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PubMed2005

Emergency medical services in Islamabad, Pakistan: a public-private partnership.

OBJECTIVES: The objective of this study was to evaluate the emergency medical services (EMS) based in Islamabad, Pakistan. Rescue-15 is an innovative EMS collaboration project between the police, the private sector and the community. METHODS: Data from Rescue-15 were used for systems analysis. The institutional set-up, private-public partnership, client satisfaction and sustainability issues were examined. The access and efficiency of EMS were assessed in terms of ambulance response time. RESULTS: Primarily, systems analysis showed community participation to explain the project's strength. Since its establishment, the project has been meeting its own recurrent expenditures without levying an extra burden on the Government. Sustainability issues such as amendments to legislation have been addressed at departmental and governmental levels. Data analysis showed that rescue time is, on average, 10.4 min (SD=2.6 min). A client survey also demonstrated user satisfaction and increased confidence in the service. CONCLUSIONS: This EMS programme exemplifies the potential of public-private partnership involving the police and the private sector in project implementation and management in a developing country with scarce resources. This initiative to involve the public and the private sector may provide a model for implementation of such services in other resource-poor developing countries, which may in turn facilitate realistic solutions for better prehospital care in developing countries.

Consumer Behavior↗
PubMed2004

Motivation and values of hospital consultants in south-east England who work in the national health service and do private practice.

In the UK, a small private health care sector has always existed alongside the national health service (NHS). The conventional assumption is that doctors who work as salaried employees of the NHS are guided in their clinical practice by professional values which encourage them to put their patients' interests first. A common suspicion is that doctors undertaking fee-for-service practice in the private sector are motivated by self-interest, with commitment to their patients compromised by consideration for their purse. The great majority of hospital consultants are salaried employees of the NHS, but most also undertake some private practice. This paper uses findings from an interview study of 60 surgeons and physicians engaged in dual practice of this kind to investigate their reasons for working in this way and look at how they reconcile their personal, professional and public sector values and responsibilities with the temptations of the market. The existence of the private sector and their own engagement in it was regarded by almost all respondents as a net benefit, not only to themselves and their private patients, but also to the NHS, so long as they handled it properly. The interviews revealed a complex range of beliefs and assumptions through which these doctors justify their activities and a variety of informal principles for dealing with such conflicts of interest as they acknowledge. Neither their values nor their actions can be adequately explained using generic concepts of professional self-interest or public service values without consideration of what such concepts represented in the specific social, economic, professional and policy context of health care in south-east England at the time of the study.

Career Choice↗
PubMed1999

Strength of indication for cesarean delivery: comparison of private physician versus resident service labor management.

OBJECTIVE: Our purpose was to compare the strength of indication for cesarean delivery for 2 groups of patients who had undergone cesarean delivery-those treated by physicians in private or group practice and those treated by a clinic or resident service. STUDY DESIGN: From records of 119 cesarean deliveries performed in 1992, data concerning patient history, labor course and management, fetal monitor tracings, and indications for cesarean delivery were extracted, summarized, and presented to 3 reviewers. Each reviewer rated the strength of indication for cesarean delivery on a 10-point visual analog scale and specified how often they would have chosen an alternative management plan. Reviewers were blinded to the research hypothesis and to patient age, type of provider, and insurance status. RESULTS: Using a multivariate linear regression model to adjust for differences in age and indication for cesarean delivery, we found that strength of indication scores were higher among patients treated by a resident service than among those treated by private physicians (P <.0001) and that an alternative action plan was more often suggested for deliveries managed by private physicians (P <.0001). CONCLUSIONS: Among women who underwent cesarean delivery, the strength of indication judged by a panel of reviewers not involved with the patient's care was stronger among resident-treated patients than among cases treated by private physicians. Although there are several possible explanations, the findings may suggest that physicians in private practice use different criteria than do resident physicians for deciding to perform a cesarean.

Adult↗
PubMed1999

Cesarean deliveries for medicaid patients: a comparison in public and private hospitals in Los Angeles county.

OBJECTIVE: The aims of the study were to describe the difference in cesarean delivery rates for Medicaid patients according to hospital type and adjusted for case mix and to determine cost implications for additional cesarean deliveries. STUDY DESIGN: This retrospective study used California discharge data for 92,800 patients delivered in 78 hospitals in Los Angeles County during 1991. Multivariable logistic regression was used to adjust for case mix and to calculate adjusted cesarean delivery rates according to hospital type. Cost estimates assumed $821 per day hospital reimbursement. RESULTS: The unadjusted cesarean delivery rate in private nonteaching hospitals (reference group) was 24.5%, compared with 13.2%, 17.4%, and 16.5% in public, health maintenance organization, and private teaching hospitals, respectively. Adjustment for case mix decreased the cesarean delivery rate in public (9.0%), health maintenance organization (12.0%), and private teaching hospitals (8.0%). Cesarean deliveries performed on patients in private nonteaching hospitals result in an additional $13.6 million in Medicaid health care expenses. CONCLUSIONS: There are increased health care costs related to increased cesarean deliveries performed on Medicaid patients in private nonteaching hospitals.

Cesarean Section↗
PubMedDate not supplied

[Health services privatization: the experiences of Chile and Costa Rica].

This study questions the premises that justify the neoliberal privatization of financing, managing and delivering health services. It also analyses the meaning of privatization and its strategies. We compare privatization in Chile and Costa Rica and suggest that the more limited, selective and locally designed privatization process in Costa Rica has resulted in a more equitable, and efficient health system than the imported privatization model introduced in Chile. The Costa Rican system also produces greater patient satisfaction and at the same time preserves the solidarity principle.

Chile↗
PubMed2001

Real world pharmacy: assessing the quality of private pharmacy practice in the Lao People's Democratic Republic.

The private sector is a dominant actor in the provision of pharmaceuticals, particularly in developing countries. Private provision of drugs has been associated with risks regarding availability, affordability, rational use and drug quality. Ensuring an effective regulatory framework is therefore a major challenge for governments, yet the capacity of regulatory authorities is often outstripped by private sector growth. In the Lao People's Democratic Republic (Lao P.D.R.), a poor, landlocked country in South East Asia, the private provision of drugs has increased dramatically since the liberalisation of the economy in the late 1980s. This paper aims to describe the quality of the private pharmacy services in the Savannakhet province of Lao P.D.R. In order to do this, a monitoring instrument which serves to make the concept of Good Pharmacy Practice (GPP) operational was developed and applied to a sample of pharmacies. Service quality, as measured by three facility-specific indicators, showed a tendency to be lower in the most distant districts. Poor dispensing practices were manifest by a lack of information about drugs sold in 59% of cases, drugs not being labelled in 47% and different drugs being mixed in the same package in 26% of cases. The prices of four sample drugs were slightly higher in the remote districts. A 10-fold price difference for the same drug was recorded in one district. After reporting the findings, the paper discusses the possible influence of district and pharmacy variables on the quality of services, and goes on to discuss the price differences. It is concluded that further government interventions are needed in order to improve the quality of services and to focus regulatory action on a limited number of aspects, to ensure that drugs can be traced before trying to establish a comprehensive regulatory system.

Developing Countries↗
PubMed1998

Comprehensive health data systems spanning the public-private divide: the Massachusetts experience.

As systems of health care delivery have evolved from claims-based fee-for-service to capitated or managed care, with its emphasis on cost-effectiveness, quality, and performance measurement, some states have begun to experiment with new ways to collect, organize, and share health information. In many cases, the drivers of these changes have been purchasers of health care, including large and small private employers and public agencies such as Medicaid. One of the results of these changes is the increased interest in the sharing of health information, between health plans and employers, and, in some instances, between private plans and public agencies such as public health. Massachusetts, which has one of the highest rates of managed care penetration in the United States, has brought together the various parties involved in the collection and utilization of health information, to craft agreements on standards and protocols that will allow the sharing of health data. While much of the activity involves business transactions between private sector health plans, the Department of Medical Assistance (Medicaid) has joined with its private sector purchasing partners in demanding cost-effective, high-quality care; it is these demands that have helped stimulate the need to reorganize previously proprietary health information systems. The activities of two public-private coalitions, the Massachusetts Healthcare Purchaser Group and the Massachusetts Health Data Consortium, have been critical in initiating and supporting the complex processes that have led to significant changes in state-based systems of health information.

Health Maintenance Organizations↗
PubMed1986

Private medical care and the British conservative government: what price independence?

This paper discusses issues raised by the uneven expansion of private health care in Britain in recent years. The problems being experienced by the industry have exposed divisions in the private health care industry and have provoked criticisms of the Government and requests for a greater degree of state support for, and regulation of, the industry. The paper therefore examines the scope for changes of government policy to facilitate further expansion. It argues that few of the alternatives are either technically adequate, in terms of solving the private sector's problems, or politically feasible, in the sense of being electorally justifiable. It concludes that policies to further private sector expansion could be implemented only at the cost of the private sector's independence, or at the expense of the Government's commitment to the NHS.

Economic Competition↗
PubMed1998

Financing the delivery of public-sector animal health services in Jamaica: pre- and post-privatization.

Lack of adequate financing was a major reason for the privatization of veterinary services in Jamaica in 1992. The belief was that, with privatization, funding of animal health services delivery would improve, since staff numbers and clinical activities undertaken by the Veterinary Division were reduced. However, analyses of data revealed that, in most cases, privatization neither improved nor stemmed the declines, that had started before privatization, in the measures or indicators used. It was concluded that privatization of veterinary services did not result in any appreciable improvement in the financing of the delivery of public-sector animal health services in Jamaica in the short term.

Animals↗
PubMed2003

Delivery of preventive services for low-income persons over age 50: a comparison of community health clinics to private doctors' offices.

This study focused on the use of 14 evidence-based preventive services for the low-income population over age 50: colorectal, breast and cervical cancer screening, cholesterol screening, counseling around diet, exercise, tobacco, alcohol and illicit drugs, and immunizations for influenza, tetanus and pneumonia. Population characteristics and rates of delivery of these preventive services are compared for low-income users of community health clinics vs private doctors' offices/HMOs. Three nationally representative data-files from the National Health Interview Survey--the Person-Level File, Sample Adult File, and Sample Adult Prevention File--were linked to obtain the necessary data on preventive services use in the 12,024 persons over age 50. Among the population of persons over age 50 living below 200% of the poverty threshold, those using community clinics were more likely to be younger, a racial or ethnic minority, less formally educated, in poorer health, uninsured, and more likely to face time, transportation or cost barriers to obtaining health care (p < .01 for all comparisons), than their counterparts using private doctors' offices/HMOs. Community health clinics performed as well as private doctors/HMOs in the delivery of cancer screening, cholesterol screening and immunizations to lower income persons over 50 years. Rates of counseling about diet and exercise were higher among users of private doctor's offices than among users of community health clinics users (40% vs. 31% respectively, p = .02). Despite the severe resource constraints under which they operate, and the greater vulnerability of the population they serve, community clinics deliver preventive services at rates comparable to private doctors' offices and HMOs.

Community Health Centers↗
PubMed2000

A longitudinal study of young Finnish adults' use of subsidized, private sector dental care, 1986-1997.

OBJECTIVES: Finns born after 1956 are now entitled to subsidized private sector dental care, or such persons could be enrolled in the Public Dental Service. Until 1986, eligibility was more restrictive. The purpose of this study was to investigate the use and costs of private dental care and effects of regularity of care on costs and treatment received among young Finnish adults during 1986-1997. METHODS: All 1986, 1990 and 1994 recipients of reimbursement for dental care from the Social Insurance Institution were included in the study. Five separate age cohorts were compared. Using their civil registration numbers, individuals were tracked from their first contact with a private dentist in one of the years 1986, 1990 or 1994 until the year 1997. RESULTS: While the total number of young adults who had received reimbursement for private dental care increased from about 53000 (1986) to 200000 (1994) due to extended eligibility, the number of users in the youngest group decreased from 53000 to 23000. Attending infrequently (1-2 times during the study period) was most common among the youngest adults and frequent attendance (annually) was most common among older adults. The annual mean cost was slightly lower among the frequent attenders in almost every cohort. Variation in the mean number of annual visits was directly correlated with costs. Frequent attenders most often received diagnostic and preventive measures while restorations and surgery were most common for the infrequent attenders. CONCLUSIONS: A substantial decline in the demand for private services among the 19-25-year-olds and stable demand among 26-34-year-olds was detected, indicating falling treatment needs or a preference for the Public Dental Service. All groups had a stable mean number of visits per year and almost constant costs. The mean number of dental visits per year remained steady in all cohorts indicating rigid treatment patterns.

Adult↗
PubMed1989

Public and private responsibility for mental health services. A report on the Tennessee Task Force.

The "privatization" of mental health services during the last decade has literally reshaped the way state and county departments of mental health go about fulfilling their statutory responsibilities. In Tennessee, a conference and later a task force examined the implications of this trend for the future. Two issues came to the forefront: Is it appropriate or possible for the private sector to take over the delivery of all mental health services, and if so, who will ensure that the poor receive adequate care? The Tennessee task force concluded that the privatization trend is appropriate and should be encouraged by government. It further concluded that government is ultimately responsible for ensuring access to care for the poor and uninsured although private facilities should provide some free care. Government best serves the poor by providing them the financial means to purchase care from private providers.

Community Mental Health Services↗
PubMed2000

West African children in private foster care in City and Hackney.

A unique feature of some Africans who come to study and work in Britain is the practice of making private arrangements to send their children to live with foster parents who assume full parental rights. Six hundred randomly selected African families, with a child born between June 1988 and May 1991, resident in one Health Authority, were sent a questionnaire to elicit the proportion of children who had been in private foster care and to gain information on the knowledge and attitudes to fostering and day care provision. Families with children in foster care were asked additional questions about their experiences. Two hundred and six (34%) of the questionnaires were analysed. Seventy-six per cent of the respondents were from Nigeria, 65% had already heard about private fostering and 29 (14%) had sent one of their children to private foster care. Only one family felt that foster care was a suitable option; the reminder would have preferred alternative facilities such as nursery placement. Of the 29 children in foster care, nine parents said their children were unhappy and five rated the foster parents as bad. Contrary to popular belief, most children were visited fortnightly, some more frequently and only two never visited. Private fostering in this group of children was found to be less common than in earlier studies.

Africa↗
PubMed2005

Combining DRGs and per diem payments in the private sector: the Equitable Payment Model.

The many types of payment models used in the Australian private sector are reviewed. Their features are compared and contrasted to those desirable in an optimal private sector payment model. The EPM(TM) (Equitable Payment Model) is discussed and its consistency with the desirable features of an optimal private sector payment model outlined. These include being based on a robust classification system, nationally benchmarked length of stay (LOS) results, nationally benchmarked relative cost and encouraging continual improvement in efficiency to the benefit of both health funds and private hospitals. The advantages in the context of the private sector of EPM(TM) being a per diem model, albeit very different to current per diem models, are discussed. The advantages of EPM(TM) for hospitals and health funds are outlined.

Acute Disease↗
PubMed2005

Distributional impact of recent changes in private health insurance policies.

The impacts of changes to private health insurance (PHI) policies introduced since 1999 - in particular the 30% PHI rebate and the Lifetime Health Cover - have been much debated. We present historical analyses of the impacts in terms of the proportion of Australians having hospital insurance cover under different PHI policies, by age, gender and socioeconomic status, and project these to 2010 using a new Private Health Insurance coverage model. The combined effect of the 30% rebate and Lifetime Health Cover was to increase PHI membership from just over 30% in 1998 to just under 50% by the end of 2000, due mainly to more people taking out PHI cover from among the richest 20% of the population. Among the poorest 40% the impact was minimal. Model projections suggested that, had the new PHI policies not been introduced, then the proportion of Australians with PHI would have declined to around 20% by 2010, compared with 40% if the current arrangements remained in place. Also, analysis of 2001 survey data regarding choices to use a public or a private hospital indicated that higher income groups with or without PHI were the more likely to have used a private hospital than lower income groups. Among those with PHI, older people were more likely to have used a private hospital than younger ones.

Adolescent↗
PubMed1995

A comparison of costs in Australian public teaching, public non-teaching and private hospitals.

This paper compares costs for caring for patients according to common diagnosis groups in Australian public teaching, public non-teaching and private hospitals. Generally, the costs for general surgical procedures are highest in public teaching hospitals, followed by public non-teaching hospitals, and are lowest in private hospitals. However, the private sector is more expensive than the public sector for obstetric activities. The reasons for the differences appear to be the much higher 'overheads' in the public sector than in the private sector, and the longer hospital stay for obstetric patients in private hospitals. Managers of individual hospitals should examine the data in detail to determine if alternative approaches are appropriate.

Australia↗
PubMed2000

Perceived competition in private dental practice in Finland.

A questionnaire study was conducted among 350 private dentists in Finland to investigate their perception of competition and how this associated with practice characteristics. The questionnaire comprised 46 questions dealing with perceptions of competition, marketing, and collegiality, respondents' personal and practice characteristics, including age, sex, area of main practice location, weekly hours in private practice, functioning in solo or in joint practice, cooperation with other dentists, and whether practicing in more than one location. The majority of these private dental practitioners perceived much competition between themselves. Almost all (96%) of those feeling much competition today expected it to be more intense after 5 years, compared to 60% of those not perceiving much competition today (P < 0.001). Private practitioners perceiving much competition also felt it from public health centers significantly (P < 0.001) more often (46%) than others (24%). Logistic regression models revealed that those with a practice in more than one location were over 7 times more likely not to perceive competition. Those practicing outside metropolitan Helsinki area had 3.6 times the odds of not perceiving competition, and for women overall the odds ratio was 2.5. Increasing competition in private practice is a widely felt concern, and it may diminish the willingness of new graduates to attempt penetration of the market and establish their clinics.

Adult↗
PubMed2000

Two separate tracks? A national multivariate analysis of differences between public and private substance abuse treatment programs.

OBJECTIVE: This study describes differences between public and private substance abuse treatment programs. METHOD: Data from the National Drug and Alcoholism Treatment Unit Survey (NDATUS) were analyzed with regression models that evaluated the association between ownership and program characteristics. RESULTS: Programs operated by state and local government and nonprofit agencies had more staff, but federal and for-profit programs employed more psychologists and medical doctors. We found that, in most treatment settings, for-profit programs were smaller and more likely to specialize in providing treatment in a single setting. Methadone maintenance programs were larger when operated under for-profit ownership, however. For-profit programs received more funding from private insurance and client fees. CONCLUSIONS: We found substantial differences between public and private programs, but this division was not strictly dichotomous. Federal programs differed from public programs operated by state and local governments. Programs operated by nonprofit agencies had characteristics that placed them between private for-profit and public programs. State and local agencies are contracting with private managed behavioral health care organizations to provide sub stance abuse treatment and other mental health care. The characteristics of for-profit programs may represent the future direction of substance abuse treatment.

Humans↗