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PubMedDate not supplied

[A survey of private practice psychiatrist's training and activity in activity in Aquitaine, France, in 1993].

UNLABELLED: This study was conducted to gather information regarding the current professional activities of French private practice psychiatrists. METHOD: A mail survey was carried out in an attempt to find more about the characteristics of the 380 private practice psychiatrists in Aquitaine (south west France) in 1993. Data are reported in terms of psychiatrist's characteristics (demographics, training and practice activities), patient characteristics and trends in treatment modalities. RESULTS: There was a good response rate (55%), and this enabled us to statistically analyze the data to determine profiles of activities. For the respondents in this survey, the median age is 45 years and 30.7% of respondents are women. The portion of responders reporting a qualification in Neuropsychiatry versus Psychiatry, is low (1/7). The patients seen in private practice are generally young females with anxiety and affective disorders. An important feature was the trend for psychotherapy training and practice. Psychoanalytically oriented and individual psychotherapy were predominant over other forms of psychotherapy. Half of the psychiatrists reported using pharmacotherapy in combination with psychotherapy. There are only little differences in the practice of young and female psychiatrists. CONCLUSION: The impact of psychodynamic theories on the training of French private practice psychiatrists is still very important. Interestingly, these same psychiatrists seem to use an eclectic approach to their practice of psychiatry; about half of the respondents report using pharmacological treatments in combination with psychoanalytically oriented psychotherapy.

Adult↗
PubMed2000

Social Security privatization in Latin America.

The new, partially privatized social security system adopted by Chile in 1981 has attracted attention in many parts of the world. Since then, a number of Latin American countries have implemented the Chilean model, with some variations: either with a single- or multi-tier system, or with a period of transition to take care of those in the labor force at the time of the change. The single-tier version consists of a privatized program with individual accounts in pension fund management companies. Multi-tier systems have a privatized component and retain some form of public program. This article describes each of the new programs in Latin America, their background, and similarities and differences among them. Much more information is available for Chile than for the other countries (in part because Chile has the oldest system), enough to be able to evaluate what, in most cases, is the most accurate information. That is often not the case for the other countries, especially when dealing with subjects such as transition costs and net rates of return (rates of return minus administrative fees). No country has copied the Chilean system exactly. Bolivia, El Salvador, and Mexico have closed their public systems and set up mandatory individual accounts. Argentina has a mixed public/private system with three tiers. In Colombia and Peru, workers have a choice between the public and private programs. Uruguay created a two-tier mixed system. Costa Rica has a voluntary program for individual accounts as a supplement to the pay-as-you-go program and has just passed a law setting up mandatory accounts containing employer contributions for severance pay. All of the countries continue to face unresolved issues, including: High rates of noncompliance--the percentage of enrollees who do not actively and regularly contribute to their accounts--which could lead to low benefits and greater costs to the governments that offer a guaranteed minimum benefit; Proportionately lower benefits for women and lower earners than for men and higher earners; A minimum required rate of return among the pension fund management companies (in most of these countries) that has resulted in similarity among the companies and the consequent lack of meaningful choice; and High administrative fees in most of these countries, which reduce the individual's effective rate of return. To what extent these issues can be mitigated or resolved in the future is not yet clear. In general, a definitive assessment of the Chilean model and its Latin American variations will not be possible until a cohort of retirees has spent most of its career under the new system.

Aged↗
PubMed2001

STD care in the South African private health sector.

OBJECTIVES: To establish the accessibility and quality of sexually transmitted disease (STD) care provided by private general practitioners (GPs) and workplace health services in South Africa. DESIGN: Structured telephone interviews were conducted with a random national sample of 120 GPs and 244 occupational health nurses (OHNs) between May and July 1997. The interview schedules covered indicators of access (including utilisation) and processes (drug treatment, partner management, counselling and condom promotion) of STD care. RESULTS: An estimated 5 million STD-related visits were made to private general practices in 1997. Reported treatment of STDs was assessed for effectiveness using well-established syndromic case management guidelines. Only 28% of GPs reported effective treatment for urethral discharge. This dropped to 14% for genital ulcer and 4% for pelvic inflammatory disease. Fifty-five per cent of the OHNs interviewed indicated that their workplace clinics provided STD care. Nurses provided this care, with or without the support of doctors, in 87% of clinics. Reported urethral discharge and genital ulcer treatment regimens were assessed as effective in 34% and 14% of responses, respectively. CONCLUSIONS: The private sector is a major provider of STD care and is key to national efforts to achieve better STD control, thereby preventing the spread of HIV. However, the results of the research suggest that the poor quality of STD care may be undermining attempts to control these epidemics in our society. Although a complex task, strategies need to be found to improve the quality of care provided within the private sector.

Adult↗
PubMed2001

Prevalence of diabetes and patterns of health services utilization: a comparative analysis between a private and a health reform group of insured, 1997-1998.

OBJECTIVE: To compare the prevalence and health services utilization patterns of diabetes mellitus in a group of insured under the Puerto Rico Health Reform Act and the private sector of the same insurance company. METHODS: The medical claims of the public sector insured whose main diagnosis was diabetes mellitus (ICD9-250.0-9) were selected for analysis. Prevalence and medical utilization rates were estimated. General characteristics and services utilization were compared by age and sex using the chi-square distribution. RESULTS: A total of 38,139 diabetic cases were identified during the study period. Overall prevalence was 6.23% (95% CI: 6.17%-6.29%); 5.22% among males (95% CI: 5.14-5.30) and 7.09% among females (95% CI: 7.00%-7.18%). The proportion of cases was larger in persons aged 65 years or more (60.3%) and females (61.6%). Overall, 84.7% of insured diabetics had medical office visits, while 7.8% had emergency room services and 1.3% had hospital admissions. Female cases had more physician office visits (62%) and insulin prescriptions (65%) compared to males (p < 0.05). The most reported complication was cerebrovascular accident (4.4%). The prevalence of diabetes was higher in the public sector (6.23%) when compared to the private sector (4.73%) (p < 0.01). The mean number of oral hypoglycemic (32.77 +/- 0.40) and insulin (40.99 +/- 0.54) prescriptions were higher in the public sector (p < 0.01). Emergency room utilization rate was larger among males in the younger age groups of the private sector. However, hospital admissions were larger in both sexes of the younger age group of the public sector when compared with the private sector. CONCLUSIONS: A higher prevalence of diabetes and mean service utilization was observed in the public sector. An in-depth analysis of the health care of patients with diabetes in the public sector is needed.

Adult↗
PubMed1975

Immunization activities of private-practice physicians: a record audit.

A record audit of the office immunization records of 13 private-practice Idaho physicians included 813 2-year-old children. Thirty-six percent had completed all the Public Health Service recommended immunizations for a 2-year-old child. Forty-four percent of the "active" patients (those seen by the physician within the previous 12 months) were complete as opposed to 8% of the "inactive" patients. In general, the children who received immunizations exclusively from their private physician were better immunized (38% complete) than those who received immunizations from both their private physicians and the health department clinics (22% complete). Despite the low percentage of overall completeness, the vaccine-specific immunization levels were at least as high as the levels computed from the National Immunization Survey. While the limitations of the study prevent application of the results to physicians in general, the data suggest that the inability to complete an immunization schedule, once begun, is a major weakness in the immunization activities of private-practice physicians.

Child, Preschool↗
PubMed2003

Quality and comparison of antenatal care in public and private providers in the United Republic of Tanzania.

OBJECTIVE: To compare the quality of public and private first-tier antenatal care services in Dar es Salaam, United Republic of Tanzania, using defined criteria. METHODS: Structural attributes of quality were assessed through a checklist, and process attributes, including interpersonal and technical aspects, through observation and exit interviews. A total of 16 health care providers, and 166 women in the public and 188 in the private sector, were selected by systematic random sampling for inclusion in the study. Quality was measured against national standards, and an overall score calculated for the different aspects to permit comparison. FINDINGS: The results showed that both public and private providers were reasonably good with regard to the structural and interpersonal aspects of quality of care. However, both were poor when it came to technical aspects of quality. For example, guidelines for dispensing prophylactic drugs against anaemia or malaria were not respected, and diagnostic examinations for the assessment of gestation, anaemia, malaria or urine infection were frequently not performed. In all aspects, private providers were significantly better than public ones. CONCLUSION: Approaches to improving quality of care should emerge progressively as a result of regular quality assessments. Changes should be introduced using an incremental approach addressing few improvements at a time, while ensuring participation in, and ownership of, every aspect of the strategy by health personnel, health planners and managers and also the community.

Adolescent↗
PubMed2003

A new face for private providers in developing countries: what implications for public health?

The use of private health care providers in low- and middle-income countries (LMICs) is widespread and is the subject of considerable debate. We review here a new model of private primary care provision emerging in South Africa, in which commercial companies provide standardized primary care services at relatively low cost. The structure and operation of one such company is described, and features of service delivery are compared with the most probable alternatives: a private general practitioner or a public sector clinic. In a case study of cost and quality of services, the clinics were popular with service users and run at a cost per visit comparable to public sector primary care clinics. However, their current role in tackling important public health problems was limited. The implications for public health policy of the emergence of this new model of private provider are discussed. It is argued that encouraging the use of such clinics by those who can afford to pay for them might not help to improve care available for the poorest population groups, which are an important priority for the government. Encouraging such providers to compete for government funding could, however, be desirable if the range of services presently offered, and those able to access them, could be broadened. However, the constraints to implementing such a system successfully are notable, and these are acknowledged. Even without such contractual arrangements, these companies provide an important lesson to the public sector that acceptability of services to users and low-cost service delivery are not incompatible objectives.

Community Health Centers↗
PubMedDate not supplied

Public perception of alcohol policy issues relating directly or indirectly to privatization: results from a 1999 Ontario survey.

OBJECTIVE: The purpose of this study is to measure public opinion on alcohol policy issues relating to youth, litigation, outlet density, and government action. The authors comment on the implications of public opinion with regard to proposals for privatization of alcohol retailing in Ontario. METHOD: Using data from a 1999 provincial survey (n = 1,288), the authors examine the opinions of Ontario adults (male and female over the age of 18) on seven alcohol policy-related items. In order to identify characteristics of persons tending to express certain opinions, the opinion items are cross-tabulated with sex, age, drinking pattern, marital status, and education. A scale is created to show the level and strength of aggregate support for alcohol controls. A logistic regression confirms associations between demographic characteristics and opinions. RESULTS: The majority expresses opinions favouring alcohol controls and disagreeing with privatization (73% of total sample against). However, differences of opinion are observed within groups, between groups, and between items. In particular, higher-risk drinkers stand out for their dislike of most control measures. DISCUSSION: Taken as a whole, the results suggest that privatization of alcohol retailing in Ontario would run contrary to the wishes of the majority. Disapproval would probably be even stronger if more people realized there is often a connection between privatization and increased outlet density, relaxation of other controls, and less consideration for public health.

Adult↗
PubMed2003

Is the DOTS strategy sufficient to achieve tuberculosis control in low- and middle-income countries? 2. Need for interventions among private physicians, medical specialists and scientific societies.

In the first of these two articles it was expressed how, in practically all middle-income and many low-income countries, it is necessary to implement interventions in addition to the DOTS strategy if adequate tuberculosis control is to be achieved. We need to act in two directions: 1) in universities and medical schools, as explained in the first article, and 2) specifically among private physicians and medical specialists, an important obstacle for many National Tuberculosis Programmes (NTPs). These professionals, especially medical specialists (many of whom also work in private practice), are an influential sector that is held in high regard, but which tends not to follow guidelines considered as excessively simplistic or rigid, such as those stipulated by the NTP. Private physicians have practically no access to information or training programmes, which accounts for the surprising disparity in their clinical criteria. All this leads to important distortions that can compromise the NTP's outcome. The present article evaluates the need to intervene among private physicians and medical specialists in order to achieve better tuberculosis control. Special strategies are described to obtain concrete, specific agreements for their participation in the NTP, and for the implementation of specific training programmes for this group. At the end of the article the work performed by the IUATLD in these groups in Latin America is described.

Developing Countries↗
PubMed2003

Feasibility and effectiveness of a public-private mix project for improved TB control in Delhi, India.

SETTING: New Delhi, India. OBJECTIVE: To assess the feasibility of a public-private mix (PPM) project for improved tuberculosis (TB) control and determine its impact on case detection, case-management quality, treatment outcome and patient convenience. DESIGN: 1) Monitoring of case detection through the review of record data; 2) cohort analysis of patients treated by private providers (PPs); 3) questionnaire-based surveys of patients and private providers. RESULTS: A total of 612 cases were detected, of whom 168 (27%) were new sputum-positive cases. Incremental case notification due to PPs was 47% for new cases and 29% for new sputum-positive cases. Sputum examination for diagnosis and evaluation was performed in 100% and 84%, respectively, of notified patients. The treatment success rate for new sputum-positive cases treated by PPs was 81%, which was not significantly different from the 86% in the public sector. Directly observed treatment (DOT) was confirmed by 95% of patients. CONCLUSIONS: This PPM project, carried out with government funding in accordance with the RNTCP recommendations and with the support from several government and private organisations, achieved improved case detection as well as acceptable treatment outcome for patients receiving DOT from PPs.

Adolescent↗
PubMed2003

Funding long-term care by applying the trade-off principle to public and private insurance.

The uncertain need for long-term care (LTC) services is a risk that is best protected by insurance. However, current LTC funding in the United States relies heavily on personal payment and public welfare and only lightly on social insurance and private insurance. This method is akin to sitting on a two-legged stool, which is likely to be unstable. This brief describes a "three-legged" funding model where social insurance would provide basic LTC protection that would be supplemented by private insurance and personal payment. The model would mobilize public and private resources more effectively by linking LTC insurance to social security, private life insurance, and other financial products.

Aging↗
PubMed2003

Knowledge, attitude and practice of private medical practitioners in Calabar towards post-abortion care.

This study examined the knowledge, attitude and practice of private medical practitioners in Calabar on abortion, post-abortion case and post-abortion family planning. Forty eight private practitioners who were proprietors of private clinics in the city were interviewed using a structured questionnaire. The results showed that 22.9% of the doctors routinely terminate unwanted pregnancies when requested to do so by women, while 83.3% of them treat women who experience complications of unsafe abortion. The major reasons given by some of the doctors for not terminating unwanted pregnancies were religious, moral and ethical considerations rather than respect for the Nigerian abortion law. Only 18.2% of the doctors use standard procedures such as manual vacuum aspiration (MVA) for the management of patients with abortion and abortion complications. A good number of them did not routinely practice integrated post-abortion family planning and STDs management. There is need for a comprehensive programme of retraining of private medical practitioners in Calabar on the principles and practices of safe abortion, post-abortion care and family planning. These aspects of reproductive health need to be integrated into the medical training curricula in Nigeria. It is believed that this approach would help reduce the present high rate of abortion-related morbidity and mortality in Nigeria.

Abortion, Induced↗
PubMed2004

Patient education through the Internet: academic and private practice sites.

Although Internet use among patients continues to increase, the quality of disseminated information in orthopaedic surgery often is substandard. We reviewed and compared the web sites of academic orthopaedic surgery departments and private practices and rated their informational content with respect to patient education. Only 11.5% of academic sites and 52% of private practice sites list information on common orthopaedic conditions. Of these, less than 1/3 have information on various topics, and few have links to other patient education sites. Private practice web sites make better use of the Internet to provide patients with practical information about their individual practices. Few sites post the date of last update and those that do often have not been updated for more than 6 months. Academic and private practices underutilize the Internet as an educational resource. Orthopaedic surgeons are missing an important opportunity to provide accurate and reliable information to their patients.

Academic Medical Centers↗
PubMed2004

The cost of privatization: extra payments to Medicare Advantage plans.

The recently enacted Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) includes a broad set of provisions intended to enlarge the role of private health plans (called Medicare Advantage plans) in Medicare. This issue brief examines the payments that private plans are receiving in 2004 relative to costs in traditional fee-for-service Medicare, using data from the 2004 Medicare Advantage Rate Calculation Data spreadsheet. The authors find that, for 2004, Medicare Advantage payments will average 8.4 percent more than costs in traditional fee-for-service Medicare: $552 for each of the 5 million Medicare enrollees in managed care, for a total of more than $2.75 billion. In some counties, extra payments by Medicare are more than double this amount. Although the stated objective of efforts to increase enrollment in private plans is to lower costs, the policies of MMA regarding private plans explicitly increase Medicare costs in 2004 and through 2013.

Aged↗
PubMed2004

[Relations between official and private veterinary services in epidemiology and the control of contagious diseases].

Growing budget restrictions in many countries have meant that official Veterinary Services cannot assume responsibility for any new activities. The natural reaction is to turn to private veterinary services to provide the support needed to strengthen the control and surveillance of priority diseases and thereby support the development of the livestock sector and the establishment of safe international trade. In this context, official Veterinary Services must work together with private veterinarians, delegating various technical animal health activities, so that they may focus their efforts on those tasks that cannot be delegated: standardisation, control, auditing, general system co-ordination, epidemiological surveillance, etc., as well as organising veterinary policy in order to make best use of budget resources. For these relations to be efficient, a dynamic, two-way epidemiological information mechanism must be created, whereby private veterinarians periodically keep governments informed, on the basis of an agreed methodology. Moreover, the official Veterinary Services must systematically transmit information on List A and B diseases of the OIE (World organisation for animal health), and perform detailed analyses of epidemiologically significant events. The article proposes the establishment of relations between public and private veterinary services as a way in which to provide the livestock sector with the health and hygiene conditions that are necessary for effective disease control, which in turn provides greater security for international trade and increased consumer protection.

Animals↗
PubMed2004

[Disease monitoring and surveillance systems and the role of public and private animal health agents: the experience of Africa].

The current importance of animal diseases, and their emergence or re-emergence, show that surveillance is crucial for defining suitable control measures. Surveillance systems rely on networks of different people, whose activities include collecting, transmitting, analysing and disseminating disease information. These activities can be distributed among both the public and private sectors. However, nowadays it is essential to clearly define the different roles of the public and private sectors. In Africa, where budget cuts for state Veterinary Services over a number of years have promoted the growth of private veterinary medicine, the tasks of public officials (veterinarians, technicians, etc.) and private sector workers (veterinarians, livestock farmers) must be clearly determined and harmonised. This article presents and comments upon a number of different experiments that various sub-Saharan African countries have conducted in this field.

Africa South of the Sahara↗
PubMed2004

[Is methadone maintenance provided by private practitioners effective?].

OBJECTIVES: Involvement of private practitioners in methadone maintenance treatment (MMT) enhances its availability. However, effectiveness of such treatments is still debated. METHODS: A retrospective case register analysis comparing the retention of private practices with that of specialised institutions. All methadone maintenance treatment starting between January 1, 1997 and December 31, 1999. Kaplan-Meier survival estimates to test for different retention times; Cox-regression procedure to control for baseline differences between the two populations. RESULTS: Even after controlling for distinct patient characteristics, MMT by private practitioners resulted in a longer retention time. CONCLUSION: Our findings favour the involvement of private practitioners. Providing better professional and financial support may enhance their participation.

Adult↗
PubMed2005

Every provider counts: effect of a comprehensive public-private mix approach for TB control in a large metropolitan area in India.

SETTING: Mumbai, India. OBJECTIVES: To assess impact on case notification and treatment outcome of a public-private mix approach for tuberculosis (TB) control involving private providers, non-governmental organisations (NGOs), and public providers not previously involved in the Revised National TB Control Programme (RNTCP). METHODS: Under the stewardship of the RNTCP, providers were allocated different roles in referral, diagnosis, treatment initiation, directly observed treatment (DOT) provision, training and supervision. Referral forms were introduced and RNTCP registers were adapted to enable monitoring of case notification by different providers and cohort analysis disaggregated by provider type. RESULTS: A fraction of all non-RNTCP providers had become actively involved by the end of 2003. These providers contributed 2145 new smear-positive cases in 2003, an increment of 40% above the 5397 cases detected in RNTCP facilities. The treatment success rate for new smear-positive cohorts for 2002 was 85% in RNTCP facilities, 81% in private clinics, 88% in medical colleges, 91% in NGOs and 73% in the TB hospital (where the death rate was 16%). CONCLUSION: Active involvement of some key public and private providers can increase case notification substantially while maintaining acceptable treatment outcomes. The impact can be expected to be even larger when all health providers have been involved.

Disease Notification↗