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PubMed2003

The public-private mix in India's Revised National Tuberculosis Control Programme--an update.

The Revised National TB Control Programme (RNTCP) in India has made definite progress over the last 2 years and given a boost to global DOTS expansion. The Private Practitioners (PPs) involved in Public-Private Mix (PPM) in India's RNTCP are the first point of contact for more than 2/3rds of TB symptomatics. The vital components of PPM approach are supervision and monitoring of diagnosis of referred cases from PPs, functioning of private laboratories, registration of confirmed cases, treatment with DOT and documentation. The most important contribution of some of the PPM projects has been the creation of a link in the form of a referral system between the private and public sectors. PPM can contribute positively to the performance of RNTCP. RNTCP should be seen as the first step towards an exciting direction in engaging private sector in public health programmes.

Communicable Disease Control↗
PubMedDate not supplied

[Private sector health services use in the Omsk region].

The progress made by the private medical sector in different Russia's regions has been uneven. A key share of private medical facilities is concentrated in big cities. The frequency rate of citizens' asking the rural and urban private practitioners for medical care was investigated by the example of the Omsk Region. The dynamic morbidity and the specificity of its structure are described on the basis of the data contained in basic medical registration documents borrowed from private medical institutions. The importance and value of the information-and-analytical cooperation between the private-sector structures, on the one hand, and the healthcare management bodies, on the other hand, are pointed out.

Adolescent↗
PubMed2004

Impact of an educational intervention to improve prescribing by private physicians in Uganda.

INTRODUCTION: Private physicians in urban Uganda treat a large percentage of common adult illnesses. Improving their prescribing would not only encourage more rational drug use, but also reduce costs to patients. Interventions to improve drug use are generally more successful when face-to-face educational methods are included. OBJECTIVES: To determine the effectiveness of a face-to-face educational intervention on the treatment of acute respiratory infections (ARI), malaria, and non-dysenteric diarrhoea by private physicians in three urban areas of Uganda. METHODS: The study used an intervention with comparison group design to evaluate the impact of the educational intervention. A total of 108 private physicians was divided into intervention (n = 30) and control (n = 78) groups. Surrogate patients, trained to simulate presenting symptoms and signs of the target conditions, were used to collect data on the medical practices and prescribing behaviours of the physicians. Intervention physicians were invited to a one-day interactive educational seminar facilitated by local opinion leaders that covered principles of rational drug use and the National Standard Treatment Guidelines for treating the target conditions. Physicians were also provided with data about baseline practices. RESULTS: Baseline data indicated high rates of inappropriate treatment practices by both intervention and control groups. There was nearly universal antibiotic use for ARI (over 90%), high rates of injections recommended for malaria (over 30%), and high rates of polypharmacy (over thee drugs per patient). After the intervention, some significant improvements in key practices were observed in the intervention group. Compared to control physicians, antibiotic prescribing for ARI decreased by 23% in the intervention group, use of combination products for malaria declined by 28%, there were trends towards better adherence to guidelines for ARI and malaria, and marginal decreases in drug costs. However, the overall impacts of the intervention were limited, especially on quality indicators concerning history taking, adequate examination, and advice to patients. CONCLUSION: The face-to-face educational intervention resulted in some small improvements in key prescribing practices of private physicians. However, an intervention that involved repeated contacts with prescribers and which addressed economic considerations would be needed to obtain larger improvements. Private physicians need to be sensitized to and encouraged to use the National Standard Treatment Guidelines, and attempts to improve their prescribing should be supported by community education.

Acute Disease↗
PubMed2004

Mechanisms for collaboration between public and private veterinarians: the animal health accreditation mandate.

There are several examples of national collaboration between official Veterinary Services and the private sector, in both developed and developing countries. In developed countries national veterinary systems tend to have a 'centripetal' structure: from the private to the somewhat centralised public system, whilst in developing countries there is currently the reverse, i.e. a 'centrifugal' movement. Faced with international quality requirements for national Veterinary Services, the institutional foundations for the execution of certain official activities by the private sector are provided by the OIE (World organisation for animal health), particularly in the Terrestrial Animal Health Code. The private sector should however be employed using clear formal procedures governed by various legally recognised systems. At this level, the animal health accreditation mandate has the advantage of combining within a single concept several legal benefits associated with each type of collaboration. Moreover, it can encourage private veterinarians to work in the field, and to continue to do so for a reasonable length of time, thus providing a de facto territorial network of competent, logistically independent professionals, acting as ad hoc public service agents for both the design and implementation of animal health related activities, all at an economic cost that does not compromise the budget of the national Veterinary Services. By making savings in terms of human and material resources, the animal health accreditation mandate appears to be particularly suitable for developing countries where means of communication and intervention often come up against unforeseen logistical difficulties.

Animal Welfare↗
PubMed2004

[The National Order of Veterinary Doctors of Madagascar and the quality control of private veterinarians].

Veterinary medicine was introduced into Madagascar with the arrival of French settlers in the early 1900s. At first, veterinary practitioners were all French, and they trained Madagascan veterinary auxiliaries. The first Madagascan veterinarians were trained in French veterinary schools. The idea of organising the profession dates back to the 1970s, but only in 1991 was the Animal Health Law, covering the veterinary profession, adopted by the National Assembly; it was promulgated by President Ratsiraka on July 25 of that same year. Thus, the National Order of Veterinary Doctors of Madagascar (ONDVM: Ordre national des docteurs vétérinaires malagasy) was instituted by a decree in February 1992. All veterinarians and paraprofessionals were employed in the public sector at the time and this new structure proved vital for the private exercise of the veterinary profession. With the adoption of a new national livestock policy, vaccination against major cattle and swine diseases became a profitable activity. One of the objectives of the sectoral livestock programme was that a total of 90 new posts for veterinarians should be created and located throughout the different regions and rural townships of the country. The Centre de promotion vétérinaire (Centre for Veterinary Promotion), which was created in 1992, was the organisation charged with carrying out this task. In 1998, once the private veterinarians were installed, a survey was undertaken with the aim of making an exhaustive assessment of all private veterinarians, collecting data from the public veterinary stations in zones covered by private veterinarians, and establishing a programme of disengagement and withdrawal of the decentralised services, particularly the public veterinary stations. More recently, the Administration and the ONDVM have been facing various organisational problems, notably with regard to the different levels of animal health staff working in the field. Thus, the Order is currently waging a mobilisation and awareness campaign for the adoption of a new animal health law. All new measures would be aimed at strengthening the management of artificial insemination centres and border protection and improving the work of all those involved in animal health: official and private veterinarians and members of the Order of Veterinary Doctors and the Order of Veterinary Paraprofessionals.

Animal Welfare↗
PubMed1992

[Private practice-hospital network for the management of HIV infected patients. An initial survey in the Val de Marne region].

A transmissible disease, necessitating medical, social and preventive management, AIDS implicates the involvement of diverse parts of the social and health care systems. The private health sector (general practitioners and specialists, nurses, physical therapists, dentists) must assure part of this management throughout the evolution of the disease. Discussions on how to handle the transference of the responsibility from the hospital to the private health sector have given rise to the network concept. Prior to establishing such a network, an inquiry was carried out to determine the practitioner's level of theoretical knowledge of AIDS and their involvement with infected patients. Mastery of theoretical elements varied, but better scores were obtained on questions dealing with diagnosis and treatment. As regards private practice (care, follow-up, prevention), responses indicated that, in the region around Créteil, experience was moderate, not exceeding 300 acts per year. Thirty doctors had more than a passing acquaintance with the disease and this activity had increased slightly from 1989 to 1990. As most patients were simultaneously followed by a staff physician, private practitioners preferred an annual update to long-term study leading to specialization. Thus the private sector, which is far from being saturated, has sufficient knowledge available and dispenses care ethically in agreement with institutional recommendations. The high number of responses (356 for 1,353 questionnaires) indicates the credibility of the inquiring organizations and the extreme sensitivity of the medical profession to AIDS.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Tuberculosis control and the private health sector in Bolivia: a survey of pharmacies.

BACKGROUND: Bolivia is a high tuberculosis (TB) incidence country with a large private for-profit health sector. TB drug sales in private pharmacies are not illegal. OBJECTIVES: To measure the availability of TB drugs in private pharmacies, study vendors' attitudes, and explore the potential for collaboration between the public health sector and pharmacies. METHODS: Simulated clients visited a random sample of 100 pharmacies in the city of Cochabamba, presenting with a prescription for four TB drugs. After the survey, contacts were made with the local Pharmacist's Association. RESULTS: Twenty-five pharmacies sold at least one drug, 23 sold rifampicin and 16 sold isoniazid. Of 99 pharmacies unable to fill the whole prescription, 59 referred the client to another pharmacy, and 22 to the public services. Pharmacists said that rifampicin was often prescribed for non-TB indications, and that TB drug sales were of minimal contribution to their income. They agreed to stop selling the drugs and to refer clients seeking them to the public sector. CONCLUSION: This study has documented a small market for TB drugs sales in private pharmacies and provided the opportunity to start collaboration with the pharmacists. Our results suggest that the private sector contributes little to managing TB in Bolivia.

Antitubercular Agents↗
PubMed2004

The privatization of human services: myths, social capital and civil society.

It is fashionable to point to privatization and the involvement of for-profits as the parties responsible for many, if not most, of the ills that plague the social welfare system today. This article takes a contrary point of view. Three arguments are made. First, private sector human service delivery and the use of for-profits in the United States predate privatization as a defined public policy. Second, the privatization of the human services is a world wide phenomenon that transcends politics and ideology. Third, the privatization of human services helps to promote civil society and generate social capital.

Government Agencies↗
PubMedDate not supplied

[Nurses in private practice in France].

In the French health care system, most nurses work in hospitals as salaried, but a number are also salaried in health centers or operate in their private offices. About 48,000 are private practitioners, they provide nearly all the ambulatory nursing care to the population. A survey undertaken in early 2004 shows that on the average, their weekly working time is 40 hours: 10 hours are devoted to injections, 9 to dressings, 17 to nursing care and 4 to other activities. Out of 10 nurses in private practice, 3 think that their workload is too heavy. Moreover, 19% declare that they are willing to leave private practice over the 3 coming years. If all the individual plans become reality, more that 9000 private nurses would disappear during the coming years from a workforce of 48,000:2900 would retire, 2700 would become salaried in hospitals, 3200 would take up an other job and 400 would become temporary workers in interim companies. Will the tasks they let be carried out by their remaining colleagues? No doubt that this will not be the case only 7% of the surveyed professionals declare that they are willing to increase their workload. As nurses shortage in French hospitals is evident nowadays, it seems that shortage in ambulatory care is unavoidable. The surveyed nurses point out 3 important difficulties they are encountering. One nurse out of 4 complain about the heavy administrative procedures i.e. the numerous and complex forms they have to fill out. One out of 6 complains about the lack of locum tenets. Furthermore, one out of 15 are in favour of suppressing the official "Nursing Care Approach" which was promoted recently, precisely to highlight the importance of their professional work.

Adult↗
PubMed2006

Perceptions and practices of private medical practitioners to adolescent reproductive health in Lagos State, Nigeria.

INTRODUCTION AND OBJECTIVES: Adolescent sexual and reproductive ill health is a major global public health issue, contributing to high levels of morbidity and mortality in adolescents. Although adolescents are known to have low levels of doctor consultations, private medical practitioners remain the preferred health care providers. This study was carried out to document the attitudes and experiences of private medical practitioners to adolescent reproductive health issues and to assess the factors that may influence their attitudes. METHODS: Information was obtained from a random sample of 187 out of 352 (53% ) registered private medical practitioners in 5 of the 20 Local Government Areas in Lagos State using a self-administered structured questionnaire. RESULTS: Sixty-two per cent of the doctors claimed they saw adolescents regularly, mainly for the treatment of sexually transmitted infections (STIs). Many (86% ) believed that adolescents should use contraception and suggested that parents, teachers and health workers provide sexuality information to adolescents. Sixty one percent of the practitioners believed that abortion should be legalised, though with restrictions. Many of them admitted to providing post abortion care to adolescents. The religious affiliation of the private medical practitioners influenced their perception and practices. CONCLUSION AND RECOMMENDATIONS: Improving the reproductive health care of adolescents is key to improving the world's future economic and social well being. It is recommended that appropriate sexuality education be made widely available to adolescents. In addition, private medical practitioners should strengthen their skills and be more actively involved in the care of adolescents by making their facilities more adolescent friendly.

Abortion, Induced↗
PubMed1995

A study of maternal and child health care services and private sector in urban Asir Region.

The differences in the maternal and child health care services offered by government and private sector in Abha and Khamis Mushayt cities in Asir Region of Saudi Arabia were compared. Self administered questionnaires and observation sheet were used for the study. It was found that the government clinics were more involved in the running of under 5 clinics and giving health education to patients. The private clinics took more care of women general health care but lacked the continuous domiciliary visit to pregnant women. The catchment area which served the government PHCCs made accessibility to service easier to government patients and this was thought to be the reason why government patients kept regular appointments. On the other hand, private patients who have the freedom to choose where they get service have been found to be irregular in keeping clinic appointment. It was suggested that there should be geographical spread in the location of private clinics to facilitate accessibility and that the health education and under 5 clinics should be well incorporated into the services offered by private clinics.

Child Health Services↗
PubMed1990

A survey of Papua New Guinean private medical practitioners.

A postal survey of all Papua New Guinean private medical practitioners was conducted to ascertain their practice characteristics, how well they kept up with current medical knowledge and whether they were interested in contributing to public sector medicine. Replies were received from 44% of the doctors, who mostly represented the younger age group of graduates. The majority of the responders had entered private practice since 1981, were self-employed and made little use of existing opportunities for keeping up to date with medical knowledge. The average number of patients seen in a day showed a normal distribution with a peak at 20-29 patients per day. Over 75% of the responders stated that they would be willing to work for the government health services on a sessional basis at an average minimum hourly rate of K40. Financial reasons were given as the main justification for leaving government service. When asked whether they would return to full-time public service if doctors' terms and conditions improved, the private practitioners were evenly divided. Those interested in returning would expect an average annual salary of approximately K30,000 per annum. In this paper we argue that private medical care has so far been allowed to develop without guidance and controls, and little use has been made of it to support government health services. Escalating shortages of financial and human resources have now made it imperative to find innovative ways of developing both services in harmony with each other so that private medical services for the mostly urban minority will not grow to the detriment of public medical services for the rural majority.

Delivery of Health Care↗
PubMed1989

Employment choices and earnings of social workers: comparing private practice and salaried employment.

Direct recognition statutes, such as freedom of choice and vendorship laws, have the potential to increase the number of independent providers of psychotherapy, and thus to increase competition in the market for psychotherapy. These laws increase the economic return to private practice by requiring that third-party payers directly reimburse psychologists and social workers. There has been, however, little empirical investigation of the responsiveness of psychotherapists' employment choices to changes in the economic return to private practice. In this study, a structural model of social workers' earnings and employment choices between private practice and salaried employment is estimated. After correcting for the potential self selection bias, the results suggest that increasing the relative return to private practice does not increase the probability that a social worker will enter private practice.

Economic Competition↗
PubMed1986

Clinical experience of medical students in model family practices and private family practices.

The clinical experience of 21 Duke medical students during their family medicine clerkship is analyzed to compare experience in model family practices with that in private family practices. In model practices where 50 percent of the time involved patient care, students saw an average of 41 different patients for 45 encounters and 73 problem contacts during the month. In private practices with 100 percent time devoted to patient care, students saw 140 patients for 193 encounters and 346 problem contacts during the month. Most patients were seen in the physician office in both sites (89.0 percent model and 70.4 percent private), but fewer were seen as hospital inpatients in the model than in the private practices (6.3 vs 25.7 percent). The types of patient problems were alike, with the same 11 problems ranking in the top 15 most frequently seen in the two locations. The major difference in experience relates to the larger volume of patients and problems encountered in the private than in the model sites.

Clinical Clerkship↗
PubMed1985

Referral to consultants--the National Health Service versus private practice.

In a three-month audit of referrals to consultants by 18 general practitioners, a wide variation in individual doctor's referral rates was observed. The rate for private referral varied between doctors to a remarkable degree. Referrals made privately were twice as likely as NHS referrals to have been initiated by the patient. Private referrals were perceived by the doctors to have been no less worth-while than NHS referrals. The holding of private health insurance by patients was a factor in a third of private referrals.

Family Practice↗
PubMed1978

New dimensions: the dietitian in private practice.

Private practice is coming to the fore in the profession of dietetics. It can serve as a much needed arm of the health care delivery system in the area of nutrition. Institutions need to re-evaluate and expand their opportunities to sue private practioners, thus releasing more employee time for short-term remedial counseling and education. Referral processes need to be designed and implemented to open new opportunities for consumers to choose and obtain continuing services. Private practice must be included in funding methods, such as third-party payment. Educationl institutions must design programs to prepare persons for private practice. The profession must solve the problem of obtaining community recognition of properly qualified professional authority. The profession must also support the concept of a lifetime career in direct private practice and plan career tracks to keep the most able practioners available to consumers.

Community Health Services↗
PubMed1995

Prostate cancer screening practices: differences between clinic and private patients.

How often prostate cancer screening tests are conducted in general practice is unknown. It is known that at the primary care level, health care delivered to uninsured and Medicaid patients and to privately insured patients differs. We investigated the frequency of digital rectal examination and prostate-specific antigen testing in a clinic (an internal medicine clinic) and a faculty private practice population at The Mount Sinai Hospital over a period of one year. A total of 165 male patients over 40 years of age were asked to respond to a survey questionnaire; 142 interviews were completed (62 private and 80 clinic). Chart and computer database review were used to record the last serum prostate-specific antigen test performed. There was no difference in age distribution between the two groups. The private practice patients were more likely to be insured and college educated, whereas the clinic patients were more likely to have no more than an eighth-grade education and to receive Medicaid. The two groups did not differ in frequency of digital examination within the past year. Private patients were six times more likely than clinic patients to have had prostate-specific antigen screening and seven times more likely to receive both of the recommended prostate screening tests within the past year. Results also showed that 25% of all patients were not screened for cancer by digital rectal examination. Study of a larger population is recommended to further corroborate these findings.

Adult↗
PubMed1995

[Negotiations between a general practitioner and the patient after his visit to a private physician].

OBJECTIVE: To find what patients request from their general practitioner after they have seen a doctor privately and the type of negotiation which follows. DESIGN: A descriptive observation study of a crossover type. SETTING: Palma-Palmilla Health Centre (Málaga); within the primary care ambit. PATIENTS AND OTHER PARTICIPANTS: Everyone at the on-demand clinics of five general medical practices, who requested something concrete from their general practitioner after they had seen a doctor privately, in the period from june to october 1993. MEASUREMENTS AND MAIN RESULTS: There were 83 patients who attended a clinic after seeing a doctor privately, which was 0.63% of the total consultations during this period. 69 of these patients asked their general practitioner to give them the same prescriptions that they had been prescribed privately. In 77% of the cases there was negotiation with the patient, a mutual promise being the most common result. There was no negotiation with 19 patients (23%). In 74% of the cases the medication prescribed privately was considered necessary. The wishes of the patients were fulfilled in practice in 65% of cases. CONCLUSIONS: In most cases there was negotiation with patients. doctors agreed to a high degree with patients' requests, which doctors considered sufficient and necessary for the diagnosis and/or treatment of their condition.

Adolescent↗