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PubMed2002

Private health insurance uptake and the impact on normal birth and costs: a hypothetical model.

Recent Australian government policy has encouraged large numbers of women of childbearing age to enter private health insurance. This paper describes how increased uptake of private health insurance may impact on the rate of normal birth, caesarean section and the costs of providing maternity care in low risk primiparous women in New South Wales. A hypothetical model was developed using data from the NSW Midwives Data Collection. Costs were calculated using data established from previous research in NSW (Homer et al 2001). It suggests that, as the proportion of low risk primiparous women with private health insurance increases, the rate of normal birth may decrease with a subsequent increase in rate of caesarean section. As the rate of caesarean section rises, the cost of providing intrapartum and postpartum care may also increase. I argue that increased rates of private health insurance membership have the potential to increase the rate of caesarean section and the cost of providing maternity care to low risk women. It is evident that government policy can impact on the outcome of maternity care in Australia in ways that might not have been predicted. Paradoxically, the care of healthy childbearing women may cost the Australian government more to provide in the future.

Cesarean Section↗

PubMed2006

Private hospital insurance status among a state-wide injured population.

Injury is a leading cause of inpatient hospital episodes. Over a 4-year period (1997-2000) the Australian Government introduced measures to support the private health insurance industry by providing incentives for people to take up private health insurance (PHI) in order to take the pressure off public hospitals. This study examined the levels of PHI for moderately and severely injured people in Victoria as a way of determining the effectiveness of government incentives. The method involved an analysis of all Victorian public and private hospital injury admissions between July 2000 and June 2003. We found that people with injuries, either unintentional or intentional, had lower levels of PHI than state norms. While numbers of injured patients occupying private hospital beds initially increased, levels then dropped below the levels before the introduction of the incentives. The burden of injury is substantial and suggests that incentives need to be targeted towards at-risk groups.

Hospitalization↗

PubMed2001

Do older people receive equitable private psychiatric service provision under Medicare?

OBJECTIVE: The objective of this study is to determine the 1998 rates, types, regional variation and Medicare expenditure of private psychiatry services for older people in Australia, as compared with younger adults and with 1985-1986 data. METHOD: Medicare Benefits Schedule Item Statistics for the psychiatric item numbers 300-352 and item 14224 were obtained from the Health Insurance Commission for each State and Territory. The items were examined in the age groups 15-64 years, 65 years and over and 75 years and over. Main outcome measures were per capita service provision by age group, State and Territory and Medicare expenditure by age group. RESULTS: During 1998, 6.4% (5765.6 per 100 000) of private psychiatric services were to patients aged > 64 years. Patients aged 15-64 received 2.7 times the number of psychiatric services per capita than patients > 64 and 3.6 times that of patients aged > 74 years. Patients aged > 64 received more hospital and nursing home consultations, home visits and electroconvulsive therapy per capita, while younger adults used more office-based consultations, longer consultations, and group therapy. Victoria had the highest per capita rate (7659.2 per 100 000) and the Northern Territory the lowest (540.4 per 100 000), although the highest proportion of services to older patients was in Western Australia. Per capita the proportion of Medicare expenditure allocated to adults aged less than 65 years was 4.1 times that for adults over 64 years. CONCLUSIONS: Private psychiatric service provision to older people is inequitable when compared with younger adults. The proportion of Medicare private psychiatry expenditure on older adults has declined since 1985-1986.

Adolescent↗

PubMed2005

Does the private finance initiative promote innovation in health care? The case of the British National Health Service.

The Private Finance Initiative (PFI) is a specific example of health care privatization within the British National Health Service. In this essay, I critically assess the ways in which various Private Finance Initiatives have increased health care efficiency and effectiveness, as well as encouraged medical innovation. Indeed, as the analysis will demonstrate, significant empirical evidence supports the conclusion that Private Finance Initiatives are a driving force of innovation within the British Health Care System.

Biomedical Technology↗

PubMed2006

The RANZCP Australian Private Practitioners' Network.

OBJECTIVE: To provide an overview of the challenges and opportunities afforded by the practice of psychiatry in the private sector, and in so doing build a rationale for the formation of a formally established network of Australian psychiatrists who meet to advance constructive proposals concerning the private practice of psychiatry, encourage mutual support, and promote this area of psychiatric endeavour. CONCLUSIONS: Private psychiatry has dangers, challenges and many responsibilities, but it also has the potential for relative independence and creative fulfilment. It is desirable that its practitioners support each other and work constructively together in addressing the sorts of issues delineated in the Private Practitioners' Network's mission statement and objectives.

Australia↗

PubMed2003

Prevalence of prenatal drinking assessed at an urban public hospital and a suburban private hospital.

BACKGROUND: Although the prevalence of fetal alcohol syndrome (FAS) varies within the population, few data are available concerning variation in the prevalence of prenatal drinking. METHODS: Postpartum women delivering singleton infants at two Atlanta hospitals in 1993 or 1994 were interviewed. Those delivering infants who were small for gestational age (SGA) (n = 638) were over-sampled relative to those delivering infants with birth weights that were appropriate for gestational age (AGA) (n = 247). The prevalence of prenatal drinking was estimated as a weighted average of reports from mothers of SGA and AGA infants. Estimates of the prevalence of FAS come from the Metropolitan Atlanta Congenital Defects Program (MACDP) of the Centers for Disease Control and Prevention. RESULTS: The prevalence of first-trimester drinking was half that reported for the three previous months (private hospital: 72% vs. 35%; public hospital: 52% vs. 28%). Most women (85%) reported abstaining throughout the second trimester. Fewer than 10% of women delivering at the public hospital (7.5%), but one-quarter of those delivering at the private hospital, reported third-trimester drinking. Binge, moderate and heavy drinking in pregnancy were more common among women delivering at the public hospital. Eight infants born at the public hospital during this period, but none of those born at the private hospital, were identified as possibly having FAS; four of the eight were identified as probably having FAS. CONCLUSIONS: These results have implications for health education programs. For example, obstetricians in private practice may wish to reaffirm their advice to abstain from drinking in the third trimester. They also suggest that prenatal abstinence programs be targeted at populations identified as most likely to engage in risky drinking.

Alcohol Drinking↗

PubMed1997

Viewpoint: public versus private health care delivery: beyond the slogans.

In most settings, a 'public' health service refers to a service which belongs to the state. The term 'private' is used when health care is delivered by individuals and/or institutions not administered by the state. In this paper it is argued that such a distinction, which is based on the institutional or administrative identity of the health care provider, is not adequate because it takes for granted that the nature of this identity automatically determines the nature of the service delivered to the population. A different frame of classification between public and private health services is proposed: one which is based on the purpose the health service pursues and on the outputs it yields. A set of five operational criteria to distinguish between health services guided by a public or private purpose is presented. This alternative classification is discussed in relation to a variety of existing situations in sub-Saharan Africa (Mali, Uganda, Zimbabwe). It is hoped that it can be used as a tool in the hands of the health planner in order to bring more rationality in the current altercation between the public and the private health care sector.

Africa South of the Sahara↗

PubMed2001

Social class inequalities in the use of and access to health services in Catalonia, Spain: what is the influence of supplemental private health insurance?

OBJECTIVE: To analyse social class inequalities in the access to and utilization of health services in Catalonia (Spain), and the influence of having private health insurance supplementing the National Health System (NHS) coverage. DESIGN: 1994 Catalan Health Interview Survey, a cross-sectional survey conducted in 1994. SETTING: Catalonia (Spain). STUDY PARTICIPANTS: The participants were a representative sample of people aged over 14 years from the non-institutionalized population of Catalonia (n = 12,245). MAIN OUTCOME MEASURES: Health services utilization, perceived health, having only NHS or NHS plus a private health insurance, and social class. RESULTS: Although one-quarter of the population of Catalonia had a supplemental private health insurance, percentages were very different according to social class, ranging from almost 50% for classes I and II to 16% for classes IV and V in both sexes. No inequalities by social class were observed for the utilization of non-preventive health care services (consultation with a health professional in the last 2 weeks and hospitalization in the last year) among persons with poor self-perceived health status, i.e. those in most need. However, social inequalities still remain in the use of health services provided only partially by the NHS, and when characteristics of last consultation are taken into account. Subjects who paid for a private service waited an average of 18.8 minutes less than those attending the NHS. Within the NHS, social classes IV and V waited longer (35.5 minutes) than social classes I and II (28.4 minutes). CONCLUSION: The NHS in Catalonia, Spain, has reduced inequalities in the use of health services. Social inequalities remain in the use of those health services provided only partially by the NHS.

Adolescent↗

PubMed1977

Job satisfaction-dissatisfaction. A comparison of private practitioners and organizational physical therapists.

Job factors which results in feelings of satisfaction or dissatisfaction were studied in a sample of 25 physical therapists engaged in private practice and 25 physical therapists employed as chiefs of departments. Our purpose was to determine the meaningfulness of work for physical therapists and to compare private practitioners with therapists who work within an organization. Ten factors of the sixteen studied were found to be significantly satisfying or dissatisfying for all therapists. In addition, organizational therapists were satisfied with the work itself and valued recognition for their efforts, whereas private practitioners were more concerned with personal responsibility. Organizational therapists experienced periods of unhappiness with some aspects of interpersonal relationships and with some policies of the organization, and private practitioners were unhappy with long working hours. There was no significant difference in salaries, achievement, possibilities for growth, status, or security.

Achievement↗

PubMed1986

Private physicians in ambulatory care training in U.S. medical schools.

The contribution of private physicians to medical student education in ambulatory care was determined by a questionnaire directed to departments of family practice, internal medicine, and pediatrics in 124 U.S. medical schools and their branch campuses. The response rate was 84 percent. Of the responding departments, 82 percent offered an ambulatory care course in curricular years three and/or four, and 56 percent utilized private physicians in their courses. Departments of internal medicine were least likely to offer such a course, and their courses less frequently included teaching by private physicians (p less than 0.0001). When offered, internal medicine courses in ambulatory care were least likely to be required for graduation and involved the fewer students. Departments of family practice were most likely to offer ambulatory care courses and were most likely to utilize private physicians in their courses.

Ambulatory Care↗

PubMed2005

Private pay home care referrals: issues and challenges.

Assisting clients in determining the need for and choosing the type of private duty services can be confusing. This article provides: .An overview of the types of private duty home care services; . Key issues and challenges associated with each model; . Referral guidelines for quality private duty agencies; and . How the National Private Duty Association (NPDA) can assist in making quality referrals.

Community Health Nursing↗

PubMed2001

Length of stay as a source of bias in comparing performance in VA and private sector facilities: lessons learned from a regional evaluation of intensive care outcomes.

OBJECTIVES: Compare intensive care unit (ICU) mortality and length of stay (LOS) in a VA hospital and private sector hospitals and examine the impact of hospital utilization on mortality comparisons. RESEARCH DESIGN: Retrospective cohort study. SUBJECTS: Consecutive ICU admissions to a VA hospital (n = 1,142) and 27 private sector hospitals (n = 51,249) serving the same health care market in 1994 to 1995. MEASURES: Mortality and ICU LOS were adjusted for severity of illness using a validated method that considers physiologic data from the first 24 hours of ICU admission. Mortality comparisons were made using two different multivariable techniques. RESULTS: Unadjusted in-hospital mortality was higher in VA patients (14.5% vs. 12.0%; P = 0.01), as was hospital (28.3 vs. 11.3 days; P <0.001) and ICU (4.3 vs. 3.9 days; P <0.001) LOS. Using logistic regression to adjust for severity, the odds of death was similar in VA patients, relative to private sector patients (OR 1.16, 95% CI 0.93-1.44; P = 0.18). However, a higher proportion of VA deaths occurred after 21 hospital days (33% vs. 13%; P <0.001). Using proportional hazards regression and censoring patients at hospital discharge, the risk for death was lower in VA patients (hazard ratio 0.70; 95% CI 0.59-0.82; P <0.001). After adjusting for severity, differences in ICU LOS were no longer significant (P = 0.19). CONCLUSIONS: Severity-adjusted mortality in ICU patients was lower in a VA hospital than in private sector hospitals in the same health care market, based on proportional hazards regression. This finding differed from logistic regression analysis, in which mortality was similar, suggesting that comparisons of hospital mortality between systems with different hospital utilization patterns may be biased if LOS is not considered. If generalizable to other markets, our findings further suggest that ICU outcomes are at least similar in VA hospitals.

APACHE↗

PubMed1996

Knowledge of the childhood immunization schedule and of contraindications to vaccinate by private and public providers in Los Angeles.

BACKGROUND: Missed opportunities to vaccinate occur commonly and contribute to the underimmunization of young children. They are related to provider knowledge of the immunization schedule and contraindications to vaccination. METHODS: We surveyed private physicians (n = 50) and public health department physicians and nurses (n = 47). The questionnaire presented two sets of clinical scenarios in which they had to assess what immunizations were due and assess whether there were any contraindications to vaccination. RESULTS: The mean percent correct responses on the immunization schedule questions was 64% (sd = 3.6%) for the private physicians, 71% (SD = 4.7%) for the public physicians and 78% (SD = 2.8%) for the public nurses (P = 0.04). The mean percent correct responses on the contraindications to vaccinate questions was 73% (SD = 5.4%) for public physicians, 58% (SD = 3.3%) for private physicians, and 55% (SD = 4.7%) for public health nurses (P = 0.02). CONCLUSIONS: Our survey shows that providers in the public and private sectors have important deficits in their knowledge of the immunization schedule and the appropriate contraindications to vaccinate which might lead to missed opportunities to vaccinate and low immunization coverage.

Child↗

PubMed1997

Public and private workers' compensation insurance.

Utilizing unique data from the federal government's Social Security office, we analyze the costs of providing workers' compensation by public vs private insurers. Our analysis has the advantage that public and private recipients are likely to be more similar than public (Medicare, Medicaid) and private recipients of health insurance in the US or Canadian economies. We find that public firms appear to provide workers' compensation insurance more efficiently than private firms.

Canada↗

PubMed2003

Public insurance expansions and crowd out of private coverage.

BACKGROUND: The extent to which persons enrolling in new public insurance programs substitute the public coverage for private insurance is of concern to policy makers. OBJECTIVE: To look at the extent of the substitution resulting from new state programs that cover a broad base of the low-income population and to look at the responses of both families and employers. METHODS: The March CPS for 1991-1993 and 1997-1998 were used to study the responses of families. Two large national surveys of employers with information about the employment-based system in 1993 and 1997 were used to study employer responses. The analysis looks at changes in coverage and employer offer rates before and after the public insurance expansions in selected states and compares these changes to those in a control group in states without expansions. RESULTS: Coverage by private insurance for low-income persons in states with expansions fell by more than expected based on the control states, indicating some substitution of public coverage for private insurance. Changes in employee coverage in own-employer sponsored insurance accord with this result. The expansion of public insurance has a bigger effect on employer offer decisions when a large share of its workers is eligible for public programs. CONCLUSIONS: The results show a significant substitution of public insurance for private coverage in the expansions studied. However, endogeneity of state expansion policies and possible confounding with other policy changes temper the conclusions. More recent public insurance expansions as part of the State Childrens' Health Insurance Program have adopted a range of methods to limit crowd out. Future research is needed to evaluate whether these procedures and rules have succeeded.

Adult↗

PubMed2003

Estimating private sector values for VA health care: an overview.

OBJECTIVES: To provide an overview of methods used to establish what taxpayer costs would be if all Veterans Health Administration (VA) patient care were paid for by the federal government but provided in the private sector. METHODS: Study assumptions included (1) that there would be a hypothetical policy change to pay for VA care through a Medicare-based fee-for-service program, (2) that the VA coverage benefit would not change, (3) that practice styles would remain the same, and (4) that there would be no impact on market values. To achieve the objective, project staff adapted Medicare payment schedules and guidelines, where available, with oversight of an advisory committee with VA and non-VA expertise in costs and data. For six sites, detailed payments were estimated using VA utilization databases and software and Medicare rate schedules available in the private sector. Overhead, interest on capital, and malpractice costs were added to VA-reported operating costs. Patient severity was examined, and patient-level costs were explored. FINDINGS: Detailed methods for pricing seven types of health services are presented. Three methods articles focus on process issues. DISCUSSION: Because VA care is not directly comparable with private sector health care as a result in part of differences in benefits covered and the scope of services provided, estimating costs for this care based on a private sector model requires careful consideration of market valuation approaches. The articles in this supplement describe the methods used to estimate market values for VA care so that other researchers can use them in future studies.

Cost-Benefit Analysis↗

PubMed2006

Determinants of choosing public or private health care among patients with sexually transmitted infections in Uganda.

OBJECTIVES: To identify variables that distinguish patients with sexually transmitted infections (STIs) who seek care in public or private health units. GOAL: To recommend measures for improved care of patients with STIs. STUDY DESIGN: Patients with STIs were interviewed at public (n = 101) or private health units (n = 124). Information was collected on attitudinal, normative, and self-efficacy beliefs; STI symptoms; health-seeking behavior; sociodemographic characteristics, and on partner referral. RESULTS: Choosing private health units is favored by age >25 years, favorable beliefs towards private health units (e.g., they cure or prevent STIs and give adequate drug doses); unfavorable beliefs towards public health units (such as they make STIs chronic and have corrupt staff); not being influenced by sexual partner(s) in choice of treatment site, being likely to chose a treatment site if sexual partners were not treated free, and being likely to choose a treatment site if not recommend by a friend. This 9-variable model correctly classified 214 (95%) of the 225 patients (model chi squared = 192, 9 degrees of freedom, P <0.001). CONCLUSIONS: Psychosocial variables markedly influence choice of health care provider. Improving quality of care will enhance STI management and help to modify the unfavorable psychosocial beliefs.

Adult↗

PubMed2006

Gonorrhea prevention and clinical care in the private sector: lessons learned and priorities for quality improvement.

We reviewed literature on gonorrhea prevention and clinical care in the private sector, the setting where most gonorrhea cases in the United States are now diagnosed. Although most private-sector health settings had a low prevalence of gonorrhea (0.1-2.5%), some private emergency departments and specialty clinics that serve a large number of high-risk or infected patients had prevalences ranged from 1.7% to 11.0%. Studies of diverse settings and populations suggest that, in general, diagnostic testing of symptomatic patients (69-83%), appropriate treatment (61-100%), and case reporting (64-94%) are delivered more commonly than risk assessment for asymptomatic patients (15-28%), routine screening of pregnant women (31-77%), risk-reduction counseling (35-78%), and sex partner management (0-82%). To sustain the recent declines in gonorrhea incidence in the United States, private-sector providers and health systems must continue to offer gonorrhea prevention and clinical services and consider implementing interventions to improve delivery of risk assessment, risk-reduction counseling, and partner management services.

Diagnostic Tests, Routine↗