by offering a higher wage, we find that a ban on dual practice is more efficient if private sector competition is weak and public and private care are sufficiently close substitutes. On the other hand, if private sector competition is sufficiently tough, a mixed system, with physician dual practice, is always preferable to a pure NHS system.

Health Care Rationing↗
PubMed2001

[2d Report on increasing volume of diagnostic and interventional heart catheterization in hospitals and private practice in Germany 1990-1999].

Despite all warnings from the German Ministry of Health, the healthcare insurances and the media, the number of diagnostic (DIAG) and therapeutic (PCI) cardiac catheterizations is continuously growing in hospitals and in private practices. From 1997 to 1999, the number of DIAG increased from 478837 to 561623 and PCI from 135925 to 166132. The average number of DIAG per institution decreased from 1482 in 1997 to 1324 in 1999 and the average number of PCI from 535 to 479. The number of DIAG-performing hospitals increased from 256 to 315 and that of DIAG-performing private practices from 67 to 109. The number of PCI-performing hospitals increased from 211 to 278 and the corresponding private practice locations from 43 to 69. In 1999, 18% of all DIAG and 15% of all PCI in Germany was performed in private practice. Since 1994, the average number of DIAG per private practice continuously decreased as well as the average number of PCI per private practice since 1997. This decrease was more pronounced in private practice (DIAG 378/lab and PCI 111/lab) than in hospitals (DIAG 68/lab and PCI 35/lab). Possible reasons for this trend are an increasing number of low volume centers, a more rigid indication for DIAG and PCI due to quality control programs, and the reduction of reimbursement incentives for social healthcare insured patients in private practice. The real optimal need for DIAG and PCI in Germany, however, has to be determined.

Cardiac Catheterization↗
PubMed2006

[Muscle relaxants in Germany 2005: a comparison of application customs in hospitals and private practices].

Aim of this study was to evaluate application customs of muscles relaxants in hospitals compared to their use in private practice. Of the 3,260 questionnaires sent-out, 66.9% could be analyzed. Of these 54% were from anesthetists in private practice, 41% from heads of hospital anesthesia departments and 5% from heads of level one hospital anesthesia departments. The first difference between private practices and hospitals was the number of available muscle relaxants: 87% of private practices use 1-3 relaxants, whereas 79% of hospitals use 3-5. Another apparent difference was the relationship between general anesthesia and the number of intubations: 60% of private practices have over 80% of general anesthesia cases, but only 50% of these patients are intubated. On the contrary, two thirds of the hospitals have 50-80% general anesthesia cases and 60-70% of patients are intubated. The main wish for an ideal muscle relaxant was independent of private practice or hospital, short onset time, followed by fast recovery. In accordance 74% of anesthetists in hospitals and 72% of anesthetists in private practice voiced the wish for a non-depolarizing succinylcholine substitute. The results of this nationwide survey suggest that time pressure in combination with an increased specialization of anesthetists in private practice are the main factors for availability and use of muscle relaxants in routine anesthesia.

Anesthesia↗
PubMed1993

Private doctors and tuberculosis control in India.

Over three quarters of the 8 million registered doctors in India are engaged in private medical practice. In urban and rural areas alike people prefer private doctors to public health services for their health care needs. A majority of patients and those with suspected tuberculosis also report first to private doctors. Nevertheless private doctors seem to be alienated from national efforts towards control of tuberculosis, there being no well-defined role for them in the National Tuberculosis Programme. This study of private doctors practising in the low income areas of a metropolis of India reports on the knowledge of private doctors about diagnosis and treatment of tuberculosis and their awareness and perceptions about the public health services available for tuberculosis control. The study reveals gaps and weaknesses in the private doctors' reported practice of managing lung tuberculosis, the most important and persistent problem of public health concern in India. The need for organized efforts towards involving private doctors in disease control programmes wherein their curative functions could contribute significantly is stressed.

Clinical Competence↗