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PubMed1975

The changing role of private philanthropy in health affairs.

Since World War II societal changes have fundamentally altered the very special position held by private philanthropy in the health area. The expanding expenditures for health services by the private and public sectors now dwarf those of philanthropic insitutions. Yet the need for private philanthropy has not diminished. Indeed, given some of the problems that may be created by large-scale public-sector support, private philanthropy may prove to be even more imporant in the future. But to respond to this changing state of affairs, the philanthropic community and the nation's health institutions will have to recognize that private philanthropy has become a relatively scarce national resource. To continue to play a major part in health affairs, philanthropic giving will have to become well targeted on select national and regional priorities, moving away from the more broadly scattered approaches reflecting the needs of the earlier parts of the century.

Charities↗
PubMed2002

The protection of the patient's private life: a vast normative landscape. First Part.

The debate on the protection of people's private life is stronger than ever, particularly in the health care sector, where choices have to be made in order to decide between the conflicting interests at stake. This Article gives an overview of the general provisions that aim, for the time being, at guaranteeing this protection to the patient. His or her right to respect for private life, which aims at protecting not only the confidentiality of his or her private realm and relationships with others, but also his or her freedom of choice regarding this private realm and these relationships, is indeed expressed, in various forms, in a large number of texts of every possible origin. It would be a mistake to regard these as a heap of redundant rules. These texts can be distinguished according to their content, the time of their elaboration and their authors. Although complex, the normative structure that they form is not void of effectiveness. A next article will examine how they are extended and supplemented by provisions trying to answer, at the level of the respect of private life, to the growing use of computers in medical practice.

Belgium↗
PubMedDate not supplied

The protection of the patient's private life: a vast normative landscape. First part.

The debate on the protection of people's private life is stronger than ever, particularly in the health care sector, where choices have to be made in order to decide between the conflicting interests at stake. This Article gives an overview of the general provisions that aim, for the time being, at guaranteeing this protection to the patient. His or her right to respect for private life, which aims at protecting not only the confidentiality of his or her private realm and relationships with others, but also his or her freedom of choice regarding this private realm and these relationships, is indeed expressed, in various forms, in a large number of texts of every possible origin. It would be a mistake to regard these as a heap of redundant rules. These texts can be distinguished according to their content, the time of their elaboration and their authors. Although complex, the normative structure that they form is not void of effectiveness. A next article will examine how they are extended and supplemented by provisions trying to answer, at the level of the respect of private life, to the growing use of computers in medical practice.

Confidentiality↗
PubMed2006

Shaping the future of surgery: the role of private regulation in determining quality standards.

OBJECTIVE: To educate surgeons about the growth of the private regulatory movement and its potential implications for the practice of surgery. METHODS: An in-depth analysis and literature review of one of the largest private regulatory groups, the Leapfrog Group, provides a model for understanding the impact of these groups on the practice of surgery. A detailed discussion of the history, mission, structure, and quality initiatives of Leapfrog is included. RESULTS: Private regulatory groups are using quality standards as a method for controlling the rising cost of health care. Traditionally, little financial support, manpower, or incentives have existed for individual surgeons and hospitals to report and maintain their own outcomes data. However, as surgical outcomes have increasingly become the target of quality improvement initiatives, the need to measure performance is gaining importance. Surgical quality has been both a direct target of private regulation, as illustrated by the evidence-based hospital referral guidelines of Leapfrog, and an indirect target with initiatives like computerized physician order entry and ICU staffing guidelines. CONCLUSIONS: Private regulation is rapidly reshaping the way we practice and teach surgery. It is almost a certainty that their power, popularity, financial support, and missions will all continue to expand. As surgeons, we must decide soon if we wish to be an active participant in shaping the movement or, rather, if we are going to let it shape us by remaining largely uninvolved.

General Surgery↗
PubMed2006

Comparing public and private hospital care service quality in Turkey.

PURPOSE: The aim of this article is to examine the differences in service quality between public and private hospitals in Turkey. DESIGN/METHODOLOGY/APPROACH: This study applies the principles behind the SERVQUAL model and compares Turkey's public and private hospital care service quality. The study sample contains a total of 200 outpatients. Through the identification of 40 service quality indicators and the use of a Likert-type scale, two questionnaires containing 80-items was developed. The former measured patients' expectations prior to admission to public and private hospital service quality. The latter measured patient perceptions of provided service quality. FINDINGS: The results indicate that inpatients in the private hospitals were more satisfied with service quality than those in the public hospitals. The results also suggest that inpatients in the private hospitals were more satisfied with doctors, nurses and supportive services than their counterparts in the public hospitals. Finally, the results show that satisfaction with doctors and reasonable costs is the biggest determinants of service quality in the public hospitals. ORIGINALITY/VALUE: Consequently, SERVQUAL, as a standard instrument for measuring functional service quality, is reliable and valid in a hospital environment.

Hospitals, Proprietary↗
PubMed1986

Traumatic dental injuries in children from private and public schools.

The purpose of this retrospective study was to analyze, by age and sex, the prevalence of traumatic injuries to permanent incisors and canines, and their distribution according to type in children from private and public schools. The samples consisted of 1,200 children aged 7-16 yr old enrolled in 12 private and public schools from the city of Santo Domingo, Dominican Republic. Garcia-Godoy's classification for traumatic injuries was used. The prevalence of injuries in private schools was 21.3% and in public schools 16.3% (P less than 0.05). The higher prevalence in private schools is mainly due to the enamel fractures. All together, more boys injured their teeth than girls. The most common type of injury in both sexes in private and public schools was the enamel fracture followed by the enamel-dentin fracture without pulp exposure.

Adolescent↗
PubMed1997

Caries prevalence and periodontal treatment needs in public and private school pupils in Jordan.

A total of 886 pupils aged 15-16 years selected from 20 public and 10 private schools in northern Jordan were investigated for frequency of toothbrushing and sweet consumption, dental caries and periodontal treatment needs. A questionnaire and clinical examination were used utilising decayed-missing-filled teeth (DMFT) code and the Community Periodontal Index of Treatment Needs (CPITN), respectively. Results revealed that 35.5 per cent of public and 57.1 per cent of private school pupils reported to brush their teeth regularly while the majority of them frequently consumed sweets. There were slight differences in caries experience amongst public and private school pupils, as measured by DMFT (4.74: 4.95). While bleeding and calculus scores were prevalent in pupils of both types of schools, they were slightly higher in pupils of public schools than those in private schools. Both shallow and deep pathological pockets were found in fewer numbers (6.09 per cent) in pupils in public schools only. Oral hygiene instruction and scaling were the predominant periodontal treatment needs in both types of schools. However, the treatment needed by pupils in public schools was higher than those in private schools. Complex treatment was rarely needed by public school pupils only.

Adolescent↗
PubMed1995

Clinical hematology practices at veterinary teaching hospitals and private diagnostic laboratories.

The clinical hematology practices utilized at veterinary teaching hospitals and private veterinary diagnostic laboratories were surveyed using a questionnaire. The hematology caseload at private diagnostic laboratories was larger, and comprised predominantly of canine and feline submissions. The Coulter S Plus IV and Serono Baker 9000 were the hematology analyzers used most frequently at veterinary medical laboratories. The Abbott Cell-Dyn 3500, a multispecies analyzer capable of leukocyte differential counting, was utilized more by private laboratories. Commercial hematology control reagents were used at all laboratories; teaching hospital laboratories more often used reagents supplied by the manufacturer of the analyzer. A greater percentage of private diagnostic laboratories participated in the external quality assurance programs offered by Veterinary Laboratory Association and College of American Pathologists. While private diagnostic laboratories retained the EDTA blood specimens longer after initial testing, the teaching hospital laboratories retained blood smears and complete blood count reports longer. The complete blood count reports at veterinary teaching laboratories more often included red blood cell volume distribution width, mean platelet volume, manual hematocrit, plasma protein, and leukocyte differentials as absolute concentrations. The laboratory practices utilized by these veterinary medical laboratories were generally similar, and differences were attributed to divergent emphasis on economic accountability and clinical investigation.

Journal Article↗
PubMed1998

Public, private and voluntary residential mental health care: is there a cost difference?

OBJECTIVES: To determine how public (NHS or local government), private (for-profit) and voluntary (non-profit) providers of residential mental health care compare. Do they support different clienteles? And do their services cost different amounts? METHODS: Based on a cross-sectional survey of residential care facilities and their residents in eight English and Welsh localities, the characteristics and costs of care in the different sectors (NHS, local government, private, voluntary) were compared. Variations in cost were examined in relation to residents' characteristics using multiple regression analyses, which also allowed standardisation of results before making inter-sectoral comparisons. RESULTS: Private and voluntary providers of residential care support different clienteles from the public sector. The patterns of inter-sectoral cost differences vary between London and non-London localities. In London, voluntary sector facilities may be more cost-efficient than the other sectors, but local government/private sector comparisons show no consistent difference. Outside London, the results suggest clear cost advantages for the private and voluntary sectors over the local government sector. CONCLUSIONS: Private and voluntary providers may have some economic advantages over their public counterparts. However, outcomes for residents were not studied, leaving unanswered the question of comparative cost-effectiveness.

Community Mental Health Services↗
PubMed2006

Geography, private costs and uptake of screening for abdominal aortic aneurysm in a remote rural area.

BACKGROUND: The relationship between geographical location, private costs, health provider costs and uptake of health screening is unclear. This paper examines these relationships in a screening programme for abdominal aortic aneurysm in the Highlands and Western Isles of Scotland, a rural and remote area of over 10,000 square miles. METHODS: Men aged 65-74 (n = 9323) were invited to attend screening at 51 locations in 50 settlements. Effects of geography, deprivation and age on uptake were examined. Among 8,355 attendees, 8,292 completed a questionnaire detailing mode of travel and costs incurred, time travelled, whether accompanied, whether dependants were cared for, and what they would have been doing if not attending screening, thus allowing private costs to be calculated. Health provider (NHS) costs were also determined. Data were analysed by deprivation categories, using the Scottish Indices of Deprivation (2003), and by settlement type ranging from urban to very remote rural. RESULTS: Uptake of screening was high in all settlement types (mean 89.6%, range 87.4-92.6%). Non-attendees were more deprived in terms of income, employment, education and health but there was no significant difference between non-attendees and attendees in terms of geographical access to services. Age was similar in both groups. The highest private costs (median 7.29 pound sterling per man) and NHS screening costs (18.27 pound sterling per man invited) were observed in very remote rural areas. Corresponding values for all subjects were: private cost 4.34 pound sterling and NHS cost 15.72 pound sterling per man invited. CONCLUSION: Uptake of screening for abdominal aortic aneurysm in is remote and rural setting was high in comparison with previous studies, and this applied across all settlement types. Geographical location did not affect uptake, most likely due to the outreach approach adopted. Private and NHS costs were highest in very remote settings but still compared favourably with other published studies.

Aged↗
PubMed2005

Patient-initiated switching between private and public inpatient hospitalisation in Western Australia 1980 - 2001: an analysis using linked data.

BACKGROUND: The aim of the study was to identify any distinct behavioural patterns in switching between public and privately insured payment classifications between successive episodes of inpatient care within Western Australia between 1980 and 2001 using a novel 'couplet' method of analysing longitudinal data. METHODS: The WA Data Linkage System was used to extract all hospital morbidity records from 1980 to 2001. For each individual, episodes of hospitalisation were paired into couplets, which were classified according to the sequential combination of public and privately insured episodes. Behavioural patterns were analysed using the mean intra-couplet interval and proportion of discordant couplets in each year. RESULTS: Discordant couplets were consistently associated with the longest intra-couplet intervals (ratio to the average annual mean interval being 1.35), while the shortest intra-couplet intervals were associated with public concordant couplets (0.5). Overall, privately insured patients were more likely to switch payment classification at their next admission compared with public patients (the average rate of loss across all age groups being 0.55% and 2.16% respectively). The rate of loss from the privately insured payment classification was inversely associated with time between episodes (2.49% for intervals of 0 to 13 years and 0.83% for intervals of 14 to 21 years). In all age groups, the average rate of loss from the privately insured payment classification was greater between 1981 and 1990 compared with that between 1991 and 2001 (3.45% and 3.10% per year respectively). CONCLUSION: A small but statistically significant reduction in rate of switching away from PHI over the latter period of observation indicated that health care policies encouraging uptake of PHI implemented in the 1990s by the federal government had some of their intended impact on behaviour.

Journal Article↗
PubMed2005

Potential impact of a targeted cardiopulmonary resuscitation program for older adults on survival from private-residence cardiac arrest.

OBJECTIVE: Traditional cardiopulmonary resuscitation (CPR) training programs do not target older adults who are most likely to witness private-residence cardiac arrests and do not reliably result in a bystander who is likely to perform CPR in the event of an arrest. This study was performed to compare targeted CPR training programs for older adults (older than 50 years) that 1) increase numbers of CPR-trained bystanders of private-residence cardiac arrest or 2) increase the percentage of trained bystanders of private-residence cardiac arrest who perform CPR. A simultaneous outcome was to estimate the minimal significant survival benefit associated with each of the training programs. METHODS: A probabilistic simulation model was developed in Fortran95 that incorporated key out-of-hospital cardiac arrest elements, including witnessed arrests, CPR-trained witness, CPR provision, and impact of CPR on ventricular fibrillation. Input data were derived from published or publicly available data, including a large prospective cohort study of outcomes in Oakland County, MI. Monte Carlo simulation (n = 10,000) and sensitivity analyses (n = 40) were used to assess median and the empiric 95% confidence intervals [CIs] for incremental survival with either intervention. RESULTS: The baseline model, calibrated to the characteristics of the input-data community, established that, for private-residence cardiac arrests, 40.8% of cardiac arrest bystanders were trained in CPR; however, only 25.7% performed CPR. This yielded 4.81% survival (95% CI = 4.72 to 4.89). Modeling the impact on the baseline training level with increased CPR performance among trainees indicated that 75% of private-residence trained bystanders would need to perform CPR in order to reach a minimally significant improvement in survival (5.02%; 95% CI = 4.94 to 5.15). Similarly, targeted CPR training that would result in a significant survival benefit (to 5.01%; 95% CI = 4.93 to 5.09) would require that 70.8% of bystanders be trained. CONCLUSIONS: CPR training programs that focus on yielding 75% of trainees who perform CPR in the event of witnessing an arrest would have equivalent results to mass CPR training programs that result in 70% of bystanders being trained in CPR. However, the minimal survival benefit associated with these programs (around 0.2%) may prove either method costly with minimal effect.

Aged↗
PubMed1977

Controlling health care costs: strengthening the private sector's hand.

The council on Wage and Price Stability recently has discovered evidence suggesting "an unackonwledged potential of the private sector to exert influence and control in the area of health care cost inflation." This article examines the limitations on private-sector cost-control efforts and suggests actions which would permit and encourage private decision makers to be more effective. In particular, private health insurers' potential role in cost control is explored, and some promising insurer strategies are adumbrated. Carefully designed coverage limitations and plan-initiated reviews to exclude nonessential care from coverage are suggested, together with wider use of fixed indemnity payments or negotiated fees and charges (instead of paying unusual and customary rates or incurred costs). Among the steps needed to permit insurers to provide this added service to cost-conscious customers is enforcement of the antitrust laws to prevent doctors' organized resistance to unwanted measures. In general, it is argued that private-sector efforts are likely to be more effective than government-sponsored controls as well as more appropriate in a pluralistic society.

Cost-Benefit Analysis↗
PubMed2002

Private schools and "Latino flight" from black schoolchildren.

Several recent studies provided evidence that white students' choice between private and public schools is influenced by the racial composition of the local student population. None of these studies, however, examined whether Latinos are also fleeing to private schools in response to black schoolchildren. I explore the "Latino-flight" hypothesis using data from the National Educational Longitudinal Study and a recently released confidential data set from the National Center for Educational Statistics. In probit regressions for the probability of Latinos attending private schools, I found a large, positive, and statistically significant coefficient on the black share of the school-age population. The coefficient estimates imply that a 10-percentage point increase in the black share increases the probability of private school attendance by 25.7% to 33.2% among Latino 8th graders and 35.2% to 52.2% among Latino 10th graders. I interpret these results as providing evidence of "Latino flight" from public schools into private schools. I did not find evidence that Latinos respond differently to black schoolchildren than do whites.

Adolescent↗
PubMed2003

Recent trends in dental visits and private dental insurance, 1989 and 1999.

BACKGROUND: This article describes recent trends in dental visits and private dental insurance in the United States. METHODS: This study is based on the analyses of data regarding dental visits and private dental insurance among the population 2 years of age or older from the 1989 and 1999 National Health Interview Surveys. RESULTS: Overall, the percentage of the population with a dental visit rose from 57.2 percent in 1989 to 64.1 percent in 1999, while the percentage with private dental insurance fell from 40.5 percent to 35.2 percent. CONCLUSIONS: Although a higher percentage of people with private dental insurance reported having a dental visit than did those without private dental insurance in both years, the increase from 1989 to 1999 in the percentage of those with a visit was larger among the uninsured. PRACTICE IMPLICATIONS: If this trend persists, a smaller portion of practicing dentist's clientele will be insured. This may affect demand for services, as well as front office operations.

Adolescent↗
PubMed1988

A national comparison of public- and private-sector alcoholism treatment delivery system characteristics.

The primary purpose of this study was to investigate the question of the existence, nationally, of separate public- and private-sector alcoholism treatment delivery systems in regard to the economic status of clients served, types of care provided and treatment setting. The analysis was based on data from the 1982 National Federal Census Survey of Treatment units. Public- and private-sector profiles based on the aforementioned delivery system characteristics were constructed and compared. Each of the profiles was also compared to a hypothesized profile, based on perceptions drawn from the literature, of the characteristics of treatment delivery in the private sector, generally, or the private-for-profit sector, specifically. The results of the analysis support the conclusion that two separate systems of treatment delivery existed, nationally, during the study period. The distribution of the nation's alcoholism treatment units among the public and private ownership sectors and ownership trends were also investigated using data from national federal census surveys conducted in 1979, 1980, 1982 and 1984. The implications of the study findings for the future are discussed.

Alcoholism↗
PubMed2003

Medicaid participation by private and safety net pediatricians, 1993 and 2000.

BACKGROUND: Eligibility expansions and managed care growth were 2 major forces shaping the Medicaid program during the 1990s. Although Medicaid managed care was introduced to contain rising costs of growing enrollment and expenditures, it also offered states an opportunity to improve enrollees' access to mainstream health care providers. By enrolling in commercial managed care plans, they could gain access to private office-based physicians, thus eliminating a 2-tiered health care system. OBJECTIVES: To investigate changes in private and safety net pediatricians' participation in Medicaid between 1993 and 2000, a period noted for eligibility expansion for children and rapid managed care growth. DESIGN: Survey data collected from private and safety net pediatricians in 1993 and 2000 were analyzed to investigate how pediatricians' Medicaid caseloads were affected by 1) their practice setting, and 2) whether they accepted all Medicaid patients. RESULTS: Pediatricians' Medicaid caseloads increased significantly between 1993 and 2000, with those in private practice settings reporting greater increases. More pediatricians accepted all Medicaid patients in 2000, but Medicaid caseloads remained twice as high for safety net pediatricians. Medicaid caseloads increased dramatically for those accepting all Medicaid patients, except in safety net settings, where pediatricians who were turning away some Medicaid patients had heavier Medicaid caseloads than those who accepted all Medicaid patients. CONCLUSIONS: Although Medicaid children were still disproportionately served in the safety net in 2000, their access to private pediatricians had improved since 1993. But a ceiling in the safety net's capacity to absorb more Medicaid patients was suggested by the finding that safety net pediatricians turned away Medicaid patients as their Medicaid caseloads increased. Combined with decreasing participation by commercial plans in the Medicaid managed care market, increasing hospital emergency department overloads, and growing Title XXI Medicaid enrollments, interventions may be needed to avert a looming pediatric provider shortage for publicly insured low-income children.

Analysis of Variance↗
PubMed2006

Increased rates of morbidity, mortality, and charges for hospitalized children with public or no health insurance as compared with children with private insurance in Colorado and the United States.

BACKGROUND: There has been a gradual decrease in the proportion of children covered by private health insurance in Colorado and the United States with a commensurate increase in those with public insurance or having no insurance which may impact access to care and outcomes. OBJECTIVE: The purpose of this work was to determine whether children with public or no health insurance have differences in hospital admission rates, morbidity, mortality, and/or charges that might be improved if standards of primary care comparable to those of children with private insurance could be achieved. METHODS: We conducted a retrospective comparison of hospitalization-related outcomes for children < 18 years of age in Colorado from 1995-2003 and in the United States in 2000. Population-based rates for hospital admission were determined stratified by age, race/ethnicity, disease grouping, and health insurance status. RESULTS: Compared with those with private insurance, children in Colorado and the United States with public or no insurance have significantly higher rates of total hospital admission, as well as admission for chronic illness, asthma, diabetes, vaccine-preventable disease, psychiatric disease, and ruptured appendix. These children have higher mortality rates, higher severity of illness, are more likely to be admitted through the emergency department and have significantly higher hospital charges per insured child. Higher hospitalization rates occur in children who are nonwhite and/or Hispanic and those who are younger. If children with public or no health insurance in the United States in 2000 had the same hospitalization outcomes as children with private insurance, $5.3 billion in hospital charges could have been saved. CONCLUSIONS: There is an opportunity to achieve improved health outcomes and decreased hospitalization costs for children with public or no health insurance if private insurance standards of health care could be achieved for all US children.

Adolescent↗