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PubMed1994

[The public-private mix in hospital care in the Lombardy region].

OBJECTIVES: 1) to compare complexity and severity of the case-mix in the public and private sector, overall and across individual hospitals, and to examine their relative efficiency, by contrasting DRG and/or stage specific average length of stay (ALOS); 2) to assess the impact of a new contractual scheme based on a preassigned number of beddays for a restricted list of specific conditions. DATA SOURCES: Discharge data on 940.670 admissions to 101 public hospitals and 185.161 admissions to 55 private hospitals in the Regione Lombardia in 1990, assigned to HCFA-DRGs, 8th version and to stages and substages of principal and unrelated diagnostic categories, based on Disease Staging. RESULT: The spread of the case-mix is higher in the private sector, which also shows a higher concentration of admissions across hospital for specific medical and surgical conditions. The proportion of more advanced stages of disease is higher in the public sector, for most of the most frequent diagnostic categories. Obstetric care, including abortion, is the largest single public sector activity, while it is virtually not existent in the private sector. Elective surgical procedures, including ENT, cataract and varicose veins surgery make up a substantial proportion of the private hospitals' case load. DRGs-specific ALOS is longer in public hospitals for the most frequent surgical DRGs, mainly due to their preoperative LOS. The net impact of the proposed contractual scheme will save substantial proportion of beddays for most of the conditions considered, except cataract and varicose veins surgery.

Adult↗
PubMed1994

Quality of care in public and private primary health care facilities: structural comparisons in Jamaica.

This article examines the quality of care provided by Jamaican primary health care clinics by comparing various structural quality indexes derived from a nationwide 1990 survey of 366 public clinics and 189 private clinics. This comparison points up important differences in the quality of care being provided by public versus private and urban versus rural facilities that might not have been anticipated. Among other things, the study found that the public clinics provided better prenatal diagnosis and counseling and more family planning services than the private clinics. However, the private clinics tended to be better condition, better equipped and supplied, and better able to provide certain laboratory test results in a timely manner. Comparison of urban and rural public clinics indicated that the urban clinics were somewhat better provisioned with equipment, supplies, and pharmaceuticals. However, the rural clinics appeared to be in better repair. Comparison of basic and higher-level public clinics showed the basic clinics to be in better condition and more fully staffed than the higher-level clinics while having similar perinatal diagnostic capabilities. However, the higher-level public clinics tended to have an overall profile more resembling that of the private clinics, being better equipped and supplied than the basic clinics. While structural measures of quality such as those employed here tend to poorly estimate health outcomes, they do serve as good indicators of access to services where resources are severely constrained. For policy-makers, the results presented here could prove useful in guiding concrete interventions, summarizing the structural elements of health care quality at different types of facilities, and providing a method for less costly evaluation of programs designed to improve services at primary health care clinics.

Ambulatory Care Facilities↗
PubMed1993

Private sector response against the cholera threat in Trinidad and Tobago.

During the first half of 1992 the threat of cholera to Trinidad and Tobago prompted a strong health education effort by public authorities and the private sector. To help assess the private sector effort, the cost of cholera-related advertisements and private announcements placed in the country's two leading newspapers during January-June 1992 were reviewed. The review indicated that an estimated TT$ 540,660 was spent on these ads and announcements, that they contributed strongly to keeping cholera prevention continuously in the public eye, and that most of the messages published were accurate, specific, and safe. The strength and success of the private contribution to cholera prevention in this case suggests that similar approaches could be applied to other health problems and to the cholera problem outside Trinidad and Tobago. Overall, the lesson appears to be that if one can find congruence between private sector motives and public health interests, then the potential prospects for a successful partnership are great.

Advertising↗
PubMed1993

Anonymous cocaine screening in a private obstetric population.

OBJECTIVE: To establish the prevalence of cocaine use in private obstetric patients during their prenatal care and at admission to delivery units. METHODS: Urine samples were collected anonymously during routine sampling from 1425 patients in six private hospitals and four private physicians' offices. RESULTS: Positive cocaine metabolites were identified in three of 555 urine specimens (0.54%) obtained from hospitals and in two of 870 (0.23%) obtained from private offices during prenatal examinations. The total positive urine cocaine results were five of 1425 (0.35%). CONCLUSIONS: Universal screening in a private obstetric population similar to that found in Denver would not be cost-effective. We urge health care providers to ask patients about substance abuse and to screen patients who are at high risk for substance use.

Cocaine↗
PubMed1996

Utilisation of government and private health services in Dar es Salaam.

Following the liberalisation of medical practice in Tanzania since the early 1990's, and the introduction of user fees in public hospitals in 1993, a household survey evaluated utilisation of health care in Dar es Salaam. A sample of 6,589 inhabitants was interviewed in April 1995 by means of a two-stage cluster sampling technique. Of the respondents, 32% reported some use of health care within the previous two weeks. Among these respondents, 35% had used government health services, 41% had used private services and self-treatment was chosen by 27%. The user patterns identified reveal that adults aged 15-49 years used government health service least often. Use of government services clearly decreased as the level of education, socioeconomic class and wealth status of the zone of residence of the ill person increased. Conversely in the study sample, there was an apparent tendency for people with a high level of education or belonging to a rich socio-economic class to use private facilities more often. The data also indicate that already after two years the private sector plays an important role in providing medical care and that a two-tier system of health care delivery is developing. In order to render the private sector complementary to public services, there is need for a coherent policy on legislation, development, regulation and control of private sector health services as well as a monitoring system to reinforce the policies.

Adolescent↗
PubMedDate not supplied

Immunization rates among young children in the public and private health care sectors.

INTRODUCTION: To meet the national goal of 90% immunization levels in 2 year olds, both the public and private sectors must achieve optimal standards for immunization delivery. This study investigated differences in characteristics of children receiving immunizations from public and private providers and assessed parental attitudes about prevention, perception of barriers, and attitudes about vaccines. METHODS: Data are from a 1994 statewide household survey of 3,813 parents of children between the ages of 3 and 24 months. Information on the percentage of children up-to-date for recommended diphtheria and tetanus toxoids, pertussis, oral polio, measles, mumps, and rubella vaccines was based on parent-held immunization records (72%) and parental recall. RESULTS: The percentage of children up-to-date for their immunizations was higher for those attending public clinics (59.8%) than those at private offices (53.8%). Users of the public system were more likely to be Hispanic, not to have graduated from high school, to be < or = 100% of poverty, never married, and unemployed. These parents also were significantly more likely to wonder about the safety and efficacy of vaccines and to have their child's immunization record. Multiple logistic regression showed that possession of an immunization record accounted for differences in immunization levels. CONCLUSIONS: Public clinics can achieve immunization levels in their pediatric clients comparable to those for children in the private health sector. Levels in both public and private sectors are well below 90% and need to be improved.

Attitude to Health↗
PubMedDate not supplied

Adult clients' recall of oral health education services received in private practice.

PURPOSE: The purpose of this study was to determine adult clients' recall of oral health education services they received in private practice settings. METHODS: A written questionnaire was completed by a convenience sample of 199 adult clients who each had an appointment at a university dental hygiene clinic. Responses were statistically analyzed to generate frequency distributions of recall of oral health education services received in private practice and to determine if statistical differences existed in the number of services recalled according to selected client characteristics. RESULTS: The results indicated that 14 of the 22 oral health education services included on the questionnaire were reported to have been provided to fewer than half of the study participants when they were treated in their private dental care setting. The subjects were most likely to recall they were given a toothbrush. Chi-square analysis of selected client characteristic variables indicated that only four of the services were statistically significant between the reported frequencies and client age and periodontal health status. The differences between the reported frequency of services for females and males were not statistically significant. Subjects recalled that more oral health education services had been provided in conjunction with a prophylaxis by a dental hygienist; the differences in the reported frequencies for 16 of the 22 services were statistically significant. (p < or = .05) CONCLUSIONS: The convenience sample and data constraints, which depended on the clients' recall of services received in a private practice setting, must be considered in interpreting the results. Even though dental hygienists provide more oral health education services than other oral healthcare practitioners, the generally low frequencies of adult client recall of oral health education services received in private practice settings indicate that oral healthcare providers may not incorporate effective learning strategies into their health education programs.

Adult↗
PubMed1998

Tuberculosis patients and practitioners in private clinics in India.

SETTING: Rural and urban areas of Maharashtra, a large state in Western India. OBJECTIVE: To understand tuberculosis (TB) management practices among private medical practitioners (PPs) and the treatment behaviour of the patients they manage. DESIGN: Prospective study of help-seeking patterns and treatment behaviour among 173 pulmonary TB patients diagnosed in private clinics, and the TB management practices of 122 PPs treating these patients. RESULTS: The first source of help for 86% of patients was a PP. The diagnostic and treatment practices of PPs were inadequate; 15% did not consider sputum examination to be necessary, and 79 different treatment regimens were prescribed by 105 reporting PPs. Sixty-seven percent of the patients diagnosed in private clinics remained with the private sector, and the rest shifted to public health services within six months of treatment. The treatment adherence rate among the patients in private clinics was 59%. There were discrepancies between the reported management practices of the PPs and what their patients actually followed. CONCLUSION: The study identifies and highlights the need to educate PPs and their TB patients, and indicates ways in which PPs could be meaningfully involved in efforts to revitalize the national TB control programme.

Adolescent↗
PubMed1991

Development and functional significance of private speech among attention-deficit hyperactivity disordered and normal boys.

We compared the development of spontaneous private speech and its relationship to self-controlled behavior in a sample of 6- to 12-year-olds with attention-deficit hyperactivity disorder (ADHD) and matched normal controls. Thirty-eight boys were observed in their classrooms while engaged in math seatwork. Results revealed that ADHD children were delayed in private speech development in that they engaged in more externalized, self-fuiding and less inaudible, internalized speech than normal youngsters. Several findings suggest that the developmental lag was a consequence of a highly unmanageable attentional system that prevents ADHD children's private speech from gaining efficient mastery over behavior. First, self-guiding speech was associated with greater attentional focus only among the least distractible ADHD boys. Second, the most mature, internalized speech forms were correlated with self-stimulating behavior for ADHD subjects but not for controls. Third, observations of ADHD children both on and off stimulant medication indicated that reducing their symptoms substantially increased the maturity of private speech and its association with motor quiescence and attention to task. Results suggest that the Vygotskian hypothesis of a unidirectional path of influence from private speech to self-controlled behavior should be expanded into a bidirectional model. These findings may also shed light on why treatment programs that train children with attentional deficits in speech-to-self have shown limited efficacy.

Attention↗
PubMed1992

Shift of private and not of cross-reactive anti-DNA idiotypes in systemic lupus erythematosus.

The shift of private idiotype (Id) and cross-reactive Id (CRI) on anti-DNA antibodies in a lupus patient KE was investigated during a 7-year period. Anti-private Id and anti-CRI activities were separated by affinity chromatography from rabbit (R)-anti-Ids raised against KE anti-DNA antibodies during active (1/84) and inactive (4/90) stages of the disease. Anti-CRI isolated from the 84 R-anti-Id appeared to recognize binding site-related Ids that are shared with KE non-anti-DNA antibodies, unrelated lupus patients' sera, and certain normal sera. Id expression on serial serum samples of KE using these fractionated R-anti-Ids as probes showed that the 1/84 private Id expression declined while the 4/90 private Id expression gradually increased. Expression of the CRI showed a relatively stable pattern. These results suggest that anti-DNA populations detected by anti-private Id can shift, while populations expressing CRI may stay stable.

Antibodies, Antinuclear↗
PubMed1985

Former state hospital patients in private general hospital psychiatric emergency settings.

Increasing numbers of patients formerly hospitalized in state facilities are using private general hospital psychiatric emergency services. To define their clinical needs, the authors compared the characteristics of patients hospitalized in state institutions to those hospitalized privately and to those never hospitalized. They found that two discrete clinical groups exist: those from state and those from private systems. Clinicians reacted most negatively to former state patients. This was also reflected by differences in the dispositions of voluntary patients from the emergency room. Those not hospitalized or privately hospitalized were more likely than former state hospitalized patients to be sent to private facilities.

Adult↗
PubMed1986

Public and private sector interactions: an economic perspective.

The debate about the public-private mix for health care has been dominated by rhetoric and the failure to evaluate the characteristics of the outcomes of public and private health care systems and to relate these to policy targets. After a brief analysis of the competing, liberal (conservative) and collectivist (socialist), objectives, the nature of the private health care sector in Britain is described and it is shown that growth has faltered due to cost containment problems. This outcome is the product of characteristics of the private health care system, paralleled precisely in the NHS: asymmetry information, monopoly power, moral hazard and third party pays. The final section discusses briefly some remedies for the inefficient and inequitable outcomes which are seen in all health care markets and it is argued that competition within public and private health care systems may enable each system type to achieve its own particular objectives more efficiently.

Costs and Cost Analysis↗
PubMed2005

Social interactions and resource ownership in two private protected areas of Paraguay.

This paper describes the results of field research to dissect how social interactions differ between two reserves in Paraguay having very different styles of governance. The two reserves were Mbaracayú Natural Forest Reserve (Reserva Natural del Bosque de Mbaracayú, RNBM) and San Rafael Managed Resource Reserve (Reserva de Recursos Manejados San Rafael, RRMSR). RNBM is a private reserve owned by a non-governmental organisation, while RRMSR is a publicly-managed reserve, albeit with a substantial degree of private land ownership. Both reserves are intended to protect Atlantic Forest, one of the five world biodiversity 'hotspots', and also one of the most highly threatened. Each reserve and its buffer zone comprises a set of stakeholders, including indigenous communities and farmers, and the paper explores the interactions between these and the management regime. Indeed, while the management regimes of the two reserves are different, one being highly top-down (RNBM) and the other more socially inclusive (RRMSR), the issues that they have to deal with are much the same. However, while both management regimes will readily acknowledge the need to address poverty, inequality appears to be a far more sensitive issue. Whereas this may be expected for the privately-owned RNBM it is perhaps more surprising in RRMSR even when allowing for the fact that much of the land in the latter is in private hands. It is argued that the origins of this sensitivity rest within the broader features of Paraguayan society, and the prevalence of private land ownership. Yet ironically, it is the inequality in land ownership that is perhaps the most significant threat to conservation in both reserves. Therefore, while reserve-level analyses can provide some insight into the driving forces at play in the interaction between conservation and sustainable management, larger scales may be necessary to gain a fuller appreciation of the dynamics operating at site level. Even in a society with a history of centralised control these dynamics may be surprising.

Conservation of Natural Resources↗
PubMed1997

Involving the private sector in improving obstetric care, Anambra State, Nigeria. The Enugu PMM Team.

PRELIMINARY STUDIES: Of 11 facilities providing obstetric services in the Njikoka Local Government Area, four were private, for-profit institutions. Focus group discussions in seven communities revealed a preference for private facilities due to flexible payment schedules, proximity, reliable availability of a medical doctor and poor quality government services. Each of the private facilities had one doctor and one midwife and the bulk of patient care was performed by health aides with no formal midwifery training. INTERVENTIONS: In 1992, 15 aides from the private facilities were trained in the recognition and management of obstetric complications. The training consisted of one week of classroom instruction and two weeks of practical training in local missionary hospitals. RESULTS: Improvements were assessed by a written test. The percent of trainees obtaining a passing test mark increased from 33% (pre-training) to 61% (post-classroom) to 77% (post-practicum). COSTS: The cost of this intervention was approximately US $18,000. CONCLUSIONS: Auxiliaries' skills can be improved with classroom and practical training. The involvement of private sector institutions is important where they provide a substantial proportion of emergency obstetric services. However, maintaining improvements requires sustained efforts.

Allied Health Personnel↗
PubMedDate not supplied

The non-use of 9-1-1. Private transport of trauma patients to a trauma center.

HYPOTHESIS: Privately transported, major trauma patients made up approximately 4% of the total trauma patients population at a major, regional trauma center which treats over 90% of all major trauma victims in the geographic area. This study was undertaken to evaluate the patient profile of those individuals who did not access 9-1-1 for transport to a trauma center, including their reasons for such non-use. METHODS: Data on all major trauma occurring within Dade County, Florida, were collected by the county trauma registry. RESULTS: In the last six months of 1989, 1,672 patients were entered into the trauma registry. One-thousand-six-hundred-thirteen (1,613) were transported by professional ground or air services, 59 by private vehicle. For those patients transported directly from the Emergency Department to the Operating Room, only 35% of private vehicle patients entered surgery within 90 minutes of presentation compared to 57% of those who gained access to the 9-1-1 system and used emergency medical services (EMS). One-half of those patients who did not use 9-1-1 did not have telephone access. Patient acuity was similar for those transported by private vehicle compared to those transported by basic or advanced life support units. Private vehicle transport often delayed patient triage and assessment. Thus, for a number of lower income patients, 9-1-1 access was difficult. CONCLUSION: Underestimation of the severity of the injury or fear of delay in rescue response were prominent reasons for non-use of 9-1-1. While educational efforts should concentrate on decreasing inappropriate 9-1-1 use for non-emergencies, the causes of underutilization should not be ignored.

Adult↗
PubMed1989

Public and private responsibility for mental health services.

Relative to public services, private sector corporate mental health care has significantly increased since the late 1960s. The many tensions encountered in assigning public and private responsibility for mental health service give rise to significant value-laden questions for psychologists. These questions go to the heart of community mental health, deinstitutionalization, mental health policy development and evaluation, and many other areas in which psychologists are playing major roles. The public-private issue should be understood historically, from the twin vantage points of developments in general medicine and in mental health. Among the many public interest and public policy matters psychologists and others concerned with mental health should address are the emergence of corporate chains; the nature, cost, and quality of private sector services; the compatibility of profit motivation and the motivation to provide care; and patient selection issues (e.g., cream-skimming). Public and private cooperation and planning are certainly in order if the public interest is to be served in addressing the nation's mental health problems.

Community Mental Health Services↗
PubMed1999

Antibodies to private and public HLA class I epitopes in platelet recipients.

BACKGROUND: Transfusions or pregnancies can cause immunization against private HLA determinants and public epitopes shared by more than one private HLA antigen. HLA antibodies are correlated with febrile transfusion reactions, lower platelet response following platelet transfusion, and an increased rate of renal transplant rejection. Until now, antibody specificities in alloantisera from platelet recipients have been poorly characterized. STUDY DESIGN AND METHODS: Consecutive serum screens from platelet recipients were analyzed for antibodies against private HLA class I antigens and public HLA epitopes using a serum analysis program based on the 2 x 2 table analysis of correlations. Serum screens of highly immunized patients and of patients with new alloimmunization events were reviewed separately. RESULTS: Of the serum screens from 566 platelet recipients, 1577 indicated alloimmunization (panel-reactive antibodies >5%). The program assigned a specificity in 1024 of these screens (64.9%) and at least once in 522 of 566 patients (92.2%). In 267 patients, antibodies detecting public epitopes in the combined A- or B-locus cross-reacting groups were found; other public markers were detected in 39 patients. Patterns of reactivity were remarkably less stable than in patient groups previously studied. In many patients, antibodies with apparent private epitope specificity preceded the identification of antibodies against a shared marker of the same cross-reactive group. However, the disappearance of antibodies (whether or not this was followed by a new antibody against a private or public marker belonging to another cross-reacting group) was also observed. CONCLUSION: The computerized analysis of microlymphocytotoxicity tests enhances the rate of antibody specification in sera from platelet recipients with lymphocytotoxic antibodies. The identified antibodies should be taken into account in the selection of platelet donors. The data confirm and extend previous observations on HLA class I antibodies and elucidate new alloimmunization events.

Antibodies↗
PubMedDate not supplied

[Optimizing French scientific and economic performance: the Cifre system of public-private partnership in doctoral research and Servier's contribution].

The European Union has set itself the daunting target of becoming the world's most competitive and dynamic knowledge-based economy by 2010. Any hope of success against the United States and the Asian tiger economies lies in the quality of scientific and technological research. In France, postgraduate training has long labored under a deep academia/industry divide. Although the universities have introduced supervised 3 year doctoral courses along the lines of the English-speaking countries, they still produce too many postdocs with little experience or understanding of, and little taste for, the private sector. This ignores career realities: the public sector can offer employment to only half the postdocs it produces. The rest must fall back on positions in the private sector, in some cases with a sense of failure, ill suiting them to drive the intellectual economy forwards compared to their international competitors. To combat the divide and emphasize the quality of the research training available within industry, the public/private National Association for Technical Research (ANRT), acting on behalf of the Ministry of Research, created the Industrial Research Training Agreement (Cifre) scheme in 1981. Higher education laboratories and private companies combine to offer doctoral students the opportunity to undertake their 3 year course in a mixed public/private environment (the exact ratio is not defined but in the case of the Servier Research Group, an early and active participant in the scheme, at least one third of the course is spent in the private sector). The doctoral thesis is thereby transformed into a meaningful career qualification. Funded by the Ministry, with maintenance grants to the students and compensatory payments to the companies, the Cifre scheme, which is currently being expanded, has produced 12,000 postdocs personally and intellectually equipped for careers transiting seamlessly between the public and private sectors, to the enrichment of each.

Charities↗