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PubMed2006

Asthma guideline use by pediatricians in private practices and asthma morbidity.

OBJECTIVE: We sought to examine whether pediatric clinicians in private, non-health maintenance organization practices could implement the national asthma guidelines and whether, when implemented, these guidelines would decrease medical services utilization and improve asthma care for children. METHODS: A trial of a disease management program (Easy Breathing II) involving 20 private pediatric practices in the greater Hartford, Connecticut area was conducted between January 1, 2001, and December 31, 2003. Demographic data on participating practitioners and patients were obtained from questionnaires. Medical services utilization data from claims were obtained from ConnectiCare, a regional managed care organization. RESULTS: Of the 16750 children enrolled in Easy Breathing II, 2458 were enrolled in ConnectiCare and 490 had asthma. Inhaled corticosteroid use increased in the community overall during the study period. After enrollment in Easy Breathing II, with adjustment for age, gender, ethnicity, asthma severity, season, and calendar year, children with persistent asthma experienced an additional 47% increase in inhaled corticosteroid use, a 56% reduction in outpatient visits, and a 91% decrease in emergency department visits for treatment of asthma. Adherence to national asthma guidelines for prescribing inhaled corticosteroids was 95%. Seventeen of the 20 practices are still using Easy Breathing, 5 years after program implementation. CONCLUSIONS: Pediatric primary care clinicians in private practice settings can implement an asthma management program patterned after the national asthma guidelines. When implemented, this program is successful in reducing medical services utilization for children with asthma. Just as differences in patterns of medical services utilization exist in private practices, compared with urban clinics, the impact of disease management on medical services utilization differs in private practices, compared with urban clinics.

Adolescent↗

PubMed2006

Coverage of the Brazilian population 18 years and older by private health plans: an analysis of data from the World Health Survey.

This study analyzes data from the World Health Survey (WHS) conducted in 2003, with a sample of 5,000 individuals 18 years and older. Some 24.0% of the interviewees had private health insurance, and the main variables associated with private coverage were number of household assets, age, level of education, formal employment, living in municipalities with more than 50,000 inhabitants, and good self-rated health. The socioeconomic profiles of needs for and use of health services in the population covered by private health plans are different, confirming the findings of other studies reporting that this population segment as a whole presents better health conditions and greater use of services as compared to the population without private coverage, even after adjusting for socio-demographic variables and self-rated health. The WHS data also suggest that individuals with private health plans do not always use their insurance to pay for services, except in the case of mammograms.

Adolescent↗

PubMed2006

Comparison of rates of potentially inappropriate medication use according to the Zhan criteria for VA versus private sector medicare HMOs.

BACKGROUND: Inappropriate prescribing in the elderly is common, but rates across different health care systems and the impact of formulary restrictions are not well described. OBJECTIVE: To determine if rates of inappropriate medication use in the elderly differ between the Veterans Affairs (VA) health care system and the private sector Medicare health maintenance organization (HMO) patients. METHODS: A cross-sectional study design compared administrative pharmacy claims from 10 distinct geographic regions in the United States in the VA health care system and 10 analogous regions for patients enrolled in Medicare HMOs. The cohorts included 123,633 VA and 157,517 Medicare HMO patients aged 65 years and older. Inappropriate medication use was identified using the Zhan modification of the Beers criteria, which categorizes 33 potentially inappropriate drugs into 3 major classifications: "always avoid," "rarely appropriate," and "some indications." Comparisons between the VA health care system and the private sector Medicare HMO were performed for overall differences and stratified by gender and age. The drug formulary status of the Zhan-criteria drugs was known for the VA health system but not for the Medicare HMO patients. RESULTS: Compared with private sector patients, VA patients were less likely to receive any inappropriate medication (21% vs. 29%, P <0.001), and in each classification: always avoid (2% vs. 5%, P <0.001), rarely appropriate (8% vs. 13%, P<0.001), and some indications (15% vs. 17%, P <0.001). The rate of inappropriate drug use was lower in the VA compared with the private sector for males (21% vs. 24%, P <0.001) and females (28% vs. 32%, P <0.001). Differences were consistent when stratified by age. CONCLUSION: Compared with private sector Medicare HMOs, elderly VA patients were less likely to receive medications defined by the Zhan criteria as potentially inappropriate. A restrictive formulary that excludes 12 of the 33 Zhan criteria drugs may be a factor in the reduction of undesired prescribing patterns in elderly populations.

Aged↗

PubMed1989

Privatization in French health politics: few projects and little outcome.

The author presents the main features of the organization of the French health care system, revealing an important mixture of public and private actors and institutions and a large number of political restraints that oppose resistance to privatization. In spite of traditional references to "liberal medicine" and recurrent debates opposing public and private intervention, neither the doctors nor the political decision makers have really supported the few projects that have been proposed for privatization or liberalization of health care. On the contrary, the cost-control policy introduced growing State intervention and new management methods into the health care sector, whose actors were not used to it. The privatization and liberalization debates appear as a rhetoric necessary to accommodate these difficult changes.

Cost Control↗

PubMed2006

Perceived importance and integration of the human-animal bond in private veterinary practice.

OBJECTIVE: To determine perceptions of the human-animal bond (HAB) among veterinarians in private practice and evaluate how these veterinarians incorporate the HAB in their practices. DESIGN: Survey. SAMPLE POPULATION: 1,602 veterinarians in private practice in Washington state. PROCEDURE: Participants were contacted and asked to complete a survey. RESULTS: Response rate was 26% (415/1,602). Most respondents agreed that veterinarians will be more successful if they recognize and facilitate the HAB, that facilitating the HAB was important to their practices, that they actively evaluated the degree of bonding between clients and their animals, and that the bonding between a client and his or her animal affected the way they practiced medicine. However, > 50% of respondents did not train veterinary technicians and front office staff members in the HAB or encourage veterinary technicians or front office staff members to learn about the HAB. Fifty-one percent of respondents offered few or no HAB resources to clients. When asked to quantify the importance of 10 nontechnical skills associated with private veterinary practice, respondents ranked communication skills, ethical reasoning, and business management first, second, and third; the HAB was ranked fifth. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that for veterinarians in private practice in Washington state, there is a dichotomy between how important they consider the HAB to be in their practice and the degree to which they facilitate the HAB with regard to communication, training, and client resources. More research on the HAB is necessary to better understand what the HAB encompasses and its implications for private practitioners.

Animal Technicians↗

PubMed2002

Cost-effectiveness of primary care services provided by nurses' private clinics in Thailand.

The purpose of this descriptive study was to determine the cost-effectiveness of primary care provided at nurses' private clinics in Thailand. The sample consisted of 63 nurses' private clinics and 3518 clients. These clinics were selected by multi-stage random sampling. An observation sheet and three questionnaires were used to collect the data. The data indicated that Nurses' private clinics can provide services for about 90% of the clients' problem at the primary care level at about a 50% lower cost than physicians' services. Thus, nurses' private clinics' services should be included in the reimbursement criteria of the national health care system. For nurses who run their own clinics, the Thailand Nursing Council should require additional training and certification in primary medical care. Nurses' private clinics should extend to home care service for people in the nearby area.

Adolescent↗

PubMedDate not supplied

British privatization--taking capitalism to the people.

From 1983 to 1986, John Moore served in the Thatcher government in Britain, launching that country's privatization program. In "British Privatization--Taking Capitalism to the People, " he describes the thinking behind privatization, the objections raised against it, and the actual measures taken to implement it. With privatization, corporate performance has improved and the government has been able to focus on regulation, not ownership. But in the end, says Moore, the greatest success of British privatization was that it transformed the public's attitude toward ownership and economic responsibility.

Economic Competition↗

PubMed1993

How do Medicare physician fees compare with private payers?

Under the new fee schedule, Medicare physician fees are 76 percent of private fees. Consistent with the intent of payment reform, Medicare physician fees more closely approximate private fees for visits (93 percent) than for surgery (51 percent) and in rural areas as compared with large metropolitan areas. Variation in private fees across the country is considerably greater than it is for Medicare fees. Consequently, Medicare fees are most generous in areas that compare least favorably with the private market because private fees in these areas are well above average. These results shed light on the impact of the fee schedule and on the implications of using Medicare payment methods as part of a broad-based health reform.

Data Interpretation, Statistical↗

PubMed1995

Long-term care and the private insurance market.

Increased life expectancy and the aging of the baby boom generation will bring rapid growth in the number of people at risk of needing long-term care (LTC). This Issue Brief provides an overview of the current LTC financing and delivery system in the United States, focusing on private-sector initiatives to meet the United States' LTC needs. It discusses private-sector plan design--particularly employment-based plan design--providing an in-depth look at the dramatic changes taking place in the private-sector LTC market since its inception in the early and mid 1980s. Aside from informal care provided in the community, the current system of financing LTC depends largely on the Medicaid program and individual financing. Issues confronting this system include spiraling costs associated with LTC services that may threaten beneficiaries' access to care. Other issues include the potential depletion of personal assets and a bias toward institutionalization (which may not always provide the most cost-effective or desired type of care available). Many leaders regard private long-term care insurance (LTCI) as a way to increase access to financing and as a potential alternative to Medicaid and out-of-pocket financing. By the end of 1993, a total of 3.4 million private-sector LTCI policies had been sold, up from approximately 815,000 in 1987. While the majority of these plans were sold to individuals or through group associations, employment-based plans accounted for a significant proportion of this growth. Premiums for LTCI vary substantially based on age and plan design. Insurers generally attempt to set premiums such that they will remain level over the insured's lifetime. However, because little LTC claims insurance experience yet exists, the actuarial basis for developing premiums and statutory reserves is limited. Several bills over the last three Congresses have been introduced to address the issue of LTC. However, due to cost implications and lack of consensus regarding the optimum overall structure required to finance and deliver care, broad legislation to expand coverage--particularly public coverage--is not likely in the near term.

Aged↗

PubMed1995

Gynaecology: the experience of patients referred to NHS and private clinics.

This cohort study compared the experience of patients seeking treatment for menorrhagia who were referred to National Health Service (NHS) or private clinics. Two-hundred and nine patients in 73 general practices in Berkshire, Buckinghamshire, Northamptonshire and Oxfordshire were recruited by their general practitioners and followed-up with questionnaires at nine months and 18 months after entry to the study. One hundred and fifty patients were referred to NHS clinics and 59 to private clinics; there were no significant differences between the two groups of patients in terms of symptom severity, reason for referral or treatment received. Patients who went to private clinics were more likely to report active participation in decisions about their care (p < 0.05 after adjustment for age and educational status), and were slightly more likely to be satisfied with the care they had received. The treatment decisions made in gynaecological clinics in the NHS and private sector were similar, but the decision-making styles appeared to be different. Private patients were more likely to participate in treatment decisions than NHS patients.

Adult↗

PubMed1998

Privatization, social structures and delivery of health care in the Slovak Republic.

Each country in Central and Eastern Europe has developed a variety of strategies for implementing interventions and improvements in their health care delivery system. Transformation efforts in the Slovak Republic have focused on decentralization, privatization, democratization and liberalization. While the pressures for change have unevenly fallen throughout Central and Eastern Europe, the Slovak Republic has initiated structural changes, particularly in the area of privatization. The concept of privatization requires further discussion especially when considering the principle of subsidiarity and the need to develop coherent social structures. Areas for structural changes in the Slovak Republic are examined in the area of privatization of transformation efforts. Characteristics of successful voluntary organizations in private economies are discussed with appropriate future concerns identified for further analysis.

Accreditation↗

PubMed1999

[Initial results of privatization of primary health services in the area of Pozega].

Privatization of the primary health care in the Pozega region has been going on gradually since 1992, when 30 general practice teams and 27 dentist teams provided care for 71,745 inhabitants. Up to 1998, 17 general practices with the contract with the Croatian Institute of Health Insurance (HZZO) for 36,714 insured, 15 dentist offices with the contract with the HZZO for 39,715 insured, one orthodontist office, and one for home care, underwent privatization. Another three dentist offices, one gynecological, and one ophthalmological practice were privatized without the contract with the HZZO. As it turned out, the successful privatization requires good knowledge of the project devised by the Ministry of Health, positive attitude of the county authorities and the administration of health care centres, as well as flexibility during the implementation of the project. On the basis of the conducted poll and other objective indices, it is concluded that the initial positive results of the privatization of the primary care are numerous and encouraging. However, there are also some negative ones which should be eliminated.

Croatia↗

PubMed1999

Sputum examination for acid-fast bacilli in private laboratories, Kathmandu Valley, Nepal.

OBJECTIVE: To investigate the characteristics of private laboratories and the process of sputum examination for acid-fast bacilli (AFB). DESIGN: A door-to-door survey of private laboratories in an urban municipality of Kathmandu valley was conducted during the first quarter of 1998. Semi-structured interviews were conducted with staff of 14/20 (70%) identified laboratories. RESULTS: All 14 private laboratories conducted sputum examination for AFB. The majority (71%) of staff lacked special training for AFB examinations. Monocular microscopes were commonly used (36%). Reagents were prepared irregularly, without quality control, and kept for as long as they lasted, often up to 4-6 months (43%). Laboratory registers were usually present (86%), but lacked information on patient's address and the purpose of the test. A median of 12.5 slides per laboratory had been examined during the previous month (range 0-70). A total of 235 AFB slides were examined, of which 18 (7.7%) were reported as positive. CONCLUSION: AFB examinations were widely available. Lack of training and quality control suggest a variable standard of AFB test results. It is recommended that the National Tuberculosis Programme (NTP) provide support and quality control to two to three (i.e., one for every 10) private laboratories in the area to secure private doctors' confidence in sputum testing.

Humans↗

PubMed2000

Global public-private partnerships: Part I--A new development in health?

The proliferation of public-private partnerships is rapidly reconfiguring the international health landscape. This article (part I of two on the subject) traces the changing nature of partnership, and discusses the definitional and conceptual ambiguities surrounding the term. After defining global public-private partnerships (GPPPs) for health development, we analyse the factors which have led to the convergence of public and private actors and discuss the consequences of the trend toward partnership between UN agencies (including the World Bank) and commercial entities in the health sector. Generic factors such as globalization and disillusionment with the UN, and factors specific to the health sector, such as market failure in product development for orphan diseases, are examined. Reviewed are the interests, policies, practices and concerns of the UN, the private-for-profit sector, bilateral organizations, and governments of low-income countries with respect to public-private partnership. While GPPPs bring much needed resources to problems of international health, we highlight concerns regarding this new organizational format. Part II, which will be published in the May issue of the Bulletin, presents a conceptual framework for analysing health GPPPs and explores the issues raised.

Global Health↗

PubMedDate not supplied

Socio-demographic and clinical profile of patients attending a private psychiatric hospital in Lagos, Nigeria.

The pattern of private psychiatric practice in Nigeria was examined by carrying out a prospective study in a private hospital. In all, one hundred and thirty-eight (138) consecutive patients of nearly equal sex distribution were seen in a total of about six hundred and forty-four (644) consultation sessions in one year. The young adults (31 - 45 years old) constitute the highest percentage (43.5%) of the patients' age groups. Contrary to the findings of some Nigerian studies in the recent years, neurological disorders mainly epilepsies accounted for the highest number of cases seen (36%). In frequency, this was followed by schizophrenias (22.5%) and affective disorders (18.8%). The peculiarity of these findings could be explained on the ground of referral bias because the hospital is reputed for managing neuropsychiatric disorders; however, despite this factor, the apparent lesson from this study is that psychiatrists in private practice should be equipped with skills to manage neurological disorders. It is concluded that private psychiatric practice in Nigeria is still at an infancy stage but contributing significantly to mental health care services in the country; and the need for further research into private psychiatric practice was highlighted.

Adolescent↗

PubMed1992

Appropriateness of cholecystectomy: the public and private sectors compared.

OBJECTIVE: To investigate the appropriateness of cholecystectomies undertaken in the public and private health sectors. DESIGN: Retrospective case note review using the findings of two consensus panels. SETTING: 35 consultant surgeons working for North West Thames Regional Health Authority and in the private sector. PATIENTS: 269 patients undergoing cholecystectomy during the study period, of whom 17 were excluded because there was insufficient information available. MAIN OUTCOME MEASURES: Appropriateness ratings as assessed by two consensus panels, one composed of surgeons and one mixed, containing doctors from different specialties. RESULTS: The mixed panel would have rated 41 per cent of cases appropriate, less than 1 per cent equivocal and 30 per cent inappropriate. The remaining 29 per cent had indications about which the panel did not reach agreement. The surgical panel would have rated 52 per cent appropriate, 3 per cent equivocal and 2 per cent inappropriate. The remaining 44 per cent had indications about which the panel did not reach agreement. Most of the patients who would have been rated inappropriate had vague symptoms only. There were no significant differences between the NHS and private patients as regards their appropriateness. NHS patients were more likely to have more than one ultrasound and to be operated on as an emergency. CONCLUSIONS: An appreciable proportion of patients undergo cholecystectomy for indications which were deemed inappropriate by a mixed panel, but not a surgical panel. Variation in clinical judgement is an important factor in the decision to operate--44 per cent of cases had indications, the appropriateness of which the surgical panel were undecided about. There were no significant differences between NHS and private patients as regards the appropriateness of their indications. These findings need to be confirmed by further studies comparing the public and private sectors.

Adult↗

PubMed2003

Promoting safe motherhood through the private sector in low- and middle-income countries.

The formal private sector could play a significant role in determining whether success or failure is achieved in working towards goals for safe motherhood in many low- and middle-income settings. Established private providers, especially nurses/midwives, have the potential to contribute to safe motherhood practices if they are involved in the care continuum. However, they have largely been overlooked by policy-makers in low-income settings. The private sector (mainly doctors) contributes to overprovision and high Caesarean section rates in settings where it provides care to wealthier segments of the population; such care is often funded through third-party payment schemes. In poorer settings, especially rural areas, private nurses/midwives and the women who choose to use them are likely to experience similar constraints to those encountered in the public sector - for example, poor or unaffordable access to higher level facilities for the management of obstetrical emergencies. Policy-makers at the country-level need to map the health system and understand the nature and distribution of the private sector, and what influences it. This potential resource could then be mobilized to work towards the achievement of safe motherhood goals.

Adolescent↗

PubMed2003

Involvement of private practitioners in RNTCP.

Private Practitioners are often the first point of conduct for a significant proportion of TB patients. For long-term success of RNTCP involvement of them is very essential. All Private Practitioners can support and encourage effective TB control by ensuring prompt referral, providing reassurance to patients, giving RNTCP recommended drug regimens and only starting treatment with rifampicin containing regimens if the full course of treatment can be ensured to be completed under direct observation. Schemes for Private Practitioners' involvement in RNTCP are: Scheme 1 referral services, scheme 2 provision of Directly Observed Treatment, scheme 3a designated MC--microscopy only, scheme 3b designated paid MC-microscopy and treatment, scheme 4a designated MC-microscopy only, scheme 4 b designated MC-microscopy and treatment. Nationwide Public--Private Mix (PPM) services involving 1500 private practitioners are providing RNTCP services successfully.

Communicable Disease Control↗