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PubMed2005

[Private education and academic performance among medical students].

BACKGROUND: A large proportion of Norwegian medical students have some private education behind them. The question raised here is whether the educational performance of these students is lower than that of other students. MATERIAL AND METHODS: The analysis is based on data from the National Educational Database, which includes information on the total population. The dependent variable is grades obtained early in medical training. The impact of private education is estimated by linear regression models. The analysis controls for time between completing secondary school and entering medical school, as well as university, gender and social background. RESULTS: Students with a background from private schools have a lower level of academic performance in medical school than other students. This also holds true when we compare students who have waited equally long for admission to medicine, and who had the same level of performance in secondary school. INTERPRETATION: A likely explanation is that private schools tend to put emphasis on preparation for examinations. By doing this, they raise the level of performance among students who do not necessarily score highest with respect to academic abilities.

Databases, Factual↗
PubMedDate not supplied

Effect of providing free sputum microscopy service to private practitioners on case notification to National Tuberculosis Control Program.

BACKGROUND: This study was undertaken to see whether providing free sputum microscopy services to private practitioners helps in case notification to the national tuberculosis control program. The knowledge, attitudes and practices of these practitioners regarding tuberculosis were also evaluated. METHODS: A questionnaire was administered to all the private practitioners practicing in a densely populated area of Karachi. They were asked to fill tuberculosis notification cards for the first three months and then for another three months when an incentive in the form of free sputum microscopy was provided to the practitioners. RESULTS: Although the majority of the practitioners knew that cough, fever and weight loss are the main symptoms of tuberculosis, less than half knew that blood in sputum, poor appetite and chest pain could also be associated with tuberculosis. Only 66% of the practitioners indicated sputum microscopy as the preferred diagnostic method for tuberculosis. Only 50% of the practitioners self treated the patients, while the remaining half referred their patients to specialists. Around 80% of the practitioners were aware of the four first-line anti-tuberculosis drugs. Less than half of the practitioners considered sputum microscopy as the most useful follow-up investigation in a patient with pulmonary tuberculosis. Generally, there was a poor response in case notification by private practitioners on provision of free sputum microscopy. CONCLUSION: An overwhelming majority of the practitioners had poor knowledge concerning the correct treatment practices in Tuberculosis. Providing sputum free microscopy does not significantly help in improving tuberculosis case notification. Strategies for public-private collaboration in tuberculosis control are needed.

Clinical Competence↗
PubMed2006

Episiotomy rates in private vs. resident service deliveries: a comparison.

OBJECTIVE: To compare the use of episiotomy by private practitioners vs. resident staff and to determine if number of years in practice influences episiotomy use. STUDY DESIGN: A retrospective chart review of vaginal deliveries at 35 weeks or greater between January 2001 and June 2001. The number of years in practice by each private physician was documented. Independent sample t tests and chi2 tests were used to analyze data. RESULTS: In 995 deliveries, episiotomies were performed in 6% of low-risk resident deliveries vs. 26% of low-risk private deliveries (p<0.001). Physicians in practice > or = 15 years performed episiotomies in 32% of low-risk births. Physicians in practice <15 years performed episiotomies in 22% of low-risk births (p = 0.027). CONCLUSION: Deliveries performed by private practitioners are associated with a higher rate of episiotomy than those by resident staff. The number of episiotomies appears to increase by number of years in practice.

Adolescent↗
PubMed2006

Private GPs contribute to TB control in Myanmar: evaluation of a PPM initiative in Mandalay Division.

SETTING: Mandalay Division, Myanmar. AIM: To assess the effect of an initiative to involve private general practitioners (GPs) in the National Tuberculosis Programme (NTP) and to identify lessons learnt for public-private mix scale-up. METHODS: Source of referral/diagnosis and place of treatment were included in the routine recording and reporting systems to enable disaggregated analysis of the contribution of GPs to case notification and treatment outcomes. Case notification trends were compared between the intervention and control areas over a 4-year period. RESULTS: Private GPs contributed 44% of new smear-positive cases registered during the study period (July 2002-December 2004). The notification of new sputum smear-positive TB in the study area increased by 85% between the year prior to the GP involvement and 2 years after (from 46 to 85/100,000). Case notification increased by 57% in the control townships and by 42% in all of Mandalay Division. The treatment success rate for new smear-positive cases treated by GPs was 90%. CONCLUSIONS: The involvement of private GPs substantially increased TB case notification, while a high treatment success rate was maintained. Success factors include a well-developed local medical association branch, strong managerial support, training and supervision by the public sector and provision of drugs and consumables free of charge by the NTP.

Family Practice↗
PubMed2006

Can public-private collaboration promote tuberculosis case detection among the poor and vulnerable?

Private-public mix (PPM) DOTS is widely advocated as a DOTS adaptation for promoting progress towards the international tuberculosis (TB) control targets of detecting 70% of TB cases and successfully treating 85% of these. Private health care plays a central role in health-care provision in many developing countries that have a high burden of TB. It is therefore encouraging that PPM projects are being set up in various countries around the world to explore possible interaction between the national TB programmes and other partners in the fight against TB. The objective of this review was to use the published literature to assess the range of providers included in PPMs for their ability to provide case-detection services for the vulnerable. From a case-detection perspective, we identify the essential elements of a pro-poor PPM model, namely, cost-effectiveness from a patient perspective, accessibility, acceptability and quality. The review revealed that a very large part of the total spectrum of potential PPM-participating partners has not yet been explored; current models focus on private-for-profit health-care providers and non-governmental organizations. We conclude that it is important to think critically about the type of private providers who are best suited to meeting the needs of the poor, and that more should be done to document the socioeconomic status of patients accessing services through PPM pilots.

Developing Countries↗
PubMed2007

Compliance with DOTS diagnosis and treatment recommendations by private practitioners in Kerala, India.

The Indian government has a national tuberculosis (TB) plan based on DOTS recommendations. The private health sector plays an increasing role in health care provision in India, and a public-private mix (PPM) project has been introduced to standardise TB diagnosis and treatment methods in Kerala, India. This study interviewed 45 private practitioners (PPs) to evaluate diagnostic, treatment and reporting practices, of whom 80% diagnose with sputum microscopy and 43% treat all of their patients according to the treatment regimens recommended by the DOTS strategy. This study demonstrates that the current management of TB by private practitioners in Kerala is still in need of improvement.

Adult↗
PubMed1991

Public and private donor financing for health in developing countries.

Among the many variables that influence the outcome of national health status in both developed and developing countries, the availability and efficiency of financing is critical. For 148 developing countries, annual public and private expenditures from domestic sources (1983) were estimated to be approximately $100 billion. For the United States alone, annual public and private costs for medical care are almost five times larger ($478 billion, 1988). In contrast to domestic expenditures, the total flow of donor assistance for health in 1986 was estimated to be $4 billion, approximately 5% of total current domestic expenditures by developing countries. Direct donor assistance for development purposes by the United States Government approximates 0.5% of the US federal budget (1988). Approximately 10% of all United States development assistance is allocated for health, nutrition, and population planning purposes. While the total health sector contribution is on the order of $500 million annually, the US contribution represents about 13% of health contributions by all external donors. In sub-Saharan Africa, all donor health allocations only reach 3.4% of total development assistance. While available data suggest that private and voluntary organizations contribute approximately 20% of total global health assistance, data reporting methods from private agencies are not sufficiently specific to provide accurate global estimates. Clearly, developing countries as a whole are dependent on the efficient use of their own resources because external financing remains a small fraction of total domestic financing. Nevertheless, improvement in health sector performance often depends on the sharing of western experience and technology, services available through external donor cooperation. In this effort, the available supply of donor financing for health is not restricted entirely by donor policy, but also by the official demand for external financing as submitted by developing countries. In perspective, the supply of financing for health greatly exceeds the receipt of well-articulated and officially approved proposals from developing countries. The major constraints that produce this imbalance are unfamiliarity of ministries of health with potential donor sources; passive approaches to external financing; unfamiliarity with proposal preparation; increasing competition within developing countries by competing sectors, such as industry and agriculture; limited numbers of trained personnel; and absence of an international system which is able to support developing countries in mobilizing external financing. Tested solutions to these issues have been applied in one geographic region.(ABSTRACT TRUNCATED AT 400 WORDS)

Delivery of Health Care↗
PubMed1990

A comparison of prescribing patterns and consequent costs at Alexandra Health Centre and in the private fee-for-service medical aid sector.

About 25% of private health expenditure in South Africa goes on medicines. This compares with about 6% in the public sector, and about 12% in the UK. A major factor contributing to these differences is the prescribing practices of physicians, and generic prescribing in particular. This is a preliminary study to assess the savings that might be possible by altering prescribing practices. A sample of 528 scripts from Alexandra Health Centre (AHC) was analysed to calculate the average number of items per script and the average cost per script. In order to make the costs comparable to expenditure on medicines in the private fee-for-service sector, the scripts from AHC were costed as if they had been dispensed by private pharmacies--including dispensing fees, packaging costs and general sales tax. Since AHC clinicians generally prescribe medicines in the prepacked quantities, nothing is added to the costs for 'broken bulk'. However, as is the practice at AHC, cheaper therapeutic equivalents were substituted wherever possible. The number of items per script in the fee-for-service sector was 17% higher than at AHC, and the cost per item at AHC was one-quarter that in the private sector. Various explanations are offered including the possible incomparability of the case mix in the two sectors and the relative quality of care. However, the difference is so large that it is concluded that generic substitution, prepackaging and the use of treatment protocols by the clinicians are the major contributing factors.

Costs and Cost Analysis↗
PubMed1979

Oral surgeons in full-time private practice.

The most prevalent type of practice of oral surgeons is full-time private practice. Its characteristics as obtained from data of The Manpower Survey of Oral Surgery in 1974 are described in this article. The number of offices or type of practice (solo or group) was not correlated significantly with the age of oral surgeons. The factor of reason for practice location had no influence on the factors of size of population where the practice was located, size of the trade area where practice was located, or annual income. The factor of average annual income indicated that the greatest income was earned by oral surgeons who were between the ages of 40 and 50 and whose practice was located in a population area of between 250,000 and 500,000. Annual income was also influenced by number of years in a practice location up to about five years. After that, years in a location had little influence. The question of adding a partner influenced younger oral surgeons more than older ones. More oral surgeons in solo practice intended to add a partner than oral surgeons in group practice. Neither the population of the city where a practice was located nor the waiting period for admission to a hospital for patients who needed elective surgery influenced significantly the plans of oral surgeons in full-time private practice with regard to the addition of an associate. The opinion of oral surgeons in full-time private practice with regard to methods of increasing the effectiveness of practice also was reviewed. A large proportion of oral surgeons in full-time private practice believed that they needed more training in outpatient ambulatory general anesthesia and more time rotating in internal medicine and general surgery. They stated that, in general, their preparation in activities of a professional nature was adequate but that their preparation in activities of an administrative nature was inadequate. Attendance of oral surgeons at professional meetings was not influenced by age, population of the city where their practice was located, population of trade area where their practice was located, or professional income. The majority of oral surgeons thought that there was enough dental manpower to meet the demand for oral surgery service. Age had no significant influence on this opinion. Oral surgeons in population areas of less than 150,000 were less inclined to think there was excessive manpower in the dental specialties than those in population areas of more than 150,000.

Adult↗
PubMed1988

Legal requirement of private practice medical records.

The hospital medical record is a critical communication vehicle for the numerous health professionals who provide care to each patient. It is also an essential evidentiary tool in malpractice suits. Even though the medical record is not the sole information upon which the courts will rely in determining negligence liability, it can serve as an important chronology of care. Dietitians entering private practice, whether with a physician or not, should establish a system of record keeping. Although specific standards have not been set for private patient records, it is argued that records kept must meet many of the requisite guidelines for medical records in institutional settings. Additionally, the records must provide documentation that may be absent and difficult to obtain in the private setting. Discussed are legal issues surrounding patient records of the dietitian in private practice.

Defensive Medicine↗
PubMed1978

Patients of internists in hospital outpatient departments and in private practice.

To test the contention that patients in outpatient departments and private practices differ, variables were assessed that might affect both the process and the outcome of medical care. Two groups of 60 patients consulting nine Montreal internists who worked in both private practice and in an outpatient department of a university teaching hospital were surveyed. The internists served as their own controls. The two groups of patients were compared for 57 demographic, socioeconomic, access, utilization, attitudinal and current medical status variables. Financial factors were minimized by the existence of universal health insurance. The outpatient group was found to be older, less fluent in English, less likely to be employed, less educated, less wealthy, more dependent on public transportation, more disabled, more likely to use ambulatory services, more anxious about health, and more sceptical about physicians, yet more dependent on them than the private practice group. The outpatient group tended to have more active, significant medical conditions and to receive more prescriptions for medication than the private practice group, in contrast to the national patterns in the practice of internal medicine in the United States. Medical educators, researchers, administrators and providers of health care who have assumed that these two groups of patients are comparable must re-evaluate their practices.

Adult↗
PubMed1995

Costs, resource utilisation and financing of public and private hospitals in Uganda.

A descriptive cross-sectional, retrospective cost analysis was conducted in a public and private hospitals in Arua district, Uganda with the aim of assessing the resource use, costs, and financing of those hospitals. It employed the "full costing" approach to hospital costing. The results showed that most of the government recurrent expenditure on health facilities in the district went to the public hospital, while most of the revenues at the private hospital was from donations. The distribution of costs by category of inputs showed that materials and supplies costs were highest in both hospital, followed by employee costs. The administration, pharmacy and store had the highest cost at both hospitals. The cost of the kitchen was very high in the public hospital. The ratio of the unit costs of an out patient visit to an inpatient day and to the unit cost per case treated was 1:1:6 in the private and 1:7:46 in the public. This indicates the relative low cost of public hospital outpatient service and the relative high cost of the outpatient in the private hospital. The employee costs and the drug costs were the most important components of the unit costs in the OPD at both hospitals while in the inpatient wards, besides the above mentioned components, there were also the kitchen, blood bank (public) and theatre in both hospitals. It is concluded that hospitals should look for ways of increasing the level of recurrent funding available to them by increasing the efficiency of their operations and by mobilising additional resources from other sources other than government.

Costs and Cost Analysis↗
PubMed1995

Health care utilization and attitudes toward health insurance. A comparison of privately insured and medical assistance or uninsured patients.

A questionnaire was distributed to 108 patients to find if there were differences in health care resource usage and attitudes towards health insurance between patients seen in the hand clinic, designed for patients with medical assistance or without insurance (57 patients), and those seen in the private offices of staff hand surgeons (51 patients). Clinic patients reported a mean of 18 visits to their physician in the past year as compared with 7 for private patients (P < 0.0005) and attended 52% of their scheduled appointments as compared to an 83% attendance rate for private patients (P < 0.001). Patients enrolled in a medical assistance program were less willing to pay for their health care than were private patients. Sixty-two percent of clinic patients responded that they would not be willing to pay anything at all for their health care coverage. These data suggest that health care and health insurance is a lower priority for the clinic patient. Any new health care system that includes the uninsured and underinsured must be prepared to handle different attitudes toward health care and an increase in utilization of resources.

Adult↗
PubMed1995

The privatization of Canadian health care is moving into high gear.

The future of Canada's public health care system has been the source of much debate in the past year. Several signs, ranging from laser-surgery clinics in Ontario to the possible opening of a new private hospital in Toronto, indicate that the trend toward privatization is growing. Dr. Hugh Scully, former chair of a CMA working group that looked at the issue, expects the trend toward privatization to continue because "it simply isn't the case that the coverage people have come to expect will continue to be provided through the public purse." Dr. Jeffery Machat, a laser-surgery specialist from Windsor, Ont., thinks privatization brings needed investment to Canada's health care system.

Canada↗
PubMed1994

Managing competition in public and private mental health agencies: implications for services and policy.

There were clear differences in our study between the management strategies employed by public agencies and those favored by private agencies. These differences, however, appeared to reflect the realities of financing rather than any fundamental differences in their orientation toward public service. There was no clear evidence that particular management practices affected an agency's performance on measures of financial access or acceptance of referrals from public hospitals. Government regulation and pressure from advocacy groups probably helped to maintain private agencies' focus on these and other public goals. From a public policy perspective, choosing a provider solely on the basis of ownership status is, at best, a naive approach to providing public mental health treatment. Not only is there great variation in process and practices within both private and public groups, but external factors such as competition from private practitioners may also exert a stronger influence on agency behavior than does ownership status. Because most current proposals for health care reform rely heavily on increased competition among providers to achieve their goals, the importance of ownership status as a predictor of conduct or performance may be further diminished. The emphasis on competition could increase differences between urban agencies and those in rural areas where there is less competition and, therefore, require different contracting approaches. As we move toward a health care system based on competition, administrators and policy makers will be forced to abandon their reliance on stereotypical public/private agency behavior as guides for policy decisions. Instead, they will have to consider more carefully the effects of political and market influences as well as agency characteristics when choosing community mental health providers.

Community Mental Health Centers↗
PubMed1994

[A social study of a group of depressed patients recovering in a private clinic].

Depression is a widespread illness in Sardinia and is treated mainly in private clinics which accept National Health patients. The aim of the present study was to evidence socio-demographic and clinical characteristics of depressed subjects who turn to these clinics. Furthermore we will examine the reason which led to the choice of a private clinic on the basis of services provided by the same, of those available in public hospitals and of patients' psychopathological history and socioeconomic characteristics. We examined 122 depressed patients who had been admitted to a private clinic in Cagliari over a period of six months. By means of a data collection sheet the following parameters were studied: sex, age, place of birth and residence, marital status, family nucleus, profession, level of education, head of the family's occupation, receipt of pension or subsidy, geriatric or other forms of assistance, diagnosis, age at onset of illness, characteristics of current episode, previous hospitalizations, treatment received (public or private), structures usually applied to patients, social welfare aid and reason for the same, psychiatric structures available locally, persons who had requested current and previous hospitalization, reason which had led to choice of clinic. Examination of data collected revealed that females are hospitalized (94.27%) more than males (5.73%); this finding is in agreement with data reported in the literature which evidence a higher incidence of depression among females. The majority of patients were in the over-50 age group (56.5%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1996

It's time for CMA to put the lid on privatization.

Family physician Cynthia Carver wasn't heartened by the CMA's "last-minute retreat" from a call to pursue privatization of health care. During its August annual meeting, the association not only supported a strong, publicly funded health care system but also passed a number of resolutions related to the private sector and the appropriate role for regulated private medical insurance in Canada. Carver proposes that the energy being expended on schemes to delist, privatize, define core services and design payment schemes should instead be applied to improving the existing system.

Canada↗
PubMedDate not supplied

Factors influencing dental hygiene retention in private practice.

PURPOSE: The objective of this study was to identity specific factors that contribute to dental hygienists remaining in the same private practice employment setting for five or more years. Working conditions, the employer and the organizational structure of the employment setting, scope of practice, and personal factors were assessed. METHODS: In 1992, a self-designed questionnaire was sent to a sample of 1,200 licensed dental hygienists. One state was randomly chosen from each of the 12 American Dental Hygienists' Association (ADHA) regions of the United States, and 100 licensed dental hygienists were randomly selected from each of these twelve states. Data were analyzed using univariate analysis (frequency distribution) and multivariate analyses (factor analyses). RESULTS: A 62.9% (n = 755) response rate was obtained from the 1200 questionnaires mailed. Of those dental hygienists, 14.3% (n = 108) were not practicing, and 85.7% (n = 647) were currently practicing. Nearly two-thirds (63.3%; n = 480) of the total number of respondents had been practicing five or more years in the same practice setting. Six major factors were identified by dental hygienists as reasons for remaining in one private practice setting for at least five years (1) quality/safe work environment, (2) time management for high-quality dental hygiene services, (3) effective employer office policies/procedures and personnel management, (4) employer support of professional career, (5) supportive work environment, and (6) variety in scope of practice. CONCLUSIONS: Factors identified in this study as influential in dental hygienists' retention in private practice are similar to those identified as reasons for leaving the profession in previous attrition and reentry studies. To increase retention and job satisfaction of dental hygienists in the private practice setting, strategies for effectively working with employers should be emphasized in dental hygiene and dental curriculums and in continuing education programs.

Adult↗