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At least 703 records · Page 39Linked to original sources
PubMed2004

The availability of psychiatric programs in private substance abuse treatment centers, 1995 to 2001.

OBJECTIVE: The high rate of co-occurrence of substance abuse and mental disorders renders the availability of psychiatric programs, or integrated service delivery, a vital quality-of-care issue for substance abuse clients. This article describes the availability of psychiatric programs and integrated care for clients with severe mental illness in the private substance abuse treatment sector and examines these patterns of service delivery by profit status and hospital status. METHOD: S: Survey data from the National Treatment Center Study, which is based on a nationally representative sample of privately funded substance abuse treatment centers, were used to identify the proportion of centers that offered psychiatric programs in 1995-1996, 1997-1998, and 2000-2001. Centers reported whether they treated clients with severe mental illness on-site or referred them to external providers. Repeated-measures general linear models were used to test for significant changes over time and to assess mean differences in service availability by profit status and hospital status. RESULTS: About 59 percent of private centers offered a psychiatric program, and this proportion did not significantly change over time. The proportion of centers that referred clients with severe mental illness to external providers increased significantly from 57 percent to 67 percent. For-profit centers and hospital-based centers were significantly more likely to offer psychiatric programs and were less likely to refer severe cases to other providers. CONCLUSION: S: Although the importance of integrated care for clients with dual diagnoses is widely accepted, data from the private substance abuse treatment sector suggest that this pattern of service delivery is becoming less available.

Health Facilities, Proprietary↗
PubMed1982

The future of private psychiatric hospitals.

In the near future the programs, the staff, and the physical plant of private psychiatric hospitals will become increasingly specialized. Development of neuropsychiatric evaluation units and greater liaison between the psychiatric hospital and the clinical laboratory have already begun. Improved standards of patient care and opportunities for research should attract to the private hospital more psychiatrists who are academically oriented. The authors predict a decrease in inpatient acute-care alcoholism treatment and shorter hospital stays for adolescents and those who were formerly considered long-term patients. The private hospital will need to increase its contacts with industry and health maintenance organizations. The authors also predict that ownership will become more centralized in hospital chains, similar to the pattern in general hospitals. The believe the major risk to the private hospital lies in abrupt changes in insurance coverage and regulatory interference.

Cost Control↗
PubMed2001

On the efficiency of public, welfare and private hospitals in Germany over time: a sectoral data envelopment analysis study.

This paper examines the efficiency of the German hospital sector over time and the relative efficiency of public, welfare (both nonprofit) and private (for-profit) hospital sectors using data from the Federal Statistics Office of German hospitals. Efficiency scores were computed using data envelopment analysis. The absolute efficiency of the hospital sector as a whole was found to have improved between 1991 and 1996. In this comparison, the empirical results showed that the hospitals in the public and welfare sector are relatively more efficient than private hospitals. Our results suggest that public, welfare and private hospital sectors have different best-practice frontiers; and that public and welfare hospital sectors appear to use relatively fewer resources than private hospitals. These results suggest differences in quality of care arising from ownership.

Efficiency, Organizational↗
PubMed2005

Development of a health care policy characterisation model based on use of private health insurance.

OBJECTIVE: The aim of this study was to develop a policy characterisation process based on measuring shifts in use of private health insurance (PHI) immediately following implementation of changes in federal health care policy. METHOD: Population-based hospital morbidity data from 1980 to 2001 were used to produce trend lines in the annual proportions of public, privately insured and privately uninsured hospital separations in age-stratified subgroups. A policy characterisation model was developed using visual and statistical assessment of the trend lines associated with changes in federal health care policy. RESULTS: Of eight changes in federal health care policy, two (introduction of Medicare and Lifetime Health Cover) were directly associated with major changes in the trend lines; however, minor changes in trends were associated with several of the other federal policies. Three types of policy effects were characterised by our model: direction change, magnitude change and inhibition. Results from our model suggest that a policy of Lifetime Health Cover, with a sanction for late adoption of PHI, was immediately successful in changing the private: public mix. The desired effect of the 30% rebate was immediate only in the oldest age group (70+ years), however, introduction of the lifetime health cover and limitations in the model restricted the ability to determine whether or if the rebate had a delayed effect at younger ages. CONCLUSION: An outcome-based policy characterisation model is useful in evaluating immediate effects of changes in health care policy.

Journal Article↗
PubMed2001

Specificity and heterogeneity in children's responses to profound institutional privation.

BACKGROUND: The sequelae of profound early privation are varied. AIMS: To delineate the behavioural patterns that are specifically associated with institutional privation. METHOD: A group of 165 children adopted from Romania before the age of 42 months were compared at 4 years and 6 years with 52 non-deprived UK children adopted in infancy. Dysfunction was assessed for seven domains of functioning. The groups were compared on which, and how many, domains were impaired. RESULTS: Attachment problems, inattention/overactivity, quasi-autistic features and cognitive impairment were associated with institutional privation, but emotional difficulties, poor peer relationships and conduct problems were not. Nevertheless, one-fifth of children who spent the longest time in institutions showed normal functioning. CONCLUSIONS: Attachment disorder behaviours, inattention/overactivity and quasi-autistic behaviour constitute institutional privation patterns.

Adoption↗
PubMed1988

Public and private self-consciousness and social phobia.

The relationship between public and private self-consciousness and self-report questionnaires, clinician ratings, and various measures derived from an individualized simulation of an anxiety-provoking situation was examined in a sample of men and women seeking treatment for social phobia. As predicted, public, not private, self-consciousness was generally related to self-report and naive observer ratings of anxiety and to behavioral disruption during the simulation. The predicted relationship between public self-consciousness and how accurately subjects evaluated their performance in the anxiety-provoking situation was marginally supported. Hypotheses regarding the relationship between private self-consciousness and self-reported anxiety during an anxiety-provoking situation, and between private self-consciousness and the correspondence between physiological assessment and self-report, were not supported. The discussion focuses on methodological issues and the theoretical implications of the relationship between self-consciousness and social anxiety.

Adult↗
PubMed1987

Private insurance for Medicaid recipients: the Texas experience.

Shifting financial risk from the public to the private sector is an increasingly attractive option to policymakers seeking to constrain Medicaid costs. This paper discusses the potential advantages and disadvantages of private insurance arrangements for Medicaid recipients and examines the Texas Purchased Health Services Program, the oldest and largest private insurance program for Medicaid recipients in the U.S. Our analysis of the Texas program suggests that while the political benefits are real, the administrative costs are substantial and the fiscal benefits uncertain. While overall benefits may outweigh costs in Texas, differing political and fiscal circumstances may alter the balance in other states considering private insurance arrangements.

Actuarial Analysis↗
PubMed2001

Access to orthopedic care for children with medicaid versus private insurance in California.

OBJECTIVE: To compare the availability of timely orthopedic care to a child with a fractured arm insured by Medi-Cal (California state Medicaid) and by private insurance. STUDY DESIGN: Fifty randomly chosen offices of orthopedic surgeons were telephoned with the following scenario: "My 10-year-old son broke his arm last week during a vacation" followed by a request for an appointment that week. Each office was called twice with an identical script except for insurance status: once with Medi-Cal and once with private insurance. RESULTS: All 50 offices offered an appointment to see the child with private insurance within 7 days. Only 1 of the same 50 offices offered an appointment to see the child with Medi-Cal within 7 days. Of the offices that would not see a child with Medi-Cal, 87% were unable to recommend an orthopedic office that accepted Medi-Cal. CONCLUSIONS: Timely access to orthopedic care was available in 100% of offices polled to a child with private insurance versus in 2% of offices to a child with Medi-Cal. This is a significant difference. Lack of timely orthopedic care may result in poor outcome, ie, if a fracture is not properly aligned in the first few weeks, a permanent deformity may result. Although causation cannot be established from this study, we suspect that Medi-Cal reimbursement rates below the cost of office overhead may be of significance. Although federal guidelines require that payments must be sufficient to enlist enough providers so that services to Medi-Cal recipients are available to the same extent as those available to the general population, this study finds that that children with Medi-Cal insurance have significantly less access to timely orthopedic care.

Appointments and Schedules↗
PubMedDate not supplied

[Giardiasis and helminthiasis in children of both public and private day-care centers and junior and high schools in the city of Mirassol, São Paulo State, Brazil].

This study showed different frequencies of intestinal parasitosis (giardiasis and helminthiasis) among children in day-care centers and junior and high schools (public and private). The survey involved 199 individuals, 96 belonging to public schools and 103 to private institutions. The frequency of giardiasis in public institutions was shown to be greater than in private institutions. Regarding helminthiasis, frequencies were similar among day-care centers, but greater for public schools in comparison to private institutions. When levels of socio-economic status, education, basic sanitary conditions and hygiene were analyzed as determinants of intestinal parasitosis, it became evident that greater frequency of giardiasis and helminthiasis occurred among children from low-income families and those whose parents had low levels of education. The source of vegetables was also a significant factor in determining such parasitosis.

Adolescent↗
PubMed2004

Does supplemental private insurance affect care of Medicare recipients hospitalized for myocardial infarction?

OBJECTIVES: We sought to determine whether supplemental private insurance coverage among Medicare recipients alters patterns of health care or outcomes associated with acute myocardial infarction. METHODS: Medicare patients hospitalized after a myocardial infarction were identified from New York City hospitalization records. Patients who had only Medicare coverage were compared with those who had supplemental private or public insurance coverage. RESULTS: Patients with supplemental private insurance exhibited increased rates of revascularization and decreased rates of in-hospital mortality relative to patients with either Medicare only or Medicare and public insurance. Moreover, Blacks and women were less likely to undergo revascularization and exhibited higher in-hospital mortality rates. CONCLUSIONS: Despite Medicare, private insurance coverage appears to influence the likelihood of coronary revascularization among older patients hospitalized for acute myocardial infarction.

Aged↗
PubMed2002

The ethics of access to online genetic databases: private or public?

With the sequencing of the human genome comes the promise of advances in medical science. For this promise to be fully realized, researchers must have access to information resulting from this landmark endeavor as well as from subsequent research initiatives. However, because genomic sequences are potential sources of profit for the biotechnology and pharmaceutical industries, many private companies seek to limit access to this information. Some argue that this will impede scientific progress and increase the cost of basic research, while others argue that the privatization of genetic information is needed to assure profits and generate the considerable funding necessary to bring therapeutic products to the market. In analyzing the arguments for both sides, we conclude that both private funding and public access to information are important in genetic research. Precedents for compromise are necessary, as is increased dialog between private and public interests in order to ensure continued advancements in genetic science and medicine.

Databases, Genetic↗
PubMed2002

The occupational and environmental status of Polish industry: a comparative study of the private and public sectors.

During the last decade, Poland has made a successful transition toward democracy and market economy. Since the mid-1990s, we have studied the reforms in the environmental and occupational protection system in Poland, focusing on the privately owned firms. We found that considerable progress has taken place, especially in increasing the accountability of private employers and in improved enforcement. The fundamental legitimacy of regulators and the regulatory process, and the capacity for case-specific decision-making, are among the key explanatory factors. The case-specific implementation in Poland is consistent with models advocated by several authors in relation to other industrialized European economies. We attribute these developments in Poland to the continuity of institutions, and the generally good "fit" between the policies and institutions on one hand, and their social context on the other, including a wide sharing of certain values and norms. The outstanding question from our previous work has been the fate of state-owned firms, which may be facing different issues than the privatized ones, both in terms of economics, organizational culture, and relationships with the regulatory authorities. In this article, we report the results of a comparison between the private and state-owned firms, based on the questionnaire surveys of the two sectors. We find a striking similarity in performance of both sectors and in the authorities' attitudes toward both. These findings support our earlier proposition that Poland's success in instituting an effective occupational protection system is deeply embedded in the attitudes toward protecting workers' health and safety and toward balancing competing societal objectives. These attitudes have not changed during the transition to the market economy.

Journal Article↗
PubMed1987

The Social Security program and the private sector alternative: lessons from history.

As the Social Security program in the United States emerged from the crisis of the 1970s with a solid set of reforms intended to guarantee the program's financial solvency into the twenty-first century, a new attack on the system arose in the form of debates centering around the relationship of the Social Security fund to the federal deficit. Conservative economists used concerns about the national economy as fuel for their own arguments that Social Security has negatively affected the economy and that heavier reliance should be placed on private sector benefits. This paper uses historical evidence to analyze how adequately private sector benefits functioned in the past. Among the conclusions reached are that the private sector failed to provide adequate protection for older citizens, and that benefits were inequitably distributed on the basis of gender and social class. Any tendency toward heavier reliance on the private sector for provisions for old age security would only exacerbate existing inequalities.

Aged↗
PubMed1997

The growth of corporate private hospitals in Malaysia: policy contradictions in health system pluralism.

The rapid growth of corporate investment in the Malaysian private hospital sector has had a considerable impact on the health care system. Sustained economic growth, the development of new urban areas, an enlarged middle class, and the inclusion of hospital insurance in salary packages have all contributed to a financially lucrative investment environment for hospital entrepreneurs. Many of Malaysia's most technologically advanced hospitals employing leading specialists are owned and operated as corporate business ventures. Corporate hospital investment has been actively encouraged by the government, which regards an expanded private sector as a vital complement to the public hospital system. Yet this rapid growth of corporately owned private hospitals has posed serious contradictions for health care policy in terms of issues such as equity, cost and quality, the effect on the wider health system, and the very role of the state in health care provision. This article describes the growth of corporate investment in Malaysia's private hospital sector and explores some of the attendant policy contradictions.

Cost-Benefit Analysis↗
PubMed1980

A study of private hearing aid users in London.

A pilot study of 40 hearing aid users sampled directly from private hearing aid dispensers' records is described. Some comparisons are made between this sample and (a) 37 private hearing aid users who had sought help from the RNID Hearing Aid Advisory Service, and (b) 58 NHS hearing aid clinic patients who also possessed a private hearing aid. The main objective was to discover people's reasons for buying a hearing aid rather than obtaining one free of charge from the NHS. The reasons given were found to be mainly those of range of design and choice of hearing aids in addition to some advantages in the type of service offered by private hearing aid dispensers.

Adolescent↗
PubMed1988

The receptivity to and the feasibility of patient education for patients of private practice, primary care physicians.

This article describes a study of the receptivity to and the feasibility of a patient education service for patients of private practice, primary care physicians. A stratified (by medical specialty), random sample of 400 private practice, primary care physicians in the State of Maryland was selected from the State medical society roster. In addition, a random sample of 800 health care consumers was selected from a listing of residents in a five county area of Maryland. Questionnaires were developed, pilot tested, revised, and eventually mailed to the physician and consumer samples. Completed questionnaires were obtained from 140 physicians and from 314 consumers. Results indicated that both physicians and consumers were receptive to patient education in the private practice medical setting. Based upon the findings, recommendations are offered regarding the manner in which patient education in a private practice medical setting should be organized.

Attitude of Health Personnel↗
PubMed1978

Private health insurance plans in 1976: an evaluation.

Private health insures collected a record $39.4 billion in premiums and returned $35 billion in benefits to their subscribers in 1976--a reflection of the steadily rising cost of health care, higher utilization, and the demand for expanded services. The industry experienced a net underwriting loss of $611 million, mainly because claims and operating expenses under insurance-company group business ran 3 percent above premium income. About 77 percent of the civilian population had some form of private hospital insurance, and about the same percentage had some form of surgical insurance. Lesser proportions were covered for other types of care. An estimated 12--13 percent of the population under age 65 had no economic protection against the costs of illness or health-related care--under either a private insurance plan or public program. Although virtually all of the aged were covered by Medicare, some 13--15 million bought private insurance, most of it under plans that covered some or all of the gaps in the Federal program.

Age Factors↗
PubMed1999

Outbreak of gastroenteritis associated with contamination of a private borehole water supply.

An outbreak of gastroenteritis affected 58 of 700 people served by a private water supply at a biological research institute located in a village. No cases were detected in 250 residents of the same village served by a public water supply over the same period. Consumer complaints of tainting and laboratory evidence of bacterial and chemical contamination were obtained for the private water supply, but not for the public water supply. The outbreak was probably caused by contamination from a nearby sewer of a borehole used for the private supply. The outbreak showed how a large, private water supply posed a substantial risk to public health. The regulatory framework for such water supplies should be modified to ensure their safer design and operation.

Adolescent↗