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PubMed1984

Differences in the direct costs of public and private acute inpatient psychiatric services.

This exploratory study examined differences in the direct costs of acute inpatient psychiatric services in seven public county-operated specialty hospital units and six private community general hospital units in Wisconsin. There were no significant or substantial differences in measures of severity of patients between the public and private systems. Direct costs per stay and per day were significantly lower in the private units, although charges may have been higher in the private units. These differences in costs appear to be the result of private units having a significantly higher average daily census, more goal emphasis for cost containment, and more psychiatrist influence on how the unit was run. Our findings suggest that mental health system managers examine opportunities for achieving economies of scale and that they set and manage goals for efficiency.

Cost Control↗
PubMed1993

Attitudes of private general practitioners towards health care in South Africa.

The need for health care reform in South Africa is acknowledged by the government as well as by the non-governmental health sector. There is, however, no unanimity regarding the nature of the envisaged reform. A country-wide postal survey of 700 private sector general practitioners (GPs) from a commercial database of 5,000 was conducted to explore attitudes towards health care. A response rate of 67.4% was obtained. Respondents were mostly male (92%) and urban-based (64%). The median age was 42 years. Most respondents: (i) believed health care to be a right for all citizens; (ii) favoured private or a combination of private and public funding mechanisms with fee-for-service arrangements; (iii) opposed cost-containment measures imposed by funders, e.g. medical aids; and (iv) believed doctors should be responsible for primary care in under-served areas. After sex, age, location (urban versus rural) and GP postgraduate qualification had been controlled for by means of logistic regression techniques, the university at which a respondent's basic degree was obtained emerged as the only independent predictor of attitudes to the following: (i) comprehensive care as a right; (ii) integration of the public and private sectors; (iii) preferred funding source for a future health system; and (iv) preference for fee-for-service remuneration. Both university and gender independently predicted attitudes on GPs' income. Graduates of white, Afrikaans-medium universities were strongly in favour of a privately funded and fee-for-service orientated system. Those who qualified at black universities, on the other hand, favoured public funding with less emphasison fee-for-service.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Private speech of learning disabled and normally achieving children in classroom academic and laboratory contexts.

Learning disabled (LD) children are often targets for cognitive-behavioral interventions designed to train them in effective use of a self-directed speech. The purpose of this study was to determine if, indeed, these children display immature private speech in the naturalistic classroom setting. Comparisons were made of the private speech, motor accompaniment to task, and attention of LD and normally achieving classmates during academic seatwork. Setting effects were examined by comparing classroom data with observations during academic seatwork and puzzle solving in the laboratory. Finally, a subgroup of LD children symptomatic of attention-deficit hyperactivity disorder (ADHD) was compared with pure LD and normally achieving controls to determine if the presumed immature private speech is a function of a learning disability or externalizing behavior problems. Results indicated that LD children used more task-relevant private speech than controls, an effect that was especially pronounced for the LD/ADHD subgroup. Use of private speech was setting- and task-specific. Implications for intervention and future research methodology are discussed.

Attention Deficit Disorder with Hyperactivity↗
PubMed1996

Stress and coping amongst South African dentists in private practice.

Stress and coping were investigated in a randomly selected sample of 311 South African dentists of whom 268 were in private practice and 43 were non-private practitioners. Some of the most important findings are the following: Indications were that about 40 per cent of the respondents reported extremely high stress levels, irrespective of type of employment. No significant relationships were found between stress levels and biographical variables. Stressors most often experienced by private practitioners were financial issues and time and scheduling pressures. Other important stressors included patients' unfavourable perceptions of dentists, being perceived as an inflictor of pain, working with children, treating nervous patients, concerns about the future and worrying about the oversupply of dentists. The most stressful stressors were financial issues. Although it was found that time and scheduling pressures were the next most prevalent category of stressors, dentists reported, next to financial issues, problems in dealing with patients as the second most stressful group of stressors. Making decisions about future career directions and limited future options were intense stressors for 47.54 per cent of respondents. Dentists identified rising costs and problems with medical aid schemes as the most prevalent and intense stressors, ones they experienced most difficulty in handling. Stressors which posed few coping problems were staff-related problems, difficulties in keeping to appointment schedules, working under constant time pressures, repetitive nature of the work, feeling isolated and the possibility of a viral contraction. The results indicated that, in general, drug use amongst South African dentists was low. However, fairly high numbers of dentists used analgesics on a regular basis. Substantial numbers of dentists reported marital problems. The prevalence of severe interpersonal problems with the dentists' own children was low. In addition to marital problems, substantial percentages of the sample reported severe problems in other personal relationships and experienced a severe lack of social involvement or outside interests. In the present study 27 (10.23 per cent) of the private practitioners and 2 (4.76 per cent) of the non-private practitioners reported severe suicide ideation.

Adaptation, Psychological↗
PubMed1993

Public and private imperatives of Greek health policies.

Health care in Greece has historically developed into a multi-tier system, a mosaic of public and private providers of services covering the members of occupational social insurance organizations. In 1983 PASOK's socialist government established a unified National Health System. The aim was to arrest the growth of the private sector and promote the public sector to a dominant position. The socialist legislation has recently been reviewed by a conservative government that aims at a competitive mixed market of public and private providers. The growth of private health care, however, is not solely a matter of political support but also of new opportunities for profitable investments that arise from a shrinking public sector under economic and fiscal constraints.

Greece↗
PubMed2000

The determinants of the public-private mix in Canadian health care expenditures: 1975-1996.

The health care policy issue regarding the balance between public and private health spending is examined. An empirical model of the determinants of the public-private mix in Canadian health care expenditures over the period 1975-1996 is estimated for total health care expenditures as well as separate expenditure categories such as hospitals, physicians and drugs. The results find that the key determinants of the split are per capita income, government transfer variables and the share of individual income held by the top quintile of the income distribution. Much of the public-private split is determined by long term economic forces. However, the importance of the federal health transfer variables and the variables representing shifts in fiscal transfer regimes suggest the increase in the private share of health spending since 1975 is also partly the result of the policy choice to reduce federal health transfers.

Canada↗
PubMed2004

Factors affecting fee setting for private treatment in general dental practice.

OBJECTIVES: To examine how pricing policies were contrived in general dental practice in terms of fee-for-item and hourly rate and how these were affected by specialist status and the level of private care provided in a practice. DESIGN: A postal questionnaire. SUBJECTS: Members of the British Society for General Dental Surgery working in dental practice. RESULTS: Out of 160 eligible members, responses were received from 124 members (78%). Fifty-seven respondents claimed to specialise in one or more fields of dentistry. The majority of respondents consulted fellow colleagues or partners for advice on fee setting. A minority took external advice. The charging method varied according to the item of treatment with fee-for-item used predominantly for items such as a new patient examination, and hourly rate used more for items such as a direct composite restoration. Seventy-one respondents stated that their practice was 80-100% private treatment and these practitioners were significantly more likely to charge by hourly rate than fee-for-item for many items of treatment. Specialist status did not have any effect on charging method. The most important factors related to the setting of fees-for-item or hourly rate were clinical time spent, practice overheads and laboratory costs. CONCLUSIONS: This project has taken the views of a large group of experienced general dental practitioners, many of whom work purely in the private sector. The most important factors affecting fee setting were clinical time, practice overheads and laboratory costs. The method of charging was most affected by the proportion of private treatment provided by the practice.

Dental Care↗
PubMed2003

Models for future delivery of care in infertility: the role of the private sector.

An estimated 85% of infertility treatment at the tertiary level in the UK currently is funded by the infertile couples themselves. Of the 15% of couples who receive NHS funding for assisted reproductive technology (ART), a sizeable proportion is provided by private clinics. If the National Institute of Clinical Excellence (NICE) decides that the National Health Service (NHS) should provide funding for an increased number of treatments, then it is unlikely that wholly NHS ART clinics will be able to provide the extra number of cycles required. Those private clinics in the UK that bid to provide treatment funded by the NHS through primary care trusts (PCT) generally provide a cost-effective service in a 'patient friendly' environment. The case is made in this article that ART clinics in the private sector that wish to bid for PCT contracts, should be allowed to compete on an equal basis with NHS or NHS-private combined clinics. PCTs awarding contracts should be wholly driven by good evidence of clinical effectiveness, cost effectiveness and the provision of a quality service to patients.

Adult↗
PubMed1997

Reform follows failure: I. Unregulated private care in Lebanon.

This first of two papers on the health sector in Lebanon describes how unregulated development of private care quickly led to a crisis situation. Following the civil war the health care sector in Lebanon is characterized by (i) ambulatory care provided by private practitioners working as individual entrepreneurs, and, to a small extent, by NGO health centres; and (ii) by a fast increase in hi-tech private hospitals. The latter is fuelled by unregulated purchase of hospital care by the Ministry of Health and public insurance schemes. Health expenditure and financing patterns are described. The position of the public sector in this context is analyzed. In Lebanon unregulated private care has resulted in major inefficiencies, distortion of the health care system, the creation of a culture that is oriented to secondary care and technology, and a non-sustainable cost explosion. Between 1991 and 1995 this led to a financing and organizational crisis that is the background for growing pressure for reform.

Ambulatory Care↗
PubMed1997

Bridging public and private sector quality assurance.

Just as the private sector has emerged as the predominant force the greater efficiency in the delivery of health care services, so too is the private sector gaining importance as a source of quality oversight strategies. Public reliance on private sector quality assurance efforts is being fueled by such developments as the growth in the number and diversity of private health care accrediting agencies, and the increase in consumer and purchaser-driven demands for comparative information about the quality of health care providers.

Accreditation↗
PubMed1999

Treatment delay and reliance on private physicians among patients with sexually transmitted diseases in China.

We examined health-care seeking practices among patients with sexually transmitted diseases (STDs) in south China. In 1995, we recruited a consecutive sample of 939 STD patients attending the STD clinics of the Municipal STD Control Centers of Guangzhou and Shenzhen, 'special economic zones' near Hong Kong. Attending physicians interviewed patients face-to-face using a standard survey questionnaire. Twenty-seven per cent of all subjects had sought treatment elsewhere for their presenting complaints, before visiting a study clinic. The main sources of prior treatment were private physicians followed by public clinics and drugstores. Women were more likely than men to delay in presenting their current symptoms to a study clinic (32% vs 25%, P=0.046). Factors associated with treatment delay differed by gender. Among men, seeking prior treatment from private physicians (OR=3.31; 95% CI=1.70, 6.43), having no urethral discharge (OR=4.00; 95% CI=2.33, 6.85), having engaged in sex trade (OR=1.64; 95% CI=1.03, 2.63), or being a resident in Shenzhen (OR=1.80; 95% CI=1.12, 2.89) were more likely to delay seeking treatment. Among women, only living in Shenzhen (OR=2.86; 95% CI=1.56, 5.25) was associated with treatment delay. Promotion of appropriate health-seeking behaviours and better management of STDs must be a top priority to slow a rapid spread of STD/HIV in China. Health education, improvement of STD care in the public and private sectors, and regulations of unauthorized private physicians, may help with STD control and HIV prevention.

Adult↗
PubMed2005

Private health insurance and regional Australia.

Since 1996, an increasing proportion of federal government expenditure has been directed into Australia's healthcare system via private health insurance (PHI) subsidies, in preference to Medicare and the direct funding of public health services. A central rationale for this policy shift is to increase the use of private hospital services and thereby reduce pressure on public inpatient facilities. However, the impact of this reform process on regional Australia has not been addressed. An analysis of previously unpublished Australian Bureau of Statistics data shows that regional Australians have substantially lower levels of private health fund membership. As a result, regional areas appear to be receiving substantially less federal government health funding, compared with cities, than if these funds were allocated on a per-capita basis. We postulate that the lower level of membership in regional areas is mainly due to the limited availability of private inpatient facilities, making PHI less attractive to rural Australians. We conclude that PHI as a vehicle for mainstream federal health financing has potential structural failures that disadvantage regional Australians.

Australia↗
PubMed1999

Improving immunization rates in private pediatric practices through physician leadership.

OBJECTIVE: To determine whether a physician-led quality improvement initiative can improve immunization rates in participating private practices. DESIGN: Surveys of private pediatric practices at 6-month intervals over an 18-month period. SETTING: Ten private pediatric practices in Norfolk and Virginia Beach, Va. PATIENTS: Children aged 9 to 30 months attending the private practices. INTERVENTIONS: Practice immunization rates were assessed and presented to practices on 4 occasions at 6-month intervals. A physician leader convened an immunization task force meeting following the first 3 assessments to review practice guidelines, examine data, and discuss practice changes. MAIN OUTCOME MEASURES: Practice immunization rates for patients at age 24 months, with 3- and 12-month immunization rates as secondary outcomes. RESULTS: The mean practice immunization rate at age 24 months increased significantly (P<.05) from 50.9% at baseline to 69.7%. Rates also increased at age 3 months, from 75.5% to 88.9%, and at age 12 months, from 72.9% to 84.6%. The median age at administration of the fourth dose of diphtheria toxoid, tetanus toxoid, and pertussis vaccine decreased (P<.05) from 17.6 to 16.8 months. Physicians also reported making additional changes, including improved record keeping and screening for immunizations at every visit. CONCLUSION: A quality improvement initiative enabling physician leadership can improve preschool immunization practices and coverage levels in pediatric practices.

Analysis of Variance↗
PubMed1981

An analysis of the movement to private psychiatric practice.

Survey data were analyzed from 900 psychiatrists who graduated between 1961 and 1976 from one of 17 state mental hospitals (SMHs) or ten university psychiatry residency programs in one of five states and are used to describe the differential influence of (1) foreign or US medical education, (2) SMH or university training program, and (3) years since graduation on the decision to take a job in either a private, public, or university medical school practice setting. Descriptive statistical models show that (1) about 25% of all respondents chose a private, 55% a public, and 20% a university for their first job, and (2) substantial numbers of both foreign and US medical graduates (FMGs, USMGs) left public jobs and chose and remained in private jobs, so that 55% of respondents had their current job in the private sector. Type of residency training was associated only with first job choice. Compared with USMGs, more FMGs initially took and remained in public jobs. These models highlight manpower problems. In fact, most of the respondents did not confine their work to a single kind of practice setting.

Humans↗
PubMed1998

Financing health services in Poland: new evidence on private expenditures.

This paper estimates total expenditure on health care in Poland in 1994 and provides new evidence on high levels of private spending on health care. The analysis shows that health care expenditures in Poland are higher than has usually been maintained, and are comparable with the prevailing levels in many other European countries. Private expenditure on health is a significant proportion of total expenditure on health, and in particular on financing outpatient care. Available evidence indicates that informal payments made by patients to physicians contribute as much as double of the physician's salary, and thus form an important source of earnings for physicians. This situation of high private expenditures on health care and informal payments to physicians is likely to be true of other transitional economies of Central and Eastern Europe as well. One policy implication that emerges is these transitional economies face a big challenge in managing existing resources, as opposed to finding new resources, in the health sector more effectively to meet the health care needs of their population. The paper highlights the need for better understanding of the current availability and distribution of resources in the health sector and their directions of flow, in both public and private sectors, and suggests using tools such as National Health Accounts to track and monitor changes in the financing of the health care system.

Adolescent↗
PubMed2003

Demand for private health insurance: how important is the quality gap?

Perceived quality of private and public health care, income and insurance premium are among the determinants of demand for private health insurance (PHI). In the context of a model in which individuals are expected utility maximizers, the non purchasing choice can result in consuming either public health care or private health care with full cost paid out-of-pocket. This paper empirically analyses the effect of the determinants of the demand for PHI on the probability of purchasing PHI by estimating a pseudo-structural model to deal with missing data and endogeneity issues. Our findings support the hypothesis that the demand for PHI is indeed driven by the quality gap between private and public health care. As expected, PHI is a normal good and a rise in the insurance premium reduces the probability of purchasing PHI albeit displaying price elasticities smaller than one in absolute value for different groups of individuals.

Adult↗
PubMedDate not supplied

Prescription practices of public and private health care providers in Attock District of Pakistan.

The irrational use of drugs is a major problem of present day medical practice and its consequences include the development of resistance to antibiotics, ineffective treatment, adverse effects and an economic burden on the patient and society. A study from Attock District of Pakistan assessed this problem in the formal allopathic health sector and compared prescribing practices of health care providers in the public and private sector. WHO recommended drug use indicators were used to study prescription practices. Prescriptions were collected from 60 public and 48 private health facilities. The mean (+/- SE) number of drugs per prescription was 4.1 +/- 0.06 for private and 2.7 +/- 0.04 for public providers (p < 0.0001). General practitioners (GPs) who represent the private sector prescribed at least one antibiotic in 62% of prescriptions compared with 54% for public sector providers. Over 48% of GP prescriptions had at least one injectable drug compared with 22.0% by public providers (p < 0.0001). Thirteen percent of GP prescriptions had two or more injections. More than 11% of GP prescriptions had an intravenous infusion compared with 1% for public providers (p < 0.001). GPs prescribed three or more oral drugs in 70% of prescriptions compared with 44% for public providers (p < 0.0001). Prescription practices were analysed for four health problems, acute respiratory infection (ARI), childhood diarrhoea (CD), fever in children and fever in adults. For these disorders, both groups prescribed antibiotics generously, however, GPs prescribed them more frequently in ARI, CD and fever in children (p < 0.01). GPs prescribed steroids more frequently, however, it was significantly higher in ARI cases (p < 0.001). For all the four health problems studied, GPs prescribed injections more frequently than public providers (p < 0.001). In CD cases GPs prescribed oral rehydration salt (ORS) less frequently (33.3%) than public providers (57.7%). GPs prescribed intravenous infusion in 12.3% cases of fever in adults compared with none by public providers (p < 0.001). A combination of non-regulatory and regulatory interventions, directed at providers as well as consumers, would need to be implemented to improve prescription practices of health care providers. Regulation alone would be ineffective unless it is supported by a well-established institutional mechanism which ensures effective implementation. The Federal Ministry of Health and the Provincial Departments of Health have to play a critical role in this respect, while the role of the Pakistan Medical Association in self-regulation of prescription practices can not be overemphasized. Improper prescription practices will not improve without consumer targeted interventions that educate and empower communities regarding the hazards of inappropriate drug use.

Administration, Oral↗
PubMed1982

Primary care, private physicians, and public health personnel: a conflict in expectations.

The elimination of categorical grants and their replacement by block grants provides public health departments the opportunity to integrate their services and provide general primary care to the underserved. While some may consider this an opportunity long overdue such a change may generate considerable conflict with private physicians. Questionnaire data from private physicians and health department personnel collected in North Carolina during an experimental program of primary care delivery by health department shows that there is substantial conflict. Private physicians oppose health department involvement in general primary care and in acute ambulatory care for the medically underserved. Physicians expect health departments to focus on preventive services, especially environmental monitoring and communicable disease control. Health department personnel want to expand their efforts beyond these more traditional areas into primary care and are in apparent conflict with private physicians. The community attitudes of a group of physicians within a community as well as the attitudes of a group of public health workers were found to be a major determinant of each individual's attitude toward public health, followed by the individual's age, sex, and years of working in the community.

Adult↗