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PubMedDate not supplied

Clinical trials of antiepileptic drugs performed in the private practice setting.

Clinical trials of antiepileptic drugs (AEDs) are usually performed only in major teaching centers, thus ignoring the very real contribution available from private practice. The relation between the consultant and the referring family physician is often much closer in private practice, allowing much earlier recruitment of de novo patients into clinical trials. Between October 1988 and February 1992, 50 subjects were entered into various clinical trials including gabapentin (both an open add-on trial and parallel-arm add-on study in generalized epilepsies), vigabatrin (placebo-controlled cross-over study in focal epilepsies), and lamotrigine (both placebo-controlled cross-over add-on studies and parallel-arm comparative monotherapy study in newly diagnosed patients with epilepsy). All these trials were coordinated in private neurologic practice in Sydney, Australia, as part of either national or international multicenter AED studies. The experience demonstrated the improved ease of recruitment and patient liaison available in the private sector. It also highlighted the very real logistic problems, such as the need for a noninstitutional-based ethics committee, the training of support staff and a modified primary information resource system. Inclusion of private practice centers in clinical trials demonstrates the potential for improved patient recruitment and administrative management, especially in studies requiring newly diagnosed patients.

Acetates↗

PubMed2003

Birth outcomes and maternal morbidity in abused pregnant women with public versus private health insurance.

PURPOSE: To compare the effects of recent intimate partner abuse on maternal and infant health in publicly versus privately insured pregnant women. DESIGN: Exploratory descriptive analysis in 13 Massachusetts prenatal care sites from records of 2,052 women who had been screened during pregnancy for domestic violence. METHODS: Clinicians screened pregnant women for domestic violence using the Abuse Assessment Screen. After delivery, prenatal and birth outcome data and abuse screening results were extracted from medical records by project staff. Odds ratios were used to compare maternal and infant health indicators in abused and nonabused women. Data from women with public and private health insurance then were examined separately, using logistic regression to control for low education and single marital status while examining the odds of adverse maternal and infant outcomes in abused and nonabused women. FINDINGS: In the sample as a whole, recently abused women were more likely to be publicly insured and unmarried, to have less than 12 years of formal education, and to have medical and obstetrical complications. Parity, ethnic background, and infant birth outcomes did not differ in relation to abuse. In separate analyses for women with public and private health insurance, after controlling for marital status and education, abuse increased the odds of low infant Apgar scores, poor nutrition, hyperemesis, hypertension, and substance abuse in publicly insured women, and abuse increased the odds of poor nutrition and bleeding during pregnancy for privately insured women. CONCLUSIONS: The different correlates of abuse in publicly and privately insured women might be important for clinicians caring for these different populations. Screening for abuse and providing abuse-related services are indicated for pregnant women.

Adolescent↗

PubMed1999

Health status disparities among public and private emergency department patients.

OBJECTIVE: To explore whether patients in a public ED had poorer health than patients in a private ED, the authors compared the physical and mental health statuses of patients seeking emergency care. METHODS: A cross-sectional observational study of all adult patients, regardless of acuity, seen during two 24-hour periods in spring 1997 in an urban county trauma center (68,000 annual visits) and a private community ED (35,000 annual visits). Scores on the Physical Component Summary (PCS) and the Mental Component Summary (MCS) scales of the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12) were compared between sites, with published national norms, and with hospital admission. RESULTS: Of 571 eligible patients, 392 (69%) completed the SF-12. Patients in the public ED had a mean PCS score of 40.1, compared with 43.7 for patients in the private ED, for a difference of 3.6 points (p < 0.01; 95% CI = 0.9 to 6.1). After controlling for age, sex, ethnicity, triage acuity, ambulance arrival, and insurance status, this difference increased to 3.9 points (p = 0.02; 95% CI = 0.7 to 7.0). The mean MCS score among public ED patients was 44.1, compared with 46.5 in the private ED population, for a difference of 2.4 (p = 0.08; 95% CI = -0.3 to 5.0); after adjustment this difference increased to 2.5 (p = 0.15; 95% CI = -0.9 to 5.8), but remained statistically not significant. While all scores were significantly lower than national norms (mean PCS 50.1, mean MCS 50.0), patients in the public ED scored consistently lowest. PCS score was significantly inversely correlated with admission, with each point decrease in PCS score increasing the odds of admission by 0.05 (95% CI = 0.01 to 0.08), and conferring an odds ratio of 5.1 (95% CI = 1.2 to 21.1) for admission among the 25th percentile for PCS scores. CONCLUSIONS: Patients seeking care in the public ED had lower adjusted physical health status scores than comparable patients obtaining care in a private ED. The SF-12 is sufficiently responsive to detect hypothesized differences between ED populations, and correlates well with admission decisions.

Adult↗

PubMed1983

Use of public and private dental services by adults in Finland.

The aim of this study was to analyze the factors that affected the choice between public and private dental services in 1979, when 9% of adults had received their dental services in a public health center. In September 1979 the National Board of Health conducted a telephone interview among Finnish adults over 15 yr old. When a representative sample of 1992 adults was drawn, the response rate was 90.4%. All subjects over 17 yr of age who had used dental services within the last 5 yr were included in the study, making a final sample of 1368. According to the logistic function, the greatest differences were between rural and urban areas. Of the subjects living in urban areas, 18% had visited public health centers; and of those living in rural areas, 45% had visited health centers. Of the adults living in an urban setting, 70% and in rural areas 49% visited private dentists. Of the subjects who had used private dental services, nearly half were managers and upper white-collar workers; while of those using communal services, less than one third worked in such jobs. In urban areas managers and upper white-collar workers used private services twice as often as they used public services. In an urban setting, subjects who had visited a dentist during the last 2 yr had received treatment mainly in the private sector; and in a rural setting, subjects had been treated mainly in health centers.

Adolescent↗

PubMed1989

Role of the private sector in elective surgery in England and Wales, 1986.

From a sample of 19,000 treatment episodes at 183 of the 193 independent hospitals with operating facilities in England and Wales that were open in 1986 it is estimated that 287,000 residents of England and Wales had elective surgery as inpatients in 1986 (an increase of 77% since 1981) and 72,000 as day cases. From 1985 Hospital In-Patient Enquiry data it was estimated that a further 36,000 similar elective inpatient treatments were undertaken in NHS pay beds (a decrease of 38%) and 21,000 as day cases. Overall, an estimated 16.7% of all residents of England and Wales who had non-abortion elective surgery as inpatients were treated in the private sector, as were 10.5% of all day cases. An estimated 28% of all total hip joint replacements were done privately, and in both the North West and South West Thames regions the proportion of inpatients treated privately for elective surgery was 31%. It is concluded that mainly for reasons of available manpower private sector activity may not be able to grow much more without arresting or reversing the growth of the NHS, in which case some method of calculating NHS resource allocation which takes account of the local strength of the private sector will be needed.

Adolescent↗

PubMed1993

Comparison of NHS and private patients undergoing elective transurethral resection of the prostate for benign prostatic hypertrophy.

OBJECTIVES: To compare the operative thresholds and clinical management of men undergoing elective transurethral resection of the prostate for benign prostatic hypertrophy in the NHS and privately. DESIGN: Cohort study of patients recruited by 25 surgeons during 1988. SETTING: Hospitals in Oxford and North West Thames regions. PATIENTS: Of 400 consecutive patients, 129 were excluded because of open surgery (nine), lack of surgeons' information (three), and emergency admission (117) and three failed to give information, leaving 268 patients, 214 NHS patients and 54 private patients. MAIN MEASURES: Sociodemographic factors, prevalence and severity of symptoms, comorbidity, general health (Nottingham health profile) obtained from patient questionnaire preoperatively and reasons for operating, and operative management obtained from surgeons perioperatively. RESULTS: NHS and private patients were similar in severity of symptoms and prevalence of urinary tract abnormalities. They differed in four respects: NHS patients' general health was poorer as a consequence of more comorbid conditions (49, 23% v 7, 13% in severe category); the condition had a greater detrimental effect on their lives (36, 17% v 2, 4% severely affected; p < 0.01); private patients received more personalised care more quickly and were investigated more before surgery, (29, 54% v 60, 20% receiving ultrasonography of the urinary tract); and NHS patients stayed in hospital longer (57, 27% v 3, 6% more than seven days; p < 0.001). CONCLUSIONS: Private patients' need for surgery, judged by symptom severity, was as great as that of NHS patients, and there was no evidence of different operative thresholds in the two sectors, but, judged by impact on lifestyle, NHS patients' need was greater.

Comorbidity↗

PubMed1978

Comparing clinic and private practice of psychiatry.

The author compared data on 2,020 cases treated by private psychiatrists with those on 2,052 cases treated by clinic psychiatrists in California. He also compared data on private treatment in California with those from a national survey of private psychiatrists. Private psychiatrists in California treated as many psychotic patients and used relatively brief psychotherapy about as often as clinic psychiatrists and were more likely to use hospitalization and to see patients individually. In comparison with the national sample, private psychiatrists in California treated more children and patients with situational disturbances and were more likely to receive payment from government sources.

California↗

PubMed2002

Testing privatization of "long arm" service of process.

The research addresses questions about the desirability of privatizing a key component of the child support enforcement process, namely, the serving of legal documents or "service of process" for cases in which the noncustodial parent is living in another state. Child support enforcement cases that require this type of "long arm" service of process were randomly assigned to a private vendor and to out-of-state sheriff offices using an experimental research design. The author finds that although there is no difference in the time it took the two groups to process cases, the private vendor was more successful, on average, at performing this function. Furthermore, he finds that the higher success rate of the private vendor is sufficient to produce a substantively important increase in collections in child support enforcement cases. Additional questions about the suitability of privatizing "service of process" and other like services are also discussed.

Child Care↗

PubMed2001

Utilization of public and private dental services in Sibu, Sarawak: a sociodemographic appraisal and types of treatment received.

This study investigated the sociodemographic profiles of patients attending public and private dental clinics and the types of treatment received. Patients (n=454) were interviewed using a structured questionnaire at two public and four private clinics in Sibu District, Sarawak. Generally, Chinese (74.7%), females (60.0%) and urban dwellers (83.7%) were more likely to visit the dentist. Both clinics had more females and more Chinese but private clinics had a lower percentage of female attendees (53.1% versus 67.0%) but a higher percentage of Chinese (85.0% versus 64.5%). Private attendees were younger (mean age of 31.0 years compared to 41.0 years) and from higher income households (median value of MR 2,000 versus MR 900) than public attendees. Treatments were mostly curative and a third of the visits were associated with painful conditions. Age (p=0.006), gender (p=0.003), ethnicity (p<0.001) and household income (p<0.001) were associated with the type of clinic visited. Choice of clinic was not related to having painful conditions (p=0.970). To ensure a more affordable and equitable distribution of oral healthcare, health planners need to identify disparities in the utilization of services and differences between public and private attendees.

Adolescent↗

PubMedDate not supplied

Using severity-adjusted mortality to compare performance in a Veterans Affairs hospital and in private-sector hospitals.

The objective of this study was to compare hospital mortality in Veterans Affairs (VA) and private-sector patients. The study included 5016 patients admitted to 1 VA hospital. Admission severity of illness was measured using a commercial methodology that was developed in a nationwide database of 850,000 patients from 111 private-sector hospitals. The method uses data abstracted from patients' medical records to predict the risk of death in individual patients, based on the normative database. Analyses compared actual and predicted mortality rates in VA patients. VA patients had higher (P < .05) severity of illness than private-sector patients. The observed mortality rate in VA patients was 4.0% and was similar (P = .09) to the predicted risk of death (4.4%; 95% confidence interval 4.0-4.9%). In subgroup analyses, actual and predicted mortality rates were similar in medical and surgical patients and in groups stratified according to severity of illness, except in the highest severity stratum, in which actual mortality was lower than predicted mortality (57% vs 73%; P < .001). We found that in-hospital mortality in 1 VA hospital and a nationwide sample of private-sector hospitals were similar, after adjusting for severity of illness. Although not directly generalizable to other VA hospitals, our findings nonetheless suggest that the quality of VA and private-sector care may be similar with respect to one important and widely used measure.

Aged↗

PubMed1999

Open heart surgery in public and private practice.

OBJECTIVES: To compare open heart surgery services provided by public and private hospitals in Catalonia (Spain) according to case mix, procedures undergone and surgical mortality. METHODS: Data on all adult patients undergoing open heart surgery procedures were collected prospectively in a sample of public and privately owned centres for a 6.5-month period in 1994. Sociodemographic, clinical and procedural variables were collected. A predictive model stratifying patients according to their surgical mortality risk was used to adjust for differences in case mix between providers. RESULTS: Included were 1287 open heart surgery procedures. Public and private patients differed significantly in terms of gender, clinical history (e.g. hypertension, pulmonary disease, recent infarction) and procedural variables (e.g. reoperation, type of intervention). There were also statistically significant differences related to educational level, with better educated patients more likely to be treated in private centres. Crude surgical mortality rates differed between providers, although public centres operated on higher-risk patients. After adjusting for differences in case mix, the association between the type of provider and surgical mortality was not statistically significant (odds ratio 1.68; 95% CI from 0.94 to 3.0). CONCLUSIONS: Although crude mortality rates differ between public and private providers, there is a significant trend towards higher surgical risk in public centres. After adjusting for surgical risk, differences between types of provider decreased and were no longer statistically significant. The importance of other social and health-related factors, such as educational level, may explain differences between providers in their patients' surgical risk and in their performance in open heart surgery.

Aged↗

PubMedDate not supplied

A decade of growth in public and private pharmaceutical expenditures: the case of Belgium 1990-1999.

OBJECTIVE: To make a systematic, transparent, internationally comparable description of trends (1990-1999) in total, public and private (co-payment + out-of-pocket) spending on pharmaceuticals in Belgium. SETTING: Belgium, a western European country, with a Bismarck-type universal coverage healthcare system. NATURE OF THE STUDY: Descriptive analysis of time-series. METHODS: Collaborative data gathering effort between academic and private research institutes and IMS health. RESULTS: Mean annual growth rate was 3.9% for total, 5.3% for public, and 2.0% for private drug expenditures (expressed in constant 1999 EUR). The ratio of public to private spending shifted from 53.4% to 60.3%. Of the private spending, one third was co-payment for reimbursed medication and two thirds was out-of-pocket payment for non-reimbursed medication. CONCLUSION: Co-operation between several data gathering constituencies within one country was necessary to achieve completeness and detail in data collection on out-of-pocket payments for non-reimbursed medicines, and hence in total drug expenditures. Discrepancies were found between the estimate of the public/private mix and OECD health data 2000 for public drug spending.

Belgium↗

PubMed1992

Private outlets for public limitations: the rise of commercial health insurance in Israel.

In recent years, dissatisfaction with aspects of the Israeli health care system has grown. Labor conflict and unrest, long waits for elective surgery, increases in out-of-pocket payments for health care, and declining government investment have given rise to a new phenomenon: the increasing use of private services. This has led consumers to seek financing sources for their private care and created opportunities for commercial insurers and sick funds to offer new insurance packages to meet this demand. As a result, over the last five years more than twenty commercial health policies and four mandatory supplemental policies provided by the sick funds are currently on the market. The market for these policies is small but growing, with consequences for the cost and quality of care, access, the level and composition of national expenditures, and the allocation of resources to both the public and private health systems. As the balance between private and public financing changes, so too do the trade-offs between differing objectives. Greater private pluralism and competition at the financing level have many advantages but also make it more difficult for government to manage the tradeoffs that occur. Thus, a changed emphasis in government regulation and policy-making is required.

Adult↗

PubMed1992

HMO versus private care medical systems: a study to determine the aging consumers' satisfaction with medical care under these two systems.

In one community, 175 aging persons (44 HMO and 132 private medical care patients) completed a 20-item scale that measured satisfaction with medical care. Data on demographics, health care utilization, and self-assessed health status were collected to determine whether these variables would relate to HMO membership. Satisfaction scores were compared between HMO and private care medical groups by multivariate analysis of variance. Satisfaction with the doctor-patient relationship and convenience of care was higher in the private medical care group, whereas satisfaction with cost was higher in the HMO group. Furthermore, the HMO group evaluated private medical care and HMO care similarly. The private medical care group rated HMO care less favorably. Additional comments reveal specific areas of satisfaction/dissatisfaction.

Aged↗

PubMed2001

A review of private residential care in Hong Kong: implications for policy and practice.

Hong Kong government policy encourages and facilitates families to care for their older members as long as possible by providing families and their older relatives with community support services. Residential care for the elderly is viewed as a last resort. Due to the inadequate supply of community support services, the long period of care required, and the gradual breakdown of values of filial support, families may increasingly give up their caring roles and seek residential care for their dependent elderly relatives. A shortfall in subsidized residential care may lead to needy elderly persons' being cared for in private residential facilities. The demand for private residential care is projected to increase, despite criticism about the standard of care provided. Although an Ordinance, a Regulation, and a Code of Practice for residential care homes are in place to control, monitor, and upgrade private residential care in Hong Kong, problems remain that put the elderly at risk of receiving substandard services. These include the existence of substandard private aged care homes operating either with or without a license; the provision of substandard "places" to the elderly under the government's "bought place" scheme and "enhanced bought place" scheme; ineffective inspection; a lack of grading to indicate the quality of private aged care homes; and a general neglect of the quality of care. We provide recommendations to address these concerns. This requires paying attention to both the quality of care, as well as to the physical environment of homes.

Aged↗

PubMed2006

Do empirically supported treatments generalize to private practice? A benchmark study of a cognitive-behavioural group treatment programme for social phobia.

OBJECTIVES: There is much debate as to whether the treatment effects achieved in well-controlled studies such as randomized controlled trials (RCTs) are generalizable to more "naturalistic" clinical populations, such as that seen in private practice. The current study sought to examine this issue in relation to social phobia. DESIGN: A benchmarking strategy was used to compare the effectiveness of a cognitive-behaviour therapy group programme for social phobia that was developed and evaluated in a research unit, to that of a private practice population. METHODS: Fifty-eight participants from a university research unit and 54 participants from an independent private practice who met the principal diagnostic criteria for social phobia completed the 10-session group programme. Symptom severity was measured at pre-treatment, post-treatment, and 3 months after treatment. RESULTS: No significant treatment differences were found between the research unit and private practice groups. Both groups showed significant treatment effects that were maintained at 3-month follow-up. CONCLUSION: These findings suggest that treatments developed for RCTs are potentially transportable to private practice settings.

Adult↗

PubMedDate not supplied

Bariatric and associated operations in private and academic practices.

BACKGROUND: The types of bariatric and the associated operations performed by academic and private surgeons were surveyed. METHODS: A survey containing 8 questions regarding type of practice, type of surgery, associated procedures during bariatric surgery, years in practice and bariatric training was e-mailed to all members of the American Society for Bariatric Surgery. RESULTS: 46% of the members responded and were divided between those who performed their procedures laparoscopically and those who performed open procedures. Laparoscopic adjustable gastric banding was almost exclusively performed in academic centers and encompassed 20% of their bariatric operations, while the gastric bypass was the most common operation performed (65%), followed by vertical banded gastroplasty and duodenal switch. Operations performed simultaneously indicated that cholecystectomies were performed equally in private practice (92.5%) and the academic sector (95%), with higher incidence in open procedures (95%) compared to laparoscopic (40%). Of the surgeons performing appendectomies, 20% were in private practice and 10% in academic. Liver biopsy was performed with the same incidence in private and academic practices (60%). A minority of responders had formal fellowship training (17%), and many had learned from a partner (40%). The approach was dictated by the surgical training (85%) and background. CONCLUSION: No significant difference was found between the private and academic surgeons in performing operations. Appendectomy is rarely performed academically, and cholecystectomy is mostly performed in the open procedure.

Academic Medical Centers↗

PubMed2002

Factors that influence the willingness of private primary care pediatricians to accept more Medicaid patients.

OBJECTIVE: State Medicaid programs are obligated by federal law to ensure that enrolled children have access to care and services to the same extent as other children in the same geographic area. Because most children in the United States receive health care from private primary care physicians, participation by private, office-based primary care pediatricians is critical to meeting this equal access obligation. The objective of this study was to document variations in Medicaid participation of private office-based primary care pediatricians across states and to examine the effects of payment levels, prevalence of capitated Medicaid payment, and paperwork concerns on participation. METHODS: Survey data collected from 3773 primary care pediatricians who practice in private office-based settings were analyzed with Medicaid physician payment data from other sources. Univariate analyses and a multiple regression were used to examine the effects of payment level, prevalence of capitated Medicaid payment, and paperwork concerns on private primary care pediatricians' participation in state Medicaid programs. RESULTS: Results revealed substantial state-to-state variation in respondents' participation in Medicaid. Univariate analyses found that participation increased with state Medicaid payment levels but decreased as the proportion of Medicaid enrollees with primary care capitated payments rose and as paperwork concerns increased. With physician workforce held constant, a regression analysis showed that pediatrician participation in Medicaid increased significantly with Medicaid payment but decreased as the proportion of capitated Medicaid patients increased and as paperwork concerns rose. CONCLUSIONS: This study found that low payment, capitation, and paperwork concerns all relate to low Medicaid participation by primary care office-based pediatricians. It behooves state policy makers to address these 3 factors to ensure sufficient primary care physician capacity to serve appropriately children who are enrolled in state Medicaid programs.

Capitation Fee↗