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PubMed1999

International developments in social security privatization: what risk to women?

Throughout the world, older women are generally poorer than men. In an era when Social Security programs are increasingly under challenge by advocates of savings and pension schemes administered by the private sector, there is a need to assess the relative advantages of different public/private approaches for dealing with older women's financial needs. What would happen to women if more of the burden were shifted from the public sector to the private sector? This article presents an overview of women's vulnerability in old age and examines the role of public and private pensions in meeting their income needs. It then discusses approaches to Social Security privatization and the special issues for women raised by these issues. Finally, the issues and approaches discussed are illustrated by developments in the United States and Australia.

Journal Article↗
PubMed1998

Comparison of Baseline Characteristics and Outcome of Patients with Chest Pain Brought to the Hospital by Private Versus Public Mobile Intensive Care Units.

The baseline characteristics and outcome of patients with acute chest pain who were brought to the hospital by public versus private mobile intensive care units were compared. Of 283 patients brought to the Department of Emergency Medicine at the Tel Aviv Sourasky Medical Center by mobile units in July and September of 1995, 163 were transported by the private service and 120 by the public service. Patients who were brought by the private service were older and had significantly more comorbidities, especially cardiac history. However, a significantly higher proportion of patients brought by the public service suffered confirmed myocardial infarction, and were hospitalized in the intensive coronary care unit. In addition, mortality in this group was significantly higher (4.0% vs. 2.2%). Possible explanations for this finding are greater accessibility or bias in the prehospital management of patients channeled through the private mobile service.

Journal Article↗
PubMed1982

Depression and self-reinforcement in a public and a private setting.

Three groups of subjects--depressed, nondepressed, and nondepressed pretreated with an insolvable-problems (failure) manipulation--were compared on self-reinforcement during a 22-trial skill task. Success rate was experimentally controlled, and all subjects received either an initially high rate of success followed by a low rate of success or an initially low rate of success followed by a high rate of success. Subjects responded in either a public (experimenter present) or a private (unobserved and anonymous) condition. Measures of self-reinforcement revealed differences among the groups' responses across the public-private conditions, suggesting greater support for predictions derived from an interpersonal view of depression than for predictions from current cognitive theories of depression. Moreover, it was found that within the high-low sequence depressed-private subjects reinforced themselves at a significantly higher level than nondepressed-private subjects, a finding at odds with predictions derived from cognitive theories.

Adult↗
PubMed2002

Sampling private wells at past homes to estimate arsenic exposure: a methodologic study in New England.

We are conducting a collaborative, population-based case-control study in Maine, New Hampshire, and Vermont to investigate the reasons for the elevated bladder cancer mortality in northern New England. Arsenic in drinking water is one of the primary exposures under investigation. To estimate subjects' lifetime exposure to waterborne arsenic, it will be necessary to obtain water samples from private wells that subjects used in the past. We conducted a methodologic study to assess the feasibility of locating and sampling from private wells at subjects' past residences. Ninety-eight New Hampshire residents (mean age 67 years) completed a questionnaire requesting the complete address, dates of occupancy, and drinking water sources for each home lived in since birth. An interviewer then asked subjects for more detailed information about each home to assist in a field search of past homes in the three-state study area of Maine, New Hampshire, and Vermont. Fifty-eight of the 98 subjects indicated that they had used a total of 103 private wells in 95 previous homes located in these three states. We conducted a field search to locate these 95 homes, visited town offices to find the properties on tax maps and obtain the current owners' names and addresses, attempted to obtain permission from the current owners to sample the wells, and collected water samples. In all, 48 (47%) of the 103 past wells in the study area were sampled successfully. The remaining wells were not sampled because the homes were not located (22%) or had been demolished (2%), permission to sample the wells was not obtained (17%), the wells had been destroyed (7%) or could not be found on the grounds of the residence (3%), or for other reasons (2%). Various approaches for improving the success rates for sampling water from private wells are discussed, as is the use of predictive modeling to impute exposures when sampling is not feasible.

Adult↗
PubMed2003

Receiving money for medicine: some tensions and resolutions for community-based private complementary therapists.

During recent years, private complementary medicine has grown as a significant provider of healthcare in the UK and much of this provision is through small private businesses financed by out-of-pocket payments made by privately paying clients. Using a combined questionnaire (n = 426) and interview survey (n = 49), the present paper considers the potential tensions and dilemmas which therapists face and the resolutions which they come to in being carers, but in market terms, also profit makers. Therapists generally identified with being carers first and business people second, and this was reflected in their caring decisions. Indeed, under circumstances where the roles potentially conflicted (e.g. when clients could no longer afford to pay for their treatments), most therapists claimed that they continued to provide care, either by providing their services free-of-charge, at a reduced rate, by deferring payment or by accepting alternative forms of compensation. There is a relative lack of dedicated research literature on complementary therapists, their attitudes and actions, and this paper provides some important data on their specific management and caring decisions. At the same time, the evidence also provides some initial food-for-thought and indicates some potential research directions for exploring ethical issues in the private practice of complementary medicine.

Adult↗
PubMed2002

House dust mite allergen levels in carpeted sleeping accommodation are higher in private houses than public places.

OBJECTIVE: To compare mite allergen levels in carpeted sleeping accommodation in private dwellings and public places. METHODS: The concentration of Dermatophagoides pteronyssinus Group 1 allergen in house dust was measured in mat-tresses and bedroom floors in 12 homes, 5 hotels, 11 child care centres and a university hall of residence. Indoor temperature and relative humidity were also measured. A questionnaire clarified details regarding the age of the building, age of the carpet, method and frequency of cleaning, frequency of room use and use of air-conditioning. RESULTS: Median allergen levels in mattresses and carpets in private homes (21.1 and 20.6 micro g/g dust, respectively) were significantly higher than in public places (2.5 and 3.1 micro g/g, respectively; P < 0.0001). Mean relative humidity was significantly higher in private houses (68.5%; 95% CI 67.2-69.3%) than in public places (56.4%; 95% CI 52.7-60.1%; P < 0.0001). CONCLUSIONS: Carpeted sleeping accommodation in public places has lower house dust mite allergen levels than private houses. Lower levels of relative humidity may be an important component of the explanation.

Allergens↗
PubMed2004

Impact on public hospitals if private health insurance rates in Victoria declined.

The additional cost of treating acute care type Victorian private patients as public patients in Victorian public hospitals based on the current public sector payment model and rates was calculated, as was the loss of health fund income to public hospitals. If all private cases became public the net recurrent cost would be $1.05 billion assuming all patients were still treated. If private health insurance (PHI) uptake had declined to 23.3% as was projected without Lifetime Health Cover and the 30% rebate, the additional operating cost and income loss would be $385 million. This compares to the Victorian cost of the 30% rebate for acute hospital cases of $383 million. This takes no account of capital costs and possible public sector access problems. The analysis suggests that 31 extra operating theatres would be needed in the public sector (had the transfer of surgical patients from the public sector to the private sector not occurred). This analysis suggests that without the PHI rebate the current stresses on Victorian public hospitals would be increased, not decreased.

Hospital Costs↗
PubMed1992

A comparison of private and public methadone maintenance patients.

A study was undertaken to examine claims that unsuitable individuals were being admitted into private methadone maintenance programs in New South Wales in late 1985, early 1986. A comparison was made of interview data collected by an independent team of researchers from 457 private and 91 public patients. Exhaustive attempts were made to identify individuals who failed current official admission criteria. While there were statistically and clinically significant differences between private and public methadone patients, there was no evidence that unsuitable individuals were being admitted into maintenance. The data and a review of the literature suggest that the rapid expansion of private sector methadone programs allowed suitable individuals more immediate and more equitable access to maintenance treatment.

Journal Article↗
PubMed2001

Private high school students are at risk for bulimic pathology.

The objective of this study was to assess whether private high school students constitute a group that is at high risk for eating pathology. Female and male public and private high school students (N = 465) were compared on self-reported eating disordered attitudes and behaviors. Private high school students reported elevated eating disordered attitudes and behaviors when compared with students from public schools. The results were somewhat stronger for females than males. The findings suggest that private high school students are a group at high risk for eating pathology. The identification of such high risk groups may facilitate etiologic studies and aid in the implementation of targeted prevention programs.

Journal Article↗
PubMed1982

Private welfare in the welfare state: recent U.S. patterns.

This paper examines recent trends in American philanthropy and relates these to changes in the composition and size of both the private and public welfare sectors in the United States. The findings reveal that private welfare has been overwhelmed - but not replaced - by the growth in public welfare. Although private welfare maintains some of it traditional functions, it has become more closely linked to and in some cases dependent on, public welfare. Consequently, there have been significant changes in the institutional character and organizational format and operations of private welfare. These transformations of the American welfare system are interpreted within the mass-society perspective.

Financial Management↗
PubMed2004

A quantitative analysis of the content and structure of public requests for private interaction posted in online public chatrooms.

Evidence is presented suggesting that the majority (88%) of online requests for private computer-mediated communication posted in Internet Relay Chat (IRC) chatrooms are derivations of the following prototypical structure: (a) a target specifier, e.g., "any girls"; (b) the communication request itself, e.g., "wanna chat"; (c) a self-identifier, e.g., "to a guy"; and (d) a communication directive, e.g., "msg me!" A methodology capable of identifying individual differences in the frequency of language usage on IRC was developed and used to generate a taxonomy of the phrases commonly used in each of these four components. This taxonomy of 82 phrases accounted for 14.5% of the total language used across a variety of IRC chatrooms and 77% of the words used in requests for private interaction. It also identified at least one component in 83% of all requests for private interaction posted on IRC, while having only a 10% rate of false (non-request) identification. The reduced complexity and increased explicitness of requests for private interaction on IRC is interpreted using politeness theory. The application of the current methodology for research assessing the formation of online romantic and interpersonal relationships is considered, as are the utility of quantitative analyses of discourse structures in computer-mediated communication for profiling people who use IRC for various purposes.

Communication↗
PubMed2000

Does private religious activity prolong survival? A six-year follow-up study of 3,851 older adults.

BACKGROUND: Previous studies have linked higher religious attendance and longer survival. In this study, we examine the relationship between survival and private religious activity. METHODS: A probability sample of elderly community-dwelling adults in North Carolina was assembled in 1986 and followed for 6 years. Level of participation in private religious activities such as prayer, meditation, or Bible study was assessed by self-report at baseline, along with a wide variety of sociodemographic and health variables. The main outcome was time (days) to death or censoring. RESULTS: During a median 6.3-year follow-up period, 1,137 subjects (29.5%) died. Those reporting rarely to never participating in private religious activity had an increased relative hazard of dying over more frequent participants, but this hazard did not remain significant for the sample as a whole after adjustment for demographic and health variables. When the sample was divided into activity of daily living (ADL) impaired and unimpaired, the effect did not remain significant for the ADL impaired group after controlling for demographic variables (hazard ratio [RH] 1.11, 95% confidence interval [CI] 0.91-1.35). However, the increased hazard remained significant for the ADL unimpaired group even after controlling for demographic and health variables (RH 1.63, 95% CI 1.20-2.21), and this effect persisted despite controlling for numerous explanatory variables including health practices, social support, and other religious practices (RH 1.47, 95% CI 1.07-2.03). CONCLUSIONS: Older adults who participate in private religious activity before the onset of ADL impairment appear to have a survival advantage over those who do not.

Activities of Daily Living↗
PubMed2006

Private practitioners' communications with patients around HIV testing in Pune, India.

Unlike any other disease so far, the 'exceptional' nature of HIV/AIDS has prompted debate about the necessity, but also the challenges, of regulating practitioner-patient communication around HIV testing. In India, the National AIDS Control Organization (NACO) has adopted the guidelines of the World Health Organization with regard to HIV testing and counselling, yet the extent to which these guidelines are fully understood or followed by the vast private medical sector is unknown. This paper examines the gaps between policy and practice in communications around HIV testing in the private sector and aims to inform a bottom-up approach to policy development that is grounded in actual processes of health care provision. Drawing on 27 in-depth interviews conducted with private medical practitioners managing HIV patients in the city of Pune, we looked specifically at practitioners' reported communications with patients prior to an HIV test, during and following disclosure of the test result. Among these practitioners, informed consent is rare and pre-test communication is prescriptive rather than shared. Confidentiality of the patient is often breached during disclosure, as family members are drawn into the process without consulting the patient. While non-adherence to guidelines is a matter of concern, practitioners' communication practices in this setting must be understood in the given social and legal context of the patient-practitioner relationship in India. Communication with their patients is strongly influenced by practitioners' perceptions of their own roles and relationships with patients, perceived characteristics of the patient population, limitations in knowledge and skills, moral values as well as perceptions of legal guidelines and patient rights. We suggest that policy guidelines around patient-practitioner communication need to take sufficient cognizance of existing practices, cultures and the realities of care provision in the private sector. Patients themselves need to be empowered in order to grasp the importance and implications of HIV testing and counselling.

Communication↗
PubMedDate not supplied

The privatization of the welfare state: a review.

Although the privatization of social services is not new, its purpose, form, and content have changed over time. Under the Reagan Administration, it has meant a greater role for private enterprise in a scaled-down welfare state. Intervention in the economy was historically conceived to modify the market in behalf of social justice. In contrast, privatization channels public dollars into private hands, strengthens the two-class welfare state, and reproduces the inequalities of the free market.

Health Services Accessibility↗
PubMed1992

The feasibility of a public-private long-term care financing plan.

In this study, the feasibility of a public-private long-term care (LTC) financing plan that would combine private LTC insurance with special Medicaid eligibility requirements was assessed. The plan would also raise the Medicaid asset limit from the current $2,000 to the value of an individual's insurance benefits. After using benefits the individual could enroll in Medicaid. Thus, insurance would substitute for asset spend-down, protecting individuals against catastrophic costs. This financing plan was analyzed through a computer model that simulated lifetime LTC use for a middle-income age cohort beginning at 65 years of age. LTC payments from Medicaid, personal income and assets, Medicare, and insurance were projected by the model. Assuming that LTC use and costs would not grow beyond current projections, the proposed plan would provide asset protection for the cohort without increasing Medicaid expenditures. In contrast, private insurance alone, with no change in Medicaid eligibility, would offer only limited asset protection. The results must be qualified, however, because even a modest increase in LTC cost growth or use of care (beyond current projections) could result in substantially higher Medicaid expenditures. Also, private insurance might increase personal LTC expenditures because of the added cost of insuring.

Aged↗
PubMed1989

Regulating the construction of hospitals or vice versa: the courts and private hospital planning in Victoria.

This paper examines the legal framework for regulating the development of new private hospitals in Victoria. It first reviews the genesis of the statutory power for private hospital regulation and outlines the two court cases which clarified the interpretation of the statute. The legislation and its interpretation by the courts emphasise a particular approach to private hospital planning which does not necessarily address the problems faced by consumers of hospital services in Victoria. It is argued that the law has constructed a particular framework for private hospital regulation which does not address the critical problems facing the hospital system in the 1990s. The legal framework for regulation is based on property rights rather than the needs of hospital users, despite the language used in the legislation.

Health Planning Guidelines↗
PubMed2004

[Legionella pneumonia which occurred in a private whirlpool bath user].

A 88 year old female with active rheumatoid arthritis treated by low dose of prednisolone and methotrexate was admitted to our hospital because of severe bilateral pulmonary infiltration and acute respiratory distress syndrome. On admission, she had consciousness disturbance and was intubated because of severe respiratory failure. We heard from her family of her habit she had taking a private whirlpool bath 2 or 3 times everyday. So, we suspected a Legionella pneumophila infection. We started intravenous erythromycin (EM) (1,500mg/day) and methylprednisolone pulse therapy (1,000mg x 3days) and full controlled mechanical ventilation supported with PEEP. Her respiratory failure was gradually improved and she was discharged on the 44 the hospital day. Legionella pneumophila (serogroup 6) was isolated in her sputum by B-CYE alpha culture. Legionella pneumophila (serogroup 6) was isolated in her private whirlpool bath too. Both samples revealed the same by genetic analysis with pulse field gel electrophoresis (PFGE). This is the first adult case of Legionella pneumophila pneumonia infected from a private whirlpool bath confirmed by genetic analysis. We should always suspect Legionella pneumonia as one of the severe community-acquired pneumonia, because Legionella pneumophila were frequently detected among various water sources including the private whirlpool bath.

Aged↗
PubMed1996

Mental disorders in public, private nonprofit, and proprietary general hospitals.

OBJECTIVE: The authors' goal was to assess the effects of facility ownership on the characteristics of psychiatric inpatients treated in public, private nonprofit, or proprietary general hospitals. METHOD: Data from the 1993 National Hospital Discharge Survey were analyzed to determine the number, sociodemographic and diagnostic composition, and treatment characteristics of patients with primary mental disorders discharged from public, private nonprofit, and proprietary general hospitals. RESULTS: An estimated 1.83 million patients with a primary mental disorder diagnosis were discharged from general hospitals in 1993; the number of such discharges in the National Hospital Discharge Survey, which excluded federal general hospitals, was 13,086. These patients were unevenly distributed among public (9.4%), private nonprofit (78.9%), and proprietary (11.7%) hospitals. Psychiatric patients of public and private nonprofit hospitals were more likely to be diagnosed with schizophrenia (public: 23.4%, nonprofit: 18.8%, proprietary: 12.6%), a comorbid substance-related disorder (public: 29.9%, nonprofit: 31.0%, proprietary: 17.4%), a personality disorder (public: 11.6%, nonprofit: 11.3%, proprietary: 4.7%), or a general medical disorder (public: 62.4%, nonprofit: 57.4%, proprietary: 41.1%) than patients of proprietary hospitals. Uninsured psychiatric patients were far more common at public hospitals than at the other types of facilities (public: 17.0%, nonprofit: 9.9%, proprietary: 6.4%). CONCLUSIONS: Public general hospitals play an important role in caring for uninsured patients with severe mental illness. Before widespread closures occur in the public general hospital sector, it is critical that policy makers identify and develop resources to replace the care these institutions currently provide to poor patients with severe psychiatric disorders.

Adolescent↗